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cancer, STDs

What Michael Douglas neglected to mention about oral sex and cancer

Michael Douglas, who is now three years post diagnosis for head and neck cancer, blamed oral sex with women for his disease. Apparently, he also says cunnilingus is the cure, but we’ll tackle that nugget another day.

Douglas revealed his tumor was HPV positive while doing his press tour for Behind the Candelabra (which is great, by the way, and Douglas is appropriately both creepy and predatory as Liberace).

Palatal papilloma

Palatal papilloma

Some strains of the human papilloma virus (HPV) are benign and simply cause warts (papilloma), but others are oncogenic and cause cancer. Cervical and anal cancers are the most common, but HPV-related head and neck cancers are on the rise, specifically head and neck squamous cells carcinoma (HNSCC).

HPV is detected in about 25% of all HNSCC. It is most commonly identified in oropharyngeal cancers (tonsils and base of tongue), 45–90% of these cancers are HPV positive. Douglas apparently had an oropharyngeal cancer (he reported his tumor was on the base of his tongue). However, HPV is also implicated as a co factor in 25% of cancers of the larynx and 23% of oral cavity cancers.

Studies are conflicting as to the role of kissing in oral HPV acquisition. The clearest link between oral HPV and thus oral HPV related cancers is, as Douglas states, via cunnilingus (possibly explaining why this disease is more common among men, although it would be interesting to know if the incidence of HPV related head and neck cancers among women who have sex with women is the same as heterosexual men).

However, there are a few things that Douglas left out (or perhaps were left out by the press, to give him the benefit of the doubt of course). First of all, typically it requires more than one oral sex partner to increase the risk of HPV related head and neck cancers. For example, oral sex with 6 or more partners increases the risk of HPV associated head and neck cancers 8-fold. It’s simply math…almost everyone has been exposed to HPV, but only a small percentage are actively shedding the virus and thus contagious. So, the more people you have oral sex with, the more likely you are to be exposed to someone shedding HPV.

While there is no denying that exposure to oncogenic (high-risk) HPV is a co factor, smoking should not be dismissed. Smoking more than doubles the risk of head and neck squamous cell cancers and alcohol is also a risk factor. Douglas is an ex-smoker and admitted in his biography to having a problem with alcohol (and other drugs).

This was a great opportunity to reinforce the important fact that oral sex is sex and carries with is the risk of both STDs and cancer. But Michael Douglas’s claim that “Oral sex caused my cancer” seems to gloss over the fact that he probably had oral sex with at least 6 partners, smoked a lot, and drank enough alcohol to need rehab.

Whether Douglas simply wanted to forget his other risk factors, was looking for the best headline to promote his Liberace biopic, or is truly invested in his cancer being simply a-bad-luck-you-went-down-on-the-wrong-woman kind of thing, I don’t know. Regardless, Douglas seems to have has missed the irony in blaming his cancer on the act of oral sex while promoting a movie about a man who died because of risky sexual behavior. It wasn’t anal sex that gave Liberace HIV, it was unprotected anal sex with multiple partners. There’s a big difference.

Douglas had a great opportunity to discuss several risky behaviors for oral cancer, both sexual and lifestyle, and it was sadly squandered.

Discussion

11 thoughts on “What Michael Douglas neglected to mention about oral sex and cancer

  1. Jen, I love your blog, but I’m a bit troubled by this post. I’m a former HIV educator now working in social marketing and studying social epi. Leaving Michael Douglas aside for a moment, I want to focus on the statement that ‘unprotected anal sex with multiple partners’ is what gave Liberace HIV. Yes, UAI with multiple partners increases the likelihood of getting HIV, but you didn’t get HIV from the UAI with multiple partners — you got it from the one partner who gave it to you. That’s a causal distinction not enough people appreciate, and it leads to stigmatising practices like total strangers interrogating people who disclose HIV positivity to find out how they acquired the virus. Coming back to Michael Douglas, sure, smoking and alcohol and rate of partner change are co-factors in his cancer etiology, but in his age group, there are so many smokers, drinkers, and people with >6 lifetime partners that it doesn’t distinguish him greatly from the average risk group.

    Posted by badblood | June 3, 2013, 12:21 am
    • Badblood has a good point. It is not uncommon for college students to have had at least 6 partners. The distinction about UAI and getting HIV is important, especially when trying to educate patients about the need to discuss their risk factors with each other and using protection.
      Along this line of discussion, will you also discuss Farrah Fawcett’s demise from rectal cancer?

