Monthly Archives: June 2013

Gastric Reflux Is an Independent Risk Factor for Laryngopharyngeal Carcinoma

Source: http://cebp.aacrjournals.org
Authors: 
Scott M. Langevin1,2,Dominique S. Michaud1,Carmen J. Marsit4,5,Heather H. Nelson6,7,Ariel E. Birnbaum3,Melissa Eliot1,Brock C. Christensen4,5,Michael D. McClean8, and Karl T. Kelsey1,2
 

Abstract

Background: Gastric reflux can reach into the upper airway, inducing cellular damage in the epithelial lining. This condition is believed to be a risk factor for development of laryngopharyngeal squamous cell carcinoma (LPSCC), although the literature is conflicting.

Methods: To better clarify this relationship, we assessed the association of self-reported heartburn history and medication use among 631 patients with LPSCCs and 1234 control subjects (frequency-matched on age, gender, and town of residence) enrolled as part of a population-based case–control study of head and neck squamous cell carcinoma in the greater Boston area.

Results: After adjusting for age, gender, race, smoking, alcohol consumption, HPV16 seropositivity, education, and body mass index, subjects reporting a history of frequent heartburn and who were neither a heavy smoker nor heavy drinker had a significantly elevated risk of LPSCCs [OR, 1.78; 95% confidence interval (CI), 1.00–3.16]. Among those with a history of heartburn, there was an inverse association between antacid use and LPSCCs relative to those never taking heartburn medication (OR, 0.59; 95% CI, 0.38–0.93) that remained consistent when analyzed by smoking/drinking status, HPV16 status, or by primary tumor site.

Conclusions: Our data show that gastric reflux is an independent risk factor for squamous cancers of the pharynx and larynx. Further studies are needed to clarify the possible chemopreventive role of antacid use for patients with gastric reflux.

Impact: Elucidation of additional risk factors for head and neck cancer can allow for risk stratification and inform surveillance of high-risk patients. Cancer Epidemiol Biomarkers Prev; 22(6); 1061–8. ©2013 AACR.

This article is featured in Highlights of This Issue, p. 1005

  • Received February 15, 2013.
  • Revision received March 28, 2013.
  • Accepted April 5, 2013.

©2013 American Association for Cancer Research.

 

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

 

June, 2013|Oral Cancer News|

Enhanced radiation sensitivity in HPV-positive head and neck cancer

Source: http://cancerres.aacrjournals.org
Authors: 
Randall J. Kimple1,*,Molly A. Smith1,Grace C Blitzer1,Alexandra D Torres1,Joshua A Martin1,Robert Z. Yang1,Chimera R Peet1,Laurel D. Lorenz2,Kwangok P Nickel3,Aloysius J Klingelhutz4,Paul F Lambert5, andPaul M Harari1

 

Abstract

Patients with human papillomavirus associated (HPV+) head and neck cancer (HNC) demonstrate significantly improved survival outcome compared to those with HPV-negative (HPV-) tumors. Published data examining this difference offers conflicting results to date. We systematically investigated the radiation sensitivity of all available validated HPV+ HNC cell lines and a series of HPV- HNC cell lines using in vitro and in vivo techniques. HPV+ HNCs exhibited greater intrinsic radiation sensitivity (average SF2 HPV- 0.59 vs. HPV+ 0.22, p<0.0001), corresponding with a prolonged G2/M cell cycle arrest and increased apoptosis following radiation exposure (percent change 0% vs. 85%, p=0.002). A genome-wide microarray was used to compare gene-expression 24 hours following radiation between HPV+ and HPV- cell lines. Multiple genes in TP53 pathway were upregulated in HPV+ cells (Z score 4.90), including a 4.6 fold increase in TP53 (p<0.0001). Using immortalized human tonsillar epithelial cells, increased radiation sensitivity was seen in cell expressing HPV-16 E6 despite the effect of E6 to degrade p53. This suggested that low levels of normally functioning p53 in HPV+ HNC cells could be activated by radiation, leading to cell death. Consistent with this, more complete knockdown of TP53 by siRNA resulted in radiation resistance. These results provide clear evidence, and a supporting mechanism, for increased radiation sensitivity in HPV+ HNC relative to HPV- HNC. This issue is under active investigation in a series of clinical trials attempting to de-escalate radiation (and chemotherapy) in selected patients with HPV+ HNC in light of their favorable overall survival outcome.

• Received February 28, 2013.
• Revision received April 9, 2013.
• Accepted April 26, 2013.
 

• Copyright © 2013, American Association for Cancer Research.

 

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

 

June, 2013|Oral Cancer News|

Don’t Take Your Vitamins

Source: New York Times
By PAUL A. OFFIT
Published: June 8, 2013    
 
 
 

PHILADELPHIA — LAST month, Katy Perry shared her secret to good health with her 37 million followers on Twitter. “I’m all about that supplement & vitamin LYFE!” the pop star wrote, posting a snapshot of herself holding up three large bags of pills. There is one disturbing fact about vitamins, however, that Katy didn’t mention.

