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  • Alcohol drinking in never-tobacco users and cigarette smoking in never drinkers: pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium

    Fri, Oct 10, 2014

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    Source: http://cancerres.aacrjournals.org
    Authors: Paolo Boffetta, Mia Hasibe & On Behalf Of INHANCE Consortium
     

    Abstract: Cigarette smoking and alcohol drinking account for at least 75% of head and neck cancers. A precise understanding of the independent effect of each of these factors in the absence of the other has important implications, in terms of elucidating the mechanisms of head and neck carcinogenesis and assessing the effect of interventions aimed to control either risk factor.We determined the extent to which head and neck cancer is associated with cigarette smoking among never-drinkers and alcohol drinking among never-tobacco users. We pooled individual-level data across 15 individual case-control studies including 10,244 head and neck cancer cases and 15,227 controls.There were 1,072 cases and 5,775 controls who never used tobacco, and 1,598 cases and 4,051 controls who never drank alcohol. Cigarette smoking increased the risk of head and neck cancers [odds ratio (OR)=2.10, 95% confidence interval (CI) 1.49-2.95] among never-drinkers, with clear dose-response relationships for frequency, duration and packyears of cigarette smoking. Approximately 24% of head and neck cancer cases among non-drinkers would have been prevented if these individuals had not smoked cigarettes. Among never-tobacco users, an increasing risk of head and neck cancer was detected for increasing alcohol drinking frequency (p for trend<0.001), but the effect was apparent only at high doses.Our results represent the most precise estimate available of the independent effect of each of the two main risk factors of head and neck cancer and exemplify the strengths of large-scale consortia in cancer epidemiology. 

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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    E-cigarette laws may be harder to regulate than originally thought

    Tue, Oct 7, 2014

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    Source: apnews.com or ap.org
    Author: Summer Ballentine & Michael Felberbaum
     

    JEFFERSON CITY, Mo. (AP) – In a rush to keep electronic cigarettes out of children’s hands while the federal government creeps forward with a proposed national ban for minors, experts say that many states are passing laws that could mean fewer restrictions on the nicotine devices later.

    Lawmakers last month made Missouri the 41st state to outlaw selling e-cigarettes to minors. Age restrictions have wide support, but Gov. Jay Nixon and public health advocates opposed a piece of the legislation that prevents tobacco taxes or regulations from being imposed on the electronic devices, which heat liquid nicotine into an inhalable vapor.

    E-cigarette makers have been in a tug-of-war with state and federal governments since the battery-powered devices first were sold in the U.S. in 2007.

    A 2009 law gave the U.S. Food and Drug Administration the power to regulate a number of aspects of tobacco marketing and manufacturing. It first said it planned to assert authority over e-cigarettes in 2011, but it hasn’t yet done so.

    In April, the FDA for the first time proposed a set of regulations for e-cigarettes, including banning sales to minors and requiring health warning labels, as well as approving new products. The agency has said its proposal sets a foundation for regulating the products but the rules wouldn’t immediately ban the wide array of flavors of e-cigarettes or curb marketing on places like TV.

    In the absence of regulation, members of Congress, state leaders and public health groups have raised concerns over e-cigarettes and questioned their marketing tactics. An FDA official said the agency has similar concerns and acknowledged that it has taken the agency too long to act.

    “Part of what is driving those elected officials are public health concerns that we share about any aspect of the marketing of this emerging technology that is appealing to kids,” Mitch Zeller, director of the FDA’s Center for Tobacco Products, said in a recent interview with The Associated Press at the agency’s sprawling campus in suburban Maryland. “It took us too long to get the proposed rule out and we don’t intend a repeat of that as we go from proposed to final.”

    Zeller did not give a timeline for when the final regulations would be in place, but has said any rules will have to be grounded in scientific evidence.

    Scientists haven’t finished much research on e-cigarettes, and the studies that have been done have been inconclusive. The government is pouring millions into research to supplement independent and company studies on the health risks of e-cigarettes and other tobacco products – as well as who uses them and why.

