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Smokeless tobacco use on the rise among high school athletes

Sun, Sep 13, 2015


Author: Jeron Rennie

A new Centers for Disease Control and Prevention (CDC) report shows a trend they don’t want to see.

A Morbidity and Mortality Weekly Report (MMWR) shows that from 2001-2013, smokeless tobacco use increased significantly among high school athletes, but not with non-athletes.

The report also found there was lower use of combustible tobacco products among athletes than non-athletes. The CDC said that could be due, in part, to an awareness of the negative consequences on athletic performance. However, they say the use of smokeless tobacco suggests they find those products as being harmless.

“When you see it in the media and you see all those athletes that you’re looking up to as a younger student and trying to reach some of the goals that they’ve reached,” said Freeborn County Drug-Free Coalition Prevention Coordinator Lana Howe. “It definitely plays a large impact on you as a youth.”

The CDC said using smokeless tobacco can, however, adversely impact athletic performance and lead to disease and early death since they contain nicotine, toxins and carcinogens.

Several athletes with a history of smokeless tobacco use have been diagnosed with, or died from, oral cancer.

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UC Davis will use dogs to sniff out cancer

Sun, Sep 13, 2015


Author: staff

A university team of physicians, veterinarians and animal behaviorists has begun training a pair of very special canines to sniff out cancer. One of the 4-month-old puppies is Alfie, a Labradoodle. months old.

A university team of physicians, veterinarians and animal behaviorists has begun training a pair of very special canines to sniff out cancer. One of the 4-month-old puppies is Alfie, a Labradoodle. months old.

UC Davis clinicians are hoping to advance cancer screenings with the innate olfactory skills of man’s best friend. A university team of physicians, veterinarians and animal behaviorists has begun training a pair of very special canines who may represent high-tech health care on four feet in the effort to better screen for cancer, especially at early stages of the disease.

About 4-months old, the puppies Alfie (a Labradoodle) and Charlie (a German Shepherd) are undergoing a rigorous twelve-month training program to develop their abilities to identify the scent of cancer in samples of saliva, breath and urine.

According to sensory scientists, the olfactory acuity of dogs enables them to detect odorant concentration levels at 1 to 2 parts per trillion, roughly 10,000 to 100,000 times that of a human. UCD physicians and researchers believe Alfie and Charlie have the potential to add an important diagnostic element to patient care. Cancer is the second leading cause of death in the United States, and early detection of the disease gives patients the best chance of survival.

“For the past number of years, we have been developing very high-end, expensive new tests to try and detect the presence of cancer,” said Ralph de Vere White, distinguished professor of urology and director of the UC Davis Comprehensive Cancer Center. “Dogs have been doing this, detecting disease in the urine of people suspected of having bladder cancer, for example. This work marries sophisticated technology with low-tech, yet sophisticated, dogs’ noses to see if they can help us identify the molecules that differentiate cancer from non-cancer.”

Hilary Brodie, professor and chair of the UCD Department of Otolaryngology, hopes that the identification of these molecules will lead to innovative and readily available methods of detection.

“Much like the hand-held devices used to detect alcohol, drugs and explosives have revolutionized our safety, having a new tool to detect early-stage cancer would have incredible benefits for patient care,” noted Brodie, whose department treats many head, neck and throat cancer patients.

Researchers have established that dogs can recognize melanoma as well as bladder, lung, breast and ovarian cancers. Canines have been successfully trained to distinguish the breath samples of lung and breast cancer patients from those of healthy volunteers. Such promising results have cancer experts at UCD enthusiastic about the potential for the dogs to represent a safe, noninvasive method for detecting cancer before it is too late.

Current cancer screening methods frequently result in the disease being identified at a later stage, often past the so-called golden hour when treatment is most effective and when the cases aren’t as challenging.

“Identifying patients at earlier stages could be extremely helpful in the fight against cancer,” said Gregory Farwell, professor of otolaryngology and director of the university’s Head and Neck Oncology and Microvascular Surgery program.

Alfie and Charlie are being trained by Dina Zaphiris, director of the In Situ Foundation in Chico. Zaphiris has trained more than two dozen dogs in their ability to detect cancer. As in training for drug and explosives detection, the UCD canines are learning how to distinguish samples from cancer patients and healthy individuals. According to Zaphiris, almost any dog can be trained to detect cancer. She prefers German Shepherds, Labradors, poodles and herding breeds because of their work ethic.

