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Current tobacco reports show 50 years of progress

Thu, Apr 17, 2014

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Source: the-scientist.com
Author: Jef Akst

 

In 1964, the U.S. Surgeon General released the first report on the effect that cigarettes and other forms of tobacco have on human health, presenting strong evidence of the link between smoking and lung cancer, among other adverse consequences. During the last 50 years, significant progress has been made in terms of understanding how smoking causes various diseases and how to treat them, and educational campaigns have contributed to a drop in smoking rates from 42 percent to 18 percent of US adults. Nevertheless, more than 480,000 Americans still die from tobacco-related diseases each year, and additional health consequences continue to be linked to smoking.

“Between now and mid-century, nearly 18 million Americans will die preventable avoidable deaths if we don’t do something to alter that trajectory,” Mitchell Zeller, the director of the Center for Tobacco Products of the Food and Drug Administration (FDA), said during a press conference held today here at the American Association for Cancer Research (AACR) meeting in San Diego, California.

To this end, the AACR released a compilation of peer-reviewed research and review articles, published across seven of its journals, covering basic scientific research on the molecular mechanisms of tobacco carcinogenesis, tools for the diagnosis of lung cancer and other tobacco-related diseases, and the impact of the original Surgeon General’s report on tobacco control. Ellen Gritz from the University of Texas MD Anderson Cancer Center helped put the new report together. “Together, these reports add to the broad reach of important tobacco-related research at the forefront of cancer research and policy, and shine a light on both the challenges and opportunities ahead,” Gritz said.

“[The report] drives home the need for action, citing this large burden of smoking-attributed premature death and morbidity, . . . [and] ends with a call for more action,” added Jonathan Samet, a pulmonary physician and epidemiologist at the University of Southern California.

In addition to the special report, AACR today hosted speakers from the FDA, the National Cancer Institute (NCI), and other groups to discuss the way forward for tobacco-related research, education, and regulation. “Clearly, if you think about other domains of health and risk, if a consumer product were to be introduced onto the market which caused a few dozen deaths it would easily make national news, and produce a public outrage, 60 Minutes reports, headlines,” said Robert Croyle, who directs the Division of Cancer Control and Population Sciences at NCI. “But we’re in a bizarre situation where we have a legal product on the market that’s responsible for about half a million deaths [each year].”

Zeller pointed to several recent FDA initiatives aimed at reducing tobacco-related deaths, including education campaigns targeting young people. Like the other panelists, Zeller praised the progress that has been made, noting the “remarkable denormalization of tobacco use” since a time when his parents would put out bowls of loose cigarettes at parties, and when he and his classmates would make ashtrays in arts and crafts class. But he emphasized that the fight is far from over. “As we pause to acknowledge all of that progress, we also have to take stock of the work that lies ahead of us,” Zeller said.

 
 *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
 
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Could the everyday use of mouthwash be linked to oral cancer?

Tue, Apr 15, 2014

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Source: nursingtimes.net
Author: Staff

 

“Experts warn using mouthwash more than twice a day can give you cancer,” the Daily Mirror reports.

The news comes from a European study that examined the oral health and dental hygiene of people diagnosed with cancers of the mouth, throat, vocal chords or oesophagus (collectively called “upper aerodigestive cancers”).

The researchers found that people with the poorest oral health (including wearing dentures and bleeding gums) had a more than doubled risk of these cancers compared with those with the best oral health.

Similarly, they found that those with the poorest dental care (including frequency of tooth brushing and visiting the dentist) had a more than double risk compared with those with the best dental care.

Importantly, these associations remained after adjustment for smoking and alcohol consumption – established risk factors for these cancers – and for other factors that may influence risk, such as socioeconomic status.

But despite the Mirror’s headline, the link between oral cancer and mouthwash is less clear. The association was only significant when looking at very frequent use (three times a day).

Very few people used mouthwash this frequently, which decreases the reliability of this risk estimate. There is certainly no credible evidence that mouthwash “can give you cancer”.

Even if there is a true link, it is unclear whether it is mouthwash itself (the alcohol content) or the reasons it is being used, such as poor oral hygiene, that are responsible for the association.