    Most lawmakers, as well as e-cigarette manufacturers, agree that they don’t belong in children’s hands. Yet as states enact age restrictions, experts say lawmakers could also be making it more difficult to regulate and tax e-cigarettes down the road if the FDA determines they’re unhealthy.

    Of the states that have banned e-cigarette sales to minors, 31 have specified that e-cigarettes are “alternative nicotine” or vapor devices, not traditional tobacco cigarettes, according to the National Conference of State Legislatures.

    Some lawmakers say these definitions would prevent e-cigarettes from later being treated as a tobacco product, but others disagree. Missouri’s law apparently is the first to explicitly state that e-cigarettes can’t be regulated or taxed as a tobacco product, said Michael Eriksen, dean of the School of Public Health at Georgia State University.

    Regulations that currently apply to tobacco would restrict where the electronic cigarettes can be used, and how and where they can be advertised, among other things. Such regulations also would likely end the use of candy-flavored nicotine solutions, Eriksen said.

    Laws skirting those restrictions have the blessing of e-cigarette companies, which contend that the devices aren’t the same as regular paper-and-tobacco cigarettes and don’t pose the same public health risks, so taxing and regulating them the same way doesn’t make sense.

    Just six states classify e-cigarettes as a tobacco product, the NCSL reports. Only two states, Minnesota and North Carolina, have approved taxes on e-cigarettes, while three others, Michigan, Ohio and New York, are considering it.

    Instead of adding e-cigarettes to existing tobacco laws that ban smoking indoors or tax the products, lawmakers in Missouri and possibly other states will have to create new tax structures and write regulations from scratch, said Mark Gottlieb, executive director of the Public Health Advocacy Institute at Northeastern University School of Law in Boston.

    It’s a lot of work, he said, and unlikely to happen.

    “In practice,” Gottlieb said, “this can hamstring the state and what it can do.”

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
     
     
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    Number of immune cells in tumors could soon help predict and treat cancers

    Fri, Sep 26, 2014

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    Source: www.science20.com
    Authors: Emma King, University of Southampton and Christian Ottensmeier, University of Southampton

    Immune cells in the blood primarily defend us against infection. But we’re now learning that these cells can also keep us free from cancer. Patients with less efficient immune systems such as organ transplant recipients or those with untreated HIV, for example, are more susceptible to cancers. It is also becoming increasingly apparent that we can use immune cells to predict survival in people who do develop cancer. And that, in fact, there are immune cells within cancers.

    Head and neck cancer underway

    Head and neck cancer underway

    The number of immune cells inside a tumor can hugely vary: some patients have vast numbers while some have very few. In a recent study, we showed that in head and neck cancers, the survival of a patient depends on how many immune cells are within the tumor. This could be a valuable way of individualizing cancer treatments.

    Patients with lots of immune cells, for example, could be offered less toxic cancer treatment while those with few immune cells may need more aggressive treatment to improve their chances of survival.

    Not all immune cells within the tumor are able to “attack” the cancer. By looking at specific cell markers – proteins on the cell exterior that allow us to see whether, for example, cells are exhausted – we can determine which individual immune cells in the tumor will be effective in tackling the cancer, or if they are exhausted and not able to perform any useful function. It’s possible that these exhausted cells could be reinvigorated to become useful again with targeted immunotherapy treatments currently in development.

    These include vaccines, so if a cancer has been caused by a virus, we can vaccinate the patient with a short segment of the same virus to encourage the immune system to react to it. Around 30% of head and neck cancers, for example, are the result of human papillomavirus (HPV). There has been a 225% increase in these types of cancers over the past 15-20 years and in the US, HPV will cause more of these cancers than cervical ones. In these cases, cancer cells continue to express part of the HPV on their surface. The hope is that following vaccination, immune cells will be better able to identify these HPV cancer cells and kill them.

