Monthly Archives: March 2010

Adjuvant radiotherapy helpful in early, node-positive oral cancer

Source: www.acr.org
Author: David Douglas

Postoperative radiotherapy significantly improves survival in patients with early T stage oral cavity squamous cell carcinoma and a single positive lymph node, researchers report in the March issue of Archives of Otolaryngology: Head and Neck Surgery.

“Even for small primary tumors of the oral cavity, the presence of a single positive lymph node may be an indication to offer radiation despite the relatively early stage of these tumors,” lead author Dr. Mark G. Shrime told Reuters Health by email. “This is especially true in T2 tumors of the tongue and the floor of mouth.”

Dr. Shrime of Boston University Medical Center and colleagues examined data on more than 1500 patients who had surgery between 1983 and 2004.

Patients who had postoperative radiotherapy had significantly better 5-year overall survival (54.2% versus 41.4%). The largest advantage was in patients with T2 primary tumors (48.8% versus 32.5%). The difference in patients with T1 tumors (63.4% versus 56.5%) was not statistically significant.

Also, the authors report, adjuvant radiotherapy was particularly effective in T2 tumors of the tongue (improving 5-year survival from 37.9% to 52.3%) and floor of the mouth (boosting survival from 17.7% to 39.9%). For all other sites, adjuvant radiotherapy was not associated with improved overall 5-year survival.

The 5-year cause-specific survival rate was 64.3% in patients treated with surgery alone, versus 72.1% in patients who also had radiotherapy.

While the results appear encouraging, the researchers call for “further analysis with either large multi-institutional series or more detailed population-based registries…with other prognostic pathologic factors controlled for.”

Source: Arch Otolaryngol Head Neck Surg 2010;136:225-228.

March, 2010|Oral Cancer News|

Rise in mouth cancer linked to STI’s, primarily HPV16

Source: www.nhs.uk
Author: staff

The Daily Telegraph reported that a “rise in mouth cancer may be due to sexually transmitted infection”. The newspaper said that there has been a 50% increase in the number of mouth cancers in the last 20 years, and the increase appears to be in those cases related to the human papilloma virus (HPV).

The story is based on an editorial in the British Medical Journal by cancer specialists, which highlighted an increase in the numbers of a specific type of throat cancer in the UK. The specialists also discussed studies from other countries that show an increase in the proportion of HPV-related throat cancers.

The editorial reported on a very small number of studies, but it shows that there may be a need to investigate the incidence of HPV-related throat cancers in the UK, to track these cases and to see if HPV-related cancers should be treated differently to non-HPV-related throat cancers. There is insufficient evidence at the moment to suggest that the HPV vaccination, currently available for teenage girls, should also be given to boys.

Where did the story come from?
This editorial was written by Hisham Mehanna, director of the Institute of Head and Neck Studies and Education at University Hospital, Coventry, and colleagues at the University of Liverpool, Université Catholique de Louvain and the University of Texas.

The editorial was commissioned and published by the British Medical Journal and was not externally peer reviewed.

What was the editorial about?
This editorial was written by cancer specialists to highlight the increase in throat cancers in the UK, an increasing proportion of which are thought to be related to HPV.

The researchers looked at a particular type of throat cancer, called oropharyngeal squamous cell carcinoma, in men. They say that, between 1989 and 2006, there was an increase from seven cases per 100,000 men to 11 cases per 100,000. The authors discussed the implications of this rise for both prognosis and policy decisions, and also looked at the proportion of this type of throat cancer that may be associated with HPV.

What evidence did the editorial put forward?
The authors suggest that the increase in numbers of oropharyngeal squamous cell carcinoma could be accounted for by a rise in HPV-related oropharyngeal carcinoma.

They cite a study from Stockholm in Sweden, which looked at how many biopsies from this type of cancer were positive for HPV. The results suggest that 23.3% of biopsies were positive for HPV in the 1970s, compared with 93% between 2006 and 2007. They say that another study in America found that 60-80% of recent biopsies from this type of cancer were HPV positive, compared with 40% in the previous decade.

