Monthly Archives: November 2010

Mum’s two-year ‘earache’ was huge tumour

Source: Mirror News

By: Jeremy Armstrong

A mum told she had earache actually had a giant tumour.

It took medics a year to spot Paula Bell’s mouth cancer. Believing it harmless, they took another year to operate. Part of the tumour remains.

Paula, 41, of Newcastle, said: “I got on my knees and begged the specialist to operate. I was that desperate.”

She was referred to Newcastle’s Freeman Hospital in 2006 and said: “I was put on antibiotics as they thought it was an ear infection. That went on for months.” In March 2007, a doctor suspected a dislocated jaw and sent her to the nearby General Hospital.

It took two months for scans to find the tumour. Surgeons operated in April 2008 – then realised its severity.

Paula got an undisclosed payout.

Newcastle Hospitals Trust said it was not an “admission as to liability”.

November, 2010|Oral Cancer News|

Nation backs HPV vaccination for boys

Source: www.dentalhealth.org.uk
Author: press release

An overwhelming majority of people in the UK have indicated that they want the vaccination for the Human Papilloma Virus (HPV) to include boys and not just girls. In a survey carried out by the British Dental Health Foundation as part of November’s Mouth Cancer Action Month, nine out of every ten people want to see the vaccination introduced for secondary school boys.

A vaccination programme for girls aged 12 to 13 has been in place in the UK since 2008, handing out over four million doses of the jab, but now the UK’s leading oral health charity says it is time for a change. Chief Executive of the Foundation, Dr Nigel Carter, says cases of HPV in men are growing at an alarming rate and that more must be done to prevent any future outbreak.

Dr Carter said: “HPV is such growing concern – much of the 42 percent rise in incidence of mouth cancer over the last 10 years is down to HPV and whilst vaccination of young girls will help, in order to be truly effective we will need to consider vaccination of boys as well.

“It is about time we took action to prevent this hidden killer, which is beginning to affect more and more young people. Expert studies suggest HPV is set to become the leading cause of mouth cancer alongside smoking and alcohol, so let us be proactive and plan against this threat.

“The government wisely acted on the above controversy to give young girls anti–HPV jabs to young girls to curb cervical cancer. Mouth cancer is responsible for more deaths than cervical cancer, so surely it is time to widen the programme to boys.”

One person dies every five hours in the UK from mouth cancer, making it the UK’s fastest growing cancer, with new research showing almost 6,000 new cases every year.

The disease is twice as common in men as in women, though an increasing number of women are being diagnosed with the disease. Previously, the disease has been five times more common in men than women.

Age is another factor, with people over the age of 40 more likely to be diagnosed, though more young people are now being affected than previously.

People who smoke and drink to excess have been found to be at a higher risk and are up to 30 times more likely to develop mouth cancer while poor diet is linked to a third of all cancer cases.

A mouth ulcer that has not healed within three weeks, red or white patches and any swelling or unusual lumps in the mouth are all early warning signs of the disease and must be checked by a professional immediately.

Dr Carter added: “Mouth cancer is a potentially fatal condition that is taking more lives each year.

“Like with all cancers, early diagnosis is essential. If mouth cancer is not caught early the chances of survival could plummet down to as little as half. Learning what the risk are, the symptoms and causes, along with promoting self examination and dental visits could see most mouth cancers being caught during the early stages, where nine in every ten people go on to survive.”

The HPV is the term for a collection of viruses that affect the skin by creating lesions in the moist membranes, it then develops into cancer. It can affect the cervix, anus, mouth and throat.

The current programme is delivered mostly through secondary schools and comprises of three injections over a six month period.

The jab identifies one of two exceptionally dangerous forms of HPV – known as 16 and 18 – long before the virus develops into cancer and creates lesions.

November, 2010|Oral Cancer News|

Scared smokeless–The FDA should use the most graphic images possible in its new warnings on cigarette packs.

Source: Los Angeles Times

It’s easy to guess what would happen if a pharmaceutical company asked the Food and Drug Administration to approve a new product with the following characteristics: no proven health benefits. Major known side effects: greatly increased risk of emphysema, heart attacks, stroke and cancer, including lung, cervical, mouth, stomach and bladder. The product also lowers bone density in older women and causes higher rates of serious health problems among newborns. It significantly harms the health even of those who merely spend time near the drug while it’s in use. And it’s addictive.

If cigarettes were a new invention, they’d never pass muster with even the most lax of regulatory agencies. Unhappily for our collective health, not only does tobacco’s legacy date back thousands of years, but it is inextricably tied to the birth of the United States. None other than John Rolfe, best known as Pocahontas’ husband, is credited with the first commercial cultivation of tobacco in Jamestown, in 1612.

Four hundred years later, we’ve learned a thing or two about tobacco, especially in its inhaled form. Now we wrestle with how to act on that information. Cigarettes are a terrible health scourge, but this is also a country that respects the right of adults, in most cases, to ruin their own health as long as they are not endangering others. So driving drunk is forbidden, as is smoking in many indoor public spaces, but cigarettes themselves remain legal.

Yet as a society, we don’t want to sit idly by and watch tobacco take its toll. So we tried public service messages to counter the lure of cigarette advertising. Then we banned TV commercials and placed small warnings from the surgeon general on cigarette packs. We raised excise taxes and restricted the settings where smoking is legal.

