Monthly Archives: June 2011

The Value of Vaccines

Source: Medscape.com

Vaccines Decrease Rate of Bacterial Meningitis

A recent, retrospective study revealed that the incidence of bacterial meningitis decreased by 31% over 10 years, likely the result of vaccinations (Thigpen et al. 2011). In addition, the median age of those infected increased from 30.3 to 41.9 years, evidence that vaccinating the young has protected them from infections while leaving older, unvaccinated people more vulnerable.

The authors analyzed data on bacterial meningitis from 1998-1999 to 2006-2007 in 8 surveillance areas of the Emerging Infections Programs Network, which includes 17.4 million people. The 5 most common pathogens for bacterial meningitis were Haemophilus influenza type b (Hib), Streptococcus pneumonia, group B streptococcus (GBS), Listeria monocytogenes, and Neisseria meningitides. Cerebrospinal confirmation of the clinical diagnosis was required.

The beneficial effect of vaccines during the surveillance period is striking. The incidence of bacterial meningitis from Haemophilus influenza decreased by 35%. For strains of bacterial meningitis from Streptococcus pneumonia included in the PCV7 vaccine, infections decreased by 92%. Conversely, rates of meningitis from group B streptococcus, for which there is no vaccine, did not change.

Deadly Choices

In a recent Medscape One-on-One video interview, Eli Adashi, MD, discussed the dangers of the anti-vaccine movement with Paul Offit, MD, Chief of Infectious Disease at Children’s Hospital, Philadelphia, PA. Dr. Offit is a pediatrician and author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, Basic Books, 2011.

It’s a Conspiracy…

According to the Centers for Disease Control and Prevention (CDC), “Unfounded claims can cause harm to children if they result in less protection for them against potentially serious diseases.”

However, judging from some of the online comments to Dr. Adashi’s program, not all health care workers are convinced of the value and safety of vaccines. Their uncertainty may be contributing to the 40% of parents who refuse or delay vaccination of their children, a factor that appears related to the increase in measles, mumps, and other outbreaks.

A recent blog written by Steven Salzberg published in Forbes regarding the importance of measles vaccination was attacked by Robert Schecter of “The Vaccine Machine,” a website that “fights the misinformation and propaganda disseminated by the Machine and its unwitting media allies and stands firmly in opposition to the forced vaccination of America’s children.” Schecter argues that the health risk from measles is exaggerated, “but more importantly we must begin to dismantle the hidden police [state] which already exists and has as its foundation mandatory vaccination.”

Yikes! If there’s a “hidden police state,” I guess it’s well hidden, because I haven’t found it yet. But I’ll keep looking…

While those who choose not to vaccinate themselves or their children may consider this their “right,” their refusal not only puts themselves at risk, but others as well, particularly those who are immunocompromised or with chronic medical conditions [Thigpen et al. 2011]. Unvaccinated newborns, who have yet to have a say in the matter, are the most vulnerable (Thigpen et al. 2011).

A Global Concern

The problem of bacterial meningitis may be better appreciated when examined from a global perspective. Data from the CDC are enlightening:

Haemophilus influenzae type b (Hib) is a bacterial disease that each year causes pneumonia and meningitis in young children, resulting in three million illnesses and 400,000 deaths. Bacterial meningitis alone kills more than 65,000 young children in the developing world each year. The United States has been able to virtually eliminate pediatric bacterial meningitis through several interventions including the introduction of Hib vaccines.

Your Son is Going to Die

Here is an excerpt from the Introduction of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.

On February 17, 2009, Robert Bazell, a science correspondent for NBC Nightly News, told the story of an unusual outbreak in Minnesota: a handful of children had contracted meningitis caused by the bacterium Haemophilus influenzae type b, or Hib. What made this outbreak so unusual was that it didn’t have to happen; a vaccine to prevent Hib had been around for twenty years. But most of the Minnesota children-including one who died from the disease-weren’t vaccinated. The problem wasn’t that their parents couldn’t afford vaccines, or that they didn’t have access to medical care, or that they didn’t know about the value of vaccines. The problem was that they were afraid: afraid that vaccines contained dangerous additives; or that children received too many vaccines too soon; or that vaccines caused autism, diabetes, multiple sclerosis, attention deficit disorder, learning disabilities, and hyperactivity. And despite scientific studies that should have been reassuring, many weren’t reassured. When the outbreak was over, one mother reconsidered her decision: “The doctor looked at me and said, Your son is going to die. He doesn’t have much time.’ Honestly, I never really understood how severe the risk [was] that we put our son at.”

