Monthly Archives: January 2012

Squamous cell subgroups respond differently to treatment

Source: www.medscape.com
Author: Nancy A. Melville

A long-term follow-up of patients with head and neck squamous cell carcinoma suggests that only certain high-risk subgroups benefit from radiation plus chemotherapy. This information will spare patients who will not benefit from undergoing the additional treatment.

According to the study, presented here at the 2012 Multidisciplinary Head and Neck Cancer Symposium, patients with microscopically involved resection margins and/or extracapsular spread of disease had a lower risk for cancer recurrence with radiation plus chemotherapy 10 years later, whereas those with tumors in multiple lymph nodes did not benefit from combination treatment; they fared better with radiation alone.

“The clinical implication of these findings is that the high-risk group of patients is not as homogenous a group as we believed it was before the study started,” lead author Jay S. Cooper, MD, director of the Maimonides Cancer Center, in Brooklyn, New York, told Medscape Medical News.

Dr. Cooper and his colleagues analyzed 10 years of follow-up data from the Radiation Therapy Oncology Group (RTOG) 9501/Intergroup phase 3 trial, which examined 410 patients with high-risk resected head and neck cancers.

The patients were considered high risk for cancer recurrence because they had microscopically involved resection margins, extracapsular spread of disease, or multiple lymph node involvement.

“The allocation was equally divided [according to treatment regimen] at the beginning of the study; the groups were not intended to be balanced for the different [risk] factors,” Dr. Cooper said. “We thought they were all equally important.”

The treatment regimen was either postoperative radiation therapy (60 Gy in 6 weeks) or identical radiation therapy plus intravenous cisplatin 100 mg/m² on days 1, 22, and 43.

Whereas an earlier follow-up of surviving patients at 45.9 months showed improvements in local-regional control and disease-free survival in the radiation plus chemotherapy group in general, the different responses in risk-factor subgroups was not observed, Dr. Cooper said.

In the 10-year follow-up, however, the analysis showed trends in the subgroups.

The local-regional failure rate with radiation alone was 28.8% and with radiation plus chemotherapy was 22.3% (P = .10). Disease-free survival was 19.1% and 20.1% (P = .25) and overall survival was 27.0% and 29.1% (P = .31), respectively.

In the unplanned subgroups of patients with microscopically involved resection margins and/or extracapsular spread of disease, local-regional failure occurred in 33.1% of the group treated with radiation alone and in 21.0% of the group treated with radiation plus chemotherapy (P = .02).

Disease-free survival in the high-risk subgroups was 12.3% with radiation alone and 18.4% with radiation plus chemotherapy group (P = .05); overall survival was 19.6% and 27.1%, respectively (P = .07).

Patients with tumors in multiple lymph nodes received no benefit from postoperative radiation plus chemotherapy in the longer-term follow-up, compared with radiation alone.

Cause-specific survival rates showed a trend toward improved outcome in patients receiving radiation plus chemotherapy whose death was due to the study cancer, compared with those receiving radiation alone. However, an increased number of deaths related to causes other than the study cancer was observed in patients treated with radiation plus chemotherapy, the authors noted.

“These findings tell us that these subgroups of high-risk patients — who had either a tumor at the margin or extracapsular spread of the disease — do benefit from the addition of chemotherapy in terms of better local control, even at 10-year follow-up. Simultaneously, patients who have multiple node involvement but who don’t have a tumor at the margin or extracapsular spread of the disease do not benefit from chemotherapy,” Dr. Cooper said.

“In a crazy way, it’s a win–win situation, in that we now know how to spare some of the patients we thought were high risk from the toxicity of chemotherapy,” he said.

“For patients we identified as truly high risk, at least in terms of their response to chemotherapy, we now have a better therapy.”

Although similar findings have been observed before, this analysis sheds light on the longer-term response of high-risk patients, said Stuart J. Wong, MD, associate professor of medicine and otolaryngology at the Medical College of Wisconsin in Milwaukee, who moderated the session.

“There was a combined analysis of RTOG 9501 and the EORTC postop study, which had an identical study design,” said Dr. Wong.

“This was a landmark analysis that defines how we currently treat high-risk patients in the postoperative setting.”

“The long-term analysis of RTOG 9501 by Dr. Cooper and colleagues reiterates these findings,” he added. “These key study results are being used in the design of ongoing and future Radiation Therapy Oncology Group (RTOG) studies.”

