freedomhealth - private medical service - sexual health services - aesthetic & cosmetic health

There has been renewed concern over the link between oral sex and cancer.  Oral sex, you may be familiar with, but HPV Cancer, you may not…

What is HPV?

HPV, Human Papilomavirus, is the name for a group of over 150 viruses.  The viruses are common, most occur without symptoms and go away without need for treatment. However, some can lead to cancer, and this is where the concern lies…

So what’s the link between cancer and oral sex?

There’s been an increase in HPV-related oral cancers. The issue of HPV viruses being spread through sexual contact surely makes both girls and boys equally susceptible?  Currently, only girls receive the vaccination. The reason for this? In the past girls have been considered most at risk of infection developing into cancer, in particular, cervical cancer.

Mouth Cancer, from which men are at higher risk, actually kills more people than cervical and testicular cancer combined, so, with an increase in HPV-related oral cancers, there is a strong argument for boys to receive the vaccine too. The problem is cost. The cost is high, at around £400 per vaccine. According to the director of immunisation, David Salisbury, the evidence for increased spending in this area is insufficient. This is one of the issues actress Jaime Winstone explored in her recent documentary for the BBC.

A bit more about HPV prevention

HPV can be quite an elusive virus and there is no uniform test for men or women. So currently, for women, emphasis is placed on cervical screening. For men, a reliable way of collecting male genital skin cells is yet to be developed. But for both sexes, there are methods of prevention…

Safe sex

Safe sex might seem like a common sense precaution. It is, at the very least, one that everyone can take. And again, this might seem obvious, but that includes oral as well as penetrative sex. The final advice to come under the safe sex bracket, is to limit the amount of sexual partners. One other thing to keep in mind though,  HPV is not just an STI, and can infect other areas, so a condom is not full protection.

Circumcision

Recent findings, published in the Lancet, claim that male circumcision can help reduce rates of high risk HPV transmission to women. It is worth noting that this is a slight reduction and should not be viewed as a substantial form of prevention, but as a developing area of research, worthy of a mention.

The Vaccine

The strongest form of prevention is the HPV Immunisation – Gardasil. This is given in three separate injections over a course of 6 months, and protects against a number of HPV subtypes, including those which cause genital, anul and oral cancers.

So can oral sex lead to cancer?

Yes it can, but can is the key word. As for most causes of cancer, it’s not black and white, and there are grey areas being investigated. It’s worth remembering that any developments or revelations that may follow are not designed to scare, but to raise awareness.

Helen Cripps, Guestblogger, Freedom Health

A New Dimension in predicting the risk of Cervical Cancer.

Expression of specific viral oncoproteins E6 and E7 is required for the development and maintenance of cervical cancer cells. The DNA of specific HPV types has
been found in almost all cervical cancer biopsies.

Links between human papillomaviruses (HPV) and cervical
cancer, anal cancers and also latterly oral cancers are well documented. The very high prevalence of HPV compared with the very low incidence of cervical cancer has since presented a problematic issue when trying to use the presence of HPV as the diagnostic tool to prevent cervical cancer. However by the mid-nineties it became better understood that it was not the entire viral particle that was responsible for the development of cancer. Since then, more than 1400 international publications have
documented that it is not the HPV virions that have an active role in the carcinogenic process, but that abnormal transcription from fragments of HPV DNA giving fulllength E6/E7 oncoproteins are required for initiating the transformation and immortalisation of normal cervical cells into abnormal cells. Production of E6/E7
oncoproteins is required for maintaining the malignant growth of cervical cancer cells.

This wealth of scientific documentation repeatedly confirms that it is not possible to develop HPV related cervical, anal or oral cancer without the presence of full-length E6/E7 oncoproteins in abnormal cells. Normal HPV infection does not produce
full-length oncogene E6/E7 proteins or mRNA. Most HPV infection is transient
and short lived. Therefore, the majority of HPV DNA positive cases are without
oncogene or transforming activity. Testing for HPV-DNA therefore identifies the
presence of an extremely common virus. Looking, instead, for full-length E6/E7
mRNA, has the capability of directly identifying the presence of abnormal cells in
the cervix.