      Posted by Kristina Knight | June 3, 2013, 5:09 am
    • sure, smoking and alcohol and rate of partner change are co-factors in his cancer etiology, but in his age group, there are so many smokers, drinkers, and people with >6 lifetime partners that it doesn’t distinguish him greatly from the average risk group

      I believe that what Dr Jen meant (correct me if I’m wrong) is that stating something like “Performing oral on women gives you cancer” is like saying “Driving a car is fatal”. It’s too simplistic, and doesn’t take into account the associated behaviours that can act as catalysts.

      With driving those are things like speeding, DWI, not wearing a seatbelt etc.

      With oral sex it’s alcohol use, smoking, multiple partners, etc.

      All Douglas’statement does is tell (mostly men) “Going down on your female partner is bad”. That’s all. How many women and girls are now going to be told “Well you can go down on me, but I don’t want cancer so I’m not returning the favour”? Given how few female partners of men are even given reciprocal oral to begin with, such an unqualified statement has fairly dismal potential.

      Further to that, head and neck cancers are occurring in younger and younger men. Surgeons who once saw a couple of cases a year are seeing them on a weekly basis now. Try and get hold of the BBC documentary “Is Oral Sex Safe?”, it’s an hour-long investigation of the topic, including interviews with surgeons, and with cancer sufferers in their twenties.

      Just like HIV/AIDS is not “gay-related” these days and is known to occur in virtually any population, the profile of oral HPV carcinoma patients as 50+yo men who were hard-drinking, chain-smoking guys with multiple sexual partners over a lifetime is no longer strictly accurate.

      Posted by Boostick | June 3, 2013, 5:22 am
    • Oh, and not to mention that there’s now HPV vaccination. Douglas could’ve performed a public health service by saying “Guys, get the Cervarix/Gardasil series to protect yourself and your future partners”, he didn’t mention safer oral sex practices, he just said that oral sex on women gave him cancer.

      Reductive, pointless, and furthering the damaging myth that the female genitalia is a disgusting, diseased area. Women and girls everywhere feel shame or disgust over the appearance or smell of their genitals. Ya think this will help the situation and increase body-positivity?

      Posted by Boostick | June 3, 2013, 5:32 am
    • The pet is dangerous? Who wants to believe tha? Its like saying buggers are bad. All the kids know that buggers are a healthy source of energy. Still, hearing it made my throat hurt. I know some brothers who would never admit that was how they caught it. “How did you catch it?” “I told too many lies.” Hes telling a story now.

      Posted by missy wilson (@funnycomedianch) | June 3, 2013, 6:37 pm
  2. Michael Douglas did everyone who is sexually active a big favor. How many people were aware of the fact that one could get warts in the mouth which may be cancerous before he spoke up? Recently, I went down on a woman for the first time in 5 years and immediately got a sore throat and wart on the inside of my lip. An antibiotic got rid of the sore throat but the wart remains and I must now have a biopsy on it. And what the hell does the Liberace movie have to do with anything?

    Posted by Mick | June 8, 2013, 7:31 am
  3. From what I’ve read from a columnist in Salon and other places {including Dr. Jen} some insecure women assume that Michael Douglas was some how “bragging” about getting HPV from performing oral sex on women rather than blaming his smoking and alcohol problems. The truth is that it is a medical fact that this can and does happen. Do these women let some kind of inferiority complex keep them from accepting science? I thought the women’s movement had moved past such immature carping..

    Posted by Fred | June 9, 2013, 8:31 am
    • And I thought men had stopped feeling so panicky and neurotic about losing a tiny bit of their privilege.

      Chauvinism is so 1970s dear.

      *yawn*

      Learn to read, it’ll be an immense benefit to you.

      Posted by boostick | June 15, 2013, 10:08 am

Trackbacks/Pingbacks

  1. Pingback: How to reduce the risk of cunnilingus-related oral cancer | Dr. Jen Gunter - June 5, 2013

  2. Pingback: I’ve already had HPV, should I still get the vaccine? | Dr. Jen Gunter - June 6, 2013

  3. Pingback: New York Times misleading regarding HPV vaccine and throat cancer | Dr. Jen Gunter - July 18, 2013

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