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Understanding personal risk of oropharyngeal cancer: risk-groups for oncogenic oral HPV infection and oropharyngeal cancer

Author: G D’Souza, T S McNeel, C Fakhry
Date: October 19, 2017
Source: Academic.oup.com

Abstract

Background

Incidence of human papillomavirus (HPV)-related oropharyngeal cancer is increasing. There is interest in identifying healthy individuals most at risk for development of oropharyngeal cancer to inform screening strategies.

Patients and methods

All data are from 2009 to 2014, including 13 089 people ages 20–69 in the National Health and Nutrition Examination Survey (NHANES), oropharyngeal cancer cases from the Surveillance, Epidemiology, and End Results (SEER 18) registries (representing ∼28% of the US population), and oropharyngeal cancer mortality from National Center for Health Statistics (NCHS). Primary study outcomes are (i) prevalence of oncogenic HPV DNA in an oral rinse and gargle sample, and (ii) incident oropharyngeal squamous cell cancer.

Results

Oncogenic oral HPV DNA is detected in 3.5% of all adults age 20–69 years; however, the lifetime risk of oropharyngeal cancer is low (37 per 10 000). Among men 50–59 years old, 8.1% have an oncogenic oral HPV infection, 2.1% have an oral HPV16 infection, yet only 0.7% will ‘ever’ develop oropharyngeal cancer in their lifetime. Oncogenic oral HPV prevalence was higher in men than women, and increased with number of lifetime oral sexual partners and tobacco use. Men who currently smoked and had ≥5 lifetime oral sexual partners had ‘elevated risk’ (prevalence = 14.9%). Men with only one of these risk factors (i.e. either smoked and had 2–4 partners or did not smoke and had ≥5 partners) had ‘medium risk’ (7.3%). Regardless of what other risk factors participants had, oncogenic oral HPV prevalence was ‘low’ among those with only ≤1 lifetime oral sexual partner (women = 0.7% and men = 1.7%).

Conclusions

Screening based upon oncogenic oral HPV detection would be challenging. Most groups have low oncogenic oral HPV prevalence. In addition to the large numbers of individuals who would need to be screened to identify prevalent oncogenic oral HPV, the lifetime risk of developing oropharyngeal caner among those with infection remains low.

Introduction

Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the United States. HPV now causes ∼70% of all oropharyngeal squamous cell cancer (OPC) in the United States [1] and the incidence of HPV-related OPC (HPV-OPC) among men has more than doubled over the past 20 years [2]. Indeed, OPC is projected to be more common than cervical cancer in the United States by 2020 [3]. Given the ‘epidemic’ of HPV-OPC, there is interest in identifying specific groups that could benefit from screening, if effective tests were developed.

Sexual behaviors responsible for exposure to oral HPV infection are common (80% of the US population reports ever performing oral sex) [4]. Given the ubiquitous exposure to HPV infection and resulting anxiety [5], there is interest in identifying healthy individuals most at risk for development of OPC. As oncogenic oral HPV infection is the precursor to malignancy, identification of individuals with oncogenic oral HPV infection may point to individuals with premalignant disease. Such risk triage could both inform screening approaches and assist the public in understanding personal risk. This analysis therefore aims to understand how common HPV16, oncogenic HPV and HPV-OPC are in groups of people with different risk factor profiles.

Methods

Study population

This study included 13 089 people ages 20–69 years old who participated in National Health and Nutrition Examination Survey (NHANES) between 2009 and 2014 and had oral HPV DNA testing. Analyses involving number of oral sex partners were limited to ages 20–59, with data for number of oral sex partners, resulting in a sample size of 9425. Incidence and incidence-based mortality data from SEER 18 registries between 2009 and 2014 [6] were used with NCHS mortality data for projections of OPC risk.

HPV measurement

As previously described [7, 8] oral HPV DNA was tested in exfoliated cells collected from an oral rinse and gargle sample using PCR amplification using PGMY 09/11 consensus primers and line blot for the detection of 37 specific HPV types. Oncogenic oral HPV was defined as detection of any of the following 12 types: HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 [9].

Analytic methods

Analyses of NHANES oral HPV data were weighted by Mobile Examination Center (MEC) exam sampling weights, and conducted using SUDAAN software (release 11.0.1, Research Triangle Institute) to account for survey sample design. Projected OPC risk was calculated using DevCan software [10].

To better understand subgroup risk, prevalence of oncogenic HPV and HPV16 were explored stratifying by multiple factors including sex, sexual behavior, age, and current smoking. Groups with similar prevalence were combined to create parsimonious risk stratification of people with similar prevalence.

Results

Oncogenic oral HPV and oral HPV16 infection are rare in the general US population. As expected, prevalence of infection is higher among men than women of every age group (oncogenic HPV; 6.0% versus 1.1%, P < 0.001; Table 1). Prevalence of oncogenic oral HPV is contrasted with risk of OPC in Table 1 by sex and age groups. While oncogenic oral HPV is detected in 3.5% of all adults age 20–69, the lifetime risk of OPC is low (37 per 10 000). For example, among men 50–59 years old, 8.1% have an oncogenic oral HPV infection, 2.1% have an oral HPV16 infection, yet 0.7% will ‘ever’ develop OPC in their lifetime; and risk of developing OPC in the next 10 (0.2%) or 20 (0.4%) years is even lower (Table 1).

Table 1.

Oral HPV prevalence by sex and age, compared with the risk of developing oropharyngeal cancer (OPC) in each group

    Risk spectrum: infection to cancer

 

NHANESa (prevalence)

 

SEERb (OPC risk: cases/100 people) 

 

Sex  Age  Oncogenic Oral HPV (%)  Oral HPV16 (%)  Lifetime (%)  Next 20 years (%)  Next 10 years (%) 
Men
20–29 4.8 1.1 0.7 0.01 <0.01
30–39 4.7 1.5 0.7 0.07 0.01
40–49 6.2 2.3 0.7 0.3 0.06
50–59 8.1 2.1 0.7 0.4 0.2
60–69 6.1 2.4 0.5 0.4 0.3
Total 6.0 1.9 0.7
Women
20–29 1.4 0.3 0.2 <0.01 <0.01
30–39 1.0 0.3 0.2 0.01 <0.01
40–49 0.8 0.1 0.2 0.05 0.01
50–59 1.6 0.5 0.2 0.08 0.03
60–69 0.7 0.1 0.1 0.10 0.05
Total 1.1 0.3 0.2
Men and women All 3.5 1.1 0.4

a- Weighted prevalence accounting for NHANES study design weights to reflect the general US population.

b- Estimates of OPC risk combine data on cancer occurrence from SEER with population data. OPC is shown as risk per 100 people to contrast with HPV prevalence. For reference in interpretation, 0.6% risk represent that 0.6 people out of the 100 (or 6 out of 1000, or 600 out of 100 000) would develop OPC.

While prevalence of oncogenic oral HPV infection is low, the distribution of infections is not representative of the population (supplementary Table S1, available at Annals of Oncologyonline). Indeed 84% of oncogenic oral HPV infections in 20- to 69-year olds were among men. To elucidate why oncogenic oral HPV was more concentrated among certain groups, behavioral characteristics were considered. Performing oral sex and smoking are each strongly associated with detection of oncogenic oral HPV (Table 2) and HPV16 (supplementary Table S2, available at Annals of Oncology online). Oncogenic oral HPV prevalence is low (<2.5%) among both men and women who never performed oral sex. Prevalence of oncogenic oral HPV increased with number of lifetime oral sexual partners, up to 14.4% in men age 20–59 years old with ≥10 lifetime oral sexual partners (Table 2).

 

Table 2.

Oncogenic oral HPV prevalence by participant characteristics and behaviors

    Oncogenic oral HPV prevalencea(%)

 

 
Men  Women  All 
Characteristics (among those 20–69 years old)  No. of people  N = 6420  N = 6669  N = 13 089  P-valueb 
Sex
Women 6669 1.1 1.1 <0.0001
Men 6420 6.0 6.0
Currently smoke
No 10 041 4.5 0.9 2.6 <0.0001
Yes 3044 10.5 2.1 6.7
Age, in years
 20–29 2738 4.8 1.4 3.1 0.13
 30–39 2668 4.7 1.0 2.8
 40–49 2699 6.2 0.8 3.4
 50–59 2494 8.1 1.6 4.8
 60–69 2490 6.1 0.7 3.3
Race/ethnicity
 White non-Hispanic 5135 6.3 1.1 3.7 0.008
 Black non-Hispanic 2931 7.5 1.4 4.2
 Any race Hispanic 3347 4.5 1.3 2.9
 Other 1676 3.7 0.7 2.1
Ever oral sex (or man or woman)
 No 2453 2.3 0.2 1.1 <0.0001
 Yes 9272 6.5 1.4 4.0
Ever oral sex on a woman
 No 6660 3.6 1.0 1.4 <0.0001
 Yes 5095 6.4 3.5 6.2
Ever oral sex on a man
 No 7054 5.8 0.2 4.9 <0.0001
 Yes 4693 10.2 1.4 1.8
Number of partners performed oral sex on in lifetimec
 0 1661 2.4 0.2 1.2 <0.0001
 1 1877 1.2 1.0 1.1
 2–4 3165 4.8 0.7 2.5
 5–9 1363 3.9 2.5 3.3
 10+ 1359 14.4 3.0 11.1

a- Weighted prevalence accounting for NHANES study design weights to reflect the civilian non-institutionalized US population.

b-Wald F test (based on transforming the Wald χ2) for independence of row variable and oral HPV16, not accounting for sex (except where sex is the row variable).

