How HPV and Oral Cancer Are Linked

Person holding DNA swab in young woman's mouth

Peter Dazeley / Photographer's Choice / Getty Images

It is something a misnomer to call human papillomavirus (HPV) the "cervical cancer" virus. It has been known for years that HPV is associated not only with genital warts and cervical cancer but also other serious malignancies including anal cancer, penile cancer, and vulvar cancer.

In recent years, scientists have found a strong link between HPV and oral cancers of the mouth and throat. Some researchers have even hypothesized that oral cancers could eventually replace cervical cancer as the most common malignancy caused by HPV in the United States.

Incidence

Worldwide, most mouth and throat cancers (also known as oropharyngeal cancer) are associated with tobacco and/or alcohol use. With the rapid rise in HPV infections in the United States—in which 79 million Americans are already believed infected, according to the 2014 National Health and Nutrition Examination Survey (NHANES)—oral cancers have come to the fore as another major public health risk.

In fact, a 2012 study in JAMA concluded that 10.1% of American men and 3.6% of American women have developed oropharyngeal cancers as a direct result of HPV. The risk is seen to increase in tandem with the number of sex partners a person has and the number of cigarettes smoked per day.

Even as tobacco-associated oral cancers continue to decline in the United States, the rate of HPV-associated oral cancers have nearly tripled since the late 1980s.

Sexual Risks

Anyone can get HPV-associated oral cancer but, for reasons not entirely clear, some people are at greater risk than others.

Overall, white men appear to be at the highest risk. Part of the reason for this may be that white American men are more likely to engage in oral sex than African American men.

In fact, according to a 2015 review in Cancer Prevention Research, white teens and adolescents are 147% more likely to engage in oral sex on their first sexual encounter compared to their African American counterparts. This is believed to contribute in part to a 20% increased risk of oropharyngeal cancers in white men.

Rates among gay and bisexual men are especially high. According to research from the Young Men's HPV study, 9.4% of gay or bisexual men between the ages of 18 and 26 had oral HPV increasing to 19.3% in those with HIV.

Other risk factors include having more than five sex partners within the past three months and starting sex in one's early adolescence or teen years. (Anal cancer rates are also disproportionately high in gay and bisexual men due to HPV infection).

By contrast, rates among women are lower due in part because of the lesser impact of HIV co-infection (which is exponentially higher in men). Women also tend to have half the number of lifetime sex partners than men, according to a 2018 study in the Journal of Sex Research.

Challenges in Testing

HPV is strongly associated with cancer of the tonsils, although it is can found in almost any part of mouth or throat. Most are squamous cell carcinomas, the second most common skin cancer developing in the middle and outermost layers of skin.

Of the more than 200 strains of HPV identified by scientists, HPV 16 is the type most commonly linked to oral cancers. HPV 16 is also one of 14 high-risk strains linked to cervical and anal cancer.

It is been postulated, though yet unproven, that the routine vaccination of girls and boys with Cervarix, Gardasil, or Gardasil-9 may reduce the risk and incidence of HPV-associated oral cancers.

Part of the reason for the uncertainty is the limitations of the current HPV test. Although the DNA-based test can accurately detect HPV from a simple oral swab, having HPV (even high-risk HPV) does not mean you will get cancer.

A Word From Verywell

Given the limitations of the HPV testing, safer sex practices should be adhered to, including the consistent use of condoms and a reduction in the number of sex partners. HPV vaccination should also be strongly considered where appropriate.

As of June 27, 2019, the Centers for Disease Control and Prevention (CDC) endorsed HPV vaccination for women and men 27 to 45 who are not adequately vaccinated. This was in addition to previous guidance in which vaccination was recommended as early as 9 right through to the age of 26.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Centers for Disease Control and Prevention. Immunization Works June 2019. Atlanta, Georgia. Issued June 27, 2019.

  • Chaturvedi AK, Engels EA, Pfeiffer RM et al. Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States. J Clin Oncol. 2011 Nov 10;29(32):4294-301. doi:10.1200/JCO.2011.36.4596.

  • Fakhry C and Cohen E. The Rise of HPV-Positive Oropharyngeal Cancers in the United States. Cancer Prevent Res. 2015 Jan;8(1). doi:10.1158/1940-6207.CAPR-14-0425.

  • Gillison ML, Broutian T, Pickard RK et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA. 2012 Feb 15;307(7):693-703. doi:10.1001/jama.2012.101.

  • Han JH, Beltran TH, Song, JW et al. Papillomavirus Infection and Human Papillomavirus Vaccination Rates Among US Adult Men: National Health and Nutrition Examination Survey (NHANES) 2013-2014. JAMA Oncol. 2017;3(6):810-816. doi:10.1001/jamaoncol.2016.6192.

  • Mitchell KR, Mercer CH, Prah P et al. Why Do Men Report More Opposite-Sex Sexual Partners Than Women? Analysis of the Gender Discrepancy in a British National Probability Survey. J Sex Res. 2019 Jan;56(1):1-8. doi:10.1080/00224499.2018.1481193.

  • Oliver SE, Gorbach PM, Gratzer, B et a. Risk Factors for Oral Human Papillomavirus Infection Among Young Men Who Have Sex With Men—2 Cities, United States, 2012–2014. Sex Trans Dis. 2018 Oct;45(10):660-65. doi:10.1097/OLQ.0000000000000845.