The results do suggest a link between poor dental hygiene and oral cancers, however, and reinforce the importance of maintaining good dental health.

Where did the story come from?

This was multicentre research conducted by numerous academic institutions across Europe and the US.

The study was supported by the European Community Fifth Framework Programme, the University of Athens Medical School, the Bureau of Epidemiologic Research Academy of Athens, Padova University, Compagnia di San Paolo, Associazione Italiana per la Ricerca sul Cancro (AIRC), the Piedmont Region, targeted financing from the Estonian government through the European Regional Development Fund in the frame of Centre of Excellence in Genomics, and the 7FP Project ECOGENE.

It was published in the peer-reviewed Journal of Clinical Oncology.

The quality of the UK’s media reporting on the study was mixed. BBC News rightly focused on the link between poor dental hygiene and oral cancer.

But the Daily Mirror incorrectly states in its headline that, “Experts warn using mouthwash more than twice a day can give you cancer”. In fact, the researchers specifically go out of the way in their conclusion to state that their data does not provide proof that excessive mouthwash increases cancer risk.

What kind of research was this?

This was a case-control study that included a group of people diagnosed with cancer of the mouth, throat, vocal chords or food pipe (oesophagus). They were then matched with a group of people without these cancers (the controls) and were interviewed about their oral health, dental care and lifestyle.

The researchers aimed to see whether oral health and dental care – in particular, the use of mouthwash – may be associated with these cancers. As a group, these cancers are sometimes called “upper aerodigestive cancers” as they involve the upper parts of the respiratory and digestive system.

These cancers are said to account for around 129,000 new cancer cases in the European Union, making them the fourth most common cancers for men and the tenth for women.

Alcohol and smoking are widely known to be risk factors for these cancers. Other research has also associated the cancers with lower fruit and vegetable consumption, and found that they are more common among lower socioeconomic status groups.

Additional research has also suggested that poorer dental and oral health may be associated with increased risk, independent of alcohol and smoking behaviour.

It is also speculated that frequent use of mouthwash could be a risk factor as a result of the ethanol (alcohol) it contains. However, there is limited evidence proving that there is an increased risk associated with mouthwash containing alcohol.

This study aimed to examine whether mouthwash and wider oral health and dental care are associated with the risk of upper aerodigestive cancers, importantly adjusting for the potential confounders of smoking and alcohol.

What did the research involve?

This study used information from the multicentre alcohol-related cancers and genetic susceptibility in Europe (ARCAGE) case-control study, which was conducted across 13 centres in nine European countries.

The study included 1,963 people newly diagnosed with cancers of the mouth, throat, vocal chords or oesophagus between 2002 and 2005 (cases). They were matched by age and sex to 1,993 people without cancer, who were randomly selected from people attending the same medical centres or hospitals as the cases for other health reasons.

All participants were interviewed about a range of health and lifestyle measures:

  • sociodemographic characteristics (number of years of full-time education was used as the main indicator of socioeconomic status)
  • smoking history (lifetime smoking history was used to calculate “pack years”)
  • alcohol consumption (lifetime consumption of number of drinks per day was assessed for all categories of alcoholic drinks)
  • weekly consumption of fruits and vegetables (recorded by food frequency questionnaire)
  • employment history
  • body measurements
  • medical and dental history, including oral hygiene habits

Oral health was assessed using the following scoring system, where a maximum total score of 7 would indicate poorest oral health:

  • wearing of dentures (none = 0; partial denture in upper or lower jaw = 1; partial denture in both jaws = 2; complete denture in one jaw = 3; complete denture in both jaws = 4)
  • age at starting to wear dentures (no denture = 0; denture at age 55 years or older = 1; denture at age 35-54 years = 2; denture at age below 35 years = 3)
  • frequency of gum bleeding from brushing teeth (sometimes or never = 0; always or almost always = 1; 0 in subjects wearing complete dentures in both jaws)

Similarly, dental care was assessed as follows, where a maximum total score of 8 would indicate poorest dental care:

  • frequency of tooth cleaning (at least twice per day = 0; once per day = 1; 1-4 times per week = 2; less often or never = 3)
  • use of toothbrush, toothpaste or dental floss (two or three of these = 0; only one of these three = 1; none of these = 2)
  • frequency of visiting a dentist (at least once per year = 0; every 2-5 years = 1; less than every 5 years = 2; never = 3)

Participants were asked about their use of mouthwash in a separate question, but this was not included in these scores.

