Michael Douglas: ‘My particular cancer is caused by cunnilingus’ – what do we really know?

Comments by Michael Douglas about the cause of his throat cancer over the last few days have caused quite a stir. In an interview with the Guardian, he suggested that his cancer had been caused by oral sex although he now claims that he was misquoted. So what is the truth behind the hype?  Does oral sex really cause cancer?

Douglas’ assertion that human papillomavirus (HPV) is implicated in head and neck cancer is rooted in strong scientific evidence.  HPV is a very common sexually transmitted virus – around 80% of sexually active people will contract it at some point in their lives.  In the vast majority of cases, the immune system clears the virus without the person even knowing they have it.  In rare cases, the virus persists and that’s when cancer can develop.  The virus has long been known to be the main cause of cervical cancer in women, and girls aged 12-13 are routinely vaccinated against HPV in schools in the UK.

It is now known that HPV also plays a role in the development of other cancers, including some head and neck cancers.  As yet, we understand relatively little about exactly what puts people at higher risk of oral HPV, although sexual behaviour is likely to play a role.  Given that HPV is so common, it could be considered a normal consequence of being sexually active; the key scientific question is why, when most people clear the infection without any problems, some people don’t get rid of it.  

What we do know is that oral cancer is on the rise.  In the past, drinking alcohol and smoking were the main risk factors, but that seems to be changing. HPV-related oral cancer is often seen in people who don’t drink and smoke, and who tend to be younger and more affluent than non-HPV oral cancer patients.  The good news is that the prognosis appears to be better for these types of cancers – something that’s borne out by Douglas’ successful treatment despite late-stage disease.

For some patients, being told that their cancer is caused by HPV might raise difficult questions about when and how they got the virus.  Michael Douglas was refreshingly open and up-front in his discussion of cunnilingus but not everyone is so comfortable talking about sex and sexually transmitted infections.  While scientific research continues to push forward our understanding of the virus, we also need good communication and information about HPV as a cause of head and neck cancer.  Previous research has shown that women who test positive for HPV in cervical screening can sometimes experience feelings of stigma and anxiety, but understanding that the virus is very common can help reduce these feelings.

Very little psychological research has been done in the area of HPV and head and neck cancer. This is why I am beginning a PhD in September which is going to look at the psychosocial implications of a diagnosis of HPV-related head and neck cancer. I will be starting with interviewing health professionals and ask them about their experiences of talking to patients about the causes of their cancer. I will also talk to patients about their experiences with a view to developing information about HPV that can address patients’ needs. I hope that my research will assist health professionals in talking to patients with HPV-related head and neck cancer and also provide patients with much needed information they can use to address questions or concerns they may have around their diagnosis.

 

Rachael Dodd (r.dodd@ucl.ac.uk)

References

Brooks, X. (2013, June 3) ‘My particular cancer is caused by cunnilingus. And if you have it, cunnilingus is also the best cure’. The Guardian, p6-9

McCaffery K, Waller J, Nazroo J, Wardle J. Social and psychological impact of HPV testing in cervical screening: a qualitative study. Sex Transm Infect. 2006 Apr;82(2):169-74.