Oral Cancer News

Head and neck cancer: An overview of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Welcome to this CURE Connections® program titled “Head and Neck Cancer: Through the Eyes of a Patient.” I’m Meryl Kaufman, a certified speech-language pathologist and founder of Georgia Speech and Swallowing LLC. I am joined today by Dr. Itzhak Brook, a professor of pediatrics and medicine at Georgetown University School of Medicine, who was diagnosed with throat cancer in 2006. Together we will discuss the prevalence of head and neck cancer, what unique challenges patients may face and how one can adjust to life after receiving treatment for their disease. Dr. Brook and I also serve as board members on the Head and Cancer Alliance.

Dr. Brook, let’s talk about head and neck cancer in general. What’s the difference between head and neck cancer associated with the traditional risk factors, such as smoking and drinking, and HPV-related head and neck cancers?

Itzhak Brook, M.D., M.Sc.: The traditional head and neck cancer is related to smoking and alcohol consumption. It’s usually associated with a high rate of laryngeal cancer. And HPV-related cancer is a relatively new arrival on the scene of head and neck cancer, and it’s associated with a condition of infection by a venereal disease. The virus HPV is usually associated with a posterior tongue cancer or an oropharyngeal cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly, yes. So the HPV viruses typically in the oropharynx, the tonsil and the tongue basis are certainly rising in incidence as compared with the traditional head and neck cancers, which are decreasing in incidence. In fact, it’s anticipated that in the year 2020, the HPV-related oropharyngeal cancers are going to surpass HPV-related cervical cancers, which are typically what you think of with the HPV virus. So that is a new patient population, but the good news is that the survival rates are better for the HPV-related head and neck cancers versus the non-HPV-related cancers. Can you speak a little bit about the incidence of the two?

Itzhak Brook, M.D., M.Sc.: The incidence of head and neck cancer is not as high as others like colon cancer, breast cancer in women or lung cancer, but it’s around the ninth or 10th cause of cancer in the world in this country. In countries where there is smoking and alcohol consumption, it’s a higher rate. HPV is usually happening in younger people, in the late 30s or early 40s. And fortunately, we hope that it could be prevented by vaccination. Although it’s approved that it can, it’s not yet available because the incubation period for the cancer, as you may call it, takes 20, 30 years, so we don’t really know. Fortunately, even though HPV is very common, the occurrence of HPV-related cancer is very, very rare.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Correct. In terms of the vaccination for the HPV virus, I agree, the proof certainly isn’t definitively out there yet, but the vaccine protects against the strain of virus that ultimately can lead to head and neck cancer. So the thought is that by preventing the contraction of the virus, hopefully we can also prevent these head and neck cancers, which is why the American Academy of Pediatrics and the CDC (Centers for Disease Control and Prevention) recommend that children between the ages of 11 and 12, female and males, are vaccinated prior to sexual debut in the hopes of preventing these cancers down the road, certainly. So yes, head and neck cancer does account for about 6 percent of all cancers worldwide, with about 500,000 cases worldwide. And in the United States, we anticipate about 65,000 a year, I believe, and they do occur more frequently in men, almost twice as often in men than in women and typically in people over the age of 50 in the traditional head and neck cancers. But certainly, there is a change in that with the introduction of the HPV-related cancers. Can you talk a little bit about prevention in terms of things that we can do to prevent the risky behaviors?

Itzhak Brook, M.D., M.Sc.: Of course, with the traditional cancers, it can be prevented by not smoking or drinking alcohol in high quantities. But there’s the behavioral changes that men and women can change that can reduce the risk of acquiring it. It’s a sexually transmitted disease. Oral sex has been the No. 1 cause, so you think of condoms or men using them also when having oral sex may prevent it.

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September, 2018|Oral Cancer News|

Head and neck cancer: Novel treatment approaches

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, traditionally the treatment for head and neck cancer has been surgery, radiation, chemotherapy or some combination of those three. But there are some new and emerging treatment approaches to head and neck cancer along with many other cancers. Can you tell us a little bit about immunology? What is immunotherapy in the care of the head and neck cancer patient?

