Monthly Archives: April 2004

Sex and the rise of oral cancer

  • 4/29/2004
  • Dr Thomas Stuttaford
  • The London Times

WORDSWORTH’S early romantic experiences were not confined to admiring daffodils. But the results of these experiences were not as transient as the beauty of the daffodils fluttering in the breeze by a lake. After Cambridge he went on a walking tour of the Continent before living for a time in France, where he fell for a French woman. When he returned to England, he had a nasty dose of chlamydia. The infection spread to his eyes and gave him life-long trouble. The additional lights he needed to follow a church service can still be seen on his pew.

It is not only the eyes that may be damaged by sexually transmitted diseases. There is a suggestion that infection with the human wart virus — HPV (Human Papilloma Virus) — which is the cause of cervical cancer, may also be one of the reasons why oral cancer is becoming more common. Springtime love might have a surprising and unpleasant sequel, for the type of cell involved in cancer of the mouth and the cervix is the same.

Two years ago Professor Saman Warnakulasuriya, of King’s College London, presented findings on oral cancer to the Royal College of Surgeons of Edinburgh. Seventy five per cent of the patients had lifestyles that included well-known risk factors for mouth cancers. In the past it was customary to attribute these to rotten or broken teeth, but either changing circumstances, or greater knowledge, has shown that the great risks for these tumours are smoking and too heavy an alcohol intake. Smoking cannabis represents a greater risk than smoking normal cigarettes. Even after these and other known factors had been excluded, 25 per cent of the patients had no obvious cause for the cancers.

Fifty years ago five men developed mouth cancers for every woman; this has now changed to two to one. In the past ten years in Scotland there has been a 50 per cent increase in the numbers of younger people developing oral cancer, and over the past 40 years a fourfold increase in those under 45 affected by it.

Before the Second World War, and the start of the welfare state, patients with oral cancers usually had them on their lips, and nearly all had appalling teeth. Many also either smoked pipes or were chain smokers of home-rolled cigarettes. Previously the cancer usually developed on the lips as a result of smoking. Now the incidence of lip cancer has fallen, whereas cancer of the tongue in men, and the floor of the mouth in women, has more than made up for this.

Recent research by Dr Elaine M. Smith, from the University of Iowa, and published in the Journal of the National Cancer Institute, supports the involvement of HPV as a causative agent for oral cancers. HPV 16, one of the high-risk types of wart virus for cervical cancer, was the most frequently detected type of HPV found in the mouth and was present almost twice as often in cancer patients as it was in healthy subjects.

The case for the increase in mouth cancers in young people being the result of changing sexual habits, especially oral sex, could account for the changes in age group, differences in the site of the tumors — tongue in men and floor of mouth in women, rather than lips — and for social class differences. Income group is now becoming a more important risk factor, whereas older age is becoming less relevant.

April, 2004|Archive|

Why We’re Losing the War on Cancer.

  • 4/29/2004
  • Ralph W. Moss, PhD
  • CancerDecisions.com

An article of great importance has appeared in Fortune magazine. It is titled “Why We’re Losing the War on Cancer.” The author, Clifton Leaf, is Executive Editor of the magazine and is himself a survivor of adolescent Hodgkin’s disease. So he is no stranger to cancer or to the potential of modern treatment to cure some of its less common manifestations.

Leaf recognizes that he himself was extraordinarily lucky in surviving. But he still has the courage to ask, “Why have we made so little progress in the war on cancer?” He readily acknowledges the flood of recent favorable publicity for drugs such as Gleevec, Herceptin, Iressa, Erbitux and most recently Avastin. “The cure has seemed closer than ever,” he says. “But it’s not,” he continues. “Hope and optimism, so essential to this fight, have masked some very real systemic problems that have made this complex, elusive, relentless foe even harder to defeat. We are far from winning the war. So far away, in fact, that it looks like losing.”

Leaf gives some facts about cancer that are well known to insiders but will come as a shock to many readers:

–More Americans will die of cancer in the next 14 months than have died from every war that the US has fought…combined.

–Cancer is about to replace heart disease as the number one US killer. It is already the biggest killer in many age groups.

–Even adjusting for age, the percentage of Americans dying from cancer is about the same as it was in 1971 (when Nixon declared the war on cancer) or even back in 1950! Meanwhile, age-adjusted deaths from heart disease have been slashed by 59 percent and from stroke by 69 percent during that same half-century.

–The much-vaunted improvement in survival from cancer is largely a myth. “Survival gains for the more common forms of cancer are measured in additional months of life,” says Leaf, “not years.”

–Most of the improvement in longevity of cancer patients can be attributed to life style changes (the promotion of which has not been a conspicuous priority for the National Cancer Institute) and especially to early detection.

–The few dramatic breakthroughs (such as in Hodgkin’s disease) mainly occurred in the early days of the war on cancer. There has been little substantial progress in recent decades despite nearly ubiquitous claims to the contrary.

