Oral Cancer News

Source: www.medpagetoday.com
Author: Charles Bankhead, Staff Writer, MedPage Today

Treatment of head and neck cancer causes potentially severe lymphedema, which responds to complete decongestive therapy in most cases, a retrospective chart review showed. The most severe lymphedema occurred in patients treated with surgery and radiation therapy, followed by definitive surgery alone. Complete decongestive therapy led to clinical improvement in a majority of the patients, including 83% of those treated with surgery alone.

“Lymphedema is vastly under-recognized and under-reported in patients with head and neck cancer,” Jan S. Lewin, PhD, of M.D. Anderson Cancer Center in Houston, said in an interview at the Multidisciplinary Head and Neck Cancer Symposium (MHNCS).

“The lymphedema can be just as severe as what’s seen after treatment of breast and other types of cancer. Lymphedema in patients with head and neck cancer can be terribly disfiguring and cause severe functional problems.”

“Complete decongestive therapy leads to clinically significant improvement in most patients, whether it’s performed in a clinic or at home,” she added.

Available evidence suggests that fewer than half of patients with head and neck cancer develop lymphedema after treatment. However, cosmetic and functional sequelae can be severe, including problems with speaking, eating, airway obstruction, and drooling, as well as self-image.

As compared with lymphedema in other cancers, a paucity of information exists about the presentation and treatment of the condition in patients with head and neck cancer, said Lewin. In an effort to add to the information base, she and her colleagues retrospectively reviewed records of patients referred for evaluation of lymphedema following treatment of head and neck cancer. Data collection included patient and disease characteristics, site and severity of lymphedema, and the type of complete decongestive therapy each patient received (outpatient or at home).

Investigators stratified patients by type of cancer treatment and decongestive therapy regimen. Outcomes were assessed by clinical examination, and improvement was defined as a reduction in lymphedema stage, resolution of the lymphedema site, or ≥2% decrease in total surface area affected.

Complete decongestive therapy conformed to recognized standards and consisted of manual lymphatic drainage massage, use of compression bandages, physical exercise, and a skin-care regimen.

Outpatient therapy was performed by a certified therapist and consisted of an intensive phase of three to five sessions weekly for two to four weeks, followed by maintenance home therapy. Patients who were unwilling or unable to complete the outpatient regimen were assigned to a self-administered home-based regimen.

The study population consisted of 270 patients, 30% of whom were treated with definitive external beam radiation therapy, 9% with surgery alone, and 61% with surgery and radiation therapy.

The neck was the most common site of lymphedema (89%), followed by the submental (84%), facial (32%), and intraoral (6%) areas. Some patients had more than one affected area.

Lewin reported that 53% of the patients had moderately severe lymphedema, defined as M.D. Anderson stage 1b (reversible, pitting edema). Combined therapy resulted in significantly worse lymphedema (P=0.001).

Overall, 161 (60%) patients reported functional problems related to lymphedema, including difficulty swallowing in 80 patients (30%) and speech problems in 31 (11%).

Outcome data were available for 152 patients who received complete decongestive therapy and returned for follow-up evaluation (an average of 10.7 weeks after initial evaluation).

Lewin and colleagues found that 54% (82 of 152) of patients had improved clinically at follow-up (15 of 20 who had outpatient therapy and 67 of 132 who had home-based therapy).

Improvement was observed in 83% of patients treated by surgery alone, 55% of patients treated with definitive radiation therapy, and 49% of patients treated with surgery and radiation.

Evaluation of functional outcomes is ongoing, said Lewin.

Notes:
1. Primary source: Multidisciplinary Head and Neck Cancer Symposium
2. Source reference: Lewin JS, et al “Early experience with head and neck lymphedema after treatment for head and neck cancer” MHNCS 2010; Abstract 45.

Source: prnewswire.com
Author: press release

The Coalition to Stop Contraband Tobacco today praised the U.S. Senate for passing S. 1147, the Prevent All Cigarette Trafficking (PACT) Act of 2009. Sponsored by Sen. Herb Kohl (D-WI) and co-sponsored by a bipartisan group of 20 senators, this legislation will help combat online cigarette sales that have robbed hundreds of millions of dollars in tax revenues from the states and that undermine state laws that prevent youth access to tobacco products.

“Passage of the PACT Act is a huge victory for American taxpayers, American small business owners and America’s youth,” said Scott Ramminger, AWMA president and CEO and coalition spokesperson. “We applaud the Senate for its action today and thank Sen. Kohl for his leadership in ensuring that contraband tobacco sales are eliminated.”

Numerous stakeholders have worked with Sen. Kohl through the years to pass the PACT Act, which was passed in the House of Representatives last May. The PACT Act closes gaps in current federal laws regulating “remote” or “delivery” sales of cigarettes and smokeless tobacco products.

“In a recent study we found that illegal cigarette sales cost states $5 billion per year, and that with online sales there is almost no age verification at the time of purchase,” continued Ramminger.

