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Immokalee health clinic earns national award for vaccination rate

Source: www.naplesnews.com
Author: Liz Freeman

The public health department in Immokalee set a goal for getting children vaccinated against cancer and brought home a U.S. Centers for Disease Control and Prevention award for its high success rate.

The Florida Department of Health in Collier County, specifically the Immokalee location, was named the regional winner of the 2017 HPV Vaccine Award because of its 76.2 percent vaccine series completion rate among 13 to 15 year olds.

A point-in-time survey in August found 560 children aged 13 to 15 in Immokalee had been vaccinated against HPV, according to a health department spokeswoman.

In the last four years, the Immokalee clinic took on an ambitious campaign in the farmworker community to boost HPV vaccination rates, starting with ensuring that all staff members who have contact with clients are knowledgeable about the virus and the vaccine. The virus is common and can cause certain cancer of the genitals, head and neck. There are about 31,000 new cases of cancer a year caused by the virus, according to the CDC.

Controversy is attached to the HPV vaccine by some groups who argue that getting kids vaccinated may promote early sexual interaction with others. State governments that have authority over school vaccination requirements have faced debate over requiring it and over the cost

State Surgeon General and DOH Secretary Dr. Celeste Philip said she was proud of the Immokalee clinic and its success rate for the vaccinating young people against the virus.

“Their commitment to preventing cancers caused by HPV infection and ensuring that every child and parent that visits the clinic are educated about the benefits of the HPV vaccine has a positive impact on the health of their county and our state,” she said in a news release.

The CDC award criteria stipulates that candidates must achieve a vaccination series rate of at least 70 percent of the patient population aged 13 to 15, both girls and boys, seen in the last two years.

Stephanie Vick, administrator of the Collier health department, said the Immokalee team identified a public health challenge and set out to achieve results.

“Their efforts reflect their professionalism and dedication to tackling what for some groups can be a taboo subject and placed the focus upon a universally accepted prevention subject,” Vick said.

People get HPV from another person during sexual contact, and both men and women can get it. A person can get it even if the partner has no sign or symptoms. About 79 million Americans are infected with some type of HPV, and 14 million people become newly infected each year. Most infections go away by themselves within two years, but sometimes it can take longer and can cause cancer of the genitals, in the back of the throat and the tongue.

Since 2006, the CDC has recommended the HPV vaccine, initially in a three-dose series over six months, and then it changed its recommendation to two doses for people before the 15th birthday. The second does should be given six to 12 months after the first dose.

November, 2017|Oral Cancer News|

Know what’s worse than the risks of getting the HPV vaccine? Getting an HPV-related cancer. Trust me

Source: www.statnews.com
Author: Michael D. Becker

In an era of $500,000 cancer treatments, you’d expect a vaccine series that costs about $300 and helps prevent several types of cancer to be popular with physicians, insurers, and consumers. It’s not, and, as a result, people are dying. I should know — I’m one of them.

The human papillomavirus (HPV) can cause changes in the body that lead to six cancers: cervical, vaginal, and vulvar cancer in women; penile cancer in men; and anal cancer in both women and men. It can also cause oropharyngeal cancer — cancer in the back of the throat, including the base of the tongue and tonsils — in both sexes. In the U.S., approximately 30,000 new cancers attributable to HPV are diagnosed each year.

In 2006, the first vaccine became available to protect against HPV infection. I was 38 years old at the time, well above the upper age limit of 26 the Centers for Disease Control and Prevention recommends for getting the vaccine. Ideally it should be given before the teen years, but can be given up to age 26.

Uptake of the HPV vaccine in the U.S. is abysmal, with just 49 percent of girls and 37 percent of boys having received the recommended HPV vaccination series.

Individuals who oppose the use of vaccines argue that safety concerns should preclude the use of the HPV vaccine. I disagree. The safety and effectiveness of this vaccine to protect against cancer-causing strains of the HPV virus have been unquestionably proven. Others point to side effects of the HPV vaccine as a reason not to vaccinate young Americans. These may include pain, swelling, redness, itching, bruising, bleeding, or a lump at the injection site as well as headache, fever, nausea, dizziness, tiredness, diarrhea, abdominal pain, and sore throat. Most people who get the vaccine experience no side effects from it other than the pain that accompanies most shots.

