Changing sexual practices have led to a dramatic rise in throat cancer in the United States over the past two decades, and experts say they fear an epidemic of the disease.

The comments were made Wednesday at a news conference held by the American Association for Cancer Research to discuss research into the role of the sexually transmitted human papilloma virus ( HPV) in head and neck cancer.

Increasing rates of HPV infection, spread through oral sex, is largely driving the rapid rise in oropharyngeal cancers, which include tumors of the throat, tonsils, and base of the tongue, said Scott Lippman, MD, who chairs the thoracic department at the University of Texas M.D. Anderson Cancer Center.

Studies of oropharyngeal tumor tissue stored 20 years ago show that only around 20% are HPV positive, Lippman said. Today it is estimated that 60% of patients are infected with the virus.

“The percentage of oropharyngeal cancers that are HPV positive is much higher now than it was 20 years ago,” he said. “This is a real trend, and that is why there is concern of an epidemic given that fact that oropharyngeal cancer is increasing at an alarming rate.”
Changing Face of Throat Cancer

Smoking and alcohol abuse were once considered the only major risk factors for these cancers, but this is no longer the case.

American Cancer Society Chief Medical Officer Otis Brawley, MD, said as many as half of the oropharyngeal cancers diagnosed today appear to be caused by HPV infection.

“Changing sexual practices over the last 20 years, especially as they relate to oral sex, are increasing the rate of head and neck cancers and may be increasing the rates of other cancers as well,” he said.

He added that there is some evidence that oral HPV infection is also a risk factor for a type of cancer of the esophagus.

“The paradigm is changing,” Lippman said. “The types of patients we are seeing now with oropharyngeal cancers are not the patients we have classically seen who were older, smokers, and have lots of other problems. These are young people, executives, a whole different population.”
Oral Sex Not Safe Sex

The experts agreed that it is critical for the public to understand that oral sex doesn’t equal safe sex.

The message was unofficially promoted in the early days of the HIV epidemic and it is still widely believed by many, especially teens.

Studies suggest that teens are often unaware of the risks associated with unprotected oral sex, including the transmission of HPV, chlamydia, and gonorrhea.

“There is a huge public health message here,” Brawley said.

source: http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20090729/oral-sex-cause-throat-cancer-rise

In a study published in The New England Journal of Medicine, gay and bisexual men were found to have a significantly higher risk for developing anal cancer, over thirty-five times greater than the general population. HIV-positive men were estimated to be eighty times more likely to get it. Although anal cancer accounts for less than 5 percent of all digestive and intestinal tract cancers, the rates have increased 160 percent over a thirty- year period. Gay African-American men have the sharpest increase and the lowest survival rates. Interestingly, anal cancer in gay men is as common as cervical cancer was in women before the use of the Pap smear, the test that screens for precancerous lesions on the cervix. Both types of cancer are caused by the human papillomavirus (HPV), which also causes anal and genital warts. HPV is one of the most common STDs in the world. Fortunately, anal cancer is highly preventable and treatable if caught in time.

There are more then one hundred different subtypes of HPV, and some are the source of common warts as seen on the hands and feet. HPV affects approximately 65 percent of HIV-negative gay men, and nearly 95 percent of HIV-positive gay men carry HPV in their anal canals. Most do not even know they have it. Subtypes 6 and 11 cause 90 percent of genital warts, while subtypes 16 and 18 are far more dangerous because of their precancerous potential.

The lining of the anal canal, once infected with HPV, can reproduce uncontrollably if left untreated. In most cases, the immune system clears the infection naturally, but in a small number of cases, usually over many years, HPV can cause changes in the cells of the anus and rectum that can lead to cancer. The Pap smear is something that should be offered to all gay men. In March 2007, the New York State Department of Health AIDS Institute, in collaboration with the Johns Hopkins Division of Infectious Diseases, issued the following recommendation concerning anal Pap smear.

Clinicians should perform anal Pap tests at baseline and annually in the following populations:

1. Men who have sex with men

2. Any patient with a history of anal or genital warts

Clinicians should refer patients with abnormal anal Pap test findings for high- resolution anoscopy and/or examination with biopsy. Like cervical cancer, invasive squamous cell cancers of the anal canal are associated with certain types of HPV infection, most notably, HPV-16 and HPV- 18. Although this is a new practice that may not be routinely available, screening for cellular dysplasia is recommended, particularly in persons at high risk for infection with papilloma viruses.

There are various ways to treat genital and anal warts depending on the size and location. Topical medications, like podofilox & Imiquimod (Aldara) can sometimes be used.  Cryotherapy, electrodesiccation, application of trichloroacetic acid or bichloroacetic acid and interferon injections are just some of the many treatment options that should be discussed with your physician.

