Oral Sex Stoking Throat Cancer ‘Epidemic’ in UK and US | Hacker News Reader

Oral Sex Stoking Throat Cancer ‘Epidemic’ in UK and US

independent.co.uk

91 pointsDocFeind110 comments

I wonder what has changed. The virus has been endemic for generations and many sexual practices are similar today as a generation ago. Have the practices changed? Has the virus mutated? Is there another environmental/immune system factor?

My understanding is there's 2 big changes. The biggest concern of HPV previously was cervix cancer, but as women are pretty standardly immunized against HPV it's almost disappeared, but for men it's relatively new (well like a decade, but it's still not pushed like it is on young women) to be immunized against HPV as part of standard care so it's no longer an issue of immunize to prevent cervix cancer but immunize to prevent throat cancer. I'm in my mid thirties and asked my pharmacist about it, I can get the shot but my insurance says I'm to old so I have to pay out of pocket for it.

Also, yes, sex practices have changed widely in regard to oral sex, many men considered it to be emasculating to go down on a woman and sex was pretty much just PIV until the man finishes and then done.

> I'm in my mid thirties and asked my pharmacist about it, I can get the shot but my insurance says I'm to old so I have to pay out of pocket for it.

Are you sure? Also a mid-30s male and my PPO insurance covered it fully last year, no copay, coded as preventative. Call your health insurance and ask about “CPT code 90651”.

Such a fascination the various incantations one must give when interfacing with insurance companies to have any hope of achieving whatever your objective might be.

Same. Had no problem getting it done at CVS. I saw it selectable when getting some standard boosters and opted into it. I did have to look up the schedule for adults on the CDC website.

I was super annoyed as a teen and young adult when they kept opening the window for when you could receive it for a few years younger than me. My understanding is the manufacturers didn’t want to market an STD vaccine so Cervical cancer it was. Never mind men could transmit and harbor it. Guarding all susceptible parties just didn’t work with how they were going to market it.

> Call your health insurance and ask about “CPT code 90651”.

There's no point to this. Health insurance providers are explicitly exempted from having to be truthful with you about coverage. The better ones will just tell you they don't answer coverage questions at all as a blanket policy; the rest will tell you whatever they think profits them the most.

Most have tools that will tell you if a provider is in network and what a procedure will cost at them. Most have a pre-authorizarion process to confirm coverage as well. Also, if your insurance is through an employer, HR typically has liaisons that can help.

> Health insurance providers are explicitly exempted from having to be truthful with you about coverage

citation needed? What entity rules that they are explicitly exempted?

In Canada and received it three years ago in my early-30s. Public health didn't cover due to age, and private insurance covered most of it, but remaining cost after deductibles and injection costs was still non-trivial. ($170 across three shots.)

Compared to US medical costs, $170 CAD is a nothingburger.

If anything, I'd be more annoyed about the 3-shots and repeated trips, vice a <200 charge; time is money, too.

I'll try that, I didn't get it at the time cause life was busy but it has been on my mind.

They seem to be expanding the recommendation to wider and wider groups, was told the insurance company pretty much assumed you had HPV over a certain age and wouldn't cover it.

When I was in grad school (mid-20s) I was consulted not to get it.

NowI'm pretty sure any adult with insurance can get it through any pharmacy that does vaccines. I think the actuarial tables must have changed or the cost of the vaccine decreased.

I reached out to mine, not covered :(

Get it

> Also, yes, sex practices have changed widely in regard to oral sex, many men considered it to be emasculating to go down on a woman and sex was pretty much just PIV until the man finishes and then done.

It's always felt normal to me. I learned that it might not had always been like that from the Sopranos.

That scene on the golf course with Tony making fun of Uncle Junior.

Most people dont realise that thrush can kill.

75% of women will have at least one episode of vulvovaginal candidiasis and this is when thrush gets out of control, but it can still be spread when its not out of control because its practically impossible to get rid of.

In-hospital all-cause (crude) mortality among people with candidemia is approximately 25% and remains a persistent public health problem[1].

What annoys me, is this knowledge is not something new, its been known for decades and I remember the sex education I got at school or complete lack of it apart from the mechanics but never taught the implications of STD's et al, which means the Govt and health experts are fuelling these persistent public health problems along with all the nutters who should be locked up in the funny farms who think God will save them!

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797637/

Thrush is a fungal yeast infection that's almost universal for most people -- you're going to have these critters living on or in you eventually anyways.

And it's not an issue unless you're immunocompromised or otherwise highly vulnerable. It's not an issue for most people.