C- Data on number of lifetime oral sex partners was not collected consistently in those 60 and older so is only presented among those 20–59 years old.

 

 

Oncogenic oral HPV prevalence was explored by sex, sexual behavior, and tobacco use to better understand groups that have higher and lower prevalence (Figure 1). Regardless of what other risk factors participants had, oncogenic oral HPV prevalence was low among those with only ≤1 lifetime oral sexual partner (women = 0.7% and men = 1.7%). Oncogenic oral HPV prevalence doubled among women with ≥2 versus 0–1 lifetime oral sexual partners (1.5% versus 0.7%, P = 0.02), but remained low among women with higher number lifetime oral sexual partners (Table 2). Oncogenic oral HPV prevalence was highest among men who currently smoked and had ≥5 lifetime oral sexual partners (14.9%, 95% CI = 11.4–19.1). Men with only one of these risk factors (i.e. either smoked and had two to four partners or did not smoke and had ≥5 partners) had ‘medium risk’, with 7.3% (95% CI = 5.8–9.1) oncogenic oral HPV prevalence (Figure 1). Findings were similar when considering oral HPV16 infection specifically.

 

What is my risk of oral HPV? Prevalence of oral HPV16 and any oncogenic oral HPV infection by risk group. In the ‘very low-risk’ group (among women with 0–1 lifetime oral sexual partners), oncogenic oral HPV was similar among smokers and nonsmokers (1.8% versus 0.5%, P = 0.26). In the ‘low-risk’ group of women, oncogenic oral HPV prevalence was 1.5% among women with two or more lifetime oral sexual partners. In the ‘low-risk’ group of men, oncogenic oral HPV prevalence was 1.7% among men with 0–1 lifetime oral sexual partners and was higher among men who did not smoke and had 2–4 lifetime oral sexual partners (4.1%, P = 0.0042). In the ‘medium risk’ group, oral HPV16 prevalence was 7.1% among men who smoke and had 2–4 partners and 7.4% among men who do not smoke and had 5+ partners (P = 0.87).

 

Discussion

This analysis highlights that the yield of oncologic oral HPV screening would be limited in most groups in the United States. With the increasing incidence of OPC, there is a need to understand how to identify individuals at risk of OPC. Oncogenic oral HPV detection is attractive as it samples the relevant epithelium in a non-invasive method, has relatively low cost and serves as a biomarker for HPV-OPC. However, for screening to succeed, a high prevalence population is needed to limit false positives, and balance the psychologic and physical harms of screening with the benefits.

From this analysis, it is clear that screening based upon oncogenic oral HPV detection would be challenging. Women across all categories have low prevalence of infection and low risk of OPC and therefore benefits of screening are unlikely to outweigh harms in this group. The higher prevalence of oncogenic oral HPV in men than women is thought be due to both a higher per partner risk of acquisition when performing oral sex [11, 12], and decreased clearance among men than women [11, 13]. While there are specific risk groups of men enriched for oncogenic oral HPV, most men have low prevalence of infection. Even among the elevated risk group, the majority of men do not have a prevalent oncogenic oral HPV. In addition to the large numbers of individuals who would need to be screened to identify prevalent oncogenic oral HPV, the lifetime risk of developing OPC among those with infection remains low [11, 14].

These characteristics suggest that other tests will need to be combined or supplant present methods to accurately identify those with the greatest risk of OPC in the population. Serum HPV oncoprotein antibody tests are specific [15], but are even rarer than oral HPV16 infection [16], so may be impractical to use in most groups. An additional challenge for screening is that precursor lesions for HPV-OPC have not been found and the ability to detect lesions early in an ‘elevated-risk’ group is unknown.

With growing appreciation of the relationship between oral sex, infection, and cancer, some individuals have questions about their risk of having oncogenic oral HPV infection. To address concerns about infection among individuals with high number of oral sex partners or others concerned about their cancer risk, the infographic can be used to reassure that oncogenic oral HPV prevalence is low among most groups. This analysis has several imitations. Data on oral HPV infection were cross-sectional, with no information linking HPV and SEER data used for cancer risk. Comparing oncogenic oral HPV prevalence and OPC risk in this way informs potential future screening studies, and personal risk assessment. In summary, this analysis shows that screening based upon oncogenic oral HPV infection will not be useful and presents data to communicate to the layperson the low risk of infection and cancer.

Acknowledgements

The authors acknowledge Maura Gillison who led the testing for oral HPV in NHANES provided in the publicly available dataset. This dataset has provided investigators the opportunity to better understand the epidemiology of oral HPV infection in the United States. We also acknowledge the contributions of the Oral Cancer Foundation.

Funding

National Institute of Dental and Craniofacial Research (NIDCR) (R35 DE026631).

Disclosure

The authors have declared no conflicts of interest.

 

References

1 Saraiya M, Unger ER, Thompson TD et al. US assessment of HPV types in cancers: implications for current and 9-calent HPV vaccines. J Natl Cancer Inst 2015; 107(6): djv086

 

2 Jemel A, Simard EP, Dorell C et al. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 2013; 105(3): 175-201.

 

3 Chaturvedi AK, Engels EA, Pfeiffer RM et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011;29(32): 4294-4301

 

4 D’Souza G, Cullen K, Bowie J et al. Differnece in oral sexual behaviors by gender, age, and race explain observed difference in prevalence or oral human papillomavirus infection. PLoS One 2014; 9(1): e86023

 

5 D’Souza G, Zhang Y, Merritt S et al. Patient experience and anxiety during and after treatment for and HPV-related oropharyngeal cancer. Oral Oncol 2016; 60: 90-95.

 

6 SEER Incidence and Incidence-Based Mortality Date, SEER 18 Regs (Excl Lousiana) 1973-2014; http://seer.cancer.gov/date/ (8 May 2017, date last accessed).

 

7 Gillison ML, Broutain T, Pickard RKL et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA 2012;307(7): 693-703.

 

8 NHANES 2013-2014: Human Papillomavirus (HPV)- Oral Rinse Data Documentation, Codebook, and Frequencies:

https://wwwn.cdc.gov/Nchs/Nhanes/2013-2014/ORHPV_H.htm (2 May 2017, date last accessed).

 

9 IARC. Human Papillomavirus; http://monographs.iarc.fr/ENG/Monographs/vol100B/mono100B-11.pdf (23 May 2017, date last accessed)

 

10 Devcan: Probability of Developing or Dying of Cancer- Surveillance Research Program; https://surveillance.cancer.gov/devcan/ (8 May 2017, date last accessed).

 

11 D’Souza G, Wentz A, Kluz N et al.   Sex differnces in risk factors and natural history of oral human papillomavirus (HPV) infection. J Infect Dis 2016;213(12):1893-1896.

 

12 Chaturvedi AK, Graubard Bl, Broutian T et al. NHANES 2009-2012 findings: association of sexual behaviors with higher prevalence of oral oncogenic human papillomavirus infections in U.S. men. Cancer Res 2015; 75(12): 2468-2477.

 

13 Beachler DC, Sugar EA, Margolick JB et al. Risk Factors acquisition and clearance or oral human papillomavisur infection among HIV-infected and HIV-uninfected adults. Am J Epidemiol 2015; 181(1): 40-53.

 

14 Pierce Campbell CM, Kreimer AR, Lin H-Y et al. Long-term persistence of oral human papillomavirus type 16: the HPV infection in men (HIM) Study. Cancer Pres Res Phila Pa 2015; 8(3): 190-196.

 

15 Holzinger D, Wichmann G, Baboci L et al. Sensitivity and specificity of antibodies against HPV16 E6 and other early proteins for the detection of HPV16-driven oropharyngeal squamous cell carcinoma. Int J Cancer 2017; 140(12):2748-2757.

 

16 Beachler DC, Waterboer T, Pierce Campbell CM et al. HPV16 E6 seropositivity among cancer-free men with oral, anal or genital HPV16 infection. Papillomavirus res 2016; 2: 141-144.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

October, 2017|Oral Cancer News|

3 Lessons From An Alarming Case Of Mistaken Cancer Gene Test Results And Surgery

Date: October 28, 2017
Source: Forbes.com
Author: Elaine Schattner

A horrifying story broke last week about a 36-year-old Oregon woman who had elective surgery to remove her uterus and breasts. Elisha Cooke-Moore underwent a prophylactic total hysterectomy and bilateral mastectomy, with nipple-sparing reconstruction and implants, after medical practitioners informed her she had cancer-causing genes. Only later, she learned she didn’t have the abnormality about which she’d been informed. There’s a lawsuit.