The researchers also took blood samples to look at whether people had four variations in genes that code for proteins involved in breaking down alcohol (ethanol).

The researchers previously found these variations to be associated with risk of upper aerodigestive cancers, with one particularly associated among heavy drinkers.

As many brands of mouthwash contain alcohol, the researchers wanted to test whether a person who had these variants influenced the potential link between mouthwash and upper aerodigestive cancers.

What were the basic results?

Participants were aged 60 years on average. Almost half of cases had mouth cancer (48%), followed by cancer of the lower throat or vocal chords as the next most common cancer (36%).

After adjustment for all other measured health and lifestyle factors, the risk of upper aerodigestive cancers increased with poorer dental care. People with the worst dental care (scores of 5-8) had the highest risk, more than double the cancer risk for people with the best dental care (a score of 0; odds ratio[OR] 2.36, 95% confidence interval [CI] 1.51 to 3.67).

Looking at oral health, people with the poorest oral health (score of 5, 6 or 7) had an increased risk compared with those with the best oral health (score of 0). People with the highest oral health score of 7 had a more than doubled risk compared with those with a score of 0 (OR 2.22, 95% CI 1.45 to 3.41). Those with moderate oral health – a score of 1-4 – were not at increased risk compared with those with the best oral health.

Reported use of mouthwash of more than three times per day was associated with tripled risk of upper aerodigestive cancers (OR 3.23, 95% CI 1.68 to 6.19). Importantly, the researchers say that although this effect was strong, only 1.8% of cases and 0.8% of controls reported such frequent use.

These relatively small numbers reduce confidence that these estimates of risk are correct. There was also no link between less frequent use of mouthwash (less than three times a day) and risk.

Looking at the four gene variants, certain variants associated with faster ethanol metabolism were associated with a decreased risk of these cancers, while a variant associated with slower ethanol metabolism was associated with increased risk.

One particular variant associated with faster ethanol metabolism was found to be less common in mouthwash users compared with “never users”.

How did the researchers interpret the results?

The researchers concluded that poor oral health and dental care seem to be independent risk factors for upper aerodigestive cancers, even after adjusting for potential confounders such as smoking and alcohol use.

They say that, “Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.”

Conclusion

This multicentre study conducted across nine European countries has many strengths, including its large sample size. Most importantly, it adjusted for smoking and alcohol consumption, which are well-established risk factors for these cancers and could otherwise influence the association between oral health and dental hygiene and these cancers.

The researchers also adjusted for other potential risk factors, such as socioeconomic status and how much fruit and vegetables people ate.

However, there are some potential limitations. Although the researchers have made every effort to adjust for these confounders, as the researchers themselves acknowledge, the questions asked about these lifestyle factors may not fully capture a person’s smoking habits, alcohol use and diet, so there is still the possibility that they have some effect.

Also, the questions asked around oral health and dental hygiene may not have given a full representation of the person’s mouth care. These self-reported measures were not checked against dental records.

The study asked people to rate their current oral health and dental hygiene, and in the people with cancer this was after their diagnosis. This may not reflect their lifelong oral health or care before their diagnosis. An independent assessment provided by a dentist, or examination of dental records, may have been more reliable.

Nevertheless, the study does support an independent link between oral health and dental hygiene and aerodigestive cancers. The link seems biologically plausible and further study could also assess why these links might exist. Previous studies have suggested similar links, and ideally a systematic review would be able to look at this new study alongside the other available evidence. Such a review may provide new insights into potential risk factors.

Despite reports to the contrary, the link between mouthwash and cancer is less clear. Although using mouthwash more than three times a day was more common among cases than controls, very few people used mouthwash this frequently – only 1.8% of cases and 0.8% of controls. Risk calculations involving such small numbers of people are less reliable than those including larger samples.