Missing from the discussion are the risks of not getting the vaccine. As someone with HPV-related oropharyngeal cancer, I can describe a few of them. And I can say with certainty I would gladly have experienced any of the vaccine-related side effects rather than the dozen or so “side effects” of the cancer and its treatment that I’m living with. I’ve illustrated them on the image below.

Some of these side effects, like hair loss, aren’t hazardous. Others are. I’ve spent time in an intensive care unit for my rapid heart rate, and have had to go to the emergency department several times for my pleural effusion and other issues. All of these pale beside the biggest “side effect” — a terminal disease that will eventually take my life.

I urge all parents to talk to your child’s doctor about the HPV vaccine. I wish my parents had that opportunity when I was young, as it could have prevented the cancer that’s killing me.

November, 2017|Oral Cancer News|

The iPhone ultrasound device that can spot cancer

Source: www.dailymail.co.uk
Author: Maggie O’Neill for dailymail.com

Dr John Martin diagnosed his own stage four cancer last summer – using only his iPhone.

The 59-year-old doctor is a vascular surgeon and the chief medical officer at Butterfly Network, a company that has invented a handheld ultrasound machine that can connect to an iPhone called the Butterfly iQ. While the product was being tested for FDA clearance in July, Dr Martin decided to scan his own neck using the device because he felt a mass in his throat.

The results that popped up on his phone screen revealed he had metastatic cancer. It had started in his tongue and throat and spread to his neck. After surgery, it was downgraded to stage three and now, coming to the end of six weeks of radiation, doctors say he looks set to be cured.

Dr Martin used a device called the Butterfly iQ, which can connect to an iPhone, to perform an ultrasound.

Dr Martin said that the opportunity to try the technology on himself arose when the product was being tested in Denver, Colorado, earlier this year.

‘I noticed this mass in my neck,’ he said. He tested himself by performing an ultrasound with the Butterfly iQ and looking at the instant results on his iPhone.

‘I realized I was holding the diagnostic study I needed in my hand,’ he said.

Dr Martin, who has been a physician for 40 years, said he suspected the results were not good, but he consulted with a nearby technician to make sure that was the case.

‘I walked across to a technician, and we looked at each other, and I flew home the next morning.’ But the first thing he thought when he saw the image was that he was thankful his team had invented the ultrasound technology.

‘There’s a million things that go through your mind,’ Dr Martin said. But one unexpected thought he had when he realized he had cancer was: ‘I’m glad I’ve got this picture.’

Butterfly Network founder Jonathan Rothberg said that the speed of his employee’s diagnosis was the goal he had in mind when designing the iQ technology.

The revolutionary aspect of the Butterfly iQ is that the results of an ultrasound appear immediately on an iPhone screen. The product will be used in clinical trials in 2018, and during the studies doctors will send the devices home with high-risk patients who could benefit from an immediate ultrasound.

Rothberg and Dr Martin said that their technology could help patients with diabetes, lung problems and other ailments.

November, 2017|Oral Cancer News|

Number of metastatic nodes a predictor for survival in oral cancer

Source: www.onclive.com
Author: Jason Harris

The presence of metastatic lymph nodes was directly correlated with poorer survival in patients with oral cancer. Mortality risk rose continuously with the number of metastatic nodes without plateau, according to findings published in the Journal of Clinical Oncology.

Investigators found that the effect was most pronounced with up to 4 lymph nodes (hazard ratio [HR], 1.34; 95% CI, 1.29-1.39; P < .001). Extranodal extension (HR, 1.41; 95% CI, 1.20-1.65; P <.001) and lower neck involvement (HR, 1.16; 95% CI, 1.06-1.27; P <.001) were also predictors for increased mortality.

Citing the need for more precise staging metrics and treatment stratification, the investigators assessed the effect of quantitative metastatic nodal burden in a large population of patients with oral cavity cancer. Researchers selected oral cavity cancers because of their surgical treatment paradigm with more complete pathologic nodal data.