    For people who simply don’t have many immune cells in tumors, specific, targeted immunotherapy could be one option. But also broader “brush stroke” treatments. These broader treatments cover all immunotherapies that encourage a patient’s immune system in a fairly non-specific way. Our immune cells are normally very tightly regulated and include many fail-safe systems to prevent them from over-reacting primarily to infections. General immunotherapy takes the brakes off and allows the immune cells to react to the cancer cells.

    It may be that a combination of specific vaccine and non-specific immune treatments could be enough in combination to tip the balance in favor of the patient’s immune system so that it is able to overcome the cancer.

    We’re going to further investigate how immune cells might help us to fight cancer and two head and neck cancer immunotherapy trials are due to start at the University of Southampton in the next six months.

    One of these trials will look at a HPV cancer vaccine, while the other will investigate a non-specific immunotherapy molecule for those 70% of patients that develop head and neck cancer independent of HPV. Our hope is that within five years the results of these trials could influence the way we treat cancers.The Conversation

    Note: This article was originally published on The Conversation.

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    E-Cigarettes fail to help cancer patients quit smoking

    Wed, Sep 24, 2014

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    Source: www.cancernetwork.com
    Author: Anna Azvolinsky, PhD

    Among cancer patients who smoke, electronic cigarette (e-cigarette) users had greater nicotine dependence compared with traditional cigarette smokers, and e-cigarettes did not help patients quit smoking, according to the results of a study published in Cancer.

    PTHero_ECigarette

    E-cigarettes have been touted as possible tools for smoking cessation.

    According to the study authors, these are the first published results on e-cigarette use and smoking cessation among cancer patients and put into question the potential benefits of using e-cigarettes as part of a smoking cessation program for cancer patients.

    Those diagnosed with cancer who continue to smoke are advised to quit. The uptick in the use of e-cigarettes has raised the question of whether these newer types of cigarettes can facilitate or hamper the ability to quit smoking for good.

    In the new study, Jamie Ostroff, PhD, of the Memorial Sloan Kettering Cancer Center in New York, examined 1,074 cancer patients who smoked and were enrolled in a tobacco treatment program between 2012 and 2013 at the cancer center.

    Using a complete case analysis, e-cigarette users were equally likely to still smoke as those who did not use e-cigarettes (odds ratio of 1). Using an intention-to-treat analysis, e-cigarette users were twice as likely to be smoking at the time of follow-up (odds ratio = 2, P < .01).

    The 7-day abstinence from smoking was 44.4% for e-cigarette users compared with 43.1% for non-users.

    Patients who were e-cigarette users at study enrollment were likely to be more nicotine-dependent and had more prior attempts at quitting smoking compared to traditional cigarette smokers. E-cigarette users were also more likely to be diagnosed with lung cancer or cancers of the head and neck.

    The researchers observed a threefold increase in e-cigarette use, from 10.6% to 38.5% from 2012 and 2013. “Consistent with recent observations of increased e-cigarette use in the general population, our findings illustrate that e-cigarette use among tobacco-dependent cancer patients has increased within the past 2 years,” said Ostroff in a statement.

    Follow-up data on cessation was available from 59.5% of the patients on study. Moreover, a significantly higher percentage of e-cigarette users quit the tobacco treatment program or were lost to follow-up compared to those who did not use e-cigarettes (66.3% vs 32.4%, P < .01).

    Fifty-seven percent of the patients on study were female, mean age was 56 years, and 69.2% of the patients had tried to quit smoking at least twice prior to enrolling in this study. About one-third of the patients reported a high dependence on nicotine. The highest percentage of patients had thoracic cancer (19.8%), 14.9% had breast cancer, 9.7% had head and neck cancer, and 8% had genitourinary cancer.

    First introduced in the United States in 2007, e-cigarettes are battery powered cigarette-like devices that mimic the same sensory experience as traditional cigarettes and provide nicotine for the user.

    Still, further studies of broader geographic cohorts and controlled study conditions, are needed. The current study relied on patient responses to assess cessation and was only conducted at a single cancer center.