Infants Don’t Get to Choose

While working as an ER physician several decades ago, I vividly remember treating one febrile 7 month old boy. Unlike most of the children I saw in the ER, this one wasn’t cranky, crying, or screaming. He just lay there, limp and quiet on his mother’s shoulder. I had never done a lumbar puncture on a 7 month old, but meningitis seemed likely. A spurt of green pus that shot through the needle and splattered onto my white coat confirmed the diagnosis. A helicopter ride to a tertiary medical center and vials of antibiotics saved the child’s life.

It would be nice if no one ever needed to participate in that scenario again, not doctor, parent, or patient. I hope that little boy never developed any neurological sequelae such as cognitive and behavioral dysfunction, deafness, seizures, speech and language deficits, spasticity, or vision loss. Moderate to severe sequelae of bacterial meningitis occur in approximately 25% of survivors. (Chandran et al. 2011).

Less vaccinations, more epilepsy

As an epileptologist, I have treated people suffering from intractable epilepsy due to meningitis. Of course, they were “lucky,” since they survived. The overall mortality rate of meningitis is 15%, which did not change during the 10 year surveillance period (Thigpen et al. 2011).

Conclusions

It’s ironic that modern science provides the power to eradicate epidemic infections (like measles), but irrational human behavior limits our ability to apply these tools, resulting in unnecessary morbidity and mortality for individuals and a costly societal burden. The educational efforts of the CDC, Dr. Offit, and others, as well as the observations presented by Thigpen and colleagues may convince some of those who doubt the value of vaccines to change their minds. Given the ongoing “debate” about the merits of vaccination, this New England Journal of Medicine study should be front-page news.

Adverse events may occur with any treatment, but the rigorous approval process of vaccinations by the Food and Drug Administration (FDA) as well as the excellent safety track record of current vaccines should reassure those who hesitate to vaccinate themselves or their children. Expanded coverage of the new PCV13 pneumococcal vaccine promises to be even more beneficial than the older PCV7 vaccine. However, for those who contract meningitis, case fatality rates remain at a stubborn 15%. Our limited ability to improve fatal outcomes further emphasizes the importance of vaccination for meningitis prevention.

Believe it.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

What Really Killed Farrah Fawcett?

Source: Empowher.com

In a recent interview between CNN’s Piers Morgan and Ryan O’Neal, O’Neal claimed that the stress resulting from his family turmoil may have contributed to Farrah Fawcett’s death. He stated,“…we really don’t know what causes cancer…”

When it comes to anal cancer, the disease that took Fawcett’s life in June of 2009, we certainly do know the cause. More than 90 percent of anal cancers are the result of Human Papillomavirus (HPV). This is the same virus responsible for cervical, vulvar, vaginal, penile and oral cancers.

The list of cancers resulting from HPV continues to grow, with oral cancer (mainly affecting men) as the latest on the ongoing list. It has been known for quite some time, however, that HPV is responsible for anal cancer.

Over the past three decades, anal cancer has risen among women by 78 percent, and it has risen among men by 160 percent. Those figures were taken from a study done in 2004 by the Fred Hutchinson Cancer Research Center in Seattle, Washington. It has been another seven years, and still, little is done to inform the public of this rapidly growing trend and the vaccine that can prevent the two most aggressive strains of HPV known to cause anal cancer.

When Fawcett’s documentary regarding her diagnosis and treatment for anal cancer aired in 2009, anal cancer survivors and others with HPV watched intently. They wanted to see if there would be a public service announcement at the end of the documentary to educate others on the potential for HPV to be cancer causing. Also, they wanted viewers to know a vaccine exists. But the announcement never came, nor was HPV ever spoken about during the documentary.

This doesn’t mean that Fawcett had HPV—only medical professionals and her family knows the answer to this question. It did, however, inflame weeks of posts on various HPV support blogs. The outrage took some time to die down, but the sentiment expressed by everyone was virtually the same.

Why couldn’t she have at least used this opportunity to educate the public beyond the existence of anal cancer (and the hopes of removing the stigma)?

Why didn’t she also make the connection to HPV, the virus that most only know is related to cervical cancer?

It is truly unfortunate, because whether she had HPV or not, as a well-known celebrity, and with a documentary that garnered literally millions of viewers, she had an opportunity to do so much more to educate the public. Had individuals learned even two years ago that a vaccine exists to protect against HPV and anal cancer, some victims would still probably be alive today.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Philip Morris sues Australia over cigarette packaging

Source: http://www.nytimes.com/
Author: Bloomberg News

Philip Morris International said it had started legal action against the Australian government over the nation’s plans to allow the sale of cigarettes only in plain packages.