As reported in The Washington Post, Cooke-Moore expressed concerns to a doctor about her family’s cancer history before getting tested for mutations in BRCA-1, BRCA-2 and related genes in 2015. A nurse practitioner reviewed the results and erroneously told her she had Lynch syndrome because of an MLH1 mutation. BRCA testing was “negative.” It’s not clear if any doctor directly reviewed the lab report. An obstetrician-gynecologist informed Cooke-Moore that her chances of developing breast cancer were 50% and for uterine cancer up to 80%. In 2016, at least two surgeons operated.

Cooke-Moore discovered the mistake while looking over her medical records: The MLH1 result was “negative,” she noted in 2017. “I am damaged for the rest of my life,” Cooke-Moore told The Washington Post.

Never mind the specifics. While it sounds like the plaintiff received egregious care, and I am sympathetic, I see this as a larger story of confusion over genetic test results leading to irreversible harm. My aim here is not to probe Cooke-Moore’s results or the circumstances of her decisions, but to consider the lessons for other patients and doctors. This case should be a wake-up call about the quality of DNA testing and what variable guidance patients receive about their results. The implications are broad.

Checking genes for presence or absence of mutations is not straightforward as you might think. Mutations vary: They’re rarely “positive” or “negative,” end of story. Some doctors may not fully appreciate the nuances of genetic findings. While some DNA abnormalities are clearly linked to disease, such as mutations tied to cystic fibrosis or sickling of hemoglobin, often there’s a range of severity of illness and pathology among affected patients. Among the cancer risk genes, BRCA-1 and -2 are probably the best studied. Yet even for those, doctors don’t yet understand why some people who inherit BRCA mutations don’t develop cancer, i.e., what mitigates disease risk. Some changes are deemed variants of uncertain significance.

Given the enormity of this subject, I’ll focus on three practical measures to reduce regrettable outcomes after testing for cancer genetic risk.

  1. If you consider getting tested for familial cancer risk, ask where your sample will be evaluated, and exactly what genes will be tested.

The practitioner may or may not know the answer to these questions. But part of the point of asking is to ensure that the responsible physician or genetics counselor is clued in to the details because gene testing companies vary in their methods, which gene variants they report, how fully they report on those, and how they interpret any detected abnormalities.

Some companies, like Myriad Genetics, focus on BRCA and related cancer risk-associated genes. Myriad offer various testing panels to assess hereditary cancer risk. Some large and more general commercial laboratories, like LabCorp and Quest Diagnostics, offer BRCA-related panels (BRCAssure and BRCAdvantage, respectively). Ambry is another player in this field. More recently Color Genomics, a San-Francisco based company, entered the fray; they’ll check your BRCA status for less. Some universities and hospitals offer “in house” testing.

These labs (and this is not a comprehensive list) use distinct and sometimes proprietary ways of extracting DNA from samples, amplifying and analyzing genetic material. They employ different scientists who develop methods and interpret results variously in context of the rapidly-growing literature on cancer risk and cancer-related mutations. The doctor who orders genetic tests should be aware of these possible differences.

At the minimum, before making any decisions I’d want to know that my test was performed in a CLIA-certified laboratory.

  1. Before taking any treatment based on a genetic test result, hit the pause button. Get a copy of the full report and keep it. Ask questions. Try to get a second opinion.

Before agreeing to anything so drastic as prophylactic surgery, or taking medication aimed at reducing cancer risk, you might want to have the test repeated, to confirm or supplement initial results. Even nonprescriptive changes, like adjusting your diet, or participating in a clinical trial for people with specific genetic variants, carries possible benefits and risks. You might wind up taking a medicine, or getting screened in a way that you would not have otherwise.

Among the questions I’d want to ask a doctor are these: “How confident are you about the accuracy of my test result?” and “What are the implications for my health?”

Whenever possible, get a second opinion before a major procedure or treatment is implemented. Ideally, advice would come by a physician familiar with both the nitty-gritty of DNA testing and the relevant medical condition. Keep in mind, experts may have informed but distinct and biased perspectives on the significance of an abnormality, such as an MLH1 mutation. The most knowledgeable physicians may not have ready answers when it comes to interpreting DNA findings in context of an individual patient with a unique medical history and concerns. Consulting with a genetics counselor may also be helpful.*

  1. Use the web and other resources, including patient-oriented organizations, to learn what you can about your genetic results.Here’s a partial list of societies and websites that provide information about genetic testing for cancer risk:

Cancer.net offers information about hereditary cancer syndromes that is provided by the American Society of Clinical Oncology;

FORCE (Facing Our Risk of Cancer Empowered) is a patient-oriented organization with many resources and detailed information for people affected by a familial disposition to developing breast, ovarian and other cancers;

The National Cancer Institute’s Genetics of Cancer page includes numerous links to NIH resources for particular cancer risk genes and syndromes;

National Society of Genetic Counselors details the role of genetic counselors and refers to several resources for patients;

The American Society for Human Genetics is a professional organization that offers general information on gene testing and links to additional resources.

I’m constantly amazed at the explosive field of diagnostic human genetic testing. Despite my concerns about the quality and guidance of interpreting results, I’m impressed by the power of diagnostic human genetic testing. For people who are ill, gene testing can be enormously helpful in establishing the cause of disease, pinpointing a diagnosis, and in some situations knowing how best to treat a medical condition. For those who have reason to worry about inheriting a disposition to disease, gene testing could offer life-saving information about pre-emptive or risk-reducing interventions. In each of these circumstances, informed guidance provided by doctors — in interpreting results and in clinical decision-making — is crucial.

 

October, 2017|Oral Cancer News|

Lindsey Stirling Honors Her Late Father with Moving Routine on Dancing with the Stars: ‘I Felt Like I Was Dancing with My Dad’

Author: Karen Mizoguchi
Source: People.com
Date: October 9, 2017

Lindsey Stirling has had an incredibly tragic year. The violinist is mourning the loss of her father, Stephen, who died of throat cancer. And on Monday night’s episode of Dancing with the Stars, she honored him with her routine for Most Memorable Year Week, choosing 2017.

“I am the woman I am today because of you and I love you so much,” she said on the reality dancing competition series.

To celebrate her dad’s life, Stirling and pro partner Mark Ballas — who wore her father’s hat and scarf as part of his costume — performed a touching Viennese Waltz. “I felt like I was dancing with my dad,” said Stirling, who was awarded a 26/30 by judges.

“I feel like I got to thank my dad in a way I’ve never been able to before. I was really looking forward to this dance, I was terrified to do it and I’m really happy,” she said. “When you’re dancing about something that is so important that means so much to you doing something I’ve never done before, I just wanted it to be so special. And I feel like it was.”

In January, the YouTube star announced the sad news on Facebook, Twitter and Instagram, writing, “My dad passed away early this morning. There is nothing to say that could express my gratitude for this amazing, selfless man.”

She added, “But I love you daddy. I’m the woman I am today because of you.”

Along with the loving message, the America’s Got Talent alum shared a childhood photo of herself and her father.

In June 2016, Stirling’s father, a religious educator and author, detailed his battle with cancer on his website.

“The pain in my throat persists. (That pain is likely the residual result of radiation and chemotherapy. In other words, I now suffer from the cure, now that the disease has fled.  Ironic.),” he wrote about his illness, which he was diagnosed for in late 2015.

The father of five wrote his final Facebook post. “As I prepare to write the next chapter of my life, I am not afraid. God be with you ’til we meet again,” he said.

October, 2017|Oral Cancer News|

The Journey of a “Doctor” Who Joined the Cult of Alternative Medicine and Then Broke Out of It

Source: flipboard.com
Author: Akshat Rathi
Date: September 30, 2017

One Friday afternoon in May 2014, Britt Hermes was scheduled to treat one of her cancer patients with an injection of Ukrain. This wasn’t especially unusual; people often came to Hermes, a naturopath in Arizona, for the treatment. That day, though, an expected shipment of the drug hadn’t arrived, and Hermes’s patients weren’t happy. They had been promised that Ukrain given on a strict schedule would help them when nothing else was working. So she asked her boss what was going on.

“In response, he made an off-hand remark: ‘Oh don’t worry. Most likely the FDA [Food and Drug Administration] confiscated it. It’ll just arrive late,’” Hermes recalls today. When she asked him what he meant, he fumbled. “He realized that he may have said something he shouldn’t have.”

Complementary medicine therapies drawn from traditional practices, ranging from massage and vitamin supplements to acupuncture and meditation, are today becoming broadly incorporated into mainstream medicine as more scientific studies validate their efficacy. But naturopathy, a belief system built on the concept that “nature knows best” when it comes to healing, takes it a step further. Practitioners use a host of pseudoscientific techniques including energy healing and homeopathy that can be not only ineffective, but dangerous. Instead of thinking about the techniques as adjunct therapies to proven modern medicine, many naturopaths will reject the pharmaceuticals and other treatments that we know save lives.

Over her seven years of training and practice, Hermes had had doubts about naturopathy, but she had always found ways to dismiss them. This time, however, her boss’s comment worried her: Was she doing something illegal? Could she be in trouble?

Hermes went home and began to Google. She first looked up Ukrain, and uncovered reports of studies showing the drug to be ineffective at best, and worse, potentially the cause of nasty side effects like tumor bleeding and liver toxicity. She read on and realized Ukrain hadn’t passed the clinical trials required for FDA approval. She looked up some of the other therapies frequently used by naturopaths—ozone treatment, injections of hydrogen peroxide, bloody radiation therapy—and realized that none of them were FDA-approved.

