Monthly Archives: April 2013

Robotic surgery yields better quality of life for OC patients

Source: www.drbicuspid.com
Author: Donna Domino, Features Editor

Patients with oropharyngeal squamous cell carcinoma maintain a high quality of life a year after having transoral robotic surgery, according to a new study in the JAMA Otolaryngology — Head & Neck Surgery (April 10, 2013). But elderly patients and those treated with adjuvant treatments such as external-beam radiation therapy and chemoradiation therapy do not, according to the study authors.

Patients with oropharyngeal squamous cell carcinoma (OPSCC) have historically been treated with primary open surgery. However, cure rates were low, complication rates were high, and patient health-related quality of life (HRQOL) decreased, the researchers noted. Efforts to minimize morbidity and preserve organs have shifted treatments to primary external-beam radiation therapy or chemoradiation therapy, but these treatments are often associated with significant side effects and decreased quality of life, they added.

Transoral laser microsurgery was pioneered in the 1990s by Wolfgang Steiner, MD, for laryngeal tumors and eventually adapted to the oropharynx. Since then, primary laser microsurgery has yielded favorable treatment outcomes for OPSCC patients, the researchers noted. Transoral robotic surgery (TORS), a more minimally invasive approach, was introduced in 2005 and has since been recognized as “oncologically sound,” while also preserving function in OPSCC patients.

Complication rates are low and swallowing function remains high, according to the study authors. Research has shown that speech, eating, social, and overall quality of life tend to decrease but remain high three months after TORS. However, long-term results among a significant number of patients are lacking.

Long-term quality of life after TORS
To determine the short- and long-term health-related quality of life and functional outcomes in OPSCC patients undergoing robotic surgery, the researchers analyzed 81 patients with untreated OPSCC at the Head and Neck Cancer Clinic at the Ohio State University Arthur G. James Cancer Hospital from April 2008 to September 2012.

The study is the largest to date to evaluate long-term quality of life following TORS in a single-center, prospective manner, the authors noted. The mean age of the patients was 58.3 years. Sixteen patients were women, and 65 were men. Sixty-two patients were smokers, with a mean pack-year history of 31.7 years. All patients had squamous cell carcinoma with 65 lesions occurring in a palatine tonsil and 16 in the base of the tongue.

Most of the patients had stage IV disease. “Furthermore, consistent with the current virally induced cancer epidemic, more than 70% of patients test human papillomavirus (HPV)-positive or p16-positive, yet more than three-quarters of these patients are still smokers,” the researchers wrote.

Adjuvant treatment, including external-beam radiation therapy or concurrent chemoradiation therapy was administered within six weeks of TORS. Quality of life was measured using head and neck cancer-specific outcomes in four areas: speech, eating, social disruption, and aesthetics.

The patients were asked to complete a Head and Neck Cancer Inventory preoperatively and at three weeks and three, six, and 12 months postoperatively. Seventy-six patients completed the questionnaire at baseline, 64 at three weeks, 49 at three months, 47 at six months, and 42 at 12 months post TORS.

All HRQOL scores declined three weeks after TORS, the researchers found. Speech, eating, social, and overall scores continued to drop and reached the lowest levels at three months post TORS. Most patients who have problems related to radiation therapy and/or chemoradiation therapy tend to recover after 12 months, the authors noted.

Speech attitude, aesthetic, social, and overall quality of life scores showed the greatest recovery and were not statistically different from baseline scores (p > 0.05). Speech function and aesthetic attitude showed partial recovery but remained significantly below baseline (p < 0.05). However, at one year post TORS, scores for aesthetic, social, and overall quality of life remained high. Eating function and attitude were the most affected areas at 12 months post TORS.

Effects of adjuvant therapy
Patients who underwent adjuvant external-beam radiation therapy or chemoradiation therapy had the lowest eating HRQOL scores (p < 005) with differences of nearly 40 (radiation therapy) or 30 (chemoradiation therapy) points compared with patients who avoided either therapy. “This finding is not unique,” the researchers wrote, noting that external-beam radiation therapy and chemoradiation therapy are “known to cause substantial deterioration in perceived swallowing function.” The researchers postulated that it is adjuvant external-beam radiation therapy after TORS, not chemotherapy, that influences long-term eating function the most. It is also known that objective swallowing ability will deteriorate with adjuvant treatment, they stated. Age also was a factor: Patients older than age 55 were nearly five times as likely to need a gastrostomy tube after TORS compared with younger patients. Patients who avoided any adjuvant treatment showed superior HRQOL outcomes, the study authors concluded, a conclusion supported by other studies. Overall 12-month quality of life scores demonstrated no significant change from baseline (p > 0.05) despite significant deterioration in the patients’ ability to eat and speak.

Recent studies continue to show that external-beam radiation therapy and chemoradiation theraphy have a negative impact on quality of life and swallowing function, with xerostomia-related complications being the most prominent obstacles for patients to overcome, the researchers noted.

“Minimizing and focusing [external-beam radiation therapy] while avoiding chemotherapy lead to fewer treatment toxic effects and improved outcomes,” they wrote. “Patients with early-stage disease treated with surgery alone demonstrate superior outcomes by avoiding the toxic effects of [radiation therapy].”

Although these data are still preliminary, TORS shows promise as an optimal treatment strategy in early-stage disease, the researchers concluded. Higher quality of life for patients who undergo TORS may be due to the minimally invasive nature of the technique and lower external-beam radiation therapy dosage, they added.

“This article makes a modest contribution to the growing body of literature showing that it is the adjuvant therapy, not the transoral surgery and/or neck dissection, that is the primary factor in long-term swallowing dysfunction and reduced QOL,” wrote Bruce Haughey, MB, ChB, of the Washington University School of Medicine, in an invited commentary.

Additional studies are needed to look at removing chemotherapy from adjuvant therapy for patients thought to be at low risk and to introduce less toxic chemoradiation, as well as identify those HPV-related patients with oropharyngeal carcinoma who do not need adjuvant therapy at all following transoral surgery and neck dissection, he added.

April, 2013|Oral Cancer News|

Be a trendsetter for oral cancer screenings

By Trish De Dios
April 18, 2013
Source: dentistryiq.com
 
 

April is Oral Cancer Awareness Month. We are well-trained in hygiene school to perform a non-invasive visual and tactile oral cancer screening. We perform it on every patient we see and the patients of our school clinic are accustomed to the comprehensive nature of the exam we perform. We then are set free from the chains of dental hygiene school and unleashed into the world of professional private practice. Unfortunately, the transition from school to work can cause us to cut corners and be negligent in our oral cancer screening, due in part to the demands of being in private practice. Employers are often apprehensive of the time constraints of the exam and may be misinformed regarding how screenings would take place in their practice.

