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  • Curt Schilling: Letter to my younger self

    Sun, Apr 12, 2015

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    Source: www.theplayerstribune.com
    Author: Curt Schilling

    Dear 16-year-old Curt,
    Tomorrow at lunch, a kid is going to dare you to take a dip of Copenhagen. If you say yes, like I did, you’ll be addicted for the rest of your life. Well, the rest of your life up to the point when you are diagnosed with cancer.

    I get what you’re thinking. You’re 16 — you’re invincible, just like all your buddies. If you were to jump ahead 33 years, you couldn’t write a better dream than the one your life is going to be.

    With one exception.

    If you say yes tomorrow, you will become addicted to chewing tobacco and you will get mouth cancer.
    schilling

    I’m going to tell you a little story that I think may help guide you. (I saw this on a TV series called The West Wing — great show, you’re going to love it one day — and it very much rings true).

    There was a man — we’ll call him Joe. Joe lived in the same house his entire life. One day, a huge storm came. He turned on the radio: Prepare for torrential rains and deadly flash flooding. Everyone should evacuate to safety immediately.

    See, Joe was a devout Christian. He had the Lord in his life for as long as he could remember. Church every Sunday, prayed twice a day.

    “My faith in God is resolute. He will save me,” Joe thought.

    The rain kept coming down.

    About two hours later, water began to flood his house, so he scrambled on to the roof.

    After a half-hour, with the water rising rapidly, a boat sputtered up to Joe’s house, which was now partially submerged.

    Boat driver: “Come on down, I will take you to safety!”

    Joe sat calmly on his roof.

    Joe: “No thanks! My faith in God is strong, God will save me!”

    So the boat sped off.

    Another hour went by, and the water had risen to the roof.

    A helicopter flew over, saw Joe and swooped down, dropping down a rope.

    Helicopter pilot: “Grab a hold! I will pull you up!”

    Joe: “No thank you! My faith in the Lord is strong. He will save me!!”

    The man looked awkwardly at what he could only guess was someone who’d lost his mind. The helicopter flew off.

    About 10 minutes later the water overtook Joe’s roof, so he swam out into the strong current. It quickly pulled him below.

    When Joe opened his eyes, he saw the Lord standing at the gates of Heaven.

    “Joe, what on earth are you doing here??”

    “I was just about to ask you that very question, Father,” Joe replied.

    “Wait… what?” says God.

    “Father I have had Faith in you since my first memory. I have prayed morning and night to you. I have sinned, but you know that in my heart I have asked for forgiveness and tried my hardest to do right by you.”

    “Yes, Joe I know in your heart you are a good, honest and loving man.”

    “Then why did you let me die?” Joe asked.

    “I sent you a radio message, a boat and a helicopter! What more did you want?”

    I tell you, 16-year-old me, that story for a very important reason. From tomorrow forward, you will be given the same signs that Joe was given a hundred times over. Many will be far more insightful and far more telling than the ones he received.

    You will develop sores, you will lose your sense of taste and smell. You will develop lesions. You will lose your gums — they will rot. You will have problems with your teeth for the rest of your life.

    You will meet men — many good, honest men — who chewed. None of them will have their entire face. They will be missing jaws, chins, cheeks, noses and more. None will live more than a year or two after you meet them. All of them were tobacco chewers.

    You will meet Joe Garigiola. He will introduce you to Bill Tuttle. Bill will have no lower face. His entire lower jaw is gone. It was that, or die of mouth cancer. Well, not “that or,” because that mouth cancer would kill him inside of two years.

    You will brush your teeth and your mouth will bleed. Not light blood from your gums, but darker blood from deeper inside your mouth. That’s the chew destroying your tissue. You will get message after message, but your addiction will always win, until it wins the biggest battle.

    You will get message after message, but your addiction will always win, until it wins the biggest battle

    If you say yes tomorrow, you will begin to kill yourself from the inside out. It’s difficult for you to understand in this current phase of your life, but by chewing tobacco, you are jeopardizing your participation in what will be some of your most important moments.

    You will risk any chance of seeing your four amazing children graduate high school. You will potentially lose the opportunity to walk your daughter Gabriella (who, like her dad, will be blessed with simple yet outstanding pitching mechanics) down the aisle. You will risk not seeing Gehrig, your oldest son, pitch for four years at a New England college. You may miss your son Grant graduating high school and changing the world. And you may be absent as your youngest son Garrison — who aspires to follow in your father’s footsteps and join the army — masterfully plays goalie with a remarkable passion.

    You could miss the most important and rewarding days of your life with your beautiful wife Shonda.

    If cancer kills you, what are you leaving them with? What are you leaving them for?

    schilling2
    Your dad is going to die in five years. You know what’s going to kill him? A heart attack brought on by heart disease and lung cancer caused by tobacco use. He’ll die right in front of you. You two will be alone and together for his final minutes on earth. The night before he passes away, you two are going to sit up and talk until 4 a.m. You will chalk up the conversation as peculiar, but years later it will hit you like a ton of bricks. It will hit you like a radio message, boat or helicopter. He knew. It’s why the things he told you that night were things only a dad can tell a son. He knew.

    Right now, you don’t listen to the messages God gives you. And if you don’t alter this habit, in 32 years you will be diagnosed with cancer.