“The whole house of cards came crashing down”

“The whole house of cards came crashing down for me,” she recalls. “On Monday, once I had figured out the different pieces of the story, I was in a lawyer’s office getting representation.”

Months later, after giving up her job, Hermes began blogging about the problems she saw in the practice of naturopathy. She was rapidly embraced by a loose community of skeptics who dedicate themselves to promoting critical thinking and evidence-based medicine; it isn’t easy to find someone with Hermes’s intimate knowledge of the inner workings of alternative medicine—and who is willing to speak candidly about the problems of the field. In 2016, just over a year after she began blogging, Hermes’s blog “Naturopathic Diaries” won the Ockham award for the best blog of the year given by The Skeptics magazine.

From: REDACTED
To: naturopathicdiaries@gmail.com
Subject: A former patient saying hello:)
I was a patient of yours. Your recommendations yielded no greater relief of my symptoms than anything else I have tried before or since. I stumbled across your blog tonight and I must say my mind is a little blown in a good way. I hold no anger or resentment—you were doing your job to the best of your ability and no one was forcing me to see you. Thank you for your brave, clear writing. I hope it sheds light on some of the crazy out there.

Hermes has given up her dream of becoming a doctor and instead has dedicated her life to saving patients and would-be doctors from falling for the naturopathy claims that she once so confidently made. But larger forces now want to silence her.

Bastyr University, where she trained to become a naturopath and whose education she has been publicly criticizing in recent years, has threatened to take her to court unless she stops publishing what the school’s lawyers allege are “willfully false and misleading comments” with “express intent of disparaging Bastyr.” Hermes has no plans to be cowed by the threats.

Over hours of conversation, I found Hermes to be a sharp thinker and an articulate speaker. But something kept bugging me: How could it have been that someone like Hermes remained ignorant for so long in an age when Google is at nearly everyone’s fingertips? And more importantly: Why is it rare to find examples of people like Hermes, people who for whatever reason may have believed something demonstrably false but are able to change their mind when confronted with evidence to the contrary? As I tried to unpack her story, I realized it offered a rare peek into how troubling beliefs are created in the information age, how they are reinforced in echo chambers, and how some people can break out.

BUYING INTO THE SYSTEM
Hermes grew up in a rich neighborhood in Ventura County, in southern California, and she partially attributes her career path to the material comfort of her early life. “A lot of people with disposable income seem to be drawn to alternative medicine,” she says. “The community I grew up in was into wellness treatments, whether acupuncture or ayurvedic spas.”

Her first direct experience with alternative medicine came when she was 16. Red spots started showing up all over her body, and in less than three weeks she went from obsessing about lipsticks and nail polish to desperately seeking a cure for psoriasis.

Her mother, who also suffered from the life-long condition, booked an appointment for Hermes with her own dermatologist. And like he did for her mother, the doctor prescribed steroids for Hermes. But she had seen what the disease had done to her mother, who suffers from bad side effects due to years of medication, such scars on her skin and a severely compromised immune system. Hermes wanted an alternative.

“He brushed me off. ‘Suck it up and get over it, kid,’ he said.”
“I asked him whether diet or such could help,” she recalls. “He brushed me off. ‘Suck it up and get over it, kid,’ he said. That was a turning point in my life.”

She didn’t get over it. Instead, she went to the library. (It was the year 2000 and accessing the internet wasn’t always easy.) “I was using a card catalogue and reading any book that mentioned psoriasis,” Hermes says. Somewhere she read that cod-liver oil would help her, and then made her dad drive around to find a place selling the stuff. “My skin got better, and I’ve never had a psoriasis breakout like that first time,” she says. “I was taking steroids too, of course, but I attributed the remission to the alternative therapies I tried.”

From: REDACTED
To: naturopathicdiaries@gmail.com
Subject: Thank you from a medical student
Over the years I have seen my parents quit jobs, choose to spend what little money they have on expensive “natural” products, and sever relationships with family over beliefs of pseudoscience. I am tired of watching people get hurt or hurt others over warm-fuzzy ideas. From the bottom of my heart I want to thank you for your journey. I’m certain it has been incredibly difficult. You may not be practicing medicine with patients in the way you initially thought, but your efforts are making a difference that will inevitably help the sick.

After earning an undergraduate degree in psychology, Hermes decided she wanted to become a doctor—but not like the dermatologist who treated her psoriasis. That’s when she came across Bastyr University’s naturopathy course. It seemed perfect.

True believers say the first advocate of naturopathy was the Father of Medicine himself, Hippocrates. The more mundane truth is that the term was popularized in the early 1900s by the Benedict Lust, who learned his techniques from the German practitioner Sebastian Kniepp. Lust came to the US to spread the use of “drugless therapies,” and he found instant success, creating a base of followers. Naturopathy flourished in the country until the 1940s, when the American Medical Association (AMA) began campaigning against medical practices lacking rigorous evidence of efficacy. The result was the near extinction of naturopathy in the US, with only five states offering licenses in 1958.

True believers say the first advocate of naturopathy was the Father of Medicine himself, Hippocrates.

But since the 1970s, thanks to the “holistic health” movement, there has been a revival in interest in naturopathy according to University of Arkansas social anthropologist Hans Baer. Today, as many as 15 US states offer licenses to naturopaths (though only the state of Washington requires insurance companies to reimburse naturopathic treatment). There are also more than a half-dozen schools in North America that dole out Doctor of Naturopathy (ND) degrees—including Bastyr, which has campuses in Kenmore, Washington and San Diego, California.

“When I was looking at the Bastyr website and reading phrases like ‘supported by scientific research’ and ‘drawn from peer-reviewed journals,’ the keywords I was trained to look for were there,” she says. “Bastyr described itself as the ‘Harvard of naturopathic medicine.’ I felt like I was choosing a program that was preparing me to study medicine and research natural therapies and be part of the broader medical field.”

To be sure what she was getting into was legit, Hermes even visited naturopaths.“It felt like a regular doctor’s office. There was a receptionist and a waiting room. Naturopaths were wearing white coats and had stethoscopes around their necks,” Hermes says. “The visual cues were there. They looked like doctors to me.”

HOW TO BECOME A DOCTOR
Naturopathy appeals to many because it seems to offer more than medical doctors alone. “Naturopathic physicians now claim to be primary care physicians proficient in the practice of both ‘conventional’ and ‘natural’ medicine,” Kimball Atwood, an anesthesiologist and assistant professor at Tufts University, wrote in 2003. Experts who’ve looked at naturopathy’s claims closely have found mostly deficiencies. “Their training…amounts to a small fraction of that of medical doctors who practice primary care,” Atwood wrote. “An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices.” But these deficiencies are not easy to find for an undergrad looking to sources and people that would only confirm her biases.

From: REDACTED
To: naturopathicdiaries@gmail.com
Subject: HELP!!! Just started Naturopathic School at Bastyr

I thought Bastyr would have more science-based natural medicine but I’m finding that it is not the case. The professor also discussed how Bastyr had an astrologist who would help with medicine. By this point in class, I’m terrified that I made the wrong decision.

When Hermes started at Bastyr University, it seemed like other medical schools she had read about. There were classes in anatomy, physiology, and pharmacology. Students dissected cadavers and got clinical practice, spending time with Bastyr naturopaths treating actual patients.

“When I enrolled, I thought ‘alternative medicine’ was mostly lifestyle, like diet and exercise—a practice that tries to mitigate the use of drugs,” Hermes says. “I wasn’t aware of all these different systems of medicine.”

Homeopathy has been shown to be at best a placebo.

Take homeopathy, for instance, which works on two principles. First, “like cures like.” So, for example, since chopped onions make you cry, it follows that if you want to treat hay fever, which also produces runny eyes, you should drink onion juice. Second, “dilution increases potency.” So the onion juice should be diluted to such an extent there isn’t a single molecule of it left in the solution—in other words, until the point where even if for some reason it did work, there’d be no way for scientists to determine that it was in fact a potent therapy. (There is no proof onion juice can treat the symptoms of hay fever.) Suffice it to say that these ideas go completely against any established scientific principle; homeopathy has been shown to be at best a placebo.

“I definitely had moments where I felt cognitive dissonance,” Hermes says. “In homeopathy class, for instance, what was being taught seemed to defy scientific principles. But at the same time, I felt, in order to be the best medical practitioner I could be, it was important to remain open-minded.”

To some extent, Hermes’ worries were alleviated by the training Bastyr was giving her in clinical practice. In the university’s outpatient clinic, Hermes was able to spend time on patient-care shifts, and she liked the approach the facility promoted. “A lot of the care we offered at the Bastyr clinic had counselling to it, because you spend a lot of time talking to the patient and really getting to know them by asking about minutiae in their lives: how many hours they sleep at night or what their stress level is like,” Hermes recalls. She enjoyed spending time with patients, and fell in love with the experience of working through their problems. That’s an aspect of this flavor of naturopathy from which the western model of medicine could stand to take a lesson. Experts have, in recent years, begun to push for a health care model that offers patients plenty of time with their providers, and asks doctors to consider a patient’s whole life—sleep, stress, diet, work, relationships—not just the one symptom that triggered a visit.

