Question: I heard that oral sex could cause throat cancer. Is that actually true?

Answered by Elizabeth Bradford Bell, MD, otolaryngologist and head and neck surgeon:

I’m glad people are asking this question because the answer can be surprising. Yes, oral sex could cause throat cancer. That’s not a misconception.

The cancer we’re talking about is called oropharyngeal cancer. It is cancer involving the tonsils on the sides and back of the throat, and the tonsils on the back of the tongue.

It’s primarily caused by the human papillomavirus (HPV), which is a sexually transmitted infection. It’s not only the most common cancer we see in the tonsils – it’s also the most common type of cancer we see as head and neck surgeons.

Fewer people are smoking today than they were, leading to less smoking-related cancer in the oropharynx. That’s good news, but it’s created a common misconception: Patients who tell me they don’t smoke and assume they’re not at risk. When it comes to HPV-related oropharyngeal cancer, that’s simply not true.

HPV is incredibly common

Roughly 85% to 90% of sexually active adults in the United States have contracted HPV at some point. About 90% of those people will clear the virus completely within one to two years, usually without ever knowing they had it.

Most people associate HPV with cervical cancer, and medicine has done a good job with screening and education. But we’re now seeing more HPV-related oropharyngeal cancers than cervical cancers – about 20,000 new cases per year versus about 13,000. 

That gap is why this conversation matters.

How does HPV spread to the throat?

Oral sex is the most common route, though any oral-to-genital contact can transmit the virus. Because people are largely asymptomatic, transmission often goes undetected. I also want to address patients who assume they’re low risk because they’ve had very few partners. You can’t necessarily know your partner’s history, and men are not routinely tested for HPV. Exposure is more common than most people realize.

Of the many HPV subtypes, the vast majority do not cause cancer. Two specific strains are the well-studied cancer-causing ones; others can cause genital warts or are asymptomatic and typically resolve without treatment.

Does having oral HPV mean you’ll get cancer?

No. Most cases clear on their own. But for those in whom the virus persists, we believe there’s a latency period of roughly 10 to 20 years before cancer could develop. That’s why we most commonly see these cancers in people in their 40s, 50s and early 60s, and more often in men than women.

If you are diagnosed, it’s very treatable

HPV-related oropharyngeal cancer carries cure rates significantly better than smoking-related cancers of the same area. Even patients who present with a cancerous lymph node in the neck are still considered potentially curable. The vast majority of people who walk through our doors have an excellent chance of being cured.

One terminology note: HPV-related tonsil cancer is called squamous cell carcinoma – and so is smoking-related throat cancer. Both are squamous cell cancers because that’s simply what the cells in the back of the throat are called when they become cancerous. 

We do additional testing to determine whether a cancer is HPV-driven or not. So, if you’ve never smoked but someone tells you that you have squamous cell cancer, that’s not a contradiction.

Early detection is a priority for Nebraska Medicine and UNMC clinicians and scientists. Brittney Dickey, PhD, MPH, is leading a study investigating whether a noninvasive oral gargle test can detect HPV-related oropharyngeal cancer in its earliest stages. The study is currently enrolling patients.

Symptoms to watch for

The most common sign of oropharyngeal cancer is a painless lump on one side of the neck, under the jaw or along the side. Other warning signs include:

• One tonsil that looks noticeably larger or different from the other.
• Painful swallowing that doesn’t resolve.
• Persistent ear pain on one side.

Any of these, especially alongside a neck mass or tonsil asymmetry, is a reason to see your primary care physician.

What can you do to lower your risk?

The most important thing is vaccination. The Gardasil® vaccine covers nine HPV strains, including the two that cause cancer. It can be given as young as age 9 and is approved through age 25; adults 26 to 45 can also receive it, though efficacy data for that group is less robust.

The real power of this vaccine is getting it before any potential exposure. If enough people are vaccinated, we may see a meaningful decline in these cancers by 2070. When I talk with patients, I usually tell them: Make sure your kids and grandkids get vaccinated. Most of us do things for loved ones that we may neglect for ourselves.

The bottom line

HPV is extremely common, and being exposed to it says nothing about a person’s character or choices. Not smoking, leading a healthy lifestyle and having had only one partner – none of those things eliminate your risk. Know the symptoms, get vaccinated and make sure the people you love do, too.

To schedule an appointment with a Nebraska Medicine | Fred & Pamela Buffett Cancer Center head and neck cancer specialist, call 402.559.5600.

Visit NebraskaMed.com/Cancer/trials to learn more about research study opportunities.