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Guest View: Stampede riders take stand against tobacco habits

Tue, May 26, 2015

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Source: Prospect Magazine
Author: Natalie Riggs

Smokeless/spit tobacco is one of the historic causes of deadly oral cancers, and is more addictive than other forms of tobacco use.

As a national nonprofit seeking to spread awareness of oral cancer and the dangers of starting terrible tobacco habits, the Oral Cancer Foundation has teamed up with professional barrel racer, Carly Twisselman, and bareback bronc rider, Cody Kiser, in an effort to spread the word in one of the biggest arenas of tobacco using patrons — the rodeo circuit.

While others are focused on getting users to quit, the Oral Cancer Foundation is taking a proactive stance against tobacco by reaching out and educating youth about the dangers and risks of the habit. The message is simple and non confrontational: “Be Smart. Don’t Start.” With the strong addictive powers of smokeless tobacco, we have to engage them early.

The Oral Cancer Foundation is a big believer that in order to solve problems, you have to become involved where the problem lies. The western/rodeo environment in the U.S. has had a long-term relationship with tobacco, and until 2009, the Professional Rodeo Cowboys Association and the rodeos that they sanctioned had a lengthy history of tobacco sponsorship money funding the sport.

While that has ended at PRCA events, tobacco use, and smokeless/spit tobaccos still thrive in the sport.

As a national nonprofit, OCF is taking a stance against tobacco with the help of both a cowboy and cowgirl who value their choice of not associating or partaking in this act; making them alternative positive role-models for the adolescent age group whose minds are so easily molded.

Carly Twisselman comes from a seventh-generation ranching family in California. Rodeo has always been a family sport for her and she feels it is important to protect that family lifestyle.

Besides her work with the foundation, Carly can be found as a TV host on the new Ride TV cable channel, in Hollywood as a stuntwoman for popular television shows such as: “Glee,” “Vegas” and the motion picture film “Crank.” OCF is very proud to have her as a spokesperson in our “Be Smart — Don’t Start” program.

Cody Kiser is your All-American cowboy. He graduated with a degree in engineering from University of Nevada, Reno. Cody has worked in Hollywood as a professional stuntman and can be seen in the recent blockbuster film “American Sniper,” starring Bradley Cooper. Cody’s desire to put forth effort to try to make a change in the world with his stance for non-tobacco use, while encouraging youth to make the decision against tobacco, is admirable. It is important for our youth to have positive role models who practice healthy habits, and OCF feels that Cody is the perfect candidate.

Both Cody and Carly will be riding this weekend at the Marysville Stampede.

Natalie Riggs is director of special projects for the Oral Cancer Foundation. For more information, visit the website: http://www.oralcancer.org.

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Imaging technique identifies early metastasis in lymph nodes

Sun, May 24, 2015

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Source: www.newswise.com
Author: National Institute of Biomedical Imaging and Bioengineering

NIBIB-funded researchers have developed a highly sensitive and accurate imaging technique for non-invasive screening of lymph nodes for metastatic cancer. Current practice calls for invasive surgical biopsies to determine whether deadly metastatic cancer cells have invaded the lymph nodes. The new imaging technique – so far tested in mice – offers a rapid and effective tool to noninvasively identify very small numbers of these cells, known as micrometastases, thus detecting cancer’s spread at its earliest stages, which is critical for timely treatment.

The work, developed at the University of Texas at Austin and the University of Texas MD Anderson Cancer Center, is reported in the October issue of Cancer Research. The technique uses an imaging approach known as ultrasound-guided photoacoustics combined with nanosensors designed to target and identify metastatic cells in lymph nodes.

Richard Conroy, Ph.D., Director of the NIBIB Program in Molecular Imaging elaborates on the technology’s potential: “This work is an excellent example of the development of a cutting edge technology that works very well in an experimental system but also has great potential to change the way we monitor and diagnose cancer metastasis. Identifying the accumulation of cells early in the process with some molecular characterization offers the opportunity for more targeted and effective treatment and fewer side effects.”

More than 90% of cancer deaths can be attributed to metastases either directly or indirectly. In current clinical practice, an invasive surgical procedure called sentinel lymph node (SLN) biopsy is used to identify the regional spread of tumor. This procedure results in adverse effects including swelling, pain, numbness and risk of infection in hundreds of thousands of cancer patients per year.