High Risk Subtypes – Coverage Rate

One of the most frequent questions about HPV asks which subtypes are related to
cervical cancer development. Several large international studies have been performed
and a number of HPV subtypes have been identified in biopsies from cervical cancer
patients. Almost 98% of all HPV-positive cervical cancers identify five HPV
subtypes 16, 18, 31, 33 and 45 in Europe and Northern America. In addition, new studies using cervical smears from women with cervical cancer have demonstrated 100%
coverage rate in detecting the presence of E6/E7 mRNA from these five HPV-types
only. Other HPV subtypes found in cervical cancers appear to be passengers, and not
responsible for the development of cervical cancer. The reason for this is that the
underlying fragmented HPV DNA (even with a low copy number) from these five
types may always be present in nearly 100 of the cervical carcinomas producing high
amounts of full-length E6/E7 mRNA and proteins. It would therefore be of little benefit to test for more HPV subtypes because of the dominant position these five
most prevalent HPV subtypes already hold. The HPV virion or HPV DNA with intact
transcriptional control will not take any active part in the development of cervical
cancer. In abnormal cells, the virus does not replicate itself anymore due to integration and reduced differentiation. Because of
HPV integration and loss of regulation causing disruption or fragmentation of
DNA, all available DNA based HPV tests will give a negative result in 4-25% of the
cervical cancer cases. Integration creates deletions in target sequences for HPV DNA
based tests and the loss of viral replication drastically reduces the number of HPV
DNA copies (but not the number of HPV E6/E7 mRNA copies). However, the
expression of full-length E6/E7 is never absent in HPV induced cervical cancer cells.
Therefore, a DNA-based test without target amplification will have a lower sensitivity towards HPV induced cervical cancer than PreTect HPV-Proofer.

Greater understanding of results:

POSITIVE DNA/ NEGATIVE mRN
NEGATIVE DNA/POSITIVE mRNA

Because of the totally different roles of the HPV virus and full-length E6/E7
oncoproteins in relation to the development of cervical, anal and oral cancer, there will be occasions when results will be positive for HPV-DNA
and negative for full-length E6/E7 oncoproteins (mRNA). This is due to the
high prevalence of transient HPV infections in a screening population with no clinical implications for the development of HPV induced cervical cancer. However the very low incidence when an HPV DNA based test is negative and the PreTect HPV-Proofer test is positive for full length E6/E7 oncoporoteins represents those few cases of women with persistent severe abnormalities or invasive cervical carcinoma.

Photodynamic therapy or PDT for short is a new way of treating some skin cancers and certain other pre-cancerous skin lesions. These are basal cell carcinoma’s, Bowen’s Disease and also actinic (or solar) keratosis.

PDT is quick, easy, and does not result in scarring. It is now the preferred treatment for many skin cancers in the UK. We now offer photodynamic therapy or PDT for basal cell skin cancers and also the pre-cancerous Bowens Disease and also actinic (or solar) keratoses at Freedomhealth. To make an appointment please ask for either Mr Lee Garrett or Dr Jose Gonzalez-Garcia and they will discuss the procedure with you, answer any questions you may have and if required, help you make the necessary arrangements for this simple and effective, scar free way of treating skin cancers.

Photodynamic therapy is not the preferred treatment for squamous cell skin cancers as these have a high chance of recurrence and we want to be sure that the treatment has succeeded.

Putting it very simply, photodynamic therapy for skin cancers involves applying a special light sensitizing cream to the affected area and a little of the surrounding area and then after a short while shining a bright light onto the treated area. The cells which have absorbed the chemical and are then subject to the bright light will die off leaving fresh normal skin to grow in its place. Normal cells are left relatively undamaged. This is because PDT affects mainly fast growing skin cancer or pre-cancer cells.

