What Michael Douglas Didn’t Tell You About HPV

There has been much media attention paid to celebrities’ health issues recently, with Angelina Jolie’s revelation about her genetic risk for breast cancer and Michael Douglas’ remarks regarding his throat cancer. Both have sparked national discussions. 

Following Douglas’ comments, I asked Dr. Banu Symington, one of our very talented Mountain States Tumor Institute medical oncologists, to write about human papillomavirus and the associated risk for cancer. Dr. Symington is a passionate advocate for cancer prevention, and I am sure you will learn as much from what she has written as I did. Her report follows:

Dr. Banu Symington

If you own a TV or radio, you have probably heard the furor over Michael Douglas’ statement to a British newspaper regarding the cause of his throat cancer.

The Guardian reported that when “asked whether he now regretted his years of smoking and drinking, usually thought to be the cause of the disease, Douglas replied: “No. Because without wanting to get too specific, this particular cancer is caused by HPV …”

He did us all a favor by raising awareness about human papillomavirus. But was he telling the truth? Let’s look at the facts.

By the way, if you have never had sex, kissed anyone on the mouth, or touched someone else’s genitals, you can stop reading right now. You are not at risk for HPV-related disease and don’t need to read the rest of this article. If you have engaged in any of these activities, read on.

So what’s the big deal? HPVs are a group of viruses that are sexually transmitted. The virus lives in the cells of an infected person’s genital area and throat.

There are many HPV types, and most simply cause genital warts, unsightly, contagious, but otherwise not dangerous. However, HPV types 16 and 18 have been causally linked to cancers of the cervix, anus, penis, vagina, vulva, tonsils, base of the tongue, and perhaps other areas.

The genetic material of HPV 16 viruses has been found blended into the genetic material (DNA) of these tumors. And laboratory tests have shown that HPV infection leads to cellular growth changes that cause cancer.  

It is estimated that overall, 7 percent of American men have oral HPV, and 1 percent have HPV type 16 in their oral mucosa.  

As with many cancer-causing  viruses, there is a long “latency period” between infection and the development of cancers. This means your actions as a youth can have consequences in adulthood.

Transmission of HPV has been demonstrated via genital-genital contact, digital –genital contact, and digital-anal contact. In other words, you can acquire an infection without having intercourse.

Once infected, you may have warts, but most often you have no symptoms until you develop cancer. This is the scary thing about HPV and many other sexually transmitted diseases.  

And while a linkage between oral HPV infection and oral sex seems logical, it has never been demonstrated. Links between sexual activity and HPV-related cancers have been demonstrated, however. HPV-related cancer incidence increases with an increasing number of sexual partners and with earlier age at which sexual activity starts.  

Can we treat HPV infections? Some patients can spontaneously eradicate or “clear” HPV 16 and 18 from their bodies. For others, there is no treatment, and the virus lays in wait, slowly causing genetic changes that lead to cancer. Not everyone who is infected gets cancer, but we have no predictive tool to tell who is susceptible to HPV carcinogenesis.

What we do have is an early cancer detection tool. Pap smears can be used to detect early HPV-mediated cervical and anal cancer, and tests are under way to see if they can be used for early detection of tongue and tonsil cancer. Early diagnosis can lead to cure with surgery or chemotherapy and radiation, but we currently have no way to get rid of chronic infections.

If we can’t treat chronic HPV infections, what can we do?

The best offense is a good defense. In the past decade, the Gardasil and Cervarix vaccines have been developed that protect against HPV 16 and 18 infection. They have been demonstrated to reduce the risk of cervical and anal cancer, and studies are under way to see if they reduce the risk of HPV-related oral cancers.  

The vaccine only works to prevent infection, so it has to be given to people before exposure to HPV. It is recommended that both girls and boys be immunized in their early teens, before they become sexually active in any way.

Although most insurers and Medicaid cover the cost of this three-shot series, only a third of girls and about 10 percent of young boys have been vaccinated.

Why don’t people take a simple precaution that can save lives?

Some of this is due to lack of knowledge and some due to irrational fear of vaccines, but the biggest deterrent has been parental fear that vaccination will lead to sexual promiscuity.