In an effort to improve on accuracy and safety of lymph node biopsies, a number of noninvasive imaging modalities have been tested in animals and patients. Imaging techniques, including positron emission tomography (PET) and magnetic resonance imaging (MRI) have shown some potential, but currently lack the specificity and sensitivity to replace invasive lymph node biopsy. Knowing the shortcomings of previous attempts to use noninvasive imaging techniques, the UT research group developed a technology that is noninvasive and may have better sensitivity, accuracy and specificity than surgical biopsy.

The improvement in sensitivity and accuracy comes from the smart imaging probe that interacts with the metastatic cells. The group built a molecularly activated plasmonic nanosensor (MAPS) for this task. The MAPS components include a gold nanoparticle, which is the part of the nanosensor that is seen by the imaging system. The MAPS nanosensor also contains an antibody to the epidermal growth factor receptor (EGFR). This antibody was chosen because EGFR has been shown to be abnormally highly expressed on the surface of many cancer cells including lung, oral cavity, and cervix. With these two components the MAPS can find the metastatic cell using the antibody that binds to the EGFR receptor and can be seen using photoacoustic imaging systems that detect the gold nanoparticle, but, only when the MAPS interact with a cancer cell.

To detect the gold nanoparticles bound to metastatic cells in the lymph nodes, the researchers developed an ultrasound-guided spectroscopic photoacoustic (sPA) imaging system. The technology provides the high contrast and sensitivity of optical imaging with the ability of ultrasound to provide clear resolution even in tissues deep inside the body.

The researchers tested the system in a mouse model of oral cancer. The mice were injected with the EGFR-targeted MAPS and were subsequently imaged using sPA. The results indicated that the MAPS bound specifically to the metastatic cells in the lymph nodes near the oral cavity tumor and were clearly visible with the sPA imaging system. The ability of the MAPS to bind only to the metastatic cells in the lymph nodes, and the ability of the sPA imaging system to clearly detect cancer cells labeled with MAPS were impressive and extremely encouraging, according to the researchers.

Overall, tumor-bearing mice injected with the EGFR-targeted MAPS showed a sensitivity of 100% and a specificity of 87% for detection of lymph node micrometastases as small as 50 micrometers, which corresponds to about 30 metastatic cells. The detection of such a small number of cells in the lymph node offers a system that has the ability to identify metastasis very early in the process, which would allow early treatment.

“This combination greatly improves sensitivity and specificity of detection of cancerous cells in lymph nodes as compared to any other imaging modality in use today,” says Konstantin Sokolov, Ph.D., of the University of Texas MD Anderson Cancer Center and one of the senior authors. “Our method has a great potential to provide dramatic improvement in the clinical staging, prognosis, and therapeutic planning for cancer patients with metastatic disease without the need for invasive surgical biopsy,” adds Stanislav Emelianov, another senior author.

Although these are early studies in mice, the researchers are enthusiastic about translating the technology for use in humans as well as expanding the use of the system. In addition to the potential to identify cancer metastasis, the ability of the system to non-invasively image very small clusters of cells with high sensitivity and specificity opens the possibility of using the system to identify abnormal cells early in the process in a range of cancers as well as other conditions, such as cardiovascular disease.

The authors anticipate that this system can be translated into use in the clinic following some alterations in the system to make it functional and safe in humans. Necessary changes include identifying ultrasound frequencies that can penetrate to depths that would be needed in humans. In addition, potential toxicity of gold nanoparticles will have to be addressed, primarily by testing smaller nanoparticles that are efficiently cleared from the system but still are large enough to provide an adequate imaging signal.

Note:
The study was funded by the National Institutes of Health through the National Institute of Biomedical Imaging and Bioengineering (NIBIB) grant number R01EB008101 and the National Cancer Institute.

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Public speaker back to work after tongue cancer surgery

Sun, May 24, 2015

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Source: www.komonews.com
Author: Molly Shen

Local doctors are seeing an alarming rise in the number of tongue cancer cases in people who never smoked or chewed tobacco. The Human Papillomavirus is a possible cause, but sometimes there’s no viral or obvious reason.

Robert Hasse was diagnosed with tongue cancer in 2013. He writes a blog called “Not What You Had Planned.” And he knows all about life going off schedule. A successful public speaker, he was sidelined by the news he had cancer and to save his life, he would lose half of his tongue.

hasse

“I couldn’t fathom not being able to speak,” Haase said. “And that was a possibility if the nerve was cut incorrectly or if the doctor didn’t do it right, I wouldn’t ever be able to speak again.”

