Oral Cancer News

A case for second opinions in cancer care

Source: healthblog.uofmhealth.org
Author: Beth Uznis Johnson

Jim Sitko expected minor surgery to remove a small lesion that his dentist discovered under his tongue during a routine checkup in July 2017.

An oral surgeon near his home in Clarkston, Michigan, took several samples to biopsy, a procedure that left Sitko’s tongue badly damaged. Resulting pain left the patient barely able to swallow for more than a week.

And the pathology report revealed devastating news: squamous cell carcinoma of the tongue.

Treatment, Sitko was told, would include major surgery to remove a portion of his tongue and rebuild it with veins and tissue from other parts of his body. Rehabilitation would be extensive and might also require radiation therapy once the patient healed.

Because he had received successful treatment for prostate cancer six years earlier at the University of Michigan Rogel Cancer Center, Sitko opted to return and meet with surgeon Steven Chinn, M.D., MPH.

Sitko’s mouth was still healing from his initial surgery, so Chinn relied on the outside pathology report to prep for the complicated surgery ahead. He ordered additional pathology testing by Rogel Cancer Center head and neck specialists — an essential step to confirm an advanced cancer diagnosis.

Meanwhile, the thought of having tongue cancer overwhelmed Sitko.

“The complications aside from taking care of the cancer were unbelievable,” the 70-year-old says. “I might have a breathing tube and feeding tube. I took a retreat to my condo in northern Michigan to review 25 pages of paperwork for two clinical trials, but I did not quality.”

Sitko and his wife, Jane, a master gardener, had been planning a 50th anniversary celebration in Vancouver and Victoria, British Columbia, world-renowned for its gardens. Because of his tongue cancer diagnosis, the couple canceled their plans.

But everything changed for the better one month later when Sitko and Chinn were preparing for surgery.

A second opinion and ‘tears of joy’
During the first of five preoperative meetings, Chinn was able to examine Sitko’s mouth, which had healed remarkably well for a person with tongue cancer.

Chinn called for Sitko’s prior pathology labs from the outside hospital for a careful review and comparison with the new results from the U-M pathology lab.

“My years of training taught me be thorough and make sure you are working with the best information possible,” says Chin, an assistant professor of otolaryngology at Michigan Medicine. “As part of my standard of care, I make sure all pathology is reviewed by head and neck specialists here at U-M.

“This is what makes our head and neck oncology program one of the best in the world.”

Sitko and Jane had again retreated to their northern Michigan condo. They were just unpacking their bags when a phone call with good news from Chinn came.

“He told me with cautious optimism that he saw no cancer in the pathology report but needed to verify with new samples taken at U-M,” Sitko says. “We agreed I’d go in on my scheduled surgery date. I would be in the surgical suite for an hour or 12 hours, depending on what they found.”

To begin, Chinn took three additional section samples for biopsy. Pathology results found no cancer.

Chinn took two more samples. No cancer.

He then used laser treatment to remove abnormal, non-cancerous cells from Sitko’s tongue. Surgery was over.

“We were in tears of joy,” Sitko says. “I am certainly indebted to U-M and specifically Dr. Chinn and the manner he handled my case. He could have done the complete surgery and I never would have known I didn’t have cancer.”

Life after a cancer scare
In hindsight, Sitko sees that his original tongue surgery did far more damage to his tongue than necessary.

It still surprises him that he was able to stop to eat dinner and have a beer after his surgery by Chinn. He experienced none of the discomfort.

Over the past year, he and Jane have resumed their normal retirement activities, including golfing, biking, hiking and snow skiing. They also rescheduled their wedding anniversary trip.

“We decided to kick off with a trip out East, where we spent our honeymoon,” Sitko says. “We went to Bar Harbor, Acadia National Park, Nova Scotia and New Brunswick. We drove 2,900 miles in 11 days, going from hotel to hotel.

“It was like revisiting our honeymoon 50 years later.”

Because of the abnormal non-cancerous cells found on his tongue, Sitko continues to see Chinn for follow-up and monitoring. There have been so signs of cancer.

A careful, specialized approach has guided treatment throughout.

“Having a team that’s only focus is head and neck cancer is critical to making the right diagnosis and management in a complex disease,” Chinn says. “In this case, when there was a discrepancy between the outside report and our review, I felt it prudent to do additional biopsies to make sure the initial one wasn’t a sample error and that we were, in fact, missing an advanced stage cancer.”

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October, 2018|Oral Cancer News|

Israeli doctor authors guide for throat cancer patients

Source: www.sdjewishworld.com
Author: Itzhak Brook MD, MSc

I am a physician who specializes in pediatrics and infectious diseases, and a head and neck cancer survivor. I was born and raised in Israel, graduated from the Hebrew University School of Medicine in Jerusalem, and completed my pediatric training at Kaplan Hospital in Rehovot, Israel.