The company filed a notice of claim against the government saying that the proposals violate terms of Australia’s Bilateral Investment Treaty with Hong Kong, according to an e-mailed statement on Monday from Philip Morris’s Asian unit. A copy of the court document was not immediately available.

Australia, which has already banned the public display of tobacco products in retail outlets, wants to outlaw logos on cigarette packs and force them to be sold in plain dark-olive packaging, carrying health warnings instead of company logos. Cigarette brand names will appear on the packages in the same size and style of printing. The legislation, if passed by Parliament, would come into force in 2012.

“The forced removal of trade marks and other valuable intellectual property is a clear violation of the terms of the bilateral investment treaty between Australia and Hong Kong,” Anne Edwards, a spokeswoman for Philip Morris Asia, said in the statement. “We believe we have a very strong legal case and will be seeking significant financial compensation for the damage to our business.”

The government raised tobacco taxes by 25 percent last year as it sought to curb smoking, which is the nation’s largest single preventable cause of death, according to the nation’s health minister, Nicola Roxon.

“We don’t believe that taking that action is in breach of any of our international obligations,” Ms. Roxon told Sky News. “We believe that we are able, and the Australian people I think would expect their government, to take action in the interests of public health.”

Can HPV vaccine stop throat cancer?

Source: children.webmd.com
Author: Daniel J. DeNoon, WebMD Health News (Reviewed by Louise Chang, MD)

HPV (human papillomavirus) vaccines protect against the sexually transmitted strains of HPV that cause cervical cancer. The same HPV strains — spread by kissing and by oral sex — cause oropharyngeal (OP) cancer, the form of head and neck cancer that affects the back and sides of the throat, the base of the tongue, and the tonsils.

There’s strong evidence that HPV vaccines prevent cervical cancer. There’s no direct proof that these vaccines prevent throat cancer, but the rapid rise in cases among young people has some experts wanting to vaccinate first and get proof later.

“We don’t need to wait until all these molecular events are understood,” Dong Moon Shin, MD, of Emory University’s Winship Cancer Center, tells WebMD. “The time is now. For the HPV vaccine, cost is the only issue as side effects are minimal. Routine HPV vaccination has to be implemented very soon, for both boys and girls.”

In the U.S., that recommendation is made by the Advisory Committee on Immunization Practices (ACIP). The ACIP now recommends routine HPV vaccination only for girls and young women in order to prevent cervical cancer. It permits vaccination of boys who want protection against HPV-caused genital warts.

For two years, the ACIP has been mulling whether to recommend the HPV vaccine for boys. This would help prevent cervical cancer in unvaccinated women. It also would prevent HPV-related anal cancer and genital warts in both men and women, as well as HPV-related cancer of the penis. But HPV causes anal cancer and penile cancer far less often than it causes cervical cancer, and if enough girls were to get the HPV vaccine — about 50% — it wouldn’t be cost-effective to vaccinate boys.

Throat cancer is rapidly changing this scenario. Throat cancer is tipping the scales toward HPV vaccination of boys

At yesterday’s meeting, the ACIP heard a disturbing report from Aimee Kreimer, PhD, an expert in head and neck cancer at the National Cancer Institute.

“At some point … it is projected that there will be the same incidence of OP cancer in men as cervical cancer in women,” Kreimer said. “If current trends continue, OP cancer in men will pass cervical cancer in 2025.”

And HPV is to blame. Only a few decades ago, the major risk factors for throat cancer were smoking and alcohol. Not any more. In the five-year period of 1984-1989, only 16% of OP cancers were linked to HPV. By 2000-2004, HPV was behind 75% of OP cancers.

What are the risk factors? Not all are known, but HPV-related throat cancer risk goes up with increased oral sex and kissing, Kreimer said. Current tobacco use and HIV infection also are risks. Fortunately, oral HPV infection appears to be much less common than genital HPV infection. Among healthy individuals infected with HPV, fewer than one in 20 has detectable HPV in the oral cavity.

But there are disturbing trends. Husbands of women with cervical cancer have a threefold higher risk of tonsil cancer. And people who have anal cancer have a fourfold to sixfold higher risk of tonsil cancer.

These findings are tipping the ACIP in favor of recommending routine HPV vaccination for boys.

“Most members of the [ACIP] HPV working group favor the strategy of routine vaccination of all males at the age at which they get the most benefit,” Eileen Dunne, MD, MPH, a CDC researcher assisting the working group, said in a presentation to the full ACIP.

But the ACIP did not vote on the issue at the June meeting. Some members of the panel expressed frustration with the process.