Doctors were able to rebuild Haase’s tongue with tissue from his forearm. He was determined to speak, documenting his first attempt, two weeks later, two months later and most recently, 18 months after surgery.

Dr. Stephen Bayles has done several hundred tongue reconstructive surgeries at Virginia Mason Medical Center. He says while patients lose most of the ability to taste food, he can restore movement, blood flow and some sensations like the ability to distinguish heat and cold. He said Haase’s attitude was inspiring.

“He came straight out of the operation with a thumbs up attitude and was already communicating to people how well he was doing and that he was already on his road to recovery,” Dr. Bayles described.

Haase is now back to full time public speaking. He travels nationally, running seminars on physical and massage therapy. Life hasn’t gone as planned, but Robert sums up how he feels with the simple phrase, “I am blessed.”

“I’m not fearful of death. I’m afraid not to live,” he said. “I’m afraid not to use the time I have left to make a difference in people’s lives.”

Dr. Bayles said for prevention, people should follow good hygiene habits and see a dentist regularly. Oral cancers could be spotted early during regular exams. And if you have mouth sores that won’t go away, see a doctor.

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Smoking rates are down, but a different type of tobacco use is on the rise

Sun, May 24, 2015

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Source: www.huffingtonpost.com
Author: Anna Almendrala

First, the good news: Smoking rates are down significantly in 26 states. The bad news? The use of smokeless tobacco (also known as dip, snuff or chew) is up in four states, while using both cigarettes and smokeless tobacco is up significantly in five states.

“Although overall cigarette smoking prevalence has declined significantly in recent years in many states, the overall use of smokeless tobacco and concurrent cigarette and smokeless tobacco has remained unchanged in most states and increased in some states,” summed up researchers for the Centers for Disease Control, which published the data in their weekly Morbidity and Mortality report.

From 2011 to 2013, four states showed increased smokeless tobacco use: Louisiana, Montana, South Carolina and West Virginia. Only two states — Ohio and Tennessee — exhibited decreases. In terms of total use, Massachusetts and the District of Columbia reported the lowest numbers of smokeless tobacco, at 1.5 percent, in 2013. In contrast, West Virginia reported the highest use, at 9.4 percent, with Wyoming and Montana coming in second and third, at 8.8 percent and 8 percent, respectively.

Breaking down tobacco use by state helps health officials create more targeted state and local tobacco policies, explained CDC researcher Kimberly Nguyen in an email to HuffPost.

“It’s important to note that the states with lower tobacco use prevalence typically have more robust tobacco control programs and greater adoption of evidence-based population level interventions,” she wrote.

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The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

In reality, smokeless tobacco is addictive because of the nicotine it contains, and it can cause oral, esophageal and pancreatic cancer, according to the NIH’s National Cancer Institute. It may also cause other diseases like gum disease, oral lesions and precancerous patches in the mouth called leukoplakia. In no way should it be considered an aid to help people quit smoking, notes the NCI.

“Smokeless tobacco use can also increase risks for early delivery and stillbirth when used during pregnancy, cause nicotine poisoning in children, and may increase the risk for death from heart disease and stroke,” Nguyen added. “Smokeless tobacco is not a safe alternative to smoking.”

The CDC researchers aren’t sure why smokeless tobacco use is going up, but the report notes a few possible reasons.

“These increases could be attributable to increases in marketing of smokeless tobacco, the misperception that smokeless tobacco is a safe alternative to cigarettes, and the lower price of smokeless tobacco products relative to cigarettes in most states,” wrote the researchers. “In addition, the tobacco industry has marketed smokeless tobacco as an alternative in areas where smoking is otherwise prohibited.”

Just last month, the Food & Drug Administration rejected tobacco producer Swedish Match AB’s request to remove cancer warnings from their smokeless tobacco product, Snus, and replace the warnings with the claim that it is safer than cigarettes. And last week, the FDA also rejected a petition from R.J. Reynolds Tobacco Company and American Snuff Company to similarly alter the labels on their smokeless products.

To combat rising rates of smokeless tobacco use, the CDC recommend that states increase their spending on anti-tobacco programs, which include increasing the price on products, restricting tobacco advertising, increasing anti-tobacco graphics and commercials, and helping users quit their addictions. Indeed, while states will bring in more than $25 billion in settlement payments and tobacco taxes in 2015, they’re also projected to spend less than two percent of that revenue on such programs — much less than the CDC-recommended levels for each state.