I was diagnosed with throat cancer in 2008. Regrettably, my cancer recurred after it was initial treated and my larynx (which contains the vocal cords) had to be removed. Becoming a laryngectomee (a person without vocal cords) was a trying experience that affected my most fundamental functions – speaking, breathing and eating.

Communicating with others became a challenge for me and I had to learn how to speak again. Speaking requires mastering daily procedures and techniques using equipment and devices that have to operate in the most optimal way for me to be heard and understood. Furthermore, I had to face new medical issues that emerged as a result of the treatment I had received, and had to confront many psychological, and social issues. Becoming a patient with a serious illness after practicing medicine for over 40 years allowed me to understand the hardship and difficulties that patients face in ways I could not have done before.

I realized that there was very little information available to assists head and neck cancer survivors including laryngectomees in coping with their new condition. Furthermore, most physicians and nurses are not familiar with these practical issues. I had to gather materials from many sources to learn how to deal with my new daily tasks and routines. I did it by searching and reading the medical literature, and learning from physicians, speech and language pathologist, mental health providers and fellow head and neck cancers patients.

Recognizing that there was an urgent need for a guidebook that could help voiceless individuals, their family members, as well as their medical providers with everything they need to know about this condition, I embarked on preparing one. The 170 pages “ Laryngectomee Guide” I authored provides practical information that assists patients in regaining their ability to speak, and cope with medical, dental and psychological issues. It also contains information about the side effects of radiation treatment and chemotherapy; how to care for their airway, stoma, and voice prosthesis; how to overcome eating and swallowing problems; and how to travel.

The American Academy of Otolaryngology- Head and Neck Surgery adopted the Guide and made it available for free download from its website. The Guide has been translated from English to many other languages (Spanish, Portuguese, Russian, Chinese, Bulgarian, Italian, and more). The translations were performed by medical professionals from the corresponding countries and the Guide became available for download free of charge from the websites of medical societies in each of these countries. The Guide is also given out in print in many of these countries thanks to generous grants by charitable organizations as well as the countries’ cancer societies. It became a helpful tool in educating cancer patients throughout the world within five years.

The Guide became available also in countries throughout the Middle East after it has been translated to Arabic, Iranian (Farsi), and Turkish. It is used by head and neck surgeons, speech and language pathologists, as well as patients with head and neck cancer in Egypt, Jordan, Lebanon, Turkey, Iran, Saudi Arabia, United Arab Emirates, Oman, Qatar and Dubai. I have been receiving many messages of appreciation from head and neck cancer patients, as well as medical professionals in these countries.

The translation of the Guide into Arabic has a great significance to me. I regard this as a small attempt to contribute to the cause of peace and understanding and enhance the coexistence between Israel and its neighbors. It may serve as a testimony that alleviating patient suffering and improving people’s lives has no borders.

Helping and caring for non-Israelis is not new for me. I served as a medic in the Six Day War and a battalion physician in the Yom Kippur War, during which I treated many wounded Jordanian and Egyptian prisoners of war. I delivered them the best care I could give under the difficult circumstances of war, sometimes risking my own life doing that. I am proud that I was able to save many lives and alleviate suffering. Caring for these prisoners of war offered me an inner gratification during these difficult times. I felt that even in the midst of the chaos of war, I could cherish the sanctity of human life, a value with which I had been brought up with. I knew that, as a Jew and as a medical professional I could not act differently.

Making the Guide available in countries with whom we have fought wars and with whom we still have political disagreements is for me a continuation of what I did as a young medic and physician during times of battle. Having the Guide help patients all over the Middle East and in other countries is part and parcel of the fundamental values of medicine and an acknowledgement that those of us in the medical professions are called on to help the sick anywhere they are.

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October, 2018|Oral Cancer News|

Oral cancer a risk when consuming cannabis, warns orthodontist

Source: www.cbc.ca
Author: staff

Eating or smoking pot can pose some deadly health risks, according to the president of the Essex County Dental Association.

“One of the more common ones that you hear about is oral cancer,” said Dr. Mark Parete​, adding cannabis contains known carcinogens, similar to what’s found in tobacco.

He said the ingestion of tetrahydrocannabinol (THC), marijuana’s main psychoactive ingredient, into a person’s blood stream weakens their immune system and leaves gums and teeth prone to infection.

“Just like nicotine, it actually causes a generalized inflammation which ultimately breaks down collagen and bone — which is the support system of your teeth,” said Parete​.

Full disclosure between patients and medical professionals is extremely important in treating heath events. Parete​ said people shouldn’t be shy of revealing cannabis use to their dentist or orthodontist.

“When the patients come in, we always update our medical history … Inform us if you have any new medications, including using marijuana for recreational or medicinal purposes,” he said.

Indirect health impacts can occur through cannabis use, Parete​ warns. He said when the “munchies” come calling, cannabis users aren’t usually making the best choices in terms of their oral health.