“We hope the House will pass this bill quickly and that President Obama will act swiftly to sign this common sense legislation into law so that we can put an end to the illegal sale of tobacco products,” conclude Ramminger.

The Coalition to Stop Contraband Tobacco is a group of individuals, associations, businesses and other organizations that share the goal of enacting legislation that will eliminate underage access to tobacco on the Internet, curtail associated illegal activities and capture lost state excise tax revenues.

Source: Coalition to Stop Contraband Tobacco

Source: www.tobacco-facts.net
Author: staff

General Snus, a smoke-free moist tobacco product originated in Scandinavian countries in the 19th century, is currently holding a massive promotional campaign across the United States.

Swedish Match, the manufacturer of General Snus brand has introduced a multi-million-dollar marketing drive intended for bringing the steam-cured tobacco pouches to wealthy tobacco-lovers in major markets across the nation. The General Snus are also promoted at high-end events, such as New York Fashion Week and several notable Film Festivals.

Snus are made and sold in cooled pouches packed in cans. The consumers put these tobacco items between cheek and lip and sip it getting their portion of nicotine. Snus is extremely famous among upscale professionals in Sweden, where the product saw the world for the first time almost two centuries ago. Whereas these products are still relatively unknown to the majority of American smokers, they are going through an outstanding growth of popularity since the initial nationwide launch in 2000, according to Swedish Match.

The latest General Snus promotional campaign – under slogan “Satisfaction: the Original Pursuit”— was launched at the Sundance Film Festival held in Salt Lake City in January, where Swedish Match has acquired sponsorship deal. Other venues for the marketing campaign include art shows in New York, Boston and Los Angeles, and New York’s Fashion Week.

Lars Hansson, the communication director for Swedish Match told the press that in Scandinavian countries snus has been generally used by the upscale audience, and that has been the major reason why the latest General Snus campaign is oriented at appealing to American fashionistas and white-collar professionals.

He added that the company is delighted to launch the new product in the new but already popular category of smokeless tobacco and consider that General Snus has all the features to gain the leading position in that segment.

Besides, being represented in trendy events, the General Snus drive will reach four key American markets: Dallas, Chicago, New York and Boston. The product will also be marketed at famous ski resorts, such as Aspen, Park City, and Breckenridge. The focus will be put on distributing the Snus among adult tobacco-lovers, especially visitors of clubs, restaurants, large office centers and other high-end venues. Swedish Match plans to distribute half a million of sample production.

The marketing campaign that will last for six months as well comprises sponsorship deals with eminent athletes and funding of athletic events. Moreover, the campaign will also involve communication on social networks, like Facebook, Myspace and Twitter.

Mr. Hansson said that General snus has been available in nearly 600 tobacco outlets across the nation, and their major aim is to increase the number of stores where the product is available to 1, 200.

Taking into consideration the constantly dropping number of public places where tobacco consumers can smoke, the smokeless tobacco offers a great option for smokers.

Swedish Match has a large portfolio of smokeless tobacco, pipe tobacco and cigar brands, among which are General, Cohiba cigars, 1847, Red Man and others.

Note:
1. Does anyone really believe that General Snus is targeting adults when it is advertising on Facebook, Myspace and Twitter using prominent athletes? Apparently, unscrupulous tobacco companies are not exclusively American.

Source: www.time.com
Author: Coco Masters

Oral sex can get most men’s attention. The topic becomes considerably more relevant, however, when coupled with a new study linking the human papillomavirus (HPV) to an increased risk of a kind of oral cancer more often seen in men.

The study, which appears in this week’s New England Journal of Medicine (NEJM), shows that men and women who reported having six or more oral-sex partners during their lifetime had a nearly ninefold increased risk of developing cancer of the tonsils or at the base of the tongue. Of the 300 study participants, those infected with HPV were also 32 times more likely to develop this type of oral cancer than those who did not have the virus. These findings dwarf the increased risk of developing this so-called oropharyngeal cancer associated with the two major risk factors: smoking (3 times greater) or drinking (2.5 times greater). HPV infection drives cancerous growth, as it is widely understood to do in the cervix. But unlike cervical cancer, this type of oral cancer is more prevalent in men.

HPV is ubiquitous. Of the 120 strains isolated from humans — about 40 of which are in the mouth and genital tracts — Merck’s recently FDA-approved vaccine, Gardasil, protects against four: HPV-6 and HPV-11, which cause warts; and HPV-16 and HPV-18, which cause about 70% of cervical cancers. Similarly, according to the study, HPV-16 was present in 72 of the 100 cancer patients enrolled in the study. Between 12,000 and 15,000 new cases of oropharyngeal cancer are diagnosed each year, and about 3,000 people die from it. “It is a significant health issue,” says Dr. Robert Haddad, clinical director of the Head and Neck Oncology Program at the Dana-Farber Cancer Institute. Haddad says that public awareness of the HPV virus needs to be just like that of HIV because the virus causes multiple types of cancer.

