Monthly Archives: July 2008

Oral cancer screening at Saratoga Race Course

Source: Liacars.com
Author: Dave Detling

The track is a place filled with tasty treats. It’s a confectionary dream and dentist’s worst nightmare.

Joe Gayner is spending his Wednesday at the race course. But he’s not sitting track side. He’s on folding chair with a dentist hovering over him. With tools in hand, Gayner is being told to bite down and show a big grin.

It is an odd sight, but Joe Gayner, along with a massive group of fans, is being screened for oral cancer.

“That was the easiest checkup I’ve ever had,” said Gayner.

Doctor Robert Trager is a practicing dentist. He’s been screening people at the track for the past five years. He says it’s the perfect place for early detection.

“You have a lot of people who come from all over the country, especially to Saratoga who haven’t been to a dentist. And the ones who have don’t even realize what oral cancer is,” said Dr. Trager.

It’s recommended you see a dentist at least twice a year for a cleaning and an oral cancer screening. But the last place people are expecting to find one is here at the Saratoga race track.

“It seems a little silly actually. My daughter worried because I was a smoker years ago and she wanted me to have this cancer checked to make sure I’m clean,” said Terry Rasmus.

With a clean bill of health, most people screened are glad this free service is available.

Damien Haas who works at Restaurant Row agrees.

“I think it is one of the last things I would have thought of. I was kind of dragged into the situation here but overall I’m glad that they’re doing it,” Haas said.

“I didn’t understand why they had the cancer screenings and then I asked and they said because of the tobacco and the different people smoke and smoke. A lot of people are at risk, so it’s a good idea,” said Alisha Daddario.

The goal of these dentists is to screen over 100 people.

Early detection is key, because oral cancer is something you don’t want to gamble with.

Tobacco use in baseball on the decline

Source: Major League Baseball (mlb.com)
Author: Mychael Urban

Users remain, but rules, more awareness have made impact

Baseball has taken a variety of steps to cleanse itself of the stain — literal, cultural and medical — of tobacco use, and there’s plenty of empirical evidence showing that usage, while far from completely eradicated, has decreased over the past decade or so.
“A lot of things started happening and people quit,” said Twins manager Ron Gardenhire, who went cold turkey on chewing tobacco 14 years ago at the request of his daughters. “It’s definitely not as prevalent today as it once was. You don’t see the big wad and guys spitting all over the place.

“It’s one of those things — awareness. I think making people aware of the dangers has really changed it.”

Yet there is plenty of anecdotal evidence showing that there remain a number of players, coaches, managers and other club personnel who still sneak a smoke, a dip, a wad or a plug.

And in what some see as another sign of progress, they are indeed sneaking.

The suggestion, it appears, is that those who can’t quite kick the habit have reached an unspoken compromise in the name of protecting future generations.

Conceding that tobacco use is “down but not out,” as one of several players told MLB.com, practitioners of our national pastime who continue to partake are hoping that an old adage proves helpful: Out of sight, out of mind.

“I’d love to stand up in front of a bunch of kids and tell them I don’t do it,” Oakland A’s general manager Billy Beane said. “But I can’t. I could tell them they shouldn’t do it themselves, that it’s terrible, that it can kill them, and I’d be telling the truth. But I’d also be a little bit of a hypocrite.”

So, short of lecturing impressionable youngsters who so adore their big league heroes that they’ll mimic everything from batting stances to cap-wearing quirks, Beane does the only truly helpful thing he can think of when it comes to his smokeless habit.

He hides it the best he can.

To wit: When Beane was cornered by a pack of print reporters in the home clubhouse at McAfee Coliseum in Oakland earler this season, he acquiesced to the impromptu press conference — until a television reporter, cameraman in tow, joined the group.

“Hold on. Don’t turn that camera on,” said Beane, who at the time was milking a sizeable — and quite visible — dip between his upper lip and gums. “Let me finish up with these guys; I’ll give you what you need when we’re done.”

Minutes later, when the print media peeled off, Beane peeled the dip from his lips, rinsed his mouth out with a little water, spat into a nearby garbage can and said to the TV people, “OK, thanks. Now, what do you need?”

Asked about the exchange a couple of days later, Beane sheepishly shook his head.

“The last thing I think anyone associated with the game wants is for little Timmy at home to see any of us doing something we all know is bad and thinking, ‘If they can do it, I can do it,'” Beane said. “So if you can keep it out of the public eye, you do it. It’s not the best solution, obviously, but short of the ideal, that’s probably the way a lot of guys are going these days.”