“It’s probably not your healthy fruits and vegetables. So, if you can, we really advise our patients to swish your mouth some water after eating just to make sure you’re flushing any kind of sugars off the teeth to prevent dental cavities.”

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October, 2018|Oral Cancer News|

Why oral cancer threatens men

Source: www.scientificamerican.com
Author: Claudia Wallis, Scientific American November 2018 Issue

Back in 2006, when the vaccine for human papillomavirus (HPV) was introduced, I rushed to get my teenage daughters immunized. Here, amazingly, was a vaccine that could actually prevent cancer. By blocking HPV infection, it protects girls from the leading cause of cervical malignancies. I didn’t give much thought to my son, and neither did the medical establishment. It wasn’t until 2011 that health authorities recommended the vaccine for boys.

In hindsight, that delay was a mistake, though perfectly understandable: the vaccine was developed with cervical cancer in mind and initially tested only in girls. Today, however, we see a rising tide of cancers in the back of the throat caused by HPV, especially in men, who are three to five times more vulnerable than women. This surge of oropharyngeal cancers, occurring in many developed nations, took doctors by surprise. Oral cancers were expected to decline as a result of the drop in smoking that began in the 1960s.

Smoking-related oropharyngeal cancers are, in fact, down. But making up the difference, particularly in men, are those related to HPV, which have more than doubled over the past two decades. With cervical cancer waning (thanks to screening and prevention), this oral disease is now the leading HPV-related cancer in the U.S. Nearly 19,000 cases were reported in 2015, according to a recent report by the Centers for Disease Control and Prevention. Roughly nine out of 10 involve a nasty strain called HPV-16.

Researchers link the rise of these cancers to changing sexual practices, perhaps dating back to the 1970s. “People have more partners than they had in the past, and they initiate oral sex at an earlier age than previous generations did,” says Gypsyamber D’Souza, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. Greater exposure to oral sex means that the nearly ubiquitous virus gets transferred from the genitals to the mouth.

Studies suggest that most women develop protective antibodies to HPV after having a few sexual partners, but for men, it may take more than 10 partners. A likely reason for the difference, says oncologist Maura Gillison of the University of Texas MD Anderson Cancer Center, is that “in women, the infection is vaginal-mucosal; in men, it’s entirely on the skin,” where it is much less likely to trigger an antibody response. Males can get an active infection again and again, and it lingers longer than in women, making them the “Typhoid Marys of HPV,” as Gillison puts it. The path from infection to cancer may take decades and is not well understood.

Fortunately, the HPV vaccine should prevent these oral cancers, just as it protects against cervical cancer (as well as virus-related cancers of the vulva, labia, penis and anus). After lagging for years, U.S. rates of vaccination of boys are catching up with that of girls. New CDC data show that in 2017, 68.6 percent of girls and 62.6 percent of boys, ages 13 to 17, had received at least one dose of the vaccine—up from 65.1 and 56 percent, respectively, in 2016. If the trend continues, HPV-related cancers will ultimately become a scourge of the past in the U.S.

The tough question is what to do in the meantime for the large number of people, especially at-risk men, who have never been immunized. The CDC recommends the vaccine for children as young as nine and up to age 21 for boys and 26 for girls. Merck, which makes the only HPV vaccine now used in the U.S., is seeking approval to make it available up to age 45, but the $130-a-dose vaccine is less cost-effective in older populations. “It’s best given before people are sexually active,” explains Lauri Markowitz, team lead and associate director of science for HPV at the CDC. “The vaccine is not therapeutic; it’s prophylactic.” A vaccine advisory committee meeting this fall will weigh whether to revise current recommendations. One possibility, she says, is raising the upper age for boys to 26, matching that for girls.

D’Souza, Gillison and others are investigating ways to identify and screen people who may be at an especially high risk for oral HPV cancers—a significant challenge. There is no Pap-smear equivalent for this devastating disease, no reliable way to spot precancerous or early-stage lesions. And research by and her colleague Carole Fakhry shows that even if you focus on a high-risk group such as men in their 50s—8 percent of whom are infected with one of the noxious HPV strains—only 0.7 percent will go on to develop the cancer. There’s little point in terrifying people about the small odds of a bad cancer, D’Souza says, so “we’re working on understanding which tests would be useful.”

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October, 2018|Oral Cancer News|

Long-term implant failure in patients treated for oral cancer by external radiotherapy: a retrospective monocentric study

Source: Journal of Oral Medicine and oral Surgery, JOMOS
Date: October 10th, 2018
Authors: Aline Desoutter, Sophie Deneuve, Sophie-Charlotte Condamin and Anne-Gaëlle Chaux-Bodard

Abstract

Introduction: The placement of dental implants in irradiated bone has allowed functional rehabilitation for many oral cancer patients. Nonetheless, there is only few data about implant failure in irradiated tissues and their consequences. This retrospective study aims to highlight the rate and circumstances of implant failure.