“Metastatic nodal burden is a central predictor of mortality in patients with oral cavity cancer, with each additional metastatic lymph node conferring escalated risk of mortality,” first author Allen S. Ho, MD, Department of Surgery, Cedars-Sinai Medical Center, and co-investigators wrote. “Classic factors such as lymph node size and contralateral nodal metastasis lack independent prognostic value when accounting for number of metastatic nodes.”

“Our data suggest that deeper integration of quantitative nodal burden could better calibrate the wide spectrum of risk that staging systems presently capture. Such adjustments would be a promising means to more effectively articulate patient prognosis, tailor clinical trial design, and ultimately advance clinical decision making,” added Ho et al.

Investigators at Cedars-Sinai Medical Center in Los Angeles examined data collected in the National Cancer Data Base on adult patients with oral cavity squamous cell carcinoma who underwent upfront surgical resection for curative intent (N = 14,554) from 2004 to 2013. Patients were segregated into node-negative (n = 7906) or node-positive (n = 6648) groups.

Median overall survival was 68.3 months (95% CI, 64.4-71.7), with a median follow-up of 46.5 months (95% CI, 45.7-47.3).

The mean number of lymph nodes examined was 32.1 (standard deviation [SD], ±17.4). Among patients with node-positive disease who had known data, the mean number of identified positive metastatic nodes was 3.3 (SD, ±4.3), 17.2% had lower neck (level 4-5) involvement, 45.2% demonstrated extranodal extension, and 13.3% harbored contralateral nodal involvement.

In univariate analysis, the number of metastatic lymph nodes strongly predicted poorer survival. Estimated 5-year OS was 65.3% for patients with no metastatic lymph nodes compared with 27.5% for patients with 4 metastatic nodes and 9.7% for those with 10 or more. After adjusting for potential confounders in a multivariable model, investigators found that the number of positive metastatic lymph nodes remained closely linked with OS (P <.001).

Investigators noted a change point when 4 metastatic nodes were identified. HR per metastatic lymph node increased steeply up to 4 metastatic LNs (HR, 1.34; 95% CI, 1.29-1.39; P <.001). Beyond that number, each additional metastatic lymph node increased the risk for death more slowly (HR, 1.03; 95% CI, 1.02-1.04; P <.001).

Investigators found an association between an increasing number of lymph nodes examined and improved OS in multivariable analyses (P <.001). A multivariable model with a three-knot restricted cubic spline function showed that, from a baseline of 10 lymph nodes examined, the risk for death declined continuously with each additional node harvested up to a change point at 35 nodes (HR, 0.98; 95% CI, 0.98-0.99; P <.001). There was no significant improvement in survival beyond that change point (HR, 1.00; 95% CI, 0.99-1.00; P = .126).

After adjusting for covariates, including positive metastatic lymph nodes and number of total nodes examined, both extranodal extension (HR, 1.41; 95% CI, 1.20-1.65; P <.001) and lower neck involvement (HR, 1.16; 95% CI, 1.06-1.27; P <.001) were independently associated with mortality risk. Lymph node size and contralateral lymph node involvement (N2c disease) had no significant impact on survival.

Reference:
Ho AS, Kim S, Tighiouart M, et al. Metastatic lymph node burden and survival in oral cavity cancer [published online September 7, 2017]. J Clin Oncol. doi: 10.1200/JCO.2016. 71.1176.

October, 2017|Oral Cancer News|

Oral sex increases men’s risk of cancer, new study finds

Source: www.deccanchronicle.com
Author: staff

An alarming new study found men who have performed oral sex on five or more partners are at risk of head and neck cancer related to HPV, according to a report by the Daily Mail.

Johns Hopkins researchers warn men may not be aware of this risk, particularly if they smoke. “Among men who did not smoke, cancer-causing oral HPV was rare among everyone who had less than five oral sex partners, although the chances of having oral HPV infection did increase with number of oral sexual partners, and with smoking,” lead author Dr Amber D’Souza, associate professor at the Johns Hopkins Bloomberg School of Public Health told the Daily Mail.