Still the doubts came back to haunt her. In physical medicine, for instance, she was exposed to “energy healing,” a belief system among naturopaths that says simple touching can manipulate biological pathways. Like homeopathy, there are no known scientific principles that support energy healing. (Bastyr University shared studies that conclude research in energy healing is limited.)

Halfway through her time in Bastyr, Hermes realized that maybe she had made a mistake. She started to think traditional medical training would have been a much better choice. But she was already $80,000 in debt. Worse, if she wanted to go to a proper medical school, she would have to study for and pass the MCAT exam, which wasn’t needed to get into Bastyr.

“I made a decision to become as much a physician as possible”

“The idea of starting over was too daunting. So I made a decision to become as much a physician as possible” within the naturopath system, Hermes says. “I did that by consulting medical sources instead of naturopathic sources. Instead of having a herbal medicine book on my desk, I had the drug formulary book. I was working hard to convince myself that I was practicing safely and effectively.” She became a licensed naturopath under her maiden name, Britt Deegan.

WRITING ON THE WALL
Things began to go downhill for Hermes soon after she graduated with her ND degree. The naturopathic remedies she was trained to use weren’t working on her patients. Some even had negative reactions to herbal therapies she had prescribed. But Hermes held back from acting on her doubts, until the Ukrain episode.

There are plenty of examples of naturopathic therapies going seriously wrong. Earlier this year, a California-based naturopath killed a 30-year-old woman by giving her an intravenous injection of turmeric. A report from the FDA found that the injection contained castor oil, which had a warning label that said “Caution: For manufacturing or laboratory use only.”

Then there’s the case of Ezekiel Stephan. In February 2012, David and Collet Stephan used naturopathic remedies rather than medical treatment to fight their 19-month-old’s bacterial meningitis. The infant died in March of that year. In 2016, David was sentenced to prison and Collet to house arrest for being “willfully blind” about the life-threatening risks to their son. The naturopath that the Stephans relied on wasn’t charged.

From: REDACTED
To: naturopathicdiaries@gmail.com
Subject: thank you
I am going through a divorce where the number one point of contention is my spouse’s insistence on naturopathy treatment of our mostly healthy five-year-old. Prior to reading your articles it was more of a belief that putting many non-FDA supplements into his body with the occasional prescription from his pediatrician couldn’t be a good thing. The irony I have found is highly qualified pediatricians won’t or can’t comment on non-FDA drugs while the naturopath is more than happy to talk about what pediatrician prescribes plus what supplements are needed instead or in addition to.

Some therapies like meditation, which are often categorized as “alternative” or “complementary” medicine, may be helpful, and have some scientific evidence to back them up. Others are the sorts of things drawn from the canons of traditional and alternative medicine and are essentially harmless—like hydrotherapy, where patients are treated using water at different temperature and pressure, and massage therapy. But there are also many pseudoscientific treatments that lead patients into positions of great risk, including ozone therapy, which involves injecting or breathing ozone, a toxic gas made up of three atoms of oxygen (instead of the two-atom version of oxygen keeping us alive), and treating cancer with substances like baking soda, vitamin C, and other products that have been shown to have no effect.

Lumping all these types of therapies under the umbrella of naturopathy makes it difficult for patients to understand what is backed by scientific evidence and what isn’t. “Incorporating magical thinking into the realm of evidence-based medicine is both ethically questionable and professionally irresponsible,” researcher and journalist Alheli Picazo wrote about the Stephens case in 2016. In the end, most patients simply believe whatever the naturopath has to say.

Within days of finding out that Ukrain was not FDA approved, Hermes got a lawyer. She was worried that she may have been an accessory to a crime. The lawyer assured Hermes that she was safe, because she delivered Ukrain under her boss’s direction and without knowing then that the drug was unapproved. That gave her the confidence to do something about the guilt she was feeling about mistreating her patients.

“I was willing to do whatever it took to correct the wrong”

“I was willing to do whatever it took to correct the wrong,” Hermes says. She reported her boss, Michael Uzick, to the Arizona Naturopathic Physicians Medical Board and to the state’s attorney general. She also began auditing the websites of other naturopaths and realized that the use of unapproved drugs and therapies was widespread. “I was really shocked,” she recalls. “But it also felt like a lightbulb went on. It suddenly became so obvious to me that I was amazed I had missed it.”

“I needed to decide whether or not I could go back into naturopathy knowing that a number of my colleagues are blatantly breaking the law and putting patients’ lives at risk,” Hermes says. She didn’t have to struggle with the question for long. The naturopathic board did nothing more than reprimand Uzick. The attorney general never took up the case, but passed it on to the Federal Bureau of Investigation, which has not yet replied to Hermes.

Uzick, through his lawyer, says that the reprimand “did not result from any patient complaint, but from accusations made by a disgruntled practitioner who worked with Dr. Uzick and understood his treatments, and made no complaint until she abruptly left the practice.”

When she saw the case be tossed liked a hot potato from the board to the Arizona attorney general to the federal FBI, Hermes felt her moral choice couldn’t be clearer.

A NEW START
After Hermes stopped her practice in 2014, life’s other mundane, but unavoidable, problems became apparent. She had racked up a debt of more than $250,000 for her Bastyr degree, and needed a source of income to pay back the loan or risk letting interest pile on. She had also fallen in love and gotten married. When her husband was a offered a place to study for a PhD in archaeology at a university in Germany, it felt like an opportunity for a fresh start.

That’s when, in late 2014, she discovered the story of Edzard Ernst, author of Trick or Treatment? Alternative Medicine on Trial, written with science journalist Simon Singh. “I lived with the book on my bedside table for six months,” Hermes says. “It got me through a really difficult period.”

Ernst trained as a doctor and then learned homeopathy at a hospital in Germany. He would, like Hermes, turn on his profession, showing through his own peer-reviewed research how homeopathy was nothing more than a placebo. As someone who also stopped practicing alternative medicine and began speaking against it, he saw a bit of himself in Hermes. That’s why he encouraged her to blog.

“I remember putting up my first blog post and being overwhelmed with anxiety,” Hermes says. “I wanted people to read my words, but I was so afraid of what they would think. I felt exposed. I cried a lot.” After the Ukrain revelations, Hermes developed intense anxiety, and was eventually prescribed medication for the ailment. Blogging brought similar anxiety and she went back on the meds.

“I’ve found myself in grocery stores not knowing whether to buy organic bananas or regular ones,” Hermes says. “I find it upsetting that I don’t know how to navigate my life any more. It’s a product of living in a culture of misinformation for a very long time.”

From: REDACTED
To: naturopathicdiaries@gmail.com
Subject: Thanks for what you are doing!
I know the courage it has taken you to speak out about the fallacies of naturopathic medicine. I taught at a naturopathic college myself, so I know first hand that every thing you are saying is true. I have much admiration for you. Keep up the good work.

For the past few years, after realizing she had been swindled in her education, Hermes has waged a war on naturopathy. On blogs and in online publications, she has opened a window into a profession that resists external scrutiny of its training and practices.

“These schools of quackery operate like cults”

“A conversion story like hers is rare,” says David Gorski, managing editor of the non-profit, online publication Science-Based Medicine, which was among the first few places to publish Hermes’s writing. The choice of the word “conversion” is a deliberate swipe at alternative medicine, which Gorski says is more like a religion. Ernst says the schools are, in part to blame. “These schools of quackery operate like cults,” he says. “People are being brainwashed with books, by peers, through media and so forth.”

Bastyr is a nonprofit and private university that was founded in 1978, near Seattle. Its founders named it after John Bastyr, a naturopathy practitioner based in the city. Today, it offers undergraduate, master’s, and doctoral programs to its 1,000 students, but these are not accredited by the same body that accredits US medical schools. Instead, a council of naturopaths oversees the programs. Bastyr says its courses are are also accredited by the Northwest Commission on Colleges and Universities.

Bastyr now wants to keep Hermes, who has become a warrior for the truth, from speaking out. It’s an uneven fight from the start: a university with deep pockets against a student with huge tuition loans to pay off. (In response to questions from Quartz, Bastyr University says there are no updates to report since its July 21 letter to Hermes.)

“It’s an occupational hazard,” says Steven Novella, founder of Science-Based Medicine. “When we expose quacks and cranks, it’s no surprise we get personally attacked.” In 2014, Novella was sued by Edward Tobinick, a doctor claiming to treat neurological diseases with a drug that wasn’t approved for it, because Novella exposed Tobinick’s unsubstantiated claims. After two years of trial and appeals, Novella won the case but is yet to receive the tens of thousands of dollars he had to spend in legal fees to defend himself.

Separately, Ernst and Singh were each legally threatened by two different organizations promoting alternative medicine. Though Singh won a landmark libel case, Ernst was forced to retire early from his job as a professor of complementary medicine at the University of Exeter, after finding himself unable to acquire the grants needed to continue research. Now it’s Hermes’ turn.

THE CONVERSION
From: REDACTED

To: naturopathicdiaries@gmail.com
Subject: Thank you
I was about halfway through naturopathy school when I started having doubts about the profession again. I had been searching for a while to find the opinion of someone who had graduated and left the field, and when I found your blog I felt an amazingly strong sense of relief and joy to be able to read what you had written and relate to all of it. I only wish that I had read your blog before starting!