Itzhak Brook, M.D., M.Sc.: Most days, we don’t get cancer because our immune system is like the police department of our body. They detect cancer early and eliminate it. Unfortunately, in the case of cancer, the cancer cells can fool the immune system, and they go undetected and cause the disease. The main advantage of immunotherapy is that we are using the body’s defenses, the immune system, to kill the cancer in a much better way than the chemotherapy. Chemotherapy destroys the cancer cells, but it also affects the body cells. Immunotherapy is more precise. It is directed only to the cancer cells, so the rest of the body stays unscathed. That’s the beauty of immunotherapy. So, immunotherapy is an evolving field in cancer. They have many, many new drugs in the pipeline, and many studies are being done. But right now, there are several drugs that are good and seem to help in a patient with cancer, cancer that has already spread or that surgery cannot reach. The body’s own immunity would reach it.

One of them is monoclonal antibodies that were developed specifically for the cancer cells, and the other one is checkpoint inhibitors, which overcome the attempt by the cancer cells to fool the immune system and protect the cancer cells from their own immunity. So, by blocking those checkpoints, the body’s own immunity comes in and destroys the cancer cells. Those drugs are very promising because first of all, they are more effective in getting only the cancer cells. They do cause fewer side effects, and we are hopeful that they would be the new armamentarium that we will have for head and neck cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: So, would you say that’s something you should ask your physician about to find out what clinical trials and what types of medications are offered for your specific type of cancer at the time of diagnosis?

Itzhak Brook, M.D., M.Sc.: Absolutely, and that is depending on your own illness, on the seriousness or stage of the illness. And your physician would be able to consult the right specialist to tailor the specific treatment for you, and that’s very important because now we have a new tool that can augment the chemotherapy. And many of those treatments are given in combination. Conventional treatment with chemotherapy plus immunotherapy seems to work very well in many patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. The future is exciting in that regard. In the case of the HPV-positive oropharyngeal cancers, there has also been a lot of interest and push toward robotic surgery in caring for that patient population. I know that that’s not for everybody, and it’s more suited for some of the smaller tumors because of the side effects that might go along with it. What is your understanding of the role of robotic surgery in the care of head and neck cancer patients?

Itzhak Brook, M.D., M.Sc.: Robotic therapy is an amazing new procedure. It’s being done using the robotic tools that are able to do the surgery in a much less invasive way without traumatizing many of the normal tissues of the body. They cause less damage. The recovery period is shorter, and patients benefit from it tremendously. In that procedure, there is a robotic machine that the surgeon operates, and it allows very, very precise ability to cut the cancer out, and it does cause less long-term damage to the tissues and less deformity, you may say. And that’s a wonderful tool. But unfortunately, as you said, it is limited to areas of the body that the robot can reach. And when the cancer is in places that are not reachable by the robotic approach, one needs to use the conventional approach. But even in that area, there is a development of using endoscopic surgery where one can use a laser and the endoscopic approach, or the laser can kill or burn out the cancers that are more deeply located in the throat, again saving major surgery and even saving removal of the larynx from patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s right. And also, there’s a push toward de-escalation of the radiation and the chemotherapy in some of these HPV-positive patients, as well, because the tumors are more responsive to the treatment. So, there are many studies going on looking at whether we can do less treatment for the different types of diseases. As you spoke earlier, I think finding the right specialists is important; not everybody is a specialist in all these new and advanced technologies. If you’re looking for robotic surgery, find that specialist that really does a lot of robotic surgery and is an expert in that field. The same is true for the immunotherapy and other treatment approaches as well. So, I think being your own advocate, again, to find these different alternative options and these new treatments in clinical trials becomes exceedingly important in the age of all these new discoveries.

Itzhak Brook, M.D., M.Sc.: Fortunately, the knowledge of experience in those procedures, the laser and the robotic surgery, is becoming more prevalent in the United States. And when I had my cancer, when I needed to make choices 10 years ago, there were only a handful of experts. But right now, almost every major medical center has an expert in those fields, so it’s more available for people.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. So, even if you have to travel a distance to get to those major medical centers, it’s worth the effort and travel and time to be able to seek these other opinions and see what your other options are before pursuing your treatment.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes, I agree.

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September, 2018|Oral Cancer News|

Head and neck cancer: Getting a diagnosis of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss which symptoms should lead one to seek a diagnosis of head and neck cancer and which tests are available to aid in evaluation.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: When we talk about the HPV-related cancers, those are primarily in the oropharynx, which is the tongue base and the tonsil. But the traditional cancers typically can also involve the tongue, the lips, the floor of the mouth, the jaw, the gums and the hard palate. And the pharynx; that includes the nasopharynx behind the nose. We’ve addressed the oropharynx but also the hypopharynx, near the larynx. And in your case, laryngeal cancer that involves the larynx, the voice box, and the epiglottis. So, head and neck cancers can occur in any of those places. Can you talk about some of the signs and symptoms people can look out for in those areas?

