Malka

Let me make clear that what you are doing is great. Educating the kids that smoking, drinking, and HPV can cause oral cancer is very much needed. My comments above deal with some of the other issues raised on this thread.
I wish I did know a way to get a message effectively across to teenagers but I don't. As long as you stick to the facts, throw in a few cites to some of the studies on the OCF main page, I'm sure your presentations will be both legally and socially acceptable. Don't forget these kids watch South Park. My wife and I were amazed at the graphic stuff just last night - it was funny and we laughed but it would never have been on TV when I was these kids ages.
Keep up the good work
Charm

I read this article, but I didn't get that he was a doctors because a couple of his facts were way wrong in spite of it being overall good. As to the oral sex connection - that has been throughly explored and peer reviewed published in the journal of cancer. It is the mechanism of transfer.

If he understood that HPV16 is attracted to two types of cells one of them predominantly, he would get that the wet cells of the body are its first choice. (Squamous cells) They line every opening to the human body. When a woman goes down on a man, how much of his anatomy is composed of squamous cells, and therefore harboring potential HPV virus? Only the opening to the penis, a pretty small piece of geography. When a guy goes down on a woman, how much of her anatomy is covered in squamous cells? LIkely more than 90% of where his attention is going. The leap from these simple anatomical facts to men getting oral cancers from oral sex more than women is a putt, not a drive....

And there was a sexual revolution in the developed world in the 60's and 70's, sexual behaviors changed dramatically - in spite of his opinion - that it is something that remains constant. Anyone who was a teenager in the sixties, wasn't routinely getting lucking in the back seat of dad's Chevy being orally satisfied by his girlfriend. The recent 60 minutes show interviewing high school kids of all ages, that ALL said they were doing it, would never have been a truism in 40-50 years ago.

Lastly, he completely ignores mathematical progression as a cause in the uptick of the HPV disease. In a model that uses tobacco as the prime mover, it requires that people engage in a new lifestyle choice to get the cancer. That model is accurate and as smoking has declined from 44% of the American population in the 50's to about 19% today, there was a matching decline in oral cancer of a tobacco etiology. We didn't know that 10 years ago, but we know that today looking retrospectively at the data by anatomical site. This has recently been reviewed and published by Gillison and partners inside the statistics and information branch of NCI, with a view towards what will be going on in 2020. When you speak about the spread of a virus however, it is not a choice, it is a mathematically increasing progression, as the population of infected people do what they were already doing to new uninfected people. This is the very basis of the most common of information we have on viral outbreaks that are spread through human contacts, and has been well understood for decades. If he is a doctor... epidemiology cannot be his area of expertise.

OK so now I have Googled the guy, and he is an infectious disease doc at one of the best cancer centers which is close, but not an epidemiologist. So he's got the letters after his name.

But for sure he has not read the most current stuff, and the logic which I have heard HPV experts speak to about its transfer at so many conferences, is too obvious. I can't believe that someone with his credentials missed the idea. (Or disagrees with it) We'll see what he says when he returns (I hope) my email I just sent him. He may have knowledge that I haven't heard or read, and certainly he has clinical experience that is leading his thought process.

@ Malka-Maybe the best way to get the kids and their parents educated about HPV would be at a yearly check-up starting at age 11 or so. I think a pediatrician would be the best source to address the subject legally and informatively. If not at a yearly check-up, it could be incorporated into a consultation when the child receives any of the mandated vaccines required for older children.

Parents are given the opportunity to attend information sessions regarding sex education at school. But, many parents don't attend them and don't review the materials that come home from school with their child. There is a huge lack of awareness of HPV. I don't think the public schools can reach enough of the target audience to make much of a difference.

@ Brian-You're probably familiar with a study done in Hawaii that looked at transmission methods and rates between partners. It seemed quite thorough. It didn't stop at the oral/genital contact but also genital/hand/oral, genital/genital/oral, and genital/genital/anal as well. A woman can infect herself orally or can infect herself orally through her male partner. None of this stuff should have been a mystery to the good doctor.