“HPV cancers in males account for 7,000 cases a year,” said ACIP member Mark H. Sawyer, MD, professor of pediatrics at the University of California, San Diego. “That is not a trivial number, and we are sitting around here wondering whether to immunize them. But it is not a trivial question.”

The National Cancer Institute estimated that in 2010, there were 12,660 cases of OP cancer — and 2,410 deaths. About half of those cases would have been male; at least three-fourths would have been caused by HPV.

The full ACIP likely will vote on the issue at its October meeting.

Cancer vaccines make progress in combating disease

Source: http://www.masshightech.com/
Author: Lori Valigra, Mass High Tech correspondent

Sen. Edward Kennedy’s death two years ago from the deadly form of brain cancer, glioblastoma multiforme (GBM), refocused attention on how slowly treatments have progressed since former President Richard Nixon declared the war on cancer in 1971.

But a new form of treatment that goes beyond oncology drugs and surgery is now coming of age: cancer vaccines. At the recent American Society of Clinical Oncology (ASCO) meeting in Chicago — a major forum for cancer researchers — several companies and research groups reported progress on cancer vaccines, including a New England company with a shot for GBM. Agenus Inc. of Lexington reported its Prophage G-200 almost doubled the longevity of patients with recurring GBM to 11 months. That’s good news to patients with that particularly aggressive form of cancer, which also killed composer George Gershwin and music synthesizer legend Robert Moog.

Vaccines represent a relatively new approach to fighting the spread of cancer, having appeared in the last decade. The basic concept is similar to a vaccine for a disease like measles: an injection in the arm induces an immune response that helps the body fight a particular pathogen, in this case, a cancer. An effective immune response would then shrink tumors and extend lives.

Research and Markets estimates that the relatively new market for cancer vaccines could rise sharply to top $7 billion by 2015. The research company looked at six main categories of cancer vaccines: antigen/adjuvant, DNA, vector-based, tumor cell, dendritic cell, and anti-idiotype.

“Cancer vaccines are some of the most exciting areas of medicine we’ve seen in a while. They have the potential to change the way we treat cancer worldwide,” said Anthony Vasconcellos, president and CEO of InCytu Inc., a Lincoln, R.I., company (see page 8) with a very early stage vaccine that boosts the activity of dendritic cells, which in turn activate the immune system, to target GBM and other cancers. “Instead of circumventing the body’s mechanisms, the vaccines harness them. Cancer vaccines really will change the face of medicine.”

Early cancer vaccines were not potent enough, noted Thomas Davis, MD, senior vice president and chief medical officer at Celldex Therapeutics Inc. of Needham (see page 8), a cancer vaccine spinout of Medarex Inc. of New Jersey (now owned by Bristol-Myers Squibb Co.). Davis said a critical turning point for cancer vaccines was the discovery by Drs. Ralph Steinman and Zanvil A. Cohn at Rockefeller University in New York of dendritic cells, which are pivotal to the immune system. “The cells don’t work well in patients with cancer. There’s still a lot we do not know, but we are getting a better sense of how dendritic cells work and how cancer suppresses them,” Davis said. “We are in the dawning of the vaccine era.”

Garo Armen, CEO of Agenus Inc. (formerly Antigenics), agreed. In the last 12 months, especially, there has been a lot of positive activity with cancer vaccines, he said, pointing to Dendreon Corp.’s Provenge for metastatic castrate resistant (hormone refractory) prostate cancer, which was the first cancer vaccine approved by the U.S. Food and Drug Administration, and Bristol-Myers Squibb’s Yervoy for metastatic melanoma.

“These two vaccines were very important approvals in the last year,” Armen added. “To date oncologists haven’t had many tools other than traditional chemotherapy drugs to treat patients. That improvement would extend life by two to three months at best. Now for the first time we have a different pathway, the immunological pathway, and we have the tools to make it work.” Agenus actually had the first approved cancer vaccine, Oncophage, but that was in Russia to treat kidney cancer patients post surgically and will not be submitted for U.S. approval, he said.

Several other New England companies also are working on cancer drugs, including ONCoPEP Inc. of North Andover, which is developing a vaccine for smoldering myeloma (a precursor to multiple myeloma). Celldex Therapeutics Inc. (formerly Avant Immunotherapeutics Inc.), is making a brain tumor vaccine. InCytu’s vaccines are based on intellectual property from Harvard University.

