Monthly Archives: April 2014

ASCO Launches New Survivorship Guidelines

Author: Roxanne Nelson
Source: medscape.com
 

The American Society of Clinical Oncology (ASCO) has issued 3 new evidence-based clinical practice guidelines on the prevention and management of common symptoms that affect a large number of cancer survivors — neuropathy, fatigue, and depression and anxiety.

The number of cancer survivors in the United States has risen exponentially, from 3.0 million in 1971 to about 13.7 million currently.

That is good news, but the downside is that survivors often face long-term health issues related to their disease and treatment. Thus, there is an outstanding need for comprehensive guidance to assist clinicians in this management process. The ASCO recommendations reinforce the fact that both physical and psychological needs have to be addressed in this population.

The guidelines, published online April 14 in the Journal of Clinical Oncology, are the first in a series that will focus on survivorship care.

Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common treatment-related adverse event and can affect a patient’s long-term quality of life. It is estimated that about 38% of patients who are treated with multiple agents develop CIPN, but this can vary, depending on the actual regimen and duration of treatment. Chemotherapy combinations associated with a higher incidence of CIPN are those that involve platinum drugs, vinca alkaloids, bortezomib, and/or taxanes.

Symptoms vary, and range from numbness and tingling to shooting pain in the arms and legs. If symptoms are really severe, dose reduction or another regimen might be necessary. For a minority of patients, severe symptoms can last for years.

“There is no clear panacea for neuropathy,” said Gary Lyman, MD, MPH, cochair of the ASCO Survivorship Guidelines Advisory Group, in a statement. “Some of the drugs used for prevention or treatment of neuropathy may cause side effects or interfere with other drugs. We want to be clear that if there is no evidence of benefit from those drugs, it’s probably best not to take them.”

The neuropathy guidance is based on a literature review that included 48 randomized controlled trials. However, the studies tended to be small and heterogeneous, and many had insufficient sample sizes to detect clinically important differences in outcomes, the authors note.

Key CIPN Recommendations

No established agents are recommended for preventing CIPN, because of the “paucity of high-quality, consistent evidence and a balance of benefits versus harms.”

The following agents should not be offered for prevention of CIPN: acetyl-L-carnitine, amifostine, amitriptyline, calcium plus magnesium, dietyldithiocarbamate, glutathione, nimodipine, Org 2766, all-trans retinoic acid, rhuLIF, and vitamin E.

Treating clinicians can offer duloxetine to patients with CIPN

Although recommendations cannot be made for tricyclic antidepressants, gabapentin, or topical gels containing baclofen, amitriptyline, and ketamine because of the lack of strong evidence, it might be reasonable to try them in select patients.

A number of nonpharmacologic interventions have been investigated for their role in preventing or treating peripheral neuropathy, but they could not be included in this review because of the lack of data from randomized trials, the guideline authors note.

Fatigue

The fatigue guideline provides recommendations on screening, assessment, and treatment approaches for adult cancer survivors experiencing this symptom.

It is recommended that all cancer survivors be evaluated for symptoms of fatigue after they complete their treatment, and that they be offered strategies for fatigue management.

“Fatigue is an extremely common symptom in people with cancer,” said Smita Bhatia, MD, MPH, cochair of the ASCO Survivorship Guidelines Advisory Group, in a statement. “We hope that this guideline will help ensure that screening for fatigue and appropriate management are incorporated in the care of every cancer survivor.

The authors conducted a systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature. This guideline is based on a Canadian guideline on fatigue and 2 guidelines from National Comprehensive Cancer Network on cancer-related fatigue and survivorship.

Key Fatigue Recommendations

Patients should be routinely screened for fatigue from diagnosis onward, including after the completion of primary treatment.

Screening should include a quantitative or semiquantitative assessment.

Patients should be educated about the differences between normal and cancer-related fatigue, causes of fatigue, and contributing factors.

Patients treated for fatigue should be observed and re-evaluated on a regular basis.

Patients should be offered strategies to manage fatigue, including physical activity, psychosocial interventions (e.g., cognitive and behavioral therapies, psychoeducational therapies), and mind–body interventions (e.g., yoga, acupuncture).

Anxiety and Depression Management

Most people experience some degree of depression, anxiety, and fear when diagnosed with cancer. Distress is very common, but the types and causes vary, said Dr. Bhatia. “Depression can go undetected unless it is specifically sought for and evaluated.”