The study’s findings bring to light a part of the debate over HPV vaccination and treatment that is often overlooked: the elevated risks of cancer that being HPV-positive has for men. According to Johns Hopkins’ researcher Dr. Maura Gillison, who worked on the study: “When you look at the cancers associated with HPV in men — including penile cancer, anal squamous cell carcinoma, oral cancers — it’s very close to the number of cases of cervical cancer that occur in the U.S. in women every year. We need to adjust the public’s perception… that only women are at risk.”

In his practice, Haddad has seen an increase in the number of younger people developing this cancer, people in their 30s and 40s. He attributes it in part to a “change in sexual behavior over the last decade.” He says: “The idea that oral sex is risk-free is not correct. It comes with significant risks, and developing cancer is one of them.”

Gardasil has become a vaccine rock star, but vaccines to fight HPV are still in their infancy. Another study in this week’s NEJM points out that while the preventative vaccine works 98% of the time to protect girls not yet infected with HPV-16 and HPV-18, the vaccine is only 17% effective against cancer precursors overall. These findings could undercut the argument ensuing in more than 15 states to make the vaccine mandatory for young girls.

Gardasil and some vaccines in clinical trial are preventative, but drug companies such as MGI Pharma are studying therapeutic vaccines to treat those already infected with the virus. “We need to come up with better vaccines — and we need to study them in men,” says Haddad. Gardasil has not been tested against oral HPV, but Dr. Douglas Lowy, laboratory chief at the National Cancer Institute, says that there is every reason to think that, in principle, “the vaccine should be able to have an impact on oral cancers attributable to HPV.” Lowy says that the next studies might start with a look at the rate of acquisition of oral HPV in those who are vaccinated and those who aren’t.

“There’s no question that the debate needs to go further than where it is now,” says Haddad. “Men are carriers and that is one way of transmitting this virus.”

Source: www.dentistryiq.com
Author: Jonathan A. Bregman, DDS, FAGD

In the previous articles of this series, I discussed four barriers I see as stopping those in the dental profession from doing a complete oral cancer screening examination.

In Part 1, the barrier I discussed is the overall lack of confidence in doing a complete extra-/intraoral cancer screening exam. The rationale: “not doing the exam at all puts me at less risk than doing it and missing something.”

In Part 2, the barrier I discussed is being unclear about who to examine: the changing target population, especially the influence of the human papillomavirus (HPV 16/18).

In Part 3, the uncertainties of how the complete cancer screening examination should be done, plus communicating the reasons for doing it for patients.

In Part 4: Uncertainty about how to properly record the cancer screening examination

Barrier 5: Uncertainty about how to best and most effectively deliver the message of a positive finding

The more we look, the more we find.

The more we look, the closer we look, the more abnormalities we will detect with our cancer screening exam. This makes sense, of course. The same goes for the complete periodontal examination, the complete occlusal analysis, the complete updated radiographic evaluation, etc.

In each area — tissue abnormalities, periodontal abnormalities, occlusal abnormalities — we must address the needs of the patient in a way that sets the stage for understanding of the problem(s) and presenting possible options/solutions to correct the problems.

Build on what you already know

In every program I do on this important aspect of doctor/team and patient communication, I ask the same question, “What difficult message have you delivered in the past four to five days you have been in your office treating patients?”

The answers are varied.

* “You need a root canal. And afterwards, you need a build-up and a crown!!”
* “You will lose this tooth (or this front tooth).”
* “You will lose all of your teeth.”
* “You have a disease in your mouth called periodontal disease that, if left untreated, can cause heart damage and lead to a variety of maladies including pancreatic cancer.”
* “The crown (bridge) is failing and needs to be replaced.”

So, how do you consistently set the stage to effectively deliver these messages?

Creating the right environment is the first step

Think about what you do when having a difficult discussion with a patient.
What is your body position in relation to theirs?

* Behind?
* To the side?
* Across the room?

Most of you would say, “On eye level, right in front of the patient, and close enough to have this conversation, but not too close to invade personal space.”

And what would the overall environment be like?

* Noisy?
* People coming and going
* In a public space

Once again, the unanimous reaction is, “A quiet, private space that lends itself to this important communication.”

Establishing the demeanor of the ‘giver of the difficult message’ is the second step

How do you act when you meet with your patient to discuss a difficult problem?

* Preoccupied with what you have to get back to doing?
* Distracted?
* Judgmental of the patient’s reaction?

You are probably thinking, “Of course not! I am totally focused on the patient and react in a totally nonjudgmental manner.” Yes, that is indeed critically correct.

I have set the stage with the right environment and approach with the most effective demeanor. NOW WHAT?

The third step is effectively working through the four key aspects of delivering the message of a positive finding from an oral cancer screening examination.

One: Clearly and simply state the message in as few words as possible.

Example: “Ms. Jones, I have found an abnormality on the side of your tongue. It is a mixed red and white patch. I am referring you to an excellent doctor who will help to diagnose this abnormality.” (Or, “We will do a biopsy to determine exactly what this abnormality is.”)