It worked. Smoking rates are half what they were 40 years ago, with only one in five Americans lighting up. (In California, which has led the nation in anti-smoking laws and public service messages, the rate is lower than 13%.)

For the past six years, though, progress against cigarettes has stalled, which led to congressional action last year in the form of a law empowering the FDA to regulate tobacco and requiring large, visually arresting anti-smoking warnings on every cigarette pack. The recently unveiled images, which will cover half of the front and back of each pack, show tar-blackened lungs and toe-tagged corpses, along with many tamer pictures. The depictions must also be shown in cigarette advertisements, and must take up a fifth of the ad’s space.

In the past decade, 38 countries started requiring cigarette packs to carry images designed to discourage the habit. Early research offers encouraging signs that they work, and do so without requiring a major investment of taxpayer money. Short of banning cigarettes altogether, it will take this sort of bold action to prod the nation into further reducing tobacco use. If anything, the FDA’s new warning labels err on the side of being too tepid.

We don’t say that lightly. The images will in effect force tobacco companies to advertise against themselves on the packages of their own products. The possible analogies are endless: Should wineries be required to include color photos of cirrhotic livers on their labels, or should KFC buckets of chicken have to feature a cross-section of the fat deposits on an obese individual? Concerns about a slippery slope are valid — it would be distasteful and ultimately unhelpful to litter the landscape with repulsive pictorial warnings — but those concerns shouldn’t stop the FDA from taking this potentially life-saving course of action.

That’s because when it comes to health-destroying products, cigarettes are in a class of their own. They have no real benefits and are addictive as well. Though many people might treat themselves to an occasional plate of fries or a bottle of beer, rare is the person who enjoys a cigarette every couple of weeks. Many smokers were lured into addiction by an industry that purposely withheld information about its product’s horrific effects on health. Smoking remains the No. 1 cause of preventable death in the United States.

In 2001, Canada became the first country to adopt the big, colorful, graphic warnings. Smoking rates among Canadian youth ages 15 to 19 have dropped from 26% to 15%. Adult rates dropped less dramatically. But it’s impossible to know how much of the reduction was prompted by the warning labels, because several other anti-smoking initiatives started in the country around the same time.

Still, the results from surveys in 15 countries offer persuasive evidence of the labels’ effectiveness. Smokers noticed and remembered the images better than text warnings and said the new labels had given them important health information. Teenagers were more likely to say the graphic warnings had discouraged them from smoking altogether, and adults were more likely to have at least tried to quit or to have refrained from taking the next cigarette they had planned on smoking.

As helpful as it is to adopt more prominent warnings, equally important is making sure they have the maximum impact. The FDA is considering 26 possible images, and will narrow those to nine. But David Hammond, an assistant professor at the University of Waterloo in Canada and one of the leading researchers on the topic, says many of the images are too tame to grab consumer attention. One of the most effective Canadian images shows a grinning, cancer-riddled mouth; opening the package also opens the mouth, the teeth parting to reveal the neatly packaged cigarettes. There’s a less repulsive version of the cancerous mouth among the FDA’s contenders, along with one of a smoker exhaling through a hole in his throat. But many of the FDA’s images are more symbolic than graphic; it should use the most dramatic ones.

Research shows that the warning labels work better when they’re coupled with an increase in smoking-cessation programs, and when they include a phone number or website where smokers can get quick information on how to quit. The change in cigarette labeling is welcome, but the FDA could do more. If the idea is to startle people into quitting, this is no time for timidity.

November, 2010|Oral Cancer News|

Pertussis reaches epidemic proportions in California; New links identified between vaccine-preventable infections and cancer.

Source: Disabled World

New data from the Centers for Disease Control and Prevention (CDC) show that adults remain largely unvaccinated against preventable infectious illnesses. At a news conference convened today by the National Foundation for Infectious Diseases (NFID), experts in public health, infectious disease, oncology and other medical specialties discussed the data and the health consequences for adults who skip vaccines. They collectively called on all adults and health care providers to improve vaccination rates.

“For more than six decades, vaccines have protected us from infectious illnesses that have a wide range of consequences, from lost work days and inability to meet our daily obligations, to pain, discomfort, hospitalization, long-term disability and death,” said Susan J. Rehm, M.D., NFID medical director. According to Dr. Rehm, by foregoing needed vaccines, adults not only leave themselves vulnerable to sickness, but they expose those around them to unnecessary risks, too.

This problem is evident right now, as pertussis (whooping cough) continues to claim the lives of infants in California, while adults, who are frequently responsible for transmitting the disease to infants, fail to get the one-time pertussis booster vaccine. The impact of other vaccine-preventable infections may not be as immediately apparent, but they are no less important. Other vaccines for adults protect against viruses that cause several types of cancer, reactivation of the chickenpox virus that causes shingles later in life, and infection with bacteria that are the leading cause of community-acquired pneumonia.

New survey results from NFID suggest that doctor/patient communication challenges may be at least part of the problem. While physicians perceive they are encouraging their adult patients to be vaccinated, patients say the topic of vaccination rarely comes up during their doctor visits.

