Why it May Be Good That Michael Douglas Said Cunnilingus Caused His Cancer (UPDATED)


UPDATE, June 4, 9:20 am: A representative for Michael Douglas told Agence France-Presse Monday, “Michael did not say cunnilingus was the cause of his cancer. He certainly discussed oral sex in the article, and oral sex is a suspected cause of certain oral cancers, as the doctors in the article did point out. But he did not say this was the specific cause of his personal cancer.”

Award-winning actor Michael Douglas started a firestorm in the media recently when he told The Guardian that his oral cancer was caused by cunnilingus. Though he may have over-emphasized the risks of oral sex, he will hopefully bring much-needed attention to the human papillomavirus (HPV) and the HPV vaccine as well.

As part of the publicity tour for his new HBO movie in which is plays Liberace, Douglas spoke to The Guardian’s Xan Brooks about numerous topics, including his 2010 cancer diagnosis. Douglas explained that he had been complaining about oral pain for many months and seen a number of doctors who had prescribed antibiotics. Finally, a specialist in Montreal found a walnut-sized tumor at the back of his tongue and ultimately diagnosed him with stage four cancer. Though often terminal when caught that late, Douglas was given an 80 percent chance of survival, and after an eight-week course of intensive chemotherapy was pronounced cancer-free. This type of cancer has a high chance of recurrence, and Douglas gets check-ups every six months to ensure that it has not come back.

During this part of the interview, Brooks asked him if being diagnosed with cancer made him regret all the years of drinking and smoking, which has long been linked with cancers of the mouth and throat. Douglas replied:

“No. Because without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”

He went on to say:

“I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it.”

The only part of that statement that is inaccurate is that cunnilingus can cure cancer, but I’m guessing that was said with a wink and a nod—as in, sex can make you feel better about anything.

The rest of it is the truth, but possibly not the whole truth.

For years, head and neck cancers were seen in older men who had spent years drinking and smoking. Over the past two decades or so, however, head and neck cancers began to be seen in younger men who did not have a past history of drinking or smoking. Interestingly, the tumors found in these men were not in the oropharynx (the back of the throat), as the older infections had been, but were instead found at the base of the tongue or on the tonsils. Researchers began attributing many of these cancers to HPV 16, the strain of the virus which also causes most cervical cancers.

A 2011 study by researchers at Ohio State University, for example, tested tumor samples from 271 patients diagnosed with certain types of throat cancer between 1984 and 2004. HPV was found in only 16 percent of the samples from the 1980s but in 72 percent of those collected after 2000. The researchers estimated that overall, throat cancers caused by the virus increased from 0.8 cases per 100,000 people in 1988 to 2.6 cases per 100,000 people in 2004. If the trend continues, they said, by 2020 the virus will cause more throat cancer than cervical cancer each year. Fortunately, oral cancers caused by HPV are easier to cure that those caused by other factors.

Michael Douglas may be right that oral sex caused his cancer—his tumor was at the back of his tongue, and it would explain why he was given such a good prognosis, despite the late diagnosis. However, as infectious disease specialist Kent Sepkowicz notes in his piece for the Daily Beast, the epidemiology of cancer is complicated, and a straight cause-and-effect relationship is hard to pin down. He cautions that we should not be too quick to blame oral sex—or only oral sex—and points to other research that has found between 8 and 40 percent of patients with oral cancer reported never having performed oral sex. In fact, the authors of that study found that “the lifetime number of sex partners conferred as much risk for oral cancer as does oral sex.”  Moreover, no research has been able to determine why men are far more likely to develop oral cancers than women. If oral sex was the only culprit, it would seem that women would become infected as well. Sepkowicz concludes:

So, yes, sexual activity of some sort is a risk, but that’s the most that can be said. It is manly, I suppose, at least in a Hollywood way—or at least interesting PR—to cop to the cunnilingus charge. But the story, like so much that touches the silver screen, is just close enough to a truth to grab a headline and just far enough away to drive experts insane.

Still, he believes, as I do, that Douglas’ pronouncement will ultimately be good for public health, and here is why: It will remind people that HPV causes cancer. And then people like me and Kent Spekowicz and many, many others will remind people that there are vaccines to prevent HPV.

The vaccines—there are two, Gardasil and Cervarix, both of which protect against the transmission of HPV 16—have been a hard sell in the United States because of a lack of understanding about how they work, and discomfort with the fact that it is important to vaccinate kids at a young age in order to ensure that they have completed the three-shot series before they become sexually active. In fact, recent research found that just 32 percent of teenage girls had been vaccinated as of 2011. Though the Centers for Disease Control and Prevention does recommend that boys be vaccinated as well as girls, that study did not look at how many boys had been vaccinated. The percentage is undoubtedly much lower than that for girls, as the vaccines were originally intended for women and have only been proven to prevent cervical cancer, not oral or anal cancers caused by HPV. Public health experts suspect that the vaccines will also provide protection against oral cancers in men, but that assertion has not yet been proven by research. Nonetheless, widespread vaccination of boys will help to bring down the overall rate of HPV in this country, which will in turn help prevent all HPV-related cancers.

As I’ve said over and over again, we now have a vaccine that can prevent cancer.  We should be dancing in the streets—all the way to the pediatrician’s office!—not quibbling over whether age 11 is too young to be thinking about STD prevention.

Michael Douglas’ announcement has made a ton of headlines (and had the host of MSNBC’s Morning Joe giggling like a schoolboy, presumably because he doesn’t get to say cunnilingus on air all that often). Hopefully, all this attention will remind people that cancer is a risk, and that will lead to more people rolling up their sleeves—or their kids’ sleeves—and getting the only cancer-preventing vaccine that we have right now.

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  • AnnaPPAA

    Gardasil and Cervarix are not “the only cancer-preventing vaccine that we have right now” — the hepatitis B vaccine also protects against liver cancer.