Two: Just be quiet, listen, watch, and gauge the patient’s reaction.

One patient might very calmly say, “Well, I guess we need to find out what it is. What is the next step for me?” Another patient might become hysterical or totally melt down.

By saying nothing at this time, you will be able to determine the best way to help your patient proceed instead of assuming (and we all know what the word “assume” breaks down to be!) their needs and going into a long discussion or explanation that may or may not meet their needs.

Three: Use active listening when discussing the patient’s concerns and answering his or her questions.

Active listening is accomplished by using a feedback approach to a conversation to clarify questions being asked and concerns felt.

For example: “So I am hearing that you are very concerned about this area on your tongue since you sing in the church choir and are afraid that it would stop you from doing what you love to do. Is that right?”

Another example: “So that I am clear, are you asking me how long you can wait to make the appointment with the specialist or to have a biopsy done our office?”

Peter Barry, a premier speaker, trainer, and dental consultant, stated the following during one of his recent programs. “Our patients need for us to know that we not only hear them (one of the six senses) but actually are listening to them.” I could not agree more.

Active listening accomplishes these two key goals:

1. Our patients know that we are really listening to them.
2. There is no confusion as to what the patient is asking or feeling.

Four: Ensure that there are no further questions and clarify the next steps that the patient must take.

One of the first lessons in communications that I teach is how to find out if patients understood what was said to them and if they had any further questions.

If you say, ”So, do you understand?” Unspoken, the word “dummy,” will almost always get a “yes” because who wants to be dumb. BUT, if the phrasing of the question is changed to “Is there anything I have not made clear to you today?” and “Do you have any other questions or concerns I have not answered?” opens the door to any further clarification the patient may need.

So be clear that the patient’s questions and concerns have been answered, hand out your business card in case other questions come up after the patient leaves, and hand the patient off to the person who will help him or her take the necessary next steps of scheduling an appointment with the specialist.

One warning: don’t guess. Stick to your ‘mantra.’

Patients will always ask, “So what do you think this is” or “Should I really be concerned about this?” or “Do you think that this is cancer?’

DO NOT GUESS!! ONLY A BIOPSY WILL DIAGNOSE.

THE BEST SUGGESTION IS TO CREATE A MANTRA THAT YOU CONTINUE TO REPEAT WHEN THESE QUESTIONS ARE ASKED.

“We only know that this is an abnormality. We need to diagnose exactly what it is.” Or, “It is not good dentistry and not fair to you for me to guess at a diagnosis, which is why we are going to find out what this abnormality is or is not.”

Don’t let the need to deliver the difficult message of a positive finding from your cancer screening exam be a barrier for you and your practice.

1. You have done this before: use what you have learned about the effective delivery of other difficult messages and apply those same principles to the detection of an oral abnormality.

2. Create an environment that is “patient friendly” for delivery and receipt of this important message.

3. Remember the four key aspects for the delivery of the message:

* One: State the problem simply and clearly.
* Two: Stop, be quiet, listen, and observe.
* Three: Use active listening techniques to make certain that the patient knows that you are truly listening to him or her and to prevent misunderstandings.
* Four: Wrap up the question segment using the correct communication skills and turn the patient over for the next step, which is either a referral to a specialist or reappointing in your office for a biopsy.

4. Don’t guess at a diagnosis. Let the definitive biopsy establish the diagnosis not your screening exam.

Because…IT’S ABOUT TIME!!

What’s coming up next article in this series?

Resistance factor six: Creating a seamless referral system and follow-up protocols.

Note:
1. Jonathan A. Bregman, DDS, FAGD, is a clinician, speaker, author, and trainer who led successful dental practices for more than 30 years. While dedicated to improving the dentist, team, and patient experience, he has a passion for educating dental professionals about early oral cancer detection and laser-assisted dentistry. You may contact Dr. Bregman by e-mail at info@bregmandentistry.com or visit www.bregmandentistry.com. Also be sure to check out his blog at www.oralcanceraware.com.

Source: www.businesswire.com
Author: press release

The Human Papillomavirus (HPV) is the causative agent responsible for most cases of cervical cancer, but is also associated with several other types of cancer. Expert physicians from the National Comprehensive Cancer Network (NCCN) Member Institutions presented an update on HPV and its link to various cancers including cervical cancer, anal carcinoma, and head and neck cancers discussing prevention strategies and the latest recommended treatment options according to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™).

“It is important to counsel against any tobacco use as well as excessive alcohol consumption, and also to inform patients about the role of HPV and its mechanism of spread”

Robert J. Morgan, MD, FACP of City of Hope Comprehensive Cancer Center and a member of the NCCN Guidelines Panel for Cervical Cancer began the session speaking about the link between HPV and cervical cancer as well as methods of prevention.

