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HPV and oral cancer risk in male
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HPV and oral cancer risk in male

Hi Doc,

Recently I have had some ongoing throat irritation (several weeks) and also what appears to be a small bump or cyst in one of my tonsil crypts. I suspect the throat / tonsil irritation is due to breathing in cold air through my mouth and/or snoring while I sleep.

Doing some research on the internet I found MANY articles about the risk of HPV and oral cancer (which primarily affects the tonsils or back of the mouth). Seeing this information reminded me of a conversation I had with my recent ex-girlfriend who said she was diagnosed with high risk HPV by her gynecologist and I believe had some abnormal cells removed from her cervix with in the last few years. I didn’t think much of this conversation, which I had back in 2009, but now am worried that I might have been exposed to high risk HPV such as type 16 or 18 which makes me susceptible to oral cancer. (This susceptibility through oral sex, me giving and her receiving)

I wasn’t about to post a question since I did find some useful information you already provided on HPV and oral cancer however it is a little dated and again I have seen many articles in 2009 and 2010 about young people (I am a 35 year old male) whose diagnosis of oral cancer are rising and don’t have other risk factors such as tobacco.

From reading some other posts you replied to it is my understanding that High Risk HPV such as type 16 is fairly common along with other HPV strains and more times than not it will not turn into cancer?

Also hypothetically, if my ex-girlfriend, who I dated through 2009 but recently broke up with, gave me type 16 unbeknownst to me then it couldn’t turn into oral cancer this quickly correct? I am not an oncologist obviously but I suspect it takes several years for HPV to turn into cancer even if it does. Correct?

I guess I am just trying to assess my risk since I know there aren’t many tests I can take to determine if I have high risk HPV and if I am at risk for oral cancer.

Thanks
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Welcome to the forum.  Your question is intelligent and I like the objective, non-anxious tone, unlike many questions with such concerns.  And thanks for making the effort to review other questions like yours on the forum.

Indeed there has been a lot of attention to HPV, oral sex, and throat cancer in recent years, both in the medical literature and media.  It can sound alarming.  But you and ohters with concerns about it should keep the following basic facts in mind.  (For many if not all these points, you already are doing that.)

Throat cancer due to HPV is almost entirely related to HPV-16, only one of the many HPV types that can cause cervical and other genital cancers.  Such cases remain rare, probably only 6-10,000 cases per year in the entire US.  The rates are rising, but even a doubling -- e.g. from 6,000 to 12,000 annual cases -- still means a very rare condition in a country of 360 million people.  This is very far down the list of cancer frequencies.

In addition, most of the HPV-related throat cancers occur in people over 50 years old, and you are absolute correct that they also are influenced by smoking and heavy alcohol intake.  Probably some cases occur in the absence of tobacco or alcohol abuse, but even more rarely.

And there isn't much known about when and how the HPV-16 infections associated with such cancers actually are acquired.  Are they recent (maybe nonsexually acquired) infections?  Or the result of HPV-16 acquired 10, 20, or 30 years earlier?  People can draw logical conclusions about rising rates both of HPV-related throat cancers and frequency of oral sex, but it's probably a lot more complicated than that.  What is clear is that genital HPV-16 infection is very frequent (it's one of the most common of all genital HPV types) and so is oral sex -- so in the US there must be millions of oral exposures to the virus every year, yet only the small number of cancer cases already cited. Therefore, even among people known to be exposed orally to a high risk HPV type -- as you have been -- the odds of throat cancer as a result are extremely low.

Finally, particular HPV strains are not believed to be especially frequent cancer causers.  In other words, whether you were exposed orally to a woman with asymptomatic HPV versus a woman with abnormal pap probably makes no difference in your cancer risk.  And for every person like you who is aware of a potential exposure, there are 10-100 others who have been exposed but will never know it.  The knowledge of a past partner's pap smear does not mean your low risk of throat cancer is any higher than it would be anyway.

A major unknown question is whether immunization against HPV-16 reduces the risk of throat cancer.  Although research is underway that may indirectly answer this question, the results are some years away.

I think those comments address most of your questions.  Let me know if I missed something.  The bottom line is that you really shouldn't worry about this.  If cancer is in your distant future -- as it is for up to half the population -- it's far more likely to be colon, lymphoma, skin, stomach, lung (for smokers), etc, etc.

Regards--  HHH, MD
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