Pricey, graphic deterrents
Beane is far from alone. Many of the tobacco-using players, coaches and managers contacted spoke of a degree of self-disdain, just as many of them said they do everything they can to keep their use on the down-low.

“Basically, you just don’t make it obvious,” said Brewers reliever Mark DiFelice, currently with Triple-A Nashville. “We don’t dip in front of a five-year-old kid.”

“I think certain guys try to watch the cameras and keep it away from kids, which is great,” added Indians bench coach Jeff Datz.

Some players feel so guilty about potentially influencing a youngster to try tobacco that they wouldn’t allow their identities to be revealed.

“It is something young kids should not get started on. I do it, but I wouldn’t recommend it to anyone,” said one player. “I don’t know why I do it, other than the fact I enjoy it. I don’t think it is something I would pass on to anyone and say it is worth doing.”

And while everyone acknowledged that tobacco use remains fairly prevalent, they agreed that baseball’s steps to thwart it have had an impact. Among those steps is the all-encompassing ban on tobacco products at the Minor League level that has been in place since 1993 — fines that started at $100 at the lower levels are up to $1,000.

“They have the ‘dip police,’ and nobody wants to be paying that fine in the Minor Leagues when you’re not making that much money,” said Royals first baseman Mark Teahen, a non-user. “Guys come in and check to see if you’ve got dip or chew in your locker or anything like that. If they find it, they fine the player a certain amount [and] the manager a certain amount.

“More often than that, the manager says, ‘If you get caught with it, you’re paying my fine, too.'”

“You just didn’t do it [in the Minors],” rookie Rays third baseman Evan Longoria said. “Or if they did, they hid it.”

For big leaguers, there’s no hiding from the many horror stories about the inherent health hazards associated with tobacco use. Virtually every player who has been to Spring Training with a Major League club has seen, during anti-tobacco education presentations in the clubhouse, the disturbing images of the late Bill Tuttle.

An outfielder for the Tigers, Royals and Twins in the 1950s and ’60s, Tuttle lost most of his jaw to oral cancer, and before his death in 1998, traveled extensively to speak about the dangers of chewing tobacco on behalf of the National Spit Tobacco Education Program (NSTEP) of Oral Health America.

“You look at [what happened to Tuttle], and that’s the last thing you want to have happen,” Cubs reliever Bob Howry said. “There are options. You just make the choice.”

Alas, Howry chooses to chew. Like many players, he said he only does it during baseball season.

“I’ve been trying to quit for the past four or five years,” said Phillies reliever Clay Condrey. “In the offseason, I can get down to one dip a day, then go a couple of days without one. Then the game starts back up and I’m right back into the same mode.”

Cheap tricks and no-cigs digs
“Dip” is the fine-grain tobacco that comes in the cans you see outlined in the back pocket of some players. “Chew” is the shredded, twisted or bricked tobacco that comes in pouches. Prior to 1998, tobacco company reps were allowed to leave free “logs” of dip cans for players or boxes of chew pouches in big league clubhouses. That practice, as well as clubs providing any tobacco for its players, is now banned as well.

Given the enormous salaries of Major League players, you might think these bans haven’t had much of an impact. You’d be wrong.

“Oh, God, yes. Yes it has,” said an American League equipment manager, laughing at the idea. “You wouldn’t believe how cheap some of these guys are. Believe me, it has cut down the amount of dipping and chewing around here. … Baseball did a smart thing there, because not only are some of these guys cheap, but they’re also pretty spoiled and lazy.

“[Immediately after the clubhouse ban], I started running out of gum and sunflower seeds a lot quicker than I usually did. Guys just didn’t want to spend their own money on the stuff. And the ones that did, they got all [upset] when I had to tell them the clubbies couldn’t take their money and go get it for them. A ban is a ban, man.”

Dip and chew aren’t the only tobacco products traditionally abused in baseball. Cigarettes were once such an accepted part of the game that tobacco companies advertised in every ballpark and printed their own licensed baseball cards.

Cigarettes aren’t commonplace as they were when pitcher Don Stanhouse was nicknamed “Full Pack” by Orioles skipper Earl Weaver — Weaver said he needed a full pack of smokes to handle the stress Stanhouse’s outings created — but they’re still around.