–According to one biostatistician at M.D. Anderson Cancer Center, long-term survival from common cancers such as prostate, breast, colorectal and lung “has barely budged since the 1970s.”

–According to Andy Grove, the chairman of the Intel corporation and a major “player” in funding research, “It’s like a Greek tragedy. Everybody plays his individual part to perfection, everybody does what’s right by his own life, and the total just doesn’t work.”

Today, Leaf concludes, the cancer effort is “utterly fragmented – so much so that it’s nearly impossible to track down where the money to pay for all this research is coming from.” And what money! Leaf estimates that US $14.4 billion is spent each year on cancer research. “When you add it all up, Americans have spent close to $200 billion, in inflation-adjusted dollars, since 1971.” It is certainly justifiable to ask for an accounting of that one-fifth of a trillion dollars.

Irrelevant Research

What have we gotten for that huge sum? In fact, research has become increasingly irrelevant to the real-life problems faced by cancer patients. “The narrower the research niche,” says Leaf, “the greater the rewards the researcher is likely to attain.” Particularly thought-provoking is his assertion that cancer research is fundamentally flawed in its orientation. Cancer scientists have self-confidently created “animal models” and artificial cell lines that supposedly mimic an equivalent human disease, such as breast, colon or lung cancer. These scientists then triumphantly “cure” cancer in these laboratory models. But cell lines and tumors growing in mice are drastically different from spontaneous human tumors, the kind that afflict us and our loved ones. A flawed model is not likely to yield useful results. Those who closely follow the cancer field have become inured to an endless series of “breakthroughs” in mice that almost never pan out when tried in the clinic.

According to one of America’s most celebrated cancer researchers, Dr. Robert Weinberg of the Massachusetts Institute of Technology (MIT), “a fundamental problem which remains to be solved in the whole cancer research effort, in terms of therapies, is that the pre-clinical models of human cancer, in large part, stink.”
Prof. Bruce Chabner of Harvard University expressed similar frustration: “Cancer researchers say, ‘I’ve got a model for lung cancer!’ Well,” says Chabner, “it ain’t a model for lung cancer, because lung cancer in humans has a hundred mutations. It looks like the most complicated thing you’ve ever seen genetically.” Why then are these artificial and intrinsically misleading systems still being used? The answer is simple. These artificial models are “very convenient, easily manipulated,” says Vishva Dixit of the Genentech company. “You can assess tumor size just by looking at [them, ed.].” There’s no thought, still less acknowledgement, given to the fact that shrinking a tumor, especially in a mouse, has little to say about human survival or well-being. “Hundreds of millions of dollars are being wasted every year by drug companies using these models,” says Weinberg. But with the huge profits to be made from tumor-shrinking drugs like Avastin, Erbitux and oxaliplatin, what incentive do they have to stop?

Shrinking Tumors

Leaf also tackles the subject of cancer regression, or shrinkage of tumors, pointing out that it is a totally inadequate measure of the effectiveness of a drug. (This is a theme I dealt with in depth in my book, Questioning Chemotherapy, and many times since then.) “It is exciting to see a tumor shrink in mouse or man and know that a drug is doing that, “says Leaf. “It is a measurable goal.” But, he adds, “tumor regression by itself is actually a lousy predictor for the progression of disease.” The sad truth is that “regression is not likely to improve a person’s chances of survival.” Read those words over carefully – you do not encounter such ideas often in mainstream publications.

By contrast, what really matters, says Leaf, is stopping metastases (secondary growths), which kill the great majority of cancer patients. “So you’d think that cancer researchers would have been bearing down on this insidious phenomenon for years,” he says. In reality quite the opposite is true. Fortune magazine’s examination of NCI grants, going back to 1972, revealed that less than 0.5 percent of study proposals focused primarily on metastases. Half of one percent! Of nearly 8,900 grant proposals awarded last year, 92 percent didn’t even mention the word metastasis. According to I.J. (Josh) Fidler of M.D. Anderson, the study of metastases is avoided by cancer researchers because it is a tough and so far unfruitful field, and not likely to yield quick and easy results. Instead, researchers focus on techniques and avenues that they know will produce measurable results in the laboratory. The attitude, Fidler says, is “Here’s an antibody I will use, and here’s blah-blah-blah-blah, and then I get the money.” (Fidler, to his great credit, has published over 250 scientific articles on combatting metastases.)

The current crop of new drugs comes in for scathing criticism as well. A study done in Europe showed that twelve new anticancer drugs approved in Europe between 1995 and 2000 were no better in terms of improving survival, quality of life, or safety than those they replaced. But as far as the drug companies were concerned they had one big advantage: they were several times more expensive to purchase than the old drugs. “In one case,” says Leaf, “the price was 350 times higher.” Leaf points out that two new blockbuster drugs, Avastin and Erbitux, are lacking in substantial effectiveness. Avastin, he says, “managed to extend the lives of some 400 patients with terminal colorectal cancer by 4.7 months.” And Erbitux? “Although it did indeed shrink tumors, it has not been shown to prolong patients’ lives at all.” Still, a weekly dose costs $2,400.