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Campaign increases first-time mouth and throat cancer screenings among low-income rural Floridians

Sat, May 16, 2015

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Source: news.ufl.edu
Author: press release, Elizabeth Hillaker-Downs (media contact)

Raising awareness of the dangers of mouth and throat cancer increased the number of black men in some of Florida’s poorest counties who sought screening for the first time, opening the door to improved survival rates through early detection and treatment, UF Health researchers report.

Black men have the lowest survival rates of mouth and throat cancer in the United States, and these rates have decreased even more in recent years. To combat this problem, UF Health researchers launched a five-month media campaign targeted at black men in some of Florida’s poorest counties.

The number of people receiving an initial mouth and throat cancer screening grew 13 percent.

“Black men are more likely to be diagnosed at the later stages of mouth and throat cancer, when it is most devastating and costly,” said Yi Guo, Ph.D., an assistant professor in the College of Medicine department of health outcomes and policy. “We aimed to reverse this health inequity by ensuring more black men are aware of the dangers of mouth and throat cancer, because this cancer is preventable. People need to get screened.”

While the five-year mouth and throat cancer survival rate for white men is 66.6 percent and 59.7 percent among black women, the survival rate for black men decreased from 48.5 percent to 36 percent between 2004 and 2006. Using alcohol and tobacco increases people’s risk for mouth and throat cancer, and various factors contribute to survival rates, but the key is early detection and diagnosis.

To accomplish these goals, a team of UF Health researchers, which also included Henrietta Logan, Ph.D.; Amber S. Emanuel, Ph.D.; Virginia J. Dodd, Ph.D.; John G. Marks, M.S.; and Joseph L. Riley III, Ph.D., of the UF department of community dentistry and behavioral science, and Keith E. Muller, Ph.D., of the department of health outcomes and policy, designed, tested and implemented a culturally tailored media campaign in rural communities in six of Florida’s poorest counties. This analysis, which was published in the American Journal of Public Health this month, controlled for age, education, financial security and participants’ baseline concern when first interviewed.

The campaign, which ran from April 2010 to August 2010, featured nine poster designs, two handheld fan designs, a car magnet and a trifold brochure. The posters and the brochures were displayed in 45 local businesses that serve black clients, and 45 vehicles displayed the car magnet. The posters were switched out each month, and the fans were placed in 14 churches, one funeral home and one beauty shop.

In all, the campaign was relatively inexpensive, costing only $68,000, which included the salary of a community liaison to provide vital connections to the community and insight into message creation and placement.

Focus group feedback informed the creation of each of the campaign materials. The designs featured black men and the content focused on increasing awareness about mouth and throat cancer and its consequences.

Prior to launching the campaign, the research team identified 806 individuals in the rural communities who had never had an oral and throat cancer screening. They contacted these participants after the campaign had run five months and found that exposure to the campaign materials increased the concern black men had about mouth and throat cancer, and that additional exposure to campaign messages corresponded with correctly remembering more information about the disease.

The number of first-time mouth and throat cancer screenings in this area increased by 13 percent after the campaign. Within the target demographic, 11.2 percent of black men who were surveyed after the campaign had received their first mouth and throat cancer screening within the past year.

“One of our biggest hurdles is that many black men are not even aware that mouth and throat cancer can happen to them,” said Logan, who retired from the College of Dentistry in January. “By tailoring messages about the disease and its consequences to that population, we have managed to convince them that this disease can affect them and that they should take action, which is a powerful first step in reversing the downward trend in this vulnerable population’s survival rates.”

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Factors linked with better survival in oral cancer identified

Sat, May 16, 2015

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Source: www.cancertherapyadvisor.com
Author: staff

Factors associated with improved survival in oral cavity squamous cell cancer (OCSCC) include neck dissection and treatment at academic or research institutions, according to a study published in JAMA Otolaryngology-Head & Neck Surgery.

Alexander L. Luryi, from the Yale University School of Medicine in New Haven, Conn., and colleagues analyzed correlations between treatment variables and survival in patients with stages I and II OCSCC. Data were included for 6,830 patients.

The researchers found that five-year survival was 69.7 percent. Treatment factors that correlated with improved survival on univariate analysis included treatment at academic or research institutions, no radiation therapy, no chemotherapy, and negative margins (all P < 0.001).

Improved survival was also seen in association with neck dissection (P = 0.001). Treatment at academic or research institutions correlated with increased likelihood of receiving neck dissection and decreased likelihood of receiving radiation therapy or having positive margins.