Tigers manager Jim Leyland is the most visible example. Hide, schmide. He makes little effort to shield his habit from the eyes of babes, and he certainly doesn’t let any stadium smoking bans stop him from firing up a few “heaters” — that’s what players call them — in visiting managers’ offices on the road.

Many of his smoking brethren do hide their habit, though — and not just to keep from sending an unhealthy message to children. One 50-something big league manager who puffs away at least a pack a day manages to do it without his own wife knowing she’s married to a Marlboro Man.

“If she knew I still smoked, she’d kill me,” said the skipper, who threatened a little bodily harm himself after seeing that a local newspaper reporter had outed him in a story several years back.

Few current players smoke cigarettes — “Except when they’re at a bar or something,” one player said — but Marlins lefty Scott Olsen, 24, is one of them.

“Nobody asks me for cigarettes, and I don’t ask people for dip,” Olsen said. “I would say about 10 in here do [use smokeless tobacco]. I think I’m the only one that actually smokes, as far as I know. I know a lot more used to smoke then they do now.”

Rangers reliever Eddie Guardado can vouch for Olsen on that count.

“When I first got up to the big leagues [with the Twins], it was shocking,” Guardado said. “There would be Kent Hrbek, sitting at his locker smoking a cigarette. … You’d look across at the other dugout and there would be Mickey Tettleton up the tunnel with a cigarette in his mouth, getting ready to hit. You don’t see that any more. I don’t know if guys still smoke cigarettes, but if they do it, it’s pretty quiet. You don’t see it any more.”

Defiance, gradual decline
The Minor League ban was met with resistance from some players who felt their rights were being violated.

“It’s not like [the players] are doing anything illegal,” Longoria said. “Anybody can walk into a store and buy a can of dip. I guess I can see where they’re coming from because we’re such role models to kids; they don’t want to see guys on TV with big ol’ dips in their mouths.

“But I can’t say anything against [tobacco use] because I do it.”

Mariners bullpen coach Norm Charlton was particularly defiant when discussing his tobacco usage.

“I have been doing it since I was 13 years old,” he said. “Is it bad for you? Yeah, probably. Are the studies they tell you about overblown and not the truth? Yeah, probably. Should I quit? Yeah, probably. Am I going to quit? No. It’s nicotine, which is a stimulant — and a legal one, at that. … But once you get to be 18 years old, you can make any decision you want. If it’s OK to get your butt shot off in a war, then you should be able to dip if you want.

“But little kids should not be doing it.”

If the results of a 10-year study on the Pirates’ smokeless tobacco usage is any indication, there’s hope that the kids of today won’t be doing it when they become the big leaguers of tomorrow. Published by the American College of Sports Medicine in 2006, the study — 2,266 mouth examinations were performed at Spring Training from 1991-2000 — showed a decrease in usage from 41 percent in year one of the study to 25 percent in year 10.

“I think it’s greatly diminished over the years, from the time [the ban] was implemented in the Minor Leagues,” said Royals manager Trey Hillman. “I think it’s definitely the route to go as far as the perception to the younger generation.”

“It’s less than it was in the past,” Datz said. “Whether that’s because of the Minor League ruling, I don’t know. Hopefully we can say, ‘Yes, it has helped.’ But it seems to me there is less chewing than in the past. There’s still enough that do it — myself included, unfortunately. But I think it is on the decline. It’s been a gradual trend that’s been more prominent in the last few years.”

Said MLB vice president of public relations Pat Courtney: “We are pleased that our Minor League tobacco policy is having an impact on current use in the Major Leagues. By preventing use throughout the Minor Leagues, our hope was that players would not get into the habit of using during games.”

Marlins veteran outfielder Luis Gonzalez is doing his part to keep the trend moving in the right direction, having filmed a public-service announcement denouncing tobacco use. He said he’s been influenced by Diamondbacks broadcaster Joe Garagiola Sr., who is heavily involved with NSTEP.

“I think [usage] may be less,” Gonzalez said. “When I played in Arizona, Joe … was a strong advocate against tobacco use and stuff, so I was always a big supporter of that. [I come] from a family where my dad smoked a lot, and he had cancer. My grandfather smoked a lot and died from cancer.”

Unlike one current player who still dips despite having lost three family members to various forms of cancer over the past five years, explaining his habit by saying only, “I guess I’m stupid,” Dodgers righty Joe Beimel also heeded his family history.

“I had an uncle who dipped, and he died from cancer of the throat,” Beimel said. “It’s disgusting, it tastes gross and smells bad. I tried it once and I couldn’t understand why people do it.”