My advice to the new grad is stay true to your ethical and clinical standards of care. Do not deviate from being thorough in your oral cancer screenings because of your newly acquired degree or work position. The most important part of a patient’s hygiene visit is this potentially life-saving exam, and once your patients and employer realize this, they will never undermine your clinical protocol. In addition to the great service you are providing your patients, it is a good business practice to create value in the dental hygiene appointment. Your patients are not just getting their teeth cleaned – convey to your employer and patients that when you are their hygienist, the hygiene visit will consist of a comprehensive oral cancer screening, gum disease screening, shade assessment, identification of contributing factors for diseases, and tailored dental hygiene recommendations. Then, of course, when you discuss the debridement part of the appointment, you should be sure to highlight that you wear magnification loupes and light. For the best scaling, you maintain your instruments to always have a sharp cutting edge. Even if you can’t apply all those things to your practice, the priority of the oral cancer screening should be applicable to every hygienist.

Oral Cancer Flair
Believe it or not, Oral Cancer Awareness is in style and conveniently easy for you to acquire. Did you know the Oral Cancer Foundation will gladly send you promotional awareness bracelets, buttons, and brochures for you to have available for you and your patients? These items are complimentary and I think it represents one of the most valuable things this organization does. Something as simple as sporting a burgundy oral cancer band can generate interest, imply priority, provoke change, and promote awareness. It makes a statement to me when an entire office is wearing professional lab coats and black clinical shoes and use magnifier loupes and a headlight. Now, take it a step further and imagine all those team members have completed their uniform with a burgundy oral cancer awareness bracelet. To me, this seemingly insignificant accessory is a true catalyst in spreading awareness about oral cancer and thus, saving lives. I challenge you to wear a band for at least one work week of your clinical hygiene practice. The questions it provokes and the opportunities it affords you to discuss oral cancer and your role as an early detection screener will prove invaluable to you. April the month devoted to oral cancer awareness, but since we are screening for oral cancer every single work day, I encourage you to make oral cancer awareness part of your daily uniform as you would your loupes and scrubs. Be a trendsetter for your office and colleagues. If you are looking to go a step further when it comes to patient education, and if burgundy matches your operatory décor, please visit the event page for the Oral Cancer Foundation. Under the tab “Getting Involved,” you will find printable fact posters you can frame for your operatory. Need to review your screening sequence? You will also find under this tab a video demonstration of a comprehensive exam. If you would like to know more about how to get involved with the Oral Cancer Foundation, feel free to email me at hygienist.trish@gmail.com.

Trish De Dios, RDH, graduated as president of her dental hygiene class in 2008. She currently works full-time clinically and is also a regional coordinator for The Oral Cancer Foundation. She can be contacted at hygienist.trish@gmail.com.

 

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

 

Dose of reality: HPV is epidemic, which is odd since it is largely preventable

Source: www.sciencenews.org
Author: Nathan Seppa

There are two vaccines that guard against human papilloma­virus, and they are in rare company among medical inventions — the vaccines prevent cancer. Only the hepatitis B vaccine can make the same claim. Cancer-causing HPV can trigger abnormal cell growth on the cervix, and cervical cancer still kills up to 4,000 U.S. women each year. The virus is also implicated in cancers occurring in the anus and the throat. All told, according to a 2011 study, 29 percent of sexually active U.S. girls and women carry a potentially cancer-causing HPV infection.

Preteen and adolescent girls and boys are priority groups for vaccines that prevent human papillomavirus infection.© Jessica Rinaldi/Reuters/Corbis

Preteen and adolescent girls and boys are priority groups for vaccines that prevent human papillomavirus infection.
© Jessica Rinaldi/Reuters/Corbis

Back in 2006 and 2009, when the HPV vaccines Gardasil and Cervarix came onto the market, health officials dreamed of halting the spread of HPV, which is sexually transmitted, in a single generation. Scientists call such blanket coverage herd immunity — in which a pathogen gets vaccinated into oblivion, becoming so rare that even unvaccinated people are protected.

With such heady potential, Gardasil, developed by Merck, and Cervarix, created by GlaxoSmithKline, should be an easy sell. They rev up a potent immunity against HPV 16 and 18, the two types of the virus that account for most cases of cervical cancer. Gardasil also prevents most genital warts. The immunity the vaccines provide is many-fold better than the weak protection engendered by a run-in with the virus itself, and since approval, both vaccines have proven safe. A study of nearly 190,000 girls and women, published in 2012 in Archives of Pediatric and Adolescent Medicine, found that the shots’ most common side effects were mild skin infections and fainting.

But the hope for herd immunity against HPV anytime soon is fading fast in most of the West. By 2011, only 53 percent of U.S. teenage girls from 13 to 17, a target group for the vaccines, had received them.

“It’s a disaster,” says Andreas Kaufmann of Charité University Medicine Berlin, who sees the problem from the perspective of a biologist. “HPV is strictly species-specific. It only occurs in humans.”

WHY WAIT?Many U.S. mothers are reluctant to have preteen daughters vaccinated, even though that’s when protection is most likely to prevent a future HPV infection.Source: J. Kahn et al/Pediatrics 2009

WHY WAIT?
Many U.S. mothers are reluctant to have preteen daughters vaccinated, even though that’s when protection is most likely to prevent a future HPV infection.
Source: J. Kahn et al/Pediatrics 2009

That means with mass vaccination, the virus would have no safe harbor in nature. “Theoretically, we could eradicate these HPV types, like we did smallpox,” he says. “We could end it.”

What’s the problem?
Most childhood immunizations are doled out in infancy. Although preteens and older kids routinely get shots or boosters for whooping cough, measles and meningitis, the HPV vaccines stand apart from those other shots like an unpopular kid.

For one thing, parents are uneasy about vaccinating a preteen against a virus associated with sexual activity. Researchers have found that some parents believe vaccination might lead to greater promiscuity. And a public scare about vaccines in general — including a false report linking the measles vaccine to autism — has contributed to the confusion. Not only that, but the vaccine is delivered in a three-shot regimen. Even among girls who get vaccinated, completing the course isn’t a certainty. Many U.S. preteen and teenage girls who start the course fail to get all three shots, and thus are less apt to be protected.

In the United States, responsibility for tracking kids’ HPV shots often falls to pediatricians, since the vaccine isn’t administered in schools. But pediatricians are notoriously overworked and — relative to many other physicians — underpaid. Doctors often need to cover vaccine costs up front to have them ready for patients, says Kevin Ault, a gynecologist at Emory University in Atlanta. Pediatricians also have to remind a patient to return for subsequent shots and often find themselves on the front line in contending with doubtful parents, says Noel Brewer, a health psychologist at the University of North Carolina in Chapel Hill. Instead of mass vaccinations in schools, the HPV vaccines depend on this hit-or-miss distribution system managed by individual doctors who, even if they advocate vaccination, may not want to cross parents. The result is often family indecision, procrastination and outright rejection.

 

FALLING BEHINDHealth guidelines recommend the three-shot HPV vaccine for the best protection against cancer. But recipients don’t always complete the regimen. Compliance is worse in some states than in others.Source: A. Jemal et al/JNCI 2013; Image: Geoatlas/Graphi-Ogre, adapted by E. Feliciano

FALLING BEHIND
Health guidelines recommend the three-shot HPV vaccine for the best protection against cancer. But recipients don’t always complete the regimen. Compliance is worse in some states than in others.
Source: A. Jemal et al/JNCI 2013; Image: Geoatlas/Graphi-Ogre, adapted by E. Feliciano

Then there’s the behavior of the virus itself. The vaccines don’t work in people who have active HPV infections, and it’s difficult to know who those people are. The cancer-causing HPV types are stealthy, giving rise to phantom infections with no symptoms and an iffy risk of cancer far off in the future. These characteristics make the risks posed by HPV hard to grasp, says Christina Dorell, a physician at the Centers for Disease Control and Prevention. “With polio, people were getting sick and going to the hospital,” she says. “When the image of illness is removed from a group, you may have a little less sense of urgency coming from parents.”

