Monthly Archives: May 2017

Study reveals high environmental cost of tobacco

Source: www.cnn.com
Date: May 31st, 2017
Author: Jacopo Prisco

Details of the environmental cost of tobacco are revealed in a study released Wednesday by the World Health Organization, adding to the well-known costs to global health, which translate to a yearly loss of $1.4 trillion in health-care expenses and lost productivity.

From crop to pack, tobacco commands an intensive use of resources and forces the release of harmful chemicals in the soil and waterways, as well as significant amounts of greenhouse gases. Its leftovers linger, as tobacco litter is the biggest component of litter worldwide.

“Tobacco not only produces lung cancer in people, but it is a cancer to the lungs of the Earth,” said Dr. Armando Peruga, who previously coordinated the WHO Tobacco Free Initiative and now works as a consultant. He reviewed the new report for the WHO.

Commercial tobacco farming is a worldwide industry that involves 124 countries and occupies 4.3 million hectares of agricultural land. About 90% of it takes place in low-income countries, with China, Brazil and India as the largest producers.

Because tobacco is often a monocrop — grown without being rotated with other crops — the plants and the soil are weak in natural defenses and require larger amounts of chemicals for growth and protection from pests.

“Tobacco also takes away a lot of nutrients from the soil and requires massive amounts of fertilizer, a process that leads to degradation of the land and desertification, with negative consequences for biodiversity and wildlife,” Peruga said.

The use of chemicals directly impacts the health of farmers, 60% to 70% of whom are women. This is especially prominent in low- and middle-income countries, where some compounds that are banned in high-income countries are still used.

300 cigarettes = one tree

Farming also uses a surprisingly large amount of wood, rendering tobacco a driver of deforestation, one of the leading causes of climate change.

About 11.4 million metric tonnes of wood are utilized annually for curing: the drying of the tobacco leaf, which is achieved through various methods, including wood fires. That’s the equivalent of one tree for every 300 cigarettes, or 1.5 cartons.

This adds to the impact of plantations on forest land, which the study describes as a significant cause for concern, citing “evidence of substantial, and largely irreversible, losses of trees and other plant species cause by tobacco farming.”

Deadly gases

In 2012, 967 million daily smokers consumed approximately 6.25 trillion cigarettes worldwide, the WHO estimates.”That means about 6,000 metric tones of formaldehyde and 47,000 metric tonnes of nicotine are released into the environment,” Peruga said.

Tobacco smoke contains about 4,000 chemicals, at least 250 of which are known to be harmful. It also contains climate-warming carbon dioxide, methane and nitrous oxides. “The combination of greenhouse gases from combustion is equivalent to about 1.5 million vehicles driven annually,” Peruga said.

Secondhand smoke is particularly deadly: It contains twice as much nicotine and 147 times more ammonia than so-called mainstream smoke, leading to close to 1 million deaths annually, 28% of them children.

Some of these pollutants remain in the environment (and our homes) as “third-hand smoke,” accumulating in dust and surfaces indoors, and in landfills. Some, like nicotine, even resist treatment, polluting waterways and potentially contaminating water used for consumption, the study notes.

Non-biodegradable litter

Tobacco litter is the most common type of litter by count worldwide.

“We calculate that two-thirds of every cigarette ends up as litter,” Peruga said.

The litter is laced with chemicals including arsenic and heavy metals, which can end up in the water supply. Cigarette butts are not biodegradable, and tossing one on the ground is still considered a socially acceptable form of littering in many countries.

The WHO estimates that between 340 million and 680 million kilograms of tobacco waste are thrown away every year, and cigarette butts account for 30% to 40% of all items collected in coastal and urban clean-ups.

“In addition to that, there are 2 million tons of paper, foil, ink and glue used for the packaging,” Peruga said.

A way forward?

Even though smoking is declining globally, it is increasing in some regions, such as the eastern Mediterranean and Africa. China is a world leader both in production (44%) and consumption, with 10 times more cigarettes smoked than in any other nation.

Every stage of the production of a cigarette has negative effects on the environment and the people who are involved in manufacturing tobacco products, even before the health of smokers and non-smokers is affected.

Although governments worldwide already collect $270 billion in tobacco taxes a year, the WHO suggests that increasing tax and prices is an effective way of reducing consumption and help development priorities in each country, adding that by collecting 80 cents more per pack, the global tax revenue could be doubled.

“Tobacco threatens us all,” WHO Director-General Margaret Chan said in a note. “It exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air.”

May, 2017|Oral Cancer News|

More patients presenting with HPV-associated oral cancers in Lubbock, TX

Source: lubbockonline.com
Author: Ellysa Harris

Detecting oral cancers in patients in their 50s and 60s has never been uncommon. But local dentists and doctors say finding it in younger patient populations has become a new norm.