The possible link between mouthwash and mouth and throat cancers needs to be clarified. If there is a link, it is currently unclear whether it could be related to the alcohol contained in mouthwash, or whether the link is caused by poor oral health and not a direct effect of mouthwash at all. It could be that poor oral health or dental hygiene increases the risk, and people with poorer health are also more likely to use mouthwash.

However, in the meantime, if you are concerned, there are plenty of alcohol-free mouthwash brands available. Your local pharmacist should be able to advise you.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

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Study finds the prognosis of HPV positive tumors in head and neck cancer patients to vary depending on site

Mon, Apr 7, 2014

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Source: sciencecodex.com
Author: Staff

 

Vienna, Austria: Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown. Danish researchers have now shown that HPV status appears to have no prognostic effect on the outcome of primary radiotherapy in head and neck cancer outside the oropharynx (the part of the throat located behind the mouth, and which contains the soft palate and the base of the tongue), the ESTRO 33 congress will hear today (Sunday).

Presenting her results to the congress, Dr Pernille Lassen, MD, PhD, from the Aarhus University Hospital, Aarhus, Denmark, will say that head and neck cancers located outside the oropharynx should probably not be treated with the less intensive treatment strategies that are currently being investigated in clinical trials for HPV+ oropharyngeal tumours.

“HPV status has a very potent prognostic impact in radiotherapy for oropharyngeal cancer, and DNA from HPV has been found in all types of head and neck cancer, although it is far more common in oropharyngeal tumours. We decided to investigate the impact of HPV status in non-oropharyngeal cancers in the DAHANCA database, which includes all Danish head and neck cancer patients,” Dr Lassen will say.

The researchers searched the database to identify patients with locally advanced cancers who had been treated primarily with radiotherapy, and identified 1606 patients with larynx and pharynx carcinomas. Overall, 40% of the tumours were HPV positive, and the frequency was significantly higher in oropharyngeal cancer (57%), than in non-oropharyngeal (13%).

Being positive for HPV significantly improved tumour control (81% as opposed to 55%), as well as survival from the cancer (89% and 55% respectively), and death from any cause (82% and 38% respectively), after five years.

“In non-oropharyngeal cancers we found no prognostic impact of being HPV positive in any of these endpoints,” Dr Lassen will say. “This indicates that HPV status does not help us in predicting response to treatment, and hence the outcome of these cancers.

“We know from laboratory studies that HPV positive tumour cells are much more sensitive to radiation therapy than HPV negative cells, so until now we believed that they would behave similarly irrespective of site,” Dr Lassen will say. “However, these data indicate that this is not the case, and at present we do not understand why this should be, though it probably can be ascribed to other biological/genetic differences between the tumours rather than the HPV status. We would now like to try to elucidate the underlying mechanisms behind these different outcomes.”

There could be, for example, biological and/or genetic differences between the tumours other than the HPV status, the researchers say; for example, genetic changes caused by smoking tobacco, differences due to tumours of mixed make-up (for example, a combination of HPV+ and tobacco), or perhaps simply differences due to the site. “Such tumours with a combination of causes represent a challenge in our clinical daily practice,” Dr Lassen will say.

“We have started following up our work by analysing all the tumour samples using polymerase chain reaction, a way of amplifying DNA in order to be able to analyse changes in genetic information. We hope this will enable us to understand more about why the role of HPV in non-oropharyngeal tumours is so different. There are few data available on this subject at present, so finding out will be an important step towards optimising treatment for these patients.”

President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: “These findings will have an important impact on the treatment of HPV+ head and neck cancers, and are likely to lead to a change in current practice.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

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Liquid nicotine for E-cigarettes found to be extremely toxic

Mon, Apr 7, 2014

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Source: nytimes.com
Author: Matt Richtel

 

A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

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Recurrent head and neck tumors have gene mutations that could be vulnerable to cancer drug

Sun, Apr 6, 2014

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Source: medicalxpress.com
Author: staff

An examination of the genetic landscape of head and neck cancers indicates that while metastatic and primary tumor cells share similar mutations, recurrent disease is associated with gene alterations that could be exquisitely sensitive to an existing cancer drug. Researchers from the University of Pittsburgh Cancer Institute (UPCI) and Yale University School of Medicine will share their findings during a mini-symposium Sunday at the American Association for Cancer Research Annual Meeting 2014.