Recommendations in the anxiety and depression guideline were adapted from the Pan-Canadian Guideline on Screening, Assessment and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer.

Key Anxiety and Depression Recommendations

All cancer patients should be evaluated for symptoms of depression and anxiety, using validated measures.

All patients should be offered supportive care services; those with moderate or severe symptoms of anxiety and depression should be referred for appropriate interventions.

Providers should reassess patients for compliance with individual or group psychological or psychosocial referrals.

“Doctors sometimes don’t give these symptoms much attention because they think it’s normal that their patients are a little anxious or depressed about their disease,” said Dr. Lyman. “But it’s important to keep an eye on the symptoms and step in when they start to interfere with the patients’ quality of life.”

The authors of the neuropathy and fatigue guidelines report numerous financial relationships, which are detailed in the guidelines. The authors of the depression and anxiety guideline have disclosed no relevant financial relationships.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
 
April, 2014|Oral Cancer News|

Oral Human Papillomavirus (HPV) Infection in HPV-Positive Patients With Oropharyngeal Cancer and Their Partners

Authors: 
Gypsyamber D’Souza, Neil D. Gross, Sara I. Pai, Robert Haddad, Karen S. Anderson, Shirani Rajan, Jennifer Gerber, Maura L. Gillison, Marshall R. Posner
 
Source: http://jco.ascopubs.org

 

Abstract

Purpose To better understand oral human papillomavirus (HPV) infection and cancer risk among long-term sexual partners of patients with HPV-positive oropharyngeal cancer (HPV-OPC).

Patients and Methods An oral rinse sample, risk factor survey, cancer history, and oral examination (partners only) were collected from patients with HPV-OPC and their partners. Oral rinse samples were evaluated for 36 types of HPV DNA using PGMY 09/11 primers and line-blot hybridization and HPV16 copy number using quantitative polymerase chain reaction. Oral HPV prevalence was compared with infection among those age 45 to 65 years using National Health and Nutrition Examination Survey (NHANES) 2009-2010.

Results A total of 164 patients with HPV-OPC and 93 of their partners were enrolled. Patients were primarily men (90%), were never-smokers (51%), and had performed oral sex (97%), with a median age of 56 years; they had a high prevalence of oncogenic oral HPV DNA (61%) and oral HPV16 DNA (54%) at enrollment. Female partners had comparable oncogenic oral HPV prevalence compared with members of the general population of the same age (1.2% v 1.3%). Among the six male partners, no oncogenic oral HPV infections were detected. No precancers or cancers were identified during partner oral cancer screening examinations. However, a history of cervical disease was reported by nine partners (10.3%) and two female patients (11.8%), and three patients (2.0%) reported a previous partner who developed invasive cervical cancer.

Conclusion Oral HPV16 DNA is commonly detected among patients with HPV-OPC at diagnosis, but not among their partners. Partners of patients with HPV-OPC do not seem to have elevated oral HPV infection compared with the general population.

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

April, 2014|Oral Cancer News|

Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Authors: 
Simon C.H. Yu, MD; Winnie X.Y. Zou, PhD; Yannie O.Y. Soo, MD;Lily Wang, MD; Joyce Wai Yi Hui, FRCR; Anne Y.Y. Chan, MD; Kwok Tung Lee, MSc; Vincent H.L. Ip, MD; Florence S.Y. Fan, MD; Annie L.C. Chan, MSc; Lawrence K.S. Wong, MD; Thomas W. Leung, MD
Source: http://stroke.ahajournals.org

 

Abstract

Background and Purpose—We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control.

Methods—In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR.

Results—The median follow-up was 47.3 months (95% confidence interval, 26.9–61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031).

Conclusions—The safety, effectiveness, and technical difficulty of carotid angioplasty and stenting for RIS are comparable with that for AS although it is associated with a higher rate of ISR.

Clinical Trial Registration—This trial was not registered as enrollment started in 2006.

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

April, 2014|Oral Cancer News|

FDA proposes rules to disclose e-cigarette ingredient information and ban sales to children

Source: usatoday.com
Author: Wendy Koch

 

As electronic cigarettes soar in popularity, the U.S. government Thursday is proposing historic rules to ban their sale to minors and require warning labels as well as federal approval.

