Some types of oral cancer are linked to human papilloma virus (HPV) infection in the mouth and throat. Find out the possible risks of this infection from oral sex, and how to protect yourself.
Rates of oral cancer are rising. In England, nearly 5,500 people were diagnosed with oral cancer in 2008, compared to 3,670 in 1998. The biggest rise has been seen in tonsil cancer – in the 10 years to 2008, cases of tonsil cancer in men tripled from 293 per year to 605. Cases in women increased by 50% (113 cases per year to 169).
What causes oral cancer?
Experts have known for years that the main risk factors for oral cancer are drinking alcohol and smoking or chewing tobacco. But there is growing evidence that infection in the mouth with HPV can help cause oral cancer.
It’s not known what percentage of oral cancers are HPV-related. One analysis looked at 34 studies, and found that the proportion of oral cancers that were HPV-related ranged from 3% to 84% in different trials around the world. The figures vary between different studies possibly due to different ways of testing for the virus or varying levels of smoking and other risk factors.
Detecting the HPV virus in a sample of people who have oral cancer does not mean that HPV caused the cancer – it could be that the people became infected after they developed their cancer.
How do you get HPV in the mouth?
It’s not known exactly how a person can get infected in the mouth with HPV, but there is a good chance that it can happen through oral sex.
Ed Yong of Cancer Research UK says: “Oral sex makes sense as a route of transmission because we know that HPV can be sexually transmitted. It is plausible, but there is still some uncertainty.”
There are more than 100 types of HPV, and around 15 are associated with cancers. Some types can be passed on through vaginal and anal sex, and are linked to vaginal cancer, cervical cancer and anal cancer. Some can be passed on through skin-to-skin contact and cause warts, including genital warts.
There is good evidence suggesting that, for some oral cancers, risk factors may be linked to sexual behaviour. These risk factors include:
ever having oral sex
having oral sex with four or more people in your lifetime
and, among men, having first sex at an earlier age (under 18)
Research into HPV infection in the mouth is ongoing.
At the moment, there is very little research that looks at the possible risks of giving oral sex to a man compared to giving oral sex to a woman. The writers of one review have suggested that the prevalence of HPV in the tissue of the cervix rather than the tissue of the penis might raise the chances of HPV infection when performing oral sex on a woman. Research indicates that HPV can be present in semen and passed on at ejaculation.
What is definitely known is that other infections are spread via oral sex, including herpes, chlamydia, syphilis and gonorrhoea, so it makes sense to protect yourself and your sexual partner by practising safer oral sex.
How does HPV cause cancer?
HPV does not directly give you cancer but it may cause changes in the cells it has infected (for example, in the throat or cervix), and these cells can then become cancerous. “Not everyone who is infected with HPV gets cancer,” says Yong. “It’s an incredibly common infection, and only a very small proportion of people with the virus go on to develop problems.”
Sometimes the infection is cleared naturally by the body. If cell changes do happen, it can take a long time – even decades. HPV-related oral cancers seem to respond better to treatment than non-HPV-related oral cancers.
Could an HPV vaccine help men as well as women?
In the UK, girls aged 12 and 13 are vaccinated against HPV. This is because it is known that nearly all cervical cancers are HPV- related and that the vaccine offers protection in women. The vaccine may also protect women from HPV-related oral cancers, but this is not yet known.
In time, as the HPV vaccine reduces the number of cases of HPV infection in women, HPV will become less common in the general population – therefore it will affect fewer men as well as fewer women.
Boys and men are not routinely given the HPV vaccine in the UK or in any other country. This is because they do not need to be protected against cervical cancer, and the evidence for the current vaccine protecting against oral cancer is not conclusive.
If you are worried
If you're worried about oral cancer, see your GP. “Mouth cancer has fairly clear symptoms, and you can see them by looking inside someone’s mouth,” says Yong.
“It’s not like an internal cancer where you can’t see the organ and the symptoms might be very vague. You can look for the symptoms of mouth cancer, and if you spot them early, treatment is much easier. Early detection can play a big part in giving people the best chance if they develop problems. But the risk of developing problems is fairly low anyway.”
The symptoms of oral cancer include:
red, or red and white, patches on the lining of your mouth or tongue
one or more mouth ulcers that do not heal after three weeks
a swelling in your mouth that lasts for more than three weeks
pain when swallowing
a feeling as though something is stuck in your throat
Find out more about symptoms of oral cancer.
Safer oral sex
According to the second National Survey of Sexual Attitudes and Lifestyles, carried out in 2000, more than 75% of men and women aged 16-44 years had oral sex in the previous year.
You can make oral sex safer by using a condom on a man’s penis, because it acts as a barrier between the mouth and the penis. A dam (a square of very thin soft plastic) across a woman’s genitals can protect against infection.