    Controlled research is needed to evaluate the potential harms and benefits of e-cigarettes as a potential cessation approach for cancer patients. In the meantime, said Ostroff, oncologists should advise all smokers to quit smoking traditional combustible cigarettes, encourage patients to use US Food and Drug Administration (FDA)-approved cessation medications, refer patients for smoking cessation counseling, and provide education about the potential risks and lack of known benefits of long-term e-cigarette use.

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    Baseball, youth, and smokeless tobacco

    Wed, Sep 24, 2014

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    Source: businesswest.com
    Authors: Richard Pieters, M.D. & Anthony Giambardino, D.M.D.

    The headlines first came with baseball Hall of Famer Tony Gwynn. His all-too-early death at 54 was attributed to the long-term use of smokeless tobacco. Now it’s former Red Sox pitcher Curt Schilling, who revealed on Aug. 20 that he was diagnosed in February with mouth cancer. “I do believe without a doubt, unquestionably,” said Schilling when making his condition public, “that chewing [tobacco] is what gave me cancer … I did it for 30 years. It was an addictive habit.” His physician agreed.

    Many of us who grew up with the game are used to seeing players chewing tobacco, but a new generation of children watching in the stands and on television may be seeing smokeless tobacco used for the first time. They are the ones most influenced by what baseball players do both on and off the field. And that behavior by professional athletes can be more powerful in shaping behavior than any advertising campaign by the tobacco industry.

    Although cigarette smoking in the U.S. continues to decline, a report from the U.S. Centers for Disease Control and Prevention (CDC) indicates that the use of smokeless tobacco has held steady over the past nine years. CDC says 14.7% of high-school boys, and 8.8% of all high-school students, reported using smokeless products in 2013.

    The CDC further states that smokeless tobacco contains 28 carcinogens, which can cause gum disease, stained teeth and tongue, a dulled sense of taste and smell, slow healing after a tooth extraction, and, worst of all, oral cancer.

    Smokeless tobacco is not harmless. According to the National Institute on Drug Abuse, it delivers more nicotine than cigarettes and stays in the bloodstream longer. Clearly, tobacco use is both a serious medical problem and an oral-health problem.

    In a letter to baseball commissioner Bud Selig following the death of Tony Gwynn, nine leading healthcare organizations, including the American Medical Assoc. and the American Dental Assoc., stated that “use of smokeless tobacco endangers the health of major-league ballplayers. It also sets a terrible example for the millions of young people who watch baseball at the ballpark or on TV and often see players and managers using tobacco.”

    Oral cancer continues to be a serious problem in the U.S. More than 30,000 new cases are diagnosed each year, and the five-year survival rate is only around 50%. While a batting average of .500 would be considered outstanding in baseball, 50/50 odds aren’t very good in the game of life.

    The connection between oral health and overall health is well-documented. What happens in the mouth can affect the entire body. Physicians are now being trained to examine the mouth and work with dentists to make patients more aware of the importance of oral health as it affects their overall health and well-being.

    Programs such as the Mass. Dental Society’s Connect the Dots, in which physicians and dentists work together in the community, and the Mass. Medical Society’s establishment of a Committee on Oral Health mark the beginning of a growing relationship between physicians and dentists to promote oral health in the Commonwealth.

    But oral cancer isn’t the only health risk from smokeless tobacco. Users have an increased risk of heart disease, high blood pressure, heart attacks, and strokes. Many health issues are preventable, especially those related to tobacco use. The medical and dental professions can play a key role by providing education and screening for oral cancer.

    Major-league baseball players have an important opportunity to contribute to this educational process by aiding in prevention efforts, particularly aimed at impressionable young people. For the past four years, the Mass. Dental Society, in partnership with NESN and the Boston Red Sox, has produced TV campaigns on the dangers of smokeless tobacco.

    The Mass. Medical Society and the Mass. Dental Society are committed to reducing tobacco use in all its forms and welcome the continued participation of the Red Sox and all of major-league baseball. In 2014, chewing tobacco continues to be as much a symbol of baseball as the actual action on the field.