The study authors and Dr. Wong have disclosed no relevant financial relationships.

Source: 2012 Multidisciplinary Head and Neck Cancer Symposium (MHNCS): Abstract 1. Presented January 26, 2012.

January, 2012|Oral Cancer News|

Erlotinib dose doubled for smokers with head/neck cancer

Source: www.oncologyreport.com
Author: Miriam E. Tucker

Giving smokers a higher, short-course dose of erlotinib before definitive surgery for squamous cell carcinoma of the head and neck resulted in favorable responses for the first patients evaluated in a small pilot study.

Investigators gave 300 mg of erlotinib (Tarceva) to smokers daily and 150 mg daily to nonsmokers who had a waiting period of more than 14 days before scheduled surgery for head and neck cancer. Seven of the 10 patients evaluated so far had partial responses and 3 had stable disease, according to a poster presented at a head and neck cancer symposium sponsored by the American Society for Radiation Oncology. The study was based on recent data in non–small cell lung cancer

(NSCLC) patients showing that smokers metabolize erlotinib, an epidermal growth factor receptor (EGFR) inhibitor, twice as quickly as do nonsmokers (J. Clin. Oncol. 2009;27:1220-6), said lead author Dr. Mercedes Porosnicu of Wake Forest Baptist Medical Center in Winston Salem, N.C. That study established the maximum tolerated dose of erlotinib at 300 mg daily in NSCLC patients who smoke.

Dr. Poroniscu’s presentation included the case study of a smoker with a very large oral cavity tumor protruding through his lips. He was described as being in significant pain and unable to eat or chew. The first CT scan showed a tumor of at least 8 cm and there was “significant metabolic activity” on PET scan.

“At 6 days of erlotinib treatment, his tumor was obviously smaller and he could chew, eat, and talk. Metabolic activity on PET scan dropped to 44% compared to initial tumor metabolic activity,” Dr. Porosnicu said. “At the end of 14 days’ treatment, his tumor was at least 20% smaller, and he had gained 5 pounds. His surgery wasn’t delayed, and the only treatment-related toxicity was a minimal skin rash.”

A total of 12 patients have been treated to date, for an average of 18.2 days, she reported. Nine were smokers and three were nonsmokers. All patients, smokers and nonsmokers, tolerated the erlotinib dose well with no serious adverse events and no delays in the scheduled time of surgical intervention. There were no grade 3 or 4 toxicities.

Of 10 evaluable patients (including 8 smokers who received 300 mg), 7 (including 5 smokers) showed a partial response, as defined by at least a 20% reduction in maximum tumor diameter. The other three patients (all smokers) showed stable disease. Two of the 12 treated patients received shorter duration treatment but nonetheless displayed good responses.

January, 2012|Oral Cancer News|

Head and neck cancer in transplant patients: For better or worse?

Source: medicalxpress.com
Author: Henry Ford Health System staff

Transplant patients who develop head and neck cancer are more likely to be non-smokers and non-drinkers, and less likely than their non-transplant counterparts to survive past one year of diagnosis, according to a new study from Henry Ford Hospital in Detroit.

As part of a 20-year review, Henry Ford researchers found cancers of the throat, tonsils and mouth may be more aggressive in transplant recipients as the result of long-term immunosuppressive therapy required to prevent solid organ rejection.

Transplant patients in the study who developed skin cancer in the head and neck region were more likely to have multiple lesions, compared to the general public. In all, 2.6% of transplant patients in the study developed some form of head and neck cancer.

While the risk for developing head and neck cancer is small, the study serves as an important reminder to all transplant recipients to be vigilant about any changes to their skin, as well as persistent sore throat, ear pain or swallowing issues – all signs of head and neck cancer.

“The benefits of organ transplantation and immunosuppressive therapy still outweigh the risk of transplant patients developing head and neck cancer,” says study author Robert Deeb, M.D., with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford.

“Still, our study highlights that head and neck cancer arising in transplant patients warrants the need for regular screenings and aggressive treatment.”

The study will be presented Jan. 28 in Miami Beach at the annual Triological Society’s Combined Sections Meeting.

More effective immunosuppressive therapies for transplant patients have greatly improved graft and recipient survival rates. But with longer survival, there has been an increase in long-term complications from immunosuppression, including head and neck cancer.