Thanks Brian - I won't be forwarding that article to anyone now.
The anatomical differences between male and female oral sex re mucous membranes would account for the disparity in male/female patients and undercut the doctor's rebuttal.
I always find better and more accurate information here at OCF than any article or story. Keep up the great work
Charm

Not sure I agree with the obvious conclusion the doctors have jumped to. The anatomical differences makes sense at first glance but then if HPV is transferred to the oral cavity, then why doesn't it transfer between couples just as easily once it is sitting in the oral cavity? Maybe there is a genetic difference that protects more women than men? Or maybe it is just a matter of time before the women catch up with the men?

Klo - these are good questions. Regarding a delay in women catching up to men at some point in the future, my question would be; when compared to other viral infections which have no gender bias in incidence or latency of occurrence, why would this virus be any different? Remember what we know about this virus has been explored heavily in the cervical arena and there is no guarantee that that experience will transfer exactly to oral. For instance, we know that it can take upwards of a year for the immune system to clear an HPV16 infection from the cervix, but it certainly does it. Normal defenders of the mutation cascade in a cell that exist, (there are many but the most common would be p53 regulated apoptosis) are likely different in different cell types. One possibility that has be postulated is that HPV infections in the mouth will be cleared more quickly by the immune system than on the cervix because of the significantly shorter normal life span of cells in the oral mucosa and lymphoid tissues than of the cervix. Programed normal cell death time lines, could potentially influence the impact of a necessarily cellular cascade of events to malignancy, and that is a core component of our natural immunity to things.

Time line bias is certainly an issue in some cancers. The most published example is in men's prostate cancer. There is no evidence that in the diagnosed HPV+ OC patent population going back more than a decade that there is any gender based time line bias in oral HPV carcinogenesis. If there is a genetic protection based on gender, it hasn't been identified, and to my knowledge no one is looking at that in the research world as an area of exploration. (given that the cell types in both sexes are identical)

The couples issue is a different thing. First, the virus is only a freely circulating entity for a very short period of time, and it must enter a cell (become episomal) to survive. Even if and when that happens, that does not mean that the invasion will not trigger the immune response that destroys the cell and the contained virus. As stated earlier this happens in 99.1% of those that encounter the virus. Couples are still each unique biological entities, and just because one immune system defends against it or does not defend against it, is no guarantee that the partner will have exactly the same response to the virus. And since in 99.1% of the people that are exposed to the virus naturally clear it without incident, they will not be impacted by it, so how would they know that they have even been infected by it, unless they were also a person with no immune protection against it? There are only a couple of published cases of husband/wife oral HPV+ oral cancers ever documented�. So the mathematical probabilities of it occurring are not zero, but very very small. So in essence it likely does transfer between couples orally, both routinely and commonly, it just does not progress into a negative event.

The FDA cut off vaccinations for HPV at age 26. Why? Because they determined by that time/age everyone has been exposed to the versions of the virus that it protects against. The vaccine does not work in previously exposed individuals.

One factor that may account for more men having HPV+ oral cancer is that, in the past, men tended to have more sexual partners than women and engage in more dangerous sexual behaviors. I'll wager that there are now more HPV+ young women than HPV+ older women.

I am 49 and, if the divorce ever happens, I want to have the HPV vaccine since I am HPV-. Women over 30 are routinely screened for HPV when they have a Pap. I really want to avoid HPV. I'll see if I can talk my GP into giving me the vaccine series.

Sandy - just because you are HPV- today, does not mean that you have not been exposed to it. If you have every fought it off, the vaccine does not work on you. The only way to know would be a test you just can't get easily, and that would be looking for an HPV16 antibody in you, and even that test is not 100% conclusive if you could find some research lab to do it, and also be wiling to pay an expensive price to get it done. For some unknown reasons not everyone that successfully fights off HPV retains an lifelong antibody for it. Like I said in the previous post, the FDA's data made them believe that after age 26 doing the vaccine would be a waste of $ in most American women.