    Finally, consider this: How many kids will start dipping over the next 32 years because they saw you do it?

    Do you want that on you? No?

    Then my advice is simple. Tomorrow, at lunch, just say no.

    Make the right choice,

    - Curt

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    The Oral Cancer Foundation Launches April Oral Cancer Awareness Month

    Thu, Apr 9, 2015

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    Source: Yahoo News
    Author: The Oral Cancer Foundation
     

    NEWPORT BEACH, Calif., April 9, 2015 /PRNewswire-USNewswire/ — April is Oral Cancer Awareness Month. 2015 marks the 16th year that The Oral Cancer Foundation has lead the effort to raise awareness of this disease and the need for an annual screening.

    OCF has learned that although we accomplish a great deal as an organization, we can do so much more through the formation of strategic relationships with those who share our values and goals. OCF is grateful to the thousands of private dental offices that make time on multiple days during the month of April to offer free screenings to members of the public in their local communities across the nation. Besides the screening itself, these offices provide valuable information to the public related to risk factors and early signs and symptoms. An informed public can engage in self-discovery, which has generated early stage finds in so many other cancers.

    In addition to the 1,000′s of private dental offices who will join with OCF this April, a coalition of professional organizations, private sectors companies, and educational institutions have chosen to partner with us. The professional organizations include; The American Academy of Oral Medicine (AAOM), The American Academy of Periodontology (AAP), The American Dental Hygienists Association (ADHA), The American Association of Oral and Maxillofacial Surgeons (AAOMS), The Academy of General Dentistry (AGD), The American Dental Association (ADA), The American Academy of Oral & Maxillofacial Pathology (AAOMP), and The Canadian Dental Hygiene Association (CDHA).  Our private sector corporate partners include Bristol-Myers Squibb, Henry Schein Dental, LED/VELscope, OralID and Identafi. The university partners this year are NYU, Penn Dental Medicine, and Columbia University College of Dental Medicine.

    Jamie O’Day, OCF Director of Operations, expressed, “We are very proud that we have been able to assemble a powerful coalition of organizations, all with a vested interest in the oral cancer cause. OCF is thrilled to be in the company of such prestigious organizations and institutions. Coupled with thousands of private dental practitioners, this creates a formidable force to alter the late discovery paradigm that has plagued this disease for too many years.”

    OCF Co-Founder Ingrid Hill, states that “There are steps as a nation that WE MUST take if we are to bring this disease down from its high ranking as a killer.

    • Since the HPV16 virus has become the fastest growing cause of oropharyngeal (back of the mouth) cancers, we must engage in a more robust effort to vaccinate our youth against this virus and allow our children and grandchildren to live in a country that has reached herd immunity against HPV related cancers, all of which are killers.
    • Create a national effort, ideally lead by dental professionals who see more than 60% of Americans at least once a year, to screen everyone opportunistically that currently visit their practices, as the vaccine only works in pre-sexual youth. Catching cancers in the current adult generation of Americans at early stages decreases treatment related morbidity, and improves long-term outcomes.
    • Create enough public awareness and knowledge that some SELF DISCOVERY of early signs and symptoms can occur, and self-referral for evaluation to medical or dental professionals takes place. Combined with professional screening, this will also yield more early stage discovery of both pre-cancers and early stage disease.”

    Primary risk factors for developing an oral or oropharyngeal cancer

    • Tobacco use in all its forms
    • Excessive alcohol consumption
    • A persistent HPV16 (human papilloma virus #16) oral infection

    Oral cancer signs and symptoms identifiable in a conventional visual and tactile screening

    • An ulcer or sore that does not heal within 2-3 weeks
    • A discoloration on the soft tissues of the mouth that persists. It may be white, red, or even blackish in color
    • A swelling or lump in the mouth that persists. This also applies to a tonsil that is swollen but painless
    • Any abnormality that bleeds easily when touched. (friable)
    • A lump, or hard spot in the tissue. (induration)
    • Tissue raised above that surrounding it, a growth. (exophytic)
    • A sore under a denture, which even after adjustment of the denture, still does not heal.
    • A numb feeling in the mouth or lips
    • Persistent sore throat, hoarse voice, or cough
    • A painless fixated lump felt on the outside of the neck, which has been there for at least two weeks
    • Difficult or painful swallowing, or a painless sensation that when swallowing things are becoming stuck in your throat
    • An ear ache on one side (unilateral) which persists for a protracted period of time

    OCF releases its 2015 projections for oral and oropharyngeal cancers derived from the government SEER database.

    45,750 Americans will be newly diagnosed with an oral or oropharyngeal cancer, and there will be approximately 8,650 associated deaths. That is a one-year jump of about 5%. Brian Hill, Executive Director and Co-Founder of OCF stated, “Big numbers are hard to digest, even abstract to individuals, and people are not sure how important this data is. In simpler terms, it means 125 Americans will be newly diagnosed every day, and one American will die from this disease every hour of the day 24/7/365.  Since the two drivers of these numbers are a preventable lifestyle choice, (tobacco use), and a virus (HPV16) for which we have a readily available vaccine, the use of which would protect our next generation, is disheartening. Worse, with the virus being the more aggressive driver of these statistics, this number is without doubt, going to increase every year during our generation, since there is no vaccine for adults already exposed. When compared to other first world countries, the U.S. is far behind in vaccination and reaching herd immunity in our young people. Speaking as someone who almost lost his life to this disease from an HPV etiology, and who talks with patients and families in crisis with routine, my personal opinion is that we as Americans are doing a poor job of controlling tobacco use, contrary to scientific evidence of its harm. Given the huge financial component to the tobacco paradigm in the U.S. and the lack of any political will to change it, I do not see this undergoing any significant change in the future. That we have no national vaccine policy to protect our youth/the next generation with something in our power to change, policies accomplished with huge success in other countries around the world, I find unconscionable.”