Derived from “vita,” meaning life in Latin, vitamins are necessary to convert food into energy. When people don’t get enough vitamins, they suffer diseases like scurvy and rickets. The question isn’t whether people need vitamins. They do. The questions are how much do they need, and do they get enough in foods?

Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. Vitamin manufacturers argue that a regular diet doesn’t contain enough vitamins, and that more is better. Most people assume that, at the very least, excess vitamins can’t do any harm. It turns out, however, that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.

In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta carotene, both or a placebo. The study found that those who had taken beta carotene for five to eight years were more likely to die from lung cancer or heart disease.

Two years later the same journal published another study on vitamin supplements. In it, 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.

Then, in 2004, a review of 14 randomized trials for the Cochrane Database found that the supplemental vitamins A, C, E and beta carotene, and a mineral, selenium, taken to prevent intestinal cancers, actually increased mortality.

Another review, published in 2005 in the Annals of Internal Medicine, found that in 19 trials of nearly 136,000 people, supplemental vitamin E increased mortality. Also that year, a study of people with vascular disease or diabetes found that vitamin E increased the risk of heart failure. And in 2011, a study published in the Journal of the American Medical Association tied vitamin E supplements to an increased risk of prostate cancer.

Finally, last year, a Cochrane review found that “beta carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A.”

What explains this connection between supplemental vitamins and increased rates of cancer and mortality? The key word is antioxidants.

Antioxidation vs. oxidation has been billed as a contest between good and evil. It takes place in cellular organelles called mitochondria, where the body converts food to energy — a process that requires oxygen (oxidation). One consequence of oxidation is the generation of atomic scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer and heart disease.

To neutralize free radicals, the body makes antioxidants (good). Antioxidants can also be found in fruits and vegetables, specifically in selenium, beta carotene and vitamins A, C and E. Some studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious. If fruits and vegetables contain antioxidants, and people who eat fruits and vegetables are healthier, then people who take supplemental antioxidants should also be healthier. It hasn’t worked out that way.

The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders. Researchers call this the antioxidant paradox.

Because studies of large doses of supplemental antioxidants haven’t clearly supported their use, respected organizations responsible for the public’s health do not recommend them for otherwise healthy people.

So why don’t we know about this? Why haven’t Food and Drug Administration officials made sure we are aware of the dangers? The answer is, they can’t.

In December 1972, concerned that people were consuming larger and larger quantities of vitamins, the F.D.A. announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would now have to prove that these “megavitamins” were safe before selling them. Not surprisingly, the vitamin industry saw this as a threat, and set out to destroy the bill. In the end, it did far more than that.

Industry executives recruited William Proxmire, a Democratic senator from Wisconsin, to introduce a bill preventing the F.D.A. from regulating megavitamins. On Aug. 14, 1974, the hearing began.

Speaking in support of F.D.A. regulation was Marsha Cohen, a lawyer with the Consumers Union. Setting eight cantaloupes in front of her, she said, “You would need to eat eight cantaloupes — a good source of vitamin C — to take in barely 1,000 milligrams of vitamin C. But just these two little pills, easy to swallow, contain the same amount.” She warned that if the legislation passed, “one tablet would contain as much vitamin C as all of these cantaloupes, or even twice, thrice or 20 times that amount. And there would be no protective satiety level.” Ms. Cohen was pointing out the industry’s Achilles’ heel: ingesting large quantities of vitamins is unnatural, the opposite of what manufacturers were promoting.

A little more than a month later, Mr. Proxmire’s bill passed by a vote of 81 to 10. In 1976, it became law. Decades later, Peter Barton Hutt, chief counsel to the F.D.A., wrote that “it was the most humiliating defeat” in the agency’s history.

As a result, consumers don’t know that taking megavitamins could increase their risk of cancer and heart disease and shorten their lives; they don’t know that they have been suffering too much of a good thing for too long.

 

 

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy. OCF states that this is an opinion piece, not news. 

 

June, 2013|Oral Cancer News|

The New Face of Oral Cancer

Source: nursing.advanceweb.com
By Jonathan Bassett
Posted on: April 22, 2013
 
 

For decades tobacco was the primary cause of oral cancer but a more insidious culprit has emerged. 

Jerry Wilck had no reason to suspect anything. Why would he? He only smoked for a couple of years and gave it up more than 40 years ago. He didn’t drink excessively, didn’t have a family history of cancer, and took good care of himself.

In fact, maybe the only reason the 59-year-old consulted an oral surgeon about the small sore on his tongue – the result of a habit of running this particular spot along his teeth – was that there happened to be such a specialist right there in his office.
Wilck was a general practice dentist in Langhorne, Pa., and particularly attuned to anomalies of the soft tissues of the mouth. His oral surgeon took no chances and ordered a biopsy.

Wilck was “floored” the night in March 2005 when the lab report arrived by fax from the oral pathology department at Temple University in Philadelphia – squamous cell carcinoma.