Neck dissection and treatment at academic or research institutions correlated with improved survival on multivariate analysis (hazard ratios, 0.85 and 0.88, respectively), while compromised survival was seen for positive margins, insurance through Medicare, and adjuvant radiation therapy or chemotherapy (hazard ratios, 1.27, 1.45, 1.31, and 1.34, respectively).

“Overall survival for early OCSCC varies with demographic and tumor characteristics but also varies with treatment and system factors, which may represent targets for improving outcomes in this disease,” the authors write.

Reference
Luryi, Alexander L., BS, et al. “Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases From the National Cancer Data Base.” JAMA Otolaryngology – Head & Neck Surgery. doi:10.1001/jamaoto.2015.0719. [epub ahead of print]. May 14, 2015.

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The Beginning of the End: Vaccine Prevention of HPV-Driven Cancers

Mon, May 11, 2015

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Source: JNCI – Journal of the National Cancer Institute

Anna R. Giuliano, Aimée R. Kreimer and Silvia de Sanjose
+ Author Affiliations

Affiliations of authors: Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (ARG); Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (ARK); Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Spain (SdS); CIBER Epidemiologia y Salut Pública, Barcelona, Spain (SdS). Correspondence to: Anna R. Giuliano, PhD, Professor and Director, Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, MRC-CAN CONT, 12902 Magnolia Drive, Tampa, FL 33612 (e-mail: anna.giuliano@moffitt.org).
In this issue of the Journal, Saraiya and coauthors present an important analysis of human papillomavirus (HPV) detection in tumors retrieved from select US sites prior to HPV vaccine implementation (2006) (1). Not only are these data necessary to evaluate future vaccine effectiveness in reducing cancers caused by HPV infection, but they will also aid in the growing assessment of the worldwide burden of tumors attributable to HPV infection. These data raise the question: How many cases of cancer can be prevented by HPV vaccination in the United States?

Twenty years ago, in 1995, the World Health Organization recognized for the first time that HPV 16 is the cause of cervical cancer. In 2005, 10 years after this report, there was sufficient accumulated evidence to state that HPV 16 is also the cause of multiple cancers in men and women, and that HPV 16 is only one of 13–15 HPV types deemed “high-risk” types that cause cervical cancer (2,3). Growing evidence that HPV causes cancers, combined with the technology to develop efficacious vaccines against DNA viruses (4), simultaneously led to vaccine development. This was followed by demonstration of vaccine efficacy in women and men (5–8) and, ultimately, licensure of multiple vaccines that protect against HPV infection acquisition and prevention of the lesions these viruses cause (9–11). The recent licensure in the United States of Gardasil 9 presents an opportunity to further expand vaccine protection to prevent 90% of all cervical cancers worldwide (12,13).

While there has been tremendous progress in the prevention of cervical cancer through screening of adult women in high-resource countries and, recently, prevention of cervical precancer with vaccination (14), less progress has been made in the prevention of HPV-related cancers in men, cancers for which screening interventions are not routinely available. Despite clear evidence that HPV causes cancer at the oropharynx, that HPV-related oropharyngeal cancers (OPC) disproportionately affect men, and that OPC incidence is increasing in the United States, there have been no trials conducted to assess the efficacy of HPV vaccines to prevent these cancers. There is preliminary evidence of prophylactic HPV vaccine efficacy against prevalent oral HPV16/18 infections in women (15); however, it remains unknown what proportion of HPV-related OPC can be prevented with broad dissemination of HPV vaccines to males. Moreover, it remains unclear what proportion of OPC that have HPV DNA present are truly attributable to HPV.