Echoed Mariners reliever R.A. Dickey: “I think it’s disgusting, and I haven’t done it since I tried it one time during my freshman year in high school. Someone offered me [some chewing tobacco], I tried it and threw up. Ever since then … I’ve never had the urge to try it again.”

Gonzalez tried chewing once in college and also had a bad experience.

“I’m a big bubble-gum guy,” he said.

The AL equipment manager said most of his guys are big bubble-gum guys, too, especially the younger ones. The message, he said, is being heard.

“There are still players who do it, mostly older guys, but that they’re hiding it is actually a good sign,” he offered. “At least they know it’s wrong.”

Note:
Mychael Urban is a national writer for MLB.com. Several staff reporters contributed to this story. This story was not subject to the approval of Major League Baseball or its clubs.

Evaluating Prognostic Techniques for Head and Neck Cancers Following Chemotherapy and Radiation: Presented at AHNS

Source: Doctor’s Guide (www.docguide.com)
Author: Arushi Sinha

Ultrasound-guided fine-needle aspiration is a technique that has low specificity for diagnosis of head and neck cancers following chemotherapy and radiotherapy interventions, researchers reported here at the American Head and Neck Society (AHNS) 7th International Conference on Head and Neck Cancer.

Lisa van der Putten, MD, Department of Otolaryngology — Head and Neck Surgery, VU University Medical Centre, Amsterdam, Netherlands, presented research focused on optimising prognostic techniques for patients with head and neck cancers receiving chemotherapy and radiotherapy.

“This is one of the first studies to examine the effectiveness of prognostic techniques, like ultrasound-guided fine-needle aspiration, following chemoradiation for head and neck cancer,” Dr. van der Putten explained during a presentation on July 20.

Lymph node metastasis is one of the most significant prognostic factors for patients with head and neck carcinomas, so Dr. van der Putten and colleagues examined a variety of strategies for prognosis of these patients following chemotherapy and radiotherapy interventions.

The objectives of their study were to evaluate the effectiveness of ultrasound-guided fine-needle aspiration and to determine some of the prognostic factors for outcomes following chemoradiation.

Both modified radical neck dissection (MRND) and selective neck dissection (SND) are used as treatment methods for patients with head and neck carcinomas who are at high risk for metastatic cancer. The study team evaluated the effectiveness and safety of an observational approach to lymphadenopathy following these surgical interventions.

The study followed outcomes of 61 patients who underwent salvage neck dissections for suspected recurrence. Of this patient group, 26 (43%) patients were found to have a vital tumour requiring further intervention. Thirteen patients underwent SND, and the other 13 patients underwent MRND.

The 5-year regional control rate was 79%, and the overall survival rate was 36%. In addition, looking at the efficacy of ultrasound-guided fine-needle aspiration, the researchers found that the procedure had an 80% sensitivity rate with a 42% specificity rate, resulting in a 40% positive predictive value and an 81% negative predictive value.

Importantly, the team also found that the presence of positive surgical margins (P < .001) and the presence of residual disease (P = .03) were significantly linked to adverse overall outcomes.

Based on these findings, particularly those of fine-needle aspiration, the authors concluded that there may be room for improved diagnostic techniques. “The ultrasound-guided fine-needle aspiration has low specificity,” Dr. van der Putten concluded.

[Presentation title: Effectiveness of Selective and Radical Neck Dissection for Regional Pathological Lymphadenopathy After Chemoradiation. Abstract P060]

Assessing Risk for Carotid Artery Occlusion Following Surgery for Head and Neck Tumours: Presented at AHNS

Source: Doctor’s Guide (www.docguide.com)
Author: Arushi Sinha

Use of single-photon emission computed tomography (SPECT) may be indicated to monitor patients after skull-based surgery for head and neck tumours, according to research presented here at the American Head and Neck Society (AHNS) 7th International Conference on Head and Neck Cancer.

Balasubramanian Balaji, MBBS, Department of Surgical Oncology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India, presented research results on July 20 on methods to monitor potential adverse effects on carotid artery functioning for patients undergoing head and neck tumour surgery.

The study enrolled 20 patients undergoing surgery for a wide range of head and neck tumours: 7 patients with ear malignancies; 7 with tumours of the cranial nerves; 4 with parotid tumours; and 2 with salivary gland tumours.