Vaccination rates highest among seniors; lowest among minority groups

In unveiling the adult vaccination data from the 2009 National Health Interview Survey (NHIS), Melinda Wharton, M.D., M.P.H., deputy director of the National Center for Immunization and Respiratory Diseases at the CDC, noted that the highest immunization rates are among older Americans, who tend to be vaccinated against influenza and pneumococcal infections. She suggested that one reason for this might be that older persons tend to have more routine visits with health care providers, providing more opportunities to learn about and adopt good preventive care behaviors.

“A good ongoing relationship with your medical provider is positive for so many reasons,” said Dr. Wharton, “not least of which is that you will have an ongoing opportunity learn about the best ways to stay healthy, including the best preventive care choices like vaccines.”

While adult vaccination rates are showing slow improvement overall, one vaccination trend Dr. Wharton specifically noted is the 7.4 percent decrease in pneumococcal vaccination rate in high-risk adults 19 to 64 years of age. She pointed out that this is not because people are suddenly foregoing this vaccine. Rather, the decrease reflects the recent addition of new risk groups — namely smokers and people with asthma — increasing the pool of people who should get the vaccine. Dr. Wharton called on smokers and people with asthma to check with their physicians or other health care providers about this vaccine.

In addition to generally low adult vaccination rates, Dr. Wharton touched on the problem of racial and ethnic vaccination disparities. While strides have been made to close racial and ethnic gaps, some significant vaccination gaps continue to exist among Whites, Blacks and Hispanics.

Vaccine (age and/or risk status) Non-

Hispanic

White (%)

Non-

Hispanic

Black (%)

Hispanic or

Latino (%)

Tetanus, diphtheria, pertussis (19-64 years) 51 54 49
Pneumococcal (65 years and older) 65 45 40
Pneumococcal (19-64 years, high risk) 18 18 12
Hepatitis B (19-49 years, high risk) 43 44 37
HPV (19-26 years) 20 13 13
Shingles (60 years and older) 11 4 5
Influenza (65 years and older) 69 51 51
Influenza (50-64 years) 42 37 31

The NHIS survey also reported vaccination rates in health care professionals for influenza (up 7 percent, to 53 percent), hepatitis B (up 2.5 percent, to 65 percent) and Tdap (up 1.6 percent, to 58 percent). “It’s gratifying to see health care worker vaccination rates continue to increase,” said CDC’s Melinda Wharton. “By modeling good preventive care behaviors our health care professionals are truly leading the way as good partners in their relationship with patients.” The NHIS vaccination data include anyone employed in a health care occupation or setting. In contrast, physician-only vaccination rates are much higher (>90 percent for influenza) as reported in two separate NFID surveys fielded before and during the current influenza season.

Doctor/patient communication breakdown a factor in low vaccination rates

A dramatic physician-patient communication disconnect was revealed by new data from two NFID surveys. Nearly 90 percent of primary care physicians say they discuss vaccines with their patients, yet in a separate survey of consumers, almost half cannot recall ever discussing vaccines with their physicians. As further evidence of the communication gap between physicians and their patients, 99 percent of physicians say that they or their staff initiates vaccine discussions, but just 44 percent of patients say that is true.

“Busy primary care physicians think they’re doing a good job recommending vaccines, but the survey indicates that patients aren’t getting the message,” suggested Dr. Rehm. “Consumers overwhelmingly said they look to physicians for vaccine recommendations and are likely to act on those recommendations, so it’s clear that we physicians need to be more effective in communicating with our patients.”

Among the positive findings, consumer familiarity with vaccine-preventable illnesses is rising, although still limited. Familiarity with specific vaccine-preventable diseases rose 4 to 12 percent compared with results from a 2009 survey, with the largest increase for pertussis vaccine. The only vaccine-preventable disease not to register an increase in familiarity is pneumococcal vaccine. Consumers also report that they rarely refuse vaccines if their physicians recommend them.

A realized consequence: disease resurgence

The ongoing pertussis epidemic in California demonstrates the danger still posed by diseases once thought to be gone in the U.S. There are reports of more than 6,400 cases so far in California this year, the most since 1958. While pertussis can affect people of any age and in fact, national rates have been rising in adults, it is the infants who adults pass this on to who bear the burden. Ten infants, all younger than three months, have died from whooping cough in California this year.

Patrick Joseph, M.D., a California infectious disease physician who is NFID’s vice president, implored adults to get the one-time booster vaccine, “While the epidemic is in adults, the tragedy is in kids. The situation is grave when babies too young to be immunized are dying.”

Dr. Joseph said this crisis means California doesn’t have the luxury of bringing people along slowly. The time to increase vaccination rates for pertussis is now. The California Department of Public Health recommends pertussis boosters for all adults, including those over 65, a move supported by the CDC’s Advisory Committee on Immunization Practices (ACIP). At its October meeting, ACIP voted to extend pertussis booster vaccination recommendations to include adults 65 and older nationwide.

While California has been hardest hit so far, many other areas have seen increased cases this year, including Ohio, South Carolina, Michigan, Texas, Idaho, upstate New York and the Philadelphia suburbs. Since pertussis knows no boundaries, Dr. Joseph voiced his hope that adults outside his home state would also take notice and seek a Tdap vaccine now to protect themselves and infants around them.