Alfie and Charlie’s human-cancer screening work will begin in early 2016 with a clinical trial to establish the safety and efficacy of the new diagnostic canine approach. UCD physicians say their ultimate goal is to bring more comprehensive cancer-screening capabilities to the public.

“Despite all the advances of modern medicine, we still can’t reliably detect many types of cancers in their early stages,” said Peter Belafsky, professor of otolaryngology and a physician who often deals with cases involving advanced cancer. “Our new canine colleagues represent a unique weapon in the battle against cancer. It’s the first of its kind at UC Davis, and the dogs’ incredible talent for scent detection could offer us humans a real jump on diagnosing cancer much earlier and thus save many more lives.”

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Cowboy with a statement on smoking

Fri, Sep 11, 2015


Author: Adam Robertson
55f20e17c6255.imageA cowboy stands against smoking
Above: Cody Kiser holds on as his bronco goes wild during the Sanders County Fair rodeo; Kiser has teamed up with the Oral Cancer Foundation to raise awareness of the dangers of tobacco products through the rodeo.


PLAINS – Tobacco use has been a big part of the rodeo for years; one participant of the Sanders County Fair is in the forefront of changing this, though, by promoting a tobacco-less lifestyle through the sport.

Cody Kiser, a cowboy who rode bareback broncos at the Fair, has teamed up with the Oral Cancer Foundation’s ‘Be Smart, Don’t Start’ campaign to help teach kids about the dangers of tobacco products and oral cancer. According to their website, the campaign is part of the foundation’s rodeo outreach and attempting to “become engaged where the problem lives.”

“While other [groups] are focused on getting users to quit, the Oral Cancer Foundation is reaching out to young people to not pick up the habit that they may see one of their rodeo heroes engaging in,” stated information provided by the OFC.

To help with this, Kiser and the foundation have been working to present role models within the rodeo world who do not use tobacco products and actively advocate against their use.

“How do you change that?” Kiser asked, regarding the tobacco-use culture. “I think that is in kids; you have to get to the kids and get their opinions changed.”

The foundation’s main focus has been on reaching out to middle school and high school students, though getting their message to any kid is helpful. They try to inform the kids of the dangers of tobacco products, with a particular emphasis on chewing tobacco, which is heavily linked to developing oral cancer.

“We’re not here to tell anybody how to live their life or anything, if they’re already chewing or smoking,” said Kiser. “Just give information … and hope we reach out to the kids. That’s the main thing.”

During the Sanders County Fair rodeo, Kiser only wore sponsorship logos for the OCF. He also took time to talk to kids at the fair and give out pins, bandanas as well as other items with the foundation’s message on them.

It was noted there are other rodeo riders who do not smoke or chew tobacco, though it is rare. This has been turning around in recent years, though, and there are organizations promoting tobacco-free rodeos, where only people who do not use tobacco products participate. Other organizations, like Project Filter and reACT, are also working to educate kids about tobacco use through the rodeo.

“There are groups who are doing this now,” Kiser said. “It’s not just us … There is some move towards it. It’s in its infancy right now, but there people who are doing stuff.”

He also recalled a number of athletes had used tobacco products and reported regretting it later in life; some hall of famers have said they would do things differently, in regards to tobacco use, if they could go back. The main goal of the OCF and its ‘Be Smart, Don’t Start’ campaign has been to help kids avoid having those regrets.

The foundation hopes to set up public speaking arrangements at schools for Kiser and their other ambassadors in the near future, though for now their outreach is limited to rodeos. Going directly to the schools would help them reach out to kids more and spread their message further.

Tobacco use is strongly linked to oral cancer, which has several severe impacts on the body; everything from losing teeth to serious oral sores or even death. The effects do not stop at a personal level either and can spill over to other people’s lives as well.

According to the OFC, approximately 46,000 people are diagnosed with oral cancer each year. This translates to almost 115-120 people diagnosed each day.

More information on the Oral Cancer Foundation can be found at

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

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Raising awareness at the rodeo

Tue, Sep 8, 2015


Author: Nicole Klauss


A rodeo barrel racer from California is helping spread the word in Ellensburg that people shouldn’t start using tobacco.