Material and method: Patients treated with external radiotherapy for oral carcinoma and who received dental implants were included. Patients reconstructed with free bone flaps were excluded.

Results: Eighteen patients were included. Forty implants were placed between 2004 and 2007, 8 failed, of whom one osteoradionecrosis was observed. Time interval between radiotherapy and implantation was 44.6 (6–182) months. Mean dose was 51.8 (50–66) Gy.

Discussion: In the series, the implant failure rate is 20%, which corroborates the literature’s data. Failures occur more often for doses over 50 Gy. The placement of dental implant in irradiated bone leads to soft tissue complications but also increases the risk of osteoradionecrosis. The recent reimbursement of dental implants in oral cancer patients by the National Social Health system will probably increase the indications. Multidisciplinary staffs should be aware of benefit/risk ratio for each patient.

Introduction

Dental implants in patients treated for upper aerodigestive tract (UADT) cancers have facilitated the functional and aesthetic rehabilitation of patients whose postoperative anatomy did not allow for the placement of conventional prostheses. Several studies have been conducted and the success rates have varied from 62.5% to over 90% [1]. These success rates would be similar to those found in a healthy patient’s mandible, which is reported to be 92.6% [2]. However, there is little information regarding the types of failures that occur with these implants, as well as the consequences and circumstances surrounding their occurrence, especially when the radiation dose at the implant site is >40 Gy. Indeed, most of the published studies are case studies in which there is great heterogeneity in the initial tumor sites and in the radiation doses received at the implant site. It is therefore difficult to precisely determine the failure risk in patients who have received large radiation doses in the oral area. The expected complications are mainly peri-implantitis, loss of implants, and even osteoradionecrosis (ORN) [3]. The aim of this study was to highlight long-term implant failures in patients who were treated with radiotherapy for oral cancer and to observe the circumstances and consequences of these failures.

Material and methods

The clinical records of oral cancer patients treated between 2004 and 2007 by radiotherapy (exclusively or not) and who received implants were reviewed. In the interest of maintaining the homogeneity of the study sample, patients treated with a microanastomosis fibula flap were excluded.

The following information was extracted from the case records: tumor location, tumor stage, and type of treatment received, the duration between radiotherapy and implantation, the type of implants placed, the surgical and operative protocol, the patient’s medical history (excluding oncology) as well as any implant or peri-implant clinical events and their time of occurrence. Failure was defined as loss of implant osseointegration resulting in implant loss or removal. Surgical and implant loading failures were considered. Statistical analysis was performed using XLSTAT® software (Microsoft).

Results

Eighteen patients, consisting of 14 males (77%) and four females (13%) were eventually included. The mean age at the time of implant placement was 57.5 years (range: 42–78 years).

The initial tumor locations, the initial tumor stage, and the treatments received are presented in Table I.

Table I : Population studied: sites, tumor stages, and treatments received.
Table II : Implant failures as a function of the radiation dose received, initial tumor site, and failure onset delay.

Discussion

Cervicofacial radiation is one of the primary causes of implant loss [1,4] regardless of whether it is administered early or late [5]. Several failure factors specific to implant placement in irradiated areas have been identified; these include the duration after radiotherapy and the radiation dose received.

For successful implantation, the minimum time after radiotherapy before implantation should be 6–12 months [6]. A delay of >12 months would improve implant success rates [7]. In the current study, a minimum period of 6 months was selected after the multidisciplinary consultation with the surgical oncologists and radiotherapists. After excluding the two patients who were treated several years ago, missed their follow-up, and then reappeared for prosthetic rehabilitation, the average implantation time after radiotherapy in our study was 20.37 months (range: 6–49 months). One study [8] showed that the failures are less severe in patients receiving implants a later stage of oncological treatment (17.1% failure rate for intraoperative implants versus 4.6% for those placed postoperatively). Of course, the idea of early rehabilitation encourages the surgical team to perform implantation along with tumor removal, before additional treatments are administered. Although this technique has the advantage of decreasing treatment duration, it is not always feasible because of the constraints of tumor management.

The radiation dose received at the implant site is also a major cause of implant failure, with doses <50 Gy being more favorable [9,10]. Animal studies and literature reviews show that the implant failure rate is directly correlated with the radiation dose received [9,10]. In the study, implant sites that received estimated doses >55 Gy had failure (mean: 59.33 Gy). In fact, all implant failures occurred in patients who received treatment for cancer involving the anterior aspect of the floor of the mouth. The therapeutic target was therefore very close to the implant site, and the dose administered at the implant site was close to the therapeutic dose delivered.

The biggest challenge consists in evaluating the radiation dose received at the implantation site. In most studies, the initial tumor sites involved all the UADTs, including the oropharynx, with low radiation doses of about 30 Gy at the symphyseal and parasymphyseal level. It therefore seems more appropriate to limit the evaluation of failure rates to patients treated for cancer of the oral cavity, as the radiation doses at the implant site are therefore more homogeneous. In published studies, only a few authors [11] highlight the antecedents or lack thereof of radiation, with irradiated tissue implants having osseointegration rates of 83% at 5 years.