    It’s not too late to join with the other thousands of dental offices to get involved in bringing down these numbers. Click the following link to learn more about oral cancer awareness month, and how to create your own Free Oral Cancer Screening Event if you are a professional. http://www.oralcancer.org/events/oral-cancer-awareness-month.php

    Members of the public can view our online calendar of events to find a screening event near them at - http://www.oralcancer-screening.org/events/?d=2015-04-01&b=1.

    Be aware. Get Screened. BE PART OF THE CHANGE.

    About the Oral Cancer Foundation
    The Oral Cancer Foundation, founded by oral cancer survivor Brian R. Hill, is an IRS registered non-profit 501(c)(3) public service charity that provides information, patient support, sponsorship of research, and advocacy related to this disease. Oral cancer is the largest group of those cancers that fall into the head and neck cancer category. Common names for it include such things as mouth cancer, tongue cancer, head and neck cancer, and throat cancer. OCF maintains a web site at http://www.oralcancer.org, which receives millions of hits per month. Supporting the foundation’s goals is a scientific advisory board composed of leading cancer authorities from varied medical and dental specialties, and from prominent educational, treatment, and research institutions in the United States.

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

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    A Pastime Baseball Can Do Without

    Tue, Apr 7, 2015

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    Source:http://www.wsj.com 
    Author: Larry Thornberry

     

    The Major League Baseball season starts Monday, with many a pinch of tobacco between many a cheek and gum. Not everyone is happy about this (about the chewing tobacco, that is). The San Francisco board of supervisors is considering a measure to put chew off-limits at every ball field in the city, including AT&T Park, where the world-champion Giants play.

    A bill introduced February in the California Assembly would do the same in pro and league venues across the whole state. Major League Baseball supports this approach, since it cannot get the powerful players union on board with a chewing-tobacco ban. No word on how the laws would be enforced, but the sponsor of the state bill says don’t expect chew cops in dugouts or snuff-sniffing dogs in stands.

    Until relatively recently, tobacco around baseball clubhouses wasn’t considered much to worry about. As a young fan in the 1950s, I was used to players like Nellie Fox and Bill Tuttle, who stuffed so much chaw in their cheeks that they appeared to be trying to swallow a softball. One of my favorite players of the day, Rocky Bridges, looked like a chipmunk with a buzzcut. Baseball cards, an obsession with preteen boys for the better part of the last century, first came with packs of cigarettes, only later with bubble gum.

    Back in the day, sportswriters weren’t quick to link tobacco and the early deaths of former ballplayers. It was obvious in the case of Bill Tuttle, who died of mouth cancer at 69 after disfiguring surgery. But not clear was whether all those years of Nellie Fox’s chewing had anything to do with his death at 47 from lymphatic cancer.

    Nor was a connection made in 1948 when the superstar of superstars, Babe Ruth, died at 53 of throat cancer. The Bambino smoked and admitted to taking up chewing at age 5. But he also drank heavily and generally pursued whatever life-shortening activity amused him. So we are left to wonder.

    But the risk these days is clearer. A couple of examples from the contemporary scene: Hall of Famer Tony Gwynn, one of the game’s classiest hitters and by all accounts a fine man, dead last year at 54 from salivary-gland cancer. More fortunate is former All-Star pitcher Curt Schilling, 48, whose mouth cancer is in remission. Tobacco is no airy or debatable health threat like cholesterol. We have everything but a signed confession from the weed.

    With all this carnage, you’d think it would be easy to put an end to a ritual that damages players and tempts young fans. But Major League Baseball has moved slowly on this one. Smoking on the field or in the dugout has been verboten for a good while, and smokeless tobacco has been prohibited in the minor leagues since 1993, though many players say this ban is laxly enforced. In the bigs, where players have a pit-bull union, smokeless tobacco can still be used, though players are prohibited from chewing during postgame interviews. So in the nation’s most traditional sport, the toxic habit endures.

    The normal impulse of the red-blooded Americano is to groan whenever government attempts to micromanage the lives of consenting adults. It is a little harder to protest the drive against chewing tobacco in baseball, an effort that will likely prevail in due course. That said, it sure would be nice if these guys would give up the chew of their own volition—and recognize that anyone who doesn’t is either self-destructive or dumb as a bag of hammers.

    What might doom chew in the end is simply its aesthetics. I never understood the charm—the slobbering, the expectorating, the unspeakable spit cups. For years I played in local amateur leagues, fine organizations that got husbands out from under their wives’ feet on Sunday afternoons. Some of my teammates considered a pouch of Red Man as much a part of their gear as their glove or their cleats. I was partial to bubble gum, convinced that when sliding into a 230-pound catcher, whether safe or out, I wouldn’t find swallowing a soggy clump of tobacco a highlight of my day.