Using HPV DNA-based detection to ascribe causality to tumors at different anatomic sites requires caution. There is strong evidence that HPV infection causes all cervical cancers and that DNA detection correlates well with markers of viral activity; thus, the use of DNA detection alone may be well justified at the cervix. However, for noncervical sites, particularly in the head and neck, HPV DNA-based detection methods overestimate the HPV attributable proportion. Identification of viral DNA in the tumor can occur if there is simply a transitory infection (not causal), as well as in cases where HPV is causally involved in the development of the tumor (transcriptionally active). Thus, identification of viral transcripts of the E6/E7 oncogenes by detection of the related mRNA and downstream markers, such as p16INK4a expression, is an approach utilized to ascertain whether HPV is causally involved in the development of the tumor. As an example, a recent meta-analysis of the attributable fraction of HPV in head and neck squamous cell carcinomas showed that HPV DNA was detected in 46% of OPC, 22% of laryngeal cancers, and 24% of oral cavity cancers. When E6/E7 mRNA and p16INK4a status were assessed in these same tumors, the proportion caused by HPV infection was similar for OPC (40%) but overestimated for laryngeal (9%) and oral cavity cancer (16%). Thus, in the current analysis (1), in which 70% of OPC, 21% of laryngeal cancers, and 32% of oral cavity cancers were HPV DNA–positive, it is possible that the HPV attributable fractions for oral cavity and laryngeal cancers were overestimated by two- to three-fold, respectively. Given the documented increases in the proportion of OPC tumors attributable to HPV over the past several decades, the absolute number of cases due to HPV should not be viewed as static; future estimates of the HPV-related OPC burden may be affected by changes in the underlying causes of these cancers, including smoking prevalence and HPV, especially as vaccination dissemination increases. Similar data on the importance of using measures of viral activity to determine HPV causality for noncervical anogenital tumors (penile, vulvar, vaginal, anal) are currently unavailable but will be critical in determining whether HPV DNA detection is sufficient to determine causality (as at the cervix) or whether markers of viral activity should also be utilized (as at the larynx and oral cavity).

Most cancer registries do not have access to molecular data to classify HPV infection status and therefore rely on anatomic site and histology to estimate HPV-related cancer incidence and case counts. In a best-case scenario, such as reported by Saraiya et al., registries have access to discarded samples that enable molecular analysis of tumors. For the purposes of monitoring HPV vaccine impact, these data allow surveillance of HPV-related tumor burden reduction in the post-HPV vaccination era. However, studies aiming to determine the true attributable proportion of HPV in cancers outside the cervix should assess causality with laboratory measures that capture viral activity.

The proportion of HPV-driven cancers that can be prevented with HPV vaccination differs by world region. The United States, like other high-resource countries with organized cervical cancer screening programs, has a low invasive cervical cancer rate but higher rates of noncervical cancers, particularly OPC in men. In contrast, in countries that have not yet benefited from cervical cancer screening programs or tobacco control policies, cervical cancer incidence is higher and HPV-related OPC incidence lower. In the last decade, OPC incidence increased in many economically developed countries as smoking prevalence decreased (16,17). Data reported in this issue indicate that approximately 60% to 70% of OPCs are caused by HPV infection in the United States (1), contrasting with data reported from less economically developed regions where less than 10% of tumors are HPV-positive (18–20). In a comprehensive review of the global burden of infection-associated cancers, de Martel et al. estimated that HPV infection accounts for 38% to 56% of OPC in Australia, Japan, North America, and Northern and Western Europe, compared with only 13% to 17% of OPC in other parts of the world (21). The proportion of OPC attributed to HPV may be even lower in certain African countries (19).

Regardless of how precisely we define the total number of cases due to HPV, vaccination against HPV has the potential to prevent multiple cancers in men and women, cancers for which we have no evidence-based prevention modalities, except in the case of cervical cancer. The data presented by Saraiya and coauthors estimate the number of cancers in the United States we can expect to prevent in the era of HPV vaccination. However, until we reach the national goal of 80% of men and women fully vaccinated against HPV (22), the prevention of multiple cancers with a relatively simple intervention will remain a dream. Providers are the key to implementing the national vaccine recommendations, ensuring this dream becomes a reality. Strong messages from providers to vaccinate age-eligible men and women can move the United States from among the lowest rates of HPV vaccination to the highest, with reductions in the national cancer burden to follow sooner rather than later.

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Second-line afatinib shows promise

Wed, May 6, 2015

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Source: www.nature.com
Author: David Killock

Patients with recurrent and/or metastatic head and neck squamous-cell carcinoma and disease progression after first-line platinum-based chemotherapy have a dismal prognosis. There is no standard second-line therapy; however, afatinib, an irreversible inhibitor of HER family kinases, has shown efficacy in this setting.

The LUX-Head & Neck 1 phase III trial randomly assigned patients to afatinib (n = 322) or methotrexate (n = 161) therapy. Median progression-free survival (PFS) was 2.6 months with afatinib versus 1.7 months (P = 0.03). “The study was also powered to detect a difference in overall survival, which was not significantly improved,” explains lead author Jean-Pascal Machiels, “however, patient-reported outcomes were better with afatinib.” Afatinib was associated with delayed deterioration of global health status, less pain, and improved swallowing, potentially related to the prolonged PFS, compared with methotrexate. Furthermore, afatinib toxicity was manageable and deemed favourable to that of methotrexate.