About 50 percent of patients diagnosed with head and neck squamous cell cancers already have disease that has spread, or metastasized, to the lymph nodes, explained Jennifer Grandis, M.D., distinguished professor and vice chair of research, Department of Otolaryngology, Pitt School of Medicine, and director of the Head and Neck Program at UPCI, partner with UPMC CancerCenter. About 20 to 30 percent of patients thought to be cured of the disease go on to develop recurrent cancer, which typically doesn’t respond to standard treatments.

“We decided to compare the genetic signatures of tumor cells from primary tumors with those from disease that had spread and cancers that were thought cured but then came back in the hopes of getting some clues about how best to guide therapy in these different settings,” Dr. Grandis said. “We found that recurrent cancers might have an Achilles’ heel we can exploit to kill them.”

The team conducted the first whole-exome genetic sequencing study on what Dr. Grandis called its “treasure trove” of frozen patient samples and found similar mutations both in primary tumors and in the lymph nodes to which their cancers had already spread. But there were different mutations in tumors that had recurred after a period of remission that were not found in their original cancers.

“The recurrent tumors carried mutations in a gene area that encodes for DDR2 cell receptors,” Dr. Grandis said. “Other studies have shown that DDR2 mutations can confer sensitivity to the cancer drug dasatinib, which could mean that drug has promise in the treatment of recurrent head and neck cancers.”

The researchers suggest that further investigation of dasatinib treatment is warranted.

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Prognosis of tumors positive for human papilloma virus in head and neck cancers varies according to the site

Sun, Apr 6, 2014

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Source: www.sciencecodex.com
Author: staff

Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown. Danish researchers have now shown that HPV status appears to have no prognostic effect on the outcome of primary radiotherapy in head and neck cancer outside the oropharynx (the part of the throat located behind the mouth, and which contains the soft palate and the base of the tongue), the ESTRO 33 congress will hear today (Sunday).

Presenting her results to the congress, Dr Pernille Lassen, MD, PhD, from the Aarhus University Hospital, Aarhus, Denmark, will say that head and neck cancers located outside the oropharynx should probably not be treated with the less intensive treatment strategies that are currently being investigated in clinical trials for HPV+ oropharyngeal tumours.

“HPV status has a very potent prognostic impact in radiotherapy for oropharyngeal cancer, and DNA from HPV has been found in all types of head and neck cancer, although it is far more common in oropharyngeal tumours. We decided to investigate the impact of HPV status in non-oropharyngeal cancers in the DAHANCA database, which includes all Danish head and neck cancer patients,” Dr Lassen will say.

The researchers searched the database to identify patients with locally advanced cancers who had been treated primarily with radiotherapy, and identified 1606 patients with larynx and pharynx carcinomas. Overall, 40% of the tumours were HPV positive, and the frequency was significantly higher in oropharyngeal cancer (57%), than in non-oropharyngeal (13%).

Being positive for HPV significantly improved tumour control (81% as opposed to 55%), as well as survival from the cancer (89% and 55% respectively), and death from any cause (82% and 38% respectively), after five years.

“In non-oropharyngeal cancers we found no prognostic impact of being HPV positive in any of these endpoints,” Dr Lassen will say. “This indicates that HPV status does not help us in predicting response to treatment, and hence the outcome of these cancers.

“We know from laboratory studies that HPV positive tumour cells are much more sensitive to radiation therapy than HPV negative cells, so until now we believed that they would behave similarly irrespective of site,” Dr Lassen will say. “However, these data indicate that this is not the case, and at present we do not understand why this should be, though it probably can be ascribed to other biological/genetic differences between the tumours rather than the HPV status. We would now like to try to elucidate the underlying mechanisms behind these different outcomes.”

There could be, for example, biological and/or genetic differences between the tumours other than the HPV status, the researchers say; for example, genetic changes caused by smoking tobacco, differences due to tumours of mixed make-up (for example, a combination of HPV+ and tobacco), or perhaps simply differences due to the site. “Such tumours with a combination of causes represent a challenge in our clinical daily practice,” Dr Lassen will say.