Three years after saying it would regulate e-cigarettes, the Food and Drug Administration is moving to control not only these battery-powered devices but also cigars, pipe tobacco, hookahs (water pipes) and dissolvable tobacco products. Currently, the FDA regulates cigarettes, roll-your-own tobacco and smokeless products such as snuff.

The proposed rules won’t ban advertising unless the products make health-related claims nor will they ban the use of flavors such as chocolate or bubble gum, which public health officials say might attract children.

“This is an important moment for consumer protection,” said FDA Commissioner Margaret Hamburg, noting tobacco remains “the leading cause of death and disease in this country.” The rules will require manufacturers to report their ingredients to the FDA and obtain its approval. They also ban free tobacco samples and most vending-machine sales.

“Some of these regulations will be very restrictive,” said Ray Story, founder of industry group TVECA (Tobacco Vapor Electronic Cigarette Association), who added he obtained his own pre-release copy of the rules. He said they could be costly for smaller businesses and slow the growth of a product that advocates say has helped many smokers kick the habit.

Still, Story said, consumers might benefit, because “it provides them a product that will be consistent.” E-cigarettes contain varying ingredients and levels of nicotine that are heated into a vapor that users inhale in a practice known as “vaping.” Most look like conventional cigarettes but some resemble everyday items such as pens and USB memory sticks.

The rules come as e-cigarette sales, buoyed by TV ads with Hollywood celebrities , have soared in recent year and debate has risen about whether the devices are more apt to lure kids toward tobacco or help adults quit smoking.

An increasing number of states have cracked down by extending indoor smoking restrictions to e-cigarettes. Last month, U.S. poison centers reported a surge in illnesses linked to the liquid nicotine used in the devices.

While they don’t contain many of the harmful chemicals of conventional cigarettes, the FDA found trace amounts of toxic and carcinogenic ingredients in several samples in late 2008 when the e-cigarette market was just beginning in the United States. It sought to regulate them as drug-delivery devices, but in 2010, a federal judge ruled it could only do so if they made therapeutic claims. So in April 2011, the agency said it would regulate them as tobacco products, because the nicotine is derived from tobacco leaves.

“It’s taken more than three years to issue a proposed rule, which we think is inexcusable,” said Vince Willmore of the Campaign for Tobacco-Free Kids, an anti-smoking group. “It’s allowed a Wild West marketplace with irresponsible marketing and no control over the product.” He says the FDA should quickly finalize the rules, which face a 75-day public comment period and further review.

The proposed rules walk a narrow path. They will require tobacco products that weren’t on the market by Feb. 25, 2007 — a date set by a federal law — to apply for FDA review within 24 months after the rules are issued. The products can stay on the market pending FDA’s review, says Mitch Zeller, director of FDA’s Center for Tobacco Products, adding they can seek an exemption from additional reviews if minor changes are made.

Despite these requirements, the proposal doesn’t contain the marketing restrictions sought by some critics that were almost sure to trigger litigation. Craig Weiss, CEO of NJoy, a top-selling e-cigarette, said he supports “reasonable regulation” but would “respond very forcefully to any attempt to limit my free speech right to promote my product.”

Several dominant e-cigarette manufacturers, which now include the nation’s three largest cigarette makers — Philip Morris, R.J. Reynolds and Lorillard — have embraced limited regulation such as a ban on sales to minors. Yet they’ve argued that their e-products shouldn’t be regulated as tightly as conventional cigarettes — an approach the FDA appears to be taking.

The FDA said the rule aims to bolster product safety. It said since e-cigarettes have not been fully studied, consumers have no way to know how much nicotine or other chemicals they contain and whether they’re safe or beneficial.

 

FDA’s 20-year road to regulating tobacco:

August 1996: FDA issues rules to ban tobacco sales to minors and its advertising near schools or playgrounds

March 2000: U.S. Supreme Court, in 5-4 decision, rules that Congress did not give FDA such authority

December 2008: FDA, after detaining import shipments of e-cigarettes, declares they’re unapproved drug delivery devices

April 2009: E-cigarette distributor Smoking Everywhere files suit against the FDA, joined a month later by Sottera (doing business as NJOY)

June 2009: Congress passes law granting FDA authority to regulate tobacco products

January 2010: U.S. District Court for the District of Columbia bans FDA from stopping e-cigarette imports

June 2010: FDA issues final rules to ban the sale of cigarettes and smokeless tobacco to minors and to restrict their marketing

