Throat Cancer Link to Oral Sex Gains Notice

口腔性行為導致喉癌？

ANAHAD O』CONNOR 2013年06月07日

Luca Bruno/Associated Press

邁克爾·道格拉斯認為他的喉癌是由口交感染引起的。

多年來，人們認為吸煙和飲酒是導致喉癌的主要危險因素。但是，周一，英國報紙《衛報》(The Guardian)報道，演員邁克爾·道格拉斯(Michael Douglas)認為自己的喉癌是因為口交時受到感染而引起的，這突顯出了一個讓很多科學家感到震驚的趨勢。

68歲的道格拉斯之前曾推測，多年的吸煙和飲酒和他的疾病 有關。他的發言人後來表示，雖然道格拉斯提到口交與癌症有關，但他並沒有說自己的喉癌是由此引起的。然而，《衛報》援引道格拉斯的話說，「我不想多談細 節，這種癌症是由人乳頭瘤病毒（human papillomavirus，縮寫HPV）引起的，而它實際上源自為女性口交。」

的確，近年來，科學家發現由一種HPV病毒株所引發的喉癌數量急劇增加，而這種病毒株可以通過口交傳播。這種被稱作HPV16型的病毒也是導致很多女性得宮頸癌的原因。

20世紀80年代，只有少數喉癌病例與HPV感染有關。過去，得這種病的患者都是70多歲的老人，而且他們都大量吸煙或酗酒。

如今，所有喉癌病例中大約有70%都是由HPV引起的，而30年前，這個數據大概是15%。現在的病人往往是已經身為人夫或人父的中年男子，經濟條件較好，不吸煙也不酗酒。男性被確診罹患HPV相關喉癌的幾率要比女性高三倍。

HPV的菌株有很多種，而且這種病毒十分常見，多數性活躍的成人早晚都會接觸到它。多數人都能抵抗它的感染，不出現任何癥狀。但是，在極少數人身上，慢性感染會在舌根附近以及口腔後面的區域引發口咽癌。

醫生說，由HPV引起的喉癌比抽煙所引起的喉癌更容易治療。雖然這些癌症的發生率正在增加，但它仍然較少見，10萬人中大概有3人會得這種病。研究尚未證明針對HPV的疫苗能夠預防喉癌，但很多醫生都對此堅信不疑。

癌症的出現通常是在首次感染HPV的幾十年後，而且這種疾病的診斷也可能會針對患者的伴侶提出一些敏感的問題，他們會去考慮，自己的伴侶是如何感染的，而且還擔心自己也會感染這種病毒。

「這是一種通過性來傳播的病毒，所以這種疾病本身顯然就會讓我的病人與伴侶之間的討論很尷尬，」羅伯特·I·哈達德(Robert I. Haddad)博士說。他在波士頓丹娜-法伯癌症研究所(Dana-Farber Cancer Institute)的頭部和頸部腫瘤學項目擔任疾病中心負責人。

2009年，62歲的托尼·西莫特斯(Tony Simotes)得知在他的喉嚨內有一個腫瘤，被診斷為口咽喉癌三期。西莫特斯既不抽煙也不喝酒。他和妻子露西(Lucy)在得知癌症與HPV有關時首先感到輕鬆了些，因為這提高了他可能被治癒的幾率。

「但隨後我的心開始忐忑不安，心想這是否對我也意味着什麼呢？」50歲的露西說，「因為這種癌症來自於一種病毒，我說不定也攜帶了它。」

她說自己進行了一次巴氏試驗，結果呈陰性。

馬薩諸塞州萊諾克斯的莎士比亞劇團 (Shakespeare & Company)藝術總監和總裁西莫特斯說，因為夫妻雙方之前都曾結過婚，所以他們並不忌諱談論癌症及其原因。「我們知道在我們見面之前都曾經歷過豐富的 生活，」他說，「現實情況就是有很多人攜帶病毒但沒有受其影響。」

