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Michael Douglas: "Oral sex gave me throat cancer" Cheatsheet on how to protect yourself.

Michael Douglas, 68, with Catherine Zeta-Jones, 43

By MAMAMIA TEAM

Michael Douglas, 68, has spoken publicly about what caused his throat cancer. Douglas was diagnosed in August 2010, and fought throat cancer until January 2011.

But it wasn’t smoking, or drinking that led to his throat cancer – the most common causes.

It was oral sex. Specifically, giving it.

In a candid interview published in The Guardian today, Douglas revealed, “… without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”

He continued, “I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it.”

Once the walnut-sized tumor was discovered at the base of Douglas’ tongue in 2010, he was diagnosed with stage four cancer. This level of cancer is often terminal.

Douglas has now been free of cancer for two years, and is optimistic about his chances, saying, “with this kind of cancer, 95% of the time it doesn’t come back”.

There is so much to unpack here. Let’s do it carefully.

Michael Douglas with wife Catherine Zeta-Jones and his two youngest children.

The sexually transmitted virus HPV is responsible for an increasing number of oral cancers, as well as the more commonly known genital warts and anal cancer.

Jokes aside (Michael Douglas cheekily mused that cunnilingus also ‘cured’ his cancer ), let’s clear up some basic facts around the link between oral sex and oral cancers.

Q: What does it mean when Michael Douglas says cunnilingus (the act of giving oral sex to a woman) can cause cancer?

A: HPV resides in muscous membranes like those found in the gential area. New evidence suggets that, because the mouth is a similar environment, the virus can also survive there.

The University of NSW recently undertook research that implicated the virus in oesophageal cancer. Although commonly thought of as a problem for women, who can develop cervical cancer if they are infected with the human papillomavirus, this new evidence shows that it is increasingly a problem for men, too.

The ABC reports:

Maura Gillison, Professor of Internal Medicine at Ohio State University in Columbus, claims that oropharynx cancers are rising in incidence in several regions in the world including the United States, Canada, the United Kingdom, Scandinavia, Denmark and Australia among other countries. Data from Sweden suggests this increase can be attributable to HPV, given that tumours that were analysed from the 70s had only 23% positive for HPV.

By the mid 2000s that had increased to 93%. In addition, cancer registries in Scandinavia have specimen banks where a large proportion of the population have donated serum. They looked at individuals who eventually developed oropharynx cancer and those who did not and looked back at serum that was collected on average 10 years before. And what they found was that individuals who had antibody HPV 16 in their blood had a 14-fold increase in their risk for subsequent development of oropharynx cancer.

The ABC has reported that now boys are being immunised against some forms of HPV, it’s entirely likely that in the next 20 years incidents of oesophageal will decrease dramatically.

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Q: Whoa, I thought throat and oesophagal cancer was caused by smoking. Is that not true? 

A: Hold on – Oesophagal cancer can still be caused by smoking. That is the most common cause. However there is another cause related to sex.

The Director of the Head and Neck Department at Princess Alexandra Hospital, Associate Professor Ben Panizza, spoke at a symposium on this very topic at Princess Alexandra Hospital last year.

Professor Panizza said that:

Smoking is still a cause of oesophagal cancer.

This type of cancer can be divided into two types – those that are caused by the human papillomavirus infection, and those that are caused by heavy drinking and smoking.

Previously most cases we saw were caused by the latter, and since it typically takes years of alcohol and tobacco abuse to cause this type of cancer, patients were generally elderly. Now we are seeing younger patients, around middle age, who are developing cancer following infection with the human papillomavirus, which many people usually associate only with cervical cancer.

The virus is spread by oral sex and it has a long lag phase, so it is often decades between exposure to the virus and the appearance of symptoms.

As a result, it is highly likely that the current increase in cases is directly linked to changes in sexual behaviour seen in the sixties and seventies.

Panizza also commented about the rise in these diseases, saying, “Oropharyngeal cancer, which is cancer of the tonsils and tongue, is on the rise – ten years ago we were seeing around one patient every fortnight, now we encounter about two cases a week.”

Q: Can HPV – the virus that caused the type of throat cancer Michael Douglas had – cause other types of cancer?