The patients were unselected for disease subtype, ~60% had received prior anti-EGFR antibody therapy, and 51% received further lines of treatment, possibly diluting the treatment effect of afatinib. Notably, patients with human papilloma virus (p16)-negative non-oropharyngeal cancer and local recurrence (rather than metastasis), who had not previously received an anti-EGFR antibody seemed to derive the most benefit in preplanned subgroup analyses.

Machiels concludes, “Afatinib has some activity in head and neck cancer, but we need to better understand which patients will benefit from this therapy.”

References
Machiels, J.-P. H. et al. Afatinib versus methotrexate as second-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 1): an open-label, randomised phase 3 trial. Lancet Oncol. doi:10.1016/S1470-2045(15)70124-5

Note: Nature Reviews Clinical Oncology (2015) doi:10.1038/nrclinonc.2015.86
Published online 05 May 2015

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The case for extending the HPV vaccine is clear and urgent

Wed, May 6, 2015

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Source: www.huffingtonpost.co.uk
Author: Dr Shaun Griffin

Last month the world marked Immunization Week, an opportunity to raise awareness about the importance of routine life-saving immunizations and how they have transformed our approach to public health over the course of centuries. Close the Immunization Gap was this year’s theme by the World Health Organisation. Progress towards global vaccination targets for 2015 is far off-track, according to the WHO one in five children still miss out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases.

The immunization gap also extends to gender, age and sexuality. A vaccination programme against the human papillomavirus (HPV) began in 2008 in the UK for girls aged 12-13 to reduce their risk of developing cervical cancer, which is caused by HPV. However, emerging research over the past eight years has found that cancers of the head, mouth, throat, penis and anus can also be caused by strains of the virus.

The incidence rate of anal cancer in men who have sex with men (MSM) is increasing. Anal cancer incidence rates in MSM are equivalent to the rates that existed for cervical cancer in women before 1988, when the Government introduced the cervical cancer screening programme. Cancer Research UK (CRUK) estimated incidence rate of anal cancer is 78 per 100,000 per year in HIV-positive MSMs who are on HAART (anti-retroviral treatment), compared with 5 per 100,000 per year in HIV-negative MSMs. Around 5,500 men were diagnosed with oral, penile or anal cancer in the UK in 2011.

Heterosexual men gain indirect protection from HPV through “herd protection” if a majority of women in the population are vaccinated. But if men have relationships with women who did not receive the vaccine they are at risk. Additionally, the current programme offers no protection to MSM.

At Terrence Higgins Trust we believe that the HPV vaccine should be extended to all boys irrespective of their sexuality and to MSM as a matter of urgency. This is why we are working with other health organisations as a member of HPV Action to call for the school HPV vaccination programme to include boys as well as girls. Last month Terrence Higgins Trust attended the European Men’s Health Forum (EMHF) HPV Symposium in London. The significant and growing rate of anal and other HPV-related cancers in Europe was described a “time bomb” at the meeting.

We believe that the case for extending the HPV vaccine is a clear and urgent one but progress has not happened at the speed we would like. Since October 2013 the Joint Committee on Vaccination and Immunisation (JCVI) has been considering whether MSM and/or adolescent boys should also be offered the vaccine. The JCVI made an initial recommendation in November 2014 that MSM aged 16-40 should be offered the vaccine in GUM clinics and HIV clinics.

However, the JCVI delayed making its full recommendation until October 2015, following concerns from GUM clinics that the cost for administering the vaccine for MSM would make it not cost-effective. Each delay leaves these groups unprotected against HPV-related cancers and that is why Terrence Higgins Trust is calling for these inequalities to be urgently addressed by the next Government so that the gap for the HPV vaccine is well and truly closed.

Note: Dr Shaun Griffin is Director of External Affairs at Terrence Higgins Trust, the UK’s largest HIV and sexual health charity

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Laser Treatment Halts Oral Mucositis in Its Tracks

Mon, May 4, 2015

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Source: www.medscape.com

Author: Fran Lowry

 

Spa-like treatment with a cool, low-level laser, similar to that use

for wrinkles, vanquishes oral mucositis, one of the most debilitating

toxicities of cancer therapy.

 

“I have been an oncology nurse for over 25 years, and in those 25

years, there has been nothing that helps prevent or is effective

against the treatment for oral mucositis, until now,” said Annette

Quinn, RN, MSN, from the University of Pittsburgh Cancer Institute.