    For the health of our children, shouldn’t this image of our national pastime now be considered past its time? The cases of Tony Gwynn and Curt Schilling should serve as a warning to us all.

    Note:
    Dr. Richard Pieters, a radiation oncologist at UMass Memorial Medical Center in Worcester, is president of the Mass. Medical Society. Dr. Anthony Giamberardino practices general dentistry in Medford and is president of the Mass. Dental Society.

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    Medical Grade Honey Found Not Effective in Radiation Esophagitis

    Mon, Sep 22, 2014

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    Source: medscape.com
    Author: Pam Harrison
     

    SAN FRANCISCO ― A medical grade honey from New Zealand (Manuka), which is known to be effective in wound healing, does not reduce pain from radiation esophagitis more effectively than standard supportive care, phase 2 research shows.

    “Reducing esophagitis is important so that patients can continue eating their normal diet,” Lawrence Berk, MD, chief of radiation oncology, Morsani School of Medicine, University of South Florida, Tampa, told Medscape Medicine News.

    “And since there is no proven treatment for the prevention of esophagitis during concurrent chemotherapy and radiation therapy, we decided to try honey, because of the reported success in head and neck mucositis in several small studies.

    “And neither liquid honey nor honey lozenges worked better than standard supportive care in reducing pain from esophagitis, so I would not encourage patients to take Manuka honey, because it didn’t work and it’s expensive.”

    The study was presented at the annual meeting of the American Society of Radiation Oncology, held in San Francisco, California.

    Investigators included 163 lung cancer patients who were undergoing concurrent chemotherapy and radiation therapy. Approximately 30% of patients had received 60 Gy of radiation to the esophagus.

    Patients were randomly assigned to 1 of 3 treatment arms: 56 patients received standard supportive care; 53 patients received 10 mL of Manuka honey orally, 4 times a day; and 54 patients received 1 lozenge consisting of 10 mL of dehydrated Manuka honey, 4 times per day.

    The honey was taken on the first day of treatment and continued to be taken throughout the course of radiation therapy.

    After 4 weeks of treatment, patients were asked to assess pain during swallowing using the Numerical Pain Rating Scale (NPRS) scale. Zero on the NPRS scale indicates no pain, 5 indicates moderate pain, and 10 indicates worst possible pain.

    No patients in the standard supportive care arm developed grade 3 or higher adverse events (AEs) related to the treatment protocol, whereas 11 patients in the liquid honey arm did, as did 2 patients in the honey lozenges group.

    At the end of 4 weeks of radiation therapy, the mean change in the NPRS score was 2.7 in the standard supportive care group vs 2.1 for both groups who took either the liquid or lozenge form of Manuka honey, a difference that was not statistically significant.

    There was also no difference between the 3 groups in secondary endpoints, including trend of pain over time, opioid use, AEs, weight loss, or quality-of-life measurements.

    Previous Studies With Local Honey

    The previous studies showing that honey decreased head and neck mucositis were small, randomized trials carried out in Malaysia, Egypt, Nepal, and Iran, and they all used locally produced honey, Dr Berk noted.

    However, another study (Support Care Cancer. 2014;22:751-61) conducted in Canada, which used Manuka honey, found no significant impact on the severity of radiation-induced mucositis in head and neck cancer patients. Furthermore, patients did not tolerate the honey well.

    A British study (Br J Oral Maxillofac Surg. 2012;50:221-6) again found that Manuka honey did not improve mucositis in head and neck cancer patients, although the reserachers noted that it did seem to be associated with a reduction in bacterial infections.

    “Studies with natural products are difficult to do because compounds vary from batch to batch, and the honey will depend on what flowers the bees pollinated,” Dr. Berk said.

    “The reason we chose Manuka honey is that it is widely available and it’s a well-studied, well-quantified honey, and it’s pretty much the only honey there that is well defined.