In addition, RNAi-focused biotech firm Alnylam Pharmaceuticals Inc. of Cambridge has a license deal with Australia’s University of Queensland that gives the company access to RNAi intellectual property to develop cancer vaccines. And, RXi Pharmaceuticals Corp. of Worcester presented positive Phase 2 efficacy results at ASCO for its NeuVax peptide vaccine combined with Genentech/Roche’s Herceptin for breast cancer patients. The group of patients treated with the vaccine showed no cancer recurrence for three years, compared to 22 percent recurrence in patients receiving standard care.

BioVex Group Inc. of Woburn perhaps punctuated the value now being placed on cancer vaccine technology when it said in January that it would be acquired by biotech giant Amgen Inc. of Thousand Oaks, CA, for up to $1 billion. The transaction was completed March 4. The company is in a Phase 3 multinational study in metastatic melanoma and a Phase 3 study in squamous cell carcinoma of the head and neck with an oncolytic vaccine called OncoVEX(GM-CSF). The vaccine uses a virus to target and destroy certain cancer cells as well as create an immune response to tackle cancer cells throughout the body.

Melanoma was a hot topic at the ASCO meeting, because the cancer has been tough to arrest. Armen of Agenus said Yervoy in particular was a breakthrough, because it removes the braking system of the immune system and it also potentially could be used for other cancers including lung and prostate.

Bristol-Myers released results at ASCO of a second Phase 3 randomized trial of Yervoy showing it prolonged the lives of patients with metastatic melanoma. The FDA approved Yervoy for patents with unresectable or metastatic melanoma in March 2011.

The Agenus drug for GBM induces an immune response that lets patients fight their own disease, said University of California at San Francisco (UCSF) neurosurgeon Andrew Parsa, MD, who led the G-200 study. Without treatment, he said half of the patients in the trial would have died of the cancer within five to nine months based on historical data. After receiving the vaccine, the median survival for 30 patients who received at least four vaccinations was 11 months. Several have survived for more than a year.

A second objective of the trial was to see if the vaccine could produce an immune response in all patients, and the results showed that it did in every patient in the trial tested to date. This suggests that doctors may be able to extend survival even longer by combining the vaccine with other drugs that enhance this immune response, Parsa said. Some 17,000 Americans are diagnosed with glioblastoma every year, he said, and only 2 percent of them survive longer than five years, even with treatment. Based on the study results, Agenus has started working with UCSF and other experts to design a randomized trial.

“With the recent FDA approvals of Provenge and Yervoy, which both harness the power of the immune system to fight cancer and offer the potential for combination use with other immunological agents, I believe we are entering a new era in the treatment of cancer that could see substantially improved survival rates in patients fighting this disease,” Marcel Rozencweig, MD, acting chief medical officer of Agenus, said in a statement when the data was released.

The future may involve trials combining G-200 with other agents. “G-200 patients aren’t responding to anything. Everything else has failed,” Armen said. “People don’t live with this disease.” He said cancer vaccines have the potential to be the Holy Grail in the treatment of cancer, but for that promise to be fulfilled they must be able to direct the immune system to target a patient’s own cancer and their potency must be improved. Cancer vaccines combined with immune/pathogenesis modulators could enhance activity in late-stage cancers, and G-200 could be combined with Yervoy or other drugs.

Davis of Celldex takes it a step further. “The next generation of vaccines will have multiple targets in them in the same patient,” he said. Celldex’s lead candidate is a vaccine for EGFRvIII-expressing tumors. The company also uses monoclonal antibodies to target dendritic cells, which in turn spark an immune response.

Doris Peterkin, CEO of ONCoPEP (see sidebar), said patients are getting diagnosed earlier and living longer. “There’s a general acceptance in oncology of the value of immunotherapy, but the frustration is how to make it work. We need to understand why certain patients respond and others don’t,” she said. “One drug doesn’t work the same for every patient; it will be the same thing for immunotherapy.” She added that cancer vaccines have improved by leaps and bounds in the past two years, but it’s important to get to an earlier stage of the disease.

Added Davis, “In the first 30 to 40 years of the war on cancer, the most progress was made in understanding what is going on with cancer and the immune system. It will still be many decades before we say we can cure most cancers.” 

Cigarette ads, packages must include oral cancer warnings, says FDA

Source: http://www.healthcanal.com/
Author: Craig Palmer, ADA News staff

The Food and Drug Administration will require use of a “cancerous lesion on lip” image in cigarette advertising and packaging for its potential to motivate positive behavioral change, influence youth and young adults in particular and inform the public that cigarettes cause oral cancer.

Flexing its regulatory muscle on the second anniversary of the Family Smoking Prevention and Tobacco Control Act, which was signed into law June 22, 2009, the FDA unveiled nine graphic health warnings to be placed on all cigarette packs, cartons and ads no later than Sept. 22, 2012.