The article then features a list of “Miracle Cures That Weren’t,” including radiation therapy, interferon, interleukin-2, endostatin and Gleevec. As Leaf himself admits, Fortune itself once featured Interleukin-2 on its cover with a huge headline reading: “Cancer Breakthrough.”

Yet despite the profound importance of what Leaf has to say in this article, you are unlikely to see the article cited as front-page news. I was dismayed to find that, this morning, for example, the total number of citations at Google News for this article was three (out of 4,500 news sources). By comparison, at the time of its announcement Erbitux was generating over 1,000 articles per day in the same search engine. Leaf’s article can be ordered online at http://www.fortune.com/fortune/articles/0,15114,598435,00.html (The March issue of Fortune in which it appeared may still be available at some newsstands.) However, excellent though this article is, and delighted though I am to see this subject aired so prominently, I do regret the fact that Leaf did not take his arguments quite far enough. For instance, he includes a section on “how to win the war,” but this seems anemic and hard to follow compared to his previous incisive analysis. In my opinion, he doesn’t deal with the basic economic and political underpinnings of the war on cancer. The emphasis on ever-more-profitable drugs is dictated by the very nature of Big Pharma and its unhealthy influence on the whole research and approval apparatus.

Also, Leaf fails to cite the most prominent critics of the war on cancer, especially those with an orientation towards complementary and alternative medicine (CAM). Thus, while he hits the nail squarely on the head in many instances (as, for example, when he discusses the danger of equating temporary tumor shrinkages with increased survival), he also misses many other important aspects of the problem that are well known to people who have followed this field for decades.

When he quotes a scientist as saying, “We have a shortage of good ideas,” this is likely to elicit incredulity from the CAM community. There are scores of excellent researchers who have proposed exciting new ideas for treating cancer over the last few decades. Most of them have been ignored or dismissed out of hand. Some have even been persecuted. My 1980 book, Cancer Industry, discussed eight such cases. A dozen years later I published Cancer Therapy, which contains reviews of over a hundred unconventional treatments, most of which could still be usefully pursued. Many treatments discussed in my book Antioxidants Against Cancer have still not been examined, much less acted upon.

Let me give one example of an original idea that has been studiously ignored by the mainstream. I recently received a reprint from my colleagues Eva and Laszlo Csatary, MD, of their latest results using MTH-68. This treatment is based on the non-toxic Newcastle disease virus vaccine and is seemingly quite beneficial in select cases, especially in brain cancer. The article appears in the most recent issue of the Journal of Neuro-Oncology, with co-authors from respected institutions in Germany, Hungary and California. It is not the first such article that Dr. Csatary has published. I myself co-authored a best case series with him on this topic in 1999, which appeared in a respected peer-reviewed journal. Admittedly, this is not exactly a “new” idea, simply an unrecognized one. In fact, the name of the compound, MTH-68, refers to the date of its discovery…1968, three years before the war on cancer was launched, and before many of today’s cancer researchers were even born. Despite repeated articles and letters, press releases, news conferences and appeals to governmental authorities, this promising treatment has made little progress in the world of conventional medicine. The response from the American “cancer establishment” to the Csatarys’ work has been a thundering silence.

But this June, 25,000 oncologists will once again gather at the American Society of Clinical Oncology (ASCO) meeting for their annual four-day convention. Don’t expect any center-stage attention, though, for promising non-toxic treatments, such as MTH-68, which could provide true departures from the quagmire of the stalled war on cancer. Even Mr. Leaf, for all his trenchant criticism, seems unaware or unconcerned that there are many other treatments that are potentially valuable, yet are being systematically ignored. And they will continue to be ignored until the public, Congress and scientific community wake up to the fact that the most powerful force driving cancer research is Big Pharma’s need for a hefty bottom line and a quick return on its investments.

It is enough to make the angels weep.

References

Csatary LK, Moss RW, Beuth J, et al. Beneficial treatment of patients with advanced cancer using a Newcastle disease virus vaccine (MTH-68/H). Anticancer Res. 1999 Jan-Feb;19(1B):635-8.

Csatary LK, Gosztonyi G, Szeberenyi J, et al. MTH-68/H Oncolytic viral treatment in human high-grade gliomas. Journal of Neuro-Oncology 2004;67:83-93.

Leaf, Clifford. Why we’re losing the war on cancer. Fortune 2004;149(6):76-97..