Smoking and alcohol consumption increase the risk of throat cancer. The authors cite research which suggests that the prognosis for HPV-positive throat cancers is better than for non-HPV-related cancers. This research suggests that advanced HPV-related throat cancers are associated with a two-year survival rate of 87.5-95%, compared with 62-67% for advanced non-HPV-related cancers.

The authors suggest that oral sex may be a means by which HPV is passed on and that this could be a reason for the increase in the incidence of HPV-related oropharyngeal cancers in the UK. They discuss an analysis of eight studies on the risk of various types of head and neck cancers in men and women in various countries (excluding the UK) with increasing numbers of sexual partners. The analysis had a total sample of 5,642 people with head or neck cancer and 6,069 controls. There was a borderline significant increase in the risk of developing oropharyngeal cancer for people who had six or more lifetime sexual partners (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.01 to 1.54), four or more oral sex partners (OR 3.36, 95% CI 1.32 to 8.53) and an earlier age of first sexual intercourse (OR 2.36, 95% CI 1.37 to 5.05).

The authors did not report data on whether individuals’ sexual practices have changed from 1989 to the present day, or whether the prevalence of HPV viruses (particularly HPV16, which has been linked to throat cancer) within the population has changed in this period.

What policy and practice implications do the authors suggest?
The researchers say that studies looking at an HPV vaccination scheme for boys, similar to that offered to teenage girls, showed that it may not be cost-effective owing to the low numbers of oropharyngeal cancer. However, they say that in time, an increase of this type of cancer may affect the cost-effectiveness of such a vaccination scheme. They say that the female-only HPV vaccination programmes may affect the incidence of HPV-related oropharyngeal cancers.

The researchers also say that patients with HPV-related head and neck cancers currently receive the same treatments as patients with non-HPV-related cancers. They say that clinicians should not change their treatment policies, but may wish to offer patients with oropharyngeal cancer the opportunity to enrol in clinical trials, which are currently being planned to look at different treatment options for HPV-related cancers.

Conclusion
The authors have highlighted the increasing incidence of oropharyngeal cancers in men in the UK. They have associated this with an increase in the proportion of HPV-related cancers based on studies in Sweden and the US.

Further research is needed to assess whether the increase in oropharyngeal cancers in British men reflects an increase in HPV-related or non-HPV-related cancers. As HPV-related and non-HPV-related throat cancers have a different prognosis for survival, further research may look at whether different treatments can have different effects on these two throat cancer subtypes.

There is insufficient evidence at present to suggest that the HPV vaccination currently given to teenage girls should also be given to boys.

Note:
1. Mehanna H, Jones TM, Gregoire V, Ang KK. Oropharyngeal carcinoma related to human papillomavirus. British Medical Journal 2010

March, 2010|Oral Cancer News|

Study evaluating clinical performance of Cervista(R) HPV HR presented at AOGIN

Source: www.prnewswire.com
Author: press release

Hologic, Inc. (Hologic or the Company), a leading developer, manufacturer and supplier of premium diagnostics, medical imaging systems and surgical products dedicated to serving the healthcare needs of women, today announced that interim data from the first large-scale independent evaluation of clinical performance of Cervista® HPV HR compared to Hybrid Capture 2 (hc2), were presented at the 4th Biennial Meeting of AOGIN (Asia-Oceanic Research Organization in Genital Infection and Neoplasia) in New Delhi, India on March 26-28, 2010. Cervista HPV HR is a diagnostic test for the detection of 14 high-risk human papillomavirus (HPV) types.

The study, SHENCCAST II, is a major cervical cancer screening trial including more than 10,000 women that is being conducted in China to evaluate the performance of HPV assays, among other endpoints. A preliminary analysis of data from 5,043 patients showed the Cervista HPV HR test performed as follows: Overall HPV positivity for this cohort was 12.2 percent for the Cervista HPV HR test and 14.6 percent with the hc2 test.

