Using terms such as “taboo sex act” in concert with HPV-linked cancers—including anal cancer—is not only stigmatizing; it’s inaccurate.
While the human papillomavirus, or HPV, can indeed spread during sexual activity—including anal or oral sex, which some people label “taboo”—sex doesn’t have to occur for the infection to spread. “The vast majority of humans in the U.S., both men and woman, will eventually get infected with human papillomavirus,” Dr. Allen Ho, Director of the Head and Neck Cancer Program at Cedars-Sinai Medical Center previously told SurvivorNet.READ MORE
“In spite of the optics, I care deeply about saving lives,” Cross, who was diagnosed with anal cancer about a year and a half ago, told CNN. “To that end, the important thing to do is educate the public about HPV. It is so common that nearly every person who is sexually active will get it at some point in their lifetime.”
HPV and Cancer Risk
Cross is right. According to the U.S. Centers for Disease Control and Prevention (CDC), HPV (human papillomavirus) is the most common sexually transmitted infection in the country. Roughly 80 million Americans have it right now.
Most of the time, the infection goes away on its own and doesn’t cause any symptoms. But other times, when a person contracts a specific “high-risk” strain of HPV, their body may have more difficulty shaking the virus, which can linger.
Dr. Jessica Geiger, a medical oncologist specializing in head and neck cancer at Cleveland Clinic Cancer Center, previously explained to us how the lingering virus can ultimately cause cancer: “Over time, meaning decades after we were first exposed, the virus gets into our DNA, and likes to settle in the tissues of the cervix or the back of the throat [or anus], and can ultimately cause changes that form cancer,” she said.
Such was the case for Cross, who revealed recently that her anal cancer was the result of HPV—most likely the same strain of HPV that caused her husband, Tom Mahoney, to develop throat cancer a decade ago, in 2009.
“HPV lies dormant,” said Lillian Kreppel, who, like Cross, is an anal cancer survivor and advocate for HPV advocate and Prevention. “It stays there. Don’t think it goes away—this virus is sneaky. This is what’s happening to us in our 50s. We contracted HPV in our 20s, it laid dormant, and now it’s coming out.”
Both Cross and Kreppel were diagnosed with anal cancer in their 50s, and it is likely they contracted the high-risk HPV virus decades earlier, but never showed symptoms.
Friendship in Advocacy
Since her diagnosis in 2017, Kreppel has been on a mission similar to Cross’. She wants to bring anal cancer into the public conversation. That’s why, when she came across Cross’ initial social media post sharing that she had anal cancer, Kreppel immediately reached out to the actress.
“I sent an email saying ‘Marcia, I have the same cancer,'” Kreppel recalled. “I said, ‘We’ve gotta get out there. Nobody knows about it. It’s not on anybody’s radar. It’s not on the radar of doctors, and it’s not on the radar of everyday people.'”
Cross responded to Kreppel, and, eager to help spread the word about anal cancer and the stigma they had both experienced, Kreppel and Cross began working together, planning education and fundraising events.
“She and I have become great friends,” Kreppel said of Cross.
Just last month, Cross and Kreppel collaborated on the “Skate Your Butt Off” education and fundraising roller skating party, for which Cross and Kreppel also partnered with Justine Almada and the HPV and Anal Cancer Foundation.
HPV-Linked Cancer Prevention
Although anal cancer is only seen in about one percent of cancer cases annually, 90 percent are linked to HPV—which, given the effectiveness of the HPV vaccine—means that 90 percent of anal cancer cases are preventable.
Cross’ message about prevention mirrors that of medical experts: if you have children, vaccinate them early, before they near the age of sexual activity (Cross and Mahoney have twin twelve-year-old daughters, Savannah and Eden, and Cross told CBS This Morning that they’re about to get their first rounds of the shots.)
“We need to do a big education and awareness push,” Kreppel told SurvivorNet in a conversation about her anal cancer and the importance of the HPV vaccine. “People need to know about [the vaccine] for their children, for their grandchildren, for their nieces, nephews.”
Justine Almada of the Anal Cancer Foundation, who lost her own mother, Paulette, to HPV-linked anal cancer in 2010, said she’s grateful that Marcia Cross is using her platform to spread awareness about anal cancer stigma and prevention.