April, 2004|Archive|

‘Dirty Dozen’ of Dietary Supplements Named

  • 4/24/2004
  • Jennifer Warner

Consumer Reports Issues List of Potentially Dangerous Supplements

Despite known hazards, many potentially dangerous dietary supplements are readily available for purchase in stores and on the Internet, according to a new report from Consumer Reports. Today, the magazine released its “dirty dozen” list of dietary supplements that it says are too dangerous to be on the market. The list includes yohimbe, bitter orange, chaparral, and andro. But researchers say the supplements are sold under many names, which makes it hard for consumers to know what they’re getting. Many of the supplements that made the list have already been banned in other countries. But researchers say regulatory barriers created by Congress have prevented the FDA from taking similar actions to protect consumers in this country. The announcement coincides with a report on supplement safety issued today by the Institute of Medicine, which suggests that the FDA should take action against potentially hazardous dietary supplements and asks Congress to ease restraints on the agency.

Dirty Dozen of Dietary Supplements

Researchers from the consumer magazine say the supplements that made its “dirty dozen” list may cause cancer, severe liver or kidney damage, heart problems, or even death. For example, they say the herb aristolochia has been conclusively linked to kidney failure and cancer in China, Europe, Japan, and the U.S. Yohimbe, a supplement marketed as a sexual stimulant and herbal Viagra, has been linked to heart and respiratory problems. The supplement bitter orange, whose ingredients have effects similar to those of the banned weight-loss stimulant ephedra, is also on the list of potentially dangerous supplements. Many of these dietary supplements are sold in both single and combination products marketed for a wide variety of uses, from building muscle and losing weight to easing stress and arthritis.

Researchers divided the list into three categories based on the amount of available evidence about the dietary supplement: definitely hazardous, very likely hazardous, and likely hazardous. Since the brand names of the products containing the dirty dozen supplement ingredients vary widely, researchers say consumers should read ingredient labels carefully and look for the following:

Definitely Hazardous

Aristolochic acid (Aristolochia, birthwort, snakeroot, snakeweed, snagree root, sangrel, serpentary, wild ginger).They list this as having caused documented human cancers, and it is linked to kidney failure.

Very Likely Hazardous — These are banned in other countries, have an FDA warning, or show adverse effects in studies:

Comfrey (Symphytum officinale, ass ear, black root, blackwort, bruisewort, consolidae radix, consound, gum plant, healing herb, knitback, knitbone, salsify, slippery root, symphytum radix, wallwort). Abnormal liver function or damage, often irreversible; deaths reported.

Androstenedione (4-androstene-3, 17-dione, andro, androstene). Increased cancer risks and decreases in “good” HDL cholesterol have been reported.

Chaparral (Larrea divaricata, creosote bush, greasewood, hediondilla, jarilla, larreastat). Abnormal liver function has been linked to use.

Germander (Teucrium chamaedrys, wall germander, wild germander). Abnormal liver function has been linked to use.

Kava (Piper methysticum, ava, awa, gea, gi, intoxicating pepper, kao, kavain, kawa-pfeffer, kew, long pepper, malohu, maluk, meruk, milik, rauschpfeffer, sakau, tonga, wurzelstock, yagona, yangona). Abnormal liver function has been linked to use.

Likely Hazardous — These have adverse-event reports or theoretical risks.

Bitter orange (Citrus aurantium, green orange, kijitsu, neroli oil, Seville orange, shangzhou zhiqiao, sour orange, zhi oiao, zhi xhi). High blood pressure; increased risk of heart arrhythmias, heart attack, and stroke are risks associated with use.

Organ/glandular extracts (brain/adrenal/pituitary/placenta/other gland “substance” or “concentrate”). Theoretical risk of mad cow disease, particularly from brain extracts.

Lobelia (Lobelia inflata, asthma weed, bladderpod, emetic herb, gagroot, lobelie, indian tobacco, pukeweed, vomit wort, wild tobacco). Difficulty breathing and rapid heart rates are thought to be associated with this.

Pennyroyal oil (Hedeoma pulegioides, lurk-in-the-ditch, mosquito plant, piliolerial, pudding grass, pulegium, run-by-the-ground, squaw balm, squawmint, stinking balm, tickweed). Liver and kidney failure, nerve damage, convulsions, abdominal tenderness, burning of the throat are risks; deaths have been reported.

Scullcap (Scutellaria lateriflora, blue pimpernel, helmet flower, hoodwort, mad weed, mad-dog herb, mad-dog weed, quaker bonnet, scutelluria, skullcap). Abnormal liver damage.

Yohimbe (Pausinystalia yohimbe, johimbi, yohimbehe, yohimbine) Blood pressure changes, heart beat irregularities and heart attacks have been reported.

Experts say it’s important to tell your doctor about any dietary supplement you may be taking. Not only do many supplements have significant side effects, but they may also interfere with the effectiveness of prescribed medications, such as birth control pills.

SOURCES:Consumer Reports, May 2004. News release, Consumer’s Union. FDA. Institute of Medicine.

April, 2004|Archive|

Even Though It Kills Almost One Quebecer Every Day, 61% of People Know Little About Oral Cancer

  • 4/24/2004
  • MONTREAL,Canada
  • CNW Telbec

Although it is one of the deadliest cancers and kills almost one Quebecer every day, 61% of people still know little about oral cancer. In addition, 20% of those surveyed were unable to name a single possible cause of the disease, and 36% named other causes, probably incorrect ones. These were the findings of a huge survey of 1,000 adult Quebecers by the SOM-R firm, commissioned by the Ordre des dentistes du Québec (ODQ), and conducted from March 24 to 31 this year.

