Past sexual behaviors and risks of oropharyngeal squamous cell carcinoma: a case–case comparison

Abstract

The incidence of oropharyngeal squamous cell carcinomas (SCCs) is increasing and is believed to reflect changing sexual practices in recent decades. For this case-case comparative study, we collected medical and life-style information and data on sexual behavior from 478 patients treated at the head and neck clinic of a tertiary hospital in Brisbane, Australia. Patients were grouped as (i) oropharyngeal SCC (n = 96), (ii) oral cavity, larynx and hypopharynx SCC ("other HNSCCs," n = 96), (iii) other SCCs (n = 141), and (iv) other diagnoses (n = 145). We fitted multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associated with lifestyle factors and sexual behaviors. Compared to the other three patient groups, the oropharyngeal SCC patients had overall more sexual lifetime partners (kissing, oral sex and sexual intercourse). Oropharyngeal SCC patients were significantly more likely to have ever given oral sex compared to the other three patient groups-93% of oropharyngeal SCC patients, 64% of other HNSCC patients, and 58% of patients with other SCC or other diagnoses. Oropharyngeal SCC patients were significantly more likely to have given oral sex to four or more partners when compared to patients with other HNSCC (odds ratio [OR] 11.9; 95% CI 3.5-40.1), other SCC (OR 16.6; 95% CI 5.3-52.0) or patients with other diagnoses (OR 25.2; 95% CI 7.8-81.7). The very strong associations reported here between oral sex practices and risks of oropharyngeal SCC support the hypothesis that sexually transmitted HPV infections cause some of these cancers.

Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England

“…A history of performing oral sex is a known risk factor for oropharyngeal cancer. 37 Previous evidence indicates that there is a higher probability of HPV transmission via vaginal oral sex compared with penile oral sex, 38 , 39 which would result in a higher burden of oral HPV infection among lesbian and bisexual women.…”

A Prospective Cohort Study of Human Papillomavirus-Driven Oropharyngeal Cancers: Implications for Prognosis and Immunisation

“…Furthermore, the main HPV genotype identified in oral rinse samples from the general Scottish population was HPV 16 [11]. HPV is thought to be acquired through sexual exposure [12,13] although the natural history of HPV-associated OPC is not as well defined as other HPVassociated neoplasms such as cervix. Although the increase in OPC incidence is of clear concern, patients with HPV-driven OPC generally have a better prognosis compared to those patients who are HPV-negative [14].…”

Barrier use during oro‐genital sex and oral Human Papillomavirus prevalence: Analysis of NHANES 2009–2014

“…HPV-positive oropharyngeal cancers are more likely to occur in sexually active individuals, such as those who report oro-genital sex (Dahlstrom et al, 2015;Nguyen et al, 2016;Rettig, Kiess, & Fakhry, 2015;Schnelle, Whiteman, Porceddu, Panizza, & Antonsson, 2017) or even any sex (Chaturvedi, Graubard, Pickard, Xiao, & Gillison, 2014;Gillison et al, 2012), with more oro-genital sex partners increasing the risk of infection (Dahlstrom et al, 2015;Nguyen et al, 2016;Rettig et al, 2015;Schnelle et al, 2017). The major mechanism of transmission of HPV to the upper aerodigestive tract is considered to be with oral-genital contact (Dahlstrom et al, 2015;Schnelle et al, 2017). The Centers for Disease Control (CDC) recommends the use of barriers such as condoms and dental dams during orogenital sex to reduce the likelihood of getting or transmitting sexually transmitted infections (CDC, 2017b(CDC, , 2017c, and it has been suggested that using protection during oro-genital sex can reduce the risk of HPV transmission (Nguyen et al, 2016).…”