In fact, head and neck cancers account for 4 percent to 6 percent of all post-transplant malignancies.

The challenge is that transplant patients who develop head and neck cancer may have to consider forgoing immunosuppressive therapy in order to treat the cancer. But halting immunosupression could lead to organ failure, leaving patients with a very difficult decision: treat the cancer or save the organ. Transplant patients with most forms of skin cancer typically do not need to stop immunosuppressive therapy.

To gain a better understanding of post-transplant head and neck cancer, Dr. Deeb and Vanessa G. Schweitzer, M.D., conducted a comprehensive review of the 3,639 transplants that took place at the Transplant Institute at Henry Ford Hospital from January 1990 through December 2011.

Using electronic medical records, the researchers were able to track the incidence of head and neck cancer following solid organ transplantation during a 20-year period. During that period, 95 transplant patients developed head and neck cancer – 78 had cutaneous (skin) cancer and 17 had non-cutaneous cancer.

For the 78 patients who developed skin cancer, the most common sites were the cheek and scalp. More than half of the patients were diagnosed with multiple skin malignancies in the head and neck region. The average age at cancer diagnosis was 61, and the mean time between transplant and skin cancer diagnosis was 48 months.

Seventeen patients in the study developed cancer in the upper aerodigestive tract (mouth, tongue and throat) post transplant. For this group, the average age at diagnosis was 60 and the mean time from transplant to cancer diagnosis was 66 months. Among these patients, significantly fewer were alive at one year compared to their non-transplant counterparts, regardless of cancer stage at diagnosis.

The upper aerodigestive tract cancer patients also were more likely to be non-drinkers and non-smokers. An interesting finding, notes Dr. Deeb, since the majority of head and neck cancers in non-transplant patients (75%) are the result of alcohol and tobacco use.

“That our study group had a much lower rate of smoking and/or alcohol use than non-transplant patients strongly suggests the role of immunosuppression in the development of head and neck cancer,” says Dr. Deeb.

January, 2012|Oral Cancer News|

Newer radiation technology improves head and neck cancer patients’ long-term quality of life

Source: Eurekalert.org

Patients treated with IMRT for head and neck cancer report an increasingly better quality of life post-treatment when compared to patients receiving other forms of radiation therapy, according to a study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM.

Intensity modulated radiation therapy, or IMRT, is a highly specialized form of external beam radiation therapy that allows the radiation beam to better target and conform to a tumor. It is a newer treatment that has become widely adopted for treating head and neck cancer. Prior studies have shown that IMRT decreases the probability of radiation therapy related side effects, including dry mouth and chewing and swallowing problems, but no study has been conducted to measure long-term quality of life in head and neck cancer patients treated with various forms of radiation therapy.

Investigators from the University of California, Davis, School of Medicine, prospectively administered the University of Washington Quality of Life instrument, a standardized, previously validated questionnaire that patients complete after radiation therapy, to 155 patients undergoing treatment for cancers of the head and neck and analyzed the scores over time. Fifty-four percent of patients were initially treated with IMRT and 46 percent were treated with non-IMRT techniques.

The researchers showed that the early quality of life gains associated with IMRT not only are maintained but become more magnified over time. At one-year post-treatment, 51 percent of IMRT patients rated their quality of life as very good or outstanding compared to 41 percent of non-IMRT patients. However, at two-years after treatment, the percentages changed to 73 percent and 49 percent, respectively. Also, 80 percent of patients treated with IMRT reported that their health-related quality of life was much better or somewhat better compared to the month before developing cancer. In contrast, only 61 percent of patients treated by non-IMRT techniques felt similarly.

Although the researchers acknowledged that quality of life is somewhat of a subjective concept, they nonetheless believe their findings support the widespread use of IMRT for head and neck cancer.

“Hopefully, these results provide some reassurance to patients that radiation therapy using contemporary techniques in the hands of expert specialists can maintain their function and long-term quality of life, while still curing them of cancer,” Allen Chen, MD, lead author of the study and director of the radiation oncology residency training program at the University of California, Davis School of Medicine in Sacramento, Calif., said.

“Radiation therapy for head and neck cancer is without a doubt an intensive process and very intimidating to most patients. Folks think about the prospects of six to seven weeks of radiation and naturally expect the worst. It is nice to know that technological advances have made the treatment much more tolerable than in the past.”