December 2010: U.S. Court of Appeals for the D.C. Circuit, upholding lower court decision, rules e-cigarettes can be regulated as tobacco products but not as drugs/devices unless marketed for therapeutic purposes

April 2011: FDA says it intend to expand to its authority over tobacco products to include e-cigarettes

June 2011: FDA issues new graphic warning labels that will need to be placed on cigarette packs and ads by Sept. 2012

April 2014: FDA proposes rules to regulate e-cigarettes and cigars as tobacco products

 

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

 

April, 2014|Oral Cancer News|

Current tobacco reports show 50 years of progress

Source: the-scientist.com
Author: Jef Akst

 

In 1964, the U.S. Surgeon General released the first report on the effect that cigarettes and other forms of tobacco have on human health, presenting strong evidence of the link between smoking and lung cancer, among other adverse consequences. During the last 50 years, significant progress has been made in terms of understanding how smoking causes various diseases and how to treat them, and educational campaigns have contributed to a drop in smoking rates from 42 percent to 18 percent of US adults. Nevertheless, more than 480,000 Americans still die from tobacco-related diseases each year, and additional health consequences continue to be linked to smoking.

“Between now and mid-century, nearly 18 million Americans will die preventable avoidable deaths if we don’t do something to alter that trajectory,” Mitchell Zeller, the director of the Center for Tobacco Products of the Food and Drug Administration (FDA), said during a press conference held today here at the American Association for Cancer Research (AACR) meeting in San Diego, California.

To this end, the AACR released a compilation of peer-reviewed research and review articles, published across seven of its journals, covering basic scientific research on the molecular mechanisms of tobacco carcinogenesis, tools for the diagnosis of lung cancer and other tobacco-related diseases, and the impact of the original Surgeon General’s report on tobacco control. Ellen Gritz from the University of Texas MD Anderson Cancer Center helped put the new report together. “Together, these reports add to the broad reach of important tobacco-related research at the forefront of cancer research and policy, and shine a light on both the challenges and opportunities ahead,” Gritz said.

“[The report] drives home the need for action, citing this large burden of smoking-attributed premature death and morbidity, . . . [and] ends with a call for more action,” added Jonathan Samet, a pulmonary physician and epidemiologist at the University of Southern California.

In addition to the special report, AACR today hosted speakers from the FDA, the National Cancer Institute (NCI), and other groups to discuss the way forward for tobacco-related research, education, and regulation. “Clearly, if you think about other domains of health and risk, if a consumer product were to be introduced onto the market which caused a few dozen deaths it would easily make national news, and produce a public outrage, 60 Minutes reports, headlines,” said Robert Croyle, who directs the Division of Cancer Control and Population Sciences at NCI. “But we’re in a bizarre situation where we have a legal product on the market that’s responsible for about half a million deaths [each year].”

Zeller pointed to several recent FDA initiatives aimed at reducing tobacco-related deaths, including education campaigns targeting young people. Like the other panelists, Zeller praised the progress that has been made, noting the “remarkable denormalization of tobacco use” since a time when his parents would put out bowls of loose cigarettes at parties, and when he and his classmates would make ashtrays in arts and crafts class. But he emphasized that the fight is far from over. “As we pause to acknowledge all of that progress, we also have to take stock of the work that lies ahead of us,” Zeller said.

 
 *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
 
April, 2014|Oral Cancer News|

Could the everyday use of mouthwash be linked to oral cancer?

Source: nursingtimes.net
Author: Staff

 

“Experts warn using mouthwash more than twice a day can give you cancer,” the Daily Mirror reports.

The news comes from a European study that examined the oral health and dental hygiene of people diagnosed with cancers of the mouth, throat, vocal chords or oesophagus (collectively called “upper aerodigestive cancers”).

The researchers found that people with the poorest oral health (including wearing dentures and bleeding gums) had a more than doubled risk of these cancers compared with those with the best oral health.

Similarly, they found that those with the poorest dental care (including frequency of tooth brushing and visiting the dentist) had a more than double risk compared with those with the best dental care.

Importantly, these associations remained after adjustment for smoking and alcohol consumption – established risk factors for these cancers – and for other factors that may influence risk, such as socioeconomic status.

But despite the Mirror’s headline, the link between oral cancer and mouthwash is less clear. The association was only significant when looking at very frequent use (three times a day).