Long-term implant survival rates reported by the previous clinical studies are nonhomogeneous, with values of 72.8% at 10 years [9], 24% at 5 years [10], or 72% at 8 years [11]; however, these values support the results of our present study. Thus, Wagner [12] reports a 5-year osseointegration rate of 97.5% and at 10 years of 72.8%, whereas other authors report success rates of 48.3% [3]. Another study reports complications in 41.5% patients [13].

Seven out of eight failures encountered in the series began with peri-implantitis. Werkmeister [14] observed a soft-tissue complication rate of 28.6% in irradiated areas versus 8.3% in nonirradiated areas. These complications can be explained in part by the small amount of keratinized gingiva, along with the predisposing factors of radiotherapy-related sensitization and dry mouth. The occurrence of peri-implantitis should be carefully monitored to avoid ORN [15].

An increased loss of marginal bone was reported by many authors, with 2–9 mm variations for a period of 3 years after implant surgery [16]. According to Tanaka [17], early failures are more frequent. In the studies, all failures occurred >1 year after implant placement.

In the present series, a case of loss of osseointegration resulted in extensive ORN at a rate of 2.5%. Treatment of ORN required a subsequent free vascularized bone transfer reconstruction. This patient had been treated for a mouth floor lesion in the past and had received a postoperative radiation dose of 64 Gy (See Patient 3, Tab. I). This implant failed 1 year previously, and a reimplantation was proposed because of the impossibility of prosthetic rehabilitation without bone anchorage. Thus, there were two interventions on adjacent parasymphyseal mandibular bone sites. The patient had reverted to smoking regularly despite tobacco counseling. The risk of triggering ORN following implant placement was estimated to be 1.6%–5% [9,16,18,19]. Some authors advocate the use of hyperbaric oxygen therapy before and after implantation to stimulate or optimize healing and decrease ORN risk [20,21]. Others believe that the risk/benefit/cost ratio is not sufficiently favorable. More recently, the use of low-intensity pulsed ultrasound to increase healing capacity has been advocated [22]. Animal studies are currently underway [23].

Conclusion

It is widely accepted that the use of implant techniques in cancer patients is sometimes essential to ensure functional prosthetic rehabilitation. This retrospective study, which was conducted on patients who had specifically received oral radiotherapy, confirmed that it was a reliable therapeutic treatment for radiation doses of 45–50 Gy. However, the small number of patients in this study prevents the extrapolation of results to larger populations, considering the significant morbidity and lower success rate than patients who were not irradiated. Thus, the inherent risk of a past history of radiotherapy must be taken into account. The use of software like Dentalmaps® [24] allows a better evaluation of the doses received at potential implantation sites. This software is based on the automatic segmentation and delineation of the dental zones, making it possible to estimate the dose received at different points of the dental arch to the nearest 2-Gy fraction. However, the software is expensive, the work is laborious, and this device cannot be routinely used. Considering that health organizations are responsible for the cost management of implants in patients with cancer of UADT, there will be a definite increase in the indications for implantation [25]. It is up to the members present at the multidisciplinary consultation meetings to evaluate the benefit/risk ratio on a case-by-case basis.

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October, 2018|Oral Cancer News|

As HPV-related cancer rates climb, experts scrutinize barriers to HPV vaccination

Source: www.cancertherapyadvisor.com
Author: Bryant Furlow

Oropharyngeal squamous cell carcinomas (SCCs) are now the most commonly diagnosed human papillomavirus (HPV)-associated cancers in the United States, with 15,479 men and 3438 women diagnosed in 2015, according to an analysis by the Centers for Disease Control and Prevention (CDC).1

Between 1999 and 2015, cervical cancer and vaginal squamous cell carcinoma (SCC) rates declined, by 1.6% and 0.6% per year, respectively. But rates for vulvar SCC increased by 1.3% annually during the same period. Anal SCC rates also climbed by approximately 2% a year among men and 3% among women.1

Rates of oropharyngeal SCC — cancers of the throat and tongue — climbed as well, particularly among men (2.7% a year vs 0.8% in women).

All told, more than 43,000 Americans were newly diagnosed with HPV-related cancers in 2015, the analysis showed, up from 30,115 in 1999.1 Most people diagnosed with HPV-associated malignancies are older than 49 years.1 Most women diagnosed with cervical cancer are older than 30 years.1

“We don’t actually know what caused the increase in HPV infections but we know now that we have a safe and effective vaccine that can prevent infections,” said Lois Ramondetta, MD, professor of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center, Houston.

“We’re seeing people who were infected decades ago developing these cancers,” Dr Ramondetta said. “We’ll see rates continue to rise over the coming years because the vaccine wasn’t available before 2006.”