Importance of pneumococcal and influenza vaccines also highlighted

AARP board member Catherine Georges, R.N., Ed.D., reminded adults that the time to get an influenza vaccine is now. “We know it’s important for Americans of all ages to go out now and get the flu vaccine, but it’s even more critical for people 50-plus,” said Dr. Georges, a registered nurse and professor and chair of the department of nursing at Lehman College and the Graduate Center at the City University of New York. “Older Americans are often caring for their children and for older loved ones. Getting vaccinated not only protects you, but also helps protect your family and friends.” Dr. Georges echoed the universal recommendation from CDC for influenza vaccination of all Americans six months and older.

Since pneumococcal infection is an all too frequent complication of influenza, Dr. Georges reminded Americans that, “pneumococcal and influenza vaccines can be given at the same medical visit.” Pneumococcal vaccine is recommended for everyone 65 and older and for younger adults with certain risk factors or conditions like asthma, smoking, heart disease and diabetes. For most people, pneumococcal is a one-time vaccination.

Alarmingly few Americans immunized against debilitating disease of shingles

The lowest vaccination rate for a routinely recommended vaccine is for the shingles vaccine, which is recommended for everyone starting at age 60. Only ten percent of eligible persons have received the shingles vaccine. Not only does the likelihood of getting shingles increase with age, so does the severity of shingles pain, which can last long after the shingles rash has disappeared (this pain is known as post-herpetic neuralgia, or PHN). This pain diminishes quality of life and functional capacity as much as congestive heart failure, a heart attack, type II diabetes or major depression.

Adults in the NFID survey say they are familiar with shingles, but further questioning reveals knowledge gaps; for instance, 42 percent do not know that anyone who has had chickenpox is at risk for shingles. Still, adults are aware of the pain of the disease; 55 percent say they “know someone who has had it and it was terrible.” Unfortunately, only half of adults even know there is a shingles vaccine available and just 16 percent know it is currently recommended for everyone 60 and older.

“Shingles can be a terribly painful and debilitating disease, particularly in the elderly,” said Jeffrey Cohen, M.D., chief of the Laboratory of Infectious Disease at the National Institute of Allergy and Infectious Diseases. “Shingles pain can be very difficult to treat. Current therapies are only somewhat effective and often associated with frequent and problematic side effects, especially in older people, which is why it is vitally important that we educate Americans about the vaccine.”

Vaccines prevent cancer

“Human papillomavirus (HPV) not only causes cervical cancer, but also a growing portion of head and neck cancers,” according to Maura Gillison, M.D., Ph.D, Jeg Coughlin Chair of Cancer Research at the Ohio State University College of Medicine. “Twenty years ago about 40 percent of these cancers were due to HPV; today that number is over 60 percent in the U.S. Even more alarming is that these cancers are happening in younger people without traditional risk factors—smoking and alcohol consumption.”

The hepatitis B vaccine also protects against certain cancers. The hepatitis B virus causes 30 percent of all liver cancers in the U.S. and doubles the risk of non-Hodgkin’s lymphoma. Both HPV and hepatitis B viruses are common. An estimated 70 percent of Americans will be infected with HPV in their lifetime and up to 1.4 million Americans have chronic hepatitis B infection.

CDC recommends HPV vaccine for all women 19 to 26 years of age if not previously vaccinated and recommends the hepatitis B vaccine for all sexually active adults who are not in a long-term, mutually monogamous relationship and others in more defined risk groups.

“I urge everyone to get the HPV and hepatitis B vaccines as recommended,” said Dr. Gillison. “These vaccines are truly life-saving. As a cancer-specialist, I can tell you that prevention is a far better option than treatment. These are not cancers you want to have or want your kids to have.”

About the NHIS data – The NHIS has monitored the health of the nation since 1957. The interviewed sample for 2009 consisted of 33,856 households, which yielded 88,446 persons in 34,640 families.

About the NFID data – The NFID consumer survey, conducted by Opinion Research Corporation (ORC), was based on telephone interviews with 1,013 Americans aged 18 and older when from October 15-18, 2010. The margin of error for the full sample is +/-3 percent. The NFID physician survey, also conducted by ORC, was conducted online with 300 primary care physicians

About the National Foundation for Infectious Diseases – The National Foundation for Infectious Diseases (NFID), a non-profit organization, has been a leading voice for education about infectious diseases and vaccination since 1973. It is dedicated to educating the public and health care professionals about the causes, treatment and prevention of infectious diseases. For more information on vaccines and vaccine-preventable diseases, please visit www.nfid.org and www.adultvaccination.org

November, 2010|Oral Cancer News|

Smokeless Tobacco Rates on the Rise

Source: WebMD

By: Bill Hendrick

Even after a generation of warnings from public health officials about the dangers of tobacco use, about 20% of Americans still smoke cigarettes, a CDC report says. The report also shows the rate of smokers who also use smokeless tobacco, such as chewing tobacco and snuff, is rising.

Using smokeless tobacco can keep the nicotine habit alive, making it even harder to quit than going cold turkey, Terry Pechacek, PhD, of the CDC, tells WebMD.