Oral cancers driven by Human Papillomavirus are now the fastest growing oral and oropharyngeal cancers, according to the Oral Cancer Foundation website. And local health officials say they’ve seen a few more cases than usual.

Dr. Joehassin Cordero, FACS, professor, chairman and program director ofTexas Tech’s Health Sciences Center Department of Otolaryngology-Head & Neck Surgery, said less people are smoking and that has contributed to the decrease in the number of cases of oral cancers in the past two decades.

“In that same period, we have seen an increase in the HPV oropharyngeal cancer,” he said. “And oropharyngeal cancer — what it means it’s affecting the base of your tongue and tonsils.”

Dr. Brian Herring, a Lubbock dentist, chalks the increase up to increased awareness.

“I’m assuming probably for years and years and years it has affected the mouth but we didn’t know that,” he said. “As we get better at cellular diagnostics and molecular diagnostics, things like that, we’re finding that there is a large portion of cancers that do have an HPV component.”

What’s more alarming, said Dr. Ryan Higley, oral surgeon with West Texas Oral Facial Surgery, is it’s being diagnosed in younger people.

Higley said oral cancers are generally diagnosed between the ages of 55 and 65, mostly in women.

“With HPV-associated cancers, we see those four to 10 years before that,” he said. “It’s a younger patient population.”

Cordero said the oral cancers are often caused by exposure to HPV from years before.It starts with exposure to the HPV infection. One in four people in the United States are currently infected, according to the Centers for Disease Control and Prevention website.

“It’s truly considered a sexually transmitted disease,” Cordero said. “It has to do with not so much kissing, but oral sex.”

It’s passed on when somebody with an active lesion engages in sexual activities with another person, he said.

Nine out of 10 infections will disappear on their own, according to the CDC, but infections that linger for longer than about two years can lead to cancer.

“That doesn’t mean they’ll have cancer next week,” Cordero said.

Researchers are still trying to figure out why and how long after HPV exposure it takes for cancer to develop, he said.

“We don’t know the true mechanism because most of these people were not exposed a year ago,” he said. “They were not exposed six months ago. They were exposed a long time before that.”

When it does present, he said, there generally aren’t any noticeable symptoms.Because of that, it’s often diagnosed in later stages, Herring said.

“What we’re finding is because the demographic is changing, they’re not getting diagnosed as early because they’re not expecting to have this problem,” he said.

Screenings for oral HPV exist.

“The gold standard examination is your typical dental exam,” Herring said. If your dentist detects something unusual that might need further examination, he or she will make a referral to an oral surgeon.

Higley said oral HPV cancer presents as a lesion that looks like a kanker that won’t heal.

“However, cancerous lesions can have multiple presentations so that’s not exclusive,” he said. “So oftentimes, we’ll have a patient present with a hard nodule underneath their jaw line or in their neck. Sometimes they’ll just have red or white lesions within the mouth, hoarseness in their voice or difficulty swallowing. All those are things that need to be checked.”

The cancer seems to be more treatable, he said, but it’s hard to pinpoint why.

“We really don’t know if they’re more responsive to treatment because we’re treating a little bit younger patient population who is overall more healthy or if it’s inherant in the tumor itself,” Higley said.

Cordero said he hopes the HPV vaccine, which is recommended for both girls and boys 11 or 12 years old and people up to 26 years old, provides a measure of protection against the infection.

“We’re hoping in the next 10 to 20 years that head and neck cancer caused by HPV will be completely gone,” he said.

Symptoms of throat cancer depend on which throat structures are affected

Source: tribunecontentagency.com
Author: Eric Moore, M.D.

Dear Mayo Clinic: Are there early signs of throat cancer, or is it typically not found until its late stages? How is it treated?

Answer: The throat includes several important structures that are relied on every minute of the day and night to breathe, swallow and speak. Unfortunately, cancer can involve any, and sometimes all, of these structures. The symptoms of cancer, how early these symptoms are recognized and how the cancer is treated depend on which structures are involved.

All of the passageway between your tongue and your esophagus can be considered the throat. It includes three main areas. The first is the base of your tongue and tonsils. These, along with the soft palate and upper side walls of the pharynx, are called the oropharynx. Second is the voice box, or larynx. It consists of the epiglottis — a cartilage flap that helps to close your windpipe, or trachea, when you swallow — and the vocal cords. Third is the hypopharynx. That includes the bottom sidewalls and the back of the throat before the opening of the esophagus.

Tumors that occur in these three areas have different symptoms, behave differently and often are treated differently. That’s why the areas of the throat are subdivided into separate sections by the head and neck surgeons who diagnose and treat them.