    The introduction of sunflower seeds in big-league dugouts was definitely one of the modern game’s more civilizing innovations.

    Mr. Thornberry is a writer in Tampa, Fla.

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

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    Young supports Oral Cancer Awareness with launch of new Burgundy Disposable Prophy Angle

    Tue, Mar 31, 2015

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    Source: http://www.dentistryiq.com
    Author: DentistryIQ Editors

    Screening is the beginning of the end of oral cancer, and Young is joining the Oral Cancer Foundation in empowering hygienists to “Be Part of the Change.”

    Hygienists are on the front lines of oral cancer detection, and their involvement in early screening is paramount in the fight against oral cancer. Young is helping to support hygienists and keep oral cancer awareness in the forefront by launching the new Classic Burgundy Petite Web disposable prophy angle just in time for Oral Cancer Awareness Month in April.

    In addition to being the signature burgundy color of oral cancer awareness, the Classic Burgundy Petite Web disposable prophy angle packaging acts as a billboard to promote awareness through early detection.

    According to the Oral Cancer Foundation, more than 43,000 people are diagnosed with oral cancer in the U.S. each year, and only 57% will survive past five years due to late diagnosis. When found at early stages of development, oral cancer victims have an 80 to 90% survival rate.

    Thanks to engagement from the RDH community, we are on the cusp of a major change in this paradigm. With a commitment to screening for oral cancer warning signs during routine prophylaxis procedures, hygienists are helping to save lives through early detection.

    “Just doing ‘opportunistic’ cancer screenings during routine dental hygiene procedures would yield tens of thousands of opportunities to catch oral cancer in its early stages. One of our goals is to initiate an effort within the dental community to aggressively screen all patients,” said Brian Hill, executive director of the Oral Cancer Foundation. “Screening for oral cancer during dental examinations will save lives. We are thrilled to partner with Young in launching the Classic Burgundy Petite Web disposable prophy angle to help raise awareness about the early detection of oral cancer.”

    To learn more about the Oral Cancer Foundation, visit www.oralcancer.org. To learn more about the new Classic Burgundy Petite Web disposable prophy angle, visit www.youngdental.com.

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
     
     
    Oral Cancer DPA_profile_gray
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    Green tea polyphenol helps kill oral cancer cells by destroying mitochondria

    Mon, Mar 30, 2015

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    Source: www.medicaldaily.com
    Author: Chris Weller
    First it targeted pancreatic cancer. Now it’s moved onto oral cancer. A new study from Penn State University shows the main antioxidant in green tea, epigallocatechin-3-gallate (EGCG), helps kill cancer cells through the destruction of the cells’ mitochondria.

     

    green-tea

    While highly effective at eradicating cancer cells, chemotherapy is quickly falling out of practice with doctors who seek targeted treatments. Instead of getting rid of just the harmful cells, chemo attacks healthy cells, which are often found in the hair and the intestines, resulting in the characteristic hair loss and frequent immune system-related illness.

    “You don’t see these sorts of side effects with green tea consumption,” said Joshua Lambert, associate professor of food science at Penn State, in a press release. Lambert and his colleagues carried out their study by looking at cell cultures, which they injected with the same amount of EGCG a person would normally have in her saliva after chewing green tea-flavored gum. They saw a number of promising reactions.

    “It looks like EGCG causes the formation of reactive oxygen species in cancer cells, which damages the mitochondria, and the mitochondria responds by making more reactive oxygen species,” Lambert explained. Over time, the mitochondria lose even more of its defenses with a breakdown in the expression of antioxidant genes. In their weakened state the cancer cells eventually succumb to EGCG in full, and they die.

    This isn’t the first time EGCG revealed its cancer-killing power. In May of last year, scientists from the Los Angeles Biomedical Research Institute (LA BioMed) discovered the compound’s ability to prevent and slow the growth of pancreatic cancer. One of the key enzymes in pancreatic cancer cells is known as LDHA, and prior studies have shown the enzyme inhibitor oxamate is instrumental in destroying LDHA. In similar culture tests, LA BioMed researchers found EGCG rivaled oxamate in its destructive power.

    The scientists on either coast share the same goal: getting rid of cancer. Many forms of the disease are rising in prevalence, particularly in developing nations where the Western diet wields a dangerous, processed influence. Lung cancer, for example, recently passed breast cancer as the most fatal form of cancer among women in the developed world. Pancreatic cancer is nearly just as bad. Of the 45,000 diagnoses each year in the U.S., 85 percent of cases are fatal.

    For Lambert and his research team, the more immediate goal is to move out of cell cultures. The next step is animal models, so they can see what kind of side effects — if any — EGCG brings. If the mitochondria continue to wither in the compound’s presence, they’ll move a step closer to developing alternative therapies for oral cancer that don’t rely on the wide-scoped forces of chemo.

    Source:
    Tao L, Park J, Lambert J. Differential prooxidative effects of the green tea polyphenol, (–)-epigallocatechin-3-gallate, in normal and oral cancer cells are related to differences in sirtuin 3 signaling. Molecular Nutrition & Food Research. 2015.