    “But it’s pretty clear from 3 studies now that Manuka honey has no effect, and currently, there are no proven methods of preventing radiation esophagitis except minimizing the dose of radiation, which we frequently have to do,” he said.

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
     

     

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    AACR says that new drug may assist therapy for Head and Neck Cancer

    Mon, Sep 22, 2014

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    Source: hcplive.com
    Author: 
     

    THURSDAY, Sept. 18, 2014 (HealthDay News) — The investigational drug alpelisib (previously known as BYL719) appears to inhibit activation of the pathway that leads to resistance to cetuximab, an anti-epidermal growth factor receptor agent used in the treatment of head and neck cancer. These findings were presented at the American Association for Cancer Research’s special conference “Targeting the PI3K-mTOR Network in Cancer,” held from Sept. 14 to 17 in Philadelphia.

    Pamela Munster, MD, of the University of California in San Francisco, and colleagues tested the combination of BYL719 and cetuximab in vivo in a cetuximab-sensitive and a cetuximab-resistant xenograft model of esophageal squamous cell carcinoma. In a phase Ib study, BYL719 was administered in combination with cetuximab in adults with recurrent or metastatic squamous cell carcinoma of the head and neck that was resistant or intolerant to platinum-based chemotherapy; prior cetuximab therapy was allowed.

    The researchers found that the addition of BYL719 to cetuximab showed an additive effect in the cetuximab-sensitive model. BYL719 restored sensitivity to cetuximab in the cetuximab-resistant model. In the phase Ib study, as of March 10, 2014, 37 patients have received BYL719 and cetuximab, and the overall response rate is 11%. Based on the data from preclinical studies and the phase Ib study, the combination of alpelisib and cetuximab for squamous cell carcinoma of the head and neck is being explored in a phase II study.

    “Treatment resistance is often conveyed through activation of the PI3K/AKT/mTOR pathway, and alpelisib is an inhibitor of this pathway,” Munster said in a statement.

    The study was funded by Novartis, the developer of alpelisib (BYL719).

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
     
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    Many head and neck cancer patients can avoid neck surgery

    Thu, Sep 18, 2014

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    Source: medicalxpress.com
    Author: Staff
     

    A new study shows that patients with human papillomavirus (HPV) – the same virus associated with both cervical and head and neck cancer – positive oropharyngeal cancer see significantly higher rates of complete response on a post-radiation neck dissection than those with HPV-negative oropharyngeal cancer. Fox Chase Cancer Center researchers presented the findings at the American Society for Radiation Oncology’s 56th Annual Meeting on Wednesday, September 17.

    “For patients that achieve a complete response, neck surgery is probably unnecessary,” says Thomas J. Galloway, MD, Attending Physician and Director of Clinical Research at Fox Chase and lead author on the study.

    After radiation and chemotherapy to remove tumors from the tonsils or back of the tongue, many head and neck cancer patients still have persistent lumps in their neck, albeit perhaps smaller than when they were first diagnosed. “The question is: Do we need to remove those lumps, as well, or can we just let them dissolve on their own?” asks Dr. Galloway.

    To investigate, he and his colleagues reviewed the medical records from 396 patients whose oropharyngeal tumors had spread to at least one lymph node. Within 180 days after completing radiation therapy, 146 patients underwent neck surgery. For 99 patients, their records indicated whether or not their tumors had likely been triggered by HPV.

    Interestingly, patients with HPV often respond better to treatment for their oropharyngeal tumors than those without. The researchers noted the same trend here – people who tested positive for HPV (measured by the presence of a protein called p16) were less likely to have a recurrence of their cancers, regardless of whether or not the tumors had completely disappeared following treatment. Indeed, patients’ HPV status was the strongest predictor of whether or not they were alive at the end of the study.

    Among the patients who underwent neck surgery, any lingering bumps were more likely to be benign if patients were infected with HPV. “The bump might have become a permanent scar, or in some cases, it would have eventually disappeared,” says Dr. Galloway.