The carotid artery is often located in close proximity to skull-based tumours, so its functionality may be compromised following tumour resection. Therefore, these patients were evaluated for the presence of possible carotid artery occlusion subsequent to surgery.

“We designed a stepwise study for carotid-artery occlusion based upon tolerance by the patients,” Dr. Balaji explained.

Patients were tested in stages for possible carotid-artery occlusion on the affected side using manual compression as the first step. If this was tolerated, a balloon catheter technique was used to look for signs of possible circulatory abnormalities. Following successful catheterisation, an additional SPECT scan using technetium-99 labelled ethylcysteinate dimer was performed to evaluate the severity and location of possible circulatory abnormalities.

“We used the technetium-99 labelled ethylcysteinate dimer SPECT scan as an adjunct to the other diagnostic techniques,” said Dr. Balaji.

The series of diagnostic procedures showed that 4 of 20 patients did not tolerate the balloon catheter, 5 patients had moderate hypoperfusion, and 11 patients were deemed to be normal. SPECT scan identified individuals with hypoperfusion who were previously found to be normal during the balloon catheterisation. In addition, 3 patients underwent carotid resection.

Based on these findings, Dr. Balaji concluded that SPECT scan may be indicated for monitoring patients after skull-based surgery. His study found that even though patients seemed normal during balloon catheterisation, they subsequently were revealed to have occlusions based on SPECT findings.

“Balloon occlusion test of carotid artery with only clinical monitoring is inadequate in evaluation of cerebral vascular reserve,” Dr. Balaji concluded.

[Presentation title: Assessment of at Risk Internal Carotid Artery in Skull Base Surgery. Abstract P203]

Advexin Improves Survival in Head and Neck Cancer

Source: CancerConsultants.com
Author: staff

The targeted agent Advexin (p53 tumor suppressor therapy) improves survival compared with methotrexate among head and neck cancer patients with the p53 biomarkers. These results were recently presented at the American Association for Cancer Research (AACR) Centennial Conference on Translational Cancer Medicine 2008: Cancer Clinical Trials and Personalized Medicine.

Head and neck cancers originate in the oral cavity (lip, mouth, tongue), salivary glands, paranasal sinuses, nasal cavity, pharynx (upper back part of the throat), larynx (voice box), and lymph nodes in the upper part of the neck. Worldwide, head and neck cancer is diagnosed in approximately 640,000 people annually and is responsible for approximately 350,000 deaths each year.
Patients whose head and neck cancer has returned following prior therapy have suboptimal long-term outcomes with standard therapies and research continues to evaluate novel therapeutic approaches to improve these outcomes.

The field of genetics is emerging as a potential therapeutic tool in the treatment of cancer. Although still in clinical trials, researchers are testing and exploring the use of genetic strategies for several types of cancer.

Gene therapy, a type of treatment in the field of genetics, often involves the insertion of a functional, normal gene into a cell that has a dysfunctional gene that may cause or contribute to the growth of cancer.

One gene, called the p53 gene, is of major focus in the evaluation of gene therapy since a significant portion of cancers have been shown to have a mutation (alteration) of this gene.
The p53 gene, sometimes called the “cell suicide” gene, helps to keep normal cell replication under strict control. If there is a mutation in a cell’s DNA, or if a cell is infected with a virus, one action of the p53 gene is to stop further replication of this damaged cell and inhibit further progression of the mutation. This occurs by stopping the growth of the cell or causing the cell to kill itself (apoptosis). In cells that have a mutation within their p53 gene, there is no restraint on replication; this leads to uncontrolled, rapid growth of the cell—the characteristic trait of cancer.

Advexin® is a vaccine that has completed the last phase of clinical trials. It is comprised of a functional p53 gene that is inserted into a virus that causes the common cold (adenovirus). Advexin can be injected directly into the cancer, with the cancerous cells taking up the adenovirus as well as the functional p53 gene. Researchers speculate that Advexin may have a direct cancer killing effect as well as enhance anticancer effects of treatment since cancer therapy often damages the DNA of cancer cells. A normal p53 should recognize this damage and halt replication or induce apoptosis of the cancer cell.

Researchers recently conducted a clinical trial to compare Advexin to the chemotherapy agent methotrexate among patients with head and neck cancer that has returned or stopped responding to prior therapies. Results were analyzed according to the p53 biomarker that has demonstrated an associated treatment benefit with Advexin.