“It just goes to show that we have to make an effort to inform people about this disease,” said Dr. Robert Salois, ODQ President, who was attending a screening clinic held today at Carrefour Laval. The ODQ and members of dental societies have been holding all sorts of oral cancer awareness and screening activities across the province, in fact, since early April.

Causes that could be better known

Aside from a general lack of knowledge about oral cancer, Quebecers are ill informed about its causes. It seems that 63% of those surveyed mentioned smoking as the main cause, 7% cited poor nutrition, 6% said alcohol, and 36% gave other causes. One person in five (20%) was unable to name a single cause.

The ODQ reminds everyone that heavy smoking and drinking are the main risk factors for oral cancer. Although separately they can both cause this type of cancer, when combined they multiply the risk. “A heavy smoker is 18 times more likely to develop oral cancer than a non-smoker and, if he also drinks heavily, the risk climbs to 80 times,” explained Dr. Salois.

Who can detect the disease and how

When asked which health professional was best placed to detect this disease, 39% of people said their doctor, and 35%, their dentist. Another 15% mentioned other professionals, and 11% did not know.
Finally, 56% of those queried said they knew that dentists can detect oral cancer through a clinical examination during a routine check-up. “I myself have detected three cases of oral cancer and saved three patients’ lives,” said Dr. Salois.

Early detection can save lives

According to the National Cancer Institute of Canada, there were 730 new cases of oral cancer in Quebec in 2003, leading to some 300 deaths. The ODQ reminds everyone that prevention and early detection remain the best weapons in combating oral cancer. The earlier the cancer is detected, the better the chances of survival. Eight people out of ten survive more than five years after a diagnosis of oral cancer if it is detected early, as compared with only two out of ten if it is discovered at an advanced stage.

The ODQ would also like people to be better informed about the early warning signs of oral cancer. The most common are sores or ulcers in the mouth that have not healed after more than two weeks, growths on the lip, and a red or white spot on the gums, tongue or edge of the lip. If you have any of these signs, you should see a health professional straight away.

April, 2004|Archive|

New Data Describes Tumor-Killing Activity Of Introgen

  • 4/22/2004
  • Austin, Texas

Recent preclinical studies provide new insight into the molecular pathways by which p53, the active component of Introgen Therapeutics’ (NASDAQ: INGN) Advexin therapy, kills tumor cells. These preclinical studies were undertaken in order to provide additional molecular data supporting the clinical benefit observed during the clinical development of Advexin, now in phase 3 trials for the treatment of head and neck cancer. The studies were conducted by Introgen’s collaborators at Okayama University in Japan and at The University of Texas M. D. Anderson Cancer Center and were published earlier this year in an issue of Molecular Cancer Therapeutics. Introgen has previously sponsored studies in Japan which include a phase 1-2 trial in non-small cell lung cancer and a phase 2 trial in esophageal cancer.

These recently reported findings add substantially to our knowledge of the timing and expression levels of p53 and genes that are activated by p53 protein after the delivery of Advexin therapy. The p53 protein and gene functions as a tumor suppressor by arresting cell growth, inducing programmed cell death, causing cancer cells to differentiate, and inhibiting the growth of new blood vessels required to support tumor growth. Preclinical and early clinical studies with Advexin have shown that delivery of the p53 gene to cancer cells can provide therapeutic benefit by reducing tumor volume, halting tumor growth, and improving survival. The current study provides additional information regarding the specific pathways that mediate the observed therapeutic effects of Advexin.

Lou Zumstein, Ph.D., Introgen’s director of research said, “These studies provide additional evidence supporting Advexin’s ability to attack cancer cells through multiple molecular pathways. The additional information about the timing, duration and persistence of expression of p53 and genes activated by p53 following Advexin administration may help us to further optimize Advexin therapy. Additionally, quantifying the expression levels of genes that are activated by p53 protein may help to identify other candidates for gene-based cancer therapy.” Introgen is a leading developer of biopharmaceutical products designed to induce therapeutic protein expression using non-integrating gene agents for the treatment of cancer and other diseases. Introgen maintains integrated research, development, manufacturing, clinical and regulatory departments and operates a commercial-scale, CGMP manufacturing facility.

April, 2004|Archive|

Oral cancer survey shows dental hygienist’s role in catching cancer

  • 4/20/2004
  • Dr. D. R. Sawyer, Dr. M. Pyle,
  • Case Western Reserve University’s School of Dental Medicine

In one of the first national surveys of dental hygienists about their knowledge and screening practices for oral cancers, researchers at Case Western Reserve University’s School of Dental Medicine found indications that while dental hygienists view screening for oral cancer an important component of their practice and possess comparable oral cancer knowledge with the general dentist in the private practice, they often do not carry out oral cancer screenings.