About the American Head and Neck Society

The American Head and Neck Society (AHNS) is the single largest organization in North America for the advancement of research and education in head and neck oncology. The purpose of the AHNS is to promote and advance the knowledge of prevention, diagnosis, treatment, and rehabilitation of neoplasms and other diseases of the head and neck; to promote and advance research in diseases of the head and neck; and to promote and advance the highest professional and ethical standards.

About the American Society of Clinical Oncology

The American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With more than 30,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit www.asco.org. Patient-oriented cancer information is available at www.cancer.net.

About the American Society for Radiation Oncology

The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit www.rtanswers.org. To learn more about ASTRO, visit www.astro.org.

About SNM—Advancing Molecular Imaging and Therapy

SNM is an international scientific and medical organization dedicated to raising public awareness about what molecular imaging is and how it can help provide patients with the best health care possible. SNM members specialize in molecular imaging, a vital element of today’s medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated.

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

January, 2012|Oral Cancer News|

Grape seed extract kills head and neck cancer cells, leaves healthy cells unharmed

Source: Colorado Cancer Blog

Nearly 12,000 people will die of head and neck cancer in the United States this year and worldwide cases will exceed half a million.

A study published this week in the journal Carcinogenesis shows that in both cell lines and mouse models, grape seed extract (GSE) kills head and neck squamous cell carcinoma cells, while leaving healthy cells unharmed.

“It’s a rather dramatic effect,” says Rajesh Agarwal, PhD, investigator at the University of Colorado Cancer Center and professor at the Skaggs School of Pharmaceutical Sciences.

It depends in large part, says Agarwal, on a healthy cell’s ability to wait out damage.

“Cancer cells are fast-growing cells,” Agarwal says. “Not only that, but they are necessarily fast growing. When conditions exist in which they can’t grow, they die.”

Grape seed extract creates these conditions that are unfavorable to growth. Specifically, the paper shows that grape seed extract both damages cancer cells’ DNA (via increased reactive oxygen species) and stops the pathways that allow repair (as seen by decreased levels of the DNA repair molecules Brca1 and Rad51 and DNA repair foci).

“Yet we saw absolutely no toxicity to the mice, themselves,” Agarwal says.

Grape seed extract kills head and neck squamous cell carcinoma cells while leaving healthy cells unharmed (image courtesy of Flickr user Anders Ljungberg)

Again, the grape seed extract killed the cancer cells but not the healthy cells.

“I think the whole point is that cancer cells have a lot of defective pathways and they are very vulnerable if you target those pathways. The same is not true of healthy cells,” Agarwal says.

The Agarwal Lab hopes to move in the direction of clinical trials of grape seed extract, potentially as an addition to second-line therapies that target head and neck squamous cell carcinoma that has failed a first treatment.

This work was supported by the R01 grants AT003623 from the National Center for Complementary and Alternative Medicine and CA91883 from the National Cancer Institute, NIH.

January, 2012|Oral Cancer News|

Prevalence of Oral HPV Infection Higher Among Men Than Women

CHICAGO — The overall prevalence of oral human papillomavirus (HPV) infection is approximately 7 percent among men and women ages 14 to 69 years in the United States, while the prevalence among men is higher than among women, according to a study appearing in JAMA. The study is being released early online to coincide with its presentation at the Multidisciplinary Head and Neck Cancer Symposium.

Oral HPV infection is the cause of a subset of oropharyngeal [relating to the mouth and pharynx] squamous cell carcinomas (OSCC).  Human papillomavirus positive OSCC are associated with sexual behavior in contrast to HPV-negative OSCC that are associated with chronic tobacco and alcohol use. At least 90 percent of HPV-positive OSCC are caused by high-risk (or oncogenic) HPV type 16 (HPV-16), and oral infection confers an approximate 50-fold increase in risk for HPV-positive OSCC. The incidence of OSCC has significantly increased over the last 3 decades in several countries, and HPV has been directly implicated as the underlying cause, according to background information in the article. Although oral HPV infection is the cause of a cancer that is increasing in incidence in the United States, little is known regarding the epidemiology of infection.

Maura L. Gillison, M.D., Ph.D., of the Ohio State University Comprehensive Cancer Center, Columbus, and colleagues examined the  prevalence of oral HPV infection in the United States. The researchers used data from a cross-sectional study as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010, a statistically representative sample of the U.S. population. Men and women ages 14 to 69 years examined at mobile examination centers were eligible.