    Currently, it is not routine to consider a patients’ HPV status before making the decision to perform neck surgery (the decision is based on physical examination and imaging studies), which can cause problems in the shoulder and neck, including swallowing, says Dr. Galloway; these findings suggest they should. “There’s good reason to avoid neck surgery if we can.”

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
     
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    Update on head and neck cancers, HPV: creating public awareness

    Wed, Sep 17, 2014

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    Source: www.dentistryiq.com
    Author: Maria Perno Goldie, RDH, MS

    Public awareness of head and neck cancer (HNC) is limited, with the lack of awareness including the term head and neck cancer and common symptoms and risk factors, such as tobacco use and human papillomavirus (HPV).1 The online survey of 2,126 randomly selected adults in the United States. Most respondents lacked understanding of the organs or tissues affected by head and neck cancer, with 21% incorrectly identifying brain cancer as head and neck cancer. Only 0.8% of respondents identified HPV infection as a risk factor for mouth and throat cancer, but more were aware of the vaccine.

    The investigators projected that extensive HPV vaccination could prevent almost 9,000 cases of oropharyngeal cancer yearly. The conclusion was that self-reported and objective measures indicate that few American adults know much about HNC including risk factors such as tobacco use and HPV infection and common symptoms. Strategies to improve public awareness and knowledge of signs, symptoms, and risk factors may decrease the disease burden of HNC and are important topics for future research. The American Dental Association has a pamphlet titled “Get the Facts About Mouth and Throat Cancer.”2

    ADAbrochuremsh

    Human papillomavirus type 16 (HPV-16) is a major contributory factor in oropharyngeal squamous cell carcinoma (OPSCC). The detection of primary OPSCC is often delayed due to the complicated anatomy of the oropharynx. One study examined the possibility of HPV-16 DNA detection in pretreatment and posttreatment plasma and saliva and its possible role as a marker of prognosis.3 A retrospective analysis of a prospectively collected cohort of patients with oropharyngeal and unknown primary squamous cell carcinoma with known HPV-16 tumor status was conducted. Real-time quantitative polymerase chain reaction was used to identify HPV-16 E6 and E7 DNA in saliva and plasma samples.

    HPV Virus

    HPV Virus

    The conclusion of the authors is that use of a combination of pretreatment plasma and saliva can increase the sensitivity of pretreatment HPV-16 status as a tool for screening patients with HPV-16–positive OPSCC. Also, analysis of HPV-16 DNA in saliva and plasma after primary treatment may make it easier to detect recurrence in patients with HPV-16–positive OPSCC at an earlier stage.

    cervarix

    HPV is the leading cause of oropharyngeal cancers, and a very small number of front of the mouth, oral cavity cancers. HPV16 is the version most responsible, and affects both males and females. It is a sexually transmitted disease, and while there is no cure, it can be prevented. Practicing safe sex is one way, and vaccination is another way. Two vaccines, Gardasil and Cervarix, protect against the strains of HPV that cause cervical cancers (HPV16 and 18). Garadsil also protects against two versions that cause genital warts (HPV6 and 11). Millions of young girls in the United States and in developed countries around the world have been safely vaccinated with an HPV vaccine.4

    For more information, visit the Oral Cancer Foundation, or the Oral Cancer Cause (OCC).4,5 “OCC’s purpose is to improve the quality of life for oral cancer patients through financial support so that they may face the world with peace and dignity during and after medical treatment.”5

    Oral mucositis is a common complication of cancer chemotherapy, whether for head and neck or other cancers, and is often present after radiation for head and neck cancer. The purpose of one study was to compare the beneficial effects of treatment modalities, including topical steroid, honey, and honey plus coffee, in patients suffering from oral mucositis.6 The results showed that all three treatment regimens reduce the severity of lesions. The best reduction in severity was achieved in the honey plus coffee group. The honey group and topical steroid group took the second and third places. While further study is encouraged, the honey plus coffee regimen was the most effective modality for the treatment of oral mucositis in this study.