• Patients with the p53 biomarker associated with benefit from Advexin experienced significantly improved 6-month and one-year survival compared with those treated with methotrexate
• Patients that did not have the p53 biomarker experienced a significant survival improvement with methotrexate compared to Advexin.
• Advexin was associated with fewer side effects than methotrexate.

The researchers stated that treatment with Advexin among patients with the identified p53 biomarker improves survival over methotrexate among patients with head and neck cancer that has progressed following prior therapies. Advexin is not yet approved by the United States Food and Drug Administration (FDA).

Reference:
Introgen Therapeutics. ADVEXIN(R) Shows Statistically Significant Six-Month and Overall Survival Benefit as Compared to Methotrexate in Prospectively Defined Biomarker Patient Population. Available at: http://phx.corporate-ir.net/phoenix.zhtml?c=190273&p=irol-newsArticle&ID=1178041&highlight=. Accessed July 2008.

Oral cancer test’s value unproven

Source: Boston.com
Author: Neil Munshi

The usual dental checkup goes something like this: lean back, open wide, avoid flinching, rinse, spit. But in addition to looking for cavities, dentists are increasingly checking for oral cancer, too – and not just by peering and probing.

A relatively new screening tool allows dentists to better gauge whether a patient is in the early stages of oral cancer by looking at the mouth under a special light.

But the test may be overused, and it’s not yet clear whether it justifies its price tag.

A review of studies of the devices published in this month’s Journal of the American Dental Association concluded that for low-risk patients, there is “insufficient evidence to support or refute the use of visually based examination” devices, such as the ViziLite.

Still, roughly 10 to 15 percent of the 100,000 practicing dentists in the United States offer ViziLite or a similar scan, which some credit with helping them better identify lesions in the mouth than simply looking with the naked eye.

“Frankly, I’ve seen stuff I would normally just have glossed over and it doesn’t hurt to take a second look . . . at something that might not normally be looked at – that might save somebody’s life,” said Dr. Anjum A. Ansari, a downtown Boston dentist, who charges her patients $80 for the service. Insurance has only covered the scan for one of her patients, Ansari said.

That $80 is the test’s only actual advantage, said Dr. Mark Lingen, of the University of Chicago Medical Center.

“They may be of financial benefit to the dentist, but . . . the benefit to the dentist in terms of diagnosing lesions that might be premalignant or malignant is minimal at best,” said Lingen, who published a paper on the devices in the January issue of the journal Oral Oncology. “I think there’s very little evidence that these devices are of benefit to the patients.”

The July review involved previous studies of high-risk patients – smokers or those with family history of cancer – who were screened by cancer specialists, said co-author Dr. Joel B. Epstein, of the University of Illinois at Chicago. For high risk patients, the screen may be useful, said Epstein, who is a member of the medical advisory board for Zila Pharmaceuticals, which manufactures ViziLite.

There is not enough evidence to show whether the devices are useful in the hands of general dentists caring for low-risk patients, Epstein said.

ViziLite Plus with TBlue is used by 182 dentists in Massachusetts, and approximately 12,000 nationwide.

“Our take is it’s great to have oral cancer at the forefront of discussions because it’s so critical,” said Jeff Mazzarella, vice president of Zila. Each year, roughly 32,000 Americans are diagnosed with oral cancer – compared to about 250,000 for lung cancer – and 8,000 die from the disease.

To do the cancer screen, a dentist swabs the patient’s mouth with toluidine chloride (TBlue) and looks carefully with a specially lighted probe in a darkened exam room. The stain highlights rapidly dividing cells that can indicate cancerous growth.

There’s no scientific evidence suggesting the devices help dentists detect precancerous lesions any better than the naked eye, said Dr. Vikki Noonan, associate professor at the Boston University School of Dental Medicine. “Clinical trials are needed.”

But, a second look for lesions is never a bad thing, said Dr. Michael Kahn, chairman of the oral pathology department at Tufts University’s dental school.

“Whether the light helps you see it or not, you’re taking a second look,” said Kahn, who practiced general dentistry before becoming an oral pathologist. “The bottom line is we found it, and we found it earlier than we would have otherwise.”

Has Cancer Spread? Research Identifies Best Way to Find Answers

Source: Newswise (www.newswise.com)
Author: staff

For patients with head and neck cancer, accurately determining how advanced the cancer is and detecting secondary cancers usually means undergoing numerous tests – until now. New Saint Louis University research has found that the PET-CT scanner can be used as a stand-alone tool to detect secondary cancers, which occur in 5 to 10 percent of head and neck cancer patients.