“Cervical cancer screening with the pap smear is one of the greatest success stories in medicine,” said Dr. Morgan pointing to data that shows a steadily decreasing death rate from cervical cancer since the 1980s.

The link between HPV and cervical cancer first started to emerge in the 1970’s when researchers found evidence linking cervical cancer to a wart virus coupled with the fact that cervical cancer was associated with sexual activity. In 1983, HPV DNA was identified in cervical cancer tissue.

There are 120 known HPV serotypes with 19 being considered high risk, although as Dr. Morgan noted the HPV vaccine has been proven to protect against four types of HPV, 16 and 18, which account for 70 percent of cervical cancer cases, and 6 and 11 accounting for 90 percent of genital warts.

The HPV vaccine is recommended by several major medical organizations and that the Federal Advisory Committee in Immunization Practices (ACIP) suggests starting the vaccine between age 11 and 12 years.

Dr. Morgan concurred with the medical organizations supporting the vaccine stating, “An ounce of prevention is worth a pound of cure.”

Future issues that need to be addressed in regards to the HPV vaccine range from toxicity and long-term safety as well as the age to start vaccinating, international availability, cost, and if boys should also be vaccinated.

“HPV also causes anal/penile cancers in men, so some recommend male vaccination as well,” said Dr. Morgan.

In addition to cervical cancer, infection with high-risk types of HPV is also a principal cause of anogenital cancer and oropharyngeal cancer noted J. Michael Berry, MD of UCSF Helen Diller Comprehensive Cancer Center and a member of the NCCN Guidelines Panel for Anal Carcinoma.

Individuals at an increased risk of developing anal cancer include those infected with HIV and women with a history of high-grade cervical neoplasia or HPV-related gynecologic cancer.

Dr. Berry explained that the role of HPV vaccination in anal cancer is emerging stating, “Although vaccination against high risk types of HPV prevents persistent infection in cervical cancer, similar data on efficacy of prevention of anal infection and lesions is becoming available.”

Efforts for early detection of anal cancer have focused on anal HPV infections as well as the detection of high-grade anal intraepithelial neoplasia (HGAIN) a potentially pre-cancerous lesion that is prevalent in groups at risk for anal cancer and similar under the microscope to cervical pre-cancerous lesions.

Dr. Berry noted that for high-resolution anoscopy (HRA)-directed biopsy is the most effective way of defining and identifying HGAIN and occasionally identifies cancer. It is the recommended procedure for follow-up of abnormal anal cytology. However, there are only a limited numbers of providers proficient in this technique, which limits its use as a screening modality.

“Presently, insufficient evidence exists to recommend screening for anal cancer because studies have not yet been performed demonstrating that treatment of HGAIN will prevent the development of anal cancer,” explained Dr. Berry. “We hope to perform these studies beginning in the next year or two.”

Ideally treatment of HGAIN should also be guided by an HRA-directed biopsy according to Dr. Berry.

He added, “When HGAIN is diagnosed or treated and it is not possible to refer patients for HRA, then close follow-up with anoscopy and digital rectal examination performed every 4 to 6 months is appropriate.”

Dr. Berry stressed that more providers should be trained in HRA to manage the growing number of patients at risk for anal cancer and anal precancerous lesions.

In addition to cancers of the cervix and anus, some strains of HPV have also been linked to cancers of the head and neck.

David G. Pfister, MD of Memorial Sloan-Kettering Cancer Center and chair of the NCCN Guidelines Panel for Head and Neck Cancers stated that although head and neck squamous cell cancer (HNSCC) is strongly associated with tobacco and alcohol, prior HPV infection is increasingly being appreciated as a risk factor.

“A significant minority of HNSCC’s occur in patients without a history of tobacco or alcohol abuse,” said Dr. Pfister. “Data indicates that HPV presence is associated with an increased risk of oropharynx cancer independent of tobacco or alcohol use.”

HPV-16, one of the high-risk types of HPV, is the viral subtype responsible for the vast majority of HPV-positive tumors in the head and neck. In addition, basaloid features can also raise the suspicion for an HPV-related tumor.

“Currently, there are no definitive recommendations with regard to screening,” Dr. Pfister said. “Direct inspection during dental examinations is the most commonly applied screening procedure.”

Initial treatment of HPV-related head and neck cancer depends on the extent of the disease, and at this point is similar to what is done for head and neck cancers unrelated to HPV. For example, single modality therapy (radiation or surgery) is typically recommended for early-stage disease, while combined modality therapy is used for later-stage cancers. However, an important difference is that with these treatment approaches, HPV-related head and neck cancers on average have a better prognosis than those unrelated to HPV.

Similar to HPV-related anal cancer, there is no labeled indication for an HPV vaccine to prevent head and neck cancer noted Dr. Pfister.

“It is important to counsel against any tobacco use as well as excessive alcohol consumption, and also to inform patients about the role of HPV and its mechanism of spread,” said Dr. Pfister.