For the study, data was analysed of 13,089 people part of the National Health and Nutrition Examination Survey (NHANES) and tested for oral HPV. That information was compared to data with federal figures on oropharyngeal cancer diagnoses. The results indicated that men had a higher risk of developing the disease compared to women.

The new study’s findings suggest it is crucial for boys to get the HPV vaccine.

While there are 100 different kinds of HPV, only few cause cancer. HPV strains 16 and 18 trigger most cervical cancer. HPV16 also causes oropharyngeal cancer.

Identifying who is at risk is will help curb the disease. “For these reasons, it would be useful to be able to identify healthy people who are most at risk of developing oropharyngeal cancer in order to inform potential screening strategies, if effective screening tests could be developed,” Dr D’Souza told the Daily Mail.

Further research to explore oral HPV infection in young healthy men is currently being conducted.

The study was originally published in the journal Annals of Oncology.

October, 2017|Oral Cancer News|

7 million American men carry cancer-causing HPV virus

Source: www.nytimes.com
Author: Nicholas Bakalar

The incidence of mouth and throat cancers caused by the human papilloma virus in men has now surpassed the incidence of HPV-related cervical cancers in women, researchers report.

The study, in the Annals of Internal Medicine, found that 11 million men and 3.2 million women in the United States had oral HPV infections. Among them, 7 million men and 1.4 million women had strains that can cause cancers of the throat, tongue and other areas of the head and neck.

The risk of infection was higher for smokers, for people who have had multiple sex partners, and for men who have sex with men. Frequent oral sex also increased the risk. The rate was higher among men who also had genital HPV. (Almost half of men aged 18 to 60 have a genital HPV infection, according to the Centers for Disease Control and Prevention.)

Neither age nor income made a difference in high-risk oral infection rates, but rates among non-Hispanic blacks were higher than other races and ethnicities.

HPV vaccination is recommended starting at age 11 or 12 and is effective, said the senior author, Ashish A. Deshmukh, an assistant professor at the University of Florida, and “it’s crucial that parents vaccinate boys as well as girls.”

The lead author, Kalyani Sonawane, also at the University of Florida, said that behavioral change is important, too, particularly smoking cessation. “The difference in oral HPV infection between smokers and nonsmokers is staggering,” she said.

October, 2017|Oral Cancer News|

Should women older than 18 get the HPV vaccine?

Source: www.washingtonpost.com
Author: Erin Blakemore

About half of American teenagers have been vaccinated against the human papillomavirus (HPV), the most common sexually transmitted infection in the United States. Should adult women follow suit?

Yes, says Lauri Markowitz, a Centers for Disease Control and Prevention medical epidemiologist who has worked with the advisory committee that makes national vaccination recommendations. “Women 18 to 26 should be vaccinated.”

There’s good reason to follow that recommendation. According to the American Cancer Society, about 12,820 new cases of cervical cancer will be diagnosed in U.S. women this year and more than 4,000 will die of the disease. HPV is thought to be responsible for more than 90 percent of all cervical and anal cancers in men and women. The virus also causes vaginal, vulvar and throat cancers and genital warts.

Although the majority of HPV infections do not cause cancer — most people with an infection never show any symptoms, and infections usually go away on their own — some strains are particularly dangerous. Gardasil 9, the newest HPV vaccine approved by the Food and Drug Administration, protects against nine such strains and, researchers say, may be able to prevent up to 90 percent of cervical cancers. (Older vaccines protect against fewer strains of HPV.)

However, confusion about the way HPV vaccines protect against infection can deter some women. Gardasil 9 is approved for women up to age 26. Like other vaccines, it spurs the body’s immune system to defend itself against a virus. The FDA and CDC say the HPV vaccines are safe and extremely effective: HPV rates in women ages 14 to 19 years fell 64 percent within six years of the vaccine’s introduction in the United States in the mid-2000s and 34 percent in women ages 20 to 24.

The vaccines are most effective if administered before a woman becomes sexually active. The longer a woman has been sexually active and the more partners she has had, the more opportunities she has had to become infected with an HPV strain that overlaps with the vaccine. If she is vaccinated at an older age, the vaccine may be less effective in lowering her cancer risk, Markowitz says. The vaccine can’t clear any HPV that has taken hold; it can only prevent future infection. So essentially if you already have been exposed to one of the strains it protects against, it will be useless against that strain.