Wilck immediately consulted with John Ridge, MD, PhD, FACS, chief of head and neck surgery at Temple’s Fox Chase Cancer Center. After surgical removal of part of his tongue and lymph nodes from his neck, along with a round of physical and speech therapy, Wilck is now cancer free and has full use of his jaw, throat and voice.

“I was lucky,” confessed Wilck, who retired from practice in 2009 and now spends a large part of his time speaking to dental students, advocacy groups and the media about the dangers of oral cancers. “The surgery was successful and I didn’t need radiation or chemotherapy. A lot of people in other lines of work might have ignored the symptoms. My story could have ended very differently.”

 

Under the Radar

Wilck was one of the fortunate cases caught early and treated effectively.

Oral cancer, along with cancers of the head and neck, respond well to treatment when detected early in their development, explained Dong Moon Shin, MD, FACP, Frances Kelly Blomeyer Chair in Cancer Research and professor of hematology, medical oncology and otolaryngology at Emory University School of Medicine in Atlanta.

A leading researcher in the field of oral cancer, Shin has authored more than 220 peer-reviewed articles and is principal investigator of Emory’s National Cancer Institute-funded Head and Neck Cancer Specialized Program of Research Excellence (SPORE), an interdisciplinary research collaborative on the forefront of discovering treatments and preventive measures for these cancers, along with other NCI-funded research programs.

Shin’s current research directions center on prevention with natural compounds (including green tea and cancer-fighting agents found naturally in vegetables), along with anti-cancer drug delivery with nanotechnology – using nanometer-sized particles with novel properties engineered for the targeted delivery of anticancer drugs into cancer cells, while sparing healthy cells. Such “smartly” formulated nanoparticles carrying anti-cancer drugs can be specifically delivered to the cancer cells, thus minimizing side effects and maximizing the anti-cancer activity of the drugs, explained Shin. “Nanotechnology has the potential to revolutionize cancer care.”

Despite these encouraging research avenues, oral cancer is a specialty area deserving of more physicians and scientists such as Shin devoted to it, said Terry Day, MD, FACS, director of the division of head and neck oncologic surgery and the Head and Neck Tumor Center at Hollings Cancer Center at the Medical University of South Carolina in Charleston.

 

What You Need to Know about Oral Cancer: 

Christine Brader an oral cancer activist who has survived three bouts with the disease.

Archive ImageA

While oral cancer kills almost three times as many people as cervical cancer – one person dies every hour of every day from the disease, according to the Oral Cancer Foundation – it often receives less attention than more recognizable forms such as cancer of the skin or lungs.

“During my medical school training I began to see that these patients often had nowhere to turn,” said Day of the dearth of qualified specialists. He decided to make it his career’s mission to treat this complex, disabling, and potentially deadly subgroup of oncology.

“To look in the mirror and not recognize the person looking back at you – it’s shocking,” said Christine Brader, 49, an oral cancer activist who has survived three bouts with the disease. “I couldn’t believe it was me. Children would be scared of me out in public. I looked like a monster.”

 

Complex Complications

After “too many surgeries to count,” including the removal of her teeth and half of her jaw, implantation of a titanium plate (which her body rejected), and radiation and chemotherapy, Brader is now cancer free and maintains the use of her voice.

But it wasn’t an easy road. Oral cancer affects everything, said Brader – the way you look, the way you speak, your ability to eat and swallow. She spent two weeks in a medically induced coma, months in the hospital, and a grueling year-long recovery to get where she is today. She had to give up her job, her dogs, and her beloved home in Lehighton, Pa. The single mother of two had no caregiver to depend on, making the treatments even harder to get through.

“This is different than breast cancer and [cancer of] the internal organs,” said Brader, who is now independent but lives with many aftereffects and tires easily. “There’s no hiding it with clothing.”

She spends much of her time volunteering for the Oral Cancer Foundation’s public forum, helping new members and speaking at awareness events. She speaks to young people and the media regarding the dangers of smoking and chewing tobacco. She shares her story freely with the media, attends oral cancer screening events and volunteers for anti-smoking groups. She appeared in a TV commercial for Truth, a national anti-smoking prevention campaign, and the CDC’s Tips From Former Smokers Campaign.

“I try to make a difference,” Brader said. “I tell young people, ‘if someone you know starts smoking, be a friend and try to help them quit.’ It could save their life. By never starting to smoke, you never have to quit.”

 

Emergence of HPV

Brader began smoking as a teenager as a result of peer pressure, and continued the habit throughout her life. Her journey with oral cancer represents the traditional path – for decades, oral cancer was a disease of lifelong tobacco users that showed up later in life.

Fortunately, patient education regarding the riskiness of smoking, chewing tobacco and alcohol abuse has lowered the incidence of oral cancers from those origins, said Day.