Itzhak Brook, M.D., M.Sc.: Well, the important signs that are common to oral cancers are having a sore throat, a feeling that you cannot swallow and difficulty in swallowing. In advanced stages, it can interfere with breathing. If you have increased lymph glands in the neck and are also feeling like a lump or something is stuck in your mouth, those could be a sign. Sometimes they have symptoms such as pain in the ear or pain in the throat. And there are specific cancers such as sinuses and lips. If there is an area of the mouth where there’s a red or ulcerating lesion in the oropharynx, this can indicate that there is a cancer risk.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. Can you talk about your initial presentation? What symptoms did you experience?

Itzhak Brook, M.D., M.Sc.: I experienced something stuck in my mouth, and when it didn’t go away after a week or so, I went to see my doctors, and they discovered it very early. And I was fortunate that it was possible to remove it by a simple biopsy. And then, unfortunately for me, even though I got radiation, the cancer came back about a year and a half later, and I required a laryngectomy to remove the cancer because it had moved to other places, the throat. And that was a way to treat it initially, but being vigilant and recognizing early that there’s something wrong, something is happening, can definitely save many lives.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And quality of life, right?

Itzhak Brook, M.D., M.Sc.: Right.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: What were some of the tests exactly that you underwent in trying to find this cancer and making a diagnosis?

Itzhak Brook, M.D., M.Sc.: Well, I got obviously the most important thing, which was to have a good otolaryngological examination with endoscopy, where they put the tube into your throat or through the nose to try to detect and see what’s going on through direct examination. The other tests that I am aware of are MRI and then CT. But the most important thing in my case was a good physical examination because in my case, the MRI and CT didn’t show anything wrong because you need the cancer to be larger than about a half an inch, and mine wasn’t yet. So, seeing your doctor is the most important thing a person can do to catch the cancer early.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. And one of the things the Head and Neck Cancer Alliance does and promotes is free screenings throughout the country and throughout the world. And traditionally, the Head and Neck Cancer Alliance has done that during oral head and neck cancer awareness week, which occurs in April every year. But there has been a push in the past couple of years to really spread that out throughout the year and help raise awareness to these signs and symptoms that you addressed, as well as direct patients to facilities that can provide a screening. And a screening is simple and easy, and it does involve a physical examination—feeling the neck, looking for signs and symptoms and talking about signs and symptoms. So. certainly, if any listeners were to identify any of these risk factors that you address, such as a change in swallowing, a change in voice, a lump in the neck, pain in the ear or difficulty breathing, then certainly looking to some of these screening sites or reaching out to your doctor is a good way to really find those cancers early and help minimize the intensity of the treatment that might result.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. And in terms of staging head and neck cancers, one of the important pieces of that work-up when you had the endoscopy and the scans was to come up with a TNM stage for that head and neck cancer that really kind of directs the treatment. Part of that also is being evaluated by a multidisciplinary team, and I think it’s really important in the management of head and neck cancer that there are multiple specialists, including the otolaryngologist, who’s often the first person to make the diagnosis. But a team of specialists, including radiation oncologists, hematology, oncology, speech pathology, nutrition, social work and pathology—there are so many professionals involved. Was there a multidisciplinary team involved in your care?

Itzhak Brook, M.D., M.Sc.: Yes. Fortunately, I had been examined by all those experts. In addition to it, I also, when I finally had the laryngectomy, met and represented several patients who wanted and got that procedure, and meeting them prepared me more than anything else in our life for what a laryngectomy would be.

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September, 2018|Oral Cancer News|

Cancer biology graduate student travels ‘ROCKy’ road toward a cure for post-radiation dry mouth

Source: medicalxpress.com
Author: staff, University of Arizona

The United States is in the midst of a head-and-neck cancer epidemic. Although survival rates are relatively high—after treatment with chemotherapy and radiation—survivors can suffer permanent loss of salivary function, potentially leading to decades of health problems and difficulties eating.

It is unknown why the salivary gland sometimes cannot heal after radiation damage, but Wen Yu “Amy” Wong, BS, a University of Arizona cancer biology graduate student, may have taken a step toward solving that riddle.

Radiation often comes with long-term or even permanent side effects. With a head-and-neck tumor in radiation’s crosshairs, the salivary gland might suffer collateral damage.