    Another study found that treating cancer with bacteria shows real promise.7 They directly injected Clostridium novyi, a common bacteria species that does not need oxygen to survive, into tumors in a small study. It shrunk or eliminated tumors and possibly bolstered the immune system to continue targeting tumor cells for up to two years.

    Maybe one day we will be able to cure cancer!!


    References

    1. Luryi AL, Yarbrough WG, Niccolai LM, Roser S, Reed SG, Nathan CA, Moore MG, Day T, and Judson BL. Public awareness of head and neck cancers: a cross-sectional survey. JAMA Otolaryngol Head Neck Surg. 2014 Jul 1;140 (7):639-46. doi: 10.1001/jamaoto.2014.867.
    2. http://www.ada.org/en/publications/ada-news/2014-archive/june/raise-awareness-of-mouth-and-throat-cancer-among-patients-with-ada-brochure.
    3. Ahn SM, Chan JK, Zhang Z, et al. Saliva and Plasma Quantitative Polymerase Chain Reaction–Based Detection and Surveillance of Human Papillomavirus–Related Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online July 31, 2014. doi:10.1001/jamaoto.2014.1338.
    4. http://www.oralcancerfoundation.org/hpv/hpv-oral-cancer-facts.php.
    5. http://oralcancercause.org/.
    6. Raeessi MA, Raeessi N, Panahi Y, et al. “Coffee plus Honey” versus “topical steroid” in the treatment of Chemotherapy-induced Oral Mucositis: a randomised controlled trial BMC Complementary and Alternative Medicine 2014, 14:293. http://www.biomedcentral.com/1472-6882/14/293.
    7. Roberts NJ, Zhang L, Janku F, et al. Intratumoral injection of Clostridium novyi-NT spores induces antitumor responses. Sci. Transl. Med. 6, 249ra111 (2014).

     

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    Many throat cancer patients can skip neck surgery

    Wed, Sep 17, 2014

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    Source: medicalxpress.com
    Author: Fox Chase Cancer Center

    A new study shows that patients with human papillomavirus (HPV) – the same virus associated with both cervical and head and neck cancer – positive oropharyngeal cancer see significantly higher rates of complete response on a post-radiation neck dissection than those with HPV-negative oropharyngeal cancer. Fox Chase Cancer Center researchers presented the findings at the American Society for Radiation Oncology’s 56th Annual Meeting on Wednesday, September 17.

    “For patients that achieve a complete response, neck surgery is probably unnecessary,” says Thomas J. Galloway, MD, Attending Physician and Director of Clinical Research at Fox Chase and lead author on the study.

    After radiation and chemotherapy to remove tumors from the tonsils or back of the tongue, many head and neck cancer patients still have persistent lumps in their neck, albeit perhaps smaller than when they were first diagnosed. “The question is: Do we need to remove those lumps, as well, or can we just let them dissolve on their own?” asks Dr. Galloway.

    To investigate, he and his colleagues reviewed the medical records from 396 patients whose oropharyngeal tumors had spread to at least one lymph node. Within 180 days after completing radiation therapy, 146 patients underwent neck surgery. For 99 patients, their records indicated whether or not their tumors had likely been triggered by HPV.

    Interestingly, patients with HPV often respond better to treatment for their oropharyngeal tumors than those without. The researchers noted the same trend here – people who tested positive for HPV (measured by the presence of a protein called p16) were less likely to have a recurrence of their cancers, regardless of whether or not the tumors had completely disappeared following treatment. Indeed, patients’ HPV status was the strongest predictor of whether or not they were alive at the end of the study.

    Among the patients who underwent neck surgery, any lingering bumps were more likely to be benign if patients were infected with HPV. “The bump might have become a permanent scar, or in some cases, it would have eventually disappeared,” says Dr. Galloway.

    Currently, it is not routine to consider a patients’ HPV status before making the decision to perform neck surgery (the decision is based on physical examination and imaging studies), which can cause problems in the shoulder and neck, including swallowing, says Dr. Galloway; these findings suggest they should. “There’s good reason to avoid neck surgery if we can.”

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