For histologically confirmed CIN 2 or more severe lesions, the Cervista HPV HR test showed a sensitivity of 90.7 percent and a specificity of 90.2 percent. For the hc2 test, sensitivity and specificity were 94.7 percent and 87.9 percent, respectively. While the Cervista HPV HR test demonstrated improved specificity and the hc2 test yielded higher sensitivity, a statistical analysis of overall test accuracy that plots sensitivity and specificity found the two methods were clinically equivalent (area under the ROC curves).

“These data further validate use of the Cervista HPV HR test as a viable method for identifying patients at risk of developing or harboring cervical neoplasia,” said Jerome Belinson, MD, Professor of Surgery, Section of Gynecologic Oncology at the Cleveland Clinic and President of Preventive Oncology International. “It’s the combination of sensitivity and specificity that best describes a test’s diagnostic value. Our analysis clearly showed that both of these methods performed well and with similar accuracy.”

“Hologic brought the Cervista HPV HR test to market to offer clinicians and labs specific advantages in HPV testing that were not offered with the competitive product, including an internal control to guard against false negatives, a lower required sample size and various workflow advantages for labs,” said Edward Evantash, MD, Medical Director and Vice President of Medical Affairs at Hologic. “We are encouraged by the real-world clinical performance of Cervista HPV HR. Cervical cancer is the most common preventable cancer among women. Through both Cervista and our ThinPrep Pap Test, we are committed to continuing to advance the science and practice of preventing cervical cancer.”(1)

About the Hologic Cervista® HPV Tests
The Cervista HPV HR and Cervista HPV 16/18 diagnostic tests are based on Invader® chemistry, a patented technology owned by Hologic and well established in other areas of molecular testing. Both tests are approved for use utilizing the sample collected with the ThinPrep® Pap Test, offering additional convenience for the healthcare provider.

Approved by the U.S. Food and Drug (FDA) Administration in March 2009, Cervista is the first new HPV assay in over a decade. It is the only FDA-approved test to feature an internal control, which allows confidence that a negative result is not the result of an insufficient sample. In addition, Cervista requires a sample size that is half that of the older competitor’s test, which should result in fewer patient call backs. The assay also reduces lab processing time while providing some additional workflow advantages.

The Cervista HPV HR test screens for 14 of the most common disease-causing strains of HPV. The Cervista 16/18 test is the only HPV test available to diagnose for strains 16 and 18, which account for more than 70 percent of all cervical cancers.

About Human Papillomavirus and Cervical Cancer
HPV is the most common sexually-transmitted disease (STD) in the United States and is recognized as the cause of most cervical cancers. To help prevent the onset of disease, the American College of Obstetrics and Gynecology (ACOG) suggests routine Pap and HPV testing for women over the age of 30 to identify women most likely to develop cervical cancer.(2)

About Hologic, Inc.
Hologic, Inc. is a leading developer, manufacturer and supplier of premium diagnostics products, medical imaging systems and surgical products dedicated to serving the healthcare needs of women. Hologic’s core business units are focused on breast health, diagnostics, GYN surgical, and skeletal health. Hologic provides a comprehensive suite of technologies with products for mammography and breast biopsy, radiation treatment for early-stage breast cancer, cervical cancer screening, treatment for menorrhagia, permanent contraception, osteoporosis assessment, preterm birth risk assessment, mini C-arm for extremity imaging and molecular diagnostic products including HPV and reagents for a variety of DNA and RNA analysis applications. For more information, visit www.hologic.com.

March, 2010|Oral Cancer News|

Oropharyngeal carcinoma related to human papillomavirus

Source: BMJ 2010;340:c1439
Author: Staff

Incidence is increasing rapidly, with implications for prognosis and policy

Head and neck cancer is the sixth most common cancer, with about 640,000 new cases each year worldwide. Despite an overall marginal decline in the incidence of most head and neck cancers in recent years,1 the incidence of oropharyngeal squamous cell carcinoma has increased greatly, especially in the developed world. In the United States, the incidence of oropharyngeal squamous cell carcinoma increased by 22% from 1.53 per 100,000 to 1.87 per 100,000 between 1999 and 2006, after showing no change between 1975 and 1999. 1 The United Kingdom has seen a 51% increase in oral and oropharyngeal squamous cell carcinoma in men from seven per 100,000 to 11 per 100,000 between 1989 and 2006.