Very few people used mouthwash this frequently, which decreases the reliability of this risk estimate. There is certainly no credible evidence that mouthwash “can give you cancer”.

Even if there is a true link, it is unclear whether it is mouthwash itself (the alcohol content) or the reasons it is being used, such as poor oral hygiene, that are responsible for the association.

The results do suggest a link between poor dental hygiene and oral cancers, however, and reinforce the importance of maintaining good dental health.

Where did the story come from?

This was multicentre research conducted by numerous academic institutions across Europe and the US.

The study was supported by the European Community Fifth Framework Programme, the University of Athens Medical School, the Bureau of Epidemiologic Research Academy of Athens, Padova University, Compagnia di San Paolo, Associazione Italiana per la Ricerca sul Cancro (AIRC), the Piedmont Region, targeted financing from the Estonian government through the European Regional Development Fund in the frame of Centre of Excellence in Genomics, and the 7FP Project ECOGENE.

It was published in the peer-reviewed Journal of Clinical Oncology.

The quality of the UK’s media reporting on the study was mixed. BBC News rightly focused on the link between poor dental hygiene and oral cancer.

But the Daily Mirror incorrectly states in its headline that, “Experts warn using mouthwash more than twice a day can give you cancer”. In fact, the researchers specifically go out of the way in their conclusion to state that their data does not provide proof that excessive mouthwash increases cancer risk.

What kind of research was this?

This was a case-control study that included a group of people diagnosed with cancer of the mouth, throat, vocal chords or food pipe (oesophagus). They were then matched with a group of people without these cancers (the controls) and were interviewed about their oral health, dental care and lifestyle.

The researchers aimed to see whether oral health and dental care – in particular, the use of mouthwash – may be associated with these cancers. As a group, these cancers are sometimes called “upper aerodigestive cancers” as they involve the upper parts of the respiratory and digestive system.

These cancers are said to account for around 129,000 new cancer cases in the European Union, making them the fourth most common cancers for men and the tenth for women.

Alcohol and smoking are widely known to be risk factors for these cancers. Other research has also associated the cancers with lower fruit and vegetable consumption, and found that they are more common among lower socioeconomic status groups.

Additional research has also suggested that poorer dental and oral health may be associated with increased risk, independent of alcohol and smoking behaviour.

It is also speculated that frequent use of mouthwash could be a risk factor as a result of the ethanol (alcohol) it contains. However, there is limited evidence proving that there is an increased risk associated with mouthwash containing alcohol.

This study aimed to examine whether mouthwash and wider oral health and dental care are associated with the risk of upper aerodigestive cancers, importantly adjusting for the potential confounders of smoking and alcohol.

What did the research involve?

This study used information from the multicentre alcohol-related cancers and genetic susceptibility in Europe (ARCAGE) case-control study, which was conducted across 13 centres in nine European countries.

The study included 1,963 people newly diagnosed with cancers of the mouth, throat, vocal chords or oesophagus between 2002 and 2005 (cases). They were matched by age and sex to 1,993 people without cancer, who were randomly selected from people attending the same medical centres or hospitals as the cases for other health reasons.

All participants were interviewed about a range of health and lifestyle measures:

  • sociodemographic characteristics (number of years of full-time education was used as the main indicator of socioeconomic status)
  • smoking history (lifetime smoking history was used to calculate “pack years”)
  • alcohol consumption (lifetime consumption of number of drinks per day was assessed for all categories of alcoholic drinks)
  • weekly consumption of fruits and vegetables (recorded by food frequency questionnaire)
  • employment history
  • body measurements
  • medical and dental history, including oral hygiene habits

Oral health was assessed using the following scoring system, where a maximum total score of 7 would indicate poorest oral health:

  • wearing of dentures (none = 0; partial denture in upper or lower jaw = 1; partial denture in both jaws = 2; complete denture in one jaw = 3; complete denture in both jaws = 4)
  • age at starting to wear dentures (no denture = 0; denture at age 55 years or older = 1; denture at age 35-54 years = 2; denture at age below 35 years = 3)
  • frequency of gum bleeding from brushing teeth (sometimes or never = 0; always or almost always = 1; 0 in subjects wearing complete dentures in both jaws)

Similarly, dental care was assessed as follows, where a maximum total score of 8 would indicate poorest dental care:

  • frequency of tooth cleaning (at least twice per day = 0; once per day = 1; 1-4 times per week = 2; less often or never = 3)
  • use of toothbrush, toothpaste or dental floss (two or three of these = 0; only one of these three = 1; none of these = 2)
  • frequency of visiting a dentist (at least once per year = 0; every 2-5 years = 1; less than every 5 years = 2; never = 3)

Participants were asked about their use of mouthwash in a separate question, but this was not included in these scores.