“When you get radiation therapy, you end up targeting your salivary glands as well,” Wong said. Losing the ability to salivate predisposes patients to oral complications and an overall decrease in their quality of life. “Salivary glands help you digest food, lubricate your mouth and fight against bacteria. After radiation, patients could choke on their food because they can’t swallow. They wake up in the middle of the night because their mouth is so dry. They often get cavities.”

Favorite foods may lose their flavor. “Saliva produces certain ions that help you taste,” she said. “Patients lose the ability to enjoy food. The best steak is very bland to them.”

The quest to restore salivary function in post-radiation head-and-neck cancer patients starts with learning why the salivary gland is unable to heal itself after radiation damage.

Wong’s study may have helped to unravel this mystery. Her team looked closely at two proteins, E-cadherin and β-catenin, which allow communication between cells. Normally, these proteins bind cells together, but after radiation damage, these connections are severed. “Think of them as telephone wires,” Wong said. “Radiation is like lightening hitting a telephone pole. That breaks the ability of one friend to talk to another on the other side of the city.”

Just as a maintenance crew can repair downed telephone poles after a storm, the body is able to heal itself after injury. Unfortunately, in post-radiation dry mouth, salivary glands’ ability to regenerate might be blocked.

In the lab, Wong was able to artificially force the regeneration of salivary glands, allowing her to learn where there are obstructions in the regeneration process. Wong particularly was interested in something called the ROCK pathway, which might go awry in the wake of radiation, blocking E-cadherin and β-catenin from reuniting.

“If I use an inhibitor to prevent this ROCK signaling pathway, these two proteins come back together,” Wong said.

The next step is to learn more about how a defective ROCK pathway blocks salivary glands’ natural ability to regenerate following radiation damage. Unlocking this secret could uncover novel ways to treat or cure post-radiation dry mouth.

Earlier this month, Wong and her co-authors were recognized by the American Physiological Society for their investigation, which was published in June by the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology. Wong, along with Maricela Pier, BS, a research specialist with the UA College of Medicine—Tucson Department of Cellular and Molecular Medicine, and Kirsten Limesand, Ph.D., of the UA Cancer Center and professor of nutritional sciences with the UA College of Agriculture and Life Sciences, was selected for the APSselect award, given to the best articles in physiological research.

Wong selected Dr. Limesand’s lab as her “home base” throughout her graduate studies because “I wanted to connect with a woman in science who understands the difficulties. She was very easy to talk to, and the people in the lab provide a very nurturing environment. She is a great mentor.”

Dr. Limesand takes her role as a mentor seriously, and finds it deeply satisfying.

“Hands down, the most rewarding aspect of my career is training students,” Dr. Limesand said. “They’re our next generation of scientists, tackling the big questions that need to be solved.”

Dr. Limesand is a professor with the UA Cancer Biology Graduate Interdisciplinary Program, which emphasizes translational research to address significant problems relating to cancer development and treatment. Students are prepared for careers in cancer research through an interdisciplinary approach involving faculty members from a wide range of disciplines.

“I have students from cancer biology and physiological sciences, and I’ve been on committees of genetics students and immunobiology students,” said Dr. Limesand. “These diverse perspectives add to the research we’re doing.”

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August, 2018|Oral Cancer News|

How early do the effects of smoking start? Earlier than you think

Source:
Author: Julia Mullaney

Smoking’s destructive nature has been known for quite a while. But many people think that a cigarette here and there is okay, or smoking is fine as long as you quit while you’re young. But what’s the truth? How much — and for how long — do you need to smoke before it does irreversible damage to your health? We broke down all the facts.

Put out the cigarette and prolong your life. BrianAJackson/Getty Images

Smoking’s negative effects start with the first puff
The moment you inhale a cigarette, there are instant effects — even if it’s only your first time. The tar in cigarette smoke instantly hits your teeth and starts damaging your enamel. It also hits the gums and starts to do damage. Over time, the gums turn black.

The smoke then hits the throat, where it damages the esophagus lining. In time, this is what leads to throat cancer. It also damages the cilia in your trachea, preventing them from being able to clean away the tar. The smoke then travels to the lungs, where the tar builds up and stays. The tar damages the lungs’ natural cleaning process, which hurts lungs’ ability to work and makes them more susceptible to serious infections.

Finally, inhaling that puff of smoke also means inhaling carbon monoxide, which gets absorbed in the blood stream instantly. You might feel tired and out of breath, and over time this leads to heart disease because it takes away the oxygen that is supposed to travel through your cells and replaces it with carbon monoxide. The nicotine in the cigarette also travels to your brain, which releases “feel good” dopamine and makes you want more. And so the smoking addiction begins.