More Americans are turning to smokeless tobacco because of laws that prohibit smoking in public places such as bars, restaurants, and airplanes — and also because smokeless forms can be used in offices and on the job, Pechacek says.

Immediate Benefits of Smoking Cessation

The tobacco companies market smokeless tobacco as a substitute for smokers, but they don’t help people quit smoking, Pechacek tells WebMD.

“We are making no progress in getting people to quit smoking,” he says. “This is a tragedy. Over 400,000 people are dying prematurely and won’t be able to walk their children down the aisle or see their grandchildren.”

Contrary to common beliefs of smokers, the benefits of quitting start immediately, Pechacek tells WebMD.

“We see lower rates for heart attacks within months of quitting,” he says. “And lower rates for lung cancer, too. Stopping a decline in lung function is one of the biggest benefits of quitting smoking.”

The national smoking prevalence rate was 20.6% in 2008 and 2009. About 23% of males smoke, compared to 18.3% of females.

“We are not making progress and we are going to have this burden for tobacco-related diseases for decades to come,” Pechacek tells WebMD.

Who’s Using Smokeless Tobacco

The CDC report says the use of smokeless tobacco is “predominantly a problem among men, young adults, those with a high school education or less and in some states with higher smoking rates.”

Smoking prevalence varies widely among states and territories, from 25.6% in Kentucky and West Virginia and 25.5% in Oklahoma to 9.8% in Utah, 12.9% in California and 14.9% in Washington.

Smoking prevalence was 6.4% in the U.S. Virgin Islands, 10.6% in Puerto Rico, and 24.1% in Guam.

Smoking prevalence for men was significantly higher than for women in 15 states, plus Guam and Puerto Rico. Smokeless tobacco use was highest in Wyoming at 9.1%, West Virginia at 8.5%, and Mississippi at 7.5%. It was lowest in California at 1.3% and Massachusetts and Rhode Island at 1.5%.

Among findings and conclusions in the report:

  • Smokeless tobacco use was most common among those aged 18 to 24.
  • Smokeless tobacco use decreased with higher educational attainment.
  • Among the 25% of states in which smoking prevalence was greatest, seven also had the highest numbers for smokeless tobacco use, Alabama, Alaska, Arkansas, Kentucky, Mississippi, Oklahoma, and West Virginia.
  • Doctors, dentists, and others in their offices should encourage patients to quit smoking and help them find ways to do so.

CDC Director Tom Frieden, MD, MPH, says it’s unfortunate that so many smokers also are using smokeless tobacco products, which “may keep some people from quitting tobacco altogether.” He says in a news release that anti-tobacco efforts need to be beefed up against all forms of use.

Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health, says in the news release that the new numbers showing smokeless tobacco use “are concerning” and that officials “need to fully put into practice effective strategies, such as strong state laws that protect nonsmokers from secondhand smoke, higher tobacco prices, aggressive ad campaigns that show the human impact of tobacco use and well-funded tobacco control programs, while stepping up our work to help people quit using all forms of tobacco.”

Tobacco Use State by State

Here’s a list of percentages of smokers who also use smokeless tobacco, by state, from lowest to highest.

State                   Percentage

Delaware                   2.9

Washington, D.C.     3.0

Rhode Island            3.0

California                  3.2

Maryland                  3.6

Massachusetts        4.1

New Jersey              4.4

Maine                        4.7

Louisiana                  4.8

Illinois                        5.2

Nevada                     5.2

New York                  5.2

Arizona                      5.7

Hawaii                       5.7

Connecticut              5.8

Colorado                  6.1

Wisconsin                6.1

Georgia                    6.4

Ohio                          6.5

Tennessee              6.5

North Carolina        6.6

Florida                     6.7

New Mexico           6.8

Nebraska               6.9

Missouri                 7.0

South Carolina      7.0

Pennsylvania        7.1

Kansas                  7.5

Kentucky               7.7

Washington          7.8

Indiana                  8.0

Vermont                8.1

Iowa                      8.3

West Virginia       8.3

Texas                   8.4

Mississippi           8.5

Oregon                 8.7

South Dakota       8.7

Alaska                   8.8

New Hampshire   9.2

Oklahoma             9.2

Idaho                      9.6

Alabama                9.8

Michigan               9.9

Minnesota           10.5

Virginia                10.5

Utah                    10.9

Arkansas            11.7

North Dakota     11.8

Montana             12.1

Wyoming            13.7

Puerto Rico          0.9

Guam                    3.2

Virgin Islands      4.2

November, 2010|Oral Cancer News|

Snus smokeless tobacco: Less harmful than cigarettes, but not safe.

Source: WebMD

By: Daniel J. DeNoon

If you use snus, do you win or lose?

Snus — alternately pronounced snoose or snooze — is a smokeless, flavored tobacco product very different from snuff. When placed between cheek and gum, it doesn’t make you spit.

Even its critics admit that snus is less harmful than other forms of smokeless tobacco. And it is far less harmful than cigarette smoking.

So is snus a good thing?

It would be a good thing if everyone who smoked cigarettes or dipped snuff switched to snus instead. It would be a good thing if snus were a way station on the road to quitting all forms of tobacco. It would even be a good thing if kids who would have become smokers became snus users instead.