The anal Pap smear is a simple test that is performed by your doctor in his office. It involves swabbing the anus with a Dacron swab, which looks like a long Q-Tip. The swab is then smeared on slides and sent to the pathologist. This test is so important because there are many different types of HPV. The most common are types 6, 11, 16, and 18. Certain subtypes, specifically 16 and 18, are considered precancerous. As a patient, you should report any cauliflower-like lesions that develop on your skin because HPV can show up on your penis, anus, and even your tongue.

In 2006, Merck & Co delivered the first vaccine for HPV called Gardasil. It is a quadrivalent vaccine, which means it works on HPV subtypes 6, 11, 16, and 18, and it is given in three separate injections over six months. Currently, the vaccine is indicated only for women, but the majority of gay health- care providers are urging their gay male patients to consider this vaccine, especially those men who are HIV positive or have a history of HPV. At this time the vaccine is not covered by insurance and would have to be paid for out of pocket. Presently, Merck is studying this vaccine in 4,000 young men, including those who engage in sex with other men, and the National Institutes of Health (NIH) is evaluating the response to Merck’s vaccine in preteen HIV- positive boys and girls.

adapted from source: http://www.advocate.com/health/healthstory_ektid61607.asp?Category=Health+%26+Treatments

by: Michelle Lipke

Liquid nitrogen is a popular destructive treatment for warts.  It is readily available in both dermatology and primary care offices.   Verucca-Freeze and many similar brands available over the counter are a liquid applied from a spray can, but only freeze to -70C.  Warts may not resolve with the over the counter freezing due to the fact that they do not freeze as fast as the liquid nitrogen available in the clinic setting; as well as the proper application technique may not always be used. The wart virus, known as human papilloma virus (HPV), is not destroyed by the freezing procedure.   Liquid nitrogen freezes at -196C and works by destroying the skin cells which in turn release the wart virus.  They body responds to this process by causing an immune response to resolve the wart.

The cryo-spray gun and cotton wool bud are the two main methods for treating common warts with liquid nitrogen.  Different providers often have a personal preference of which method they choose to perform this treatment.   There was no difference in cure rate between cryo-spray gun and cotton wool bud for warts treated every two weeks for three months.

Warts need to be frozen until 1-2 mm of surrounding skin turns white.  Repeat freezing after thawing may cause more effective tissue damage for some wart locations to help them resolve.  Paring the wart down with a scalpel or razor blade may reduce callous which can act as an insulator reducing the effect of the freeze.  Warts are usually treated on average of every two weeks, but sometimes the interval of treatment can depend on how a patient responds to the freezing in regard to side effects.

The common side effects from liquid nitrogen include redness, swelling, blistering and pain.  Plantar wart treatment may temporarily reduce the ability to walk due to pain and blistering.  Excessive blistering may create a ring recurrence around the treated wart which is thought to be caused by bordering dormant wart virus.  The freezing may cause lightening or darkening of the skin after the wart has resolved, especially in dark skinned individuals.  Deeper structures such as tendons, nerves and veins can be damaged with treatment that is too aggressive.

As a parent of a school-age daughter, I haven’t decided what to think about the new cervical cancer vaccine. That’s why I was interested to learn the shot may soon be given to boys primarily to benefit girls.

Merck’s Gardasil vaccine is approved for use in girls and women, ages 9 to 26, to protect them against the human papillomavirus, or H.P.V., which causes cervical cancer. Girls can be vaccinated when they are as young as 9, although it’s recommended for 11- and 12-year-olds, before they are sexually active.

But as my colleague Jan Hoffman reported yesterday in the Sunday Style section of The Times, the vaccine could be approved by 2009 for boys as well. Although Gardasil also protects against genital warts, which are not life-threatening, the primary reason to extend approval to boys would be to prevent them from transmitting the virus to girls, thereby slowing the rates of cervical cancer. The concept is called “herd immunity.”

And the story raises the difficult question: Will parents of sons consent to a three-shot regimen that has been marketed as benefiting girls?

The story talks to parents who have mixed feelings about the idea, questioning whether they would subject their boys to a vaccine that ultimately wouldn’t benefit their son’s health. What would you do? Would you give your son a shot to lower a woman’s risk for contracting cervical cancer? Hypothetically, would you give your daughter a shot that could lower a man’s risk for prostate cancer?

source: NY Times

A common ingredient found in over-the-counter vaginal spermicides may ease the transmission of human papillomavirus or HPV infection, at least in animals, according to a new study.

HPV infection causes genital warts and the majority of cervical cancers.

“Spermicides containing nonoxynol-9 may enhance the ability of the HPV to take hold in the genital tract, at least in animals,” says researchers at the National Cancer Institute at the National Institutes of Health in Bethesda, Md.  The study appears in the July issue of Nature Medicine.  Here is the original paper.

As this study was not in humans, it needs further research.   Nonoxynol-9 is found in lubricants, contraceptive jellies and creams, and other birth control products. In recent years, its use has been found in some studies to boost the risk of transmission of HIV, the virus that causes AIDS.