The study findings, which will be presented on Tuesday, July 22 at the 7th International Conference on Head and Neck Cancer in San Francisco, Calif., will streamline care for head and neck cancer patients allowing them to begin treatment earlier, says Michael Odell, M.D., assistant professor of otolaryngology at Saint Louis University School of Medicine.

“There has been a lot of confusion about the best ways to evaluate head and neck cancer patients to see if their cancer has spread,” said Odell, the study’s primary author.

“Traditionally, doctors used many different tests, such as chest X-rays, CT scans, ultrasounds, bone scans and blood work. Patients went through too many unnecessary procedures because there was no real consensus on the best way to evaluate them.”

According to Odell, when choosing the appropriate treatment plan for head and neck cancer patients, it is critical to accurately stage the primary cancer and detect secondary cancers. Odell’s research shows PET-CT scanning can replace all the other traditional tests.

Using the PET-CT scanner is not just a time saver, though; it also can be a life-saver.

“We all know that the time from when your doctor sees you to the time when you initiate treatment is important to outcomes,” Odell explained. “So minimizing the number of tests is definitely important from an outcome standpoint.”

To determine if PET-CT scans were as effective as the tradition tests, Odell and his colleagues evaluated the scans of 77 patients and found four to contain secondary cancers and one to have an additional primary cancer. The study’s rate of detection – 7 percent – was inline with the results of previous studies, which range from 5 to 10 percent.

The PET-CT, which is an acronym for position emission tomography/computed tomography, combines two the benefits of both tests to offer unsurpassed diagnostic capabilities in pinpointing cancer. The PET scan is a highly sensitive scan that detects the growth of cancer cells, while the CT scan provides a detailed picture of the internal anatomy and the location of the growth.

While the current study focused exclusively on head and neck cancer patients, Odell says that it is likely that it will be applicable to other cancers.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.

Smile — Benefits Improve

Source: Wall Street Journal (online.wsj.com)
Author: M.P. McQueen

At a time when workers are shouldering an ever-greater share of health-insurance costs, some insurers surprisingly are increasing benefits in dental plans.

A growing number of plans are rewarding patients who get regular preventive care by allowing them a higher maximum yearly allowance. More plans are paying for services that were formerly excluded, including tooth bleaching and dental implants to replace missing teeth. And more plans also are covering additional cleanings or gum treatments for patients who are pregnant or have chronic health conditions.

The new features are showing up in employer-provided group plans and some are finding their way even into individual plans.

A Way to Fight Disease
Experts say the enhanced preventive care is aimed at reducing overall employer health costs by reducing the prevalence of serious disease. A growing number of studies have linked gum disease to such conditions as pre-term births, diabetes and heart disease, although the relationship is not always well understood by science.

(All dental plans aren’t available in all areas, however, and some of the new features are included only if an employer chooses to offer them.)

Delta Dental of California, New York and Pennsylvania and Affiliates, one of the largest dental plans in the U.S., recently introduced a plan that doesn’t count diagnostic and preventive care toward the annual maximum. That enables patients to conserve more of their annual benefits allowance, usually capped at $1,500 to $2,500, for such big expenses as bridges and crowns.

Guardian Life Insurance plans are allowing patients to roll over a share of the unused portion of their annual limit for future years provided they file at least one paid claim a year.

The changes are intended to reward patients for getting regular, routine care, insurers say.

When it comes to patients with chronic diseases, Principal Financial Group just started offering extra cleanings for patients undergoing treatment for cancer of the head and neck, saying research indicates they are at greater risk of complications from dental procedures.

Delta Dental last year added a third paid exam and a free extra cleaning per year for pregnant women, and an additional deep cleaning for those with signs of periodontal disease.

Guardian is covering up to four routine or periodontal maintenance cleanings at the recommendations of the dentist, without additional verification, says Richard Goren, DDS, second vice president.

Expanded Coverage
More insurers also are paying — usually 50% — for dental implants, which formerly were excluded. Others are paying part of the cost of tooth whitening or providing a discount for it. Evelyn Ireland, executive director of the National Association of Dental Plans, says insurers are doing this to entice consumers into visiting the dentist for necessary routine care.

Many insurers also are adding interactive online tools to make it easier to shop for providers and compare fees. That’s useful because insured patients usually must share about 20% of the cost of basic services such as fillings and extractions, and 50% of major restorative work like bridges. MetLife, Principal Financial, Delta Dental and Guardian all have introduced cost estimators to calculate the average costs of services in a given Zip Code.