HPV vaccination rates are improving, Dr Ramondetta noted.

Overall, approximately half of adolescents in the United States have completed the HPV vaccine dose-series — well shy of the 2020 herd immunity goal of 80%.

“That’s the overall up-to-date vaccination rates for adolescents aged 13 to 17,” Dr Ramondetta explained. “That’s definitely not where we want it to go but it is 5% higher than last year. If you look at the one-completed-dose vaccine initiation rate, that’s 65.5%.”

HPV vaccination rates are improving more rapidly among boys than girls.

“For some reason, safety is not as big a concern for boys and their parents,” Dr Ramondetta said. “It shouldn’t be a concern at all. This vaccine has been studied more than just about any other vaccine. But if you ask parents why girls are not vaccinating, safety seems to be a concern for some.”

There appears to be less stigma among parents about sons becoming sexually active than there is about the sexual activity of daughters, said Debbie Saslow, PhD, senior director of HPV-related and women’s cancers at the American Cancer Society in Atlanta, Georgia.

Vaccination rates vary geographically, both between countries and within the US. Only a handful of states require that public school students receive the HPV vaccine. Vast expanses of the rural US have few or no pediatricians and limited access to the vaccine.

Australia introduced HPV vaccines at the same time as the US, nearly a decade ago, but Australia achieved 80% vaccination rates in just a year, Dr Saslow said. That was largely because the Australian government paid for the vaccines and they were administered in schools. As a result, this year, Australia changed cervical cancer screening recommendations to reflect the reduced risk: at age 25, women start undergoing HPV testing (rather than pap tests) every 5 years.

That will eventually happen in the US as well, Dr Saslow predicted.

“It’s going to happen but the question is when,” she said. “What will happen is we’ll start screening later, at age 25 and maybe eventually 30, and screening will get away from Pap testing, because Pap tests are not as effective in vaccinated people: they’ll detect a bunch of cervical changes unrelated to cancer. It will all be false positives. We’ll need to go to strictly HPV-based testing” or potentially some new type of screening test, according to Dr Saslow.

In the US, there appear to be socioeconomic or class barriers at play regarding HPV vaccination. Completion rates tend to be higher among more affluent groups, meaning that those who get the first vaccine are more likely to complete the series.

But there’s also a “reverse disparity” in initiating HPV vaccination at all Dr Saslow noted. “Poor and minority kids have higher rates of [the] first dose. Providers might be doing their own risk-based recommendations to parents, which they should not be doing, saying these kids are at higher risk.”

In high-socioeconomic-status urban and suburban communities, vaccine hesitance and prevalent “anti-vax” conspiracy theories may be barriers to vaccination. In rural areas, religious conservativism about sex and sexually transmitted disease — as well as the political climate — are likely factors, Dr Ramondetta added. Rates of HPV vaccination are worse than those for, say, polio or measles, suggesting that hesitance is related to the sexual nature of HPV transmission.

“There’s still a stigma about HPV infection, which is crazy, since most people are exposed,” said Dr Ramondetta. “Normalizing HPV is important — it’s just an aspect of the human condition, like flu.”

“There is ample evidence of the efficacy, safety and durability of this vaccine,” Dr Ramondetta said. “We need to find new ways to educate the public. We can talk to one another all we want in journals but meanwhile, social media is filled with [misinformation] … We need to take a larger role in social media, flooding it with accurate information.”

“Most parents just need reassurance,” she added. “Their motivation is to keep their kids safe.”

Doctors should recommend HPV vaccination every time they see adolescent patients and their parents, Dr Saslow emphasized. And, oncologists need to reach out to family physicians and pediatricians, she said.

References
1. Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB. Trends in human papillomavirus-associated cancers — United States, 1999-2015. MMWR Morb Mortal Wkly Rep. 2018;67(33);918–924.

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October, 2018|Oral Cancer News|

Adam Kay picks the best books about living with cancer

Source: www.theguardian.com
Author: Adam Kay

As Orson Welles so cheerily put it, we are born alone, we live alone and we die alone. But none of us has to struggle through cancer alone, thanks to a vast pool of literature, non-fiction and poetry that tackles the subject.

In C: Because Cowards Get Cancer Too, columnist and self-confessed hypochondriac John Diamond writes with almost unbearable honesty about his fears as he is diagnosed with throat cancer. As he puts it, this is his “attempt to write the book I was looking for the night I got the bad news”, and it explains “what it’s like to be a person with cancer, to deal with the pain and the fear and the anger”. While his feelings vacillate between hope and despair, his dark humour sings through. Taking the reader on a gripping and emotional journey, this account captures the unpalatable but essential truth that not all those living with cancer are “bravely battling” – some are just plain scared. Diamond is one of a handful of writers who can make me snort out loud in public through the magic of their words, and is much missed.