Carly Twisselman competed at the Ellensburg Rodeo slack Thursday night. She also helped share the message of the Oral Cancer Foundation, which is “Be smart. Don’t start.”

While attending and competing at rodeo events, Twisselman reaches out to youth to encourage them not to pick up the habit they may see their rodeo heroes have.

“The rodeo is known for having a lot of chewing tobacco. … The rodeo is such a small community and the heroes in it, the children look up to,” Twisselman said. “When they see their hero, growing up they think ‘I want to be like them.’”


The Oral Cancer Foundation teamed up with Twisselman and bareback bronc rider Cody Kiser to spread the word in the rodeo circuit. The goal of the campaign is to spread awareness of oral cancer and the dangers of starting tobacco use. Twisselman often spends time talking to children and hands out buttons and bandannas to spread the message.

Smokeless/spit tobacco is one of the historic causes of deadly oral cancers, and is more addictive than other forms of tobacco use, according to a news release from the Oral Cancer Foundation.

According to the Oral Cancer Foundation’s website (, mouth cancers are newly diagnosed in about 115 people each day in the U.S., and worldwide new mouth cancer cases exceed 450,000 annually. When found at early stages of development, people with oral cancers have an 80 to 90 percent survival rate.

Twisselman has never used tobacco, though some in her family have. Her two brothers both used chewing tobacco, but quit on their own before Twisselman got involved with the Oral Cancer Foundation campaign.


Twisselman grew up on a cattle ranch in central California and comes from seven generations of ranching.

“I’ve been riding horses and competing in rodeos since I could walk,” she said. “I won the youngest rider award from my fair when I was 2. It’s pretty much been in my blood and my lifestyle forever, and it’s something I’ve always been passionate about.”

She went to school in Los Angeles, Calif., to study communications and pursue an acting career. Today she is the host of a show on the Ride TV channel. She balances that with rodeo activities.

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

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An HPV-E6/E7 immunotherapy plus PD-1 checkpoint inhibition results in tumor regression and reduction in PD-L1 expression

Tue, Sep 8, 2015


Author: A E Rice, Y E Latchman, J P Balint, J H Lee, E S Gabitzsch and F R Jones

We have investigated if immunotherapy against human papilloma virus (HPV) using a viral gene delivery platform to immunize against HPV 16 genes E6 and E7 (Ad5 [E1-, E2b-]-E6/E7) combined with programmed death-ligand 1 (PD-1) blockade could increase therapeutic effect as compared to the vaccine alone. Ad5 [E1-, E2b-]-E6/E7 as a single agent induced HPV-E6/E7 cell-mediated immunity. Immunotherapy using Ad5 [E1-, E2b-]-E6/E7 resulted in clearance of small tumors and an overall survival benefit in mice with larger established tumors. When immunotherapy was combined with immune checkpoint blockade, an increased level of anti-tumor activity against large tumors was observed. Analysis of the tumor microenvironment in Ad5 [E1-, E2b-]-E6/E7 treated mice revealed elevated CD8+ tumor infiltrating lymphocytes (TILs); however, we observed induction of suppressive mechanisms such as programmed death-ligand 1 (PD-L1) expression on tumor cells and an increase in PD-1+ TILs. When Ad5 [E1-, E2b-]-E6/E7 immunotherapy was combined with anti-PD-1 antibody, we observed CD8+ TILs at the same level but a reduction in tumor PD-L1 expression on tumor cells and reduced PD-1+ TILs providing a mechanism by which combination therapy favors a tumor clearance state and a rationale for pairing antigen-specific vaccines with checkpoint inhibitors in future clinical trials.

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

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Boston votes to ban chewing tobacco from ballparks, including Fenway

Fri, Sep 4, 2015


Author: Marissa Payne


Baseball in Boston is about to change. On Wednesday, the City Council voted unanimously to make its baseball parks and stadiums, including historic Fenway, tobacco-free zones. And yes, the ordinance covers the kind of tobacco you chew, a longtime favorite of many MLB players.

“This action will save lives by reducing the number of young people who begin to use smokeless tobacco because they followed the example of the Major Leaguers they idolize,” Matthew Myers, president of the Campaign for Tobacco-Free Kids said in a statement sent to The Washington Post. “We thank Mayor Marty Walsh, the City Council and Boston’s health community for their leadership on this important issue.”