However, a new contributing factor has moved into its place – human papilloma virus number 16 (HPV16). HPV16 is a common sexually transferred virus that is also responsible for the majority of cervical cancers in women. It’s now responsible for about 52% of newly diagnosed patients with oral and oropharyngeal cancer, according to the Oral Cancer Foundation.

The emergence of HPV16 as a risk factor has changed the demographic of oral cancers in the U.S. The disease is trending younger; the fastest growing segment of the oropharyngeal cancer population is those between the ages of 25 and 50, said Day. This is primarily due to HPV16, and cancers from this origin typically occur in the area of the throat behind the mouth, in the oropharynx, tonsils, and at the base of the tongue.

It also means oral and oropharyngeal cancers can strike in subtle silence; when in years past, a history of smoking or using chewing tobacco might prompt primary care physicians and their patients to be more diligent in screenings, HPV is a silent invader that can display little or no symptoms until it’s too late.

“HPV is definitely the coming epidemic in oral cancer,” said Brian Hill, a stage four oral cancer survivor and founder of the Oral Cancer Foundation. Hill had never used tobacco and his cancer – of an HPV16 etiology – was detected after bilaterally metastasizing and progressing into his cervical lymph nodes.

“My own journey included radiation and surgery, back in the days before IMRT [intensity modulated radiation therapy], and a very difficult and protracted recovery with significant quality of life issues, now a decade out,” Hill said.

 

Partners in Prevention

For Day, the ideal strategy to get a handle on the disconcerting mortality rates associated with oral cancer arises from a partnership between primary care physicians and dental professionals providing routine screenings for early-stage symptoms and swiftly referring to specialists.

Survival rates after early detection (stages 1 and 2) can be 80%-90%, while survival rates of late-stage detections (after the disease has advanced to stage 3 and 4) fall to 40%-50%, said Shin.

Head and neck screenings for cancer are relatively simple, painless, two- to three-minute visual and tactile exams performed in the dentist’s office, said Seung-Hee Rhee, DDS, FAGD, a general practice and cosmetic dentist in New York City, and spokesperson for the Academy of General Dentistry.

“You’re looking for any asymmetries, sores that don’t heal, abnormal lesions that seem suspect,” said Rhee, who makes these screenings part of her regular dental exams along with obtaining a thorough patient history to uncover potential signs and risk factors before they become major problems.

And new technology is making these screenings even easier for dentists, explained Rhee. Handheld blue-spectrum light emitters such as the Velscope shined inside the mouth will illuminate soft tissue abnormalities in different patterns than healthy tissue. This can aid dentists in detecting cancers even before they can be picked up by the unassisted eye.

“Early detection is where we’ll make a difference,” said Rhee. “[Dentists] are often the first line of defense.” She adds that HPV vaccinations for cervical cancer administered in the pre-teen years are another potential course of action being studied to help prevent these diseases. The Oral Cancer Foundation supports the use of the HPV vaccine for its potential in reducing the incidence of oral cancer, though the FDA currently prohibits drug manufacturers from making this specific claim.

“We highly encourage people who have precancerous lesions in the oral cavity or voice box [to] participate in clinical trials of chemoprevention to block the progression to invasive cancer,” said Shin.

 

Spreading the Word

While dental professionals work on the front lines to detect cases early, and researchers work tirelessly to unearth promising new treatments,

Wilck, Brader and a small army of former patients and activists travel the country speaking to schools, community groups and media outlets to underscore the importance of avoiding risk factors and receiving periodic screenings.

To mark Oral Cancer Awareness Month, the Oral Cancer Foundation is teaming with dental offices nationwide to offer free oral cancer screenings throughout April. Over 1200 free screening events are taking place in dental offices across America. A list is viewable at www.oralcancer-screening.org/events/.

The Head and Neck Cancer Alliance this year sponsored the 16th annual Oral Head and Neck Cancer Awareness Week April 14-20, said Day, who serves as president of the HNCA. This weeklong series of events promotes awareness and offers free screenings. Details are at http://www.ohancaw.com/.

“Reducing the high death rate associated with oral cancer is a tangible opportunity today,” said Hill. “We do need increased public awareness, coupled with an engaged professional dental and medical community doing opportunistic screenings.”

“My role these days is to keep people from taking the same path I did,” said Wilck. “If I reach just one person, it’s been worth it.”

 

 

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

 

Health Experts Praise Michael Douglas For His Oral Cancer Revelation

June 3rd, 2013 7:20pm EDT
Source: starpulse.com

 

Michael Douglas

 

Health experts have commended Michael Douglas for speaking out about link between throat cancer and oral sex.

The 68 year-old actor, who endured a six-month battle with the illness, hit headlines over the weekend when he voiced his belief that his cancer was caused by HPV, the human papillomavirus, which can be contracted through oral sex.

The Behind The Candelabra star told Britain’s The Guardian newspaper, “Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus… I mean, I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it.”

Douglas’ frank admission has now won him praise from Brian Hill, executive director of Oral Cancer Foundation, who tells the New York Post, “I’m really quite proud of Michael saying this. This (oral sex) is not an aberrant sexual behavior. But the willingness to talk about this openly can be difficult.”