That doesn’t mean it’s useless to get vaccinated if you’re older than the recommended age of 11 or 12, Markowitz says. “Your chances of being protected are decreasing, but you will still have some protection,” she says. Although the likelihood that a sexually active woman has been infected with one of the strains the vaccine protects against increases as a woman has more partners, those who didn’t receive the vaccine at the recommended age are still urged to get vaccinated to increase the odds of protection.

Some insurance does not cover the vaccine for those older than 18 — the shots can be costly, though the manufacturer may provide assistance — but it really varies across the board.

October, 2017|Oral Cancer News|

Complex cancer decisions, no easy answers

Source: blogs.biomedcentral.com
Author: Jeffrey Liu

With the many different options now available for the treatment of cancer, it can be very difficult for both clinicians and patients to decide on the best possible treatment strategy, particularly when faced with a complicated cancer. In this blog, Dr Jeffrey C. Liu reflects on the challenges encountered in cancer decision making, particularly when presented with difficult cases.

When treating cancer, sometimes the treatment decisions are straightforward and unambiguous. For example, surgery is the treatment of choice for an early, uncomplicated tongue cancer. However, many times, the recommendation for cancer treatment is not straightforward and requires combination treatment – one or more of surgery, radiation or chemotherapy.

As a head and neck cancer surgeon, I work with a team to make these treatment decisions, and usually team consensus is achieved. However, when we are faced with the choice of multiple treatments that all have the same chance of cure available, it seems to result in a never ending discussion amongst our team.

Take for example an advanced tonsil cancer. These cancers can sometimes be removed first with surgery, a process which removes both the primary cancer and the lymph nodes in the neck. Then, depending on the pathology results, patients may need radiation treatment, chemoradiation or sometimes no further treatment at all. Meanwhile, chemoradiation alone, and no surgery, is an excellent option. Whether the patient receives surgery or no surgery, the chance of cure is pretty much the same. However, based on the need for additional treatment after surgery, the patient may have better, equivalent, or worse function than chemoradiation alone.

How then can a patient make a decision with imperfect data? I wish I could help my patients better with these complex decisions. Most patients will make this decision only once in their lives. With the increased emphasis on patient autonomy, there is sometimes a feeling to just “present the options and let the patient decide.”

However, when a group of smart experienced doctors who all treat the same cancer, cannot reach an agreement, how is a patient with no experience expected to make the right decision? There is not enough time to explain to patients the observations of hundreds of such decisions and their thousands of outcomes. Some patients are so overwhelmed by the decision, that they just want someone to tell them what to do. Others have so many questions and concerns that they get lost in the details and paralyzed by the process. I don’t know the right answer for such patients.

Unfortunately, there is no option but to choose a treatment strategy and move forward. We all carry the hope that one day, with more research and better understanding, such complex decisions for the treatment of cancer, will become the easy ones.

October, 2017|Oral Cancer News|

Is alcohol really good for your health? What the research reveals may surprise you

Source: www.consumerreports.org
Author: Julia Calderone

W e’ve long been told that a little wine with dinner may help prevent heart disease and perhaps offer other health benefits.

But some researchers are now questioning whether the perks of moderate drinking—one drink per day for women, two for men—really outweigh potential downsides.

We know that in older adults, too much alcohol can exacerbate high blood pressure, increase the risk of falls and fractures, and lead to strokes, memory loss, and mood disorders. And in this group, alcohol problems, such as the uncontrollable urge to drink, shot up 107 percent between 2001 and 2013, according to a study published in August in JAMA Psychiatry.

Even small amounts of alcohol can interact with medication (see chart here for a list of which ones), and contribute to cancer risk and potentially cognitive decline.

Here’s the latest research and tips on how to ensure that you’re not going overboard:

Benefits and Risks
More than 100 studies have found that a drink or two per day is linked to a 25 to 40 percent reduced risk of heart attack, stroke, and death from cardiac-related problems, according to the Harvard T.H. Chan School of Public Health.