Here’s what I have to say to parents with this concern. We are fortunate in Idaho that the public health districts will vaccinate those under the age of 19 for just the vaccine administration fee.

The vaccine is normally expensive, so this is a heck of a deal. Do you want your kids to miss the opportunity for cheap lifetime protection? And how would you feel if you had to watch your kid battle or die of an HPV-related cancer that could have been prevented?

Back to Michael Douglas. What’s the take-home message? People should be vaccinated before they become sexually active, never start to smoke, keep alcohol use to a minimum, and remember to get regular physical and oral exams. Stay healthy, Idaho!

For more information on HPV and the vaccines, watch this short video: http://www.youtube.com/watch?v=LOBSAhuotnM

And here’s an article written by Idaho native Sage Coe Smith, a University of Washington medical student completing a clinical rotation with St. Luke’s family medicine physicians: HPV Hailey article

Facts about HPV-related oral cancers

Until this millennium, most tongue and tonsil cancers were caused by smoking and alcohol use. More recently, 70 percent of these cancers have been shown to be HPV-related.

Part of this apparent increase may be due to the availability of sophisticated tests that detect HPV DNA in oral cancers. Nevertheless, HPV-related oral cancers are often misdiagnosed, leading to delayed diagnosis.   

For unknown reasons, these cancers occur more frequently in men. They occur in younger patients than other types of oral cancers, and they seem to respond better to treatment than other types of oral cancers.

Smoking and drinking have been shown to increase susceptibility to oral HPV infection and to increase the risk of HPV-related throat cancer in individuals with chronic HPV infections.

And although this cancer has received a lot of recent publicity, it is still relatively uncommon.

Perhaps the biggest mystery about HPV16-related cancers is why the incidence of oral (and penile) cancers is so much lower than the incident of cervical and anal cancers.

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15 Responses to “What Michael Douglas Didn’t Tell You About HPV on “What Michael Douglas Didn’t Tell You About HPV”

  • This was very informative and every teenager and parent needs to read this. I had my own daughter vaccinated when her physician refused. We need to protect our children with vaccination for HPV just as we do for all kinds of other diseases, like polio, tetanus, measles, etc. It’s the responsible thing to do, and what parent would want their child to end up with a cancer later on in life, a cancer that can be disfiguring and deadly?

  • You were a very enlightened and responsible parent to take her in for vaccination, even against her physician’s decision.
    Perhaps sharing this blog with the physician might be an educational opportunity for him or her …
    BES

  • This is a very informative and good piece on how to take better care of our health. I was watching that piece on Michael Douglas on CNN and my first response was, Should he really give any advice on our health? Actors should stick with what they are qualified for and let people see their doctors for medical advice.

    When it comes to HPV-related cancer, Idaho and St. Luke’s are doing a very good job of educating people, but there is still work to be done. I think that entire nation can receive much better educational programs on TV every day about what can cause our health to go down, instead of waiting for someone like Michael Douglas to come up and to teach us about it.

    I know that there are a lot of people out there who are not seeing their doctor on a regular basic and are not staying informed on current issues, but that just might be one of the problems in our society. My lesson of the day is to see your doctor regularly, shop for good medical advice, learn more about your health, and don’t be afraid to ask your doctor about anything. We need to protect our health like there is no tomorrow. That takes a lot of work and knowledge.

    Dr. Symington, thank you for sharing this great information with us. I learned a lot from it. It is always a great pleasure to get good medical question from a great doctor like yourself. The pleasure is all mine, and thank you again.

  • I had heard briefly about the Michael Douglas comment, but you absolutely picked up on it and ran with it. Unfortunately, we are much more of a “People magazine” sort of a country these days, and people don’t read things unless there is some sort of “celebrity-tie” in!

    Very succinct, and you zeroed in on the bottom line, quite effectively. I’ve never had the HPV vaccination explained to me in such an uncomplicated manner, and I’m a college graduate, for goodness sakes!

    Thanks for all you do. I have forwarded it to a bunch of my friends, most especially a friend who is an assistant head master of a school. I think she will forward this on to her parents, especially to the middle school age-range where this information is so timely, via e-mailing lists.

