Calls for men to get their shots with rise in HPV-related throat cancer
Human papillomavirus (HPV)-related throat cancer is alarmingly on the rise worldwide, affecting three times as many men as women. Many countries already have vaccination programs in place to protect women from HPV-related cervical cancer; is it time that males get vaccinated, too?
HPV is a common, usually symptomless virus spread through skin-to-skin sexual contact. Symptoms can take years to appear, making it difficult to know how, and from whom, you got the virus. Thought to be the world’s most common sexually transmitted infection (STI), HPV can lead to cancer of the cervix, vulva, vagina, penis, and anus.
Over the past 20 years, though, there’s been a concerning rise in the incidence of HPV-related cancers of the back of the throat, including the base of the tongue and tonsils (collectively referred to as oropharyngeal cancer). In the US, HPV is thought to be responsible for 70% of oropharyngeal cancers, but there has been a rise in many Western countries. It’s even been referred to as an epidemic.
A 2014 study looked at data from 2,116 males and 2,140 females between the ages of 20 and 69 to examine the link between HPV infection and the incidence of oropharyngeal cancer related to it. The researchers found that 85.4% of male participants and 83.2% of female participants had performed oral sex.
They also found that males were more likely to have had more than five sexual or oral-sex partners in their lifetime compared to females. The prevalence of oral HPV infection was significantly higher among males, regardless of sexuality. The researchers concluded that the primary predictor of oral HPV infection was oral sexual behavior.
Attitudes to sex and sexual behavior have changed over the last 50 years, driven by the increased importance placed on individual autonomy and a relaxation or rejection of social rules relating to traditional gender stereotypes. Studies have shown that more people are engaging in pre-marital sex and sexual exploration and are having their first sexual experience at a younger age.
Society’s changing attitudes toward sex were confirmed in a 2011 Pediatrics study that found that the most common form of sexual behavior among adolescents was oral sex. They found that, usually, oral sex preceded vaginal sex, and that 55% of males and 54% of females aged between 15 and 19 had had oral sex with someone of the opposite sex.
It's important to note that oral sex doesn’t cause throat cancer, but it can spread HPV, which can result in cell changes that lead to cancer. According to the Centers for Disease Control and Prevention (CDC), in nine out of 10 people, HPV goes away on its own within two years. But when it’s not cleared from the body, HPV can lead to diseases like cancer. And because it’s asymptomatic, it can still be passed on to others.
The good news is that there’s a vaccine available. Many countries have already implemented an HPV vaccination program for young girls to prevent cervical cancer. The upshot is that a study published in 2021 found that immunization with the HPV vaccination led to a significant decrease in oral or oropharyngeal HPV infections. Post-vaccination, between 93% and 100% of participants had developed HPV antibodies in their oral fluids.
The CDC recommends that females and males aged 11 and 12 should routinely get vaccinated and recommends the vaccine to anyone aged 9 to 26 years, claiming that HPV vaccination could prevent more than 90% of cancers related to the virus from ever developing, including oropharyngeal cancer.
There’s a suggestion that ‘herd immunity’ means that males are covered, too. But that’s only if the percentage of females vaccinated is over 85% and only if a person stays within the immunized ‘herd’. It doesn’t guarantee protection, especially if someone has sex with a person from a country with low HPV coverage. A 2019 study from the UK found that, in a sample group of 940 aged 12 to 24, 78% of females and no males had been vaccinated. And, in the US in 2020, only 54.5% of 13- to 15-year-olds had received two or three HPV vaccination doses.
With increasing numbers of male HPV-related throat cancer tied to oral sex, there have been calls for more countries to join those – including Australia, New Zealand, Canada, the US and the UK – that have approved HPV vaccination for males.
The message is simple: the more people are aware of this emerging health issue, the better off we will all be.