Another study published in August, one that followed more than 333,000 people for 12 years, found that light to moderate drinkers were 21 to 34 percent less likely to die from cardiovascular disease.

But no studies have yet proved directly that alcohol boosts human health. Most research in this area has looked at whether people’s reported drinking behaviors are “associated” with positive or negative health outcomes.

A growing stack of research also suggests that regular, moderate alcohol consumption may have its hazards.

A 30-year study published in June in the British Medical Journal found that men who consumed eight to 12 drinks per week had three times the odds of having an atrophied hippocampus, which is a possible sign of early Alzheimer’s disease. That’s according to the study’s author, Anya Topiwala, Ph.D., a clinical lecturer in the department of psychiatry at the University of Oxford in the U.K.

And other research has found that moderate drinking may be linked to an elevated risk of breast cancer and—especially in smokers—esophageal, mouth, and throat cancers.

Watch Your Intake
Although moderate drinking isn’t without risks, a daily glass of wine is generally fine, says George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism, even if you’re in your 80s or 90s.

“We don’t want to panic people,” Topiwala adds.

But if you don’t drink, she says, there’s no reason to start for your health’s sake. And if you find yourself exceeding the U.S. Dietary Guidelines, Koob says, there’s no controversy: Consider cutting back.

These strategies can help:
Size up your pour. It can be almost impossible to eyeball a standard drink (5 ounces of wine, 12 ounces of beer, or 1½ ounces of distilled spirits). Some wineglasses can hold up to 22 ounces, more than the amount in four drinks. So use a measuring cup or a shot glass to get it right.

Keep tabs. Tracking how many drinks you have per day or week—perhaps with tick marks on a cocktail napkin—can help you stay within your limit.

Alternate with water. Sipping a glass of water or club soda after each alcoholic drink will help you slow down.

Talk to your doctor. If you’re concerned about your drinking, don’t be afraid to bring up the issue at your next checkup.

Note: This article also appeared in the November 2017 issue of Consumer Reports on Health.

October, 2017|Oral Cancer News|

Penn surgeons become world’s first to test glowing dye for cancerous lymph nodes

Source: www.phillyvoice.com
Author: Michael Tanenbaum, PhillyVoice Staff

Surgeons at the University of Pennsylvania have achieved a global first with the use of a fluorescent dye that identifies cancerous cells in lymph nodes during head and neck cancer procedures.

The study, led by otorhinolaryngologist Jason G. Newman, seeks to test the effectiveness of intraoperative molecular imaging (IMI), a technique that illuminates tumors to provide real-time surgical guidance.

More than 65,000 Americans will be diagnosed with head and neck cancers in 2017, accounting for approximately 4 percent of all cancers in the United States, according to the National Cancer Institute. About 75 percent of these cancers are caused by tobacco and alcohol use, followed by human papillomavirus (HPV) as a growing source for their development.

Common areas affected by these cancers include the mouth, throat, voice box, sinuses and salivary glands, with typical treatments including a combination of surgery, radiation and chemotherapy.

Lymph nodes, which act as filters for the immune system, are often among the first organs affected by head and neck cancers as they spread or resurface. Initial surgeries may leave microscopic cancerous cells undetected in the lymphoid tissue, heightening the risk that a patient’s condition will return after the procedure.

“By using a dye that makes cancerous cells glow, we get real-time information about which lymph nodes are potentially dangerous and which ones we can leave alone,” Newman said. “That not only helps us remove more cancer from our patients during surgery, it also improves our ability to spare healthy tissue.”

With the aid of a fluorescent dye, surgeons are able to key in on suspicious tissue without removing or damaging otherwise healthy areas. Previously adopted for other disease sites in the lungs and brain, the practice now allows Newman’s team to experiment with indocyanine green (ICG), an FDA-approved contrast agent that responds to blood flow.

Newman explained that since tumor cells retain the dye longer than most other tissues, administering the dye prior to surgery singles out the areas where cancer cells are present.

The current trial at Penn will enable researchers to determine whether ICG is the most suitable dye for head and neck cancers and provide oncologists with a deeper understanding of how cancer spreads in the lymph nodes.

October, 2017|Oral Cancer News|