The actor recorded a public service announcement for the Oral Cancer Foundation last year.

 

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

 
June, 2013|OCF In The News|

The Man’s Guide to HPV

Source: Men’s Health
By: Melaina Juntti

What men can do about HPV

 

What men can do about HPV

Michael Douglas caught major flak for saying oral sex gave him throat cancer. But if you’re laughing, it’s time to grow up. Oral cancers caused by the sexually transmitted human papillomavirus (HPV) have skyrocketed 225 percent in the past 15 years, with men accounting for 75 percent of all cases. The number-one culprit: HPV passed via oral sex.

It used to be that cigarettes caused most of these cancers. But since smoking rates have plummeted over the past few decades, and we’re having way more oral sex today than even our fathers’ generation, HPV has become the most common STD in the U.S. – inevitably leading to more oral cancer cases. It only takes one time going down on someone to contract HPV, and experts estimate that 80 percent of us will be exposed to the virus at some point in our lives. This STD sometimes causes genital warts, but according to the Centers for Disease Control and Prevention, that’s not very common. In most cases, HPV has no symptoms. And since no test exists to detect HPV in guys, you won’t know you have the virus until years later – if it turns into cancer.

“It’s very hard to determine when you acquired HPV,” says Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. “It doesn’t usually come from just one sexual episode. That said, every once in a while, cancer develops within two years of when you think you acquired HPV. But most often it comes 10, 12, even 20 years later.”

Still, not all HPV cases lead to oral cancer. Far from it. So even though the rapidly rising prevalence of these cancers is scary – and nothing we should take lightly – we need to keep the actual risk in perspective. “It’s true that within the world of oral cancer, HPV-caused cases have become an epidemic,” says Brian Hill, executive director of the Oral Cancer Foundation. “They are rapidly increasing at a rate never seen before, and it’s going to get much worse by 2020. However, in the grand scope of the U.S. population, the term ‘epidemic’ is overstating the reality. Only a small percentage of sexually active people wind up with an HPV-related oral cancer. For 99 percent of those who get HPV, their immune system clears it within 12 to 24 months, and that’s that. So we have to look at the relative risk. Don’t stop having sex. That’s not an appropriate response.”

So what is the right response? To protect yourself without killing your sex life, there are HPV vaccines like Gardisil. These are proven to protect against HPV-caused anal and cervical cancers, and doctors overwhelmingly believe they also prevent oral cancers. However, the CDC recommends vaccination only for men under age 26, and most insurance plans won’t cover it for older guys. Still, that doesn’t necessarily mean you should rule out the vaccine if you’re past 26.

“The CDC’s recommendations are based on a generality,” Schaffner says. “Statistics show that most guys, by age 26, have had multiple sexual partners and have probably been exposed to HPV. But every individual is different. A guy may have been in a long-term monogamous relationship that’s ended, and now he’s reentering the social scene and going to have sex. It won’t do him any harm to get immunized. Insurance probably won’t cover the vaccine, but he can certainly pay the $300 to $400 out of pocket.”

But if you’ve had a handful of partners – and, if the stats are correct, have probably already come in contact with HPV – the decision boils down to whether you want that extra piece of mind, says Schaffner. After all, you could be one of the lucky few who’s had lots of sex but never been exposed. “It’s kind of like wearing a belt and suspenders,” he explains. “Wearing both may be unnecessary, but at least can be sure your pants won’t fall down. By getting the vaccine, you know you’ve done everything you can to protect yourself from HPV.”

Besides being immunized, which only spares you from HPV if you haven’t been exposed, you should limit your sexual partners and always use protection. But even then, condoms and dental dams aren’t surefire HPV blockers, Schaffner says, because you can get the virus from skin-to-skin contact. “HPV can be present on the penis shaft and vaginal lips, not just on mucus membranes, semen, or vaginal fluid,” he says. “Therefore, condoms – both male and female types – are very helpful, but they don’t offer complete protection, even if they’re used as directed and don’t break.”

Schaffner says gay men aren’t necessarily at less risk of oral cancer just because they’re not performing oral sex on women. It has more to do with how often a guy has sex and how many different men he’s slept with. However, the CDC says gay and bisexual men are 17 times more likely to develop anal cancer – also caused by HPV – than men who only sleep with women.

Even if you already have HPV – and don’t know it – you can take steps to decrease your chances of oral cancer. Schaffner says to stop smoking immediately and cut back on booze. “We’re not sure why, but smoking and drinking too much both increase HPV’s likelihood of developing into cancer,” he explains.

To be safe, you should also be on the lookout for early signs of oral cancer, which tend to be subtle, so guys often ignore them, says Hill. Unlike tobacco-caused oral cancers, which present in visible symptoms like white lesions or red spots on the tongue, HPV-related cancer cells love lymph tissue and the way back of your tongue. “HPV-caused oral cancers have very stealthy signs, so you really have to pay attention if you feel changes,” he says.