A: HPV can be responsible for a number of different tumors, anal cancer, and genital warts (which although uncomfortable do not cause cancer themselves).

The types of cancer that HPV can cause include penile, anal, cervical, vulvae and vaginal cancers. Health.gov.au says that four out of 5 people will have a HPV infection at some point in their lives.

Further, HPV doesn’t usually cause symptoms, so people infected with the virus may not know they have it for many years.

Q: Are you only vulnerable to this if you give oral sex to women? What if you give it to men?

A: Short answer: yes.

In the past people believed that HPV could only be passed along by genital-to-genital contact. But new research suggests that the virus can be passed along by mouth-to-genital contact. So that includes blow jobs and cunnilingus.

It’s also worth keeping in mind that if you engage in unprotected oral sex you can also develop herpes, Chlamydia, Syphilis and Gonorrhoea. To make sure you’re protected during oral sex, it’s best to use a condom.

Unfortunately, while condoms are a barrier to many STIs, they do not offer complete protection against HPV – becaue they do not cover all of the genital skin.

Q: So, how can I protect myself from HPV-related oral cancer?

A: See above: use condoms if you have sexual contact with a man. But also keep in mind that the are not foolproof.

If you are having sexual contact with a woman – including oral sex – sexual health experts advise using a dental dam to protect yourself. Here’s what one looks like:

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There is, however, a vaccine for HPV. Back in 2007 the Australian government announced that they would be giving the human papillomavirus vaccine, Gardasil, free of charge to girls aged between 12 and 13, through the National HPV Vaccination Program. This vaccine is being delivered on an ongoing basis.

The ‘cervical cancer’ vaccine.

Australian of the Year, Professor Ian Frazer developed Gardasil – commonly called the cervical cancer vaccine – after years of studying Human Papillomavirus (HPV). The vaccine protects against four strains of HPV including HPV16 and HPV-18, which are responsible for almost three quarters of cervical cancer cases in women and also most of the cases of penile, anal, vulva and vaginal cancers.

However, as the vaccine doesn’t protect against all the types of HPV that cause cancer, so all women (even if you have been vaccinated) should have Pap smears every two years – either from the age of 18, or two years after the first time they have sex – to screen for cervical cancer.

In February this year, it was announced that pre-teen and teen boys in Australia would become the first in the world to start receiving the Gardasil vaccine. At the time Mamamia wrote:

Of course, men can get anal and penile cancers, which are relatively rare but potentially deadly. Men can also pass on the HPV virus to their partners – who can get cervical cancer. HPV is also spread by oral sex  and can cause HPV-related tonsil cancers – which happen almost as frequently in men, as the cervical cancers do in women.

These ‘peripheral’ cancers are not always nearly so deadly as cervical cancer (which kills hundreds of thousands of women each year) but they can still cause major health problems and occasionally death.

So – the case to get boys jabbed is pretty clear.

To gain an idea of just how widespread HPV is in men, a recent study found that as many as half the adult men in Brazil, Mexico and the United States carry HPV.

And sure, the male cancers might be rare but in the US there were still 5000 new cases of anal cancer in 2010. So while women get most of the cancer risk – men are still not free from harm when it comes to HPV.

Further information is available on the Immusise Australia Program Website.

In regards to protecting yourself from HPV-related oral cancer specifically, there are two key points to keep in mind.

a) Unfortunately, it is not yet known if the HPV vaccination protects against oral cancer – there is simply not the data to support that claim yet.

b) Unfortunately again, not much is known about the possibility of HPV being transmitted via mouth-to-genitals contact – including how it can be prevented. Condoms are a good place to start, if you are giving oral sex to a man. If you are giving oral sex to a woman, you can use a dental dam, a small piece of latex that covers the vagina.

What are the warning signs/symptoms?

The HPV virus lives in mucous membranes, like those found in the genital area – so if a genital wart shows up, that’s an indication of HPV infection. Warts can appear on the anus, cervix, scrotum, penis, thigh, or groin.

To make matters more confusing, genital warts can look quite different. Pink or flesh-coloured, raised or flat – there is a big variety.  They can also be ‘shaped like cauliflower’.

For more information on HPV and the vaccination program, click here.

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