For example, in the oropharynx, most tumors are squamous cell carcinoma. Most are caused by HPV, although smoking and alcohol can play a role in causing some of these tumors. Cancer that occurs in this area, particularly when caused by HPV, grows slowly usually over a number of months. It often does not cause pain, interfere with swallowing or speaking, or have many other symptoms.

Most people discover cancer in the oropharynx when they notice a mass in their neck that’s a result of the cancer spreading to a lymph node. Eighty percent of people with cancer that affects the tonsils and base of tongue are not diagnosed until the cancer moves into the lymph nodes.

This type of cancer responds well to therapy, however, and is highly treatable even in an advanced stage. At Mayo Clinic, most tonsil and base of tongue cancers are treated by removing the cancer and affected lymph nodes with robotic surgery, followed by radiation therapy. This treatment attains excellent outcomes without sacrificing a person’s ability to swallow.

When cancer affects the voice box, it often affects speech. People usually notice hoarseness in their voice soon after the cancer starts. Because of that, many cases of this cancer are detected at an early stage. People with hoarseness that lasts for six weeks should get an exam by an otolaryngologist who specializes in head and neck cancer treatment, as early treatment of voice box cancer is much more effective than treatment in the later stages.

Early voice box cancer is treated with surgery — often laser surgery — or radiation therapy. Both are highly effective. If left untreated, voice box cancer can grow and destroy more of the larynx. At that point, treatment usually includes major surgery, along with radiation and chemotherapy — often at great cost to speech and swallowing function.

Finally, cancer of the hypopharynx usually involves symptoms such as pain when swallowing and difficulty swallowing solid food. It is most common in people with a long history of tobacco smoking and daily alcohol consumption. This cancer almost always presents in an advanced stage. Treatment is usually a combination of surgery, chemotherapy and radiation therapy.

If you are concerned about the possibility of any of these cancers, or if you notice symptoms that affect your speech or swallowing, make an appointment for an evaluation. The earlier cancer is diagnosed, the better the chances for successful treatment. — Eric Moore, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

Note: For information, visit www.mayoclinic.org

Jay Fund will forever remain dear to heart of ESPN’s Mortensen

Source: staugustine.com
Author: Gene Frenette

Chris Mortensen remembers the moment last May when his own cancer journey reminded him why he had been coming to Tom Coughlin’s Jay Fund benefit dinner/golf tournament for the previous 15 years.

As Mortensen waited in line to receive his proton radiation treatment at the MD Anderson Cancer Center in Houston, the NFL information insider for ESPN saw a man ahead of him dressed in jeans and work boots strapped to a gurney, holding his 3-year-old son.

“He’s going into the very scary radiation proton room,” said Mortensen. “You have to be in there to understand how intimidating a place it can be, even more so for a child. That’s when I thought of the Jay Fund.

“There’s a dad, who clearly took off from work, with his son who looks sick and scared. It made me think, ‘That’s what the Jay Fund is about, helping families tend to the needs of their children who are suffering from this.’ That was the moment it connected with me.”

Mortensen, diagnosed 17 months ago with Stage IV throat cancer, is now himself an indirect beneficiary of what the Jay Fund does to provide financial/emotional support to pediatric cancer victims and their families. As the man known as Mort learned in his own battle, which metastasized into his lungs in November, he draws inspiration from watching kids fight this terrible disease with an upbeat attitude.

“What I saw at MD Anderson was great humanity, the promise of young people of all nationalities,” said Mortensen. “Not just the patients, but the support of their caregivers. You’re seeing all kinds of pediatric patients and families fight this battle. Now I have a clear image and picture of what they’re feeling.”

Mortensen, 65, remains in the fight of his life to return to the ESPN airwaves for the start of the 2017 football season. He’s been through chemotherapy and the standard 35 radiation treatments. Mortensen thought he was on the cusp of remission last August, until a biopsy in November revealed the cancer had spread into his lungs.

NFL referee Tony Corrente, a throat cancer survivor who had the same oncologist as Mortensen , had forewarned him early on about the challenges he’d be facing.

“[Corrente] said you’re going to go through a period in radiation where you’re going to feel you had the worst strep throat ever in you life times 100,” said Moretensen, whose weight plummeted down to a low of 142 pounds, which he has mostly regained. “And when you’re done with radiation, it’s going to get worse for the next three or four months, which it did.”

Though he can’t play golf due to impending hernia surgery, Mortensen was determined not to miss the Jay Fund event this year. It motivates him to be around people dedicated to a cause, now closer to his heart than he could have imagined a short time ago.

Sunday night at the Jay Fund dinner, Mortensen was touched when he saw 22-year-old cancer survivor Marissa Ierna speak about her battle with rhabdomyosarcoma, which inflicted the lower calf muscles of her legs.