But despite all of that, mounting evidence suggests snus isn’t a good thing — and may be far worse than they appear.

Snus: Less Harmful, But Not Safe

Cigarettes are the world’s most efficient nicotine delivery device. They are also the most deadly. Many of the most dangerous byproducts of cigarettes are created during the burning process.

Smokeless tobacco products obviously don’t burn. But smokeless tobacco is a major cause of oral cancer, pancreatic cancer, and esophageal cancer.

Much of this risk comes from cancer-causing chemicals called nitrosamines and polycyclic aromatic hydrocarbons (PAH). And snuff products actually deliver more cancer-causing nitrosamines than cigarettes do.

But nitrosamine content is far lower in snus than in snuff, says Stephen S. Hecht, PhD, professor of cancer prevention at the University of Minnesota.

“Snus are made with a special process to help control nitrosamine levels,” Hecht tells WebMD.

There’s a catch, of course. Carcinogen levels in snus may be lower — but they are not low.

“Nitrosamine levels in snus are still 100 times greater than levels of nitrosamines in foods like nitrite-preserved meats,” Hecht says. “This is not a harmless product.”

And there’s evidence that these nitrosamines — or something else in snus — are causing cancer. In Sweden and Norway, where snus originated, snus users have a significantly higher risk of pancreatic cancer.

Snus are also linked to mouth sores, dental cavities, heart attack, stroke, and diabetes risk. And they do deliver nicotine — an addictive drug.

Snus: Harm Reduction or Multiplication?

OK, so snus isn’t without harm. But if it’s so much safer than cigarettes, wouldn’t it be good for smokers to switch to snus?

In Scandinavia, there’s some evidence that snus contributed to a decline in smoking. Whether that happens in the U.S. depends on young people, says Michael Eriksen, ScD, director of the Institute of Public Health at Georgia State University and former director of the CDC Office on Smoking and Health.

“If we see that existing smokers are the primary users of snus and go from smoking to snus, that would be a public health success story,” Eriksen tells WebMD. “But if kids start out on snus and then grow into smoking, that is going to be a disaster.”

It’s a huge public health experiment — and the results already are plain to see, says Terry Pechacek, PhD, associate director for science at the CDC’s Office on Smoking and Health.

Pechacek notes that more than a fourth of white, male high school students report having used smokeless tobacco products in the last month. Overall, nearly 7% of all U.S. high school students already use smokeless tobacco.

And they are not using snus instead of cigarettes.

“The overwhelming pattern is to smoke cigarettes along with smokeless tobacco — and two-thirds of this is among young adults,” Pechacek tells WebMD. “Over half of teens using smokeless tobacco are also using cigarettes. … It is of great public health concern.”

This isn’t an accident, says Michael Steinberg, MD, MPH, director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey.

Steinberg notes that in 2006, major U.S. cigarette companies bought the major smokeless tobacco brands. And the two major brands of snus? They’re from leading cigarette makers Altria/Philip Morris (Marlboro Snus) and RJ Reynolds (Camel Snus).

“Snus is being co-marketed with cigarettes,” Steinberg tells WebMD. “The companies are not shy in saying, ‘When you can’t smoke, use snus.’ But when you can smoke, it is clear they want you to smoke cigarettes. They make more money from cigarettes sales than anything else on the planet.”

Steinberg also notes that U.S. snus deliver less nicotine than do cigarettes.

“So if people try to get nicotine from snus, they will not get what they are used to. They will go through nicotine withdrawal and so will not use snus alone,” Steinberg says. “My conclusion is that companies do not want to replace cigarettes with snus.”

Snus: An Aid to Quitting Cigarettes?

Data from Sweden show that snus users don’t always progress to cigarette use, and that it’s possible to use snus to reduce dependence on cigarettes.

One Swedish study, for example, found that there were more ex-smokers using snus that there were ex-snus users using cigarettes.

However, Steinberg notes that this study fails to account for significant anti-smoking efforts taking place in Sweden at the same time, such as indoor health programs and government assistance to smoking cessation programs.

“Other countries, such as Norway, have not seen the same outcomes in terms of health benefits of snus as in Sweden,” he says.

Steinberg points to studies showing that snus isn’t any more helpful than nicotine replacement products such as nicotine gum and nicotine nasal spray.

“The real question is who do you buy your nicotine from?” GSU’s Erickson says. “Do you buy it from a tobacco company that can put anything on the market with no testing … or do you buy it from pharmaceutical companies that have to demonstrate the safety and effectiveness of their products as a drug and demonstrate they actually work?”

It’s right there in a big black box on the home page of the Camel Snus web site: “WARNING: Smokeless tobacco is addictive.”

Snus users get hooked on nicotine. This means that if users try to quit, they will go through the unpleasant sick feeling known as withdrawal. Many will find it very difficult, if not impossible, to stop using nicotine in one form or another.

“Those who sell nicotine would like to keep people hooked on nicotine forever. That is a question, whether lifetime nicotine addiction is acceptable,” Erikson says. “There are 50 million people in the U.S. who are regular nicotine users. The sooner we can get them from relying on smoked nicotine to not-smoked nicotine the better. The sooner we can get them all off nicotine entirely, the better.”

All of the experts who spoke with WebMD agree: Snus clearly aren’t as deadly as cigarettes, but they pose a significant risk to your health.