“The nine new health warning statements and the accompanying graphic images selected by FDA convey information that is factual and uncontroversial,” the agency said in the regulatory notice.

The FDA simultaneously announced a public inquiry and request for comments on the public health impact of modified risk tobacco products sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products. The FDA scheduled a public forum Aug. 25-26 to obtain information on “the scientific issues associated with assessment and ongoing review of MRTPs.” These include smokeless and other products promoted as alternatives to cigarette smoking.

The Association supported the 2009 tobacco control law, and has advised the FDA on using the law to shape public tobacco policy. “Dentists are the first line of defense in the war against oral cancer and many other tobacco-related diseases,” the Association told the FDA in commenting on tobacco product regulation.

“As a matter of public health, we have become increasingly alarmed by recent attempts to market smokeless tobacco as a healthier (or less harmful) alternative to cigarettes,” the Association’s Oct. 9, 2009 statement said. “Smokeless tobacco is not a healthy alternative to cigarette smoking; both products pose health risks.”

FDA issued the requirement for larger, graphic health warnings for cigarette packages and advertisements in a June 22, 2011 Federal Register document dense with analysis and research rejecting tobacco industry arguments against the proposal and explaining how and why these images and warnings will get public attention and reduce smoking-related disease and death.

An image the FDA describes as “cancerous lesion on lip” will illustrate a “WARNING: Cigarettes cause cancer” statement chosen, the agency said, for scoring high in focus group testing on emotional and cognitive reaction scales and a “difficult to look at” measure.

“First, ‘cancerous lesion on lip’ was the only image among the images proposed for use with this warning statement that had a positive impact on beliefs about the health risks of smoking and secondhand smoke exposure in one of the study samples (adults viewing a hypothetical advertisement),” the FDA said in the regulatory document.

“Furthermore, as is stated in several comments…the selected image ‘cancerous lesion on lip’ is likely to have particular relevance for youth. As explained in some of these comments, the research literature suggests that youth are likely to relate to and be susceptible to cigarette warnings depicting the negative short-term impacts of smoking on their personal appearance, including their lips and teeth.

“Several comments noted that the image could be especially effective with younger audiences and could positively influence such audiences by illustrating how the health effects caused by smoking negatively affect their physical appearance. The comments indicated that adolescents can relate to and will be susceptible to this message.

“We agree with these comments,” the FDA said in responding to the comments on image effectiveness. “It is important to include content in the required warnings that is relevant to youth. The image ‘cancerous lesion on lip’ has the potential to positively impact youth behavior in addition to adult and young adult behavior.”

The FDA disagreed with comments that the image was “too gross” to be effective and that oral cancer was an odd choice of cancers to depict in the graphic warning, noting that “the research literature indicates that images that evoke strong emotional reactions can promote greater awareness and better recollection of the health risks of smoking and can increase the likelihood smokers will reduce their smoking, make an attempt to quit, or quit altogether.

“Furthermore, the choice of cancers depicted in the required warning is appropriate and will help inform the public that cigarettes cause oral cancers and thus increase public awareness of the negative consequences of smoking.”

The National Tobacco Quitline phone number, 1-800-QUIT-NOW, must accompany the nine new warnings.

Information for professionals and the public to assist in tobacco cessation efforts can be found on ADA.org.

Cannabis use and oral diseases

Source: Nature.com

Questions: What is the effect of cannabis usage on the oral environment?

Data sources
Medline and the Cochrane Central register of controlled trails (CENTRAL).

Study selection
Randomised Controlled Trials, Controlled Clinical Trials and Cohort Studies conducted on humans investigating cannabis usage were included. Screening was performed independently by two reviewers. Only English language studies were included. Case reports, letters and historical reviews were excluded.

Data extraction and synthesis
A narrative synthesis was conducted.

Results
Seven studies were included and a range of cannabis-associated oral side effects identified.

Conclusions
Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects such as xerostomia, leukoedema and an increased prevalence and density of Candida albicans.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

$1 Million Donated for Head and Neck Cancer Research at Ohio State University Comprehensive Cancer Center

Source: Ohio State University- James Cancer Center

COLUMBUS, Ohio – Two siblings are honoring their deceased parents by pledging $1 million to create an endowed chair in head and neck cancer research at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC– James).

Ron Alford of Westerville, Ohio, along with his sister Barb Cantlin and her husband Mike of Newark, Ohio, have pledged the additional funding over the next four years.