According to Dr. Pfister, future research needs to focus on gaining a better understanding of the epidemiology of the disease, specifics about the molecular basis of HPV, the development of screening modalities and prevention strategies, incorporating HPV status into clinical trial design, and identifying survivorship issues in patients with HPV-related head and neck cancers.

The NCCN Guidelines™ are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org.

Notes:
1. The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 21 of the world’s leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.

2. The NCCN Member Institutions are: City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.

Source: American Academy of Otolaryngology
Author: Jessica Mikulski

Office-based, surgeon-performed, ultrasound-guided, fine needle aspiration (FNA) of head and neck lesions yields a statistically significant higher diagnostic rate compared to the standard palpation technique, indicates new research in the March 2010 issue of Otolaryngology – Head and Neck Surgery.

FNA is a diagnostic procedure used to investigate superficial lumps or masses. In this technique, a thin, hollow needle is inserted into a mass to extract cells for examination. FNA biopsies are a safe minor surgical procedure. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead. FNA biopsies in the head and neck have also proven to be an invaluable tool in establishing the diagnosis of lesions and masses from a broad range of sites, including the thyroid, salivary glands, and lymph nodes.

The efficacy of ultrasound-guided FNA has been well documented in many areas of the body, leading to its acceptance as the standard of care among radiologists and many cytopathologists. However, while the utility of ultrasound in the head and neck is widely appreciated and employed by the radiology community, clinicians in the United States have not embraced office-based ultrasound. The study authors sought to provide additional evidence and support for this procedure in order to ensure appropriate use by the clinical community.

In this randomized, controlled trial of 81 adults, researchers divided participants into two groups, using either ultrasound-guided or traditional palpation-guided FNA to evaluate an identified head and neck mass. The researchers then measured variables and outcomes for tissue adequacy rates, tissue type, and operator variability.

Following three passes using either palpation or ultrasound-guidance, a comparative tissue adequacy rate of 84 percent for ultrasound-guidance (versus 58 percent for standard palpation) was established. With regard to tissue type, a statistically significant comparative diagnostic advantage for ultrasound guidance was observed in thyroid tissue, while remaining statistically insignificant for lymphatic and salivary tissues.

The authors write, “With respect to FNA of palpable head and neck masses, ultrasound guidance in the hands of the clinician yields a statistically significant improved specimen adequacy rate after three passes, when compared to traditional palpation technique. This represents a discernable clinical benefit for the patient in terms of reducing the number of passes required, as well as the need and cost for a repeat office FNA or a referral for ultrasound guidance.”

Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF). The study’s authors are Jon Robitschek, MD, Mary Straub, DO, Eric Wirtz, MD, Christopher Klem, MD, and Joseph Sniezek, MD.

Source: www.msmagazine.com
Author: Adina Nack

Jorge (not his real name) feared his girlfriend would dump him. He’d been diagnosed with genital warts before meeting her, and hadn’t yet told her about his infection. Jorge was being careful—no skin-to-skin sexual contact—but the disclosure was looming. So he’d done some research and learned what caused genital warts. Armed with that knowledge, he hoped that his girlfriend wouldn’t reject him, especially since he knew she could be protected from contracting warts “because of the Gardasil vaccine.”

It never occurred to Jorge that Gardasil, made by the pharmaceutical company Merck, could also have protected him. But that’s probably because it was only last October that the Food and Drug Administration approved a “male” Gardasil for preventing genital warts. And the FDA has yet to put its stamp on another promising usage of the vaccine for men: preventing cancer, especially highly prevalent oral cancers.

Since Gardasil was FDA-approved in 2006, it has received a huge marketing push for preventing cervical cancer in women. It has come into frequent—if sometimes controversial—use for females 9 to 26 years old because it’s designed to guard them, before they ever have sex, against contracting a virus that has been linked to cervical cancer.

That virus is HPV, human papillomavirus, which causes one-third of all sexually transmitted infections (STIs) in the U.S. Gardasil offers protection against four of the 30 to 40 types of sexually transmissible HPV.

While it’s fear of cervical cancer that have motivated young women to get HPV vaccines, it can lead to oral, anal and penile cancers as well. In fact, the combined U.S. death rates for these cancers are at least twice that of cervical cancers. Oral cancers should be of particular concern, to both men and women. Some researchers believe that HPV may soon cause more oral cancers in the U.S. than alcohol or tobacco combined.

So far, Gardasil is only approved to protect men from genital warts, but that could change. Since the virus is an equal opportunity infector, it would seem that the vaccines should be equally accessible and affordable for men as well as women. But as it stands, with CDC vaccination recommendations currently less forceful for men, some predict HPV vaccination for males will be more expensive because insurance companies may be less likely to cover the costs.

STIs are medical conditions, not moral ones. Women and men should be encouraged to seek testing, consider vaccinations and, if infected, pursue treatment. When a contagious disease is stigmatized, infected individuals may be more likely to delay testing and treatment, place others at risk by not disclosing, and distort our notion of who is at risk.