Smoking’s lasting effects can begin as early as your teen years
In a 2018 study, it was found that teens who smoke and drink alcohol already showed signs of stiffening arteries — something that can lead to serious heart trouble down the road. If you begin smoking as a teen, you don’t even make it out of your teen years before the body starts to be seriously damaged. Smoking and drinking at a young age leads to the progression of atherosclerosis, which occurs when plaque forms on the inner walls of the arteries. Eventually, you might suffer a heart attack, heart disease, and heart failure.

If you start smoking before 25, your lungs will never fully develop
The lungs don’t fully develop until around age 25. If you start smoking as a teen, they never get the chance to reach full size because of the damage caused by cigarettes. Even if you quit, your lungs won’t magically get bigger. However, if you don’t begin smoking until your lungs are fully developed, you can at least reverse most of the damage done to the lungs — but that also depends at what age you quit. According to Thrillist, in order to cut your risk of smoking-related death by 90%, you need to stop smoking before you turn 40. However, the sooner the better.

Smoking for less than one week can inhibit your lungs’ performance
It doesn’t take long for smoking’s effects to damage the body. Actually, it only takes about five to seven days. Since a cigarette fills your lungs with dangerous chemicals, the lungs can’t make a full recovery. And if you keep smoking — say, a few times per day — the lungs never have a chance to get rid of the gunk that filled them. After just a little while, those chemicals will harbor in the lungs and cause lasting damage. Plus, they can lead to various cancers.

But quitting still outweighs not quitting, despite the lasting effects
While the lungs of a smoker will never as healthy as smokeless lungs, the benefits of quitting greatly outweigh not quitting. Your body does have the ability to bounce back. After being smoke-free for just six hours, the carbon monoxide levels in your body decline and the heart starts to function more normally. After a couple of months, your lung function can improve by up to 30%, and you won’t have the horrid cough you’ve had for years. After nine months, your heart is almost totally out of the danger zone (this does depend on age, though). Over time, the body rebuilds itself and heals the damage.

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August, 2018|Oral Cancer News|

DCD: Oropharyngeal squamous cell carcinoma now and most common HPV associated with cancer

In 2015, oropharyngeal squamous cell carcinoma surpassed cervical cancer as the most common HPV-associated cancer in the U.S., with 15,479 cases among men and 3,438 cases among women, according to data from the CDC published in Morbidity and Mortality Weekly Report.

The report also showed that rates of HPV-related anal squamous cell carcinoma and vulvar cancer increased over the past 15 years, whereas rates of HPV-related cervical cancer and vaginal squamous cell carcinoma decreased.

“Although smoking is a risk factor for oropharyngeal cancers, smoking rates have been declining in the United States, and studies have indicated that the increase in oropharyngeal cancer is attributable to HPV,” Elizabeth A. Van Dyne, MD, epidemic intelligence services officer in division of cancer prevention and control at the National Center for Chronic Disease Prevention and Health Promotion of the CDC, and colleagues wrote.

“In contrast to cervical cancer, there currently is no U.S. Preventive Services Task Force recommended screening for other HPV-associated cancers,” they added.

The trends in HPV-related cancers report included data from 1999 to 2015 from cancer registries — CDC’s National Program of Cancer Registries and NCI’s SEER program — covering 97.8% of the U.S. population.

The CDC reported 30,115 new cases of HPV-associated cancers in 1999 compared with 43,371 new cases in 2015.

During the study period, researchers observed a 2.7% increase in rates of oropharyngeal squamous cell carcinoma among men and a 0.8% increase among women. Rates of anal squamous cell carcinoma increased by 2.1% among men and 2.9% among women.

Among women, researchers observed a 1.6% decrease in HPV-related cervical cancer and a 0.6% decrease in rates of HPV-related vaginal squamous cell carcinoma. Rates of vulvar squamous cell carcinoma increased by 1.3%.

Rates of penile squamous cell carcinoma remained stable from 1999 to 2015.

Overall, rates of HPV-related cancers varied by age and race/ethnicity.

Researchers observed a 4% increase in the rate of oropharyngeal squamous cell carcinoma among men aged 60 to 69 years compared with a 0.8% increase among men aged 40 to 49 years.

For anal squamous cell carcinoma, the largest increases occurred among women aged 50 to 69 years (4.6% to 4.8%) and men aged 50 to 59 years (4%).