2 The increase in incidence of oropharyngeal squamous cell carcinoma seems to be accounted for by a rise in human papillomavirus (HPV) related oropharyngeal carcinoma. A recent retrospective study showed a progressive proportional increase in the detection of HPV in biopsies taken to diagnose oropharyngeal squamous cell carcinoma in the Swedish county of Stockholm over the past three decades (23.3% in 1970s, 29% in 1980s, 57% in 1990s, 68% between 2000 and 2002, 77% between 2003 and 2005, and 93% between 2006 and 2007).3 Similarly, HPV related oropharyngeal carcinoma has been reported in 60-80% of recent oropharyngeal biopsy samples in studies conducted in the US, compared with 40% in the previous decade.4 More research is needed to establish the incidence of HPV related oropharyngeal carcinoma in African, Asian, and South American countries.

HPV related oropharyngeal carcinoma seems to be a new and distinct disease entity. 5 It has a more favourable prognosis than non-HPV related oropharyngeal carcinoma, particularly in non-smokers. Two recent randomized trials have shown significantly improved two year overall survival in stage III and stage IV HPV type 16 related oropharyngeal carcinoma compared with non-HPV related cancers (87.5% and 95% compared with 67.2% and 62%). 5 6 The reason for this improved survival is not fully understood; it may be the result of an increased immunological response to HPV antigens in the host,7 or an increased sensitivity to radiotherapy because the presence of wild-type p53 causes an increase in apoptosis.8 Smoking seems to worsen outcomes for patients with HPV related oropharyngeal carcinoma—outcomes are similar to non-smokers with non-HPV related oropharyngeal carcinoma.9

Sexual transmission of HPV—primarily through orogenital intercourse might be the reason for the increase in incidence of HPV related oropharyngeal carcinoma. A pooled analysis of eight multinational observational studies that compared 5642 cases of head and neck cancer with 6069 controls found that the risk of developing oropharyngeal carcinoma was associated with a history of six or more lifetime sexual partners (odds ratio 1.25, 95% confidence interval 1.01 to 1.54), four or more lifetime oral sex partners (3.36, 1.32 to 8.53), and—for men—an earlier age at first sexual intercourse (2.36, 1.37 to 5.05).10

The rising incidence of HPV related oropharyngeal carcinoma has implications for health service providers and commissioners. Patients are typically younger and employed, and—because outcomes seem to be more favourable than for patients with non-HPV related carcinoma—they will live longer with the functional and psychological sequelae of their treatment. Consequently, they need prolonged support from health, social, and other services, and may require help in returning to work.

There are also public health implications. Female only HPV vaccination programmes may affect the incidence of HPV related oropharyngeal carcinoma. A recent modelling study of the effects of HPV vaccination in males concluded that routinely vaccinating boys for HPV could not be justified on health economic grounds.11 However, the low incidence of HPV related oropharyngeal carcinoma in that study has led to concern because the recent rapid rise in HPV related oropharyngeal carcinoma may alter the cost effectiveness of vaccinating boys before they become sexually active.12

Studies reporting treatment outcomes for head and neck cancer, particularly oropharyngeal carcinoma, must now account for HPV status, because of its association with improved prognosis. Newly diagnosed patients may wish to know their HPV status, and future stratification by HPV status will probably be necessary. Widely used methods to detect tumor associated HPV infection include detection of HPV-16 DNA using polymerase chain reaction or in situ hybridization, detection of HPV E6 or E7 mRNA using reverse transcriptase-polymerase chain reaction, and immunohistochemical analysis of p16 over expression, all of which act as markers of transcription or “activity.” However, standardized definitions and cut-off points must be agreed to identify the best test or combination of tests for clinical diagnosis, and to regulate quality assurance in clinical laboratories.