The researchers also took blood samples to look at whether people had four variations in genes that code for proteins involved in breaking down alcohol (ethanol).

The researchers previously found these variations to be associated with risk of upper aerodigestive cancers, with one particularly associated among heavy drinkers.

As many brands of mouthwash contain alcohol, the researchers wanted to test whether a person who had these variants influenced the potential link between mouthwash and upper aerodigestive cancers.

What were the basic results?

Participants were aged 60 years on average. Almost half of cases had mouth cancer (48%), followed by cancer of the lower throat or vocal chords as the next most common cancer (36%).

After adjustment for all other measured health and lifestyle factors, the risk of upper aerodigestive cancers increased with poorer dental care. People with the worst dental care (scores of 5-8) had the highest risk, more than double the cancer risk for people with the best dental care (a score of 0; odds ratio[OR] 2.36, 95% confidence interval [CI] 1.51 to 3.67).

Looking at oral health, people with the poorest oral health (score of 5, 6 or 7) had an increased risk compared with those with the best oral health (score of 0). People with the highest oral health score of 7 had a more than doubled risk compared with those with a score of 0 (OR 2.22, 95% CI 1.45 to 3.41). Those with moderate oral health – a score of 1-4 – were not at increased risk compared with those with the best oral health.

Reported use of mouthwash of more than three times per day was associated with tripled risk of upper aerodigestive cancers (OR 3.23, 95% CI 1.68 to 6.19). Importantly, the researchers say that although this effect was strong, only 1.8% of cases and 0.8% of controls reported such frequent use.

These relatively small numbers reduce confidence that these estimates of risk are correct. There was also no link between less frequent use of mouthwash (less than three times a day) and risk.

Looking at the four gene variants, certain variants associated with faster ethanol metabolism were associated with a decreased risk of these cancers, while a variant associated with slower ethanol metabolism was associated with increased risk.

One particular variant associated with faster ethanol metabolism was found to be less common in mouthwash users compared with “never users”.

How did the researchers interpret the results?

The researchers concluded that poor oral health and dental care seem to be independent risk factors for upper aerodigestive cancers, even after adjusting for potential confounders such as smoking and alcohol use.

They say that, “Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.”

Conclusion

This multicentre study conducted across nine European countries has many strengths, including its large sample size. Most importantly, it adjusted for smoking and alcohol consumption, which are well-established risk factors for these cancers and could otherwise influence the association between oral health and dental hygiene and these cancers.

The researchers also adjusted for other potential risk factors, such as socioeconomic status and how much fruit and vegetables people ate.

However, there are some potential limitations. Although the researchers have made every effort to adjust for these confounders, as the researchers themselves acknowledge, the questions asked about these lifestyle factors may not fully capture a person’s smoking habits, alcohol use and diet, so there is still the possibility that they have some effect.

Also, the questions asked around oral health and dental hygiene may not have given a full representation of the person’s mouth care. These self-reported measures were not checked against dental records.

The study asked people to rate their current oral health and dental hygiene, and in the people with cancer this was after their diagnosis. This may not reflect their lifelong oral health or care before their diagnosis. An independent assessment provided by a dentist, or examination of dental records, may have been more reliable.

Nevertheless, the study does support an independent link between oral health and dental hygiene and aerodigestive cancers. The link seems biologically plausible and further study could also assess why these links might exist. Previous studies have suggested similar links, and ideally a systematic review would be able to look at this new study alongside the other available evidence. Such a review may provide new insights into potential risk factors.

Despite reports to the contrary, the link between mouthwash and cancer is less clear. Although using mouthwash more than three times a day was more common among cases than controls, very few people used mouthwash this frequently – only 1.8% of cases and 0.8% of controls. Risk calculations involving such small numbers of people are less reliable than those including larger samples.

The possible link between mouthwash and mouth and throat cancers needs to be clarified. If there is a link, it is currently unclear whether it could be related to the alcohol contained in mouthwash, or whether the link is caused by poor oral health and not a direct effect of mouthwash at all. It could be that poor oral health or dental hygiene increases the risk, and people with poorer health are also more likely to use mouthwash.