Here’s what to look for: “If you notice it’s become more difficult to swallow, or you’re suddenly always hoarse or have a sore throat, those are definite cancer red flags, and you need to get examined,” Hill says. “Also, if a lymph node in your neck becomes enlarged – and it’s painless – that’s a warning sign of cancer starting inside the mouth and spreading to your neck. When lymph nodes swell up from ear infections or abscessed teeth, they hurt. But these ones don’t. And if you can’t push it around, that’s a definite sign.”

Thankfully, all you dads and future fathers can help spare your sons from these health issues. Get them vaccinated long before they wind up going down on a girl in the back seat of your car. “Don’t put it off until they’re 17,” Schaffner says. “Have them immunized when they’re 11.”

 

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

 
June, 2013|OCF In The News|

Michael Douglas pleased that oral sex story raised public awareness

By Agence France-Presse
Tuesday, June 4, 2013 18:40 EDT
Source: The Raw Story 

Michael-Douglas-and-Catherine-Zeta-Jones-via-Shutterstock-615x345

 

 

 

 

 

 

 

 

Michael Douglas said he would win a Nobel prize if he knew exactly what caused his throat cancer, in fresh comments Tuesday after a dispute with a British newspaper over an interview he gave.

The “Fatal Attraction” star, whose spokesman already denied he blamed his throat cancer specifically on oral sex, also said that, regardless, he was happy to raise awareness about causes of the killer disease.

“I never expected to become a poster boy for head and neck cancer,” Douglas said in comments issued by a representative.

“But, if after what started out as trying to answer a couple of questions about the suspected sources of this disease results in opening up discussion and furthering public awareness, then I’ll stand by that.”

In an interview with Britain’s Guardian newspaper, Douglas, who stars in the just-released biopic of flamboyant entertainer Liberace, “Behind The Candelabra,” said his cancer was caused by the human papillomavirus (HPV).

“Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus,” he said, in comments the newspaper said amounted to blaming oral sex for his cancer.

Douglas’s spokesman Allen Burry said Monday that the 68-year-old actor was talking in general, not personal terms.

“This is not the cause of his cancer,” he said.

On Tuesday, Douglas himself added: “Head and neck cancer can be caused by many things including HPV virus, smoking, alcohol, drug abuse, genes, environment and stress. I do not know what caused my particular cancer.”

“If I did I’d have a Nobel Prize. I do know that I am here today because of all the incredible advances in cancer research and treatment. Early awareness is a key factor.”

“If this episode contributes to public awareness, all the better,” he said.

The British newspaper stuck to its guns over the issue, posted an audio clip of the interview on its website and insisted that Douglas had been referring to his own cancer being caused by cunnilingus.

“The Guardian firmly denies this charge of misrepresentation. Mr Burry was not present at the (interview); the only two people present were Mr Douglas and the Guardian writer, Xan Brooks,” the paper noted online.

 

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

 

June, 2013|Oral Cancer News|

Researchers Investigate A Less Toxic Radiation Treatment For HPV-Positive Oropharynx Cancer

Source : Biocompare
Posted: June 03, 2013 

 

CHICAGO, IL (May 29, 2013)—Researchers from Fox Chase Cancer Center and other institutions have completed a phase II clinical trial that may help identify those patients with HPV-positive oropharyngeal cancer who do not require the full radiation dose given in a standard regimen of Intensity-Modulated Radiation Therapy (IMRT). Preliminary findings will be presented by Shanthi Marur, first author on the study and an oncologist at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, at the 49th Annual Meeting of the American Society of Clinical Oncology on Sunday, June 2.

Patients enrolled in the trial received an initial regimen of chemotherapy followed by treatment with the targeted therapy cetuximab, a monoclonal antibody. In the study, a patient’s response to those initial treatments determined the dose during radiation treatment.

“Those patients who had a really good response to chemotherapy might also be more responsive to radiation,” says Barbara Burtness, senior author on the study and chief of head and neck medical oncology at Fox Chase. “Therefore, the use of a full dose of radiation for those patients might represent overtreatment.”

Burtness is also chair of the Eastern Cooperative Oncology Group (ECOG), which sponsors this ongoing trial. ECOG is a a National Cancer Institute-funded team of researchers who organize and carry out clinical trials.

According to the National Cancer Institute, more than 40,000 people will be diagnosed with cancer of the oropharynx—a swath of tissue at the back of the throat—in 2013, and nearly 8,000 will die from the disease. Between 60 and 80 percent of cases are associated with infection by Human Papilloma Viruses, or HPVs.

“Patients with HPV-associated oropharyngeal cancer tend to be younger than other oropharyngeal cancer patients, and would be living with the aftereffects of treatment for more years,” says Burtness. A patient who undergoes standard radiation to the back of the throat—usually between 66 and 70 Gy—may suffer serious side effects like dry mouth and disfunction in swallowing.

