A wide range of behaviors around oral sex could affect the risk of oral HPV infection and cancer-related head and neck cancer that can be spread through this route, a new study led by at the Johns Hopkins Kimmel Cancer Center. These findings add nuance to the link between oral sex and oropharyngeal cancer – tumors that occur in the mouth and throat – and may help inform research efforts and public health which aims to prevent this disease.
The findings were reported Jan. 11 in the journal Cancer.
In the early 1980s, researchers realized that almost all cervical cancers are caused by the human papillomavirus (HPV), a DNA virus from the Papillomaviridae family. Although about 90% of HPV infections do not cause any symptoms and resolve within two years, a minority of people carry the virus, which can damage DNA and promoting malignancies. Nearly two decades after discovering this link, scientists found that a growing number of oropharyngeal cancers are also caused by HPV. Now, most oropharyngeal cancers are related to HPV.
Early research suggested that the higher the number of oral sex partners over a lifetime, the greater the risk of oropharyngeal cancer associated with HPV. However, says Virginia Drake, MD, first study author and surgery resident at the Johns Hopkins Kimmel Cancer Center, little was known about the other risk factors that may contribute to this disease.
“While we know that HPV-related oropharyngeal cancer is strongly associated with oral sex and the number of oral sex partners,” she says, “we did not see for sure what other behaviors could contribute to this disease. “
To answer this question, Drake and her colleagues worked with data from 163 HPV-related oropharyngeal cancer patients enrolled in the Papillomavirus Role Study in Oral Cancer Viral Epidemiology (PROVE) and 345 healthy people with demographic characteristics similar to those in the study. participants. The study ran from 2013 to 2018 at the Johns Hopkins Kimmel Cancer Center, the University of California San Francisco Helen Diller Comprehensive Family Cancer Center and the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai.
Each of these volunteers – patients with cancer and healthy controls – recently underwent the same detailed behavioral study of sexual life and behavior, including number of participants, age of sexual initiation, type and order sexual activity, partner dynamics and extramarital sex. They also submitted a blood sample to test for antibodies to strains of HPV and tumor samples from the cancer patients to confirm the presence of the virus.
When the researchers compared data from the cancer patients with data from the healthy controls, they found several key differences. For example, while the researchers found that a higher number of lifelong oral sex partners increased the risk of HPV-related oropharyngeal cancer, they also found that a higher risk was associated with an earlier age of having oral sex (under 18), higher intensity “oral” sex (more sexual partners over a shorter period of time) and having oral sex before having other sex.
The research team, which included Gypsyamber D’Souza, Ph.D., an international professor of epidemiology and health at the Johns Hopkins Bloomberg School of Public Health with a combined experience in oncology and otolaryngology — head and neck, that relationship dynamics and partner behavior may affect risk. For example, a higher number of leg sex partners, extramarital sex and a suspected extramarital sex partner also significantly increased the risk of HPV-related oropharyngeal cancer, more than 1.6 times. A sexual partner who was at least 10 years older when the study participant was younger than 23 was also associated with a disease diagnosis.
Those with cancer tested positive for serum antibodies to HPV oncogenes. And the risk of HPV-related oropharyngeal cancer was significantly higher for volunteers who were positive for more specific HPV strains.
Taken together, Drake explains, these findings provide a context in which behavior may affect the risk of this disease. They could also inform a future study of how HPV-related oropharyngeal cancers develop – in terms of questions such as whether people have a stronger immune response to HPV, and therefore a lower risk. for cancer, if their first HPV exposure is to genital HPV (previously they are exposed to oral HPV) or if they are exposed at an older age.
“Our main goal was to add context to what we already know about these cancers and gain a better understanding of the complex nature of this disease,” Drake says. this contemporary view into HPV – related oropharyngeal risk factors for us to do just that. “
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Other Johns Hopkins researchers who contributed to this study were Carole Fakhry, Melina Windon, Matthew Stewart, Lee Akst, Alexander Hillel, Wade Chien, Christine Gourin, Rajarsi Mandal, Wojtek Mydlarz, Lisa Rooper, Tanya Troy, Siddhartha Yavvari and David Eisele.
This study was supported by the National Institute for Dental and Craniofacial Research (grant P50 DE019032) and the National Institute on Deafness and Other Communication Disorders (grant 1K23DC014758).
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