Participants (n = 5,579) provided a 30-second oral rinse and gargle with mouthwash. For detection of HPV types, DNA purified from oral exfoliated cells was evaluated via testing methods. The researchers found that the overall prevalence of oral HPV infection was 6.9 percent, and the most prevalent HPV type detected was HPV-16 (1.0 percent). The prevalence of oral HPV infection had peaks in different age ranges, with a first peak in prevalence observed among those 30 to 34 years of age (7.3 percent) and a second, higher peak among those ages 60 to 64 years (11.4 percent). Men had a significantly higher prevalence than women for overall oral HPV infection (10.1 percent vs. 3.6 percent). Prevalence of HPV was higher among current smokers and heavy alcohol drinkers and among former and  current marijuana users.

The authors also found that oral HPV prevalence was associated with several measures of sexual behavior, including higher prevalence among individuals who reported ever having had sex vs. not (7.5 percent vs. 0.9 percent). Prevalence of HPV increased with lifetime or recent number of partners for any kind of sex, vaginal sex, or oral sex.

In analysis inclusive of individuals 14 to 69 years of age, factors independently associated with prevalent oral HPV included age, sex,  lifetime number of sexual partners, and current number of cigarettes smoked per day. The researchers write that their data provide evidence that oral HPV infection is predominantly sexually transmitted. ?Taken together, these data indicate that transmission by casual, nonsexual contact is likely to be unusual.

Our results have important research as well as public health implications. Natural history studies of cervical HPV infection were  essential for the development of public health interventions, such as HPV vaccination to prevent and HPV detection to screen for cervical cancer, they write. Natural history studies of oral HPV infection are therefore necessary to understand the effects of age, sex, and modifiable risk factors (e.g., smoking and sexual behavior) on the incidence and duration of oral HPV infection.

Vaccine efficacy against oral HPV infection is unknown, and therefore vaccination cannot currently be recommended for the primary  prevention of oropharyngeal cancer. Given an analysis of U.S. cancer registry data recently projected that the number of HPV-positive  oropharyngeal cancers diagnosed each year will surpass that of invasive cervical cancers by the year 2020, perhaps such vaccine  trials are warranted. Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher  prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men, the authors conclude.

Editor’s Note: This study was supported by the Ohio State University Comprehensive Cancer Center, Merck, John and Nina Cassils, and the Intramural Research Program of the National Cancer Institute. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Gillison is the principal investigator of the unrestricted grant from Merck in support of this study and has been a consultant to Merck and GlaxoSmithKline. No other disclosures were reported. Please see the article for additional information, including other authors, author contributions and affiliations, etc.

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

January, 2012|Oral Cancer News|

Oral temperature changes in head and neck cancer patients predicts side effect severity

Source: American Society for Radiation Oncology

The abstract, “Pilot study of functional infrared imaging for early  detection of mucositis in locally advanced head and neck cancer  reated with chemoradiotherapy,” will be presented at the Head and  neck Society Meeting in Arizona today. This is a synopsis of that  presentation.

Slight temperature increases of the oral mucus membranes early in a head and neck cancer patient’s chemotherapy and radiation therapy (chemoradiotherapy) treatment is a predictor of severe mucositis later in treatment, according to a study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM.

Mucositis, or mouth sores, is a common side effect of chemoradiotherapy for head and neck cancer that is painful and can be very severe. Physicians cannot predict which patients will have mild mucositis or severe mucositis that would require narcotic pain  medication, nutritional support and/or feeding tubes.

Researchers in this study hypothesized that using sensitive thermal imaging technology to measure temperature changes of less than  one-tenth of a degree early in treatment could predict the severity of mucositis later in treatment. This knowledge could allow for early  intervention and potential changes in therapy using a technology that is simple, harmless and non-invasive.

Patients receiving chemoradiotherapy underwent baseline and weekly thermal imaging of their oral mucus membranes. All patients displayed an increase in temperature and severe mucositis was found in 53 percent of patients.

“If we could predict which patients were going to suffer the greatest toxicity, we could proactively make changes to their care that could  ameliorate or prevent side effects,” Ezra Cohen, MD, lead author of the study and co-director of the head and neck cancer program at The  University of Chicago in Chicago, said. “Ultimately, we could identify the patients at higher risk of severe complications from treatment.”