 

“Patients say they rank it higher than nausea and vomiting when it

comes to adverse side effects, especially because we have good

medications to control nausea and vomiting. But the low-level laser

works better than we could have hoped,” Quinn told Medscape Medical

News.

 

She presented results from a pilot project at the Oncology Nursing

Society (ONS) 40th Annual Congress in Orlando, Florida.

 

Oral mucositis affects virtually all head and neck cancer patients

undergoing chemo and radiation therapy, and about 75% to 100% of

patients undergoing stem cell transplantation with whole-body

irradiation experience some degree of oral mucositis.

 

Low-level laser therapy (LLLT) has been used to treat oral mucositis

for a decade in Europe and South America, but it has not made its way

to the United States because there is no mechanism for reimbursement,

Quinn reported.

 

She hopes this study will change that.

 

“Reimbursement is the main obstacle to its use in the United States,

but for this study, I was able to secure the treatment through a

grant. Treating oral mucositis could easily add $20,000 to the cost of

patient care, but with the laser, we can decrease hospital

readmissions and the use of pain medication, IV antibiotics, and

feeding-tube placements. Even though we cannot receive reimbursement,

laser treatment is still cost-effective,” she said.

 

It is thought that LLLT works on the mitochondria to displace the

nitric oxide that is generated as a result of radiation or

chemotherapy, and helps to reoxygenate the cells, Quinn explained.

 

In the pilot project, 52 patients with head and neck cancer, all

deemed to be at high risk for oral mucositis, received LLLT 830 nm

wavelength three times a week, starting the first week of their

radiation treatment and continuing throughout the course of their

radiation therapy.

 

The initial intent was to see if the laser could control the oral

mucositis so patients would not be forced to have a break in their

treatment, Quinn explained.

 

“We know that patients who miss 5 days or more of radiation therapy

have poorer survival, so we wanted to focus on how to get these

patients through with no treatment breaks. We didn’t realize that we

would get them through with no mucositis. But we found that the very

first patient we treated made it all the way through,” she said.

 

None of the 52 patients treated with LLLT developed any oral mucositis.

 

When oncologists treating stem cell transplantation patients

discovered these results, they brought 23 of their stem cell

recipients for LLLT. These patients were treated until their absolute

neutrophil count was above 1000 cell/nm³.

 

Again, results were excellent, although two patients developed grade 3

oral mucositis.

 

“Normally, 100% of stem cell patients develop oral mucositis. It’s

unbelievable what the therapy has done for oral mucositis,” Quinn noted.

 

LLLT Simplicity Itself

 

“The treatment is administered immediately after the radiation

therapy. It takes only about 6 to 8 minutes to administer, and is all

done extraorally; none of the probes actually go into the mouth unless

the patient develops a lesion inside the mouth that we need to target

with the probe,” Quinn explained.

It is simplicity itself, and it works so incredibly well. We just have

to get the word out.

 

“We do five sites along their face, right along the jaw line, and then

we do their tongue. The patients love it. We call it their spa time.

It’s the same laser they use in cosmetics to prevent wrinkles. We have

not had one patient tell us they want to stop their treatment, and we

have had no adverse side effects,” she said.

 

The learning curve is very slight, Quinn added.

 

The training takes about half a day, and learning how to use the

equipment only takes about 30 minutes. “It’s just cold laser therapy,

there’s no heating, there’s no cutting. Nothing. It is simplicity

itself, and it works so incredibly well. We just have to get the word

out,” she said.

 

The poster generated a lot of buzz among the nurses attending the

Congress, noted Ruth C. Gholz, RN, MSN, from the Cincinnati Veterans

Administration Medical Center.

 

“There was a lot of excitement about the laser to treat oral

mucositis. So many people were talking about it,” Gholz told Medscape

Medical News.

 

Oral mucositis is a debilitating side effect that challenges us as we

move forward with patients and providers. Low-level laser therapy has

been a recognized treatment per guidelines, yet many have limited to

no experience in its use,” she said.

 

Gholz explained that these results challenge “all practices to

incorporate low-level laser therapy into their armamentarium.”

 

“The future is bright as we move forward in maximizing this therapy,”

she added.

 

Ms Quinn and Ms Gholz have disclosed no relevant financial relationships.

 

Oncology Nursing Society (ONS) 40th Annual Congress: Abstract 84.

 Presented April 24, 2015.

Medscape Medical News © 2015  WebMD, LLC Send comments and news tips to news@medscape.net.

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

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