“Marcia is communicating in a powerful way that this virus can—and does—infect nearly everyone,” Almada said. “She’s a shining example of a parent who is taking steps to ensure her children do not experience the same cancer that she did.”
Getting Tested for HPV-Related Cancers
The HPV vaccine, which is most effective when administered before sexual activity—officially became available in 2006. This means that many adults who were already sexually active in 2006 could be carrying around HPV (and maybe a high-risk version) without knowing it.
That’s where thorough screening comes into play. Cellular changes that can point to HPV-related cervical cancer can show up in routine Pap smears, which the American Cancer Society recommends every three years for women ages 20-29, and every 5 years for women over 30.
But what about non-cervical HPV-linked cancers, like anal cancer, vaginal cancer, testicular cancer, and tongue or throat cancer? While the American Cancer Society says there is no official test for the HPV virus in men or in any other place outside the cervix, there are ways to screen for HPV related cancers or pre-cancerous cellular changes.
Cross’ anal cancer, for instance, was found through a digital rectal exam (“digital” meaning done with the finger). And just like cervical Pap smears look for cellular changes in the cervix, anal Pap smears can look for changes in the cells of the anus that might point to cancer.
But because anal Pap smears are not always routine, people may need to request the test from their doctor if they’re concerned about HPV-linked anal cancer risk.
‘HPV is Like Glitter’: Who Should Be Concerned About HPV-Linked Anal Cancer Risk?
The idea that people can only contract HPV-linked anal cancer through anal sex is a misconception. The virus can easily spread to the anus in other ways, including vaginal sex.
In an interview with Slate, Dr. Stephen Abbott, Infectious Disease Physician at Whitman Walker Health in Washington, D.C., used the word “glitter” to explain how HPV spreads. “It goes everywhere,” he said “They’ve done studies of women who have never had anal sex that have had HPV in their anal canal, probably just from friction and moisture. Exchange of fluid during any type of rigorous sex can lead to HPV getting in the anal canal.”
Kreppel is adamant about shaking this misconception. “You don’t need to have anal sex to get anal cancer,” she said. “HPV travels, so you need to be on the lookout. You need to find a doctor who can do an anal Pap.”
“Taboo Sex Acts”: The Roots of the Stigma
The misconception that an HPV-linked anal cancer diagnosis is only possible after anal sex is one of the reasons the cancer carries a stigma—one which Cross, Kreppel, and Almada are actively trying to shake.
Word choices like “taboo” can perpetuate the detrimental stigma that can make many people diagnosed with the cancer hesitant to discuss it.
“When I was ill, I read a lot of blogs online, and read a lot of cancer survivor stories,” Cross said in an interview with People in March. “And a lot of people—women especially—were too embarrassed to say what kind of cancer they had. They had a lot of shame about it, and the doctors even were uncomfortable talking about the anus.”
And anal cancer isn’t the only HPV-linked cancer that carries a stigma; HPV-derived oral cancers like tongue and throat cancers (which Cross’ husband Mahoney had) have been associated with oral sex, and Academy-Award winning actor Michael Douglas came under media fire in 2013 for sharing in an interview that his HPV-related tongue cancer was “caused by cunnilingus.”
And while you can indeed contract cancer-causing HPV from anal sex or oral sex, that’s not the only way to get it—and even if it was, the stigma, as Cross pointed out, is unfair to put on someone who is already dealing with the challenges of a cancer diagnosis in the first place.
The Importance of Early Detection
Cross and Kreppel both received their anal cancer diagnoses early, while the cancer was still stage II, meaning it hadn’t spread widely and was very treatable.
After chemotherapy and radiation, Cross and Kreppel were both able to beat their cancers (and so too was Mahoney, who also caught his throat cancer early on).
Now in remission, Cross is adjusting to her new normal while cherishing the important moments in her life—such as her twin daughters’ grade school graduation.
“As I sat at my twin daughters’ graduation yesterday, I was so grateful to be alive and well,” Cross told CNN. “And thought that if I could give that gift to another person it would all be worth it.”