Note:
1. Adina Nack, Ph. D., is associate professor of sociology and gender and women’s studies at California Lutheran University. She is the author of Damaged Goods? Women Living with Incurable Sexually Transmitted Diseases (Temple University Press, 2008.

Source: pharmalive.com/News
Author: press release

BT Pharma, a biopharmaceutical company developing innovative immunotherapies to prevent cancers caused by the human papillomavirus (HPV), announces today that it has raised EUR 13.1 million in additional funding and changed its name to Genticel. AGF Private Equity led the round, which brought in three new investors, IRDI (Institut Régional de Développement Industriel), Amundi Private Equity Funds and InnoBio fund, managed by CDC Entreprises, within FSI France Investment program. Previous investors, including Edmond de Rothschild Investment Partners (EdRIP), also took part.

To best leverage its unique and broadly applicable therapeutic vaccine platform, Adenylate Cyclase (CyaA), Genticel will focus its efforts on the prevention of cervical cancer in HPV infected women. A phase I clinical trial of Genticel’s lead therapeutic HPV vaccine, ProCervix, is scheduled for the second quarter of 2010. This bivalent product, which carries antigens originating from both HPV16 and HPV18, should offer a curative vaccine solution that will complement current prophylactic vaccines.

“This level of support from investors, particularly in the current economic environment, is extremely encouraging and confirms the potential of our drug candidates and our business plan,” said Dr Benedikt Timmerman, CEO at Genticel. “The new funding will not only enable us to conduct our ‘first-in-man’ clinical trial with the CyaA technology but also allow the company to prepare for phase II in the same indication and prepare pipeline products up to the development stage.”

Dr Alain Munoz, MD, representative of AGF Private Equity, who has joined the Supervisory Board of Genticel, stated: “I am eager to contribute to this exciting company which develops a therapeutic solution for over 90 million women worldwide who are no longer eligible for prophylactic HPV vaccines because they are already infected by either of these two most frequent oncogenic papillomaviruses.”

Thierry Hercend, MD, PhD, President of the Supervisory Board added: “We are satisfied with the way BT Pharma, initially a research entity, is making the transition to a clinical development company, now named Genticel. Its antigen delivery technology has a broad medical potential which should materialize into a clinical success in the selected HPV area, where vaccines constitute a transforming solution towards the eradication of life threatening cancers.”

M. Laurent Arthaud, General Manager of the InnoBio fund, managed by CDC Entreprises commented: “This second investment by InnoBio illustrates the objectives that were set by the FSI for the biotechnology sector: InnoBio allows selected innovative French companies, such as Genticel, to accelerate the development of their products and potentially benefit from business interests from our industrial investors, which count among the world’s largest pharma companies.”

Source: Lifestyles
Author: Nicole Printz

Just like the trucks on every corner in Abilene, rings on back jean pockets are a common sight.

Gruen Von Behrens, who visited Abilene High School on Wednesday, knows all about smokeless tobacco. He began with snuff at 13 years old.

He asked the packed high school auditorium if the students knew someone who smoked cigarettes. A sea of hands rose at the question, with almost the same number rising for his next question – did they know someone who used smokeless tobacco?
“I think about half our school smokes or uses smokeless tobacco,” Dynae Whiteley, a junior, said. “I mean, not to get anyone in trouble or anything.”

“I have friends and relatives that use tobacco,” said senior Matt Bowers. “I think smokeless tobacco is safer because the use of cigarettes affects more people through second-hand smoke. Smokeless tobacco only affects that person.”

Collin Sexton, a sophomore, also thought smokeless tobacco would be safer than smoking.

Dynae Whiteley and Paige Piper, both juniors, thought all tobacco was “equally bad.”
According to the Communities That Care 2009 survey, 23.1 percent of Dickinson County students sixth through 12th grade have used smokeless tobacco, and 27.4 percent had smoked a cigarette. Almost half of all seniors in Dickinson County had smoked a cigarette at least once. This statistics are almost double the state average.
Von Behrens, one of the eight members of the National Spit Tobacco Education Program’s speakers bureau, continued his life story. He said “not to toot my own horn, but I was hot,” a popular kid in school who played baseball. His future was bright. Fellow students looked up to him, and he “never had trouble finding a date.”

Blond with sparkling blue eyes, five foot ten inches tall and 190 pounds, the high school junior had it all. He had continued to use smokeless tobacco.

“I grew up in a rural area,” Von Behrens explained. He said his relatives, friends and older people in the community all used smokeless tobacco.

“Tobacco is a highly addictive drug,”
Von?Behrens said. “Nicotine is more addictive than crack and heroin combined.”

He found a white spot on his tongue when he was 16. He had begun drooling, having difficulty speaking and eating. It was cancer. Within six months the squamous cell carcinoma split his tongue.

“I didn’t want to tell my mother I was sick because of a choice I made to put this crap in my mouth,” Von Behrens said. His mother, a surgical nurse, made a dental appointment for him. Von Behrens had told his mother that his wisdom teeth were coming in to avoid more questions about his mouth.