Their $1 million pledge adds to the original $500,000 donation made by John Alford to create the first research endowment at The James shortly after the free-standing cancer hospital opened in July 1990.

After his wife died of stomach cancer in 1987, John Alford chose to honor her memory by creating the Mary E. Alford Cancer Research Endowment Fund for cancer research at The James. When John Alford died of esophageal cancer in 1996, his children donated an additional $500,000 to create the Mary E. and John W. Alford Cancer Research Endowment Fund at The James.

With the latest gift pledge, once the fund reaches $2 million it will be renamed the Mary E. and John W. Alford Research Chair in Head and Neck Cancer.

“The level of support shown by the Alford family through the years to The James is a testament to their lifelong mission of trying to improve and enhance the lives of others,” says Dr. Michael Caligiuri, director of Ohio State’s Comprehensive Cancer Center and CEO of The James. “This additional funding will allow us to attract the best and the brightest to join the elite team of our stellar head and neck cancer program.”

Part of the funding will come from the Alford Family Foundation, which is operated by Ron Alford and Barb Cantlin and primarily supports organizations in Licking County, where John and Mary raised their family in Newark, Ohio, during their 36-year marriage.

“Our Dad always had a love of the Buckeyes and he had an allegiance to the university. My father was very giving, and the last 10 years of his life he was known more as a philanthropist than as a banker,” says Ron Alford, who last year was successfully treated at The James for cancer of the larynx.

John Alford was a prominent banker in Licking County, where he rose through the ranks at Park National Bank, eventually becoming director, president, CEO and chairman of the executive committee. He also served as president of the Ohio Banker’s Association and was a member of the Cleveland Federal Reserve Board and the Visa International Board.

“We look at this gift as a tribute to our parents, and we are proud that the gift will support cancer research at The James,” says Barb Cantlin. “We always try to give back to Licking County, and there is a clear connection with this gift. We know that plenty of people in Licking County have benefitted from The James. Daddy always taught us to give back.”

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (cancer.osu.edu) is one of only 40 Comprehensive Cancer Centers in the United States designated by the National Cancer Institute. Ranked by U.S. News & World Report among the top cancer hospitals in the nation, The James is the 205-bed adult patient-care component of the cancer program at The Ohio State University. The OSUCCC – James is one of only seven centers in the country funded by the NCI to conduct both phase I and phase II clinical trials.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Can HPV Vaccine Prevent Oral Cancer?

Source: WebMD.com

June 23, 2011 — Can HPV vaccines stop the explosive rise of HPV-related head and neck cancer?

HPV (human papillomavirus) vaccines protect against the sexually transmitted strains of HPV that cause cervical cancer. The same HPV strains — spread by kissing and by oral sex — cause oropharyngeal (OP) cancer, the form of head and neck cancer that affects the back and sides of the throat, the base of the tongue, and the tonsils.

There’s strong evidence that HPV vaccines prevent cervical cancer. There’s no direct proof that these vaccines prevent throat cancer, but the rapid rise in cases among young people has some experts wanting to vaccinate first and get proof later.

“We don’t need to wait until all these molecular events are understood,” Dong Moon Shin, MD, of Emory University’s Winship Cancer Center, tells WebMD. “The time is now. For the HPV vaccine, cost is the only issue as side effects are minimal. Routine HPV vaccination has to be implemented very soon, for both boys and girls.”

In the U.S., that recommendation is made by the Advisory Committee on Immunization Practices (ACIP). The ACIP now recommends routine HPV vaccination only for girls and young women in order to prevent cervical cancer. It permits vaccination of boys who want protection against HPV-caused genital warts.

For two years, the ACIP has been mulling whether to recommend the HPV vaccine for boys. This would help prevent cervical cancer in unvaccinated women. It also would prevent HPV-related anal cancer and genital warts in both men and women, as well as HPV-related cancer of the penis.

But HPV causes anal cancer and penile cancer far less often than it causes cervical cancer, and if enough girls were to get the HPV vaccine — about 50% — it wouldn’t be cost-effective to vaccinate boys.

Throat cancer is rapidly changing this scenario.
Throat Cancer Tipping Scales Toward HPV Vaccination of Boys

At yesterday’s meeting, the ACIP heard a disturbing report from Aimee Kreimer, PhD, an expert in head and neck cancer at the National Cancer Institute.

“At some point … it is projected that there will be the same incidence of OP cancer in men as cervical cancer in women,” Kreimer said. “If current trends continue, OP cancer in men will pass cervical cancer in 2025.”

