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For the war against oral cancer, what’s in your arsenal?

Wed, Jul 22, 2015

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Source: www.dentistryiq.com
Author: Dennis M. Abbott, DDS

The face of oral cancer has changed: No longer is oral cancer a disease isolated to men over 60 years of age with a long history of smoking and alcohol consumption. Today, the demographic for the disease includes younger people of both sexes with no history of deleterious social habits who are otherwise healthy and active. It spans all socioeconomic, racial, religious, and societal lines. In other words, oral and oropharyngeal cancer is an equal opportunity killer. Today, as you read this article, 24 people in the US will lose their battles with oral cancer. That is one person for each hour of the day, every day of the year. Each of those lost is someone’s sister, a father’s son, a small child’s mommy, or maybe even a person you hold dear to your heart. The truth is, oral and oropharyngeal cancer has several faces . . . and each of those faces is a human being, just like you and me. So how can we, as dental professionals, be instrumental in the war against oral and head and neck cancer?

Views of the oropharynx, the base of the tongue, and the epiglottis, taken with the Iris HD USB 3.0 intraoral camera using different points of focus. Photos courtesy of the author.

Views of the oropharynx, the base of the tongue, and the epiglottis, taken with the Iris HD USB 3.0 intraoral camera using different points of focus.
Photos courtesy of the author.

The answer, as with most other cancers, lies in early detection. When oral and oropharyngeal cancer is detected early, the five-year survival rate can be as high as 80% to 90%. The harsh reality is that most oral and head and neck cancers are only found at late stages after the cancer has advanced—often to the lymph system. As a result, the chance of the person living for five years after diagnosis falls to approximately 55%.

As dentists and dental hygienists, we—like it or not—are on the front line of this war. We often have the opportunity to see potential cancer patients more frequently than our medical colleagues do, and we are trained to see abnormalities inside the mouth and in the head and neck region. (This is a huge part of the solution!) Many of my medical colleagues tell me that they do not have the training to see what I can see in the mouth. But I do not have the training to practice oncological medicine like they do. The truth is, it takes all of us doing our jobs to care and manage the individual person—not just the teeth, not just the liver, not just the breast, but the whole patient.

Years ago, we could almost profile who would or would not be likely to present with oral cancer. It was always the “Marlboro man”—that guy who was older, drank alcohol frequently, and had a smoking pack-year history that was two or three times his age. But those days are long gone. With the recent understanding that the human papillomavirus (HPV), the most common sexually transmitted infection in the United States, is an etiological factor for oral and oropharyngeal cancer, virtually everyone is a potential cancer patient. As such, everyone should be screened. While the individual with classic risk factors still remains at risk for developing oral cancer, many who present with HPV-related oral and head and neck cancers have no other discovered risk factors, other than exposure to HPV and an immune system that, for reasons still unknown, will not adequately clear the virus without repercussions.

It is believed that 80% to 90% of all Americans have been exposed to HPV at least once in their lifetimes. Most people manage to clear the virus through the immune system’s normal defense function within six to seven months; in some patients, however, damage takes place at the cellular level that may take months, years, or even decades to manifest as cancer. The majority of HPV-related oral and head and neck cancers present in areas that are difficult for us as dental professionals to visualize, such as the tonsils, the base of the tongue, the oropharynx, the posterior pharyngeal wall, and the larynx. That, however, does not give us an excuse not to screen in these areas . . . we just have to think outside of the box and get creative about how we screen.

Visual inspection combined with palpation remains the essential foundation of screening for oral and oropharyngeal cancers, but where visualization is difficult—such as with the base of the tongue and the lower oropharynx—knowing and asking the right questions can become critically important for identifying potential concerns:
“Are you noticing any unusual hoarseness?”
“Are you having any difficulty swallowing?”
“Do you ever have a sensation as though something is caught in your throat?”
“How long has that tonsil been inflamed?”
“Have you noticed any sinus or allergy issues since that tonsil has been enlarged?”
While these questions may seem unrelated to teeth, they are not unrelated to oral health. Simply asking the right questions can open a dialogue of discovery that may lead to the detection of an oropharyngeal cancer early. And early detection is the key to beating the disease and maintaining a good quality of life during the survivorship years.