“We have started following up our work by analysing all the tumour samples using polymerase chain reaction, a way of amplifying DNA in order to be able to analyse changes in genetic information. We hope this will enable us to understand more about why the role of HPV in non-oropharyngeal tumours is so different. There are few data available on this subject at present, so finding out will be an important step towards optimising treatment for these patients.”

President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: “These findings will have an important impact on the treatment of HPV+ head and neck cancers, and are likely to lead to a change in current practice.”

Source: European Society for Radiotherapy and Oncology (ESTRO)

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After-effects of oral cancer surgery forces patients into unemployment and depression

Mon, Mar 31, 2014

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Source: economicvoice.com
Author: Economic Voice Staff
 

Cancer Patients are being forced into unemployment due to the after-effects of surgery and higher levels of depression.

Research into head and neck cancer patients discovered the rate of those employed fell by more than 40 per cent five years after diagnosis, where only one in three managed to secure work. They also reported unemployed cancer survivors had lower social well-being and higher depression scores

For those cancer sufferers out of work prior to diagnosis, their reasons for not returning to work also included the knock-on effect of surgery as well as dangerous levels of alcohol consumption.

Figures from Cancer Research UK reveal more than 331,000 people were diagnosed with cancer in 2011 – around 910 every day. According to mouth cancer campaigners, the problems are exacerbated for mouth cancer patients.

Previous research identified mouth cancer survivors face a diminished quality of life. Survivors reported poor oral function, resulting in persistent eating problems and long term depression. More than half of respondents (51.6 per cent) reported problems with eating, while on average one in four survivors who lived for five or more years still experienced speech problems.

It was a similar story when it came to a patient’s physical and mental health, with more than a third (36.7 per cent and 39.3 per cent respectively) recording low functionality after the five year analysis.

According to Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, the study highlights the problems mouth cancer sufferers face on a daily basis.

Dr Carter said: “The results of the study show the scale of the problems cancer patients have to live with. For mouth cancer patients, the corrective surgery required to remove cancerous cells often leaves physical and emotional scars that can take years to heal.

While all cancer patients require a great deal of care, those recovering from mouth cancer clearly suffer from the after-effects of surgery, both physically and mentally. It can take a prolonged period of time to eat solid foods, learn to speak again, swallow without feeling discomfort and even breathe properly. In some cases, mouth cancer patients will experience these for the rest of their lives.

That is why early detection of this disease is so important. Most people with mouth cancer present late as stage 4 – the most advanced stage where time is of the essence in potentially saving a life and reducing the need for invasive surgery.

Warning signs for the disease include ulcers that do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings. If you spot any of these, or are unsure if it’s something normal or otherwise, our advice is crystal clear – if in doubt, get checked out.”

The research identified 55 head and neck cancer patients under the age of 60 who had survived more than two years. Each patient completed a survey including subscales from the Functional Assessment of Cancer Therapy (FACT) instrument, the Miller Behavioural Style Scale, the General Perceived Self-Efficacy Scale, the Patient Health Questionnaire-9 (PHQ-9) and the Hornheider Fragebogen-short version measuring need for psychological interventions.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

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Jim Kelly’s toughest game: Fighting oral cancer

Sun, Mar 30, 2014

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Source: www.foxnews.com
Author: Dr. Manny Alvarez

Jim Kelly, the Hall of Fame quarterback who played for the Buffalo Bills until 1996, is one of the greatest football players that I have ever seen. During his football career, I followed him closely and was always in awe of his athletic abilities, his leadership qualities and his love of family.

Unfortunately, Jim Kelly is currently battling a second recurrence of oral cancer and has been scheduled to undergo surgery in an attempt to control the disease. His wife, Jill, told the Associated Press that her 54-year-old husband’s cancer is aggressive and beginning to spread.

I’ve been following Jim Kelly’s health struggles and have been thinking about him, praying that he gets better. It is easy to think of some humans as immortal – especially when you’re looking at an individual as physically fit as Jim Kelly. But we tend to forget that sometimes nature has a unique plan for all of us.