Quality of life in patients treated for cancer of the oral cavity requiring reconstruction: a prospective study

Source: Acta Otorhinolaryngol Ital, June 1, 2008; 28(3): 120-5
Authors: AB Villaret et al.

Surgical treatment for cancer of the oral cavity can result in dramatic aesthetic and functional sequelae partially avoidable by reconstructive techniques. Many studies concerning quality of life have been carried out in order to retrospectively assess outcomes after such major oncological procedures. Aim of this study was to evaluate, in a prospective fashion, the quality of life as a primary endpoint in patients treated for cancers involving the oral cavity and requiring reconstruction.

The study design consisted of a prospective evaluation of pre- and post-operative quality of life at 3, 6, and 12 months to assess variations during follow-up using two different questionnaires: the University of Washington Quality of Life and the Head and Neck Performance Status Scale.

Between May 1999 and October 2004, 92 patients with oral cancer requiring reconstruction were treated. All were included in the study, but only 35 (38%) concluded the evaluation protocol at one year after surgery without evidence of disease. The mean pre- and post-operative (3, 6, and 12 months) scores of the questionnaires and the scores of specific University of Washington Quality of Life categories (disfigurement, chewing, swallowing, comprehension of speech) were evaluated.

The impact on residual quality of life of different factors such as gender, extension of tongue and mandibular defects, type of reconstruction, and radiotherapy was statistically quantified with a Wilcoxon non-parametric test and logistic regression for multivariate analysis. Comparison of mean pre- and post-operative scores between the University of Washington Quality of Life and Head and Neck Performance Status Scale, showed a similar trend during the study period with a significant decrease at 3 months after surgery and subsequent gradual improvement at 6 and 12 months. The majority of patients (77%) preserved normal or near normal functions at 12 months after surgery. The chewing domain worsened considerably (p <0.05), with poorer outcome in patients undergoing segmental mandibulectomy (p <0.05). By multivariate analysis, mandibular resection maintained its statistical significance in the chewing domain (p = 0.038). Moreover, the type of reconstruction was an independent factor (p = 0.038) that influenced the University of Washington Quality of Life total score, with better functional results after free flap reconstruction.

Despite the dismal prognosis of patients affected by advanced oral cavity cancer, reconstructive techniques play a crucial role in maintenance of satisfactory quality of life.

Authors:
AB Villaret, J Cappiello, C Piazza, B Pedruzzi, and P Nicolai

Authors’ affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy

Cancer nurse takes on a special role

Source: ChronicleLive (www.chroniclelive.co.uk)
Author: Helen Rae

A head and neck cancer nurse specialist has been appointed to offer expertise to those living with cancer in the region. Macmillan Cancer Support has employed new head and neck cancer nurse specialist, Laura Gradwell-Nelson, based at Newcastle’s Freeman Hospital. Laura, 28, of New York, North Shields, will work alongside existing Macmillan head and neck nurse specialist Amanda Dear and will see patients throughout Tyneside and Northumberland.

Laura said: “We have a fantastic team working with head and neck patients in the area and I’m delighted to be part of it.

“I work with patients who may have lost the ability to speak, eat, drink or even breathe. Some have to deal with facial disfigurement after surgery.

“These are complex cases and my job is to try and make life as easy as I can for the patient and their family in what can be an incredibly stressful and frightening time. I try and build a relationship up with the patient because I feel being on the same level is crucial to helping them deal with their cancer.

“Amanda and I coordinate the patient’s medical care, such as pain control and managing side effects.

“We also spend time listening to their concerns, talking through their options and generally being a point of contact when they need help, advice or are worried about anything.

“I also point them to the Macmillan benefits advisers if they need financial help. Throughout my career I’ve always had an interest in head and neck cancer and I love my job. No day is ever the same and I meet some remarkable people.”

There are more than 30 different places head and neck cancers can occur, including cancer of the throat, mouth, nose, ears, tongue and lymph nodes in the neck.

Head and neck cancers are more common in smokers and people who drink, and even more common in people who do both. Chewing tobacco or betel nut is also a risk factor.

Often the care needed for head and neck cancers is very complex and Laura and Amanda work with a multi-disciplinary team. The team includes surgeons, head and neck radiologists, a reconstructive surgeon, a plastic surgeon, speech and language therapists and Macmillan dieticians.