Technology-based adjunctive devices to assist the dental professional in the early detection of oral cancer have existed in the market for the past 10 to 15 years. Much has been written about fluorescence and reflective technologies, which help the examiner to detect subtle changes in tissue through the usage of light in the violet and yellow ranges of visible light, respectively. Examination with these wavelength-specific devices enhances visualization by highlighting changes in the oral mucosa and vasculature. Usage of these adjuncts has also demonstrated value in enabling clinicians to better understand the size of affected tissue surrounding suspected lesions. As such, these may be useful in selecting a field for biopsy that may produce clear, or noncancerous, margins.

Since the completion of the Human Genome Project (HGP) in 2003, there exists a more clearly defined understanding of how diseases such as cancer affect our cells at the nucleic acid level and how genetic mutations can serve as risk factors or catalysts for cancerous changes in cells. Technology used in the HGP has also provided insight into the genotyping of viruses, leading to a sharper picture of how viral interaction with our genetic code can lead to disease. Today, the dentist and dental hygienist have this technology readily available to move their practice into the era of personalized health.

Salivary tests, such as the MOP (Molecular Oral Testing) by PCG Molecular, take advantage of innovative, advanced genetic testing to establish the risk or presence of oral or oropharyngeal squamous cell carcinoma. MOP does this by evaluating cellular abnormalities in the oral cavity and oropharynx, DNA damage associated with oral and oropharyngeal cancer, and the presence of HPV. With this information, the clinician can better determine the appropriate course of action for the patient.

Sometimes striving to provide the best possible patient care means thinking outside of the box to use technology designed for one purpose and discovering a new application to meet an unanswered need. Most of us are at least familiar with intraoral cameras, and many of us have them in our offices. Using the magnified imagery of a quality intraoral camera and a high-resolution monitor, this tool is a favorite device for illustrating the need for proposed treatment and for establishing patient trust. But what if we could use those images to possibly save a life?

The Iris HD USB 3.0 intraoral camera by Digital Doc LLC has catapulted intraoral photography into the high-definition age. Using the Iris HD precision optical lens array and an advanced HD sensor from Sony, the Iris HD USB 3.0 provides unmatched 720p-resolution clarity that is perfect for the magnification and photographic capture of suspicious areas discovered during a thorough head and neck examination/oral cancer screening. Because of the size of the camera head, the device even makes it possible to examine areas of the oropharynx that were previously difficult for dentists and hygienists to visualize.

Of course, the camera cannot substitute for laryngeal endoscopy, especially if cancer inferior to the epiglottis is suspected, but the camera’s ability to see beyond the palatopharyngeal arch is an improvement over an angled dental mirror. Most patients can tolerate the necessary posterior placement of the camera to capture an oropharyngeal image either by breathing through the nose or with placement of a topical anesthetic on the posterior soft palate and uvula to suppress the gag reflex.

Regardless of the power of the technology, the ultimate skill in detecting early-stage oral and oropharyngeal cancer lies in the eyes, hands, and brain of the examiner. Careful inspection, knowledge, discernment, and experience are the real tools of the professional for acquiring and processing all of the available data and for correctly fitting the puzzle pieces into a picture that illustrates either health, concern with reason for reevaluation, or the need to biopsy the area in question. When reevaluation is required, no more than two weeks should elapse between the initial examination and follow-up, as time is of the essence in proceeding to treatment should the suspicious area indeed be cancerous.

Responsibility to the patient does not end with an abnormal screening result. The dental professional should have a plan in place to either biopsy or refer. The dental professional should biopsy only if he or she is well-experienced in the removal of suspected cancerous lesions. Otherwise, the patient should be referred to an oral/maxillofacial surgeon, periodontist, otolaryngologist, or head and neck surgeon who is comfortable with and experienced in the safe and effective biopsy of a potentially cancerous area. It is most often the case that only one opportunity to obtain a diagnostic tissue sample exists, so the skills of the doctor performing the biopsy should be without question. Every effort should be made to ensure that the patient is seen promptly for biopsy and that the pathology results are returned and shared with the patient expeditiously. Delay can be detrimental to the survival of a patient with oral or oropharyngeal cancer.

