Sir, the title of the letter Oral cancer: Link with early coitus (BDJ 2016;220: 279–280) suggests a link which is misleading since it is oral sex that is associated with human papilloma virus (HPV), not early coitus.1
HPV is associated with between 12-63% of all oropharyngeal cancers and prognoses of HPV associated non-cervical cancers are better than HPV-negative noncervical cancers.2 Engaging in orogenital sex with multiple sex partners is associated with HPV-associated oropharyngeal cancer.3 Oral HPV is found three times more commonly in men than women; 8-40% of HPV-positive oropharyngeal squamous cell cancer patients report never having had oral sex4 and oral sex and open-mouthed kissing are a risk factor for HPV-associated oral cancer.5
Dentists should take a history of oral sex from all patients, particularly young patients who present with lymphadenopathy and sore throat, and educate them about HPV-associated oral cancers as early detection provides better prognosis. Dentists should discuss and educate patients about HPV vaccination and prevention of HPV transmission.
References
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Chaturvedi A K . Beyond cervical cancer: burden of other HPV-related cancers among men and women. J Adolesc Health 2010; 46(4 Suppl): S20–26.
Dahlstrom K R, Li G, Tortolero-Luna G, Wei Q, Sturgis E M . Differences in history of sexual behavior between patients with oropharyngeal squamous cell carcinoma and patients with squamous cell carcinoma at other head and neck sites. Head Neck 2011; 33: 847–855.
Sathish N, Wang X, Yuan Y . Human Papillomavirus (HPV)-associated oral cancers and treatment strategies. J Dent Res 2014; 93(7 Suppl): 29S–36S.
D'Souza G, Agrawal Y, Halpern J, Bodison S, Gillison M L . Oral sexual behaviors associated with prevalent oral human papillomavirus infection. J Infect Dis 2009; 199: 1263–1269.
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L S, V. Misleading association. Br Dent J 220, 500 (2016). https://doi.org/10.1038/sj.bdj.2016.358
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DOI: https://doi.org/10.1038/sj.bdj.2016.358