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    Researchers ID potential prognostic marker for recurrence of head and neck squamous cell carcinoma

    Mon, Mar 23, 2015

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    Source: medicalxpress.com
    Author: press release

    A new study provides the first evidence that the mediator complex subunit 15 (MED15) may play a crucial role in the pathophysiology of head and neck squamous cell carcinoma (HNSCC). MED15 overexpression was found to be associated with higher mortality rates in HNSCC patients with cancer recurrence, particularly in oral cavity/oropharyngeal tumors, according to the study published in The American Journal of Pathology. MED15 overexpression was also associated with heavy alcohol consumption, which is an HNSCC risk factor.

    HNSCC is the sixth most common  worldwide and has a high rate of recurrence and early metastatic disease, resulting in approximately 350,000 deaths each year. “Our findings suggest that MED15 may serve as a prognostic marker for HNSCC recurrence and as a therapeutic target in HNSCC patients suffering from recurrences,” said lead investigator Sven Perner, MD, PhD, of the Department of Prostate Cancer Research, Institute of Pathology, and the Department of Otorhinolaryngology at the University Hospital of Bonn (Germany).

    Mediator is a multiprotein complex that regulates many signaling pathways. In humans, it consists of 30 subunits including MED15, which has been implicated in breast and , with particular attention being given to its link to transforming growth factor-β (TGF-β) signaling. “The evidence that multiple aberrant pathways account for the progression of HNSCC calls for a much deeper understanding of the effect of molecules involved in these signaling pathways upon HNSCC progression,” noted Dr. Perner.

    To investigate the role of MED15 in HNSCC, the researchers analyzed tissues from 113 patients with primary tumors, 30 recurrent tumor tissues, 85 , and 20 control samples of normal squamous epithelial tissue. Using immunohistochemical staining, expression scores were calculated by multiplying staining intensity by the index of immunoreactive cells and categorized as no expression (<0.07), low expression (0.07<0.2), or overexpression (0.2). They found that MED15 was overexpressed in 35% of primary tumors, 30% of lymph node metastases, and 70% of recurrences, in contrast to no or low expression in control samples.

    To determine the extent to which MED15 levels correlated with mortality, the investigators performed immunohistochemical analysis of primary tumor tissues from the 108 patients who developed recurrent tumors. They found that the mortality rate (defined as death within 1 to 12 years after first diagnosis) increased from 58% overall to 78% in the subset of patients whose tumors showed MED15 overexpression, with a significant association found between MED15 overexpression and high mortality.

    Further investigation revealed that the mortality rate of patients with tumors in the oropharynx or oral cavity was significantly higher than that of patients with tumors in the hypopharynx or larynx. Likewise, the expression of MED15 was found to be higher in oral cavity/oropharyngeal tumors compared with tumors from the hypopharynx or larynx.

    The study also investigated whether MED15 levels were associated with any of the risk factors for HNSCC, such as tobacco use, alcohol consumption, or chronic oncogenic human papillomavirus infections. Only heavy alcohol consumption was found to be significantly associated with MED15 overexpression, shedding light on the possible mechanism of action of alcohol’s adverse influence.

    Dr. Perner and his co-investigators believe MED15 may be a molecular marker that can be used to predict the risk for development of tumor recurrence or metastases that can help clinicians make early diagnosis and treatment decisions. Support for this hypothesis comes from their observations that in 74% of cases, there was a concordance for the presence or absence of MED15 overexpression in samples from a patient’s primary tumor and corresponding lymph node metastasis. In addition, MED15 expression correlated with high proliferative activity in HNSCC tissues and genetic inhibition of MED15 reduced both cell proliferation and migration. They also found that MED15 was highly expressed in the HNSCC malignant cell lines HSC-3 and SCC-25.

    “Such observations indicate that MED15 overexpression is likely to be a clonal event in the progression of HNSCC,” explained Dr. Perner. (A clonal event is a mutation, deletion, or translocation that occurs within a tumor and recurs in a significant proportion of patients.) “These findings regarding MED15 overexpression are particularly significant, as genetic alterations that provide cells with growth advantages and metastatic potential may be present only in subpopulations of cells in the primary tumor, but increase in tissue from metastases and relapsed HNSCC tumors.” He suggests that a MED15 inhibitor may be a future therapeutic option, especially for patients with advanced disease and tumor recurrence.

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    Head and neck cancer on rise in young men

    Mon, Mar 23, 2015

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    Source: www.healthcanal.com
    Author: staff

    “The head and neck cancers we have found in younger men with no known risk factors such as smoking are very frequently associated with the same HPV virus that causes cervical cancer in women.” said Kerstin Stenson, MD, a head and neck cancer surgeon at Rush and a professor of otolaryngology at Rush University. The cancer develops from an HPV infection, likely acquired several years earlier from oral sex.

    “Men are more susceptible to these cancers because they don’t seem to have the same immune response as women and do not shed the virus like women do,” Stenson said.

    ‘Epidemic proportions’
    According to the Centers for Disease Control and Prevention, cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils) are usually caused by tobacco and alcohol, but recent studies show that about 72 percent of oropharyngeal cancers are caused by HPV.

    “There has been significant change in the last decade. Overall, head and neck cancers account for approximately 3 to 5 percent of all cancers, but what’s changed in the past decade is the HPV-associated oropharyngeal cancer. It has reached epidemic proportions,” said Stenson.