However, Jim Kelly’s struggles can serve as a reminder for us all to be vigilant about our health. Jim Kelly is suffering from oral cancer, which doesn’t get the attention that it deserves, despite the fact that 42,000 new cases will be diagnosed in 2014, according to the National Cancer Institute.

Oral cancers are any cancers occurring in the oral cavity, which starts in your throat and extends all the way to your lips. The sad part about this disease is that oral cancers are typically not identified early, which severely reduces survival rates.

The early signs of oral cancer are often missed because lesions are small, painless and often not irritating – especially in tongue cancers or cancers of the gums. But, as the cancer grows, these lesions become ulcerated, causing burning and severe tenderness in the affected areas. Because of the vascular nature of the mouth and throat, many of these cancers tend to metastasize, making matters much worse.

Some risk factors for oral cancer include tobacco use, excessive alcohol consumption and exposure to some strains of the humanpapilloma virus (HPV). HPV has also been linked to cervical cancers in women.

One very important fact to know about oral cancer is that diagnoses of the disease have increased every year for the past five years, according to The Oral Cancer Foundation. That is why it’s so important for people to schedule regular appointments with their dentist – and to make sure they get examined for signs of oral cancer.

If you catch oral cancers early, the survival rate can be over 80 percent. Treatments for oral cancer often include surgery, in addition to radiation and chemotherapy. Yet, once the tumor has metastasized, it can be very challenging for doctors to control or remove it.

Please join me in wishing Jim Kelly all our love and support, and keep his family in our hearts.

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Beaumont Researchers: biomarkers predict effectiveness of radiation treatments for head and neck cancer

Sun, Mar 30, 2014

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Source: www.healthcanal.com
Author: staff

An international team of researchers, led by Beaumont Health System’s Jan Akervall, M.D., Ph.D., looked at biomarkers to determine the effectiveness of radiation treatments for patients with squamous cell cancer of the head and neck. They identified two markers that were good at predicting a patient’s resistance to radiation therapy. Their findings were published in the February issue of the European Journal of Cancer.

Explains Dr. Akervall, co-director, Head and Neck Cancer Multidisciplinary Clinic, Beaumont Hospital, Royal Oak, and clinical director of Beaumont’s BioBank, “Radiation therapy is a common treatment for people with squamous cell cancer of the head and neck. However, it’s not always well-tolerated. It can take two months, resulting in lots of side effects. Some of these complications are permanent. Before my patient goes down that path, I really want to know if their tumors are going to respond to radiation. That’s where the patient’s biomarkers can shed some light. If not, we can look at other treatment options – saving time, possible risk for complications and expense.”

A biomarker is a gene or a set of genes or its products, RNA and proteins, that researchers use to predict a key clinical issue such as diagnosis, prognosis, and response to treatment, choice of treatment or recurrence. Biomarker studies can provide a bridge between emerging molecular information and clinical treatment. Biomarkers may also lead to personalized treatment, in contrast to protocol-based medicine of today.

“Personalized treatment decisions based on biomarkers go beyond traditional cancer staging classifications. Individualized treatment plans could reduce morbidity and potentially improve survival by avoiding treatment failures,” says Dr. Akervall. “There is reason to believe that a better understanding of the biological properties of these tumors, as measured in the patient’s pre-treatment biopsies, may lead us to predict the response to radiation therapy and concurrent chemoradiation, thus allowing for tailored patient-specific treatment strategies.”

The study followed two groups of patients. In the first group, researchers screened 18,000 genes and identified five distinct markers. The second group was larger and confirmed these findings and two of them in particular. Two markers were good at predicting whether or not radiation-based therapy would be effective.

Adds Dr. Akervall, “While our findings are encouraging, and a step toward personalized medicine, we hope to do more of this research with a larger, randomized trial.”

According to the National Cancer Institute, most cancers of the head and neck usually begin in the squamous cells that line the moist surfaces of the mouth, nose and throat. Three risk factors identified with squamous cell carcinomas of the head and neck include – tobacco and alcohol use, as well as infection with cancer-causing types of human papillomavirus or HPV.

The team was comprised of researchers from University Hospital in Lund, Sweden; Van Andel Institute in Grand Rapids; and Beaumont Health System.