To date, we have no good evidence to support managing patients with HPV related head and neck cancer differently from those whose tumors are not HPV related, although several studies are being planned to evaluate different treatment options. Until data from such studies are available, we suggest that clinicians should not change their current treatment policies for patients with HPV related oropharyngeal squamous cell carcinoma, but should aim to offer all patients with oropharyngeal cancer the opportunity to enroll in an appropriate clinical trial.

Hisham Mehanna, director 1, Terence M Jones, reader2, Vincent Gregoire,

professor3, K Kian Ang, professor4

1 Institute of Head and Neck Studies and Education (InHANSE), University Hospital, Coventry CV2 2DX, 2 Liverpool CR-UK Cancer Centre, School of Cancer Studies, Division of Surgery and Oncology, University of Liverpool, Liverpool L69 3GA, 3 Radiation Oncology Department and Centre for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, 1200 Brussels, Belgium, 4 Department of Radiation Oncology, University of Texas, MD Anderson Cancer Centre, Houston, TX 77030, USA hisham.mehanna@uhcw.nhs.uk Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: (1) None have support from any companies for the submitted work; (2) HM is the director of an institute that does contract work for GlaxoSmithKline that has interests in head and neck cancers; (3) Their spouses, partners, and children have no financial relationships that may be relevant to the submitted work; and (4) TMJ holds a CR-UK research grant for a phase I clinical trial involving patients with HPV related oropharyngeal carcinoma and for which Advaxis will be providing a therapeutic vaccine (ADXS11-001) free of charge. Provenance and peer review: commissioned not externally peer reviewed


March, 2010|Oral Cancer News|

HPV-related cancer leap to have big impact on health services

Source: www.dentistry.co.uk
Author: staff

The rapid rise in cases of squamous cell carcinoma related to human papillomavirus (HPV) infection has serious implications for health services around the world, warn researchers. They suggest that sexual transmission of HPV might be the reason for the rise. Head and neck cancer is the sixth most common cancer, with about 640,000 new cases each year worldwide.

Despite an overall marginal decline in most head and neck cancers in recent years, the level of oropharyngeal squamous cell carcinoma (OSCC) has increased greatly, especially in the developed world. In the US, cases increased by 22% between 1999 and 2006, after showing no change between 1975 and 1999, while the UK has seen a 51% increase in oral and oropharyngeal cancer in men between 1989 and 2006. This increase seems to be accounted for by a rise in HPV-related tumours, say the authors, led by Hisham Mehanna at the Institute of Head and Neck Studies and Education, University Hospital, Coventry.

A recent study showed a 70% increase in the detection of HPV in biopsies taken to diagnose oropharyngeal carcinoma in Stockholm since the 1970s. HPV-related oropharyngeal carcinoma has also been reported in 60-80% of recent biopsy samples in studies conducted in the US, compared with 40% in the previous decade.

HPV-related oropharyngeal carcinoma seems to be a new and distinct disease entity, explain the authors. It has a better prognosis than non-HPV related oropharyngeal carcinoma, particularly in non-smokers, but the reason for this improved survival is not fully understood. They suggest that sexual transmission of HPV might be the reason for the rise.

A recent study found that the risk of developing oropharyngeal carcinoma was associated with a history of six or more lifetime sexual partners, four or more lifetime oral sex partners, and – for men – an earlier age at first sexual intercourse.

But, whatever the reason, the rising rate of HPV related oropharyngeal carcinoma has implications for health service providers and commissioners, they warn. For instance, patients are typically younger and employed, and – because outcomes seem to be more favourable than for patients with non-HPV related carcinoma – they will live longer. Consequently, they need prolonged support from health, social, and other services, and may require help in returning to work.

There are also public health implications, they add. For example, including boys in HPV vaccination programmes before they become sexually active.

They write: ‘At present, we have no good evidence to support managing patients with HPV related head and neck cancer differently from those whose tumours are not HPV related, although several studies are being planned to evaluate different treatment options. Until data from such studies are available, we suggest that clinicians should not change their current treatment policies, but should aim to offer all patients with oropharyngeal cancer the opportunity to enrol in an appropriate clinical trial.’