Rates of oral cancer are rising. In England, nearly 5,500 people were diagnosed with oral cancer in 2008, compared to 3,670 in 1998. The biggest rise has been seen in tonsil cancer – in the 10 years to 2008, cases of tonsil cancer in men tripled from 293 per year to 605. Cases in women increased by 50% (113 cases per year to 169).
What causes oral cancer?
Experts have known for years that the main risk factors for oral cancer are drinking alcohol and smoking or chewing tobacco. But there is growing evidence that infection in the mouth with HPV can help cause oral cancer.
It’s not known what percentage of oral cancers are HPV-related. One analysis looked at 34 studies, and found that the proportion of oral cancers that were HPV-related ranged from 3% to 84% in different trials around the world. The figures vary between different studies possibly due to different ways of testing for the virus or varying levels of smoking and other risk factors.
Detecting the HPV virus in a sample of people who have oral cancer does not mean that HPV caused the cancer – it could be that the people became infected after they developed their cancer.
How do you get HPV in the mouth?
It’s not known exactly how a person can get infected in the mouth with HPV, but there is a good chance that it can happen through oral sex.
Ed Yong of Cancer Research UK says: “Oral sex makes sense as a route of transmission because we know that HPV can be sexually transmitted. It is plausible, but there is still some uncertainty.”
There are more than 100 types of HPV, and around 15 are associated with cancers. Some types can be passed on through vaginal and anal sex, and are linked to vaginal cancer, cervical cancer and anal cancer. Some can be passed on through skin-to-skin contact and cause warts, including genital warts.
There is good evidence suggesting that, for some oral cancers, risk factors may be linked to sexual behaviour. These risk factors include:
ever having oral sex
having oral sex with four or more people in your lifetime
and, among men, having first sex at an earlier age (under 18)
Research into HPV infection in the mouth is ongoing.
At the moment, there is very little research that looks at the possible risks of giving oral sex to a man compared to giving oral sex to a woman. The writers of one review have suggested that the prevalence of HPV in the tissue of the cervix rather than the tissue of the penis might raise the chances of HPV infection when performing oral sex on a woman. Research indicates that HPV can be present in semen and passed on at ejaculation.
What is definitely known is that other infections are spread via oral sex, including herpes, chlamydia, syphilis and gonorrhoea, so it makes sense to protect yourself and your sexual partner by practising safer oral sex.
How does HPV cause cancer?
HPV does not directly give you cancer but it may cause changes in the cells it has infected (for example, in the throat or cervix), and these cells can then become cancerous. “Not everyone who is infected with HPV gets cancer,” says Yong. “It’s an incredibly common infection, and only a very small proportion of people with the virus go on to develop problems.”
Sometimes the infection is cleared naturally by the body. If cell changes do happen, it can take a long time – even decades. HPV-related oral cancers seem to respond better to treatment than non-HPV-related oral cancers.
Could an HPV vaccine help men as well as women?
In the UK, girls aged 12 and 13 are vaccinated against HPV. This is because it is known that nearly all cervical cancers are HPV- related and that the vaccine offers protection in women. The vaccine may also protect women from HPV-related oral cancers, but this is not yet known.
In time, as the HPV vaccine reduces the number of cases of HPV infection in women, HPV will become less common in the general population – therefore it will affect fewer men as well as fewer women.
Boys and men are not routinely given the HPV vaccine in the UK or in any other country. This is because they do not need to be protected against cervical cancer, and the evidence for the current vaccine protecting against oral cancer is not conclusive.
If you are worried
If you're worried about oral cancer, see your GP. “Mouth cancer has fairly clear symptoms, and you can see them by looking inside someone’s mouth,” says Yong.
“It’s not like an internal cancer where you can’t see the organ and the symptoms might be very vague. You can look for the symptoms of mouth cancer, and if you spot them early, treatment is much easier. Early detection can play a big part in giving people the best chance if they develop problems. But the risk of developing problems is fairly low anyway.”
The symptoms of oral cancer include:
red, or red and white, patches on the lining of your mouth or tongue
one or more mouth ulcers that do not heal after three weeks
a swelling in your mouth that lasts for more than three weeks
pain when swallowing
a feeling as though something is stuck in your throat
Find out more about symptoms of oral cancer.
Safer oral sex
According to the second National Survey of Sexual Attitudes and Lifestyles, carried out in 2000, more than 75% of men and women aged 16-44 years had oral sex in the previous year.
You can make oral sex safer by using a condom on a man’s penis, because it acts as a barrier between the mouth and the penis. A dam (a square of very thin soft plastic) across a woman’s genitals can protect against infection.
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