Mortensen, who met Ierna briefly two years ago when they sat at the same table as she received a Jay Fund scholarship, received an email from her right after his cancer diagnosis. Among the hundreds of correspondences of encouragement sent to Mortensen during his battle, it was the words from Ierna on January 19, 2016 that stuck with him the most.

Here is a partial transcript of Ierna’s email to Mortensen: “I want to first say how sorry I am to hear about your recent diagnosis. It took me a while to learn that in order to get through the chemo and all the hard days, I had to keep a smile on my face and always have a positive attitude. I wish I would have known that earlier in treatment, it would have made the first few months a lot easier. As you start treatment, just remember to keep a positive attitude and always stay strong.

“I am very thankful to cancer for all it has provided me. I know this sounds crazy, but it has changed my life for the better. I encourage you to take this terrible disease and turn it into something amazing! The toughest battles are given to the strongest warriors, which means you can do this!”

Now imagine a man in his mid-60s, fresh off a cancer diagnosis, reading that from a young woman he met only briefly at a Jay Fund dinner. It uplifted Mortensen beyond measure, especially when cancer was beating him down.

So when Mortensen heard Ierna’s message to the Jay Fund audience on Sunday, the memory of that email moved him to tears all over again.

“Kids in a cancer unit are just so dang resilient, they actually inspire you,” Mortensen said. “Everybody goes through the fear of cancer on some level, and Marissa’s note was one of the most memorable.

“I read it once or twice all over again when I was in the dark shadows of my cancer journey. I was more emotional listening to her [at the Jay Fund dinner] because it hit me deeper. You couldn’t meet Marissa with that unforgettable smile, hear her story, and ever forget her.”

Ierna recently graduated from Florida State with a marketing degree and just took a job working with the Jay Fund. An avid runner, she’s approaching four years in remission and just ran the Boston Marathon in 3:28.31.

“My oncologist told me I’d never be able to run again any more than five miles because of the radiation in my leg, making me prone to stress fractures,” Ierna said.

A hard tumor was wrapped around her leg muscles, and the cancer in her bone marrow showed it advanced to Stage IV, just like Mortensen.

Ierna, an Atlantic Coast High graduate, credits the Jay Fund for providing her parents and younger brother with the emotional support they needed to cope through her illness. She’s been paying it forward ever since, making it her personal mission to help others like Mortensen in the same predicament.

It’s still unclear what the outcome will be for Mortensen. Acting on a tip from Coughlin, he’s battling the cancer in his lungs with immunotherapy, a treatment option with less intense side effects than chemo or radiation.

The 26-year ESPN employee has most of his voice and hair back, but his saliva glands aren’t yet fully restored to easily get him through 30-second sound bites. He’s hopeful another three months of down time before the season starts will advance the healing process, allowing him to return to full-time duty for Sunday Night and Monday Night Countdown shows.

Mortensen has seen the ravages of cancer up close, how it initially “crushed” his wife Micki and struck fear in so many kids during cancer treatment visits. He has gained an even greater appreciation for Coughlin’s charity, which has delivered over $8 million in grants during its 22-year existence.

But the Jay Fund is about more than just providing families financial assistance. It’s also about cancer survivors emotionally lifting up the next patient.

As Chris Mortensen discovered on his cancer journey, you can never be too old to be inspired by the young.

Recommendation Against Routine Thyroid Cancer Screening Retained

Author: Shreeya Nanda
Date: 05/23/2017
Source: https://www.medwirenews.com

The decision is based on a systematic review of 67 studies, also reported in JAMA, evaluating various aspects of screening, such as the benefits and harms of screening asymptomatic individuals and of treating screen-detected cancers, as well as the diagnostic accuracy of screening modalities.

Although there were no trials directly comparing the benefits of early versus late or delayed treatment, two separate observational studies compared the outcome of treatment versus no surgery or surveillance. However, as neither study accounted for confounding variables, robust conclusions could not be drawn, say Jennifer Lin, from Kaiser Permanente Center for Health Research in Portland, Oregon, USA, and colleagues.

By contrast, they identified 52 studies, including 335,091 patients, that provided information on the harms of treating screen-detected thyroid cancers. A meta-analysis of the data showed that the incidence of permanent hypoparathyroidism varied between 2% and 6%, while the rate of permanent vocal cord paralysis ranged from around 1% to 2%.

Among patients who received radioactive iodine therapy, the excess absolute risk for secondary cancers ranged from 11.9 to 13.3 per 10,000 person–years. And the incidence of dry mouth ranged widely, from approximately 2% to 35%.

The USPSTF commissioned the systematic review due to the rising incidence of thyroid cancers against a background of stable mortality, which is suggestive of overdiagnosis. And in view of the results, the task force concluded with “moderate certainty” that the harms outweigh the benefits of screening, upholding the “D” recommendation.