Early oral cancer is often asymptomatic and if not caught during its earlier stages, the chances of surviving the disease diminish significantly, according to Dr. Danny R. Sawyer, professor and chairman of Case’ department of oral diagnosis and radiology and assistant dean of didactic education. He conducted the study along with Dr. Marsha Pyle, Case associate dean for dental curriculum; Meredith Bailey, a second-year Case dental student; and Maureen Vendemia, professor of dental hygiene from Youngstown State University.

The 25-question survey from Case was mailed to 2,000 randomly selected dental hygienists nationwide, with 575 individuals responding to questions about their oral cancer knowledge and oral cancer screening practices. The survey findings were presented at the 2004 annual research meeting of the American Dental Education Association and were compared to an oral cancer survey of dentists presented by the authors at the 2003 ADEA’s annual meeting.

Some of the findings from the dental hygienist survey were:

* Most dental hygienists place a high level of importance on oral cancer screening, are trained to screen for the cancers and are non-smokers themselves. However, only 53 percent do head and neck examinations on their patients.
* The majority of the hygienists elect to do exams on patients because of their age and/or tobacco and alcohol use.
* Most hygienists ask their patients about using tobacco products, but less than half ask about alcohol drinking habits, and less than half counsel patients about alcohol and tobacco use.
* For hygienists, working in an office with a single dentist, 79 percent said they do not have tobacco cessation materials available to give to patients, yet a similar percentage felt it was important to have this information available. Dental hygienists that smoke were less likely to offer tobacco cessation materials than those who do not smoke.
* When compared to the 2003 dentist survey, dental hygienists’ cancer knowledge that related to the cause, appearance of and risk factors related to oral cancer was comparable to that of the general dentist.

The Case surveys of dental hygienists and dentists coincide with American Dental Association efforts to raise awareness of oral cancer and increase cancer screenings by professionals in the dental field. Also the importance of the research findings will help Case rewrite the Case School of Dental Medicine’s dental curriculum, which is currently under revision as the dental school strives to train the dentist for the 21st century.

The research group encourages people to be proactive in their oral health care by suggesting that if an oral-cancer screening examination is not done with our routine dental care, then ask your dentist or dental hygienist to do one. “After all, early diagnosis offers the best chance for cure,” stressed Sawyer.

OCF Note: It’s particularly appalling that they suggest that the public should have to ask for a screening… something that should be done as a matter of routine in every dental practice.

April, 2004|Archive|

Oral cancer survey from Case dental school shows dental hygienist’s role in catching cancer

  • 4/20/2004
  • Case Western Reserve University

In one of the first national surveys of dental hygienists about their knowledge and screening practices for oral cancers, researchers at Case Western Reserve University’s School of Dental Medicine found indications that while dental hygienists view screening for oral cancer an important component of their practice and possess comparable oral cancer knowledge with the general dentist in the private practice, they often do not carry out oral cancer screenings.

Oral cancer impacts people. According to the American Cancer Society, approximately 28,900 people were diagnosed in 2002 with oral cancers and 7,400 people would died as result of their disease.

The overall five-year survival rate was 56 percent.

Early oral cancer is often asymptomatic and if not caught during its earlier stages, the chances of surviving the disease diminish significantly, according to Dr. Danny R. Sawyer, professor and chairman of Case’ department of oral diagnosis and radiology and assistant dean of didactic education.

He conducted the study along with Dr. Marsha Pyle, Case associate dean for dental curriculum; Meredith Bailey, a second-year Case dental student; and Maureen Vendemia, professor of dental hygiene from Youngstown State University. The 25-question survey from Case was mailed to 2,000 randomly selected dental hygienists nationwide, with 575 individuals responding to questions about their oral cancer knowledge and oral cancer screening practices. The survey findings were presented at the 2004 annual research meeting of the American Dental Education Association and were compared to an oral cancer survey of dentists presented by the authors at the 2003 ADEA’s annual meeting.

Some of the findings from the dental hygienist survey were:

* Most dental hygienists place a high level of importance on oral cancer screening, are trained to screen for the cancers and ae non-smokers themselves. However, only 53 percent do head and neck examinations on their patients.
* The majority of the hygienists elect to do exams on patients because of their age and/or tobacco and alcohol use.
* Most hygienists ask their patients about using tobacco products, but less than half ask about alcohol drinking habits, and less than half counsel patients about alcohol and tobacco use.
* For hygienists, working in an office with a single dentist, 79 percent said they do not have tobacco cessation materials available to give to patients, yet a similar percentage felt it was important to have this information available. Dental hygienists that smoke were less likely to offer tobacco cessation materials than those who do not smoke.
* When compared to the 2003 dentist survey, dental hygienists’ cancer knowledge that related to the cause, appearance of and risk factors related to oral cancer was comparable to that of the general dentist.