Girls might see it differently, studies show. Doctors’ opinions matter to them. Those who receive a recommendation from a doctor are 2.6 times more likely to get vaccinated than girls getting no counsel, researchers reported in Pediatrics in 2011. Also, “there is no evidence of increased sexual-risk behavior, such as decreased condom use or earlier intercourse,” says Gregory Zimet, a clinical psychologist at the Indiana University School of Medicine in Indianapolis. Other work has found no increase in sexually transmitted diseases after HPV vaccination. “The whole [promiscuity] argument is false, actually,” Zimet says.

More likely, many parents are in denial about their teens’ sexuality, says Kaufmann: “Parents don’t believe that a 15-year-old daughter may already be sexually active.” But a 2010 U.S. survey found that at least 12 percent of 14- and 15-year-old girls had engaged in oral sex or intercourse or both.

One way to skirt the problem might be to vaccinate earlier. Health psychologist Jo Waller of University College London says focus groups show that parents like the idea of vaccinating girls as young as age 8 or 9, since that means skipping the chat about how the vaccine prevents sexual transmission of HPV. “They wouldn’t have to open that can of worms,” she says. Some countries do begin vaccinating at age 9, and several trials are under way testing the effectiveness of the shots at that age.

The fact of the matter is that the science underlying the HPV link to cancer is unassailable. German scientist Harald zur Hausen discovered the connection in the 1980s and was awarded a 2008 Nobel Prize for his efforts (SN: 10/25/08, p. 10). While Pap smears have averted most deaths from cervical cancer in the United States, the malignancy remains a leading cause of women’s cancer worldwide. Three shots of Gardasil or Cervarix protect against HPV types responsible for 70 percent of cervical cancers.

The other half of the equation
While cervical cancer is the most common malignancy prevented by the vaccines, in the United States nearly two-fifths of HPV-related cancers occur in men. That’s because HPV can cause cancers in the mouth or throat areas, and those strike both sexes. HPV is implicated in roughly 60 percent of oral cancers that affect the back of the tongue, throat and tonsils. Although many of these malignancies arise from alcohol and tobacco consumption, those types of cancers have declined in the United States in recent years even as overall oral cancer rates have stayed the same. HPV-related oral cancers account for the rise, particularly in men. In Denmark, the past decade has brought a shift in tonsil cancers, from 43 percent containing HPV to 75 percent.

WORLD VIEWHPV vaccines can prevent cervical cancers. Although roughly 40 countries worldwide now have HPV vaccination in their national health guidelines, few low-income countries — where cervical cancer remains a major problem — are in this group. However, pilot programs in some poorer nations indicate that the vaccine is well accepted, particularly when delivered at schools.Source: M. Forouzanfar et al/Lancet 2011, adapted by E. Feliciano

WORLD VIEW
HPV vaccines can prevent cervical cancers. Although roughly 40 countries worldwide now have HPV vaccination in their national health guidelines, few low-income countries — where cervical cancer remains a major problem — are in this group. However, pilot programs in some poorer nations indicate that the vaccine is well accepted, particularly when delivered at schools.
Source: M. Forouzanfar et al/Lancet 2011, adapted by E. Feliciano

Scientists established a link between oral cancer and HPV more than a decade ago when studies revealed HPV 16 lurking in many oral tumors. In 2007, researchers at Johns Hopkins University found that oral cancer patients were three times as likely as people without the cancer to have had six or more partners on whom they had performed oral sex. But there’s much still unknown about the dynamics of oral HPV transmission, says epidemiologist Marc Brisson of Laval University in Quebec. “Kissing may be involved.” He and others thinks that changing sexual practices may be behind the rise in oral cancers.

HPV vaccination is now recommended for boys in the United States (SN Online: 10/26/11). But because approval came later than it did for girls, only about 8 percent of boys ages 13 to 17, the initial target group, got at least one shot in 2011. As with girls, 11- to 12-year-old boys are the main vaccination target. But teenagers and young adults of both sexes can get the shots as part of a catch-up effort.

The HPV vaccines are given to prevent genital or anal HPV infections. Vaccine companies can’t make any claims regarding oral cancer because the vaccines haven’t been tested to prevent it. But the evidence is strongly suggestive.

“It’s time to start vaccinating boys,” says Margaret Stanley, a pathologist at the University of Cambridge in England. Boys and young men in Britain are not yet getting the shots, but Stanley and others are pushing for it. “It will protect 50 percent of the population, and not doing so would be truly discriminatory because that would include gay men, who are very much at risk of anal cancer,” she says. “And if you vaccinate boys, you start to get herd immunity.”

A shot at the herd
The slow launch of HPV shots in many countries is reminiscent of an earlier campaign that also could have stopped a sexually transmitted virus and the cancer it causes. “With the hepatitis B vaccine, we essentially lost a generation,” says Basil Donovan, a sexual health physician at the Kirby Institute and the University of New South Wales in Sydney. Slow implementation since the hepatitis B vaccine became available three decades ago has left the 350 million hepatitis B carriers worldwide at an increased risk of liver cancer.

RISK ASSESSMENTMore than a dozen types of HPV can trigger abnormal tissue growth and malignancy in humans. The cancer burden affects women and men differently, as this chart of U.S. cases demonstrates.Source: A. Jemal et al/JNCI 2013, adapted by E. Feliciano

RISK ASSESSMENT
More than a dozen types of HPV can trigger abnormal tissue growth and malignancy in humans. The cancer burden affects women and men differently, as this chart of U.S. cases demonstrates.
Source: A. Jemal et al/JNCI 2013, adapted by E. Feliciano

Similarly, delayed HPV vaccination chalks up a daily cost as more teens become sexually active without protection. About 6 million new genital HPV infections occur each year in the United States, mostly in teens and young adults. Oral HPV infections go uncounted. Canada is faring better, but a study there found that while parents permitted their daughters to get hepatitis B shots in school at an 88 percent rate, only 65 percent consented to HPV vaccination. Germany has lagged behind some other European countries because shortly after the HPV vaccines were introduced, vaccine opponents raised questions about side effects of the shots. “Doctors stopped recommending it,” Kaufmann says.

Life is different in Australia. There, public health officials have now documented mass HPV vaccination and the first glimmers of herd immunity. Australian authorities have left little to chance, vaccinating preteen and teenage girls in schools since 2007. They mainly use Gardasil, which prevents genital warts, and such warts are vanishing in young women coming into city clinics. This year Australia began vaccinating boys, too, but herd immunity in them started showing up even before the first shot was fired into a boy’s arm. It seems that protecting girls means protecting boys.

Australia’s school-based program to vaccinate girls against HPV, mainly with Gardasil, is showing benefits for both sexes. Public health officials examining urban clinic records have documented a steady decline in genital warts. The findings hint at herd immunity.