About Beaumont Research
BioBank, located within Beaumont’s Research Institute, is a center focused on developing innovative methods for early detection of disease and personalized treatment plans through leading edge analysis techniques and state-of-the-art technologies. Biomarkers from tissue, blood or fluids, are used to develop the next generation of care management, taking it from bench to bedside.

The Beaumont Research Institute has 1,100 active laboratory and clinical studies involving 82,000 patients that are funded by government, foundation and commercial grants. The Research Institute has an annual operating budget of $33.8 million.

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Anti-seizure medications prevent cancer

Sun, Mar 30, 2014

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Source: guardianlv.com
Author: Lindsey Alexander

A recent report came out from the journal Cancer indicating a new finding that anti-seizure medications might prevent some forms of cancer. Drugs like valporic acid (Depakote), are one form of prescription in this classification. Though also used as a mood-stabilizer, Depakote can prevent seizures from occurring, and has been investigated for cancer prevention.

These particular anti-seizure medications have been found to inhibit genetic changes that lead to cancer of the head and neck. The study included nearly 440,000 veterans, including 27,000 who were taking valporic acid for various disorders including post-traumatic stress disorder, bipolar disorder, seizures, and migraines. The overall findings suggested that veterans who were on the prescription were 34 percent less likely to develop cancers of the head and neck, than those who were not taking the drug.

The risk decreased in those subjects who took higher doses or for longer periods of time.

Dr. Johann Brandes with Atlanta Veterans Affairs Medical Center was the team leader of this study. He claims that this 34 percent statistic means 16,000 new cases, and between 3,000 and 4,000 cancer deaths can be prevented every year. Though there is a strong association, the study did not form a direct cause-and-effect relationship between cancer prevention and anti-seizure medications.

The National Cancer Institute describes cancers of the neck and head as usually squamous cell cancers that line mucosal surfaces inside the head and neck. This can affect the mouth, the throat, and the nose. This is a carcinoma that can begin in the salivary glands, and can contain many different types of cells that can in turn also become cancerous.

Valporic acid was found not to have any impact on lung, bladder, prostate, or colon cancers.

The Mayo Clinic currently says there is no proven way to prevent throat cancer. A person can restrict the amount of alcohol consumed, avoid smoking, chose a healthy diet to stick to (which includes plentiful amounts of fruits and vegetables), and protect against the human papilloma virus (HPV). Even though the HPV vaccine is recommended by the Mayo Clinic, other sources warn against the shot.

Christina England from Vactruth claims 140 people as of 2013 were lost due to the HPV vaccine, commonly referred to as Gardasil. Statistics from the Vaccine Adverse Event Reporting System (VAERS) listed many more side-effects than deaths, however. In 2013, the VAERS recorded nearly 1,000 people physically disabled, 10,000 people made a visit to the ER, and 3,000 were hospitalized among many others severe, and sometimes life-threatening side-effects.

The American Academy of Otolaryngology mentions three people in history who suffered from either oral, head, or neck cancer.

Babe Ruth, born in 1895, played for the National Baseball League and held a record of 60 home runs in one season. He was diagnosed just before retirement with nasopharyngeal carcinoma, which metastasized and later killed him.

Ulysses S. Grant was a Civil War leader and the 18th President of the United States. He came down with a cancer of the right tonsillar pillar, which was at the base of the tongue. This was referred to as a malignant squamous epithelioma. His death was referred to a slow and painful illness.

Today, however, he could have been treated and perhaps saved with inventions such as the aspiration pump, radiotherapy, surgery, and even a tracheotomy.

Sigmund Freud was also a victim of cancer. Freud was an Austrian psychoanalytic psychologist. He suffered from multiple health disorders and smoked heavily. He had cancer in the jaw, and was diagnosed at the age of 67. Treatment continued for 16 years, and he underwent many surgeries–one of which included the merging of the nasal cavity and the mouth. He died in 1939 from heart failure, cancer, and morphine overdose.

Researchers in medicine are discovering new ways of preventing cancer, and treating cancer, ranging many disciplines. Recent findings suggest future studies are necessary to determine a more substantial link between cancer prevention and anti-seizure medications. However, people are now able to consider yet another preventative measure that might prove helpful.

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