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Throat Cancer Is Becoming an Epidemic, And Our Sex Lives Could Be Behind It
Over the past two decades, there has been a rapid increase in throat cancer in the west, to the extent that some have called it an epidemic. This has been due to a large rise in a specific type of throat cancer called oropharyngeal cancer (the area of the tonsils and back of the throat).
The main cause of this cancer is the human papillomavirus (HPV), which are also the main cause of cancer of the cervix. Oropharyngeal cancer has now become more common than cervical cancer in the US and the UK.
HPV is sexually transmitted. For oropharyngeal cancer, the main risk factor is the number of lifetime sexual partners, especially oral sex. Those with six or more lifetime oral-sex partners are 8.5 times more likely to develop oropharyngeal cancer than those who do not practice oral sex.
Behavioral trends studies show that oral sex is very prevalent in some countries. In a study that my colleagues and I conducted in almost 1,000 people having tonsillectomy for non-cancer reasons in the UK, 80 percent of adults reported practicing oral sex at some point in their lives. Yet, mercifully, only a small number of those people develop oropharyngeal cancer. Why that is, is not clear.
The prevailing theory is that most of us catch HPV infections and are able to clear them completely. However, a small number of people are not able to get rid of the infection, maybe due to a defect in a particular aspect of their immune system.
In those patients, the virus is able to replicate continuously, and over time integrates at random positions into the host's DNA, some of which can cause the host cells to become cancerous.
HPV vaccination of young girls has been implemented in many countries to prevent cervical cancer. There is now increasing, albeit as yet indirect evidence, that it may also be effective in preventing HPV infection in the mouth.
There is also some evidence to suggest that boys are also protected by "herd immunity" in countries where there is high vaccine coverage in girls (over 85 percent). Taken together, this may hopefully lead in a few decades to the reduction of oropharyngeal cancer.
That is well and good from a public health point of view, but only if coverage among girls is high – over 85 percent, and only if one remains within the covered "herd". It does not, however, guarantee protection at an individual level – and especially in this age of international travel – if, for example, someone has sex with someone from a country with low coverage.
It certainly does not afford protection in countries where vaccine coverage of girls is low, for example, the US where only 54.3 percent of adolescents aged 13 to 15 years had received two or three HPV vaccination doses in 2020.
Boys should have the HPV vaccine too
This has led several countries, including the UK, Australia and the US, to extend their national recommendations for HPV vaccination to include young boys - called a gender-neutral vaccination policy.
But having a universal vaccination policy does not guarantee coverage. There is a significant proportion of some populations who are opposed to HPV vaccination due to concerns about safety, necessity, or, less commonly, due to concerns about encouraging promiscuity.
Paradoxically, there is some evidence from population studies that, possibly in an effort to abstain from penetrative intercourse, young adults may practice oral sex instead, at least initially.
The coronavirus pandemic has brought its own challenges, too. First, reaching young people at schools was not possible for a period of time. Second, there has been an increasing trend in general vaccine hesitancy, or "anti-vax" attitudes, in many countries, which may also contribute to a reduction in vaccine uptake.
As always when dealing with populations and behavior, nothing is simple or straightforward.
注释：
oropharyngeal: adj
表示" [解]口咽的"，means "of or relating to or located near the oropharynx"，如：Oropharyngeal cancer, sometimes referred to as throat cancer, is a cancer that develops in the part of the throat located just behind the mouth, called the oropharynx. 口咽部肿瘤，有时称之为咽癌，是发生在口的后部称为咽的地方的肿瘤。
papillomavirus: n
表示" 乳头瘤病毒"，如：One example of a cancer-causing infection is human papillomavirus.一个癌感染的例子就是乳头瘤病毒。
cervix: n
表示" 颈部；子宫颈"，means "the part of an organism (human or animal) that connects the head to the rest of the body; necklike opening to the uterus"，如：The uterus consists of two uterine horns, a body and a cervix. 子宫是由两个子宫角，一个子宫体和一个子宫颈构成。
cervical: adj
表示" 颈（部）的；子宫颈的"， cervix的形容词
prevalent：adj
表示" 流行的；普遍的"，means " existing commonly,generally,or widely in a particular place or at a particular time"，如：Is malaria still prevalent among the population here? 疟疾是否仍为此地居民的多发病?
tonsillectomy: n
表示" 扁桃腺切除术"，means "surgical removal of the palatine tonsils"，如：Generally speaking, the tonsillectomy can be finished within half an hour.一般来说扁桃体切除手术在半小时之内就可以完成。
cancerous: adj
表示" 癌的；似癌的；生癌的"，means "relating to or affected with cancer;"，如：Tiny magnets made by bacteria could be used to kill cancerous cells, say researchers in Edinburgh.研究人员在爱丁堡说，被细菌做的极小的磁铁可能被用来杀癌的细胞。
albeit: conj.
表示" 虽然(即使)"，means "although"，如：I tried, albeit unsuccessfully, to contact him. 尽管未与他联系上，可是我已尽力而为了。
promiscuity: n
表示" 混乱；杂乱；放荡"，means "indulging in promiscuous"，如：In fact, bonobo promiscuity seems to be an example of this. 事实上倭黑猩猩的混交行为便是佐证。
Paradoxical: adj
表示"似是而非的 矛盾的"，means "seemingly contradictory but nonetheless possibly true"，如：However, that is paradoxical in its own aspect. 其实它的存在也相当矛盾。
abstain: v
表示"弃权；节制"，means "decline to use one's vote; keep oneself from doing or enjoying sth"，如：I abstained from voting.
我弃权不投票. He swore to abstain from smoking.他发誓要戒烟。
penetrative: adj
表示"渗透的；敏锐的"，means "tending to penetrate; having or demonstrating ability to recognize or draw fine distinctions"，如：A toxic penetrative spray applied to the surface.一种有毒的渗透性的喷雾施于该表面。
hesitancy: n
表示" 犹豫；踌躇"，means "a feeling of diffidence and indecision about doing something"，如：Sickness and hesitancy go hand in hand. 病痛与犹豫总是结伴同行的。
anti-vax: n
表示"反疫苗 "
中文简要说明：
在过去的二十年里，西方世界的咽喉癌发病率出现迅速上升趋势，病理研究发现，诱发咽喉癌的主因是人类乳突病毒(HPV)，也就是子宫颈癌的主要原因。没有错，也是因为性行为引起的。事实上，在美国和英国，咽喉癌已经高于子宫颈癌，因为男女皆有咽喉。
科学警报(Science Alert)报导，德国医学家楚尔豪森(Harald zur Hausen)发现子宫颈癌与HPV病毒有关，如此重大的发现使他获得2008年的诺贝尔生医奖。而且HPV毒可通过亲密行为传播的，这使得子宫颈癌可以视为一种性病。亲密行为过程中，嘴也是相当重要的一部分，因此病毒也会进入口腔里，而咽喉的软组织与子宫颈一样柔弱。
大多数人感染了HPV 病毒后，免疫系统有机会将它们完全清除，然而少数人无法完全摆脱感染，这使得它们成为带原者。这些患者体内，病毒能够持续复制，并随着时间的推移，嵌入宿主细胞的DNA，这个过程就可能导致细胞癌变。
如今，许多国家已经对年轻女孩进行 HPV 疫苗接种，以预防子宫颈癌，挽救了许多生病。现在有越来越多的间接证据表明，它也可以有效预防口腔中的 HPV 感染。还有一些证据表明，在女孩疫苗接种率高（超过 85%）的国家，男孩也受到「群体免疫」的保护。
这也意味着，男孩也应该接种 HPV 疫苗，保护他人，也保护自己。
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