Until recently, standard treatments for these particular skin cancers have been either destructive, for example using liquid nitrogen, or surgical. Both of these treatments has its advantages but a major disadvantage of surgical treatments has been the resulting scar left by the surgical cut and stitches. Liquid nitrogen spray or cryotherapy for skin cancer will destroy the tumour cells but is not terribly refined and will destroy other normal tissue also. Photodynamic therapy avoids scars.

Photodynamic therapy (PDT) is available on the UK NHS in some centres but relatively few and for those NHS units there is a long waiting list. The problem is the usual one of funding. NHS units are limited by their funding and so can see limited numbers of patients. Consequently large numbers of patients are sent via the surgical route and get what is now considered to be good but not the best treatment.

PDT can be used for treating other cancers but at Freedomhealth we only treat designated types of skin cancer and pre-malignant or precancerous lesions as recommended by the UK’s National Institute for Clinical Excellence (NICE). We operate under stringent conditions imposed by the Care Quality Commission and are subject to annual re-licensing and approval.

NICE issued Guidance in 2006 saying that there was good evidence to support the use of PDT for treatment of basal cell cancers, Bowen’s Disease and also solar or actinic keratoses. NICE said that photodynamic therapy for skin cancers was of particular use in situations where a person may need a lot of surgery – for example where there was a large and not too deep skin cancer, or where there were multiple cancers. An obvious use of PDT is for skin cancers that are visible on the face or neck and where a surgical scar would be equally disfiguring as the tumour.

Basal cell skin carcinoma’s or cancers are very common indeed with skin cancers as a whole being the most common cancer in the UK and of these around 80% of the skin cancers which are not melanoma’s will be basal cell cancers. Basal cell skin cancers are caused primarily by exposure to sunlight. Australians have the highest rates of basal cell skin cancers in the world. Other risk factors include fair skin, blue eyes, red or blonde hair and intermittent intense exposure to sunlight or artificial ultra-violet radiation such as sun beds. One a person has a basal cell skin cancer then the chances of another appearing will be increased by 10 times compared with the general population.

How is PDT (photodynamic therapy) for skin cancers used?

The type of skin cancer is identified using a special magnifying glass called a dermatoscope. This allows the specially trained clinician to correctly identify the skin lesion as a basal cell cancer or as a pre-malignant skin lesion such as Bowen’s disease or an actinic keratosis.

In addition, the clinician will take either a painless scrape from the lesion or a special very thin sample of tissue called a biopsy which confirms the diagnosis and in the case of the skin biopsy, the depth of the tumour, to make sure that it is the correct diagnosis and also confirms the depth is ideal for treatment. These samples are sent to our laboratory for analysis which takes a few days.

Once the diagnosis is confirmed by the laboratory then treatment with photodynamic therapy for your particular type of skin cancer can begin.

A light-sensitising cream made up of 5-aminolaevulinic acid (ALA) tradename Metvix, is applied to the target after the crusting debris has been gently removed. The area is covered with a dressing for three to six hours and then the area is subjected to a strong light for up to 45 minutes or so. A slight tingling is felt whilst the light is being used. A crusted area will then remain and will slowly fall off during the next week or two, depending on the size of the original lesion.

A second or third treatment is sometimes needed.

If you would like to discuss this further please call us on 02076371600 and ask for an appointment with Mr Lee Garrett, RN, BSc or Dr Jose Gonzalez-Garcia and they will happily discuss the possibility of treatment with you and answer any further questions you may have.