Last month, a mouth cancer charity called for the introduction of a new HPV test in Britain which would help diagnose mouth cancer at an early stage. The British Dental Health Foundation (BDHF) – organisers of Mouth Cancer Action Month – want the examination made available in the UK for the oral human papilloma virus (HPV) which can be tested in the dentist’s chair. The test identifies one of two exceptionally dangerous forms of HPV long before the virus develops into cancer and creates lesions.

Chief executive of the BDHF, Dr Nigel Carter, stressed the importance of early diagnosis. Dr Carter said: ‘Currently the best chance of beating the cancer comes from early detection, improving survival rates to more than 90%.’

March, 2010|Oral Cancer News|

Time-released muco-adhesive patch more effective than oral rinse for xerostomia

Source: www.news-medical.net/news
Author: press release

A newly developed time-released muco-adhesive patch for treating oral health conditions, including the widespread condition of dry mouth (xerostomia), has been shown to be more effective than a leading oral rinse, according to a newly-published study. As increasing segments of the population consume more medications (one of the leading causes of dry mouth), the results of this study could potentially help provide relief for millions of Americans. Chronic dry mouth impacts the quality of life and for some, can be debilitating. Published in the March 2010 issue of Quintessence International, the study found that chronic dry mouth sufferers can now get a statistically significant reduction of mouth dryness from a new time-released muco-adhesive patch (OraMoist Dry Mouth Patch), compared with the leading oral rinse which has been on the market for nearly two decades.

Overall, patients with xerostomia treated with the muco-adhesive patch reported a statistically significant reduction in mouth dryness sensation with elevated salivary flow rate (150%) after just 30 minutes, which was considered clinically outstanding by the study authors, since the product does not contain any cholinergic agonist, a drug often used to treat dry mouth.

OraMoist, a new time-released, non-drug formula, not only outperformed the mouthwash, one of the most often used delivery formats for treating dry mouth, but unlike dry mouth sprays, rinses or gels, which need to be applied frequently – sometimes every 20 minutes – OraMoist works to increase moisture and help restore a healthy oral environment for hours at a time, day or night, and can even be used by those with dental appliances, such as dentures. It moistens and lubricates the mouth with time-released lipids, citrus oil and sea salt, while simultaneously stimulating saliva production and inhibiting bacterial growth and promoting oral health with enzymes and xylitol.

“Oral disorders such as dry mouth and canker sores require long residence of the active remedy in the mouth or the disease site for effective treatment. Muco-adhesive patches made of safe ingredients that adhere to the oral mucosal tissue and slowly erode while releasing active remedies for two to six hours provide the desired residence time for effective therapy,” said Professor Abraham J. Domb, PhD, Institute of Drug Research, School of Pharmacy, Faculty of Medicine at the Hebrew University, co-author of the new published study, inventor of the muco-adhesive time-released patch and world-renowned for his work in biodegradable polymers. “This novel approach of time-released delivery has proven to be a successful and desirable approach to treating chronic conditions that affect millions of people, and can be disruptive to their lifestyle.”

The evolution of the muco-adhesive patch has found commercial viability in treating canker sores as well because the patch can also act as a bandage for the sores for eight to twelve hours while releasing active remedial ingredients.

Dry mouth affects upwards of 17% of the population, increasing in older adults (65 years and older) to about 30%. In fact, 34% of people taking three or more medications suffer from dry mouth, which is also a chronic symptom of numerous medical conditions, such as diabetes and Sjogren’s Syndrome.

Source: OraMoist

March, 2010|Oral Cancer News|

Public awareness level of oral cancer in a group of dental patients

Source: J Contemp Dent Pract, January 1, 2010; 11(2): E049-56
Authors: I Peker and MT Alkurt

Aim:
The aim of this study was to evaluate levels of public awareness and knowledge about early signs and risk factors of oral cancer among a group of dental patients in Turkey.

Methods and materials:
This study included 1022 participants. Sociodemographic information of patients was obtained. A questionnaire about awareness and knowledge of oral cancer and early signs and risk factors related to the disease was completed by two examiners. Data were statistically analyzed with descriptive analyses, crosstabs and chi-square tests.