Red Sox owner John Henry was also supportive of the legislation.

“It’s a great thing,” Henry said (via when Mayor Walsh first proposed the legislation last month. “I’m very supportive.”

The ban doesn’t just apply to players, but also fans, and it covers all stadiums from major-league to organized amateur games. Those found in violation of the ordinance face a $250 fine, Boston’s Fox affiliate reports.

Boston is now the second major U.S. city to ban tobacco at its baseball stadiums. San Francisco, which banned the substance in April, was the first. Both cities had very good reasons to nix the chew.

Smokeless tobacco, like cigarettes, contains the addictive substance nicotine and its users can become more at-risk for illnesses such as cancer, gum disease and heart disease, according to the Mayo Clinic.

“You can call chewing tobacco by whatever name you want — smokeless tobacco, spit tobacco, chew, snuff, pinch or dip — but don’t call it harmless,” a Mayo Clinic brochure says.

The most dangerous side effects of chewing tobacco rose to fame last year when two former major league players connected their cancers to the habit.

“I do believe without a doubt, unquestionably, that chewing is what gave me cancer,” former MLB pitcher Curt Schilling said at the WEEI/NESN Jimmy Fund Radio Telethon last year. “I did [it] for about 30 years. It was an addictive habit. … I lost my sense of smell, my taste buds for the most part. I had gum issues, they bled, all this other stuff. None of it was enough to ever make me quit. The pain that I was in going through this treatment, the second or third day it was the only thing in my life that … I wish I could go back and never have dipped. Not once. It was so painful.”

An even more dire warning came from the experience of San Diego Padres slugger Tony Gwynn. His cancer of the mouth and salivary glands killed him last year at the age of 54. Before his death, he too blamed his disease on smokeless tobacco.

“Of course, it caused it,” Gwynn once said. “I always dipped on my right side.”

Despite the health concerns, however, many MLB players, including several Red Sox players, continued to use chewing tobacco.

An informal Boston Globe survey last month found that 21 of the 58 Red Sox players who were invited to spring training last year indicated they used smokeless tobacco. This is despite the team already discouraging the substance’s use by offering players other things to chew on, including gum and sunflower seeds.

With the new ordinance, however, those players will now be forced to find new, possibly safer habits, which the Boston City Council and tobacco-free advocates hope trickle down to their young fans.

While cigarette use among youths in the United States is declining, smokeless tobacco use has remained steady. According to the Centers for Disease Control and Prevention, more than five out of every 100 high school students reported using smokeless tobacco in 2014. Nearly two out of ever 100 middle schoolers said they used the substance.

Boston and San Francisco aren’t the only city’s that see a problem either.

In June, a member of the Los Angeles City Council proposed legislation to also ban tobacco at area baseball stadiums.

“It’s about protecting the health of our players and the health of our kids,” Councilman Jose Huizar told the Los Angeles Times. “America has a great pastime, but chewing smokeless tobacco shouldn’t be part of that.”

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

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Five reasons to schedule a dental exam today

Wed, Sep 2, 2015


Author: Raquel Braemer

Often times we can get caught up in our day-to-day life, neglecting things like routine check-ups. Until, of course, a problem arises. An aching tooth requiring an immediate appointment and possibly requiring time off from work or even an unexpected trip to the Emergency Room. We all know we should make time for routine dental exams. But – if you need some motivation to pick up the phone – here are 5 reasons to schedule that appointment today.

1. 9 in 10 Adults Have Cavities. A recent study from the Centers for Disease Control and Prevention found that 91% of adults ages 20-64 had cavities. Further, 1 in 4 adults had untreated tooth decay.

2. Complications with Diabetes. If you are one of nearly 30 million Americans reported to be suffering from diabetes according to the American Diabetes Association, you are also at risk of developing gum disease. Working with a dentist to develop and maintain good oral health practices could help you control your diabetes.

3. Early Detection of Oral Cancer. The American Cancer Society reports that 39,500 Americans are expected to get oral cancer in 2015. Your dentist’s chair is often the first place these cancers of the tongue, tonsils, and gums can be identified. Early detection and treatment are critical to survival.