And HPV is to blame. Only a few decades ago, the major risk factors for throat cancer were smoking and alcohol. Not any more. In the five-year period of 1984-1989, only 16% of OP cancers were linked to HPV. By 2000-2004, HPV was behind 75% of OP cancers.

What are the risk factors? Not all are known, but HPV-related throat cancer risk goes up with increased oral sex and kissing, Kreimer said. Current tobacco use and HIV infection also are risks.

Fortunately, oral HPV infection appears to be much less common than genital HPV infection. Among healthy individuals infected with HPV, fewer than one in 20 has detectable HPV in the oral cavity.

But there are disturbing trends. Husbands of women with cervical cancer have a threefold higher risk of tonsil cancer. And people who have anal cancer have a fourfold to sixfold higher risk of tonsil cancer.

These findings are tipping the ACIP in favor of recommending routine HPV vaccination for boys.

“Most members of the [ACIP] HPV working group favor the strategy of routine vaccination of all males at the age at which they get the most benefit,” Eileen Dunne, MD, MPH, a CDC researcher assisting the working group, said in a presentation to the full ACIP.

But the ACIP did not vote on the issue at the June meeting. Some members of the panel expressed frustration with the process.

“HPV cancers in males account for 7,000 cases a year,” said ACIP member Mark H. Sawyer, MD, professor of pediatrics at the University of California, San Diego. “That is not a trivial number, and we are sitting around here wondering whether to immunize them. But it is not a trivial question.”

The National Cancer Institute estimated that in 2010, there were 12,660 cases of OP cancer — and 2,410 deaths. About half of those cases would have been male; at least three-fourths would have been caused by HPV.

The full ACIP likely will vote on the issue at its October meeting.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Global Rise in Cancer Cost $300 Billion in 2010, Harvard Economist Says During Press Briefing Hosted by the American Cancer Society and the United Nations

23 June 2011

United Nations — Newly diagnosed cancer cases cost the global economy $300 billion in 2010, as illnesses once believed to be largely confined to wealthier countries took hold in developing nations, a Harvard University economist said during a press briefing hosted by the American Cancer Society Global Health Programs and the United Nations Department of Public Information.

Tobacco use, alcohol intake, obesity and decreased physical activity have grown in poorer countries, causing the rise of cancer and diabetes, said David E. Bloom, professor of economics and demography at Harvard’s School of Public Health in Boston. Bloom and other researchers held a briefing today in advance of the United Nations High Level Meeting on noncommunicable diseases.

The Sept. 19-20 meeting will be the first gathering of the UN Assembly dealing with cancer, cardiovascular illness, chronic lung conditions and diabetes. These diseases cause 60 percent of deaths worldwide, killing 36.1 million people annually, according to an April report by the World Health Organization.

“Noncommunicable diseases will evolve into a staggering economic burden in the coming years,” Bloom said. “It’s a huge impediment to the mitigation of poverty.” Bloom said treating newly diagnosed cancer cases cost $300 billion globally in 2010, and obstructive pulmonary disease — often correlated with smoking tobacco — costs $4 billion a year.

Not Confined to Health

“Economic policy makers like ministers of finance and ministers of planning see noncommunicable diseases as an issue confined to the health sector,” a misperception that needs to be addressed, Bloom said. “Dangers of NCDs are well-ensconced in the business screen of the world community,” he said.

The global decline in productivity due to illness and deaths from noncommunicable diseases will reach $35 trillion by 2030, Bloom said, an amount seven times larger than the current level of global health spending. Noncommunicable diseases undermine physical and human capital, as losses of labor put a burden on developing countries, he said. “The main asset the poor possess is their labor, and that is the most threatened by the noncommunicable diseases,” Bloom said.

Cary Adams, chief executive officer of the Union for International Cancer Control, said people in poorer countries were “getting fatter, lazier, smoking too much tobacco, and eating unhealthy food.”

“It is the poorest people in the poorest nations that suffer the most,” said John Seffrin, CEO of the American Cancer Society, at the briefing.

Poverty Cycle

Seffrin said more than 80 percent of noncommunicable diseases occur in low and middle-income countries. “Noncommunicable diseases perpetuate the poverty cycle,” he said.

The estimate of the costs of noncommunicable diseases includes medical care, transportation, information and education campaigns, and productivity losses from those who die, Bloom said. Of 14,000 business executives surveyed worldwide, he said half believed that noncommunicable diseases would have a negative impact on their bottom line.

“Think about health spending as not consumption but investment,” said Bloom. “As investment that yields a handsome rate of return.”

“This is a moral issue,” Seffrin said. “Unlike other health problems in the past, we know what’s coming.”

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.