When Michael Douglas revealed to CNN in 2013 that he had mouth cancer, and not throat cancer as earlier reported, his audacious revelation sent the entire world talking about one of the most taboo subjects: oral sex, or, more specifically, cunnilingus.
Truth is, there’s more to mouth cancer than oral sex.
Mouth cancer is cancer of the oral cavity—the lips, mouth, gums, sides of the mouth, two-thirds of the tongue, said Jesster Navarro, diplomate of the Philippine Board of Otolaryngology and visiting consultant at Makati Medical Center.
Mouth cancer, also known as oral cancer, is mainly caused by smoking or using products that contain tobacco, drinking, betel nut chewing, poor oral hygiene and the human papillomavirus virus (HPV).
The risk increases significantly when the smoker, for example, also drinks, or when betel nut chewing, already carcinogenic on its own, is enjoyed with tobacco.
Last year the human papillomavirus virus, specifically HPV 16, which also causes cervical cancer, was linked to mouth cancer. HPV has nearly 200 strains, most of which are harmless, except for nine that are known to cause cancer. HPV 16 is also associated with cervical, anal and penile cancers.
“The incidence of mouth cancer has been increasing,” said Navarro.
9th leading cause
In the Philippines, he said, oral cancer is the ninth leading cause of cancer, especially among men.
The last study, conducted in 1995, showed that 6.8 per 100,000 people had mouth cancer. “That does not include the HPV infection, that today is attributed to 30-32 percent incidence of mouth cancer,” he said.
Navarro said that people are embarrassed to have themselves checked, ashamed of the HPV link, choosing to get examined only when the cancer is already in an advanced stage. Patients turn to doctors because by then, they could no longer swallow or open their mouths.
“I really urge people, especially the sexually active, to do a self-examination of their mouths every two weeks. If you have a mouth sore that’s been there for more than two weeks, have yourself examined by a doctor,” Navarro said.
Other symptoms include: difficulty in swallowing, throat obstruction, hoarseness of voice, bad breath, bleeding, numbness, lump in the neck, difficulty speaking, red or white patches on the lining of the mouth or tongue, ulcers, jaw pain and stiffness, sore throat, soreness that doesn’t heal, difficult or painful chewing.
Mouth cancer affects both men and women. Symptoms normally begin to appear when people are in their 50s. Early detection, he said, means 40 percent survival rate in the next five years; late detection gives one a 20 percent chance of survival.
Tongue
The signs first appear on the tongue. Since the tongue is very vascularized (forming new blood vessels), the cancer spreads easily.
“It’s a very disabling kind of cancer,” Navarro said.
One female patient, a heavy smoker, had a very advanced mouth cancer; she could no longer open her mouth. She never gave up, he said, and even wanted to go on with the procedure.
“She didn’t make it to the ER [emergency room]. Two days after consulting with me, she passed away,” he said.
Mouth cancer surgery is drastic. In some cases, the entire tongue has to be removed. Half the jaw will also be removed to pull out all the lymph nodes before the doctor uses the muscles from the chest to recreate the mouth’s floor, the mouth and jaw.
Through rehabilitation and therapy, patients can learn to communicate and swallow again.
According to CNN and The Guardian, this is probably the reason Michael Douglas did not, at first, admit he had mouth cancer. He may have had movie contracts. A disfigured face could have cost him his job.
It is still uncertain why mouth cancer is uncommon, and what triggers the changes in the DNA to cause the disease. The Boston Globe reported that about 70 percent of mouth cancers diagnosed each year in the United States are now related to HPV.
In cervical cancer, the more sexual partners you have, the more likely you are to contract a genital HPV. That’s true for mouth cancer as well. When engaging in oral sex, you are more likely to contract HPV with a partner who has had multiple sex partners.
But women now have an option to get vaccinated.
“The best prevention for this is lifestyle change. Get regular dental checkups, stop smoking and drinking,” Navarro said.
And if you like oral sex, make sure you know the sexual history of your partner.