The true story beautifully told by Rebecca Skloot in The Immortal Life of Henrietta Lacks is astonishing. Henrietta was a penniless black tobacco farmer who died in 1951, but whose cervical cells changed the shape of medicine. Taken without permission, cells from her tumour have since been multiplied and shared around the world to advance our understanding of cancer. Skloot’s book was inspired by a science lesson in which her teacher told the class that if they went to almost any cell culture lab in the world and opened its freezers, they might find billions of Henrietta’s cells in small vials on ice. The biography examines how those cells enabled scientists to make advances in fields ranging from cancer and gene mapping to IVF. Skloot confronts issues of racism, poverty, consent and the anguish of Henrietta’s family.

Clive James wrote in this paper about living with late-stage cancer in his weekly column, Reports of My Death. One of his latest (and, he assumed, last) books of poetry, Sentenced to Life, and its surprise sequel, Injury Time, are filled with verses that address the feeling of wanting to live life to its fullest while waiting for death to knock. “Now, not just old, but ill, with much amiss / I see things with a whole new emphasis,” he reflects. In these volumes, he describes his sense of loss, and guilt at leaving behind the people he loves, and draws on his trademark humour.

There are many cancer blogs out there, but to my mind one of the best was The C Word, subsequently turned into a book and a TV series starring Sheridan Smith. Lisa Lynch has a gloriously witty turn of phrase in dealing with the emotional ups and downs of living with breast cancer – or, as she put it, The Bullshit. Made all the more poignant as she died after the book was published, it is no-nonsense, funny, moving and entirely devoid of self-pity.

If we trust the Pulitzer prize panel about this kind of thing, and I suspect we should, then read The Emperor of All Maladies by oncologist Siddhartha Mukherjee. It is an in-depth, but clear and at times poetic depiction of the “lethal, shape-shifting entity” – its past, present and putative future.

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October, 2018|Oral Cancer News|

AN E-CIGARETTE COMPANY PUT VIAGRA AND CIALIS IN ITS VAPING LIQUIDS, AND THE FDA IS NOT PLEASED

Source: newsweek.com
Date: 10/13/18
Author: Kelly Wynne

A vape company, HelloCig Electronic Technology Co., has included Viagra and Cialis in its liquids, and has raised the ire of the Food and Drug Administration.

One liquid was called e-Cialis, a popular erectile dysfunction drug, and was displayed with photos of the real product, according to Ars Technica. A weight loss drug, whose brand was banned in Europe, was allegedly adapted into the liquid form as well, though FDA testing proved it instead contained the erectile dysfunction medication found in Viagra.

The FDA sent a warning letter to HelloCig on Thursday. It urged the company to make the necessary changes to properly market their products and asked they comply with FDA regulations to continue selling any type of drug.

HelloCig alleged they responded to the FDA in a statement sent to USA Today Saturday. “Our aim is to fully comply with all FDA regulations, both in letter and spirit,” the statement read.

The FDA also released a statement, written by FDA Commissioner Scott Gottlieb, on the illegal sale of these liquids on Thursday. “There are no e-liquid products approved to contain prescription drugs or any other medications that require a doctor’s supervision,” the statement read. “Prescription drugs are carefully evaluated and labeled to reflect the risks of the medications and their potential interactions with other medicines, and vaping active drug ingredients is an ineffective route of delivery and can be dangerous.”

Gottlieb considers the e-cigarette usage among teenagers an epidemic, he clarified in a statement last month. “E-cigs have become an almost ubiquitous—and dangerous—trend among teens,” he wrote. “The disturbing and accelerating trajectory of use we’re seeing in youth, and the resulting path to addiction, must end. It’s simply not tolerable. I’ll be clear. The FDA won’t tolerate a whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products.”

HelloCig is based in China but sells vaping products in America. The brand carries over 150 flavors of e-liquid among other products like “e-herbs, e-healthcare and e-beverages smoke liquid.”

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October, 2018|Oral Cancer News|

Oral treatment may not be far off for head and neck cancer patients

Source: app.secure.griffith.edu.au
Author: staff, Griffith University

A highly promising approach to treating HPV-driven head and neck cancer is on the way, and it could be in the shape of a simple oral medication. This is according to new breakthrough research led by Griffith University, which has conducted trials showing that the drug, Alisertib, tested in trials to treat other cancers such as lung and kidney, can also successfully destroy the cancer cells associated with head and neck cancer.

Human Papilloma Virus (HPV) is the main culprit in head, neck and oral cancers. The virus is thought to be the most common sexually transmitted infection (STI) in the world, and most people are infected with HPV at some time in their lives.

The latest trials – which have taken place over the past three years at Griffith’s Gold Coast campus – have shown a particular enzyme inhibitor in the drug, has the ability to prevent proliferation of HPV cancer cells in advanced head and neck cancers.

A 100 per cent success rate
Led by Professor Nigel McMillan, program director from Griffith’s Menzies Health Institute Queensland, the trials have shown a 100 per cent success rate in the drug eradicating the cancerous tumours in animals.