However, in the meantime, if you are concerned, there are plenty of alcohol-free mouthwash brands available. Your local pharmacist should be able to advise you.

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

 

April, 2014|Oral Cancer News|

Study finds the prognosis of HPV positive tumors in head and neck cancer patients to vary depending on site

Source: sciencecodex.com
Author: Staff

 

Vienna, Austria: Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown. Danish researchers have now shown that HPV status appears to have no prognostic effect on the outcome of primary radiotherapy in head and neck cancer outside the oropharynx (the part of the throat located behind the mouth, and which contains the soft palate and the base of the tongue), the ESTRO 33 congress will hear today (Sunday).

Presenting her results to the congress, Dr Pernille Lassen, MD, PhD, from the Aarhus University Hospital, Aarhus, Denmark, will say that head and neck cancers located outside the oropharynx should probably not be treated with the less intensive treatment strategies that are currently being investigated in clinical trials for HPV+ oropharyngeal tumours.

“HPV status has a very potent prognostic impact in radiotherapy for oropharyngeal cancer, and DNA from HPV has been found in all types of head and neck cancer, although it is far more common in oropharyngeal tumours. We decided to investigate the impact of HPV status in non-oropharyngeal cancers in the DAHANCA database, which includes all Danish head and neck cancer patients,” Dr Lassen will say.

The researchers searched the database to identify patients with locally advanced cancers who had been treated primarily with radiotherapy, and identified 1606 patients with larynx and pharynx carcinomas. Overall, 40% of the tumours were HPV positive, and the frequency was significantly higher in oropharyngeal cancer (57%), than in non-oropharyngeal (13%).

Being positive for HPV significantly improved tumour control (81% as opposed to 55%), as well as survival from the cancer (89% and 55% respectively), and death from any cause (82% and 38% respectively), after five years.

“In non-oropharyngeal cancers we found no prognostic impact of being HPV positive in any of these endpoints,” Dr Lassen will say. “This indicates that HPV status does not help us in predicting response to treatment, and hence the outcome of these cancers.

“We know from laboratory studies that HPV positive tumour cells are much more sensitive to radiation therapy than HPV negative cells, so until now we believed that they would behave similarly irrespective of site,” Dr Lassen will say. “However, these data indicate that this is not the case, and at present we do not understand why this should be, though it probably can be ascribed to other biological/genetic differences between the tumours rather than the HPV status. We would now like to try to elucidate the underlying mechanisms behind these different outcomes.”

There could be, for example, biological and/or genetic differences between the tumours other than the HPV status, the researchers say; for example, genetic changes caused by smoking tobacco, differences due to tumours of mixed make-up (for example, a combination of HPV+ and tobacco), or perhaps simply differences due to the site. “Such tumours with a combination of causes represent a challenge in our clinical daily practice,” Dr Lassen will say.

“We have started following up our work by analysing all the tumour samples using polymerase chain reaction, a way of amplifying DNA in order to be able to analyse changes in genetic information. We hope this will enable us to understand more about why the role of HPV in non-oropharyngeal tumours is so different. There are few data available on this subject at present, so finding out will be an important step towards optimising treatment for these patients.”

President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: “These findings will have an important impact on the treatment of HPV+ head and neck cancers, and are likely to lead to a change in current practice.”

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

April, 2014|Oral Cancer News|

Liquid nicotine for E-cigarettes found to be extremely toxic

Source: nytimes.com
Author: Matt Richtel

 

A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.

 

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

April, 2014|Oral Cancer News|

Recurrent head and neck tumors have gene mutations that could be vulnerable to cancer drug

Source: medicalxpress.com
Author: staff

An examination of the genetic landscape of head and neck cancers indicates that while metastatic and primary tumor cells share similar mutations, recurrent disease is associated with gene alterations that could be exquisitely sensitive to an existing cancer drug. Researchers from the University of Pittsburgh Cancer Institute (UPCI) and Yale University School of Medicine will share their findings during a mini-symposium Sunday at the American Association for Cancer Research Annual Meeting 2014.

About 50 percent of patients diagnosed with head and neck squamous cell cancers already have disease that has spread, or metastasized, to the lymph nodes, explained Jennifer Grandis, M.D., distinguished professor and vice chair of research, Department of Otolaryngology, Pitt School of Medicine, and director of the Head and Neck Program at UPCI, partner with UPMC CancerCenter. About 20 to 30 percent of patients thought to be cured of the disease go on to develop recurrent cancer, which typically doesn’t respond to standard treatments.