The USPSTF emphasizes, however, that this recommendation pertains only to the general asymptomatic adult population, and not to individuals who present with throat symptoms, lumps or swelling, or those at high risk for thyroid cancer.

Editorialists Louise Davies (Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA) and Luc Morris (Memorial Sloan Kettering Cancer Center, New York, USA) welcome the decision, noting that “[e]pidemiologic data from around the world demonstrate that finding more cases of cancer, as has occurred over the past approximately 15 years, has not made death from the disease less likely.”

They write in JAMA Otolaryngology–Head & Neck Surgery: “While suggestions to ‘check your neck’ are well intentioned, the USPSTF recommendation indicates that these practices should not be encouraged or endorsed.”

Other commentators are more circumspect. Julie Ann Sosa (Duke University Medical Center, Durham, North Carolina, USA) and co-authors point out in JAMA Surgery that both the incidence and mortality rates of advanced-stage papillary thyroid cancer have risen over the years, as has the overall thyroid cancer incidence-based mortality.

These findings “[challenge] the prevailing hypothesis that overdiagnosis is the sole culprit for the changing epidemiology,” they write.

Sosa and colleagues continue: “If the explanation for the rise in thyroid cancer is, indeed, not just overdiagnosis, and if mortality from thyroid cancer is also increasing, then enthusiasm for this (non)screening recommendation should be more muted.”

Writing in an accompanying piece in JAMA, Anne Cappola (University of Pennsylvania, Philadelphia, USA) notes that “[t]he rationale for the recommendation against screening is compelling,” but she does not want the conversation about screening to stop.

Like Sosa et al, Cappola does not think that over diagnosis explains all and she believes that “additional research into possible environmental etiologies is needed, particularly to inform prevention efforts.”

May, 2017|Oral Cancer News|

First long-term study on HPV claims the vaccine is 100% effective at protecting men from cancer caused by the STI

Source: www.dailymail.co.uk
Author: Cheyenne Roundtree

The first long-term study conducted into the HPV vaccine confirm it is almost 100 percent effective at protecting men from developing oral cancer.

The treatment was approved to the market in 2006 to prevent women from getting cervical cancer but experts haven’t been able to fully examine its effect over time. Now, the results are in from a three-year study on the effects – the longest investigation ever on HPV.

It confirmed that there was no trace of cancer-linked strains of HPV among men who received the vaccine – whereas two percent of untreated men had a potentially cancerous strain.

Another study, also released today, found the jab makes it next to impossible for vaccinated children to develop genital warts from the STI in their late teens and 20s.

Despite a multitude of interest and research, these are the first substantial studies to confirm the vaccine’s ability to protect people from the STI and diseases that can stem from it.

Human papillomavirus (HPV) is the most common sexually-transmitted disease in the US, with approximately 80 million people currently infected.

Although most infections disappear on their own, without even displaying symptoms, some strains can lead to genital warts and even cancers, including prostate, throat, head and neck, rectum and cervical cancer. Approximately 28,000 cases of cancer caused by HPV are diagnosed annually – most of which would have preventable with the vaccine, the CDC says.

The vaccine was first introduced with the main goal to prevent cervical cancer in women, but only about half of those eligible are getting the shots.

The study on HPV vaccines leading to oral cancer in men was led by Dr. Maura Gillison of the University of Texas MD Anderson Cancer Center. It was the first research done on whether the vaccine might prevent oral HPV infections in young men, and the results suggest it can.

The data were compiled from 2,627 men and women ages 18 to 33 years in a national health study from 2011 to 2014. The results in men were striking – no infections in the vaccinated group versus 2.13 percent of the others.

The two-dose vaccine study on genital warts was conducted by medical experts at the Boston University School of Medicine and examined the number of shots given to patients. They concluded that girls given two or three jabs prevented better against genital warts compared to those given one or no jabs.

There were similar results in the two and three jab test subjects, which experts concluding two counts of the vaccine were enough.

Rebecca Perkins, an obstetrician and the lead author of the Boston study, said: ‘This study validates the new recommendations and allows us to confidently move forward with the two dose schedule for the prevention of genital warts.’

Health Beat: Hunting head and neck cancer cells

Source: www.wfmz.com
Author: Melanie Falcon

Leonard Monteith led a healthy lifestyle. That’s why sudden problems with his mouth caught his attention.

“I noticed that when I would stick my tongue out, it would deviate to one side, and I thought that’s not right,” said Monteith, 66.

Doctors found an inch-wide tumor at the base of Monteith’s tongue. He was diagnosed with HPV positive cancer.

“The traditional treatment for head and neck cancer is really toxic and exhaustive and leads to side-effects that are very significant,” said Dr. Nabil Saba, a medical oncologist at Emory University Winship Cancer Institute in Atlanta.