TRENDING DOWNWARDAustralia’s school-based program to vaccinate girls against HPV, mainly with Gardasil, is showing benefits for both sexes. Public health officials examining urban clinic records have documented a steady decline in genital warts. The findings hint at herd immunity.Source: H. Ali et al/International Union Against STI World Congress in Melbourne 2012

TRENDING DOWNWARD
Australia’s school-based program to vaccinate girls against HPV, mainly with Gardasil, is showing benefits for both sexes. Public health officials examining urban clinic records have documented a steady decline in genital warts. The findings hint at herd immunity.
Source: H. Ali et al/International Union Against STI World Congress in Melbourne 2012

Australia’s school-based vaccination program, which offers Gardasil free of charge for students, has set the pace for other nations. Between 2007 and 2009, 83 percent of preteen and teenage girls designated for vaccination had gotten at least one shot and 70 percent had received all three. More than half of young adult women got at least one shot, too.

Within two years of the program’s start, the rate of genital warts among girls and women was dropping every quarter at clinics monitored by scientists, Donovan says. Among women under age 21 examined at a eight clinics in Australia in 2011, less than 1 percent had genital warts, compared with more than 8 percent during the pre-vaccination years. Also in 2011, of 235 women who had been vaccinated against HPV, none had any warts, Donovan says. “Warts were a fairly obvious thing to monitor,” he says, since they can appear within months of infection. “In contrast, for cancer it’s measured in decades.”

Updated Australian data were released in late 2012 at conferences in Melbourne and San Juan, Puerto Rico. What really shocked attendees was the finding that genital warts in young men also dropped — from a range of 7 to 14 percent in pre-vaccination years to about 2 percent in 2011 — even though the widespread vaccination of boys hadn’t yet started in Australia.

The findings have changed how some people view HPV vaccination campaigns, Brewer says. “The data in Australia are just jaw-dropping.” Danish researchers recently reported substantial declines in warts as well.

Waller says the findings in heterosexual Australian men offer proof that there is herd immunity developing from having vaccinated women in Australia. “That leaves men who have sex with men as the main unprotected group,” she says.

The United States has special problems with school-based vaccination programs because there is no national health insurance that will cover the cost of the vaccine, as is the case in Britain, Canada and Australia. Still, a demonstration project in Denver is investigating a school-based program, says Lauri Markowitz, a medical epidemiologist at the CDC. While states can make vaccinations mandatory for school entry, mandates for HPV are rare, with only schools in Virginia and the District of Columbia requiring the shots.

In the long run, herd immunity remains the goal, and it’s not exotic. Anyone with children sees herd immunity in action. Routine childhood vaccines given to babies nowadays largely maintain herd immunity against scourges that beset previous generations. “The risk is near zero for an individual ever getting polio again,” Zimet says. “We continue to use the Salk vaccine to maintain herd immunity.”

The outlook for HPV may improve in coming years. Markowitz reported at the Puerto Rico meeting that among U.S. teenage girls, the rate of HPV infections of the types covered by the vaccines fell from 11.5 percent before vaccination introduction to 5.1 percent in the years after it, based on a nationwide database. And California public health authorities reported in 2012 that medical records show a substantial decline in genital wart diagnoses in girls in the post-vaccination years and a modest drop in boys.

Also, Merck is testing a new vaccine that covers the four HPV types in Gardasil as well as five others that can cause cancer. Math models suggest it could have a big impact on the HPV infection rate. “This seems like a great step forward,” says Zimet, who expects a nine-type vaccine to get cleared within a year or two.

Such a vaccine would help turn the tide, Stanley says. “You really want to prevent 90 percent of cervical cancers,” she says, “and that’s what it should do. Eventually, you wouldn’t need to screen for them [with a Pap smear]. You’d be looking for a rare disease. We ought to have no cervical cancer in 20 years.”

Other help might come financially. The Affordable Care Act — “Obamacare” — will eventually require insurance plans to cover all recommended vaccines, including HPV.

“The solution to the problem,” says Brewer, “is to improve the public health system we have. It may not rest solely on getting parents to act.” He suggests delivering HPV vaccines in schools and at pharmacies, like flu shots, and getting doctors to implement a system to recommend them routinely. “One or all of those would work,” he says.

Vaccinating against cancer
There are over a hundred types of human papillomavirus, says Robert Burk, a medical geneticist at the Albert Einstein College of Medicine in New York. But only about a dozen cause the vast majority of HPV-related cancers — and they take years or decades to do it. Still, those few viruses’ stealth makes them dangerous. Over millennia the viruses have perfected the art of colonizing humans and create very little stir when they do.

“In most of us the immune system recognizes the virus and deals with it,” says Margaret Stanley, a pathologist at the University of Cambridge in England. But these viruses can evade people’s immune reactions better than most. In some unlucky few, HPV triggers genetic mutations in the cells it infects, leading to abnormal cell growth and even to cancer. “A fraction of immune systems cannot handle these viruses well,” Stanley says. “We don’t know why.”

The Gardasil and Cervarix vaccines alert the immune system to the two most-studied cancer-causing HPV types, HPV 16 and 18. Together, these two viruses are thought to cause some 70 percent of cervical cancer. The vaccines against them appear effective, with evidence suggesting that even two doses may provide protection.

Research has now targeted several other cancer-causing members of the HPV family, and work is under way to test a nine-type vaccine that would add protection against HPV 31, 33, 45, 52 and 58. Gardasil and Cervarix may induce the immune system to develop partial cross-protection against these other HPV types. However, such cross-protection is not as strong as direct immunity.

Basil Donovan of the University of New South Wales in Sydney estimates that by the end of a young woman’s first sexual partnership, she has a 30 percent chance of having acquired an HPV infection. A 2011 study found that 43 percent of sexually active U.S. girls and women up to age 59 were carrying some type of HPV infection. Among U.S. men, the rate was about 50 percent for an HPV infection. In Germany and Denmark, the infection rate is roughly 35 to 40 percent among young women, says Andreas Kaufmann of Charité University Medicine Berlin.

“The vaccine has no effect on existing infections,” Burk cautions. But women who have been vaccinated before being diagnosed with an abnormal cell growth on the cervix — and treated to have the potentially precancerous growth removed — may benefit from that prior vaccination, researchers reported in BMJ in 2012. Vaccinated women were about half as likely as their unvaccinated counterparts to be diagnosed with a repeat lesion. Whether it’s useful to vaccinate a woman after she has cleared a lesion with surgery remains an open question, says gynecologist Kevin Ault of Emory University. But if it does help, those women would be prime candidates for vaccination since they would certainly be members of the unlucky few.