Several factors contribute to the increased incidence of oropharyngeal and anal squamous cell carcinomas, including changes in sexual behavior.

“Unprotected oral sex and receptive anal sex are risk factors for HPV infection,” the researchers wrote. “White men have the highest number of lifetime oral sex partners and report first performing oral sex at a younger age compared with other racial/ethnic groups; these risk factors could be contributing to a higher rate of oropharyngeal squamous cell carcinoma among white men than other racial/ethnic groups.”

Cervical cancer rates remained stable among women aged 35 to 39 years; however, younger and older woman demonstrated decreases ranging from 1.2% to 4.2%.

Cervical carcinoma rates decreased across all racial/ethnic groups, although decreases appeared more prominent among Hispanics than non-Hispanics (3.4% vs. 1.5%).

“The decline in cervical cancer from 1999 to 2015 represents a continued trend since the 1950s as a result of cancer screening,” the researchers wrote. “Rates of cervical carcinoma in this report decreased more among Hispanics, American Indian/Alaska Natives and blacks than other groups; however, incidence rates were still higher among Hispanics and blacks than among whites in 2015. These persistent disparities in incidence suggest that health care delivery needs of some groups are not fully met.”

The limitations of the report included the fact that the cancer registries do not routinely determine the HPV status of cancers and that race/ethnicity data was derived from medical records.

“Further research to understand the progression from HPV infection to oropharyngeal cancer would be beneficial,” the researchers wrote. “Continued surveillance through high-quality registries is important to monitor changes in HPV-associated cancer incidence.” – by Cassie Homer

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August, 2018|Oral Cancer News|

E-cigarettes ‘could give you mouth cancer by damaging your DNA’

Source: metro.co.uk
Author: Zoe Drewett

Researchers say vaping could lead to an increased risk of developing mouth cancer. A study carried out by the American Chemical Society found evidence to suggest using e-cigarettes raises the level of DNA-damaging compounds in the mouth. If cells in the body are unable to repair the DNA damage after vaping, the risk of cancer can increase, the study claims.

The long-term effects of e-cigarettes are not yet known but researchers say they should be investigated further (Picture: PA)

The researchers admit the long-term health effects of using electronic cigarettes are still unknown. Researcher Dr Romel Dator said: ‘We want to characterize the chemicals that vapers are exposed to, as well as any DNA damage they may cause.’

Since they were introduced in 2004, e-cigarettes have been marketed as a safer alternative to smoking. But the team carrying out the study claim genetic material in the oral cells of people who vape could be altered by toxic chemicals. E-cigarettes work by heating a liquid – which usually contains nicotine – into an aerosol that the user inhales. It is often flavoured to taste like fruit, chocolate or bubblegum.

‘It’s clear that more carcinogens arise from the combustion of tobacco in regular cigarettes than from the vapor of e-cigarettes,’ Silvia Balbo, the project’s lead investigator said. ‘However, we don’t really know the impact of inhaling the combination of compounds produced by this device. ‘Just because the threats are different doesn’t mean that e-cigarettes are completely safe.’ The latest study, due to be presented at a meeting of the American Chemical Society this week, analysed the saliva and mouth cells of five e-cigarette users before and after a 15-minute vaping session.

Researchers found levels of the toxic chemicals formaldehyde, acrolein and methylglyoxal had increased after vaping. Now they plan to follow up on the preliminary study with a larger one involving more e-cigarette users. They also want to see how the level of toxic chemicals differs between e-cigarette users and regular cigarette smokers.

According to a 2016 report by the US Surgeon General, 13.5% of middle school students, 37.7% of high school students and 35.8% of 18 to 24-year-olds have used e-cigarettes, compared with 16.4% of adults aged 25 and over. Ms Balbo, a professor at the Masonic Cancer Center at the University of Minnesota, said:

‘Comparing e-cigarettes and tobacco cigarettes is really like comparing apples and oranges.  The exposures are completely different. ‘We still don’t know exactly what these e-cigarette devices are doing and what kinds of effects they may have on health, but our findings suggest that a closer look is warranted.’

 

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August, 2018|Oral Cancer News|

Why a patient paid a $285 copay for a $40 drug

Source: pbs.org
Author: Megan Thompson

Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help manage her blood pressure.

Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.

The copay for a 90-day supply was $285, which seemed high to Ma.

“I couldn’t understand it — it’s a generic,” said Ma. “But it was a serious situation, so I just got it.”