A long time ago, sure. But even the previous generation would have had more open views. Not to mention, wouldn't the oral cancers still show up in women if the power dynamic was as you say?

> Not to mention, wouldn't the oral cancers still show up in women if the power dynamic was as you say?

It did. It's just a much lower prevalence than cervix cancer so it was framed around preventing cervix cancer, but as that's largely gone away the focus has shifted to preventing throat cancer.

According to the article, there is a new epidemic, indicating a rise in rates. I'm asking why we didn't see it before. If it was there all along as you say, then is the article wrong for suggesting a rate increase?

I think you're massively underestimating the change in sex practices in the last 2 or 3 decades.

HSV (Herpes simplex virus) vaccine? Do you mean HPV (Human papillomavirus)? I've only ever heard of the HPV vaccine, as well as its relationship to cervical cancer.

yep, meant HPV

Yeah I was wondering the same too, I was given the HPV vaccine when I was born

Isn't that unusual?

Yeah I don't think that's status quo anymore. I didn't know I had it until I was going through my vaccination records and saw it was listed as one of the ones I got when born and then a booster like 2 months later

Yeah, meant HPV

Men in the US of almost any age can get the HPV vaccine, but it rarely happens. The medical establishment ignored men and so failed when it should've vaccinated everyone.

The medical establishment in the US thought it was a great idea to circumcize men for ages after the rest of the developed world abandoned the practice. They'll still happily do it for newborns if the parents request it, even though there's no medical basis, only religious.

It should be no surprise the US medical establishment wouldn't want to push a vaccine for an STD.

Statistically, if you're sexually active, what's the chances you already have HSV, and will the vaccine do anything if you already have it?

They might mean HPV. HSV consists of HSV-1 (oral herpes) and HSV-2 (“pubic area” herpes).

There isn’t really a consensus across studies for what percentage of the population has HSV-1, but all studies agree that it’s “very common”. The reason you don’t see more people with herpes sores around their mouths is because most people with HSV-1 never have an outbreak, and those that do only usually have an outbreak when they are under a lot of stress or ill (because the immune system is occupied with things other than the HS virus).

A few companies are working on vaccines and cures for HSV-2 and even HSV-1 that are based on the COVID 19 RNA vaccines and we might be able to get them in the next decade.

Yep, definitely meant HPV.

The more active you are the more likely you are to have been exposed to both hsv and HPV. Hsv can be passed through just kissing, so a lot of kids get it long before they are sexually active. I’m of the boomer generation, and somewhere around 50% of us have one or another version of HSV. I have been lucky enough not to get it (so far!), but I don’t believe there is an accepted test for HPV unless you have a cervix.

For HPV, my personal opinion is that it is worth it to get vaccinated no matter what age you are, since only certain strains cause cancer and you might not have gotten those strains yet. The medical profession doesn’t agree with me however.

I wonder if the old cases were essentially hidden in the larger number of cases caused by smoking? With smoking on the way down, the percent of cases that would be attributable to HPV would go up. Trying to find the throat cancer rate by year for the past few decades and not having any immediate luck though.

Edit: This data from the CDC seems to indicate that the increase is in number of new cases, but the rate has been fairly flat since 1999 https://gis.cdc.gov/Cancer/USCS/#/Trends/

Viruses and Bacteria evolve much faster than large organisms.

All STD's are evolving rapidly to the point even condoms might not protect you.

https://www.nbcnews.com/health/sexual-health/3-common-stds-b...

https://apnews.com/article/monkeypox-the-next-std-3266fd0ae4...

https://www.cbsnews.com/news/massachusetts-concerning-new-dr...

Typically they don't classify generally infectious diseases as STDs. It depends on the main path of infection. For example, lyme disease, zika, and many other diseases can be passed sexually yet are not called STDs.

But of course condoms already don't protect against HPV and HSV.

How do you claim sexual practices are "similar" today as a generation ago? Christianity has been prescribing missionary sex position for a long time now, and even Islam has guidelines on sexual activity (that covers the first two largest religions of the world). (Remember the line in catholic influenced Godfather where someone says that he can't have oral sex with his wife because she also kisses their kids with the same mouth, and hence his need for prostitutes for oral sex?). Pornography is the next biggest influencer. And if you look at that, oral sex were heavily promoted in the past, and now anal sex is heavily promoted. Now, even movies and television have normalised oral sex in the last 2 decades or so.

The mentioned line is from "Analyze this", not Godfather.

Oh, ok. My mistake. Don't know how I associated it with Godfather ...