    The American Cancer Society estimates that 45,780 Americans will be diagnosed with cancer of the oral cavity and oropharynx in 2015. If this trend continues, the number of cases of HPV-positive oropharyngeal cancer will surpass the number of cervical cancer cases.

    Early detection is key
    The current vaccine has been shown to decrease the incidence of HPV-associated cervical infections and cancer. While the same result is anticipated for HPV-associated head and neck cancer, the impact of vaccines on incidence of persistent oral HPV infection and/or HPV associated oropharyngeal cancer has not yet been investigated. We will need about 10-30 more years to see the anticipated effect of the vaccine on HPV-related cancers that could affect people who are now teenagers. Still, head and neck surgeons, medical oncologists and other researchers strongly advocate vaccination of both girls and boys to help prevent all HPV-associated cancers.

    “For all individuals, the key is in early detection, as with any cancer,” Stenson said.

    In addition to being vaccinated, Stenson stresses the importance of regular visits to the dentist. “Dentists play a key role in detecting oral cancer. You might not see a primary care physician even once a year, but most people see their dentist twice a year. Having regular dental visits can help catch cancers early to help ensure the best outcome.”

    The American Dental Association states that 60 percent of the U.S. population sees a dentist every year.

    Oral cancer warning signs
    The Oral Cancer Foundation presumes that cancer screenings of the existing patient population would yield tens of thousands of opportunities to catch oral cancer in its early stages.

    “There is much that can be done for those who are diagnosed with head and neck cancer. Since early detection and treatment is critical, it’s important to see your dentist regularly and to promptly see a medical professional if there are any warnings signs,” Stenson advised. Strategies to improve public awareness and knowledge of signs, symptoms, and risk factors are critical topics for study and may decrease the disease burden of head and neck cancers.

    Possible warning signs of oral cancer may include difficulty swallowing, pain when chewing, a white patch anywhere on the inside of your mouth, a lump or sore in the mouth or on the lip that does not heal.

    If you notice any of these symptoms, ask your dentist or doctor about it.

    Treatment includes surgery for early or low-volume late stage lesions and radiation or chemoradiation for more advanced cancers.

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    Asia’s deadly secret: the scourge of the betel nut

    Mon, Mar 23, 2015

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    Source: www.bbc.com
    Author: staff

    It is used by almost a tenth of the world’s population. It gives people a buzz equivalent to six cups of coffee and is used variously as a symbol of love, marriage and a cure for indigestion and impotence.

    But it is also leading tens of thousands to an early grave.

    The culprit? The humble betel nut.

    Found across Asia, these nuts are harvested from the Areca palm and are chewed for their warming glow and stimulating properties.

    Such is its effectiveness, that alongside nicotine, alcohol and caffeine, betel nuts are believed to be one of the most popular mind-altering substances in the world.

    Although used by women and children, the nuts are especially popular among working-age men, who chew to stay awake through long hours of driving, fishing or working on construction sites.

    But the short-lived benefits come at a terrible cost.

    High rates of oral cancer are destroying the lives of many who buy betel nuts, often decades after their first taste.

    Now in Taiwan, where the nuts are affectionately known as ‘Taiwan’s chewing gum’, the government is taking action to curb this centuries-old habit and reduce the thousands of lives lost each year.

    Dangerous combination

    betel-stained

    Regular betel nut chewers stand out from the crowd with their red-stained lips and teeth

    The betel nut is a key part of many Asian cultures and can be consumed dried, fresh or wrapped up in a package known as a quid.

    Although the exact preparation varies across countries and cultures, the quid is usually a mixture of slaked lime, a betel leaf and flavourings such as cardamom, cinnamon and tobacco.

    Worryingly, the International Agency for Research on Cancer lists each ingredient, with the exception of cardamom and cinnamon, as a known carcinogen – or cancer-causing agent.

    The slaked lime is seen as a particular problem as it causes hundreds of tiny abrasions to form in the mouth. This is thought to be a possible entry point for many of the cancer-causing chemicals.

    “About half of the men here still don’t know that betel nuts can cause oral cancer,” says Prof Hahn Liang-jiunn, an oral cancer specialist at the National Taiwan University Hospital.

    “[This is despite] Taiwan’s incidence or mortality rates for oral cancer ranking among the top two or three in the world.”

    ‘I started chewing because everyone else did’

    Like most people, Qiu Zhen-huang, 54, was completely unaware of the risks.

    A former gravel company worker, he chewed for ten years. Twenty years after quitting, he developed the disease.

    “I started chewing betel nut because everyone at work did it,” says Mr Qiu.
    “We shared it with each other to build good relations.”

    Three years ago, a small hole developed in his left cheek and in just three months, the tumour grew to the size of a golf ball and completely changed his life.

    “Whatever I ate flowed out. I had a gauze pad over it. It hurt,” he said.

    “It affected me a lot. I was so ashamed I avoided going out.”

    Each year, 5,400 Taiwanese men like Mr Qiu are diagnosed with oral cancer or pre-cancerous lesions and an estimated 80 to 90% of those also chew betel nuts.

    An early symptom includes white or red lesions inside the mouth, but this can rapidly progress to grotesque flesh-eating tumours.

    Unlike other cancers, these are difficult to hide, leaving sufferers physically and psychologically devastated.