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

January, 2012|Oral Cancer News|

Oral Sex Cancer Virus More Common in Men Than Women, Study Finds

Source: Bloomberg.com

About 10 percent of men and 3.6 percent of women are orally infected with human papillomavirus, which is acquired through oral sex and can cause cancer.

There are two peaks in the age people are infected — 30 to 34 and 60 to 64, according to the study published today in the Journal of the American Medical Association. The virus is linked to throat cancer, and is becoming a more common cause of the disease as Americans quit smoking.

The virus, called HPV, is the most-common sexually transmitted virus in the U.S., where half the population will be infected at some time in their lives, according to the Centers for Disease Control and Prevention. It is known to cause cervical, vulvar, vaginal, penile and anal cancer. The higher HPV infection rate in men explains why their head and neck cancer rates are greater, said Maura Gillison, a professor at the Ohio State University College of Medicine in Columbus.

“This provides pretty strong evidence that the higher infection rate is the reason why,” said Gillison, the study’s lead author, in a telephone interview. “This is a jumping board for additional research.”

Besides sex, other demographics associated with oral HPV infection include age, lifetime number of sex partners, and the number of cigarettes smoked each day.

The research is the first population-based study to examine how many men and women were infected, Gillison said.

Existing Vaccines

Though Merck & Co.’s Gardasil and GlaxoSmithKline Plc (GSK)’s Cervarix target genital HPV, it’s unknown whether the vaccines will protect against oral infections as well.

Gardasil is approved for preventing cervical, vaginal and anal cancers and genital warts, and is recommended for girls and women 9 to 26 years old. It’s also approved for genital warts and anal cancer in boys and men of the same ages. Cervarix is approved for preventing cervical cancer in females 9 to 25.

In places like Australia, where 80 percent of girls have been vaccinated, the lowered prevalence of the virus may be enough to protect men against oral HPV infection, Gillison said. Further research needs to be done to see if vaccination will help lower oral HPV infection rates, she said. Not enough people in the U.S. are vaccinated to get a benefit, she said.

“We have a cancer that occurs largely among men and there’s no screening or preventive strategy,” Gillison said. It’s difficult to sample the site in the throat where the virus makes its home, she said.

Among the 2,483 men who participated in the study conducted in 2009 and 2010, 264 had an oral HPV infection. Of the 2,385 women, 88 had an oral infection, the study showed.

The infection was contracted by about 7 percent of those ages 30 to 34 and 11 percent of those 60 to 64, according to the study.

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

January, 2012|Oral Cancer News|

How online sales and promotion of snus contravenes current European Union legislation

Source: BMJ Journal

 

Abstract

Context The European Union (EU) Tobacco Products Directive that bans sales of snus (a form of oral tobacco) in EU countries other than Sweden is currently under review. Major tobacco companies favour the ban being overturned. This study aims to explore compliance with the current ban on snus sales and examines the conduct of online snus vendors, including their compliance with two other EU Directives on excise and tobacco advertising and Swedish legislation banning sales of snus outside Sweden.

Methods To determine who is currently distributing snus via the internet in the EU, searches were carried out in Google, followed by searches in the WHOIS and Amadeus databases. Five online test purchases of snus were made in each of 10 EU Member States using a standardised protocol. Feedback from the test purchases and further analysis of the websites accessed for test purchases were used to critically examine snus retailers’ conduct.

Results The majority of online vendors operate from Sweden and target non-Swedish EU citizens. Test purchases were successfully made in all 10 EU Member States; of 43 orders placed, only two failed. Age verification relied only on self-report. The majority of sales applied Swedish taxes, contrary to EU requirements. Copious sales promotion activities, many price based, are incorporated in these websites contravening the EU regulation, and three test purchases were delivered with gifts.

Conclusions Snus is currently being sold on the single market via the internet in contravention of Swedish legislation and three EU Directives. The apparent willingness of the tobacco industry to contravene EU and Swedish legislation and profit from unlawful sales raises questions about their status as stakeholders in consultations on future policy developments. The findings highlight how national and regional tobacco control legislation can be undermined in an increasingly globalised world.