“The bottom line is there is no safe form of tobacco use,” Pechacek says.

November, 2010|Oral Cancer News|

BCOCPP TEAM WINS CDA ORAL HEALTH PROMOTION AWARD—TEAM INCLUDES UBC ALUMNA / FACULTY MEMBER

Source: UBC Dentistry

The Canadian Dental Association has presented the Oral Health Promotion Award to the BC Oral Cancer Prevention Program (BCOCPP) and to two of its founding pioneers, Dr. Miriam Rosin and UBC alumna and faculty member Dr. Michele Williams (DMD 1988).

Rosin and Williams are part of a team of scientists and clinicians that has worked tirelessly to develop a program that has heightened the awareness of oral cancer, and the need for early oral cancer detection.

They led a working group in creating Guidelines for the Early Detection of Oral Cancer that have been adopted as the standard in this area and have been widely circulated in BC and the rest of Canada.

In addition, their team has established a variety of community outreach programs that are linked to the central BC Cancer Agency/BC Cancer Research Centre, Vancouver General Hospital and the University of British Columbia Faculty of Dentistry.

There has been as special emphasis on outreach to high-risk under-served groups such as the poor, new immigrant populations and the elderly who have limited access to care and information.

Through their work, Rosin and Williams have defined the pathway to reducing the incidence of oral cancer and have led the way to the initiation of research into new technologies to assist in recognizing and diagnosing oral cancer.

Their impact has been broad in the dental community where they have been recognized and in the patient community where early detection using new technology and comprehensive protocols have made huge advances in the prevention of oral cancer.

November, 2010|Oral Cancer News|

Maternal use of swedish snuff (Snus) and risk of stillbirth

Source: www.bioportfolio.com
Author: Wikström, Anna-Karin

Background:
Swedish snuff has been discussed internationally as a safer alternative to tobacco smoking. International cigarette manufacturers are promoting new snuff products, and the use of Swedish snuff is increasing, especially among women of childbearing age. The effect of Swedish snuff on pregnancy complications is unknown.

Methods:
In this population-based cohort study, we estimated the risk of stillbirth in snuff users (n = 7629), light smokers (1-9 cigarettes/day; n = 41,488), and heavy smokers (>/=10 cigarettes/day; n = 17,014), using nontobacco users (n = 504,531) as reference.

Results:
Compared with nontobacco users, snuff users had an increased risk of stillbirth (adjusted odds ratio = 1.6 [95% confidence interval = 1.1-2.3]); the risk was higher for preterm (<37 weeks) stillbirth (2.1 [1.3-3.4]). For light smokers, the adjusted odds ratio of stillbirth was 1.4 (1.2-1.7) and the corresponding risk for heavy smokers was 2.4 (2.0-3.0). When we excluded women with preeclampsia or antenatal bleeding and infants who were small for gestational age, the smoking-related risks of stillbirth was markedly attenuated; the elevated risk for snuff users remained the same level.

Conclusions:
Use of Swedish snuff during pregnancy was associated with a higher risk of stillbirth. The mechanism behind this increased risk seems to differ from the underlying mechanism in smokers. Swedish snuff does not appear to be a safe alternative to cigarette smoking during pregnancy.

Source: Epidemiology (Cambridge, Mass.)

Authors Affiliations:
a Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden;
b Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; and
c Division of Obstetrics and Gynecology, Department of Woman and C
Journal Details

November, 2010|Oral Cancer News|

HPV vaccination of young women may protect men through herd immunity

Source: www.medscape.com
Author: Laurie Barclay, MD

High coverage of quadrivalent human papillomavirus (HPV) vaccination in young Australian women resulted in a lower frequency of genital warts, which might protect heterosexual men through herd immunity, according to the results of an analysis of national sentinel surveillance data published online November 9 in Lancet Infectious Diseases.

“The natural history of cervical and HPV-associated diseases is slow,” Mark H. Einstein, MD, MS, associate professor of obstetrics and gynecology and women’s health, and director of clinical research for women’s health and gynecologic oncology at Albert Einstein College of Medicine and Albert Einstein Cancer Center, Montefiore Medical Center, in New York City, told Medscape Medical News when asked for independent comment. “This is the first registry-based study that has already shown the declines after vaccinating a large population of vaccine-eligible adolescents and young adults. This prospectively shows what all the models have been predicting all along.”

The annual incidence of genital warts has been increasing for decades and is currently about 1% in young, sexually active people. Up to 90% of cases of genital warts are caused by HPV types 6 and 11, which are 2 of the 4 types targeted by the quadrivalent HPV vaccine used in Australia (Gardasil; CSL Biotherapies).

“While it will probably be as effective as the quadrivalent HPV vaccine at preventing anogenital and other cancers, the bivalent HPV vaccine (Cervarix, GSK) used in the UK national program provides no protection against genital warts,” lead author Basil Donovan, MD, head of the Sexual Health Program, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, in Sydney, Australia, said in a news release.

Beginning in July 2007, Australia was the first country to fund an HPV vaccination program for all women 12 to 26 years of age. Using a national surveillance network, the investigators assessed trends in diagnoses of genital warts in Australia from January 2004 to December 2009. New patients attending 8 sexual health services in Australia during that time provided standardized data for demographic factors, frequency of genital warts, HPV vaccination status, and sexual behavior.