Results:
In total 60.7% of participants had never heard of oral cancer. While 79.2% of the participants were unaware of the early signs related to oral cancer, 29.9% of them were unaware of risk factors of the disease. There were no statistically significant differences between age, gender, and education levels for awareness of risk factors. Statistically significant differences were found between age and gender and no statistically significant difference was found between education levels for awareness of early signs.

Conclusion:
This study showed that public awareness and knowledge about oral cancer were insufficient in Turkey.

Clinical significance:
There is an important need to inform the public about oral cancer, its risk factors, and early signs of the disease. Media campaigns can be useful to raise oral cancer awareness.

March, 2010|Oral Cancer News|

Fluoroscopically guided balloon dilation for pharyngoesophageal stricture after radiation therapy in patients with head and neck cancer

Source: AJR 2010; 194:1131-1136
Authors: Hong-Tao Hu et al.

Objective:
The purpose of this article is to assess the safety and long-term efficacy of fluoroscopically guided balloon dilation for pharyngoesophageal strictures after radiation therapy in patients with head and neck cancers.

Materials and methods:
From April 1997 to February 2009, fluoroscopically guided balloon dilation was performed in 17 patients with pharyngoesophageal strictures caused by radiation therapy. Technical success, clinical success (decrease of at least one grade in dysphagia score and good contrast passage on 1-month follow-up esophagogram), recurrence of dysphagia, and complications related to the procedure were retrospectively evaluated.

Results:
All 17 patients underwent 41 balloon dilation procedures, with each patient undergoing one to seven procedures (mean, 2.4 procedures). The technical success rate was 100%, and clinical success was achieved in 64.7% (11/17) of the patients. Five patients (29.4%) showed no recurrence of dysphagia after one session of balloon dilation. Of 12 patients (70.6%) with recurrence of dysphagia, 10 underwent repeat balloon dilation and two underwent gastrostomy after the first session of balloon dilation. The maximum balloon diameters were 15 mm (n = 22), 20 mm (n = 16), and 25 mm (n = 3). As minor complications, three cases of type 1 esophageal rupture occurred in two patients (11.8%). There were no major complications.

Conclusion:
Although the recurrence rate was high with repeat balloon dilation, fluoroscopically guided balloon dilation seems to be a simple and safe primary treatment technique for pharyngoesophageal stricture due to radiation therapy in patients with head and neck cancer.

Authors:
Hong-Tao Hu1, Ji Hoon Shin2, Jin Hyoung Kim2, Jung-Hoon Park2, Kyu-Bo Sung2 and Ho-Young Song2

Authors’ affiliations:
1 Department of Radiology, Henan Tumor Hospital, Zhengzhou, Henan Province, People’s Republic of China.
2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.

March, 2010|Oral Cancer News|

Experts warn that new “smokeless” tobacco products are still dangerous

Source: FOX21News
Author: Tracee Tolentino

DULUTH – The tobacco industry is offering new products and finding new ways to attract and keep customers. However, health advocates say the new products are just as dangerous, and the customers are getting younger and younger.

“Most 6-year-olds, if you queried them, they would know who Joe Camel is,” said Michele Hughes of the Douglas County Health Department.

Now, with the introduction of new smokeless tobacco alternatives, there are new ways that young adults can get hooked to nicotine.

“They’re out there as the ‘good guy’ or look, these aren’t quite as harmful, but indeed these are deadly products that lead to a lifetime of addiction and this is an industry that is out for our youth,” said Pat McKone of the American Lung Association of Minnesota.

Many new tobacco products are more appealing to younger customers, with bright packaging, candy flavors and the illusion of a “safer” nicotine delivery source. McKone warns that these products are tricks.

The alternative products include forms of snuff, chewing tobacco, e-cigarettes or snus, which are spit-less tobacco pouches that users place under their upper lip.

“These products are to enable people to keep using nicotine and nicotine delivery systems until they can get out to smoke,” said McKone.

The popularity of these products has increased as more states have adopted smoking bans for workplaces and businesses. Minnesota’s ban is already in place and in July, Wisconsin will follow suit.