A month later, Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication. Because 90 days hadn’t yet passed, Anthem wouldn’t cover it. So during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.

The pharmacist told him it would cost about $40.

“I was very shocked,” said Ma. “I had no idea if I asked to pay cash, they’d give me a different price.”

Ma’s experience of finding a copay higher than the cost of the drug wasn’t that unusual. Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics.

USC researchers analyzed 9.5 million prescriptions filled during the first half of 2013. They compared the copay amount to what the pharmacy was reimbursed for the medication and found in the cases where the copay was higher, the overpayments averaged $7.69, totaling $135 million that year.

USC economist Karen Van Nuys, a lead author of the study, had her own story of overpayment. She discovered she could buy a one-year supply of her generic heart medication for $35 out of pocket instead of $120 using her health insurance.

Van Nuys said her experience, and media reports she had read about the practice, spurred her and her colleagues to conduct the study. She had also heard industry lobbyists refer to the practice as “outlier.”

“I wouldn’t call one in four an ‘outlier practice,’” Van Nuys said.

“You have insurance because your belief is, you’re paying premiums, so when you need care, a large fraction of that cost is going to be borne by your insurance company,” said Geoffrey Joyce, a USC economist who co-authored the study with Van Nuys. “The whole notion that you are paying more for the drug with insurance is just mind boggling, to think that they’re doing this and getting away with it.”

Joyce told PBS NewsHour Weekend the inflated copays could be explained by the role in the pharmaceutical supply chain played by pharmacy benefit managers, or PBMs. He explained that insurers outsource the management of prescription drug benefits to pharmacy benefit managers, which determine what drugs will be covered by a health insurance plan, and what the copay will be. “PBMs run the show,” said Joyce.

In the case of Express Scripts, the company manages pharmacy benefits for insurers and also provides a prescription mail-delivery service.

Express Scripts spokesperson Brian Henry confirmed to PBS NewsHour Weekend the $285 copay that Ma paid in 2016 for his wife’s telmisartan was correct, but didn’t provide an explanation as to why it was so much higher than the $40 Costco price. Henry said that big retailers like Costco sometimes offer deep discounts on drugs through low-cost generics programs.

USC’s Geoffrey Joyce said it is possible that Costco negotiated a better deal on telmisartan from the drug’s maker than Express Scripts did, and thus could sell it for cheaper. But, he said, the price difference, $285 versus $40, was too large for this to be the likely explanation.

Joyce said it is possible another set of behind-the-scenes negotiations between the pharmacy benefit managers and drug makers played a role. He explained that drug manufacturers will make payments to pharmacy benefit managers called “rebates.”

Rebates help determine where a drug will be placed on a health plan’s formulary. Formularies often have “tiers” that determine what the copay will be, with a “tier one” drug often being the cheapest, and the higher tiers more expensive.

Pharmacy benefit managers usually take a cut of the rebate and then pass them on to the insurer. Insurers say they use use the money to lower costs for patients.

Joy said a big rebate to a pharmacy benefit manager can mean placement on a low tier with a low copayment, which helps drives more patients to take that drug.

In the case of Ma’s telmisartan, Express Scripts confirmed to PBS NewsHour Weekend that the generic drug was designated a “nonpreferred brand,” which put it on the plan’s highest tier with the highest copay.

Joyce said sometimes pharmacy benefit managers try to push customers to take another medication for which it had negotiated a bigger rebate. “It’s financially in their benefit that you take the other drug,” said Joyce. “But that’s of little consolation to the person who just goes to the pharmacy with a prescription that their physician gave them.”

But Joyce said the pharmacy benefit managers also profit when collecting copays that are higher than the cost of the drug.

In recent years, the industry has taken a lot of heat from the media and elected officials over a controversial practice called “clawbacks.” This happens when a pharmacist collects a copay at the cash register that’s higher than the cost of the drug, and the pharmacy benefit manager takes most of the difference.

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August, 2018|Oral Cancer News|

Smoking, cancer, heart disease, and the oral-systemic link: Where we are with research

Source: www.dentistryiq.com
Author: Richard H. Nagelberg, DDS

Dr. Richard Nagelberg examines the links between smoking, lung cancer, and heart disease, as well as the types of research and studies that established the strength of their credibility over time. Likewise, he considers where we are today with the link between oral health and overall health as he evaluates the current state of oral-systemic research.