Timeline:
1940s
– George Papanicolaou develops Pap smear

1970s
– Harald zur Hausen’s team isolates HPV in genital warts

1980s
– zur Hausen’s team isolates HPV in cervical cancer
– Early vaccine development

1990s
– HPV vaccines developed
– HPV linked to oral cancers
– HPV found in 99.7 percent of cervical cancers

2000s
– Clinical trials of HPV vaccines
– Gardasil recommended for girls and young women (2006)
– zur Hausen wins Nobel Prize (2008)
– Cervarix recommended for girls and young women (2009)

2010s
– HPV vaccines recommended for boys and young men (2011)

Citations:
H. Bauer et al. evidence of human papillomavirus vaccine-effectiveness in reducing genital warts: An analysis of California public family planning administrative claims data, 2007-2010. American Journal of Public Health. In press, 2012. doi: 10.2105/AJPH.2011.300465

R. Bednarczyk et al. Sexual Activity-related outcomes after human papillomavirus vaccination of 11-to-12 year olds. Pediatrics. Volume 130, Number 5, November 2012, p. 1. doi/10.1542/peds.2012-1516.

J. Berkhof and J. Bogaards. Vaccination against human papillomavirus types 16 and 18: the impact on cervical cancer. Future Oncology. Volume 6, 2010, p. 1817.

B. Donovan et al. Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. Lancet Infectious Diseases. Volume 11, 2011, p. 39. doi: 10.1016/S14733099(10)70225-5

C. Dorell et al. Human Papillomavirus Vaccination Series Initiation and Completion, 2008–2009. Pediatrics. Volume 128, Nov. 1, 2011, p. 830. doi: 10.1542/peds.2011-0950

C. Dorell et al. National and state vaccination coverage among adolescents aged 13-17 years – United Sates, 2011. Morbidity and Mortality Weekly Report. Volume 61, Aug. 31, 2012, p. 671.

G. D’Souza et al. Case–control study of human papillomavirus and oropharyngeal cancer. New England Journal of Medicine. Volume 356, May 10, 2007, p. 1944.

C. Fairley et al. Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women. Sexually Transmitted Infections. Volume 85, 2009, p. 499. doi: 10.1136/sti.2009.037788

A. Forster et al. Human papillomavirus vaccination and sexual behavior: Cross-sectional and longitudinal surveys conducted in England. Vaccine. Volume 30, July 13, 2012, p. 4939.

M. Forouzanfar et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet. Volume 378, October 22-28, 2011, p. 1461. doi.org/10.1016/S0140-6736(11)61351-2.

E. Garnaes. Oropharyngeal cancer and HPV in a large Danish cohort. 28th International Papillomavirus Conference – Puerto Rico, 2012.

M. Gillison et al. Prevalence of oral HPV infection in the United States, 2009-2010. Journal of the American Medical Association. Volume 307, Feb. 15, 2012, p. 693. doi:10.1001/jama.2012.101

S. Hariri et al. Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003-2006. Journal of Infectious Diseases. Volume 204, Aug. 15, 2011, p. 566. doi: 10.1093/infdis/jir341

D. Herbenick et al. Sexual behaviors in the United States: Results from a national probability sample of men and women ages 14-94. Journal of Sexual Medicine. Volume 7, 2010, p. 255. doi: 10.1111/j.1743-6109.2010.02012.x

A. Jemal et al. Annual Report to the Nation on the Status of Cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)–associated cancers and HPV vaccination coverage levels. Journal of the National Cancer Institute. Volume 105, 2013, p. 175. doi: 10.1093/jnci/djs491. [Go to]

E. Joura et al. Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. Volume 344, online March 27, 2012, p. e1401. doi: 10.1136/bmj.e1401

J. Kahn et al. Mothers’ intention for their daughters and themselves to receive the human papillomavirus vaccine: A national study of nurses. Pediatrics. Volume 123, June 2009, p. 1439. doi: 10.1542/peds.2008-1536

N. Klein et al. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Archives of Pediatric and Adolescent Medicine. Volume 166, December 2012, p. 1140. doi:10.1001/archpediatrics.2012.1451

A. Kreimer et al. Proof-of-principle evaluation of the efficacy of fewer than three doses of a bivalent HPV16/18 Vaccine. Journal of the National Cancer Institute. Volume 103, Oct. 5, 2011, p. 1. doi: 10.1093/jnci/djr319. [Go to]

L. Markowitz. HPV vaccine impact on HPV prevalence in females in the United States: data from nationally representative surveys. 28th International Papillomavirus Conference – Puerto Rico, 2012.

S. Marur et al. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncology. Volume 11, August 2011, p. 781.

E. Simard et al. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA: A Cancer Journal for Clinicians. Volume 62, March/April 2012, p. 118. doi: 10.3322/caac.20141

April, 2013|Oral Cancer News|

Oral cancer cases higher in developing countries

Source: pakobserver.net
Author: staff

Oral cancer is the sixth most common cancer reported globally with roughly two thirds of these reported in developing countries, according to a report. Regardless of nationality, roughly half of long-term smokers will die from the effects of tobacco smoking, be it oral cancer, lung cancer or cardiovascular disease. In India 20 deaths per 100,000 are caused by oral cancer as compared to 10 deaths per 100,000 in the US and two deaths per 100,000 in the Middle East.

Oral cancer, as well as updates in maxillofacial reconstruction, microneurosurgery, oral trauma, and facial cosmetic and orthognathic surgery, will be reviewed at the 2nd Oral and Maxillofacial Surgery Congress to be held in Dubai from May 1-5. Organised by Imedex in association with Arab Health, this year’s meeting will provide a number of new features that explore the rapidly reshaping field of oral and facial surgery.

“The main causes of oral cancer have classically been related to smoking tobacco products and the Middle East has a higher rate of tobacco consumption then many other countries and this includes the use of the Shisha or Hookah,” said Dr Eric J Dierks, Clinical Professor of Oral and Maxillofacial Surgery at Oregon Health and Science University, USA and director of the Fellowship in Head and Neck Oncologic Surgery based at Legacy Emanuel Hospital in Portland, Oregon, who will be speaking at the congress.

“There is a myth that smoking through a Shisha pipe is safer than smoking cigarettes but this is almost certainly not the case. Several recent studies have indicated that Shisha smokers actually inhale more of the cooled smoke than would a cigarette smoker thereby increasing their exposure to carcinogens within the smoke,” he said.

To an ever greater extent, human papilloma virus (HPV) is a causative factor in cancer of sites in the oropharynx such as the tonsil or the base of the tongue, although HPV related cancer is much less common within the mouth itself. Approximately two thirds of cancers of the base of tongue and tonsil are caused by HPV and 80 per cent of these cases occur in men.

“There is no relationship between either smoking or alcohol intake with the HPV associated oropharyngeal cancer. Fortunately, HPV associated oropharyngeal cancer actually carries a much better prognosis than does a cancer in this location that is not associated with HPV. Although research is ongoing, the reason for this is as yet unclear,” Dierks said.

The early diagnosis of oral cancer is extremely important because not only is the prognosis significantly better for early stage cancer, but the treatment involved is often less extensive, Dr Dierks said.

April, 2013|Oral Cancer News|

Lower radiation reduces xerostomia in head/neck cancer patients

Source: www.drbicuspid.com
Author: DrBicuspid Staff

Lowering the radiation dose to the submandibular gland of patients with head and neck cancer decreases xerostomia, according to a study presented on April 20 at the European Society for Radiotherapy and Oncology (ESTRO) meeting in Geneva.

