years ago, when actor Michael Douglas candidly revealed that his
throat cancer was linked to having oral sex, two things happened.
made headlines that mortified his family. And he helped publicize
the fact that a pervasive, sexually transmitted virus called HPV
was unleashing an epidemic of oral cancer among men.
then, scientists have made headway in figuring out why HPV, the
human papillomavirus, has this glaring gender bias. Men are four
times more likely than women to be diagnosed with oral cancer, a
hard-to-detect, hard-to-treat disease that has overtaken cervical
cancer as the most common HPV-related malignancy in the United
be sure, changes in sexual norms over the last few generations
have played a role in this alarming trend. But research
increasingly shows the real problem is something men have
practically no control over: their immune response.
with women, men are more likely to get infected with HPV –
including “high-risk” cancer-causing strains. They also are less
able to wipe out infection on their own, and more likely to get
reinfected. The reasons are unclear.
is good evidence that men acquire oral infections more readily
than women, even if they have similar sex practices,” said Ashish
A. Deshmukh, a University of Florida HPV researcher. “And more
than the acquisition, it’s the persistence of the virus. The
clearance rate is not that fast in men.”
Becker of Yardley has stepped up as the face of this immunological
inequity. The 49-year-old former biotech executive is
health-conscious, clean-living, happily married for 26 years – and
battling terminal oropharyngeal cancer, the medical term for
malignancies in parts of the mouth and throat.
also battling the misconceptions and ignorance that keep too many
parents from protecting their pubescent children – especially boys
– against HPV-driven cancers. Two shots. That’s all it takes for
the leading vaccine, Gardasil, to prevent most cervical cancers,
less common genital malignancies, and the disease that is killing
can’t tell you how many emails I got from parents after the CBS
segment,” he said, referring to a national television interview
last month. “They said, ‘What do you mean this vaccine is for
boys?' and ‘What do you mean oral cancer incidence has eclipsed
is a family of more than 100 virus types that can live in the
flat, thin cells on the surface of the skin, cervix, vagina, anus,
vulva, penis, mouth and throat.
virus is spread through contact with infected skin, mucous
membranes, and bodily fluids. Some types can be passed during
intercourse or – as Douglas pointed out – oral sex.
virtually all sexually active people will get infected at some
point, the virus is usually wiped out by the immune system without
so much as a symptom.
the cervix, persistent infection with high-risk HPV types can lead
to precancerous changes that, left alone, slowly turn malignant.
Fortunately, the Pap smear enables the detection and removal of
abnormal cells before cancer develops. What’s more, age-related
changes in cervical cells reduce the risk that HPV will take hold
there as women get older.
such screening test exists for oropharyngeal sites - the tongue,
soft palate, tonsils, the throat behind the nasal cavity - and
symptoms usually don’t appear until cancer is advanced. Becker,
for example, had metastatic disease by the time he noticed a lump
under his jaw line in late 2015.
smoking and heavy alcohol use are the big risk factors for oral
cancer, but the non-HPV tumors linked to these bad habits have
been declining in recent years.
tumors, in contrast, have increased more than 300 percent over the
last 20 years. The virus is now found in 70 percent of all new
13,200 new HPV oral cancers are diagnosed in U.S. men each year,
compared with 3,200 in women, according to federal data. Treatment
– surgery, chemotherapy, radiation – can have disfiguring,
disabling side effects. About half of late-stage patients die
within five years.
HPV infection rates are skewed by gender, just like the resulting
cancers. The latest national estimates of this disparity,
published in October, come from Deshmukh and his University of
Florida colleagues. They used a federal health survey that
collected DNA specimens to estimate that 7.3 percent of men and
1.4 percent of women have oral infections with high-risk HPV
types. That translates to 7 million men and 1.4 million women.
chance of oral infection increases for women as well as men who
have simultaneous genital HPV infections or a history of many sex
partners, but male infection rates still far surpass female rates.
Gravitt, an HPV researcher at George Washington University,
believes these estimates are a bit oversimplified because women
counted as uninfected may actually have undetectably low virus
levels, or HPV may be hiding in a dormant state in their cells.
Gravitt said the study is in line with others that suggest “men
are more susceptible to HPV viral infection than women.”
women, an HPV infection usually sets off the body’s defense
mechanisms. The immune system makes antibodies that kill off the
invader, then immune cells remain on guard, ready to attack if the
in men, something goes awry. The HIM study – for HPV in Men –
documented this by collecting genital, anal, and oral samples from
4,100 unvaccinated men in Florida, Mexico and Brazil between 2005
and 2009. The samples were tested for the presence of two
high-risk HPV types and two that cause genital warts.
384 men who developed infections during a 24-month period, only 8
percent produced antibodies. But this response rate varied
depending on the site of infection; none of the small number of
orally infected men produced antibodies.
than putting the immune system on guard and protecting men from
the virus, infection sharply increased the chance of getting
infected again with the exact same HPV type. And many men who got
reinfected were celibate at the time.
could this be? Anna R. Giuliano, the researcher at the Moffitt
Cancer Center in Tampa, Fla., who led the HIM study, said
recurring infections may be due to reactivation of dormant virus,
or to auto-inoculation - the man spreads infection from one part
of his body to another. Or to something else entirely.
the scientific understanding of this puzzle is evolving, one
implication is clear. “HPV vaccination is the only reliable method
to ensure immune protection against new HPV infections and
subsequent disease in males,” Giuliano and her co-authors declared
in a recent paper.