Should a screening result from your office lead to a diagnosis of oral or oropharyngeal cancer, be prepared to counsel and educate your patient about what to expect in his or her cancer journey. Learn about and be prepared to meet the unique dental and oral health needs of patients with oral and head and neck cancers, and become equipped to continue care for your patients throughout their treatment and into survivorship. For all of the destruction and hardship that cancer brings, it can form unbreakable bonds, between doctor and patient and between dentist and physician.

Don’t be afraid to reach out to your counterparts in the medical community and bridge the gap between medicine and dentistry in your area. Form alliances with head and neck surgeons, radiation oncologists, medical oncologists, and oncology nurses. Let them know about your skills and the services and technology available in your office that place you on the front line of this war on oral cancer. Take time to understand your medical colleagues’ role in treating the disease and become familiar with the technology they are using to save lives and diminish the long-term effects of oral cancer treatment. We are, after all, fighting the same war, and we’re all on the same side. It is all of us against oral and oropharyngeal cancer, with the needs and health of that one patient we’re fighting for leading us in the battle.

About the author:
Dennis M. Abbott, DDS, is the founder and CEO of Dental Oncology Professionals, an oral medicine-based practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. In addition to private practice, he is a member of the dental oncology medical staff at Charles A. Sammons Cancer Center at Baylor University Medical Center in Dallas. Dr. Abbott is also the founder of the American Academy of Dental Oncology and serves as a consultant to the national American Cancer Society in the development of oral monitoring guidelines for post-treatment cancer survivors. Dr. Abbott lectures internationally on the topics of dental oncology and oral cancer.

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B.C. detection test being used to catch oral cancer in early stages

Wed, Jul 22, 2015

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Source: www.cbc.ca
Author: staff

Doctor says oral cancer is among the deadlier diseases yet rarely talked about.

mouth3

The Canadian Cancer Society estimates 4,400 people will be diagnosed with oral cancer this year. The deadly disease can often go undiagnosed because it is tough to screen for dormant symptoms. But now, researchers at the University of British Columbia (UBC)  are developing a new test that will be able to detect oral cancer at a much earlier stage.

Dr. Catherine Poh, an oral pathologist who also teaches dentistry at UBC, spoke with the Early Edition’s Rick Cluff about the latest developments.

What can you tell us about this new brushing test you’re working on?
We are a proposing a non-invasive approach to analyse genetic material collected from patients mouths using a simple brush. This can be done by a dentist or at a family doctor’s office.

This test would detect genetic change that happens in human genomes from the cells collected from the mouth. We have shown that it has prediction value for the risk for oral cancer development.

How does your test compare to how oral cancer is detected right now?
Right now the majority of oral cancer has been screened by dentists because many of the oral cancer [diagnosis] come with no pain or no symptoms. Through the dental regular checkups it can be detected early, otherwise patients come with a sore in their mouths that is essentially a delay in the diagnosis.

What symptoms should people look out for?
Many people know your mouth can be sore and that’s not a sign of oral cancer. I’m suggesting people look for a mouth sore that doesn’t heal within three to four weeks or there’s colour change with white or red bumps that don’t get resolved. [This warrants a] checkup from your family dentist or doctors.

Who does oral cancer affect?
Traditionally 75 per cent are smokers and drinkers, however we’re aware there are a number of rising incidents within the younger non-smoker, non-drinker group. Studies show increasing risks of tongue cancer for women aged 18 – 44.

We don’t know [the exact reason] yet. There are people talking about chronic inflammation and infection so we are looking for more details into that aspect.