“Head and neck cancers can unfortunately be very difficult to treat, just by the very nature of where they are located in and around the throat, tongue and mouth,” says Professor McMillan.

“This part of the body contains some delicate areas such as the vocal chords and areas relating to speech, taste, smell, saliva etc, therefore there can be some significant side effects with the current treatment options.

“Quality of life is a major consideration in this patient group and therefore a simple oral treatment regimen will have massive benefit over other treatments in terms of reducing some quite drastic side effects.”

In Australia, there are over 5000 new cases of head and neck cancer each year. First line treatments include radiation and surgery (increasingly of the robotic type), followed by chemotherapy, however survival rates of around 70 per cent have remained unchanged for the past 35 years.

Half of all head and neck cancers are known to be caused by the HPV virus, with four times as many men (784) as women (250) estimated to have already died from the disease in Australia during 2018.

In the United States, there are now more cases of head and neck cancer than there are cervical cancer, a disease which is now set to become much more rare in Australia due to the introduction a decade ago of the world-leading national (HPV) vaccination program for schoolchildren.

Professor McMillan says the next step in the research is for the drug to be extended to human trials at the Gold Coast with patients for whom other treatments have so far proved unsuccessful.

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October, 2018|Oral Cancer News|

New risk factor for mouth cancer uncovered

Source: www.medicalnewstoday.com
Author: Tim Newman, fact checked by Paula Field

In some regions, mouth cancer incidence has risen. A recent study investigates a new risk factor for mouth cancer. In certain parts of the world, over the past couple of decades, mouth cancer rates have soared. For instance, in the United Kingdom, rates of mouth cancer have increased by 68 percent. They rose from eight cases per 100,0000 in 1992–1995 to 13 cases per 100,000 in 2012–2014.

In the United States, mouth cancer and mortality rates have declined overall. However, when examined at a state level, the data reveal a more complex picture. For instance, mouth cancer deaths have risen significantly in Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming.

Some known risk factors for mouth cancer include smoking tobacco, drinking alcohol, human papillomavirus (HPV), and chewing betel quid, which is a mix of natural ingredients wrapped in a betel leaf that is popular in some parts of Southeast Asia.

In India, mouth cancers are the most common cause of cancer-related deaths in men aged 30–69 years old. Scientists think that chewing betel quid could be responsible for many of these deaths.

New risk factor for mouth cancer
Although scientists have confirmed some risk factors, there is still much to learn about how and why mouth cancer affects certain individuals and not others. Recently, scientists set out to investigate another potential risk factor: air pollution.

The researchers, funded by the Ministry of Science and Technology in Taiwan, published their findings this week in the Journal of Investigative Medicine.

In particular, the team focused on the impact of fine particulate matter, also known as PM2.5. These are particles of liquid or solid matter that measure 2.5 micrometers in diameter or under. Scientists already knew that PM2.5 has a negative impact on cardiovascular and respiratory health, but they wanted to find out whether exposure to higher levels of PM2.5 might also increase mouth cancer risk.

To investigate, they collated information from 482,659 men aged 40 years old or above. All participants had attended health services and given information about smoking and chewing betel quid.

The scientists next gathered data from 66 air quality-monitoring stations across Taiwan. By referring to the participants’ health records, the scientists could estimate each person’s exposure to PM2.5.

Risk increased by 43 percent
The researchers collected the data in 2012–2013. During this time, 1,617 men developed mouth cancer. As expected, both tobacco smoking and chewing betel quid increased mouth cancer risk. After taking a range of influencing factors into account, the scientists demonstrated that exposure to PM2.5 also increased mouth cancer risk.

The scientists compared PM2.5 levels of below 26.74 micrograms per cubic meter (ug/m3) with those above 40.37 ug/m3. They associated the higher levels of PM2.5 with a 43 percent increase in the risk of developing mouth cancer. According to the authors:

“This study, with a large sample size, is the first to associate mouth cancer with PM2.5. […] These findings add to the growing evidence on the adverse effects of PM2.5 on human health.”

Alongside PM2.5’s relationship with mouth cancer, the authors identified a correlation between higher levels of ozone and an increased risk of developing the disease.

The next challenge will be to understand how particulate matter might cause mouth cancer. Although this will require more detailed studies, some theorize that carcinogenic compounds found in PM2.5, including polycyclic aromatic hydrocarbons and heavy metals, might be part of the answer.

Because these particles have such a small diameter, the body absorbs them relatively easily, potentially causing damage as they travel through the body.

However, the authors also remind us to be cautious — this is an observational study, so it cannot definitively prove that pollution causes mouth cancer. Also, it is not clear exactly how much PM2.5 enters the mouth.

This interaction needs further investigation, but the large size of the current study makes their conclusions worthy of follow-up.

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October, 2018|Oral Cancer News|