“We decided to compare the genetic signatures of tumor cells from primary tumors with those from disease that had spread and cancers that were thought cured but then came back in the hopes of getting some clues about how best to guide therapy in these different settings,” Dr. Grandis said. “We found that recurrent cancers might have an Achilles’ heel we can exploit to kill them.”

The team conducted the first whole-exome genetic sequencing study on what Dr. Grandis called its “treasure trove” of frozen patient samples and found similar mutations both in primary tumors and in the lymph nodes to which their cancers had already spread. But there were different mutations in tumors that had recurred after a period of remission that were not found in their original cancers.

“The recurrent tumors carried mutations in a gene area that encodes for DDR2 cell receptors,” Dr. Grandis said. “Other studies have shown that DDR2 mutations can confer sensitivity to the cancer drug dasatinib, which could mean that drug has promise in the treatment of recurrent head and neck cancers.”

The researchers suggest that further investigation of dasatinib treatment is warranted.

April, 2014|Oral Cancer News|

Prognosis of tumors positive for human papilloma virus in head and neck cancers varies according to the site

Source: www.sciencecodex.com
Author: staff

Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown. Danish researchers have now shown that HPV status appears to have no prognostic effect on the outcome of primary radiotherapy in head and neck cancer outside the oropharynx (the part of the throat located behind the mouth, and which contains the soft palate and the base of the tongue), the ESTRO 33 congress will hear today (Sunday).

Presenting her results to the congress, Dr Pernille Lassen, MD, PhD, from the Aarhus University Hospital, Aarhus, Denmark, will say that head and neck cancers located outside the oropharynx should probably not be treated with the less intensive treatment strategies that are currently being investigated in clinical trials for HPV+ oropharyngeal tumours.

“HPV status has a very potent prognostic impact in radiotherapy for oropharyngeal cancer, and DNA from HPV has been found in all types of head and neck cancer, although it is far more common in oropharyngeal tumours. We decided to investigate the impact of HPV status in non-oropharyngeal cancers in the DAHANCA database, which includes all Danish head and neck cancer patients,” Dr Lassen will say.

The researchers searched the database to identify patients with locally advanced cancers who had been treated primarily with radiotherapy, and identified 1606 patients with larynx and pharynx carcinomas. Overall, 40% of the tumours were HPV positive, and the frequency was significantly higher in oropharyngeal cancer (57%), than in non-oropharyngeal (13%).

Being positive for HPV significantly improved tumour control (81% as opposed to 55%), as well as survival from the cancer (89% and 55% respectively), and death from any cause (82% and 38% respectively), after five years.

“In non-oropharyngeal cancers we found no prognostic impact of being HPV positive in any of these endpoints,” Dr Lassen will say. “This indicates that HPV status does not help us in predicting response to treatment, and hence the outcome of these cancers.

“We know from laboratory studies that HPV positive tumour cells are much more sensitive to radiation therapy than HPV negative cells, so until now we believed that they would behave similarly irrespective of site,” Dr Lassen will say. “However, these data indicate that this is not the case, and at present we do not understand why this should be, though it probably can be ascribed to other biological/genetic differences between the tumours rather than the HPV status. We would now like to try to elucidate the underlying mechanisms behind these different outcomes.”

There could be, for example, biological and/or genetic differences between the tumours other than the HPV status, the researchers say; for example, genetic changes caused by smoking tobacco, differences due to tumours of mixed make-up (for example, a combination of HPV+ and tobacco), or perhaps simply differences due to the site. “Such tumours with a combination of causes represent a challenge in our clinical daily practice,” Dr Lassen will say.

“We have started following up our work by analysing all the tumour samples using polymerase chain reaction, a way of amplifying DNA in order to be able to analyse changes in genetic information. We hope this will enable us to understand more about why the role of HPV in non-oropharyngeal tumours is so different. There are few data available on this subject at present, so finding out will be an important step towards optimising treatment for these patients.”

President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: “These findings will have an important impact on the treatment of HPV+ head and neck cancers, and are likely to lead to a change in current practice.”

Source: European Society for Radiotherapy and Oncology (ESTRO)

April, 2014|Oral Cancer News|