Significant trends in proportions of patients diagnosed with warts in periods before and after vaccination began were identified using χ2 analysis. The main study population was female Australian residents eligible for free vaccination, but the investigators also analyzed data for patients ineligible for free vaccination, including women older than 26 years of age, nonresident women, and men.

Genital warts were identified in 9867 (9%) of 112,083 new patients attending sexual health services between 2004 and 2009. Before the vaccination program began, the proportion of women or heterosexual men diagnosed with genital warts did not change, but after vaccination began, young female residents had a significant decline in number of diagnoses of genital warts from 11.7% in July to December 2007 to 4.8% in July to December 2009 (59% change; P trend < .0001). There was no significant decrease in diagnoses of genital warts among female nonresidents, women older than 26 years in July 2007, or men who have sex with men. During the vaccine period, proportionally fewer heterosexual men were diagnosed with genital warts, from 12.3% to 8.9% (28%; P trend < .0001). This effect was most apparent in young men. By 2009, 65.1% of female Australian residents who were eligible for free vaccine had received quadrivalent or unknown HPV vaccine. "The strengths of this study are the large numbers and the very high uptake in Australia, which came about for a number of reasons," Dr. Einstein said. "Firstly, the year the quadrivalent vaccine was introduced, one of the patent holders of the technology, Ian Frazer, was named Australia's Man of the Year. Also, the prime minister's wife came out saying she was a cervical cancer survivor, and all this led to large campaigns for young women being vaccinated." Limitations of this study include the failure to yield true population-based data on genital warts; the use of a clinic-based sample, with possible bias against detecting a decline in incidence of genital warts; and misclassification of some women as eligible or ineligible for free vaccination. "The decrease in frequency of genital warts in young Australian women resulting from the high coverage of HPV vaccination might provide protective effects in heterosexual men through herd immunity," the study authors write. "The high morbidity in [men who have sex with men] attributable to HPV-related disease, including anal cancer, and the possible role of anal warts in facilitation of transmission of HIV, means that this group should be considered in future HPV-vaccination programmes." When asked about suggestions for additional research, Dr. Einstein recommended continued follow-up with good registries in well-vaccinated populations, such as many Western European countries (including the United Kingdom, Scandinavia, Belgium, Netherlands, Australia) and certain provinces in Canada, where most young adults have already been vaccinated. If possible, he also suggested linking the disease with HPV types in some subsets of these populations. "We hope that our findings of national population benefit from the quadrivalent HPV vaccine, showing much the same efficacy as in clinical trials, will be followed by widespread reductions in infection and disease from oncogenic HPV 16 and 18," the study authors conclude. "This reduction might already be underway, but will take longer to document than did decreased incidence of genital warts." CSL Biotherapies supported this study. Some of the study authors report various conflicts of interest with CSL Biotherapies, Sanofi Pasteur, GlaxoSmithKline (GSK), and/or Merck. Dr. Einstein has advised or participated in educational speaking activities but does not receive an honorarium from any companies. In specific cases, his hospital, Montefiore Medical Center, has received payment for his time spent for these activities from Merck and GSK. Montefiore has also received grant funding from Merck and GSK for research related costs of clinical trials for which he has been the Montefiore PI. Source: Lancet Infect Dis. Published online November 9, 2010.

November, 2010|Oral Cancer News|

Smoking patterns in cancer survivors

Source: ntr.oxfordjournals.org
Author: Deborah K. Mayer & John Carlson

Introduction:
More than 11 million cancer survivors are at risk for new cancers, yet many are receiving inadequate guidance to reduce their risk. This study describes smoking trends among a group of cancer survivors (CaSurvivors) compared with a no cancer (NoCancer) control group.

Methods:
The Health Information National Trends Survey 2003, 2005, and 2007 cross-sectional surveys were used in this secondary data analysis. Descriptive statistics were produced, and logistic regressions of current smokers were performed on weighted samples using SUDAAN. The sample included 2,060 CaSurvivors; the average age was 63 years; and the majority of respondents were female (67%), White (80.6%), married, or partnered (52.5%), with at least some college education (57%). The mean time since diagnosis was 12 years; 28.7% reported fair or poor health status.

Results:
The overall smoking rate was 18.7% for CaSurvivors and 21.7% for the NoCancer group. Education (less than college), age (younger), marital status (widowed or divorced), and health care access (none or partial) were significant personal variables associated with a greater likelihood of being a current smoker. Controlling for these variables, there were no differences between the CaSurvivors and NoCancer groups over time. Women with cervical cancer were still more likely to be smokers (48.9%) than other CaSurvivors (p < .001). Conclusions: CaSurvivors’ current smoking trends were similar to the control group. While most variation was explained by demographic variables, women with cervical cancer, a smoking-related cancer, had the highest prevalence of smoking. Smoking cessation interventions should be targeted to this high-risk group. Auhors: 1. Deborah K. Mayer, Ph.D., R.N., A.O.C.N., F.A.A.N. and 2. John Carlson, M.S. Authors Affiliations 1. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC

November, 2010|Oral Cancer News|