Huge change in hookup culture due to dating apps.

That would only apply if it meant people had more partners now on average than they did in the past. That might be true, I haven’t seen statistics on it.

Based on what, perception? Most people report how bloody useless those apps are.

The top 10% most eligible (attractive, well off, etc.), are slaying on those apps, but studies have shown that Millennials and Gen Z are having less sex overall.

And those highly eligible folks are were slaying long before apps -- meat-market bars were a thing before most of HN was born.

But that wouldn't be manifesting as cancer yet. It should take a few decades to see the results.

This is about the previous generation. The article says that 2 in 3 cases develop in adults over 55, and ony 1 in 8 in people younger than 50.

Yes, but even boomers (from the first sexual revolution) would have been 55+ around 2000ish.

This is all happening in the last 20 years, so less than a single generation.

In those 20 years we've had another sexual revolution, deconstruction of any barrier to promiscuity and any number of apps to facilitate hookups.

The demographic hit hardest is 55+, which is unsurprising. We only started pushing HPV vaccines to teenagers (only) right around that time, so most of the current generation is unvaccinated.

> The demographic hit hardest is 55+, which is unsurprising.

Not surprising, just like smokers don't get throat cancer at 25, but more likely at 50,60 year old.

We wouldn't be seeing the data from people in th last 20 years since it takes longer for cancer to develop. I would expect that we would have seen this since the last sexual revolution when boomer are hitting 55+ (2000ish).

It's absurd that you can't get the vaccine past age 45. I've read that the reasoning is that people beyond that age are "likely" to have already been exposed. Except there are many strains of HPV, and exposure to one may not protect from others. There are also plenty of people who've managed to avoid it by age 45, but who could still be exposed later in life. Especially because condoms for birth control purposes aren't necessary in late life. STD rates at some of these retirement villages are out of control.

"There is a vaccine for HPV, which is more than 80 per cent effective and available in much of the developed world."

Men should get this, as well. US CDC doesn't recommending it for boys only because "it is not cost-effective."

Get the vaccine, for yourself and boys. Whether or not you can afford it!

SRC: Dealing with this!

'US CDC doesn't recommending it for boys only because "it is not cost-effective."'

I believe that was true years ago. The current guidelines are for children to get it around age 12.

This is correct. Now recommended for boys and girls. [1]

[1]: https://www.cdc.gov/vaccines/schedules/easy-to-read/adolesce...

Are there any downsides?

It increases the risk of some side effects: https://pubmed.ncbi.nlm.nih.gov/28730271/ .

All medications, including vaccines, have side effects or adverse events. Most are mild or occur in only a subset of the patients. CDC should have some data on their site, including the package insert going over the basics of safety, administration, etc. The think that I remember hearing the most about 15 years ago was POTS. Not sure what they found out about that.

From what I briefly read about the HPV vaccine on the CDC website, it seems _pretty much safe_.

It's recommended in France for boys and girls, and there's a big push to vaccinate your kids from 11 to 14 years old. My son got his shot the other day - 65% of the cost covered by state, remainder by top-up/mutuelle insurance.

Looks like Australia has been giving it to everyone since 2007

https://www.theguardian.com/australia-news/2023/feb/02/austr...

In addition, there are prophylactics that will protect against other oral sex transmitted pathogens as well. This is really an STD "epidemic" which includes other diseases as well. I wonder if removing risk of some diseases increases recklessness related to the others.

Edit: why disagree about additional protection and legitimate question?

Anecdote here, but…In the US you can get vaccinated for HPV until I think age 45. I did it a few years ago at age 40. I used to get bad ulcers in the back of my throat 3-4 times per year, now I rarely do. Hoping that this means the risk of cancer will be reduced as well.

In Denmark you have to be a man who has sex with men (MSM) to get it as a male.

Don't see why there is a need for discrimination.

Seems pretty easy to lie in that case? I’m assuming they don’t make you prove it?

They didn't in my case.

Maybe the odds of getting it through cunnilingus are a lot lower than through fellatio. There's no possibility of throat contact in the former case and what seems like a short distance to us might be an impassible obstacle for a virus.

Apparently cunnilingus contributed to Michael Douglas getting throat cancer.

I had forgotten about that. That does make the decision harder to understand, unless there's a strong statistical tilt backing it up.

Anecdotes aren't data, and one film star getting oral cancer does not an epidemic make.

Plus, as a good looking actor, I'm sure that mouth of his was getting a lot of use compared to the average person; the 1% of rug munchers. His risk profile may be a wildly uncommon exception, and as a rich dude he can pay for whatever medical stuff he needs out of pocket.