西莫特斯接受了化療和放療，他的癌症現在處於緩解期。

上周末，在美國臨床腫瘤學會(American Society of Clinical Oncology)的一次會議上展示的一項研究中，哈達德博士和其他研究者首次證明，患有HPV導致的喉癌者的性伴侶，其口腔感染HPV的幾率並不比一般 人高。這項研究對200多人進行了約1年的跟蹤檢查。

哈達德博士稱，研究結果表明，配偶和長期性伴侶無需採取特殊的防護措施或改變其性行為。

翻譯：陳柳、林蒙克

Throat Cancer Link to Oral Sex Gains Notice

By ANAHAD O’CONNOR June 07, 2013

 

For many years, smoking and drinking were considered the dominant risk factors for cancers of the throat. But on Monday, The Guardian, a British newspaper, reported that the actor Michael Douglas believed that his throat cancer was caused by an infection acquired during oral sex, highlighting a trend that has alarmed many scientists.

Mr. Douglas, 68, had previously speculated that years of smoking and drinking played a role in his disease, and his spokesman later said that although the actor had discussed oral sex’s link to cancer, he did not say it was the cause of his own cancer. But The Guardian quoted Mr. Douglas as saying, “Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes from cunnilingus.”

Indeed, in recent years scientists have documented a steep rise in throat cancers caused by a strain of HPV that can be transmitted through oral sex. The virus, human papillomavirus Type 16, also causes many cases of cervical cancer in women.

In the 1980s, only a small number of throat cancers were linked to HPV infection. Historically, patients who developed the disease were in their 70s and were heavy smokers and drinkers.

Now, about 70 percent of all throat cancers are caused by HPV, up from roughly 15 percent three decades ago. Patients are now more frequently middle-aged husbands and fathers who are economically well off, nonsmokers and not particularly heavy drinkers. Men are three times more likely to be diagnosed than women with HPV-related throat cancer.

There are many strains of HPV, and the virus is so common that at some point most sexually active adults are exposed to it. A majority of people fight off the infection and do not develop symptoms. But in a very small number of people chronic infection causes oropharyngeal cancers near the base of the tongue and the area just behind the mouth.

Throat cancers caused by HPV are easier to treat than those caused by tobacco, doctors say. Rates of these cancers are increasing but are still fairly uncommon, striking about 3 in 100,000 people. Studies have not proved that vaccines against HPV prevent throat cancers, but many doctors believe they will.

The cancers typically occur decades after initial infection with HPV, and the diagnosis can raise delicate questions for spouses who wonder how partners were infected and worry that they, too, may contract the virus.

“It is a sexually transmitted virus, so that by itself obviously creates uncomfortable discussions between my patients and their partners,” said Dr. Robert I. Haddad, the disease center leader of the head and neck oncology program at the Dana-Farber Cancer Institute in Boston.

In 2009, Tony Simotes, 62, learned that he had a tumor in his throat, which was diagnosed as Stage 3 oropharyngeal cancer. Mr. Simotes had never been a smoker or a drinker. He and his wife, Lucy, were relieved at first to learn the cancer was HPV-related, because that raised the odds that he could be cured.

“But then I started going through all the motions of what does that mean for me, too?” said Ms. Simotes, 50. “Because this cancer came from a virus, and I may or may not have it.”

She said she had a Pap test that came back negative.

Because both partners had been previously married, they were comfortable discussing the cancer and its cause, said Mr. Simotes, the artistic director and president of Shakespeare & Company in Lenox, Mass. “We know that we’ve lived pretty full lives until we met each other,” he said. “The reality is that a lot of times people carry the virus and it doesn’t affect them.”

Mr. Simotes underwent chemotherapy and radiation, and his cancer is in remission.

In a study presented last weekend at a conference of the American Society of Clinical Oncology, Dr. Haddad and other researchers showed for the first time that the partners of people with throat cancers caused by HPV were not at greater risk of developing oral HPV infections themselves. The study involved more than 200 people followed for about a year.

Dr. Haddad said the findings suggest that spouses and longtime partners do not need to take special precautions or change their sexual behavior.