    Well done. Thanks for sharing.

  • Great job, Banu.

    A significant proportion of my day job is taking care of people with locally advanced tonsillar cancer related to HPV.
    Vaccination makes a lot of sense, as it will not only protect the individual but decrease the prevalence in the population. But you knew that. :)

    Hope all is well.
    Rita

  • Omer,
    Thanks for your comments. I share your thoughts about actors giving medical advice, but it seems we want to make Hollywood our beacon. Look at Angelina Jolie’s effect on genetic testing for breast cancer!

  • Sallee, you can help with this mission as you are a prominent local businesswoman who WILL be listened to by the masses. Let’s keep collaborating to get the word out in our corner of the world!

  • Rita,
    Thanks for weighing in. I should let the blog readers know that you are a much-respected head and neck oncology specialist at the Jefferson Medical Center in Philadelphia, adding much credence to my message!

  • Thank you!

    I had my daughter vaccinated a few years ago, and the parents of her friends were horrified that I was promoting promiscuity. I’m feeling even better now about our decision; I know she’ll be “kissing” boys at some point. :)

    One thing that I hadn’t realized from commercials, etc., was that the vaccination is recommended for boys as well. I think there is a perception out there that it is a female issue.

    Thanks again!

  • Thanks for this article. As the mother of three young men under 23, I was very thankful for this information. My youngest is 18 and wanted to get the vaccine but heard he was too old. I’ll let him know he can get it at the health department.

    I’m sure a lot of parents out there are grateful for this article and this information. You did a great job, Dr. Symington.

  • Amy,

    Thanks for your bravery in taking honest action.

    Regarding those horrified parents, three points. We really don’t have effective protection against the many other sexually transmitted diseases, so protection against one STD should not open the floodgates to promiscuity. I assume those horrified parents may want their kids to be married and giving them grandbabies eventually, and they should know that HPV can be transmitted between someone with no sexual experience and a more experienced partner, within or outside of committed relationships.

    Furthermore, it is like a whole life insurance policy: You have to take it out when you are young to get the most protection.

    About the boys: We knew of the link between HPV and cervical cancer long before we recognized the link between HPV and penile, anal, tongue, or tonsil infections, hence the delay in considering protecting the boys.

    And as with any disease transmitted through intimate contact, the best protection is achieved when both parties are immunized. So we have some catching up to do to protect the men of our world!

  • Pam,

    Thank you for your interest and your compliment. I am thrilled to see parents of boys seek the vaccine.

    The age cutoffs for vaccination are based on the thinking that most young adults have been sexually active by the time they are 19. If you have kids who are older and who have not been sexually active, it is probably worth vaccinating them.

    And the best way to eradicate a disease that is transmitted through intimate contact such as kissing, petting, and intercourse is to protect both partners!!! Please get the word out to your friends and relatives so we can make headway in getting rid of these types of cancers.

  • This is a very excellent article and much-needed by our community. It dispels all the fears and deals with the plain facts. Hopefully it will bring people into action.

    Here in Idaho, we have a tendency to want to ignore the facts and hide from the truth. It does take celebrities sometimes to bring our attention to important matters, then we pay attention to the facts when they are presented to the public.

    Thanks to Dr. Symington; she has done that for us. Now we need to help keep it moving forward.

  • Thank you, Lana.

    It is wonderful that the blog has been not only a very transparent source of information about our journey to accountable care, but a trusted source for information about health policy and healthcare issues. Thanks to the many outstanding St. Luke’s physicians who have been willing to share their expertise on the blog, including Dr. Symington, we have been able to help educate our communities. It’s another wonderful service St. Luke’s can provide to all those who trust us with their care.

    Thanks for your comment and for following the blog!

  • Lana,

    You have been a wonderful advocate for women with breast cancer and I know you are trusted by the patients of our community.

    So you can help keep the message moving forward by sharing it with appropriate people you encounter. I have been saying, “Share the word so we don’t share the virus.” These are my marching orders, and they can be yours too!

    BES

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