Each individual has to decide for themselves, but skeptics say these fights are always worth fighting. Each voice is unique and necessary, and each voice lost is a huge blow to the skeptic mission. On her blog, Hermes has separate resources section for patients, students, lawmakers, and journalists. She has a section where former or current naturopaths, patients, and healthcare workers who’ve experienced naturopathy can submit guest posts. “It is important for more voices to be heard,” she writes.

And the feedback she receives from readers, including medical doctors and patients looking to use naturopathy, reminds her she is doing the right thing and gives her the motivation to continue. (We’ve reproduced some of these emails, interspersed throughout this article.) Some praise her for being “brave”; others thank her for giving “the final push” needed to quit studying naturopathy; most are simply grateful for having Hermes speak when they themselves couldn’t. Her testimonies have been crucial in defeating two proposed legislations—one in North Dakota and another in California—which would have increased the power of naturopaths, from prescribing pharmaceutical drugs to practicing midwifery.

From: REDACTED
To: naturopathicdiaries@gmail.com
Subject: Hi Britt
I was in your class at Bastyr. I found attempting to practice naturopathic medicine a nebulous, daring venture. I absolutely did not feel qualified to be anyone’s physician. After such a huge investment in time, money, and energy, it took me a while to truly accept that I want to find another career path. It is nice to know there are others who feel as though their training was less than sufficient.
When Hermes was training to be a naturopath, the evidence against alternative medicine was easily available. But she was surrounded by believers and was personally invested in the success of naturopathy, so she found ways to dismiss any creeping doubts. It was only when she had a “crisis of conscience,” as Gorski describes the Ukrain episode, did she open up to contrary evidence. That was her moving from inside the cult to the top of the fence.

She found the evidence she needed to jump most easily in Trick or Treatment. “What Ernst and Singh were able to do so beautifully was provide information that felt nonjudgmental,” Hermes says. “I didn’t feel like I was being put down for having used naturopathy or having been a naturopath.”

“Everything I had read prior to Trick or Treatment about naturopathy from a critic’s perspective was written in such a way that it was impossible for me to digest the information,” she says. “As soon as I read the word ‘quack’ or ‘pseudoscience’ I couldn’t get anything from the article.”

The book’s matter-of-fact approach to debunking naturopathy influenced Hermes’s thinking on naturopathy. But her own persistence mattered too.“I certainly have a propensity for magical thinking and alternative medicine,” Hermes says. “Even now, whenever I get sick with cold, my first response is ‘I don’t want to take any medication,’” Hermes says. That’s why it helped to have a guide like Trick or Treatment on her bedside. “Every time I felt like maybe I shouldn’t be giving up naturopathy, I opened the chapter on naturopathy and stopped myself from making that decision.”

Today, Hermes says that when she writes, even if using the same material that’s readily available to anyone with internet access, she is able reach a bigger audience. “My training as a naturopath adds credibility to my claims,” she says.

Hermes is becoming a sought-after speaker at events organized by the skeptics community. Hearing a former naturopath helps other skeptics understand better how to reach their target audience. “Everyone knows someone who has tried alternative medicine,” Hermes says. “My advice to these people is don’t bombard them with information about how naturopathy doesn’t work. Instead, listen to why they believe in naturopathy, ask open-ended questions, understand their perspective, and then go from there.”

Going through her story again and again at these speaking events is painful. “I’m putting myself through torture every time I relive those memories,” Hermes says. Though she gets plenty of positive feedback, she receives a lot more hate mail. And for someone who has been through a great deal of change in her life, existential questions are a daily problem.

“Will it have a made a difference if I continued to do this for 25 years? Will I ever be able to convert people inside the cult?” Hermes says. “I ask these questions all the time, and I don’t yet have answers.”

 

 

October, 2017|Oral Cancer News|

A Wellness Blogger Who Lied About Having Cancer Has Been Fined $322,000

Source: Motherboard.vice.com
Author: Kaleigh Rogers
Date: September 28, 2017

There are serious consequences that come from hawking pseudoscience online, including harming your readers or yourself. But in case physical harm isn’t enough motivation to quit slinging shady “wellness” advice online, here’s another reason: you could wind up getting fined.

That’s what happened to disgraced Australian wellness blogger Belle Gibson, who has been fined $322,000 for claiming she treated her brain cancer without conventional medicine. Gibson had said she overcame an inoperable brain tumor, stroke, and cardiac arrests through clean eating, and avoiding dairy, gluten, and coffee. Conveniently, these claims helped her to sell her book The Whole Pantry, and app of the same name, raking in nearly half a million AUD. But in 2015, an investigation by Australian Women’s Weekly—complete with Gibson’s confession—revealed it was all a hoax.

In response, Consumer Affairs Victoria brought a case to federal court, and in March Gibson was found guilty of five breaches of consumer law. On Thursday, Gibson was ordered to pay the fine of $410,000 AUD ($322,000 USD).

It’s not the first time shady wellness tips have caused controversy for bloggers. Gwyneth Paltrow’s venture, Goop—the epitome of pseudoscience profiteering—has been called out for flogging all kinds of questionable goods, including a jade vagina egg that some gynecologists warned could cause infections.

Or the wellness trend of eating whole aloe vera leaves that led one vlogger to be hospitalized after eating a poisonous agave plant by mistake.

When wellness bloggers tell the truth, and really do try to fight off cancer without any conventional treatment, it doesn’t usually work out so well. A popular 30-year-old blogger died in 2015 after she tried to cure her cancer with coffee enemas and raw juices. And in case you’re inclined to trust your blogger of choice, lest we forget the former naturopath who told us how easy it was to create and sell a detox diet scam.

Wellness blogging is a trendy, profitable market right now, but let this be a warning: all that easy money can come at a price.

September, 2017|Oral Cancer News|

B.C. to begin providing free HPV vaccines for Grade 6 boys

Source: ctvnews.ca
Author: Darcy Matheson
Date: September 26, 2017

For the first time in British Columbia, boys in Grade 6 will be receiving free vaccinations for the Human Papillomavirus.

HPV is one of the most commonly sexually transmitted infections and B.C. health authorities say three out of four sexually active people will get it at some point in their lives.

Often showing no physical symptoms, HPV can lead to cervical, vaginal, and vulvar cancers in women and penile cancer in men – and can also cause anal and throat cancer in both men and women.

Up until now, the vaccine to protect against HPV was only provided free to girls in Grade 6, with the assumption that boys would be indirectly protected through “herd immunity.”

Vancouver Coastal Health will soon be sending out letters to parents and caregivers through children’s schools regarding upcoming clinics for both girls and boys.

People can also be immunized through health-care providers, family doctors and local public health units.

Dr. Meena Dawar, medical health officer for Vancouver Coastal Health, said that immunizations are key because the symptom-less virus is often passed onto others without knowing it.

“Most often an HPV infection will clear on its own but sometimes HPV won’t go away and cells infected with the virus can become cancerous,” Dawar said in a statement.

Cancer survivor Sandy Yun had her 14-year-old daughter immunized as part of the B.C. program. She was going to pay for her 11-year-old son to get the vaccine but now she will be getting it for free.

“I wouldn’t want my kids, or anyone else, to go through what I went through,” the mom said in a statement.

“We have an easy way to protect our children from cancer, parents: this is a no-brainer.”

Each year in B.C. 200 women will get cervical cancer, and 50 will die from the disease.

B.C. joins Saskatchewan, Newfoundland and Labrador and New Brunswick in offering the vaccine for free to boys starting this month.

A study published this summer by the Canadian Medical Association Journal said the number of HPV-caused oral cancers has risen sharply in Canada — about 50 per cent between 2000 and 2012.

The majority of the cases featured in the CMAJ study – about 85 per cent – were men.

Researcher and co-author Sophie Huang, a research radiation therapist at Princess Margaret Cancer Centre in Toronto, said men have a weaker immune response to HPV than females, which may explain the higher incidence of oral cancers linked to the virus in men.

 

September, 2017|Oral Cancer News|

Treatment That’s Easy to Swallow in HPV+ Throat Cancer

Source: Medscape.com
Author: Nick Mulcahy
Date: September 27, 2017

SAN DIEGO, California ― Daniel Ma, MD, of the Mayo Clinic in Rochester, Minnesota, treats a lot of relatively young patients with human papillomavirus (HPV)-related oropharyngeal cancers who are cured by various standard combinations of surgery, radiation therapy and chemotherapy and then have “another 30 to 40 years of life ahead of them.”

But that life expectancy can be marred by the “potentially life-altering side effects” of standard treatment, including dry mouth, loss of taste, and, in about one half of patients, difficulty swallowing, he said.
These patients inspired the genesis of Dr. Ma’s phase 2 study of an “aggressive dose de-escalation” of adjuvant radiation in this setting, he said.

The investigators evaluated experimental radiation doses of 30 to 36 Gy, which is a 50% reduction from the current standard of 60 to 66 Gy.

At a median of 2 years’ follow-up among 80 patients, the treatment de-escalation has resulted in locoregional control rates comparable to historical controls, low toxicity, and, perhaps most notably, no decrement in swallowing function or quality of life, Dr. Ma reported here at the American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting.

