Reviewed by: Dr. Carole Fakhry
It's not uncommon for celebrities to go public with a cancer diagnosis, but Michael Douglas wasn't just open about his illness — he was also frank about what caused it. In 2013, Douglas revealed that his cancer was attributed to human papillomavirus (HPV), a virus that is often sexually transmitted.
In speaking candidly, Douglas drew attention to HPV-associated cancers; the reaction he received starkly illustrated the stigma that surrounds them. But the stigma is based on ignorance about how common HPV-related cancers are and outdated sexual stereotypes.
What is HPV?
HPV infection is a common viral infection that affects nearly everyone who is sexually active at some point in their lives. About 85% of women and 91% of men will be infected with at least one type of HPV by age 45.
Some types of HPV infection cause warts, but others can be much more serious, leading to different types of cancer. Because HPV infection often has no symptoms and sometimes resolves on its own, many people will never know they had it.
How is HPV transmitted?
Sexual contact through vaginal, anal or oral sex is the main way HPV is spread. Its reputation as a sexually transmitted disease is one reason HPV often has a stigma associated with it.Some people are more vulnerable to HPV than others. For example, people with weakened immune systems, such as those with HIV/AIDS or taking immune-suppressing medications, may be at higher risk of HPV infection.
What’s the connection between HPV and cancer?
HPV causes 99% of cervical cancer cases and is associated with cancer of the vagina, vulva, penis and anus and oropharyngeal cancer.
Oropharyngeal cancer is a head and neck cancer that affects the oropharynx — the back one-third of the tongue, tonsils, soft palate and the side and back walls of the throat. Up to 70% of oropharyngeal cancers in the United States are attributed to HPV.
Dr. Eleni Rettig, a head and neck surgeon at Brigham and Women's Hospital and Dana-Farber Cancer Institute at Harvard Medical School, told HealthyWomen she sees a lot of patients with HPV-positive oropharyngeal cancers, and that case numbers are increasing dramatically. "It's now more common in the U.S. than cervical cancer," Retting said.
Why are HPV and HPV-related cancers hard to diagnose?
At this point, screening tests for HPV can only be done in the cervix. This screening can be helpful for preventing cervical cancer, but there's no way to screen for HPV on parts of the body associated with other types of cancer or in males, and you can't have your throat screened for HPV.
What can you do to prevent HPV and related cancers?
There's no cure for HPV, but there is a vaccine that can prevent HPV-related cancers. The Centers for Disease Control and Prevention (CDC) recommends preteens receive the HPV vaccine between the ages of 11 and 12 to help prevent some types of cancer later in life. Additionally, the HPV vaccine, which was created to prevent cervical cancer, has the potential to protect against oral infections by the strains of HPV that cause oropharyngeal cancers.
The CDC also recommends the HPV vaccine for anyone age 26 or under who has not been vaccinated already. People who are between the ages of 27 and 45 may wish to consider the vaccine, too, if they believe they are at risk of being newly infected with HPV.
Lifestyle choices like avoiding smoking and alcohol and practicing good oral hygiene can also reduce your risk of developing oropharyngeal cancer.
Why the stigma around HPV-associated cancers?
Some people with HPV-associated cancer feel shame or anxiety around their diagnosis because HPV is sexually transmitted, and sexually transmitted diseases have historically been linked to negative stereotypes like promiscuity. Because it's not something that generally comes up in casual conversation, many people don't realize how common HPV is.
So when they learn they have cancer caused by HPV, they may feel embarrassed. "I see patients who aren't comfortable asking questions about it, or maybe don't want to share that particular piece of information with their loved ones," Rettig said.
What is being done to end the stigma?
When it comes to ending any kind of stigma, accurate information is key. "Patient and provider education are tremendously helpful and will go a very long way in ending stigma," Rettig said. "Explaining how common HPV is and that it doesn't mean someone has been promiscuous."
If more people knew how prevalent HPV is, how easily it can be spread and how many people may be infected with it without realizing it, they may be less likely to feel stigmatized when they receive an HPV diagnosis or a diagnosis of HPV-related cancer. They also may be less likely to stigmatize others.
For providers, it's a matter of keeping up with the latest science. "So much of what we've learned about oropharynx cancer has just come out in the past 10 years," Rettig said. "The field is constantly changing, and we're learning so much about this disease that it can be hard for providers to keep up with everything. Just getting the information out is very important."
This resource was created with support from Merck.