By Alexandra Sifferlin
On Sunday, in an interview with the Guardian, actor Michael Douglas revealed that his throat cancer was not caused by tobacco and alcohol, but by HPV, which was transmitted through oral sex. He has since called the statement a misunderstanding, but it’s still true: you can get throat cancer from HPV.
In an eye-poppingly candid interview with theGuardian’s Xan Brooks, Douglas, who is married to actress Catherine Zeta-Jones, allegedly told the reporter his cancer was caused by the STD:
The throat cancer, I assume, was first seeded during those wild middle years, when he drank like a fish and smoked like the devil. Looking back, knowing what he knows now, does he feel he overloaded his system?
“No,” he says. “No. Because, without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”
From what? For a moment I think that I may have misheard.
“From cunnilingus. I mean, 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.” He shrugs. “And if you have it, cunnilingus is also the best cure for it.”
Right, I say. OK. So what he is suggesting is that it all evens out? “That’s right,” says Douglas. “It giveth and it taketh.”
Human papillomavirus (HPV) is a sexually transmitted disease that can cause genital warts or present itself without symptoms. If left untreated, it can also cause cancers of the cervix, anus, penis, vulva, vagina — and head and neck cancers. “HPV being a cause of head and neck cancer was really only accepted about five years ago,” says Dr. Maura Gillison, a professor at the Ohio State University who studies HPV infections in the head, throat and neck. “Before then, no one really cared about oral HPV infections.”
According to the U.S. Centers for Disease Control and Prevention, about 60% of oropharyngeal cancers — cancers of the throat, tonsils and the base of tongue — are related to HPV. It is estimated that every year in the U.S., more than 2,370 new cases of HPV-related oropharyngeal cancers are diagnosed in women and about 9,356 are diagnosed in men; they are most common in white men.
“It is a known phenomenon,” says Gillison. “In the U.S., there is an active shift going on. Fortunately thanks to tobacco policy and public-health awareness, the incidence rate for the classical head and neck cancer caused by smoking is declining. But unfortunately, the rate of oropharynx cancer is still going up and it’s because of the HPV component.”
In 2011, Gillison and her colleagues conducted a study looking at the proportion of oropharynx cancers associated with HPV over time in the U.S. The proportion increased from 16% to 72% from the late 1980s to the early 2000s. “The incidence is rising pretty rapidly in the U.S.,” says Gillison. “Approximately 10% per year, particularly among Caucasian middle-age men.”
HPV-related throat cancer presents similarly to tobacco- and alcohol-related throat cancer, but they are considered two separate diseases, says Gillison. There are about 15 different HPV types that are established causes of cancer. The most common are HPV 16 and 18, accounting for about 70% of cervical cancers. “For oral infection, we find the same types of HPV in the oral cavity as we do in the cervix or genital region for men, but the infection is considerably less common,” says Gillison.
Oral HPV doesn’t benefit from the comprehensive testing and preventative procedures established for HPV of the cervix. Women who get regular Pap smears are quickly tested for cancerous changes that may be caused by HPV of the cervix.
“When HPV was recognized to be the cause of cervical cancer, the entire algorithm for doing Pap smears and referring a patient to a gynecologist was already established,” says Gillison. “The researchers were able to just piggyback all of their analysis and testing for HPV on the cervix onto something that was already established in the field. For oral, there is no established screening algorithm so there is no piggybacking onto routine clinical care.”
There is currently no method to routinely test for oral HPV, nor is there a way to test men for genital HPV. Researchers are working on developing clinical tests for the virus, which is among the most common STDs: researchers say most sexually active people will likely have an HPV infection at some point, but many never know. The infection doesn’t always present symptoms, and typically clears the body in one to two years.
According to the Johns Hopkins School of Medicine, it is estimated that 20 million people in the U.S. currently have HPV infection, and 1 in 49 people will contract a new HPV infection each year.
Physicians recommend the HPV vaccine for both young boys and girls to prevent infection from the disease.