After treatment, Monteith’s cancer went away for six months, but then it came back in his lungs.

Saba is a nationally-known expert in the treatment of head and neck cancers. He thought Monteith would be a good candidate for a new therapy.

“Immunotherapy is really, I think, a complete game changer,” said Saba.

Saba said two separate immunotherapy drugs are showing real promise. A drug called Nivolumab blocks the cancer receptors, allowing the body’s immune system to fight the cancer. Another drug, Pembrolizumab, also works in a similar way.

Because the trials are ongoing, Saba can’t say which specific drug Monteith was on.

“He had very good response to the treatment, to the point where we could not see any more lung lesions on the scan,” Saba said.

Monteith has been improving for three years, but he knows his condition could change without warning.

“I just live my life as I think I would have anyway,” said Monteith.

Doctors say the survival rates for patients who continued on Nivolumab were twice of those who did not take the immunotherapy drug. Twenty percent of the patients on the drug had their tumors shrink.

Research Summary: Hunting head and neck cancer cells (pdf format)

Large Study Shows Reduced Oral HPV Infections With Vaccine

Author: Kate Johnson
Date: May 18, 2017
Source: http://www.medscape.com/viewarticle/880184#vp_1

Human papillomavirus (HPV) vaccination is associated with an 88% reduction in rates of oral HPV infection according to one of the first studies to investigate this association.

The findings, reported in a premeeting presscast for the American Society of Clinical Oncology (ASCO) 2017 Annual Meeting, suggest that HPV vaccination may play an important role in the prevention of oropharyngeal cancer.

“Our data indicate that HPV vaccines have tremendous potential to prevent oral infections,” said senior study author Maura L. Gillison, MD, PhD, who conducted the research at Ohio State University and is now a professor of medicine at the University of Texas MD Anderson Cancer Center in Houston.

But she emphasized that although more than 90% of oropharangeal cancers are caused by HPV-16 ― one of the types for which HPV vaccines are currently available ― the vaccine is only indicated for the prevention of cervical and anogenital infections and associated cancers.

“There haven’t been any clinical trials evaluating whether the currently approved HPV vaccines can prevent oral infections that lead to cancer, so that is not currently an indication,” she explained.

In the absence of randomized trials, Dr Gillison and colleagues carried out a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) survey collected from 2627 young adults aged 18 to 33 years during the period 2011-2014.

This study was conducted by the National Center for Health Statistics and was designed to assess the health and wellness of the US population. Since 2009, Dr Gillison and colleagues have collaborated with NHANES to study oral HPV infections and have analyzed oral rinse samples collected by mobile health facilities.

Comparing individuals who had received the HPV vaccine (29.2% of women and 6.9% of men; P < .001) to those who had not, the analysis found the prevalence of oral HPV infections covered by the vaccine (HPV-16, -18, -6, and -11) was significantly lower in the vaccinated group (0.11% vs 1.61%; P = .008).

The most significant reduction was seen in men. None of those who had been vaccinated had an HPV infection of the types for which vaccinations were available, compared to 2.1% of unvaccinated men (P = .007).

“We were particularly interested in infections among men because the burden of HPV caused by head and neck cancer is largely borne by men, and the rates are rising most dramatically among men,” she said. The prevalence of HPV-positive oropharyngeal cancer is increasing faster than that of any other cancer among young, white, American men, she added.

“Using thse data, we estimated in an unvaccinated population about a million young adults would have oral HPV infection by one of these types, and if vaccines were universally accepted, we could have prevented perhaps over 900,000 of those,” she said.

HPV vaccines are recommended by a number of organizations, including the Centers for Disease Control and Prevention, the National Comprehensive Cancer Network, and ASCO, as well as a coalition of the top US cancer centers.

They were approved by the US Food and Drug Administration in 2006 for female patients aged 9 to 26 years; in 2011, they were approved for male patients aged 9 to 21 years (for men who have sex with men, they were approved to the age of 26 years).

However, in the 2011-2014 survey, only 18.3% of this population reported being vaccinated (6.9% of men and 29.2% of women).

Given this low uptake, the researchers estimated that “only 17% of potentially preventable infections have been prevented, 25% in women and a modest 7% in men,” said Dr Gillison.

Despite this, there is “considerable optimism,” she added.

“Recent data indicate that in individuals under the age of 18, 60% of girls have received more than one vaccine and 40% of boys – so vaccine uptake is higher now,” she added.

Dr Gillison warned against concluding on the basis of this study that there is a causal relationship between vaccination and prevention, because this was not a prospective trial. “Nevertheless, we can conclude that HPV vaccination may have additional benefits beyond prevention of anogenital cancers,” she said.