The investigators suspected a subset of HPV-associated oropharyngeal cancer patients, identified by their response to chemotherapy, may be suitable for trials of lower radiation.

Burtness and her co-investigators enrolled 90 patients in the trial, 80 of whom were analyzable. Of those patients, 95 percent were men, and the median age was 57. The researchers reported that most patients tolerated the induction chemotherapy and treatment with cetuximab, and 96 percent completed all three cycles. Forty-six patients had a complete clinical response, which meant all signs of the primary tumor had disappeared following treatment. These patients went on to receive a lower-than-standard dose of radiation, at 54 Gy.

The researchers report that most patients tolerated the treatment with low incidence of high-grade side effects, but other data are premature. The primary endpoint of the study is two-year progression-free survival, the fraction of patients whose diseases have not worsened after two years. The investigators say that if the two-year progression-free survival rate is at least 85 percent, further studies on lower-dose radiation are warranted.

“We do not expect that anyone would want to lower the dose of radiation based on this study, which is very much a developmental study,” says Burtness. “We’ve never had a comparative trial of low dose versus standard dose IMRT.”

Burtness notes among patients who received a lower dose of radiation, “what seemed to predict for a slightly worse outcome was either a heavy smoking history (more than 10 pack years), or those with larger tumors.”

She says that although it’s too early to draw definitive conclusions, the early results “may justify further study of deintensifying radiation among nonsmokers with HPV-associated oropharyngeal cancers.”

In addition to Burtness and Marur, other investigators include Christine H. Chung at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center in Baltimore, MD; David R. Trevarthen at the Swedish Medical Center in Denver; Shuli Li at the Dana-Farber Cancer Institute in Boston, MA; Weiqiang J. Zhao and Maura Gillison at the Ohio State University College of Medicine in Columbus, OH; Alexander D. Colevas at the Stanford Cancer Center in Stanford, Calif.;  Anthony J. Cmelak at the Vanderbilt-Ingram Cancer Center in Nashville, TN; Julie E. Bauman at the University of Pittsburgh Medical Center, PA; Lynne I. Wagner at Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, IL; Balkrishna N. Jahagirdar at HealthPartners and Regions Cancer Care Center in St. Paul, MN; William H. Westra at the Johns Hopkins Hospital in Baltimore, MD; Robert Ferris at the University of Pittsburgh Cancer Institute, PA. The study is sponsored by ECOG.

 

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

 

 

 
June, 2013|Oral Cancer News|

ASCO: Actor’s Oral Sex Remarks May Aid HPV Prevention

By: Crystal Phend, Senior Staff Writer
Published: June 03, 2013
Source: MedPage Today

 

CHICAGO — Actor Michael Douglas’ apparent claim that he got throat cancer from human papillomavirus (HPV) contracted through oral sex may help aid prevention efforts, experts suggested.

Douglas, now 68, was diagnosed with a “walnut-sized” stage IV tumor at the base of his tongue in 2010 after months of oral discomfort. His well-known tobacco and alcohol habits — both risk factors for oropharyngeal cancers — had been thought to be the cause, but he appeared to indicate otherwise in an interview appearing in British tabloid The Guardian yesterday.

While one of his representatives has since challenged that interpretation of the interview, the spotlight on HPV as a cause of cancer should promote awareness of the need for HPV vaccination, head and neck cancer and HPV specialists contacted here at the American Society of Clinical Oncology meeting said.

“It’s no surprise to physicians such as myself, because probably 80% of the tonsil and tongue cancers I see are related to HPV,” Eric Moore, MD, an oropharyngeal cancer specialist at the Mayo Clinic in Rochester, Minn., noted in an interview with MedPage Today.

Most adults become exposed to the virus at some point but clear it like any other infection. Those who become chronically infected are at elevated risk of cervical, anal, and head and neck cancers, particularly from subtype 16.

The tonsils and base of tongue are the predominant areas affected in the head and neck because of the deep pockets in the tissue there that allows the virus a foothold, similar to the cervix, Moore explained.

Oral sexual contact is how HPV is thought to spread to the mouth and throat, and men appear to more readily acquire the virus from women than women do from men, as is true in other sexually transmitted infections, noted William Schaffner, MD, an infectious diseases specialist at Vanderbilt University in Nashville, Tenn.

While many patients worry about who they may have gotten the virus from and who they have given it to, clinicians can reassure patients that testing family members and partners isn’t necessary.

“It’s impossible to know in people with multiple sexual partners how they got it,” he said. “If you went back and tested their partners, you wouldn’t even know because they may have cleared the infection.”

Moreover, there isn’t an established and reliable test for oral HPV unlike for the cervix.

Examination of the mouth, tongue, and head and neck lymph nodes during a dental exam should help catch oropharyngeal cancers at an early stage, Schaffner noted.

But there isn’t a treatment for chronic HPV infection or any evidence supporting HPV testing for nonsymptomatic individuals, added Marcia Brose, MD, PhD, a head and neck cancer specialist at the Abramson Cancer Center in Philadelphia.