Radiation oncologists at University Medical Center Utrecht (UMCU) showed for the first time that it is possible to reduce xerostomia in patients treated with radiotherapy for head and neck cancer if the radiation dose to a salivary gland (the submandibular gland) on the opposite side to the tumor is minimized, stated a university press release.

It is the largest study yet to show a correlation between radiation doses to the submandibular glands and their output of saliva. Guidelines for the recommended maximum dose could potentially be issued for use in clinical practice to benefit patients, according to the researchers.

Approximately 40% of head and neck cancer patients suffer from xerostomia in the long term, which causes problems with eating, sleeping, speech, tooth loss, and oral hygiene, leading to diminished quality of life, social isolation, and difficulty in the ability to work. Attempts to treat xerostomia and its consequences can be costly and are not very effective, the study noted.

Therefore, the UMCU researchers looked at using intensity-modulated radiotherapy (IMRT) to treat the tumors and spare the submandibular gland on the opposite side of the tumor and both parotid glands. They also wanted to determine the maximum radiation dose and how the treatment would affect patients’ xerostomia.

They analyzed 50 patients with throat cancers in which cancer cells had not migrated into the contralateral lymph nodes and had not metastasized to other parts of the body. The patients were treated with the contralateral submandibular IMRT and compared with a historical group of 52 patients who had received radiotherapy that had spared only the parotid glands.

After six weeks and after one year, the researchers measured saliva flow objectively from the submandibular and parotid glands by stimulating saliva with citric acid on the tongue and catching the resulting saliva in specially designed cups. They also used a questionnaire to measure the patients’ subjective experience of xerostomia.

Saliva flows from the contralateral submandibular glands were significantly higher at six weeks and at one year in patients who received a dose to the submandibular gland of less than 40 Gy, which translated into fewer complaints of xerostomia, the researchers reported. Using the new technique, they were able to keep the dose to less than 40 Gy in half of the patients.

All but one of the patients who could be treated with radiation doses of less than 40 Gy to the submandibular gland had small tumors (less than 4 cm in diameter). These patients consequently had fewer problems with xerostomia after a year.

The study could lead to guidelines recommending a maximum dose of 40 Gy for the submandibular gland, the researchers noted.

April, 2013|Oral Cancer News|

What the ‘rinse-and-spit’ oral cancer test could mean for dental professionals and their patients

Source: www.dentistryiq.com
Author: Vicki Cheeseman, Associate Editor

A new oral cancer “rinse-and-spit” test for the early detection of tumors could mean great things for dental professionals and their patients when the test becomes available for use in dental practices nationwide possibly as early as late 2014 or into 2015.

The test, developed at the University of Miami Miller School of Medicine and exclusively licensed to Vigilant Biosciences, Inc., will be available as a low-cost, point-of-care screening test for the early detection of oral cancer, and is envisioned as a kit with a special oral rinse and test strip. The test strip detects proteins that are markers of oral cancer and are captured by the rinse. The markers may be present before a lesion is easily visible. Early detection tests are critical because the majority of patients present in late stage when cure rates reach only 40%.

I asked Dr. Franzmann to explain how the test strip works.
“The beauty of the test strip approach is that it is so simple for the patient and health-care professional to use. The technology behind the test strips has been around for many years and is used for many medical applications. The key is to know what to test for. Through our research, we discovered certain proteins, or markers, are present in the saliva in the early stages of squamous cell carcinoma, the most common head and neck cancer.”

How early can tumors be detected with the test strip?
Dr. Franzmann said, “The tumors can be detected in some instances before they become noticeable to the patient or the dentist. This is so important because today only about 40% of oral cancers are caught early enough to be cured.”

Does the cancer test strip distinguish among various types of tumors, or simply whether a tumor is cancerous or not?
Dr. Franzmann explained, “This test is for detecting squamous cell carcinoma, the most common head and neck cancer. The main risk factors for squamous cell carcinoma are tobacco and alcohol use and human papillomavirus infection.”

Once a test is performed, how long does it take for a patient to receive the results?
She continued, “This is a point-of-care test, meaning that the patient receives results in just a few minutes during the office visit.”

So, the big question is, when the product becomes available for dental offices, will it become part of the standard oral cancer screening process for patients?
Matthew H.J. Kim, JD, CEO of Vigilant Biosciences, said, “We believe that there is a tremendous unmet need for a test that not only detects cancer early when there is a better chance for a cure, but also rules out the disease. Current products generate many false positives that lead to unnecessary biopsies and cause undue stress on the patient and their family while they wait for results.”

Much has been in the news lately about the link between human papillomavirus and oral cancer. Dr. Franzmann weighed in:
“HPV has been linked to oral cancer and cervical cancer. In both cases not all HPV infections lead to cancer. Other risk factors for oral cancer include smoking and alcohol use. Although our test is recommended for high-risk individuals including HPV infection, the number one cause of oral cancer, our test is designed to detect markers specific for oral cancer regardless of etiology.”

Vigilant’s new test product has the potential to play an enormous role in mass screening initiatives as it eventually becomes an integral part of routine oral cancer exams.

Mr. Kim firmly believes: “With health-care costs on the rise, it is important that new technology not only help find disease earlier when it costs less to treat but that it does a good job of ruling out disease to reduce unnecessary testing and patient anxiety.”

April, 2013|Oral Cancer News|

HPV vaccination—reaping the rewards of the appliance of science

Source: bmj.com
Date: April 18, 2013
By: Simon Barton, clinical director
 

National programmes could virtually eliminate certain diseases and substantially reduce costs.

The optimism generated by scientific breakthroughs often turns to disappointment when applied to the real world of clinical care. It is therefore worth celebrating the extraordinary success of Australia’s national human papillomavirus (HPV) vaccination programme, which was implemented five years ago, as reported in the linked paper by Ali and colleagues (doi:10.1136/bmj.f2032).1 This analysis of data on 85 770 new patients from six Australian sexual health clinics shows a remarkable reduction in the proportion of women under 21 years of age presenting with genital warts—from 11.5% in 2007 to 0.85% in 2011 (P<0.001). Only 13 cases of genital warts were diagnosed in women under the age of 21 across all six health clinics in 2011. Such a reduction in this distressing disease caused by a sexually transmitted virus is a major public health achievement. Furthermore, the near eradication of genital warts in young Australian women will probably have a major impact on the costs of sexual healthcare.

In 2007, Australia became one of the first countries to implement a nationally funded HPV vaccination programme for girls and young women with the quadrivalent vaccine. It started with the vaccination of girls aged 12 years in schools and a catch-up programme for girls and women aged 13-26 years. Quadrivalent vaccine protects against HPV types 6 and 11, which cause more than 90% of genital warts, in addition to HPV types 16 and 18, which cause cervical cancer. Vaccination coverage rates were exemplary, averaging almost 80% for all three doses.

Ali and colleagues also found a significant decline in the proportion of women aged 21-30 years presenting with genital warts—from 11.3% in 2007 to 3.1% in 2011 (P<0.001). As might be expected, the rate of diagnoses of genital warts in women over 30 did not drop. The proportion of men under 21 years presenting with genital warts also decreased sharply, from 12.1% in 2007 to 2.2% in 2011 (P<0.001). From 2007 to 2011, there was no significant decrease in the prevalence of genital warts in heterosexual men over 21 years or in men who have sex with men.

