In 2014, Jason Mendelsohn was preparing for the worst. He recorded videos for his children, said goodbye and reminded them of what was important in life. He was 44 years old and had been diagnosed with stage 4 tonsil cancer, caused by a human papillomavirus (HPV) infection – possibly decades earlier.
One day, Mendelsohn found a lump in his neck, with no previous symptoms. Doctors removed her tonsils and 42 lymph nodes. He then underwent seven weeks of chemotherapy and radiation, being fed through a tube. “I had never heard of tongue, throat and tonsil cancer, nor did I know anyone who had been diagnosed with it,” says Mendelsohn.
His doctors said he probably got HPV during oral sex. They said the HPV infection could have occurred 20 years ago, when Mendelsohn was at university. “Cancer caused by HPV can take years to develop. I never thought and I don’t think anyone I know ever thought that oral sex would one day give them cancer,” says Mendelsohn.
More than cervical cancer
HPV is most often associated with cervical cancer. It is the fourth most common type of cancer among women. The World Health Organization (WHO) states that cervical cancer caused 311,000 deaths in 2018, and 90% of them occurred in low- and middle-income countries.
HPV can lead to cancers of the vulva, vagina, penis, anus, head and neck (a region known as the oropharynx), the back of the throat and base of the tongue and tonsils and can affect men.
Although these cancers can affect all genders, oropharyngeal and anal cancers are on the rise among men. Data from the US Centers for Disease Control and Prevention (CDC) suggest that about 70% of oropharyngeal cancers in the US are related to HPV.
About 3,500 new cases of HPV-related head and neck cancer are diagnosed in women and about 16,200 in men each year in the United States. This represents four times more cases in men.
HPV is transmitted through skin-to-skin contact and sexual activity, including vaginal, anal and oral sex. About 80% of sexually active adults have had an HPV infection at some point in their lives, but the CDC says most people don’t know this.
Many strains of HPV are not even harmful to humans, and 90% of the time the body simply clears the infection within two years.
But if that doesn’t happen — and the HPV remains in the body — it’s possible that infected cells will become cancerous.
Few know that it affects men
A 2018 UK study found that 64% of parents who had daughters and sons had heard of HPV. But among parents who only had boys, 36% had heard of HPV.
Overall, 55% of parents have heard of HPV. Of these, most knew that it causes cervical cancer in women, but less than half knew that HPV causes cancer of the throat and anal, and only a third knew that it causes cancer of the penis. Very few respondents mentioned oral or anal sex as ways of contracting HPV.
But once they found out more about HPV, nearly all study participants said their children should get the vaccine.
Strictly speaking, there are no vaccines that prevent cancer. But there are vaccines that prevent viruses that can lead to cancer, such as HPV.
There are three vaccines against HPV and all three protect against strains 16 and 18 of HPV. These two strains cause the majority of HPV-related cancers. But vaccines are not limited to these two strains and also protect against HPV infections that cause genital warts.
It is not possible to screen for HPV-related cancers, except cervical cancer. Therefore, the only way to protect yourself is through vaccination. “If you’re protected, you won’t have HPV to transmit to someone else, so you become a solution to the public health problem,” says Dianne Harper, professor in the departments of family medicine and obstetrics and gynecology at the University of Michigan, In the USA.
But many men –or fathers of boys– don’t even know about the problem. And that could be linked to the quality of data on HPV infections.
Types of HPV Cancer in Men
It’s difficult to be precise about the types of HPV-related cancers in men or age groups and where they occur most in the world — useful information that can help when deciding whether to see a doctor or get vaccinated.
For example, head and neck cancer caused by HPV appears to be more common among men in high-income countries. But this could be due to a lack of reliable data elsewhere. “I think we underestimated the true number of cases in low- and middle-income countries,” says Anna Giuliano, founding director of the Cancer Immunization and Infection Research Center at Moffitt Cancer Center in the United States.
And then there is the question of types of cancer and who is at risk. Some data suggest that HPV-related cancer in men is related to their type of sexual activity. “Among heterosexual men, the most common is oropharyngeal cancer, followed by anal cancer and then penile cancer. And for men who have sex with men, anal cancer predominates, followed by oropharyngeal cancer and then penile cancer.” says Giuliano.
It is also possible for a person with HPV to move the virus to other parts of the body, for example, when someone touches their mouth and then their penis.
From patient to militant
Mendelsohn, who has survived HPV-related cancer, wants more people to be vaccinated. He created a website called Superman HPV, where he supports cancer patients and advocates vaccinating children.
“Because it’s something that can be prevented with a vaccine,” says Mendelsohn. “How can people not learn more about it and give it to their children?”
The best possible protection is obtained when someone is vaccinated before becoming sexually active and exposed to HPV.
HPV vaccination programs start around age 11 in schools, where vaccines are usually free. Some countries, such as the US, recommend vaccination for adults up to 45 years of age. Other countries recommend seeing a doctor to discuss options. It can be expensive if the patient has to pay for the vaccine. In Germany, for example, vaccines against HPV cost up to around 500 euros (R$3,000) for those aged 26 or over.
But it may be worth it: vaccines can provide protection even after an infection.
In Brazil, the Ministry of Health offers free HPV vaccination for 9 to 14 year old girls and 11 to 14 year old boys, in addition to immunosuppressed women (with weakened immune system) 9 to 45 years old and immunosuppressed men of 9 to 26 years old.