“We’re not even near that yet,” she told MedPage Today.

But those considerations make prevention all the more important, and for that reason public awareness of Douglas’ case could be helpful, Schaffner said.

“It will generate many conversations,” he said. “I don’t believe it will change a great deal of behavior, but certainly knowledge that HPV is increasing and HPV is a cause of cancers may make understandable CDC recommendation that all children should be vaccinated against HPV.”

Brose and Moore agreed that physicians can take advantage of conversations about HPV- and oral-sex-related risk to promote vaccination of adolescents.

“It’s not as clear cut whether adults should be vaccinated,” Moore noted. “After you’ve already seen the virus, the vaccine doesn’t work because you’ve already been ‘auto-vaccinated’ by clearing the virus.”

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

 
June, 2013|Oral Cancer News|

It’s True. You Can Get Throat Cancer From Oral Sex

By: Alexandra Sifferlin
June 03, 2013
Source: TIME

 

On Sunday, in an interview with the Guardian, actor Michael Douglas revealed that his throat cancer was not caused by tobacco and alcohol, but by HPV, which was transmitted through oral sex. He has since called the statement a misunderstanding, but it’s still true: you can get throat cancer from HPV.

In an eye-poppingly candid interview with the Guardian’s Xan Brooks, Douglas, who is married to actress Catherine Zeta-Jones, allegedly told the reporter his cancer was caused by the STD:

The throat cancer, I assume, was first seeded during those wild middle years, when he drank like a fish and smoked like the devil. Looking back, knowing what he knows now, does he feel he overloaded his system?

“No,” he says. “No. Because, without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”

From what? For a moment I think that I may have misheard.

“From cunnilingus. I mean, I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer.” He shrugs. “And if you have it, cunnilingus is also the best cure for it.”

Right, I say. OK. So what he is suggesting is that it all evens out? “That’s right,” says Douglas. “It giveth and it taketh.”

Human papillomavirus (HPV) is a sexually transmitted disease that can cause genital warts or present itself without symptoms. If left untreated, it can also cause cancers of the cervix, anus, penis, vulva, vagina — and head and neck cancers. “HPV being a cause of head and neck cancer was really only accepted about five years ago,” says Dr. Maura Gillison, a professor at the Ohio State University who studies HPV infections in the head, throat and neck. “Before then, no one really cared about oral HPV infections.”

According to the U.S. Centers for Disease Control and Prevention, about 60% of oropharyngeal cancers — cancers of the throat, tonsils and the base of tongue — are related to HPV. It is estimated that every year in the U.S., more than 2,370 new cases of HPV-related oropharyngeal cancers are diagnosed in women and about 9,356 are diagnosed in men; they are most common in white men.

“It is a known phenomenon,” says Gillison. “In the U.S., there is an active shift going on. Fortunately thanks to tobacco policy and public-health awareness, the incidence rate for the classical head and neck cancer caused by smoking is declining. But unfortunately, the rate of oropharynx cancer is still going up and it’s because of the HPV component.”

In 2011, Gillison and her colleagues conducted a study looking at the proportion of oropharynx cancers associated with HPV over time in the U.S. The proportion increased from 16% to 72% from the late 1980s to the early 2000s. “The incidence is rising pretty rapidly in the U.S.,” says Gillison. “Approximately 10% per year, particularly among Caucasian middle-age men.”

HPV-related throat cancer presents similarly to tobacco- and alcohol-related throat cancer, but they are considered two separate diseases, says Gillison. There are about 15 different HPV types that are established causes of cancer. The most common are HPV 16 and 18, accounting for about 70% of cervical cancers. “For oral infection, we find the same types of HPV in the oral cavity as we do in the cervix or genital region for men, but the infection is considerably less common,” says Gillison.

Oral HPV doesn’t benefit from the comprehensive testing and preventative procedures established for HPV of the cervix. Women who get regular Pap smears are quickly tested for cancerous changes that may be caused by HPV of the cervix.

“When HPV was recognized to be the cause of cervical cancer, the entire algorithm for doing Pap smears and referring a patient to a gynecologist was already established,” says Gillison. “The researchers were able to just piggyback all of their analysis and testing for HPV on the cervix onto something that was already established in the field. For oral, there is no established screening algorithm so there is no piggybacking onto routine clinical care.”

There is currently no method to routinely test for oral HPV, nor is there a way to test men for genital HPV. Researchers are working on developing clinical tests for the virus, which is among the most common STDs: researchers say most sexually active people will likely have an HPV infection at some point, but many never know. The infection doesn’t always present symptoms, and typically clears the body in one to two years.

According to the Johns Hopkins School of Medicine, it is estimated that 20 million people in the U.S. currently have HPV infection, and 1 in 49 people will contract a new HPV infection each year.

Physicians recommend the HPV vaccine for both young boys and girls to prevent infection from the disease.

 

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

June, 2013|Oral Cancer News|