4. Good Oral Health Means Good Overall Health. Studies continue to show that good oral health has correlations to reduced risk of diabetes, arthritis, stroke, and heart disease. In fact, the Surgeon General now reports on the state of Oral Health in America because of this.

5. Save Money. If the four previous health reasons aren’t concerning enough, then consider how much money you will save. If you don’t have dental insurance or qualify for free care at a clinic like HealthLink, you may be deterred by the out-of-pocket cost of a dental exam and cleaning. The median cost for a dental exam in the United States is currently $261, according to data from OKCopay. However, allowing problems to progress to the point of requiring a root canal could cost you between $700 and $900.


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Hopkins team shows methylation-specific ddPCR may help predict head and neck cancer recurrence

Thu, Aug 27, 2015


Author: Madeleine Johnson

Oncologists probe the margins of surgical sites to detect epigenetic indicators that can anticipate cancer recurrence. But deep surgical margin analysis with biopsy can alter the site making it challenging to return to the exact spot if there is a problem. It also takes only a few rogue cancer cells to cause a recurrence and these may be missed by histological techniques.

Researchers at Johns Hopkins University School of Medicine have now developed a method using Bio-Rad’s Droplet Digital PCR platform that is amenable to molecular methods and only requires a tiny sample from the surgical margin.

Specifically, in a study published this week in Cancer Prevention Research, scientists examined an epigenetic signature of PAX5 gene methlyation previously determined to be specific to cancer, and found that it could be used to predict local cancer recurrence after tumor removal for head and neck squamous cell carcinoma, or HNSCC.

In a prospective study of 82 patients, if the tumors had methylated PAX5 then the presence of residual methylated cells in the surgical margins was a predictor of poor locoregional recurrence-free survival. And among patients on subgroup of patients who did not receive radiation treatment after surgery, the ddPCR method increased detection of the PAX5 maker from 29 percent to 71 percent.

Compared to conventional methylation analysis, the ddPCR method also reduced the number of false negatives. Importantly, the authors noted in the study that the method can be performed within three hours by one person. Thus, it might be completed before the reconstruction phase of a typical operation, allowing surgeons to resect the margin of the surgical site if methylated cells are detected.

The authors concluded that future personalized oncology workflows could also employ methylation arrays or methylation sequencing to pre-operatively define a patient’s methylome and design a panel of primers and probes that could be used in intraoperative surgical margin assays.

A spokesperson at Bio-Rad noted that an increasing number of researchers are using the firm’s digital PCR platform for methylation studies.

“There seems to be increasing success in applying ddPCR to measurements of methylation, as judged from an uptick in recent publications,” George Karlin-Neumann, the director of scientific affairs at Bio-Rad’s Digital Biology Center, told GenomeWeb in an email.

He cited another recent study that examined so-called “field cancerization,” or the presence of clonally-related cells in the mucosal area surrounding a tumor that have malignant potential and carry cancer-associated genetic or epigenetic alterations.

That work, published in Epigenetics in July, looked at colorectal cancer and showed MethyLight ddPCR was able to achieve a significantly lower limit of detection than the same technique using standard PCR. The author of that study told GenomeWeb that ddPCR could help detect the one or two cells with cancerous epigenetic changes out of a field of thousands.

This increased sensitivity over conventional qPCR is “translating into better clinical sensitivity and specificity with methylation biomarkers, bringing us closer to the possibility of their clinical implementation,” Karlin-Neumann said.

He further noted another recent study, published in Diabetes, which showed absolute measurements of methylated and non-methylated preproinsulin cell-free DNA in blood could provide a better association with Type 1 diabetes than ratio measures.

This result “plays to the strengths of ddPCR’s ability to make absolute measurements, rather than just relative ones.”

Raleigh, North Carolina-based biopharmaceutical company Islet Sciences is also using the methylation status of cell-free DNA to track pancreatic beta cell death. That firm licensed a ddPCR-based epigenetic method from a lab at Yale University, and representatives told GenomeWeb last year that Islet is working to commercialize the assay.

Viresh Patel, global marketing director at Bio-Rad’s Digital Biology Center, told GenomeWeb in an email that the firm is not currently marketing methylation applications specifically, but Bio-Rad continues to work with customers on assay design, sample compatibility, and data analysis.

