Aug. 08--For the whole first half of his 20-year practice, oral surgeon Dr. Eric Carlson saw one basic type of male mouth cancer patient.
In file cabinet in his home office, he has thousands of slides: men in their 50s and 60s who were heavy smokers, heavy drinkers, hard livers. Many were war veterans; most all had "exposed himself to the classic carcinogens," Carlson said.
Then, in 2000, a man in his 30s in reasonably good health otherwise, who didn't drink or smoke excessively, came into Carlson's office. He had tongue cancer.
"Never saw that," Carlson said. "Never heard of it."
But that was about to change. Over the next 10 years, more and more relatively healthy men in their 30s, 40s and even 20s became patients of Carlson's because they had oral cancer. In fact, oral cancer cases have tripled over the past 20 years.
And the most common culprit, doctors eventually discovered, is no longer liquor, or smokes. It's HPV -- human papilloma virus.
Women have long been warned about HPV, which can cause cervical cancer.
But health experts now believe HPV causes about 70 percent of cancers of the tongue and tonsils. Men account for about 80 percent of those cancers.
Health officials believe the virus is being spread through oral contact -- and that most men are unaware they're even at risk. The national Centers for Disease Control and Prevention estimates at least 50 percent of sexually active people now contract the virus at some point, though in almost all cases the immune system will clear the virus, with no ill effects, within a couple of years.
However, those who are infected often don't know and can spread the virus through both genital-to-genital contact and oral sex. There are more than 100 strains of HPV, at least 40 of which can cause cancer, the CDC said.
"It is a social disease," Carlson said. "It is a public health problem."
He said men who have had four or more oral sex partners are at greater risk.
That doesn't mean Carlson is not still treating older men who were heavy drinkers and smokers. In fact, it's possible HPV has always been a factor in that population, he said.
Public health officials see a potential salvation in HPV vaccines, already being recommended for girls ages 11-13 (before they become sexually active), as well as those up to age 26 who didn't receive it when they were younger. The vaccines are for the HPV strains that cause most cervical cancers. Each year, 12,000 U.S. women get cervical cancer, the CDC says.
But one vaccine, Merck's Gardasil, is recommended for males ages 9-26 also, because it protects against most genital warts. Now, Carlson said, doctors are beginning to think it may protect men from developing HPV-related oral, penile and anal cancers.
The National Cancer Institute quotes studies as saying the vaccines are "nearly 100 percent effective" in preventing cervical cancer caused by the strains they target (and more than 30 percent effective against 10 other high-risk strains). That suggests it could be very effective at curbing HPV-related cancers in men, Carlson said.
But though the FDA touts their safety, the vaccines are still fairly new -- and expensive: Even at Knox County Health Department, the three-dose series costs $135 per shot.
Carlson and other doctors would like to solidify the connection between oral sex and oral cancer by obtaining Pap smears of their male cancer patients' oral sex partners, to see if the women and men have the same strain of HPV. He suspects they would.
Meanwhile, he's focused on educating groups, including dentists, about the risk and the appearance of lesions. Early detection, he said, can make all the difference, dramatically increasing the potential for successful treatment.
"Then we're waging war on this disease properly," he said.
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