    “It’s miserable for them,” says Prof Hahn.

    “Sometimes, even after surgery, they still can’t perform basic functions, including expressing emotions through their face because the lower jaw also has to be cut depending on the scale of the cancer.”

    Tackling the scourge

    The Taiwanese government is offering subsidies in return for cutting down betel nut palms

    The Taiwanese government is offering subsidies in return for cutting down betel nut palms

    Luckily for Qiu Zhen-huang, his cancer was treated and his cheek reconstructed.

    But the Taiwanese government is helping people detect the disease much sooner by providing around one million free screenings and funding programs to help people quit betel nuts for good.

    In 2013, these measures helped cut the usage rate among men by nearly half.

    The government is also trying to reduce the domestic supply of betel nuts by offering subsidies to farmers to cut down their trees and plant alternative crops.

    Other countries such as India and Thailand have also launched campaigns to discourage betel nut chewing.

    But there is still a way to go. At a recent presentation to elementary school children of fishing industry workers, nearly all raised their hands when asked whether their parents or relatives chewed betel nuts.

    And as the cancer can take up to 20 years to appear, the current changes will have come too late for many people – a fact that Mr Qiu keeps close to his heart.

    “I’m one of the luckier ones.”

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    Giving chew the boot: Rodeo riders lead oral cancer awareness campaign

    Fri, Mar 13, 2015

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    Source: mohavedailynews.com
    Author: DK McDonald
     

    LAUGHLIN — Rodeo professionals Carly Twisselman and Cody Kiser are bringing something extra to their competition at the Avi Stampede PRCA Rodeo this weekend.

    They are bringing a message to kids.

    The public faces of the “Be Smart, Don’t Start” tobacco use awareness campaign, Twisselman and Kiser are sponsored by The Oral Cancer Foundation.

    “We’re the first charity to ever be the exclusive sponsors of any rodeo competitors,” said Brian Hill, founder and executive director of The Oral Cancer Foundation. “We go to the rodeos with Carly and Cody to get the word out to kids. 

    “As in most things, if we can catch kids early and can show them good role models like Carly and Cody, who are fierce competitors and great people, they can see that tobacco doesn’t have to be a part of being a great cowboy or cowgirl.”

    The Professional Rodeo Cowboys Association and tobacco have a history; until 2009 the PRCA accepted tobacco sponsorship money to fund the sport. 

    “Now, the PRCA disassociated itself with spit tobacco companies back in 2009 and they’re no longer financial sponsors of rodeo,” said Hill. “It was really a great thing for PRCA to do. That being said, the people who attend and the competitors themselves still tend to be heavy users of tobacco, spit tobacco and cigarettes.”

    Spit tobacco, which can refer to smokeless tobacco, dip, snuff, chew, and chewing tobacco, according to the OCF, can cause gum disease, tooth decay, and white patches and oral lesion that can lead to oral cancer.

    “I grew up rodeoing in a huge ranching family in California,” Twisselman said. “I have family members who have had problems with tobacco and I thought being a spokesperson for OCF would be a great way to get the youth out there that look up to rodeo athletes and show them that you don’t have to be smoking or doing drugs to be successful.”

    “We’re non-confrontational,” Hill said. “I don’t believe that you convert people to your way of thinking by being anti-everything and getting in their face about it. Our message is directed at kids and usually kids that are too young to have even thought about picking up tobacco. If we can keep them from even starting, we’ve won the battle.”

    “When the opportunity came up to do this, I wanted to get into it right away,” Kiser said. “I got involved because I want to make a difference, not only in rodeo but also in young people’s lives. 

    “It’s a lot more to it than trying to get people information about oral cancer. It’s trying to change the sport of rodeo. One day, we might be able to have an oral cancer night at a rodeo and everyone will wear maroon. Trying to move rodeo in a positive direction — it would be tremendous to be a part of that.”

    “We’re both put in front of thousands of people all the time,” said Twisselman. “What better way to use that exposure than to do good and to show our future generations that this sport isn’t about drugs and alcohol or smoking.”

    “After doing this for a while now, I look at other people that are trying to do good in the community,” said Kiser. “It’s changed my outlook on wanting to do more for the community and for other people. It’s opened my eyes to getting involved more.” 

    Kiser competes in the men’s bareback bronc riding competition at the Avi Stampede PRCA Rodeo today; Twisselman competes in the women’s barrel racing on Sunday.

    *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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    Cure Possible for Some HPV-Positive Oropharyngeal Cancers

    Thu, Mar 12, 2015

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    Source: www.medscape.com
    Author: Fran Lowry

    In a subset of patients with human papillomavirus (HPV)-related oropharyngeal cancer, the goal of achieving a “cure” is a realistic one, even in patients who have limited distant metastases, a prospective study has shown.

    Of the patients with HPV-positive oropharyngeal cancer and distant metastases, 10% survived more than 2 years after intensive treatment, which the researchers defined as a cure.

    The study was presented at the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) in Nice, France.

    The research was praised by Jean Bourhis, MD, head of the Department of Radiation Oncology at Centre Hospitalier Université Vaudois in Lucerne, Switzerland, and cochair of the ICHNO conference scientific committee.

    “This important piece of research adds substantially to what we know about the role and the importance of the human papillomavirus in oropharyngeal cancers and gives real hope of improvement in both diagnosis and treatment to those who are affected by the condition,” he said in a statement.

