Islamabad: Oral sex has emerged as the leading cause of a rapid surge in throat cancers linked to the human papillomavirus (HPV) in Western countries, with incidence now surpassing cervical cancer in the United States and, by comparison, in men in the United Kingdom.
Experts are describing the trend as an “epidemic,” pointing to HPV transmission through oral sex as the central driver.
Prof. Hisham Mehanna, chair of head and neck surgery at the University of Birmingham, said that people with multiple oral-sex partners are at significantly greater risk.
“Those reporting six or more lifetime partners are more than eight times more likely to develop HPV-positive throat cancer,” he said in an article aimed at raising public awareness. Other large studies have shown a clear dose-response effect, with risk increasing steadily alongside the number of partners, even after accounting for smoking and alcohol use.
This marks a striking shift in the cancer landscape. For decades, smoking, alcohol, and poor diet were considered the major drivers of head-and-neck cancers. These factors remain important, particularly for HPV-negative cancers, but in HPV-positive throat cancers — which now dominate in much of the West — sexual behaviour is the primary factor. Experts caution that it is misleading to say oral sex is “worse” than smoking or alcohol, but acknowledge that HPV has emerged as the central risk factor in these cases.
The numbers are stark as the US Centers for Disease Control and Prevention (CDC) reports that HPV-related oropharyngeal cancers have become the most common HPV-associated cancer, surpassing cervical cancer. In the UK, incidence in men has now outstripped cervical cancer in women. Reviews published in journals including Nature Reviews Clinical Oncology confirm this pattern, underscoring the urgency of prevention strategies.
For Pakistan, the message carries important lessons. While reliable national data on HPV-related throat cancers is limited, oncologists already report rising cases of head-and-neck cancers linked to lifestyle and viral factors. Pakistan has one of the world’s highest burdens of oral cancers, largely due to tobacco and betel-quid consumption. Adding HPV-driven cancers to this profile raises serious questions about prevention, particularly when vaccination coverage remains patchy and awareness about HPV is low.
Doctors in Pakistan caution that the issue must be addressed with sensitivity. “We cannot openly talk about sexual behaviours in our society, but we must find culturally appropriate ways to explain that HPV is transmitted between people and that vaccination is the best form of protection,” said a senior oncologist at a Karachi teaching hospital.
Pakistan launched its first large-scale HPV vaccination campaign for girls aged 9–14 in 2024, targeting over 11 million children. But official reports already show that more than 3.6 million families refused vaccination during the initial phases, citing misconceptions and weak advocacy. Public health experts fear such resistance could undermine long-term efforts to reduce not only cervical cancer but also other HPV-related diseases, including throat cancers.
Globally, gender-neutral vaccination is now seen as the gold standard. By including boys as well as girls, countries can block transmission more effectively and protect those most at risk of HPV-related throat cancer. For Pakistan, experts argue that while the immediate priority must remain improving coverage in girls, policymakers should begin considering boys as part of the long-term plan.
“HPV-related throat cancers show how the disease profile is changing worldwide,” said an Islamabad-based public health official. “We need to look beyond cervical cancer and understand that HPV vaccination is about protecting both men and women from multiple forms of cancer.”
Ends