“80% of current adult smokers started between the ages of 14 and 15 years old so if we can not get those kids access to tobacco, that’d be very good,” added Hughes

With the continuing push of new tobacco products, health professionals say it’s more important than ever to educate young people.

“They aren’t safer,” said Hughes, “I mean you can ingest them as well and get stomach cancer. Any kind of tobacco has carcinogenic side effects.” In addition to stomach cancer, some of the new products have also been linked to oral and pancreatic cancer.

March, 2010|Oral Cancer News|

Busting the myth of the cervical cancer vaccine

Source: Temple University Press
Editorial by: Gkramer

Adina Nack, author of Damaged Goods? Women Living with Incurable Sexually Transmitted Diseases, draws on her expertise as a sexual health researcher to discuss the impact of human papillomavirus (HPV) on men and the need for gender-neutral STD vaccines.

When I wrote my book, Damaged Goods? I focused on how living with contagious, stigmatizing, medically incurable (though highly treatable) infections transformed women’s lives – medically, socially and psychologically. I had included a discussion of the Gardasil vaccine, which had received FDA-approval and CDC recommendation for ‘routine’ use in girls and women (ages 9 to 26) back in 2006, and I had articulated some of my concerns about the delayed testing and approval process for ‘male’ Gardasil.

A family of viruses, HPV is an ‘equal opportunity infector,’ so why have HPV vaccines not been equally accessible for men as well as women? In a recent interview on Huffington Post, several blog posts of my own, and my new feature article, “Why Men’s Health Is a Feminist Issue” (Ms. Magazine,Winter 2010), I investigate the substantial public health costs that result from HPV vaccines, such as Gardasil, not having been originally developed, tested and approved as gender-neutral vaccines.

The narrow and inaccurate marketing of Gardasil as a female-only, “cervical cancer” vaccine has distracted us from public discourse about this family of sexually transmitted viruses that are not only a U.S. epidemic but also a global pandemic. In the U.S., HPV is estimated to affect 75% of adults and certain strains are known to cause potentially fatal oral, cervical, anal, and penile cancers. Researchers are finding that HPV-related male cancers are: on the rise, often fatal due to lack of accurate testing/screening, and, in the U.S., likely result in more combined deaths in men than in women.

Still, Gardasil— primarily branded and marketed as a cervical cancer vaccine for girls and women—remains fairly inaccessible to boys and men. The CDC recommends “routine” Gardasil vaccination for females ages 9-26 for the prevention of cervical cancer and other HPV diseases. But, last October, after the FDA approved Gardasil solely for the prevention of genital warts in boys/men, the CDC’s Advisory Committee on Immunization Practices (ACIP), which makes recommendations for the routine administration of vaccines, voted for a lesser recommendation of “permissive” use in males that is likely to keep the vaccine less affordable for male patients.

Last month, the makers of Gardasil released a study which showed the vaccine to be effective at preventing anal precancers in men. This new evidence, which supports the case for a male vaccination schedule, was presented on February 24 at a meeting of the CDC’s ACIP. As evidence mounts that HPV vaccines (e.g., Gardasil and Cervarix) may prevent a range of serious HPV-related male cancers—including types of oral cancer, which are on the rise—I will be watching to see if the FDA reevaluates its original narrow approval of ‘male’ Gardasil (only for the prevention of genital), which could shape future CDC/ACIP vaccination recommendations.

As a medical sociologist, I am neither pro- nor anti-vaccine, but I do support:

(1) equal access to vaccines

(2) medical studies of vaccines that reveal full ranges of potential health benefits and costs

(3) and a HPV public health campaign that fully educates about the range of treatable and serious health consequences for boys and girls, men and women.

Even the most successful vaccine is not 100% effective, so it is imperative that we expand the discussion of HPV prevention beyond vaccination. Whether or not you are pro- or anti-Gardasil, we all have much to gain from de-stigmatizing STDs and from making comprehensive HPV education more accessible.

This post was inspired by Nack’s posts on Girlw/Pen.

March, 2010|Oral Cancer News|