“This is an emerging application for ddPCR which we expect to gain momentum as researchers continue to publish their breakthrough research,” Patel said.

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Rinsing with salt water beats out swishing with mouthwash

Thu, Aug 27, 2015


Author: John Przybys

A bottle can be found on just about every bathroom countertop or in just about every medicine cabinet in America. But is incorporating an over-the-counter mouthwash into your daily oral hygiene routine worth it?


Dr. Daniel L. Orr II, a professor and director of oral and maxillofacial surgery at the University of Nevada, Las Vegas School of Dental Medicine, says over-the-counter mouthwashes pose no health problems to those who use them sparingly.

But Orr also notes that some over-the-counter mouthwashes contain more than 20 percent alcohol. That alcohol — in addition to being a potential poisoning danger to kids who might stumble upon it and drink it — also is “an irritant” to the gums and mouth, Orr says.

“If you want to do a little experiment, you can just put any name brand (of mouthwash) into your mouth and just hold it there for a couple of minutes. It starts to burn and doesn’t feel good at all.”

Over-the-counter mouthwashes usually are taken by consumers in an attempt to kill odor-causing bacteria in the mouth. But, Orr says, “mouthwash doesn’t really clean your mouth. It doesn’t debride like a toothbrush and floss do. So if you brush and floss correctly, there really shouldn’t be much need for mouthwash at all.”

Also, Orr says, some studies indicate that “people who use it a lot — like taking it three times a day — have a slightly increased chance of oral cancer, other things being equal.”

In addition, Orr says, there are studies that indicate that “mouthwash use can actually raise your blood pressure a little bit. We’re talking maybe two or three points. That might not be a big deal, but why do it?”

The bottom line: Using an over-the-counter mouthwash to refresh one’s mouth “once a day probably is not a big deal,” and studies that point to adverse reactions tend to involve the more chronic use of mouthwash three or so times a day.

Note, too, that there are nonalcohol over-the-counter mouthwashes on the market, and that dentists often recommend specialized mouth rinses in treating specific dental problems. And while strong over-the-counter preparations may be iffy additions to an oral hygiene regimen, “rinsing is good,” Orr says.

“For instance, I’m an oral and maxillofacial surgeon, and when you take out a tooth, you can’t mechanically debride that socket very well,” he says. “So after I take out a tooth, I recommend rinsing, and what I recommend 90 percent of the time is warm salt water.”

So try rinsing with a teaspoon of salt dissolved in an 8-ounce glass of water, Orr says. “It kills bacteria and keeps (the mouth) clean.”

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HPV DNA detected in mouthwash predicts oral cancer recurrence

Thu, Aug 27, 2015


Author: Kelly Johnson

The presence of HPV16 DNA is common at diagnosis of HPV-related oropharyngeal carcinoma (HPV-OPC) but rare after treatment. HPV-OPC has a favorable prognosis; however, 10% to 25% of patients experience disease progression, usually within 2 years of treatment.

Patients who have HPV 16 DNA in their saliva following treatment of their oropharyngeal cancer are more likely to have their cancer recur, and a prospective cohort study published in JAMA Oncology has shown that a simple mouth rinse can be used to detect it.


Gypsyamber D’Souza

Gypsyamber D’Souza, PhD, Johns Hopkins Bloomberg School of Public Health, and fellow researchers monitored 124 patients with newly diagnosed oropharyngeal cancer from 2009 through 2013. They collected oral rinse and gargle samples using 10 mL of mouthwash at the time of diagnosis as well as after treatment 9, 12, 18, and 24 months later.

HPV16 DNA was detected in 67 out of 124 of the participants testing positive. Of the 67 patients who had HPV16 DNA in their saliva at the time of diagnosis, five patients (7%) were found to still have traces of HPV16 in their oral rinses following treatment.

All five patients developed a local recurrence of oropharyngeal cancer, three of whom died from the disease.

“It’s a very small number so we have to be somewhat cautious,” said D’Souza, an associate professor in the Department of Epidemiology at the Bloomberg School and a member of the Sidney Kimmel Comprehensive Cancer Center, in a statement. However, “The fact that all of the patients with persistent HPV16 DNA in their rinses after treatment later had recurrence meant that this may have the potential to become an effective prognostic tool.”

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