“Right before he [the dentist] slapped that mask on my mouth to remove my wisdom teeth, I grabbed his hand and said ‘Wait,’” Von Behrens said. He told the doctor he had cancer, and one look in his mouth confirmed his self-diagnosis.

“Not only did I hurt myself, but I devastated that woman. I listen to people say that smokeless tobacco only hurts yourself, but I saw the pain on my mom’s face,” Von Behrens said. He had an 80 percent chance of dying within the first five years after the diagnosis.

One week after the dentist appointment, Von Behrens had surgery. During the 13 hour procedure, doctors cut off half his tongue, split the skin of his throat from ear to ear and peeled it back to search for other cancerous areas. He began radiation, which damaged the healthy skin cells while saving his life.

“My skin was so tender that if I scratched it, my skin would peel off. My mouth was blistered. It hurt to drink water,” Von Behrens said. “At the age of 19, I had to have all my teeth pulled because my gums had been damaged during the radiation.”

He had surgery to remove his mandible, and doctors reconstructed a replacement jawbone from his fibula. He pulled up his jeans to show a long scar on his left calf. He explained that doctors also removed a large section of skin from his right thigh to put on his lower face. To help his thigh heal, doctors removed sections of skin from his legs to graft on his thigh.

“Imagine holding your hand above a candle, and the flame makes your skin hot, but you can’t pull your hand away. Now your skin is blistering, but you still can’t pull your hand away. The flame is burning a hole in your hand, but you can’t pull your hand away,” Von Behrens said. “That is what my legs felt like after those surgeries.”

“Doctors are still trying to put my face back together because of what I did – using spit tobacco when I was your age,” Von Behren said. “I don’t like what I’ve been through. I hate the way my face looks and the way my voice sounds. I cringe at the thought of another surgery. I don’t feel sorry for myself – I thank God that I’m alive.”
After 34 surgeries, his face is still distorted. He will be going into surgery once more to try to reconstruct the lower part of his face.

“They’re going to insert skin expanders and put in implants.?They say that when they’re done I’ll look like before,”  Von?Behrens explained. “These surgeries have cost three million dollars – why can’t they make me look hot? Like Brad Pitt or something,” he said jokingly.

“I didn’t come here today to tell you that you’re a bad person if you use, or if your parents do,” Von Behrens said. “I would be a hypocrite if I said that. I just want to give you an opportunity to make a better choice, because I know that if someone who looked like this had come to my school when I was your age, I would have never touched the stuff.”

“I lost my face because I had an addiction,” he said solemnly.

According to the Center for Disease Control and Prevention, nicotine is a psychoactive drug that is as addictive as heroin, cocaine or alcohol.
Smokeless tobacco had been considered safer than cigarette smoking.
“Smokeless tobacco use is 98 percent safer than cigarette smoking,” a 1995 report by Dr. Brad Rodu and Dr. Phillip Cole states.

However, a 2003 testimony by Richard Carmona, M.D., M.P.H., and F.A.C.S., Surgeon General of the U.S. Public Health Service states:
“I cannot conclude that the use of any tobacco product is a safer alternative to smoking. Smokeless tobacco is not a safe alternative to cigarettes. Smokeless tobacco does cause cancer. The National Toxicology Program of the National Institute of Health continues to classify smokeless tobacco as a known human carcinogen.”
According to the National Cancer Institute, chewing tobacco and snuff contain 28 carcinogens.

“All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The amount of nicotine absorbed from smokeless tobacco is three to four times the amount delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco than cigarettes…[but] stays in the bloodstream for a longer time.”

Tobacco also contains formaldehyde, arsenic and nickel, according to the National Cancer Institute.

“In large doses, nicotine is a poison and can kill by stopping a person’s breathing muscles,” the American Cancer Society’s website states.

A brochure with tips for quitting is available at www.nidcr.nih.-gov/oralhealth/topics/spittobacco/spittobaccoaguideforquitting.htm.

The Kansas Quitline  for young adults is available by calling 1-866-526-7867 or visiting www.kstask.org/quitline. Adults can call 1-800-784-8669.

Von Behren used smokeless tobacco for four years. He was  only using one-half to three-fourths a can per day. Doctors say that even if he had gone to the hospital after noticing the white spot, he would probably have had the same surgeries.

“That white spot, that so many smokeless tobacco users have, is 60 percent more likely to turn into cancer,” Von Behrens said.

The high school students were noticeably moved by Von Behrens’ speech.

“Oh yeah, I think he’s changed how everyone thinks about smokeless tobacco,” Collin Sexton said.

“It was a big eye opener,”?Matt Bowers added.

“We didn’t know how bad the surgeries were,” Dynae Whiteley said.

“Just overall how terrible it was,” Paige Piper said in agreement.

“They [tobacco companies] try to make cigarettes and tobacco look cool,” Von Behren said.

“How cool does this look?” he asked, pointing at his face.