In the United Kingdom, policy makers chose a bivalent HPV vaccine (effective against HPV types 16 and 18) for the national vaccination programme. This was judged the best option on economic grounds—economic analyses during the tendering process found that the bivalent vaccine was substantially cheaper than the quadrivalent one. At the time, there was much debate about whether the benefits of preventing genital warts had been properly assessed, given the current high rate of new and recurrent genital warts—more than 150 000 cases a yearin the UK, which cost more than £50m (€59m; $76m) to manage. This seemingly short sighted policy decision caused consternation among experts in sexual health services. However, in September 2012, the UK national programme began to use the quadrivalent vaccine. Given Ali and colleagues’ findings, the number of young women presenting with genital warts to sexual health services should drop substantially in five to nine years’ time, reducing the workload in sexual health clinics.

What about including boys in the national vaccination programme in the UK? In 2013 the Australian government began a publicly funded HPV vaccination programme for 12-13 year old boys, with a catch-up for 14-15 year old boys. This decision was prompted by two important considerations. The first was the increasing incidence of HPV related oropharyngeal cancers in men.5 The second was the realisation that young men who have sex with men, who would not benefit from heterosexual herd immunity, would be unfairly discriminated against under a vaccination programme targeted only at girls. Ali and colleagues state that, in addition to helping prevent genital warts and anal, penile, and oropharyngeal cancers in men, “the vaccination programme is expected to increase herd immunity and provide further indirect protection to unvaccinated women.” They comment that this may lead to control, if not elimination, of the target HPV types in Australia.1

Throughout Europe, there has been regional tendering to use quadrivalent or bivalent vaccines in young women only. Doctors in sexual health would obviously favour the quadrivalent vaccine because new and recurrent genital warts are the most common sexually transmitted diseases managed in clinics.

It remains to be seen whether we will see similar dramatic reductions in HPV-16 and HPV-18 associated diseases, such as cervical cancer, vulval cancer, other anogenital cancers, and head and neck tumours as a result of national vaccination programmes. This is likely given the reported evidence for the efficacy of the vaccines. It is hoped that future vaccines will protect against other HPV types, such as types 31 and 45, which are also involved in the genesis of genital cancer. Countries should carefully explore whether it is economically feasible to vaccinate young men.

Do HPV vaccines have a role to play in treatment? It is scientifically plausible that they do, because wart virus infection and recurrence are caused by failure of immune recognition. The immunity induced by vaccination is four or five times greater than that induced by natural infection. Recent treatment studies indicate benefit.

These are exciting times in the science of HPV and the world can confidently look forward to the virtual elimination of genital warts, recurrent laryngeal papilloma, most genital cancers, and some 60% of head and neck cancers. The interruption of transmission of a major sexually transmitted infection through a public health initiative offers the prospect of substantial cost savings. Countries should consider these data seriously and act decisively.

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

 

April, 2013|Oral Cancer News|

Robotic surgery vs. radiation, chemo for throat cancer, study to see which is best

By: Sheryl Ubelacker, The Canadian Press, April 17, 2013
Source: ottawacitizen.com
 

TORONTO – It was quite a shock for Rod Sinn when he learned the persistent sore throat he’d had for five months, initially diagnosed as tonsillitis, was actually an increasingly common form of throat cancer caused by the human papilloma virus.

Equally unpleasant was the news that the standard treatment for oropharyngeal cancer, which typically affects the back of the tongue, tonsils and nearby tissues, is radiation and chemotherapy.

Sinn, a physically fit non-smoker who only drinks alcohol occasionally, had seen what the double-barrelled treatment could do. A friend diagnosed with throat cancer a year earlier and given the standard treatment lost his salivary glands and sense of taste.

“I thought, wait a minute, there’s got to be another option. I really don’t like the side-effects of all that radiation,” the 52-year-old businessman, who lives in Oakville, Ont., near Toronto, said Tuesday.

After searching the Internet, he discovered doctors at Western University in London, Ont., were the only ones in Canada performing robotic-assisted surgery for throat cancer.

Sinn had the robotic surgery in spring 2011, plus a follow-up operation to remove some lymph nodes for testing to make sure his cancer hadn’t spread. While the surgery left him unable to swallow for several weeks and he lost some taste buds for a time, he is virtually back to normal except for some numbness in his neck where the lymph nodes were removed.

“It was fantastic,” said Sinn, who counts himself a believer in the surgery.

While it may be an end for Sinn — he said he “cried like a baby” after being told he was cancer-free two months after the treatment — it is just a beginning of sorts for his surgeon, Dr. Anthony Nichols.

With the help of a $223,000 grant from the Canadian Cancer Society, Nichols and radiation oncologist Dr. David Palma are conducting a three-year trial to determine whether robotic surgery is superior to standard treatment in curing the cancer and giving patients a better quality of life with fewer side-effects.

Since late 2010, the surgical team has performed about 40 of the robot-assisted operations.

The clinical trial, which now includes doctors at the University of Ottawa, will compare treatments in almost 70 patients, with half randomly selected for standard treatment using radiation, with or without chemotherapy, and the other half getting robotic surgery.

Although robotic-assisted operations for throat cancer are widely done in the United States, the researchers say there has been no clinical trial proving the surgery is better for patients.

“Before we can adopt a new treatment, we have to prove that the rates of cure are as good as they are with the standard treatment, which is chemotherapy with radiation,” said Palma, a clinician-scientist with the Ontario Institute for Cancer Research.

“Sometimes new technologies are introduced with a lot of hype but don’t prove to be helpful in the end. Transoral robotic surgery has shown tremendous promise as a treatment option, and we are the only ones in the world doing this type of study right now.”

Nichols said that in an era of cost-containment in health care, it’s critical to show that using the $2.5-million robots for the surgery is the right thing to do, “that we’re helping patients, not harming them.”

“Patients with HPV-related throat cancers tend to be younger and healthier and have a good chance of being cured. As they will have to live with the side effects of treatment for decades, post-treatment quality of life is of paramount importance.”

From a surgical point of view, minimally invasive robot-assisted procedures seem to be head and shoulders above standard surgery for throat cancer, which often involves making large incisions in the face and neck, even splitting the jaw to allow the surgeon access to the back of the throat.

Patients who have had this kind of surgery in the past are often left not only facially disfigured, but unable to swallow and dependent on a permanent feeding tube.

With the newer technique, doctors use tiny robotically controlled surgical implements to remove tumours of the tongue, tonsils, palate or throat. The robot has a viewfinder and 3-D camera that can see around corners, and the tiny robotic arms can get into tight spaces where the surgeon’s hands won’t fit.

While the surgeon watches what’s happening on a screen, the robotic arms precisely mimic the movements of the surgeon’s hands and can even filter out a surgeon’s hand tremor.

“To work in the back of the throat, around the back of the tongue and the voicebox is just a line of sight issue,” Nichols said. “You can’t see really well around that corner, down towards the esophagus. But if you can use an angled camera to overcome that, combined with the 3D viewer and magnification, it lets you see a lot easier.