If it is caught early on, what does that mean for someone’s chances of beating cancer?
Right now, 1 in 2 patients will die in five years so it’s a deadly disease. If caught early…the chance for easier treatment increases. Early detection is the key to really improve a better outcome.

We promote that patients over 80 should have a regular check up for the disease with their family doctor.

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Professor Harald zur Hausen: Nobel scientist calls for HPV vaccination for boys

Mon, Jul 13, 2015

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Source: www.independent.co.uk
Author: Charlie Cooper & Gloria Nakajubi
 

The UK should vaccinate all boys against the cancer-causing human papilloma virus (HPV), the Nobel Prize-winning scientist who discovered the link between HPV and cancer has said.

Professor Harald zur Hausen, the German virologist whose theory that HPV could be a cause of cervical cancers led to global efforts to vaccinate girls against the virus, said that boys should also be protected.

There is now a wealth of evidence that HPV also causes cancers in men, including anal, penile and throat cancer. Professor zur Hausen added that there was now a chance to “eradicate” HPV viruses altogether if the world developed global vaccination programmes for all children.

Since 2008 the UK has offered free vaccinations against HPV to girls aged 12 to 13 – a programme that had an almost 87 per cent uptake from 2013 to 2014 and has led to falls in the number of pre-cancerous abnormalities of the cervix, according to research carried out among vaccinated girls in Scotland.

Capture

Vaccine authorities in the UK, traditionally an international leader in the field of immunisation, are yet to make a judgement on a publicly funded vaccination programme for boys, which would follow in the wake of those already in place in Australia, Austria, Israel and parts of Canada.

HPV is the name for a common group of viruses that can affect the moist membranes of the cervix, anus, mouth and throat. It is usually spread through sexual contact.

Most sexually active people will contract it in their lifetime but usually it causes no ill-effects. However, in some cases it causes changes to cells, which can become cancerous. It is the cause of almost all cases of cervical cancer, a discovery made by Professor zur Hausen in the 1970s, for which he won the Nobel Prize in physiology or medicine in 2008.

Speaking to HPV Action, in an interview to be published by the campaign group this week, Professor zur Hausen said that vaccinating boys was of “the utmost importance”, not only because boys can also contract HPV-related cancers of the throat, anus and penis, but because protecting boys is key to ending transmission of the virus altogether.

“The vaccination programme for girls [in the UK] is marvellous – it reaches a very high proportion,” he said. “In my opinion, the vaccination of boys is also of the utmost importance because virus transmission is due to male partners and men are affected by oropharyngeal [cancers of the throat], anal and penile cancers as well as genital warts.”

Last year the UK’s vaccination authority, the Joint Committee on Vaccination and Immunisation (JCVI), recommended that the UK introduce a vaccination programme for gay men, to be delivered via sexual health clinics. The rationale behind the recommendation is that heterosexual men will be protected from HPV infection because most women will have been immunised, but that men who have sex with men will miss out on “herd immunity”.

However, campaigners and some experts say this reasoning is flawed, as many gay men will have been sexually active before their first visit to a sexual health clinic, and would most likely have already contracted or transmitted the virus.

The JCVI is due to consider the cost-effectiveness of vaccination for boys but campaigners do not anticipate any decision until 2017.

However, the NHS in London is currently planning what would be the first pilot of routine HPV vaccination for boys, with a likely start date of February 2016. The “field test” will work across four sites to establish whether school-age young males would “embrace the uptake of HPV vaccination as part of a community programme”, NHS England’s London office said.

Rolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer.

Scientists say changes in sexual behaviour – with more couples having oral and anal sex – may be the cause of increased cases of anal and throat cancers in both men and women in recent decades.

Margaret Stanley, emeritus professor at the University of Cambridge and a leading expert on HPV, said that cases could continue to rise. “It’s very much under-thirties [having more anal and oral sex] so you can predict there will be a rise in both those cancers. It’s a time bomb,” she said. “Wider exposure to different sexual practices – in other words porn on the internet – is also changing sexual behaviour in teenagers.”