“The HPV vaccine has the potential to be one of the most significant cancer prevention tools ever developed, and it’s already reducing the world’s burden of cervical cancers,” said ASCO President-elect Bruce E. Johnson, MD, from the Dana-Farber Cancer Institute​ in Boston, Massachusetts.

“The hope is that vaccination will also curb rising rates of HPV-related oral and genital cancers, which are hard to treat. This study confirms that the HPV vaccine can prevent oral HPV infections, but we know it only works if it’s used.”

Approached for comment, Carole Fakhry, MD, from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, said the results are promising, but further work is necessary.

“There have been no prospective studies to date that evaluate the impact of the vaccine on oral HPV infection,” Dr Fakhry told Medscape Medical News. “It is reassuring to see that the vaccine helps reduce oral HPV infections ― that was previously largely unknown ― [but] we can’t extrapolate from anogenital HPV [data].”

May, 2017|Oral Cancer News|

Is the HPV vaccine safe?

Author: Linda Carroll
Date: May 15, 2017
Source: http://www.today.com/health/hpv-vaccine-who-should-get-it-t110710

There is so much confusion around the human papillomavirus, or HPV: what it is, what causes it, how you can prevent it, and most commonly, whether or not the HPV vaccine is actually safe.

Here are the basics: According to the Centers for Disease Control and Prevention, HPV is a group of more than 150 related viruses. It’s transmitted through intimate skin-to-skin contact, and you can get it by having vaginal, anal or oral sex with someone else who has the virus. It is very common: A recent report found 42 percent of Americans are infected with HPV.

That may sound alarming, but in most cases, HPV goes away without any signs and doesn’t lead to health issues. When HPV doesn’t go away, it can lead to genital warts and cancer. It’s important to note 25 percent of men and 20 percent of women between the ages of 18 and 59 are infected with the cancer-causing strains.

So what can you do? The best way to prevent these harmful types of HPV is to get the HPV vaccine, which was first recommended in 2006, but people are still wary of it.

“This is the only vaccine we have that prevents cancer,” said Dr. Donnica Moore, president of the Sapphire Women’s Health Group. The HPV vaccine protects against strains of the virus that have been shown to cause cervical, vaginal, vulvar and penile cancer, as well as certain cancers of the mouth and throat.

The most common cancer in women related to HPV is cervical cancer. In men, the head and neck are most commonly involved. A high-profile reminder of this hazard was Michael Douglas’s HPV-related throat cancer, which was found and treated in 2010.

The HPV vaccine is safe and effective: According to the CDC, the vaccine provides close to 100 percent protection against cervical pre-cancers and genital warts.

Currently, the vaccine is recommended for girls and young women between the ages of 9 and 26, said Dr. Melissa Simon, vice chair of clinical research in the department of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. It’s also recommended for boys and men between 9 and 21, she added.

For children between 9 and 14, the recommendation is two doses, six months apart. If started later than 14, the recommendation is three doses.

Many parents are worried that vaccinating kids against a sexually transmitted disease will make them promiscuous, but experts say that’s not true.

“It doesn’t make them want more sex,” Simon said. If that concern is what’s holding you back, just tell your children they’re getting the vaccine to prevent cancer, Moore said.

While kids are the most likely to develop new infections with HPV, increasing numbers of women in their 50s are testing positive for it, Moore said. That’s most likely tied to new sexual activity after divorce, she explained.

For women older than 26 and men older than 21, the best way to prevent infection is with barrier protection, such as condoms.

If you’re older than 26 and want to be vaccinated, you can talk to your doctor about it. “Doctors can prescribe any FDA-approved drug or vaccine for anything they determine is appropriate, however you may have to pay for it,” Moore said. That’s because the labeling says it’s for women under age 27 and men under age 22, and many insurance companies won’t pay for a treatment that is not listed.

You’ll have a better case with the insurance company if you haven’t had sex yet, Moore said. The current age restrictions are in place partly because younger people are less likely to have been exposed to the virus. There’s no point in getting vaccinated if you’ve already been exposed, but your doctor can tell you if it’s beneficial for you get the vaccine.

May, 2017|Oral Cancer News|

Changing definition of margin status for oral cancer

Source: www.medpagetoday.com
Author: staff

Data cast doubt on 5-mm standard, use of frozen sections

A commonly used metric for defining a close surgical margin for resected oral-cavity tumors failed to identify adequately the patients at increased risk of recurrence, a retrospective review of 432 cases showed.

The analysis showed an inverse relationship with increasing distance between invasive tumor and inked main specimen margin on the main specimen, but results of a receiver operating characteristic curve analysis identified a cutoff of < 1 mm as most appropriate for classifying patients as having a high risk of local recurrence, as opposed to the more commonly used cutoff of 5 mm.