“So it can make surgeries that are very challenging — and in some cases not possible through the mouth — now possible to do through the mouth.”

Nichols said in the past, most throat cancers were caused by heavy smoking combined with alcohol consumption. A dramatic reduction in smoking rates over the last few decades has resulted in a big drop in related oral cancer rates.

But in the last 10 to 20 years, there’s been a huge upswing in the number of cases caused by the human papilloma virus, or HPV, a sexually transmitted disease that can lead to throat cancer in some people two or even three decades after the initial infection.

In fact, HPV is linked to about 25 to 35 per cent of oropharyngeal cancers, and is also the major cause of cervical cancer in women.

“We’re seeing a veritable explosion,” said Nichols. “So each year, we’re seeing more and more of these patients and they have tumours in this exact location, which was otherwise hard to reach.”

Sinn doesn’t need to wait for the study results. He’s already made up his mind about robotic surgery.

“To me, it’s important to let the medical community know this is available,” he said. “I’ll be the guy standing in the corner waving the flag, saying: ‘Hey, this is fantastic.”

 

* OCF Note – The caveat to this story is that while there is little question that compared to the older surgical technique that this is far less invasive and the treatment related morbidity/ damage from it is definitely less- the big unknown will be; do these surgical only solution patients have the same disease free (no recurrence) years afterwards as those who get radiation and chemo. With some recurrences being reported out in patients more than the five year mark, it will take far longer than the time period indicated in this trial to know if surgery alone has the same long term curative rates as the current standard of care.

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

 

 

 

April, 2013|Oral Cancer News|

Researchers design drug to block incidence of head, neck cancer caused by HPV virus

Source: www.news-medical.net

Researchers have discovered a new mechanism by which the human papilloma virus (HPV) causes head and neck cancer, and they have designed a drug to block that mechanism. Though further research is needed, the new agent might offer a safer treatment for these tumors when combined with a tapered dose of standard chemotherapy.

HPV-positive head and neck cancer has become three times more common since the 1970s, and it could reach epidemic levels in the future, say researchers at the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) who led the study.

“We believe these findings will help meet the real need for more effective and safer therapy for a growing number of HPV-positive head and neck cancer patients,” says principal investigator Dr. Quintin Pan, associate professor of otolaryngology at the OSUCCC – James. The study was published in the journal Oncogene.

The research, which mainly used head and neck cancer cells, shows that a protein produced by the virus blocks a protein made by the host cell. The cell protein, called p300, regulates a gene called p53. This gene both controls cell division and protects the body against cancer by causing cells to die before they become malignant.By blocking the cell protein, HPV forces the host cell to live instead of die and to proliferate and form tumors.

The prospective new drug, called CH1iB, prevents the viral protein from binding with the cell protein. This restores the function of the p53 “tumor-suppressor” gene and triggers the death of the cancer cells.

“Our study revealed a new mechanism for p53 inactivation in HPV-positive head and neck cancer, and this allowed us to develop an agent that disrupts that interaction and reactivates p53 in HPV-positive head and neck cancer,” Pan says. “Our pre-clinical studies show CH1iB can reactivate p53 and eliminate HPV-positive head and neck cancer cells.”

Pan notes that the standard of care for HPV-positive head and neck cancer uses high-dose cis-platinum, a chemotherapy drug that causes serious side effects that are difficult for patients to tolerate. The drug’s toxicity raises the need for safer therapy, and, although further testing is necessary, combining CH1iB with a low dose of cis-platinum might one day provide an alternative.

For this study, Pan and his colleagues used high-risk HPV-positive head and neck squamous cell carcinoma cells. Key technical findings include:

  • The incidence of head and neck cancer caused by the human papilloma virus (HPV) has tripled since the 1970s and continues to grow; better therapy is needed;
  • This study discovered a new mechanism by which HPV causes head and neck cancer, and the researchers designed a drug that blocks the mechanism;
  • The findings could lead to a safer, more effective therapy for HPV-caused cancer
  • The small-molecule inhibitor CH1iB inhibits the binding of the HPV E6 protein with the p300 cell protein;
  • The binding of the CH1iB inhibitor with p300 reactivated p53 and dramatically potentiated the efficacy of cis-platinum in HPV-positive head and neck cancer cells.
  • The combination of CH1iB and cis-platinum eliminated 91 percent of HPV16-positive head and neck cancer cells; it also increased apoptosis by 984 percent and 443 percent compared with CH1iB and cis-platinum respectively alone.

“These results suggest that fewer cycles or a tapered dose of cis-platinum, along with a CH1 inhibitor, might be sufficient to effectively manage HPV-positive head and neck cancer patients and offer a better toxicity profile,” Pan says.

“Taken together, our data suggest that we’ve discovered a novel approach for reactivating the p53 gene in HPV-positive head and neck cancer that may translate to other HPV-positive carcinomas.”

Source: Ohio State University Medical Center

April, 2013|Oral Cancer News|

HPV linked to certain lung cancers; is oral sex to blame?

Source: www.medicaldaily.com
Author: Jonathan Weiss

By now, it’s a given that smoking causes lung cancer. The American Lung Association reports that 80 to 90 percent of all cases of lung cancer are smoking-related. The remaining 10 to 20 percent, though, has been more of a mystery — until now. A new line of research has implicated thye sexually transmitted infection human papillomavirus, or HPV, in lung cancers that were found in non-smokers.

HPV is the leading cause of all cervical cancer cases in the world. It’s a well-known disease that’s gottena lot of press in recent years; an effective vaccine was recently developed that can prevent the viral infection and subsequent cervical cancer development. Whether or not the vaccine should be required for teenage girls has become a hot-button political issue.

Adding fuel to the fire, a research team from the Fox Chase Cancer Center recently looked at tissue samples from lung cancer patients who had no history of smoking and saw that close to 6 percent showed evidence that they had been driven by HPV infection. Four out of 36 lung samples had signs of infection from two strains of HPV known to cause cancer. Looking more closely at the two samples infected by one strain of HPV, Dr. Ranee Mehra, MD, attending physician in medical oncology at Fox Chase and her team saw signs the virus had integrated into the tumor’s DNA — which is even more suggestive that the infection had caused the tumor in the first place.

Dr. Mehra noted that non-smoking related lung cancers kill 100,000 people a year, so 6 percent of those cases having a known and preventable cause could save lives.
It is not known how the virus could travel down to the lungs. However, Dr. Mehra notes that there is highly convincing data indicating that HPV had directly caused the tumors rather than the person just having cancer and an unrelated HPV infection. “The presence of both simultaneously, and the integration of the virus into the tumor’s DNA, fuels the hypothesis that they are related,” stated Dr. Mehra.

HPV is widely known to cause a range of cancers, including cervixal, throat, head, and neck cancer. The virus has also been implicated in a drastic rise in the number of throat and oral cancers related to oral sex. There was no comment from the research article indicating that oral sex may be associated with the risk of HPV related lung cancer.

Mount Sinai Hospital, in New York City, has an interesting infographic that explains the risk of cancer from oral sex. The current research was presened at the American Association for Cancer Research Annual Meeting 2013 on Wednesday, April 10.

April, 2013|Oral Cancer News|