HPV is also the cause of genital warts, the second-most common sexually transmitted infection in the UK. There are nearly 90,000 cases annually, costing the NHS around £55m. Campaigners hope that figure will be taken into account when the JCVI weighs up the cost-effectiveness of a vaccination programme.

Despite safety concerns being raised about the vaccine’s alleged side effects in some parts of the world, including Japan, no causal links have been established between the vaccine and reported long-term health problems. It is approved by the World Health Organisation, as well as European and UK vaccine-safety authorities. Professor zur Hausen added that it was “one of the safest vaccines we have”.

8-Injection-GetRolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer (Getty)

 

A Department of Health spokesperson said: “The HPV-prevention programme is key in helping us prevent cervical cancer. We have successfully given more than a million doses in the UK since 2008.

“Our independent vaccination experts are assessing whether it should be extended to prevent cancers in adolescent boys, men who have sex with men, or both.”

Time for an update?

Parents are currently advised and asked for consent for their daughters to have the HPV vaccination through a form and information leaflet sent out via schools.

The vaccine’s preventative effects against cervical cancer and the protection it offers against genital warts are explained. The protection against other cancers is not mentioned.

Parents and children are told that the vaccine, which is now given in just two doses instead of three, protects against 70 per cent of cervical cancers and that girls will still require cervical screening tests when they are older. Newer versions of the vaccine may protect against more cases in the future.

Parents are told that the vaccine may cause “soreness, swelling and redness in the arm” that will wear off in a couple of days. The leaflet states that “more serious side effects are extremely rare” and reassures parents that it meets European and UK safety standards. However, parents have the option to deny permission for their daughters to have the jab – and are told it would be “helpful” if they gave reasons for refusal.

The leaflet is directly targeted at girls and their parents and focuses on cervical cancer. If the Government were to extend the HPV-vaccination programme to boys, they would have to reconsider how the vaccine was presented to parents and children. The current programme has had impressive uptake, possibly in part because the key reason for taking the vaccine – to prevent cervical cancer – is straightforward and well understood. It may be that in a new HPV vaccination programme, the jab could be presented more broadly as protection against “a range of cancers”.

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

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Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician

Mon, Jul 13, 2015

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Source: 7thspace.com
Author: staff

Decisions on head and neck squamous cell carcinoma (HNSCC) treatment are widely recognized as being difficult, due to high morbidity, often involving vital functions. Some patients may therefore decline standard, curative treatment.

In addition doctors may propose alternative, nonstandard treatments. Little attention is devoted, both in literature and in daily practice, to understanding why and when HNSCC patients or their physicians decline standard, curative treatment modalities.

Our objective is to determine factors associated with noncompliance in head and neck cancer treatment for both patients and physicians and to assess the influence of patient compliance on prognosis.

Methods: We did a retrospective study based on the medical records of 829 patients with primary HNSCC, who were eligible for curative treatment and referred to our hospital between 2010 and 2012. We analyzed treatment choice and reasons for nonstandard treatment decisions, survival, age, gender, social network, tumor site, cTNM classification, and comorbidity (ACE27).

Multivariate analysis using logistic regression methods was performed to determine predictive factors associated with non-standard treatment following physician or patient decision. To gain insight in survival of the different groups of patients, we applied a Cox regression analysis.

After checking the proportional hazards assumption for each variable, we adjusted the survival analysis for gender, age, tumor site, tumor stage, comorbidity and a history of having a prior tumor.

Results: 17% of all patients with a primary HNSCC did not receive standard curative treatment, either due to nonstandard treatment advice (10%) or due to the patient choosing an alternative (7%). A further 3% of all patients refused any type of therapy, even though they were considered eligible for curative treatment.

Elderliness, single marital status, female gender, high tumor stage and severe comorbidity are predictive factors. Patients declining standard treatment have a lower overall 3-year survival (34% vs. 70%).

Conclusions: Predictive factors for nonstandard treatment decisions in head and neck cancer treatment differed between the treating physician and the patient. Patients who received nonstandard treatment had a lower overall 3-year survival. These findings should be taken into account when counselling patients in whom nonstandard treatment is considered.