The analysis also showed that resection of tissue beyond 1 mm on intraoperative frozen section did not improve local disease control, as reported online in JAMA Otolaryngology-Head and Neck Cancer.

“The commonly used cutoff of 5 mm for a close margin lacks an evidential basis in predicting local recurrence,” Steven M. Sperry, MD, of the University of Iowa in Iowa City, and colleagues concluded. “Invasive tumor within 1 mm of the permanent specimen margin is associated with a significantly higher local recurrence risk, though there is no significant difference for greater distances.

“This study suggests that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment. Analysis of the tumor specimen, rather than the tumor bed, is necessary for this determination.”

The results add to a growing volume of evidence that margins <5 mm can still be curative, said Michael Burkey, MD, of the Cleveland Clinic, who was not involved in the study. The data also add to evidence that the margins calculated from the main specimen are more predictive than frozen-section margins that many head and neck surgeons have used for years.

“This doesn’t change the fact that clearly getting all the tumor out and clearing margins microscopically are still critical to curative surgery,” Burkey told MedPage Today. “The study provided good data to show that when they got positive margins, even if they subsequently treated with radiation therapy, that led to no improvement in local recurrence.”

“A second key point is that the way we determine the adequacy of surgery is changing,” he added. “We used to say 5 mm, and now it’s probably 1 to 2 mm. More and more we’re finding that the best way to look at margins is off the main specimen, not by taking frozen sections from the tumor bed.”

Despite widespread use in surgical management of head and neck cancers, interpretation of margin status and associated prognostic implications remain imprecise. A survey of head and neck surgeons showed that 83% of respondents considered carcinoma in situ as a positive margin and 17% included dysplasia in the definition. Additionally, 69% of the surgeons used a cutoff of <5 mm between invasive tumor and resection margin to a close margin, consistent with multiple reports in the literature. However, other literature suggested a smaller-distance cutoff is adequate, Sperry’s group noted.

To continue an investigation of the clinical significance and impact of surgical margins in oral-cavity cancer, the authors retrospectively reviewed results in 432 consecutive patients with primary oral-cavity squamous cell carcinoma treated at the University of Iowa from 2005 to 2014. Patients with recurrent disease were excluded from the analysis. The primary outcome was local recurrence as determined by minimum distance in millimeters between invasive tumor and inked main specimen margin.

The patients had a median age of 62, and men accounted for 58% of the study population. T-stage distribution consisted of T1 disease in 45% of patients, T2 in 21%, and T3/4 in 34%. Subsite location was tongue in 45%, alveolus in 21%, floor of the mouth in 18%, and other in 15%.

Rates of local recurrence by margin status were:
44% for microscopic positive margins
28% for margins <1 mm
17% for 1-mm margins
13% for 2-mm and 3-mm margins
14% for 4-mm margins
11% for ≥5-mm margins

“These data demonstrated an exponential inverse relationship between distance and local recurrence, with no appreciable difference in local recurrence for distances greater than 1 mm,” the authors reported.

Local recurrence also was determined on the basis of intraoperative frozen section assessment from tumor bed sampling. The analysis showed similar recurrence rates for close-margin distances between patients with involved and negative frozen sections. Among patients with a positive main specimen margin, those with an involved frozen margin had the highest local recurrence rate at 54%, as compared with 36% for patients with a negative frozen margin.

The authors analyzed the results on the basis of whether additional tissue was resected to achieve a negative margin after initial frozen section indicated cancer. The analysis incorporated collapsed margins of ≥5 mm, 1 to 5 mm, <1 mm, and positive. Success was defined as a final margin uninvolved with either invasive carcinoma or carcinoma in situ after further resection. For patients with a positive main specimen margin, successful additional resection did not improve local control.

“For patients with final margin distances grater than 0 millimeter, the local recurrence rate appeared to be the same whether a successful additional resection of the margin was performed or note,” the authors reported.

Finally, Sperry’s group analyzed local recurrence according to whether patients received adjuvant radiation therapy. For patients with a positive main specimen margin, radiotherapy did not improve local control, and the recurrence rate was the same for the other main-specimen margin categories, regardless of whether radiation therapy was administered.
Study limitations included a relatively small group of surgeons performing the majority of surgical procedures, and the inability to compare results based on different methods of intraoperative margin evaluation, such as tumor bed versus main specimen sampling, the authors noted.

Reviewed by:
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary Source:
JAMA Otolaryngology-Head and Neck Surgery

Source Reference: Tasche KK, et al “Definition of ‘close margin’ in oral cancer surgery and association of margin distance with local recurrence rate” JAMA Otolaryngol Head Neck Surg 2017; DOI:10.1001/jamaoto.2017.0548.