Doubts have been raised over the safety of the Cervarix vaccine this week, following the tragic death of 14-year-old Natalie Morton after being given the jab at her Coventry school.
About 1.4 million Cervarix vaccines have been given to schoolgirls aged 12 and over as part of the Governments’ national campaign to combat cervical cancer. Coupled with screening for over-25’s, potentially 700 lives a year could be saved.
Cervical cancer is the second most common cancer in women under thirty five, resulting in 3,000 cases a year, and causing the death of 21 females each week in the UK or around 1000 per year. Seventy percent of these can be prevented by using one of the HPV vaccines available. Ninety nine percent of all cervical cancers are caused by HPV, or human papillomavirus, a family of viruses that affect the skin and moist membranes lining the body.
What is HPV?
Sometimes called the ‘wart virus’ or ‘genital wart virus’, HPV is passed by sexual contact with someone who has it. It’s very common and over half of all women who have sex will get infected with HPV at some time in their life.
HPV infects the cells of the surface of the cervix where it can stay for many years without any symptoms. The HPV virus can damage these cells leading to changes in their appearance, and over time, these changes can develop into cervical cancer.
There are over a hundred types of the HPV virus, but only thirteen of them are known to cause cancer. Often the virus causes no harm, and goes away without treatment.
How the vaccine works :
The HPV vaccine protects against the two strains of HPV (16 and 18) that cause cervical cancer in over 70% of women. Cervarix protects against types 16 and 18 and the rival vaccine Gardasil protects against types 16 and 18 and also the benign types 6 and 11. It does not protect against any other sexually transmitted infections or against pregnancy.
How safe is the vaccine?
Both major anti-cervical cancer vaccines, Cervarix and Gardasil, have undergone rigorous safety testing as part of the licensing process required in the UK and other European countries (PATRICIA and FUTURE II research). www.cancerhelp.org.uk
Possible side effects :
The side effects are usually mild and include :
• Headache
• Aching muscles
• Redness and soreness around the site of the injection
• Fever
• Feeling and being sick
• Stomach pain
• Diarrhoea
• Itching, rash
• Dizziness
The Medical and Healthcare Products Regulatory Agency (or MHRA) monitors vaccine safety via the Yellow Card Scheme which encourages the reporting of suspected side effects. You can report adverse reactions online or by post.

A small number of people experience an idiosyncratic or unpredictable reaction, similar to an anaphylactic shock. Extreme allergic reactions are a rare but recognised side effects of most vaccines, and symptoms include difficulty breathing and collapse.
When side effects do occur, the health professional giving the vaccine will have been fully trained in how to effectively deal with it. If you or your child has an anaphylactic reaction, following treatment, they will usually fully recover within a few hours.

There’s an interesting article in the New York Times today relating to Oral Cancer, its relationship with the Human Papilloma Virus and also its increasing detection.

Oral cancers have been mainly linked to smoking and excess alcohol consumption, or chewing of certain tobacco products. Genetics has also played a part with some people being more susceptible than others.

The developing story relating to Human Papilloma Virus (HPV) is a fascinating one. We know already that particular subtypes cause cervical and other anogenital cancers and it seems that oral sex is a risk factor for spread of HPV into the oral cavity. Some researchers have postulated that four or five oral sexual exposures with different partners might lead to an increase in risk of oral cancer.

A new device involving the use of a special blue oral rinse and also a visual detection system is said by the manufacturers of the device to be 1) beneficial in terms of detecting oral cancers and 2) lead to a reduction in both death and destructive surgery. This is postulated on the basis that early detection is always better.

An alternative view is that the number of HPV associated tumours is low, much much lower for example than prostate cancer or breast cancer and that very oftne, these tumours are found at the very back of the throat just beneath the tonsil area where they are very difficult to see. Consequently the use of the light device may not actually assist in diagnosis.

It appears that the same HPV viruses as cause cervical cancer and anogenital cancers also cause cancers of the mouth and throat where HPV is implicated. In that case a more rational approach may be to use one of the Human Papilloma Virus vaccines, eg Gardasil or Cervarix to reduce the chances of contamination with HPV 16 or 18 and thus reduce the overall risk.

I don’t think the public health implications of a mass immunisation program with HPV vaccines has been fully thought through yet.

For more information on HPV and vaccination have a look at our main site pages on HPV.

There is an excellent review published by the CDC in the US which you can read here which gives a great deal of detail and also leads to other links.