Author: Emilie Dronkers, Steven Mes. Marjan Wieringa, Marc vander Schroeff, Robert Baatenburg de Jong
Credits/Source: BMC Cancer 2015, 15:515

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Mouth cancer survivor: Dental check ups saved my life

Mon, Jul 13, 2015

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Source: www.express.co.uk
Author: Elaine McLaren

“Nobody particularly enjoys visits to the dentist and I’m no exception, but I’ve always looked after my teeth and have never missed a six-month check. So that day back in May 2009, I wasn’t expecting there to be any problems. I hadn’t been in any pain or discomfort, so I was surprised when the dentist voiced his concern.

‘There’s a white patch on the side of your tongue,’ he told me through his mask. ‘It’s probably nothing but you should get it checked out by your GP, just to be on the safe side.’

Examination over, I sat up in the chair as he explained what he thought it could be – a condition called leukoplakia, which was harmless in its mild form and often disappeared without the need for treatment.

So when, a few days later, I was sitting opposite my GP, I was shocked to hear the condition was closely linked to mouth cancer.

My heart sank at the mere mention of the word. Just seven years earlier, I’d lost my dad to lung cancer.

My thoughts immediately turned to my own children, Grace, who was then only eight, and Daniel, five, and whether they’d have to go through the same trauma as I had with Dad.

As quickly as the notion had entered my head, I brushed it aside. I was only 38 then, I didn’t smoke or drink heavily and I ate healthily. Nothing made me a high risk.

But that still didn’t stop my heart pounding as I sat in the hospital waiting to see the consultant a few weeks later. Opening my mouth wide once again, I steeled myself for the worst possible news.

When he told me I had nothing to worry about, I could have cried with relief.

But its habit of developing into something far more sinister meant that wasn’t the end. I was sent for a biopsy to check for irregular cells and continued to see the consultant for check-ups, then discharged 18 months later. I could finally start to relax and believe it was over.

My dentist wasn’t quite so laid-back. As an expert in mouth cancer, he kept a close eye on it, taking photographs every time I saw him to make sure he could track the changes. It became a routine part of my visits and something I barely even thought about, until five years later I started to notice a difference myself.

All of a sudden, the patch started to rub against my teeth, whereas I’d never noticed it before. It started to get red and aggravated and every time I ate spicy foods, an agonising, searing pain would shoot through my tongue.

As luck would have it, I already had an appointment with my dentist booked, so I decided to see him before doing anything else. I was hoping he would tell me it was nothing, but in my heart I knew that wasn’t the case. Sure enough, he took one look at it and recommended I went back to see the GP.

Just weeks later, I was once again sitting in the familiar surroundings of the consultant’s office. I knew from his straight-faced, stilted reaction – so different to the casual reassurance I’d had before – that it was much more serious.

His voice was calm and steady as he told me I would need another biopsy, but I could tell he thought the worst. I had the procedure two days before Christmas 2013 and though I tried to think positively, telling myself that I’d been worried before and it had turned out to be nothing, the truth was I was terrified.

I spent the entire festive season putting on a happy face and trying to make everything as normal as possible for the children when, inside, all I could think about were the impending results. Every waking moment, I worried about the outcome.

When I returned to the consultant early in the new year, I thought I’d prepared myself for what he was about to say. When I eventually heard the words, ‘You have mouth cancer,’ it turns out I wasn’t prepared at all.

Though I’d known deep down that it was coming, it hit me like a bolt out of the blue as if I’d never expected it at all. As the words began to sink in, it came as such a huge shock that he was talking about me.

I’d always assumed it was a disease that only affected older men who smoked heavily. How wrong I’d been. Mercifully, and thanks to the diligence of my dentist, mine had been caught early enough to give me a great chance. I felt incredibly lucky. I was going to beat this.

But just as I was counting my lucky stars, fate dealt me another blow. A routine MRI scan revealed a mass on my right lung. It couldn’t be diagnosed with a biopsy because of its position, so I had no choice but to leave it there until they’d dealt with the cancer in my mouth.