The Case surveys of dental hygienists and dentists coincide with American Dental Association efforts to raise awareness of oral cancer and increase cancer screenings by professionals in the dental field. Also the importance of the research findings will help Case rewrite the Case School of Dental Medicine’s dental curriculum, which is currently under revision as the dental school strives to train the dentist for the 21st century.

The research group encourages people to be proactive in their oral health care by suggesting that if an oral-cancer screening examination is not done with our routine dental care, then ask your dentist or dental hygienist to do one.

“After all, early diagnosis offers the best chance for cure,” stressed Sawyer.

April, 2004|Archive|

Easy, regular mouth checkups could save your life

  • 4/19/2004
  • Stephen Engroff, M.D., D.D.S.
  • PR Newswire

What did former president Ulysses S. Grant, baseball legend Babe Ruth, actor Yul Brynner and musician George Harrison all have in common? They were all diagnosed with, and died from, cancer of the head and neck. This form of cancer often gets little attention, but it remains a significant health-care problem. This disease is often missed in its early stages and, when diagnosed in its later stages, treatment becomes extensive and survival is often compromised.

Most cancers of the head and neck begin in the mucosal lining and are termed squamous cell carcinoma. They frequently involve the mouth and throat and are commonly referred to as oral cancer. It is estimated that about 28,000 cases are diagnosed in the United States every year. Of the reported cases, 1,380 occur in Pennsylvania and about 350 Pennsylvanians die of this disease every year.

Symptoms associated with oral cancer include white and red patches that persist for more than two weeks, non-healing ulcers, persistent sore throat, the feeling of a lump in the throat, loosening of teeth and pain that may radiate to the ear.

The most commonly associated risk factors for development of oral cancer are tobacco (smoking and smokeless tobacco) and alcohol use. When these two things are combined, the risk increases substantially. Although a majority of oral cancer patients have these risk factors, there is a growing number who do not have any known risk behaviors.

Treatment options depend on the stage of the disease and the areas that it involves. Surgery and radiation therapy are the most effective treatments. In the early stages, one form of treatment is sufficient. When the cancer has reached later stages, survival is increased with surgery followed by radiation. In certain instances, chemotherapy may be necessary.

Long-term survival of oral cancer is a major issue. Since the 1950s, overall survival has changed very little. When patients are diagnosed at an early stage, survival is excellent (90 percent). However, there is a low rate of cure for patients with advanced stage disease (25 percent). Low cure rates are attributed to the fact that, for many patients, their disease is not discovered at an early stage. Routine screening is advised by the American Cancer Society, including an oral exam, and should be done every three years for patients age 20 to 40 and yearly thereafter. Your medical or dental provider should do screenings.

Fortunately, one aspect of treatment that has advanced in recent years is reconstruction. In the past, surgery for oral cancer was often accompanied by a high degree of deformity and dysfunction, leaving patients with significant problems with speech and swallowing. New advances in reconstructive surgery have allowed head and neck surgeons to replace missing tissues and significantly improve quality of life for patients. Techniques that “transplant” tissues from other areas of the body to the head and neck have allowed the most ideal types of tissues to be used for reconstruction. Surgeons are now able to replace large sections of bone, soft tissue, and teeth, often allowing patients to maintain their appearance, their ability to eat and their ability to speak.

The most important messages relating to oral cancer are: modify behaviors that put you at risk for this disease, be aware of changes in your mouth and have regular check-ups.

Evaluation and treatment of seemingly small and non-painful lesions of the mouth may, in fact, save your life.

Stephen Engroff, M.D., D.D.S., is in private practice in State College and is credentialed to practice at Mount Nittany Medical Center. He specializes in oral and maxillofacial surgery and has a particular interest in oral cancer treatment.

April, 2004|Archive|

Routine thyroid cancer procedure may be shortened

  • 4/12/2004
  • New York
  • Amy Norton
  • Journal of Nuclear Medicine

A standard post-surgery routine that can leave thyroid cancer patients feeling run-down for weeks may be largely unnecessary, new research suggests. The procedure, widely used for decades, calls for patients who have had their cancerous thyroid glands removed to go off of their normal hormone replacement therapy for six to eight weeks so that they can receive follow-up care.

But in the new study, researchers found that just two weeks off of thyroid replacement was sufficient for about 90 percent of the 284 patients they assessed. This shortened time frame could cut the amount of time that patients suffer the side effects of stopping their normal hormone replacement therapy, according to the study authors.

The thyroid is a gland in the neck that secretes hormones that help regulate metabolism. When thyroid hormone levels drop too low, a condition called hypothyroidism, metabolism slows, and symptoms such as fatigue, poor memory, weight gain and depression set in. So when the gland is removed due to cancer, patients must take synthetic replacement hormones for life. However, doctors have to temporarily stop patients’ replacement therapy to give them radioactive iodine. Because the thyroid gland absorbs nearly all of the iodine that enters the body, radioactive iodine can be used to destroy cancerous thyroid cells. Alternatively, iodine can be given in a small amount to reveal on X-rays any residual cancer remaining after surgery.