The toxicity and swallowing results are “the most exciting data,” Dr. Ma told a standing-room-only crowd at a meeting session today.

“It’s the first clinical trial in head and neck cancer to demonstrate no injury to swallowing function after radiation,” he told Medscape Medical News. In other words, patients’ ability to swallow was no worse post treatment. In fact, patients’ ability to swallow improved slightly at 1 year following radiation therapy compared to pretreatment (P = .03).

“It’s an exciting concept. Everyone’s going to want to hear more about it,” said Thomas Galloway, MD, of Fox Chase Cancer Center in Philadelphia, Pennsylvania, who was asked for comment about the trial.

The answer is not yet known, but the 2-year results from Dr. Ma are encouraging.

Two-year data indicate that after de-escalated treatment, the rate of locoregional tumor control was 95%, which is comparable to results with standard radiation (60 Gy) from the Radiation Therapy Oncology Group (RTOG) 0234 trial.

In the Mayo Clinic trial, three patients experienced local recurrence, and one patient experienced a nodal recurrence.

Fox Chase’s Dr. Galloway also observed that, in the new trial, patients received 30 Gy delivered in 1.5 Gy twice a day over 12 days (along with weekly docetaxel, 15 mg/m2, days 1 and 8). Twelve days is a lot shorter than the standard 6 weeks for 60-Gy therapy, but the twice-daily schedule may not be suitable for all patients, he pointed out.

De-escalation radiation therapy is experimental, but a phase 3 study that seeks to confirm the approach, known as the DART-HPV trial, is now underway.

“This is not incremental change,” he told Medscape Medical News. “It’s a stark change from the current standard of care.”

Dr. Galloway and Dr. Ma both said that HPV-positive head and neck cancers are necessitating change, because patients with these cancers are younger and healthier than patients without the virus, whose cancers are typically caused by smoking and alcohol consumption.

Some HPV-positive patients are now being treated without surgery. “What the perfect recipe for treatment is, no one knows for sure,” Dr. Galloway told Medscape Medical News about treatment combinations.

Paul Harari, MD, of the University of Wisconsin, Madison, said the HPV-positive head and neck cancers, including oropharyngeal cancers, “warrant different treatment approaches.” Standard treatment is toxic ― “make no mistake about it,” Dr Harari commented while acting as moderator at a press conference featuring the dose de-escalation trial.

However, cutting the radiation therapy dosage, he said, prompts a “tense question: can you maintain the cure rate?”

 

More Study Details, Including Toxicity

About half of the study patients, all of whom had oropharynx squamous cell carcinoma, had the above-described 2-week-long treatment schedule. But 43 patients had extracapsular extension, a marker of aggressive disease, and thus received an additional radiation boost to the affected areas, for a total dose of 36 Gy.

Data for both groups of patients were combined in the statistical tallies.

All of the study patients had no evidence of residual disease following surgery and a minimal smoking history (eg, less than one pack per day for 10 years or less). The median patient age was 60.5 years. All patients had stage III or IV disease.

There was also a “very dramatic reduction” in side effects, compared with standard treatment, said Dr. Ma. No patients required percutaneous endoscopic gastrostomy (PEG); by contrast, with traditional radiation therapy, one fifth to one third of patients undergo PEG.

The PEG feeding tube is inserted through the abdomen into the stomach. Typically, one fifth to one third of patients will receive such a feeding tube during standard treatment for oropharyngeal cancers, he said.

The rate of grade ≥2 toxicities 2 years post radiation therapy was 10%. Again, this compared favorably with 55% rate reported in RTOG 0234.

No patients had grade 3+ toxicity at 1 or 2 years following treatment.

All 14 patients (18%) who experienced cumulative grade 3+ toxicity did so within 3 months of treatment, and all cases resolved by 6 months post treatment. One patient experienced acute grade 4 toxicity related to a chemotherapy reaction, which quickly resolved.

Patient quality of life either improved or did not change following treatment, except with regard to xerostomia. Patients reported worse salivary flow following treatment (P < .0001).

Dr. Ma, his coinvestigators, Dr Galloway, and Dr. Harari have disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 2017 Annual Meeting. Abstract LBA-14, presented September 26, 2017.

 

 

 

 

September, 2017|Oral Cancer News|

This Man Tried An ‘Alternative’ Cancer Treatment—and Ended Up Poisoning Himself

Source: Menshealth.com
Author: Alisa Hrustic
Date: September 12, 2017

Being diagnosed with cancer is one of the scariest things that can happen to you, but what follows can be even scarier. Treatment for the disease is expensive, painful, and extensive, so it’s not uncommon for people to ponder alternative solutions.

That’s all well and good, as long as it’s approved by your doctor. As for taking medicine into your own hands? That’s not always the best idea, since some alternative treatments can be extremely dangerous. Just recently, one Australian man learned that the hard way, according to a recent case report published in the British Medical Journal.

The 67-year-old man—who had been diagnosed with prostate cancer, which had gone into remission—consumed homemade apricot kernel extract daily for five years, since it’s typically marketed as a preventive medicine for cancer. He was also taking a fruit kernel supplement called Novodalin. While he was undergoing a routine surgery, his doctors noticed that his oxygen levels had severely dropped while he was under anesthesia, leading to a condition known as hypoxia, which can be deadly.

Once they performed blood tests on the patient, the doctors concluded that his blood contained 25 times the accepted level of cyanide, a potentially deadly chemical, according to the report.

That’s because apricot kernels contain amygdalin, also known as laetrile. Amygladin is a known cyanogenic glycoside, meaning it’s processed and converted into cyanide in your body, according to the Food and Drug Administration. While laetrile has been talked up for its anticancer properties, no human studies have actually proven its effectiveness in treating the disease. In fact, “no controlled clinical trial of laetrile has ever been conducted,” says the National Cancer Institute.

“Many extracts lack quality control in production and are not subject to extensive testing applied to standard medicines,” the authors of the report write, “hence efficacy and safety cannot be assured.”

Pits and seeds of several fruits—like apricots, apples, peaches, and cherries—can contain substantial amounts of cyanide. Just last July, a man in the U.K. suffered cyanide poisoning after eating cherry seeds.

If you’re exposed to small amounts of cyanide, you may experience dizziness, rapid breathing and heart rate, or headaches. If you consume a large amount, however, it can cause loss of consciousness and even respiratory failure, which can be fatal, according to the Centers for Disease Control and Prevention.

Luckily, the man described in the case report didn’t die, but his doctors quickly explained that the apricot kernel extract was slowly making him sick. He decided to continue taking it anyway.

Why? “He personally believes that the quality of evidence is sufficient for his purposes,” Alex Konstantatos, M.D., coauthor of the case report and head of pain medicine at Alfred Hospital in Melbourne told The Verge, “or maybe he cannot wait for the scientific proof to come through as it may take too long to prevent his cancer from recurring.” (Check out the video below to see how you may be approaching skin cancer all wrong, too.)

The thing is, people have actually died from ingesting too much cyanide. In 2011, a 2-year-old girl died after eating about 10 apricot kernels, according to a separate case report.

Konstantatos told The Verge that he wrote about this specific case because he wanted to bring awareness to the health implications of alternative medicine. Most doctors typically only ask about prescribed medications, and often aren’t aware of self-prescribed supplements, he says.

That means you should always check in with your doctor first before you consume any supplement, herb, or other popular “treatment”—it may just save your life.

September, 2017|Oral Cancer News|

Why HPV Vaccination Rates Remain Low in Rural States

Source: TechnologyReview.com
Author: Emily Mullin
Date: September 1, 2017

 

Mandi Price never thought she’d be diagnosed with cancer at age 24. She was a healthy college student finishing her senior year when, during a regular Pap smear, her gynecologist found abnormal cells in her cervix. It was stage II cervical cancer.

Even more devastating was the fact that her cancer was preventable. Doctors detected a strain of human papillomavirus, the most common sexually transmitted infection in the U.S., in Price’s cancer cells. That strain of HPV is targeted by a vaccine called Gardasil. But Price never got the vaccine. Her primary care doctor didn’t recommend it when she was a teenager growing up in Washington state. Had she received it before becoming infected with HPV, she wouldn’t have gotten cancer.

Price dropped out of her classes to get treatment. She needed surgery to remove the tumor from her cervix, then underwent chemotherapy and radiation to kill any remaining cancerous tissue. At her one-year follow-up appointment, doctors found that the cancer had spread. She endured chemotherapy for another six months. Now, at 29, Price is in remission and is working in Los Angeles. “Most of my 20s comprised being in a hospital. It was isolating,” she says.

Merck’s Gardasil vaccine was considered a breakthrough when it was approved by the U.S. Food and Drug Administration in June 2006. It was the first vaccine to protect against several cancers. But more than a decade after the vaccine came out, vaccination rates in many places in the U.S., especially in the South, Midwest, and Appalachian states, still remain much lower than rates for other childhood vaccines—too low to stop transmission of the most dangerous HPV strains.

In 2016, only about 50 percent of girls and 38 percent of boys had all the required doses of the HPV vaccine needed to be fully protected, according to data released last week by the U.S. Centers for Disease Control and Prevention. Those figures are up slightly from last year, but still not close to the 80 percent that public health experts want to achieve.

