For three months, 30-year-old Phil* had the feeling that there was something at the back of his throat. “I had a scratchiness near my right tonsil,” he says. “It wasn’t painful, but it irritated me constantly.
“And if I’d smoked more than usual over an evening, it would get particularly irritating the next morning and I’d cough a lot to try to alleviate it.”
Looking into his throat in the mirror, Phil could see only a “bit of redness”.
“It was only when I went for a filling in a back tooth that my dentist picked up that there was something seriously wrong and sent me to an ear, nose and throat specialist.”
A biopsy sample from his throat was sent to a lab for testing, and a week later Phil was told the bad news. He had throat cancer.
“I was baffled at first, but then the doctor explained that I had contracted human papillomavirus (HPV), probably during oral sex, and that in some people it causes oropharyngeal (throat) cancer. It put me into a state of total anxiety,” says Phil.
HPV is a common sexually transmitted virus. Most strains do not lead to symptoms or health problems but some cause genital warts as well as cervical, penile, anal and other cancers.
Oropharyngeal cancer can affect the soft palate, base of the tongue, tonsils and pharynx (the part of the throat situated behind the mouth and nasal cavity).
It isn’t known why HPV leads to throat cancer, but researchers have found that HPV-related throat cancer is increasing worldwide, especially among men in their 20s and 30s. The risk increases the more oral sex they have.
Worldwide, 400 000 new cases of oral cancer are diagnosed every year. Of these, about 70 percent are HPV-related, according to an authoritative US study.
Researchers say that HPV-related oropharyngeal cancer will overtake HPV-related cervical cancer in the US by 2020.
There aren’t up-to-date statistics of HPV-related throat cancer in South Africa. The National Cancer Register’s latest figures are from the early 2000s and it lists naso-oropharynx cancer (all nose and throat cancers) as the 11th most common cancer for males, and the 18th most common cancer for females .
Experts agree that the prevalence of oral cancer is rapidly increasing in poorer communities, where STDs are common and oral health is poor.
“Oral cancer is the sixth most common cancer in most countries, and we believe that, by now, it will be at least sixth in South Africa, if not higher up the list,” says Professor André van Zyl of the University of Pretoria’s (UP) School of Dentistry.
As human papillomaviruses spread from skin to skin and during unprotected oral or anal sex, the conditions are ideal for transmission from one person to another, Van Zyl explains.
In the case of HPV, you only get it in the location it attaches to. It doesn’t travel through the bloodstream.
“The HPV virus will typically transfer from a woman who has it, to a male performing oral sex on her. Males generally perform oral sex more than women, which is why they’re more at risk, especially if they are HIV-positive.
“Multiple sexual partners increase the risk dramatically. Six or more lifetime oral sex partners can increase chances of oropharyngeal cancer by almost tenfold,” says Van Zyl.
“The latest US studies now show that open-mouth kissing with different partners is also linked to the spread of HPV, but a link to HPV-related oropharyngeal cancer has not been proven.”
He says as HPV-related cervical cancer is the number one cancer among black women in South Africa, the expectation is that there will be a spike in HPV-related throat cancer in the black population groups in particular – mostly among men aged between 20 and 40 – when the latest data becomes available.
“But promiscuity among young people of all races – many of whom believe they are safe if they abstain from vaginal intercourse and stick to oral sex – is clearly a problem,” says Van Zyl.
“Many of these youngsters have several oral sex partners in the belief that they are safe. The reality is, you are not safe just because you are practising oral sex. And the more sexual partners you have, the more dangerous it is.”
This grim outlook has led Van Zyl’s department, together with colleague Professor Willie van Heerden, also from the UP’s School of Dentistry, and the SA Dental Association (SADA), to conduct a countrywide campaign to educate dentists about the symptoms of oral and throat cancer and how to detect it.
“Using a light, the dentist should look at the back of the tongue and the throat,” says Maretha Smit, the CEO of SADA. “Oral and throat cancer can develop from pre-cancerous lesions, such as white or red spots, as well as sores, which is why regular dental check-ups are so important. They are normally invisible to the eye of the sufferer.
“Some people will experience pain or discomfort talking or swallowing if the cancer is advanced,” adds Smit.
Men are more prone to throat cancer because of the other risk factors, such as smoking and drinking.
“The combined effect of smoking, drinking and multiple sexual relationships is a case of ‘the sum is bigger than its parts’. They all add to the overall risk profile,” says Smit.
In the world’s Asian populations, most oral cancers are caused by chewing the Areca nut. This is also a common practice in the Indian community in KwaZulu-Natal. “And it’s now been proven that the hookah pipe, which is unfortunately popular with today’s youth, is also a major risk factor. The smoke inhaled from an hour of smoking the hookah is 100 to 200 times more than the smoke inhaled from a single cigarette,” Smit says.
The good news is that if you have HPV-related throat cancer, the prognosis is good. “You have a 30 percent less likely chance of dying from this type of throat cancer than a smoking or drinking-related throat cancer,” says Van Zyl.
If it’s picked up early, you will likely survive, because HPV-related throat cancer responds better to chemoradiation therapy than smoking-related throat cancer. If it’s advanced, you will probably require surgery to remove the cancer, followed up with chemoradiation therapy. The more advanced the cancer at time of diagnosis, the poorer the outlook.
Phil was lucky enough to have benefitted from a short course of chemoradiation therapy. “It made me feel exhausted and I lost most of my hair. I’ve had my last treatment and I’m waiting for the results. I’m really hoping it has been cleared up. This has been a nightmare.”
A preventative option, albeit an expensive one at between R2 000 and R2 400, is to vaccinate against HPV.
Some medical aids cover the vaccine for women, as it is well recognised that it prevents cervical cancer. Young women have been urged for years to get it. But Smit says medical aids do not cover the vaccine for men. “This will be another important aspect of SADA’s awareness campaign,” she says.
Many parents in the US have opted for their sexually active teenagers to be vaccinated, fearful that they will fall victim to throat cancer. But, for now, Van Zyl and Smit are concentrating on raising awareness.
Says Smit: “Understand your lifestyle. Know that oral sex with multiple partners is not safe. When you visit the dentist, ask them to check the back of your throat for any abnormalities. Prevention is always better than cure.” - The Star
*Name has been changed.