Yes, but if the man has it, his partner will likely also get it.

Pretty much all vaccines (and most medicines and health interventions in general) have the possibility for adverse reactions and side effects. Health agencies will often balance the likelihood of adverse effects against how likely various population groups are to get a disease (and how serious the symptoms of the disease are).

Don't think that's the case here. In Australia they give it to everyone in high school. The vaccine is most effective when taken as an early teenager. So it makes way more sense to do it to everyone early than wait to see who is gay and sexually active when it's less effective.

Almost 40 here and my doctor recommended I get it since my father died of throat cancer and I couldn't recall if I'd ever been vaccinated for HPV. Here's hoping!

and the gods of the copybook headings limped up to explain it once more...

What are you invoking Kipling for? Cuz it sounds like something profoundly sex negative, and makes me think of Glen Beck (who used to love to flog the poem).

Unexpected Auden.

If I died of oral sex related throat cancer, when I'm gone I hope they will say of me, 'tta boy.

Kipling, not Auden

https://www.kiplingsociety.co.uk/poem/poems_copybook.htm

Ah, easy mistake. Auden always seemed more critical and political than Kipling.

like most of us, I doubt they will say much at all...

That blows.

What really blows is this has been a concern for at least 15 years: https://www.newscientist.com/article/dn11819-oral-sex-can-ca...

I watched my uncle die from this... Guys, please get the HPV vaccine.

I'm sorry for your uncle, but we have to get something right here. Fear from death is something that is controlling people more than they think, and the results of that as we have seen in the last years was devastating on our lives. It would be smarter to not place full trust into these products. Take that as my opinion.

This is an extremely odd comment. The parent post isn't suggesting that people radically alter their lives to avoid throat cancer. It's suggesting that they get a one-time vaccine that's already standard for many women.

What's the concern here other than fear of that vaccine? And if fear of an HPV vaccine itself killing someone is the concern, I might cite a quote I heard recently that "fear from death is something that is controlling people more than they think."

I responded to a comment mentioning death and calling to get the vaccine as possible protection. Why would be my comment odd then? You don't have to go far back in history to see why this is dangerous do you?

It would be a much better headline if it said "HPV, for which a vaccine exists, causes cancer: get vaccinated".

This post has inspired me to work out if I have already been vaccinated. Looks like I should have been when I was in school, but still going to verify.

Update: after a painful process trying to get the data, all clear. Got it in 2014

Don't believe every clickbait British tabloid media headline.

Is there a male/female breakdown in this data?

Because the HPV vaccine is more commonly taken by women.

How quickly this comment section turned into a fear induced vaccine sales platform is something that I don't wanted to see this quickly after the last years happenings.

What are you talking about? HPV is by far the simplest, cheapest and safest method of preventing a HPV induced cervix and throat cancer for a few decades already. Heck, I believe say most people can get it for free via health insurance.

What amazes me are people in this day and age treating vaccines recommendations as fear induced panacea.

Saw a documentary a few years ago about young girls who got injured by this HPV vaccine. In fact I saw it before that in a local newspaper how a Hungarian company that promotes these HPV vaccines lie in an advertisement using clever tactics to mislead public and induce fear. It was very clever actually, showed it to some people and all of them got tricked by it.

>What are you talking about? HPV is by far the simplest, cheapest and safest method of preventing a HPV induced cervix and throat cancer for a few decades already.

There is no evidence for it preventing any kind of cancer, not a single study supporting it. The HPV trial clinical only showed reduced incidence of the HPV strains the virus targets, over a short observation window. I.e. the same kind of study that showed the covid vaccines as 90%+ effective, when in fact far more than 10% of the vaccinated population ended up catching covid.

They were effective against the strains circulating at the time. They probably also helped protect against hospitalization and death even in those that caught it.

You are correct, to the extent I investigated they is no hard evidence for _any_ vaccine working. Somehow things are manipulated to give the appearance of it being effective. Example: In the Pfizer COVID vaccine trials both placebo and vaccine groups fell ill at the same rate, however since the placebo group group showed more COVID positives in the PCR test ( a dubious test), they arrived at the 95% effectiveness rate. The way 95% was calculated is also a complete travesty of commonsense. At this point I'm not even sure if any data is real, or completely made up. If I recollect in flu vaccine trails they check for antibodies in the participants, not actual incidence of the flu.

The simplest, cheapest, and safest method of preventing HPV induced cancer is not catching the virus by not having sex

SHHHHHHH!

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