    This study, from a world-leading group of head and neck cancer experts, is very interesting, and related to relevant clinical and interdisciplinary questions,” said Daniel Zips, MD, professor of radiation oncology at the University of Tübingen in Germany.

    “HPV status is also important for the management of metastatic disease,” he told Medscape Medical News.

    He agrees that for some patients with HPV-positive oropharyngeal cancer, using the researchers’ definition, a cure is possible.

    “I also agree that the results from this study might begin to change the view of this disease and provide some hope for patients and their families,” Dr Zips explained.

    Distant Metastases Are Main Form of Failure
    “The majority of patients with HPV-related oropharyngeal cancer can be cured, but distant metastasis can occur in about 15% of patients. In fact, distant metastasis has become the main form of failure for this patient population,” lead author Sophie Huang, a radiation therapist and assistant professor at the University of Toronto. Dr Huang was a physician in China but is an MRT(T) — a radiation therapist — in Canada.

    “When distant metastasis occurs, it is generally viewed as incurable disease. However, long-term survival after distant metastasis has been observed in nasopharyngeal cancer patients, which is another viral-related head and neck cancer, associated with the Epstein–Barr virus. Also, long-term survival in HPV-related OPC patients with distant metastasis has also been reported, but anecdotally,” Dr Huang told Medscape Medical News. “Are these just miracles? And would more miracles be found if we were able to understand how they happen?”

    Dr Huang and her colleagues established a prospective database in which they collected data on enough patients to allow them to study how distant metastasis is manifested, how the cancer behaves after distant metastasis, and whether there are any factors that influence survival after distant metastasis.

    “We felt that the answers to these questions would help us tailor surveillance strategies for the early detection of distant metastasis and explore optimal management algorithms to improve outcomes,” she explained.

    Prospective Follow-up of Patients
    The team evaluated 1238 consecutive oropharyngeal cancer patients treated at the Princess Margaret Cancer Centre in Toronto from 2000 to 2011. They identified 88 patients with HPV-related cancer and 54 with smoking-related cancer who were HPV-negative, all with distant metastases.

    They assessed the pace of the manifestation of the distant metastases, characteristics, and patient survival, and identified factors that might predict longer survival.

    The proportion of patients with distant metastases was similar in the two groups. However, metastases associated with HPV-positive oropharyngeal cancer had a later onset, different characteristics, and longer survival than those associated with HPV-negative oropharyngeal cancer.

    Specifically, more than 94% of metastases occurred in the first 2 years after treatment in HPV-negative patients, whereas only a quarter occurred in HPV-positive cancers. In the HPV-positive group, some occurred after 5 years.

    “This observation indicates that HPV-related OPC patients who are disease-free for 2 years are not out of the woods. A longer surveillance period for HPV-related OPC patients is needed to detect, and hopefully cure, distant metastases,” Dr Huang said.

    Additionally, the researchers found two phenotypes of distant metastases in HPV-positive patients.

    The disseminating phenotype is aggressive and spreads to multiple organs in a short period of time. This phenotype was found in 55% of the HPV-positive group but in 0% of the HPV-negative group.

    The indolent phenotype is characterized by a few lesions growing at a slow pace, and manifesting as oligometastasis, with five or fewer lesions. In patients with metastases in a single organ, this phenotype was found in 24% of the HPV-positive group and in 26% of the HPV-negative group.

    The lung was the most common site for distant metastasis in both groups.

    “This indolent phenotype has longer survival and might be curable,” Dr Huang reported.

    More HPV-positive than HPV-negative patients were specifically treated for distant metastasis (60% vs 31%)

    table1

    More HPV-positive patients with distant metastases than HPV-negative patients survived to 3 years (25% vs 15%; P = .01).

    “The survival advantage in HPV-positive patients is due to a number of factors. The cancer is more sensitive to radiotherapy and chemotherapy, patients tend to be younger by about 10 years, and they have fewer other health problems, including those caused by smoking. This allows them to receive the more aggressive treatment necessary to eradicate metastatic disease,” Dr Huang explained.

    table2

    “This research shows that metastatic HPV-positive patients who receive active treatment can survive considerably longer. One of the reasons patients with metastatic disease fail to receive aggressive treatment is due to the physician and patient perception that this is an incurable state. We hope these results will motivate researchers to optimize management strategies for these patients,” Dr Huang said.

    “The first distant metastasis site is mostly in the chest region,” she noted. In fact, most of the cured patients had lung metastasis. “Computed tomography of the thorax for the early detection of distant metastases” might enhance the cure rate for this disease, she added.

    Future studies should look for ways to identify patients at initial presentation who are at high risk for distant metastasis, and which type of distant metastasis will develop.

    “We know there is a degree of correlation between the initial stage and the risk of distant metastasis, but we did not find a strong relationship between this stage and the type of metastasis,” Dr Huang reported. “The intensity of cigarette smoking in the years prior to the time of diagnosis is a possible factor. Being able to identify such relationships could be a huge help in deciding appropriate treatment at an early stage.”

    Note:

    1. Dr Bourhis, Dr Zips, Dr Huang, have disclosed no relevant financial relationships.
    2. 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO): Abstract OC-044. Presented February 13, 2015.

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