2023-05-26 14:05:02
For twenty years, the number of cancers of the throat has known a rapid increase in Western countries, to the point that we have come to speak ofepidemic. This increase is attributable to a particular type of cancer, oropharyngeal cancer (which affects the area of the tonsils and the back of the throat). THE human papilloma virus (HPV), the primary cause of cervical cancer, is the main cause. In the United States and the United Kingdom, cancer of the oropharynx is now more common than that of the cervix.
HPV is sexually transmitted. For oropharyngeal cancer, the most important risk factor is the number of partners with whom a person has had oral sex. People who have had it with six or more partners in their lifetime have 8.5 times more risk of developing oropharyngeal cancer than those who do not practice this type of sexuality.
Behavioral trend studies show that oral sex is very common in some countries. In a study that my colleagues and I conducted in the UK of a thousand people who had tonsillectomy for reasons unrelated to cancer, 80% of adults reported having had oral sex at one time or another in their lives. Fortunately, only a small number of these people develop oropharyngeal cancer. We don’t really know why.
The most popular theory is that most people catch HPV infections and are able to clear them. However, a small number of people cannot get rid of it, possibly due to an impairment in some aspect of their immune system. In them, the virus can continuously replicate and, over time, insert itself into random positions in the host’s DNA, which can lead to cancer.
(Wikimedia Commons), CC BY-SA
Vaccination of young girls against HPV has been implemented in many countries to prevent cervical cancer. Proofs more and more, although indirect, indicate that it could also be effective in preventing infection of the throat by the virus. There is also some evidence to suggest that boys are protected by herd immunity in the countries where the vaccination coverage of girls is high (more than 85%). All these elements should make it possible, within a few decades, to reduce the prevalence of oropharyngeal cancer.
From a public health perspective, this is a good thing, but only if coverage is high among girls – over 85% – and if you stay in the “community” covered. This, however, does not guarantee individual protection – especially in the age of international travel – in cases where someone has sex with someone from a country where coverage is low. And it certainly does not offer protection in countries where girls’ vaccination coverage is low, such as in the United States, where only 54.3% of teenage girls aged 13 to 15 had received two or three doses of the HPV vaccine in 2020.
Vaccinate boys
This has led several countries, including the UK, Australia and the US, to extend their HPV vaccination recommendations to young boys, a so-called neutral vaccination policy. of sex.
However, a universal vaccination policy does not guarantee good coverage. A significant proportion of certain populations are opposed to HPV vaccination for reasons of safety, necessity or, more rarely, because they fear that it encourages sexual promiscuity.
At the same time, population studies show that sometimes young adults, in an effort to abstain from penetrative sex, will begin by having oral sex.
The coronavirus pandemic has also brought its own set of challenges. First of all, it was not possible to sensitize young people in schools for some time. Then, we observe in many countries a growth in reluctance towards vaccines, or “antivax” attitudes, which can contribute to a reduction in vaccination coverage.
As always, when it comes to populations and behaviors, nothing is simple or obvious.
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