When patients stop their hormone replacement, the brain produces more thyroid-stimulating hormone (TSH), which causes any remaining thyroid cells in the body to become “really hungry for iodine,” Dr. Perry W. Grigsby, the study’s lead author, explained.

So once TSH levels are high enough, any thyroid cells remaining after cancer patients’ surgery will soak up the radioactive iodine. Doctors have traditionally thought that to get this TSH elevation, patients have to reduce thyroid medication levels for four to six weeks, then go off hormone replacement completely for two weeks. The problem is that this sends them into weeks of what Grigsby called “profound” hypothyroidism. “They feel really lousy,” he told Reuters Health. “They’re tired, worn out.”

To minimize the time that patients go through this misery, Grigsby and his colleagues at Washington University School of Medicine in St. Louis have relied on simply stopping patients’ thyroid hormone therapy for two weeks.
Their study, reported in the Journal of Nuclear Medicine, reviewed the records of 284 of these patients. It found that nearly 90 percent had sufficiently high TSH levels after about two weeks off of their medication.

According to Grigsby, the standard, six- to eight-week routine arose from a recommendation made several decades ago that was essentially based on logic rather than scientific evidence. The rationale was that giving patients a weaker thyroid medication for several weeks would allow the body to clear the hormone–and boost TSH levels–more quickly once the medication was stopped. But the approach has not been backed up by evidence. “I think it’s been basically a medical myth,” Grigsby noted.

In contrast, he said he thinks there is sufficient science to support his team’s abbreviated tactic. Two other recent studies, he and his colleagues note, have also shown that at least 90 percent of patients reach the needed TSH level after two to three weeks off of hormone replacement

April, 2004|Archive|

Health Pros Warn Against Chewing Tobacco

  • 4/12/2004
  • Columbus
  • Associated Press

Health care professionals hope new education programs will prevent teenagers from getting hooked on smokeless tobacco.

Dentists say they’re seeing more Ohio kids _ rural and suburban _ using the chewing tobacco and snuff generally associated with farmhands and baseball players. Some doctors predict a dramatic rise in oral cancers in the next several decades unless more is done to teach young people about the risks of smokeless tobacco.

“It’s not (an exaggeration) to say that it represents a little bit of a sleeping-giant health risk at this point in time,” said Dr. David Schuller, director of the Arthur G. James Cancer Hospital and a specialist in head and neck cancers. In many cases, users start in middle school and think smokeless tobacco poses little risk.

A 2002 Ohio Department of Health study found that almost 12 percent of Ohio high school boys had dipped in the past month. About 1 percent of the girls had. In middle schools, about 5 percent of the boys and almost 2 percent of the girls had. And although 77 percent of teenagers recognize the danger of cigarettes, only 40 percent know chewing tobacco can hurt them, according to a survey by the U.S. surgeon general.

To combat the problem, dentists and schools throughout the state are utilizing a new program called Operation TACTIC, for Teens Against Chewing Tobacco in the Community. It includes print materials and a video in which Tammy Smith and her son Tyler tell the sobering story of their husband and father, Kevin Smith, of Gallipolis. Smith died at 31 after having his tongue removed and enduring a failed attempt to replace it with muscle from his chest and tissue from his legs.

Adult use of smokeless tobacco is twice as high in Appalachia as the rest of the state. The Ohio State University College of Dentistry is working in Hocking,
Morgan, Vinton and Washington counties in southeast Ohio to compare two approaches to quitting. One is a video; the other, one-on-one intervention.
The study is paid for with tobacco-settlement money.

“One of the things that’s remarkable about oral cancer is that it still remains difficult to treat,” said Dr. Henry W. Fields, the study’s lead investigator. “Survival rates haven’t changed much in the past several decades.”

Oral cancer grows in the lips, cheeks, tongue, throat, gums, larynx and esophagus. Those who survive it can be disfigured after surgeons remove cancerous bone and tissue. The first signs are white patches in the mouth, often discovered in the dentist’s office. Slightly more than half of patients with oral cancers live five years, according to statistics from the American Cancer Society. Doctors diagnose oral cancer in more than 18,000 people in the United States each year.

OCF Note: While out of a well-respected source, this article contains many errors or conclusions that are not explained accurately. Doctors will actually diagnose 30,000 new oral cancer patients in the US this year, not 18,000. If their description of oral cancer includes cancers of the throat as they have stated, (which have the same risk factors, but are usually categorized as a different type of cancer than oral), you can increase that number by 12,000 more individuals. When Dr. Henry Fields states that this disease is “difficult to treat”, what he should have said is that is difficult to treat in its later stages which unfortunately are about 66% of the cases. This issue of late discovery and diagnosis yields the horrible 50% death rate associated with the disease. In its early stages it responds well to conventional surgery and radiotherapy, with survival rates for carcinoma in situ, stage one, and stage two cancers between 80 and 90%.

April, 2004|Archive|