Gardasil is approved to protect against cervical, vulvar, and vaginal cancers in girls and women ages 9 through 26, as well as anal cancer for the same age group in both girls and boys. Recently, the vaccine has also been shown to protect against oral cancers in men. HPV causes about 32,000 cancers every year, with cervical cancer the most common for women and oral cancers the most frequent in men.

Electra Paskett, a cancer epidemiologist at Ohio State University, says she is still surprised that the vaccine’s uptake has been so slow. “It’s crazy that there’s not a line around the corner. If we said we have a vaccine for breast cancer, we’d be vaccinating day and night,” she says.

The problem the vaccine has faced is its link to a taboo in American culture: sexual activity among teenagers. About one in four people in the U.S., including teens, are currently infected with HPV. Health-care providers are the biggest hurdle to getting more children vaccinated. Some primary care physicians, like in Price’s case, may not recommend it at all.

For Merck, the world’s largest vaccine maker, Gardasil has been a profit generator even though the company admits the uptake of the vaccine has been surprisingly slow. The company says it’s trying to increase rates by educating health-care providers.

William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University, remembers the initial excitement in the medical community when Gardasil first came out. “I thought the advent of our first explicitly anti-cancer vaccine, and the fact that it was so incredibly successful and safe, would be immediately embraced with pizzazz and rose petals,” he says.

Regional differences
State vaccination rates were as high as 73 percent among girls in Rhode Island and as low as 31 percent in South Carolina for all three doses in 2016. Among boys, Wyoming had the lowest rate, with only 20 percent getting the full round of shots.

Overall, teens living in major metropolitan areas were far more likely to get the vaccine than those living in rural areas, which may be more socially conservative and lack access to certain health-care services. In some of these places, average household incomes are lower than the national average, and parents might not be able to afford to take their pre-teens or teens to get the vaccine.

In some states with low vaccination rates, HPV-caused cancers are the among the highest. In Mississippi, for example, only about 34 percent of girls and 25 percent of boys get all required doses of the vaccine. The state also has one of the highest rates of HPV-related cervical cancer in the country. Wyoming tells a similar story, with high rates of HPV-associated cancers in both men and women.

Of course, those cancer rates can’t yet be tied to the states’ low vaccination rates. Gardasil was introduced just over a decade ago, and many of these cancer cases are in people who were too old to get the vaccine when it came out. But it means that these disparities could grow if more people there don’t get the vaccine.

HPV vaccination for boys is especially lagging in some areas. Paskett, who has studied cancer in Appalachia, say there’s a perception that HPV only causes cancers in women. “A lot of parents don’t know that boys should be vaccinated,” she says. Boys and men not only carry HPV but can get HPV-related cancers, like anal, penile, throat, and tongue cancers.

Price says shortly after her cancer diagnosis, she urged her parents to get her two younger brothers vaccinated.

Doctor hesitancy
A 2015 study found that a little over a quarter of the 776 pediatricians and family physicians surveyed do not strongly endorse the HPV vaccine. About one-third of the total doctors surveyed also said that having to talk about a sexually transmitted infection makes them uncomfortable.

Nneka Holder, associate professor of adolescent medicine at University of Mississippi Medical Center, says she is frustrated that so many doctors don’t recommend the HPV vaccine because they think it means they have to talk to parents about sex.

“We don’t usually explain to patients how they get hepatitis or meningitis,” she says. “So why should HPV be different?” Instead, she says health-care providers should focus on the cancer prevention aspect of the vaccine, rather than how HPV is spread.

Even health-care providers who do talk to parents about the vaccine aren’t always effective at getting their message across. A study from 2014 found that 47 percent of Minnesota health-care physicians and nurses that did ask parents about their concerns with the vaccine said they lacked time to probe the issue further, and 55 percent felt they couldn’t change parents’ minds.

Schaffner says doctors that are most successful with getting parents on board with the HPV vaccine are the ones who don’t call special attention to it. He says the best tactic is for physicians to sandwich in the HPV vaccine with other recommended vaccines—as in, “It’s time for your son to get the meningococcal, HPV, and Tdap vaccines.”

Parent concerns
Since the vaccine is just over 10 years old, it’s too early to know how many cases of cancer it has prevented so far. But clinical trials have showed that the vaccine provides nearly 100 percent protection against cervical infections caused by certain strains of HPV. These infections have fallen by 64 percent among teen girls in the U.S. since 2006, when the vaccine was introduced. Large clinical trials of the HPV vaccine have also shown it’s safe for both boys and girls.

These benefits have led Virginia, Rhode Island, and Washington, D.C., to adopt public school mandates for HPV vaccination. But some parents are still uncomfortable about the HPV vaccine’s association with sex and think their children don’t need it because they’re not sexually active. That has led parents to form groups in opposition to such mandates.

Aimee Gardiner, director of one such group called Rhode Island Against Mandated HPV Vaccine, says she doesn’t see HPV as the “epidemic” she thinks the CDC has made it out to be. “For me the risk of developing a cancer from any HPV is so insignificantly small that I do not feel like the vaccine is a necessity,” she says. Gardiner has two children, one of whom isn’t old enough to receive the vaccine and the other who hasn’t received it. She says she doesn’t plan to vaccinate them with Gardasil.

It’s true that for most people, the immune system clears the virus from their systems naturally. But for a small number of people, HPV persists and can turn cancerous. For those patients, like Price, cancer can be a major life ordeal, not to mention much more expensive than a vaccine that costs about $150 per dose.

Looking ahead
HPV vaccination rates continue to increase steadily, but the problems associated with its uptake could spell trouble for other vaccines in the future. For example, researchers for years have been working on a vaccine that would protect people from contracting HIV, the virus that causes AIDS. If a vaccine for HIV were ever to be successful, it could run into the same problems. HIV’s risk factors—unprotected sex and intravenous drug use—make it even more taboo.

Another worry is that rising anti-vaccine sentiments causing parents to opt out of vaccinating their children will hurt efforts to expand HPV vaccine coverage.

One factor that may increase vaccination rates is a new guideline from the CDC announced in October 2016. Children ages 11 to 14 now only need two doses of the HPV vaccine at least six months apart instead of three, which was previously recommended. Teens 15 and older still need to complete the three-dose series. This change may increase uptake of the vaccine, as vaccination rates drop off after each dose.

For Price and other cancer patients, the thought of not getting a vaccine that could prevent something so terrible is unimaginable. “I am a huge proponent of it,” she says. “If you had the chance to prevent cancer in your son or daughter, why wouldn’t you do that?”

September, 2017|Oral Cancer News|

FDA Approves First Gene Therapy For Leukemia

Source: npr.org
Author: Rob Stein
Date: August 30, 2017

The Food and Drug Administration on Wednesday announced what the agency calls a “historic action” — the first approval of a cell-based gene therapy in the United States.

The FDA approved Kymriah, which scientists refer to as a “living drug” because it involves using genetically modified immune cells from patients to attack their cancer.

The drug was approved to treat children and young adults up to age 25 suffering from a form of acute lymphoblastic leukemia who do not respond to standard treatment or have suffered relapses.

The disease is a cancer of blood and bone marrow that is the most common childhood cancer in the United States. About 3,100 patients who are 20 and younger are diagnosed with ALL each year.

“We’re entering a new frontier in medical innovation with the ability to reprogram a patient’s own cells to attack a deadly cancer,” FDA Commissioner Scott Gottlieb said in a written statement.

“New technologies such as gene and cell therapies hold out the potential to transform medicine and create an inflection point in our ability to treat and even cure many intractable illnesses,” Gottlieb said.

The treatment involves removing immune system cells known as T cells from each patient and genetically modifying the cells in the laboratory to attack and kill leukemia cells. The genetically modified cells are then infused back into patients. It’s also known as CAR-T cell therapy.

“Kymriah is a first-of-its-kind treatment approach that fills an important unmet need for children and young adults with this serious disease,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research.

“Not only does Kymriah provide these patients with a new treatment option where very limited options existed, but a treatment option that has shown promising remission and survival rates in clinical trials,” Marks said in the FDA statement.

The treatment, which is also called CTL019, produced remission within three months in 83 percent of 63 pediatric and young adult patients. The patients had failed to respond to standard treatments or had suffered relapses. Based on those results, an FDA advisory panel recommended the approval in July.

The treatment does carry risks, however, including a dangerous overreaction by the immune system known as cytokine-release syndrome. As a result, the FDA is requiring strong warnings.

In addition, the treatment will be initially available only at 32 hospitals and clinics that have been specially trained in administering the therapy.

Novartis, which developed the drug, says the one-time treatment will cost $475,000 for patients who respond. People who do not respond within a month would not be charged, and the company said it is taking additional steps to make sure everyone who needs the drug can afford it

But some patient advocates criticized the cost nevertheless.

“While Novartis’ decision to set a price at $475,000 per treatment may be seen by some as restraint, we believe it is excessive,” says David Mitchell, founder and president of Patients For Affordable Drugs. “Let’s remember, American taxpayers invested over $200 million in CAR-T’s discovery.”

August, 2017|Oral Cancer News|