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

January, 2012|Oral Cancer News|

Emerging indications: antioxidants for periodontal disease

Source: http://www.dentistryiq.com
Author: Edward P. Allen, DDS, PhD

Since approximately 10 to 15 percent of adults worldwide suffer from periodontitis at one time or another(1), oral health professionals are constantly challenged with treating patients for existing conditions and helping them prevent future occurrences. Root planing, scaling, and in severe cases, surgical intervention are part of the standard treatment for periodontitis, and antibiotics are used for infection control.

However, in recent years, dental health professionals have honed in on the inflammation that accompanies periodontitis. Research shows that inflammation in the oral tissues—especially that associated with periodontitis—can be a factor in chronic illness such as heart and vascular disease, diabetes, arthritis, Alzheimer’s, pregnancy complications, and a growing list of other conditions.

The real culprit with inflammation is oxidative stress, a disturbance in the balance of oxidants and antioxidants. Oxidative stress is the result of overproduction of free radicals, unstable molecules that attack tissue cells by “stealing” electrons from other molecules.

Although infection is a major trigger for inflammation and oxidative stress, there are numerous other causes, such as poor diet, alcohol consumption and nicotine use or chemical pollutants. In oral tissues oxidative stress can result from dental procedures and from materials used for bleaching, composite fillings, implants, crowns, veneers, and so on.

Antibiotics control the micro-organisms that contribute to periodontitis and other infection, but they do not necessarily address the free radicals and oxidative stress that accompany inflammation.

Innate defense through natural salivary antibiotics and antioxidants
The human body has an innate defense system that combats oral inflammation: saliva. Saliva contains natural antibacterial compounds that defend against bacteria and other micro-organisms. Saliva also contains natural antioxidants that have been shown to neutralize free radicals contributing to oxidative stress and inflammation.

Several recent scientific articles have explored salivary antioxidants and their role in oral health, including periodontal disease, OLP, and even cancer.(2,3,4,5) There is a growing consensus that administration of local therapeutic agents (i.e., antioxidants) to the oral cavity should be considered.(6)

Topical antioxidants for inflammation control
Many dental health professionals have begun to augment the natural salivary antioxidants with topical application of antioxidants. A suite of products, AO ProVantage, from Dallas-based PerioSciences, LLC (www.periosciences.com), contain antioxidants, including phloretin and ferulic acid, that are applied directly to the gums. The products are distributed through professional dental offices and are best used as part of a comprehensive oral hygiene program.

In the early 1990s, compounds of phloretin and ferulic acid were clinically proven to counteract free radicals that caused damage in skin cells. More recently, scientists at Texas A&M University Baylor College of Dentistry have shown that specific concentrations and combinations of phloretin and ferulic acid are highly effective at neutralizing free radicals in oral cells that are caused by nicotine, alcohol, and hydrogen peroxide—some of the most common toxins introduced to the oral cavity. Additional studies indicate that combinations of phloretin and ferulic acid may actually promote cell proliferation and healing in oral cells.(7)

Treating periodontal disease will continue to depend on antibiotics for micro-organisms. And now, augmenting natural salivary antioxidants with topical antioxidants on oral tissues shows promise in reducing free radicals, oxidative stress and oral inflammation. In the fight against periodontitis and other oral inflammation, topical antioxidants are taking their place next to antibiotics.

References:
1. Brown, L.J., and Loe, H. Prevalence, extent, severity and progression of periodontal disease. Periodontology 2000; 2, 57-71.

2. Sculley DV, et al. Salivary antioxidants and periodontal disease status, Proceedings of the Nutrition Society 2002; 6:137-143.

3. Battino M, et al. The antioxidant capacity of saliva. Journal of Clinical Periodontology 2002; 29:189-194.

4. Miricescu D, et al. The antioxidant potential of saliva: Clinical significance in oral diseases. Therapeutics, Pharmacology and Clinical Toxicology 2011; 15 2:1-5.

5. Gupta A, et al. Lipid peroxidation and antioxidant status in head and neck squamous cell carcinoma patients. Oxidative Medicine and Cellular Longevity, April-June 2009.

6. Hershkovich O, et al. Age-related changes in salivary antioxidant profile: Possible implications for oral cancer. The Journals of Gerontology 2007; 62A 4:361-366.

7. San Miguel SM, et al. Bioactive antioxidant mixtures promote proliferation and migration on human oral fibroblasts. Archives of Oral Biology 2011; doi:10.1015/jarchoralbil.2011.01.001.

January, 2012|Oral Cancer News|