Perhaps the most universally accepted facts in health care are the detrimental effects of tobacco, particularly cigarette smoking, for nearly every part of the body. It is safe to say that no one disputes the direct causal links between cigarette smoking, lung cancer, and heart disease. Listed below are only two statements regarding the state of this knowledge.

✔️The scientific evidence is incontrovertible: inhaling tobacco smoke, particularly from cigarettes, is deadly. Since the first Surgeon General’s Report in 1964, evidence has linked smoking to diseases of nearly all organs of the body. (surgeongeneral.gov. June 21, 2018)

✔️Smoking is by far the biggest preventable cause of cancer. Thanks to years of research, the links between smoking and cancer are now very clear. Smoking accounts for more than 1 in 4 UK cancer deaths, and 3 in 20 cancer cases. (cancerresearchuk.org)

There is a boatload of research supporting this link. However, there has never been one large-scale double-blinded interventional study demonstrating that smoking causes lung cancer and heart disease. The fact that this link exists is based on the cumulative results of numerous smaller studies over a long period of time.

The reasons are the same for the lack of large-scale interventional studies investigating the link between smoking, lung cancer, and heart disease, among others, as well as that between the mouth and the body. These studies are too costly and full of variables that are difficult to control in a study spanning 20 years or more. It is the cumulative results of research that will demonstrate the strength of the link between oral health and overall health, rather than one definitive piece of research.

While the risks of smoking were being investigated, there were naysayers who doubted the emerging results. In fact, there was substantial skepticism within the medical community about whether the apparent increase in cancer deaths was real or the result of better diagnosis. The study that is credited with the beginning of the stop-smoking movement was published in 1954 by Hammond and Horn. Their paper ended with: “[we are of the opinion that the associations found between regular cigarette smoking and death rates from diseases of the coronary arteries and between regular cigarette smoking and death rates from lung cancer reflect cause and effect relationships.]” (1)

At present, we are in the middle of the oral-systemic research, waiting until a sufficient body of research provides incontrovertible evidence one way or the other.

Reference
1. Hammond EC, Horn D, The relationship between human smoking habits and death rates: a follow-up study of 187,766 men. J Am Med Assoc. 1954;155(15):1316-1328.

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August, 2018|Oral Cancer News|

Study: Cetuximab, radiation inferior to standard HPV throat cancer treatment

Source: upi.com
Author: Allen Cone

Treating HPV-positive throat cancer with cetuximab and radiation had worse overall and progression-free survival results compared with the current method of treatment with radiation and cisplatin, the National Institutes of Health revealed Tuesday.

The trial, which was funded by the National Cancer Institute, was intended to test whether the combination would be less toxic than cisplatin but be just as effective for human papillomavirus-positive oropharyngeal cancer. The trial, which began in 2011, enrolled 849 patients at least 18 years old with the cancer to receive cetuximab or cisplatin with radiation. The trial is expected to finish in 2020.

Cetuximab, which is manufactured under the brand name Erbitux by Eli Lilly, and cisplatin, which as sold as Platinol by Pfizer, are used in chemotherapy.

The U.S. Food and Drug Administration had approved cetuximab with radiation for patients with head and neck cancer, including oropharyngeal cancer.

HPV, which is transmitted through intimate skin-to-skin contact, is the leading cause of oropharynx cancers, which are the throat at the back of the mouth, including the soft palate, the base of the tongue and the tonsils. Most people at risk are white, non-smoking males age 35 to 55 — including a 4-to-1 male ratio over females — according to The Oral Cancer Foundation.

The NIH released the trial results after an interim analysis showed that cetuximab with radiation wasn’t as effective.

In a median follow-up of 4.5 years, the test combination was found to be “significantly inferior” to the cisplatin method.

“Clinical trials designed to test less toxic treatment strategies for patients without compromising clinical benefit are a very important area of interest for NCI and the cancer research community,” said Dr. Shakun Malik, of NCI’s Division of Cancer Treatment and Diagnosis.

Toxic side effects were different, with adverse events of renal toxicity, hearing loss and bone marrow suppression more common in patients in the cisplatin group and body rash more frequent in the cetuximab method.

For patients who cannot tolerate cisplatin, cetuximab with radiation is an accepted standard of care.

“The goal of this trial was to find an alternative to cisplatin that would be as effective at controlling the cancer, but with fewer side effects,” lead investigator Dr. Andy Trotti, of the Moffitt Cancer Center in Tampa, Fla., said in a press release. “We were surprised by the loss of tumor control with cetuximab.”

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August, 2018|Oral Cancer News|