Thirty years ago, Michael Stadler treated cancers that were predominantly related to smoking. A head and neck cancer surgeon, Stadler never envisioned having to question his patients about their sexual practices. Now, however, 60–80 percent of oropharyngeal—tonsil and back of the tongue—cancers are linked to oral sex and genital human papillomavirus (HPV). Stadler has had to convey that information to a growing number of white males in their 40s to 50s, who never smoked, and who did not understand that oral sex could put them at risk. Stadler declared, "We got so used to talking to patients about smoking cessation. And then this virus came along."
In 2012, the United States recorded 15,000 cases of HPV-related oropharyngeal cancer. The incidence increased 225 percent between 1988 and 2004. Federal surveillance data noted that HPV DNA detected in oropharyngeal tumors increased from 16.3 percent during the period from 1984 to 1989, to 71.7 percent during the period from 2000 to 2004. That trend starkly differed from a decreasing trend for tobacco-related oropharyngeal cancers, mainly due to the decline in cigarette smoking, according to the federal government. HPV is now the most common sexually transmitted infection.
According to a 2007 study published in The New England Journal of Medicine, the number of oral sex partners may play a role in the risk for contracting HPV-related oropharyngeal cancer. The study indicated that a high lifetime number of oral sex partners—at least six partners—was related to increased risk. Increases in HPV-associated cancers are prompting more focus on vaccinating adolescents against HPV, even though cancer death rates generally are declining.
The Milwaukee Health Department, with the University of Wisconsin–Madison and the Medical College of Wisconsin as co-investigators, is applying for a federal grant to help pediatricians and family physicians communicate to parents the need to vaccinate against HPV before adolescents become sexually active. Alderman Jim Bohl challenged the grant application, citing his concern that the grant only would emphasize the vaccine’s benefits and not inform parents of any potential side effects. The council approved the grant application in April, with Bohl being the only one opposing it.
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