I was determined to get through it and get back to being a mum again.

In January last year, I had a 10-hour operation to remove the cancer in my tongue and have it rebuilt with tissue and a vein from my arm, which was then grafted with skin from my tummy.

As soon as I recovered, in March last year, I was back in theatre again for a four-hour operation to remove the mass on my lung, which did turn out to be cancerous.

Both of the operations were a success and I’m finally getting my life back on track. I know I’ve got the vigilance of my dentist and the fact that I visited him regularly for the fact that it was caught early enough and I can put it all behind me. If it wasn’t for him, I could still be living with a cancer I didn’t even know was there.”

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Patient of Dr. Fata speaks out about her experiences

Fri, Jul 10, 2015

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Source: www.wnem.com
Author: Craig McMorris

Rhonda Teague was a patient of Dr. Farid Fata. Fata has pleaded guilty to fraud, money laundering and conspiracy. The government says he put some patients through treatments that weren’t necessary. In fact, some of those patients didn’t even have cancer.

Teague says she was given grueling throat cancer treatments that weren’t necessary.

“I threw up a lot, I had third degree burns all the way down my throat and into my chest cavity,” said Teague.

The Holly resident says she’s still suffering from the chemotherapy Dr. Fata prescribed.

“I’m losing part of my teeth, I still have no taste buds. I have no mucus glands and that’s really bad because my mouth is constantly dry.”

Not to mention Teague says she loses her voice much of the time. This was her last day on the job delivering chips and snacks, she says she just doesn’t have the energy that is necessary to do her job.

“I’m weak, I’m not the same. My energy level is not the same. I don’t have the same appetite. It hurt my relationship with my husband,” said Teague.

Prosecutors want Dr. Fata to be sentenced to 175 years in prison. Teague says “I would like him to get the 175 years, and I hope to God the court system will not give him the 25 years because he deserves 175 plus chemo.”

Teague says she still has unseen scars inflicted by Dr. Fata.

“Families and friends need to understand. Right now I haven’t been to another doctor in over a year, because I’m scared to death to go.”

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HPV vaccine now free for ‘at-risk’ boys and men under 26

Fri, Jul 10, 2015

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Source: www.vancitybuzz.com
Author: Jill Slattery

vaccine

The government of B.C. announced this week the HPV vaccine for human papilloma virus will now be available free of charge to boys and men under age 26 who classify as ‘at-risk’.

Beginning in September, the free HPV vaccine program currently only available to young women will become available to men who have sex with males or who are “street-involved”.

“Providing the vaccine for all girls protects heterosexual boys as well, but leaves at-risk boys and young men unprotected. This change will address that gap,” said the province in a media release.

“The human papilloma virus is the most common sexually transmitted infection,” said Health Minister Terry Lake. “It can lead to serious health problems and could develop into an HPV-related cancer. Our vaccination program will help protect all young British Columbians from cancers and other diseases caused by HPV infection.”

HPV can be contracted by having sex with another person infected by the virus. According to the Centers for Disease Control and Prevention (CDC), HPV is “spread easily during anal or vaginal sex, and it can also be spread through oral sex or other close skin-to-skin touching during sex. HPV can be spread even when an infected person has no visible signs or symptoms.”

While HPV may cause little to no symptoms in some, it can lead to genital warts and certain kinds of cancer. In men, oropharyngeal cancers (cancers at the back of the throat) are the most common.

“In general, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers,” reports the CDC.

“It is clear that some men are more at risk for HPV related cancers than are others,” said Dr. Perry Kendall, B.C.’s provincial health officer. “As most of these infections are vaccine-preventable, extending B.C.’s HPV immunization program to this at-risk demographic is a cost-effective way to provide protection to the people who need it most.”

Men who have sex with other men carry a disproportionately high chance of contracting HPV.

The provincial HPV vaccine program uses the Gardasil vaccine, protecting from HPV types 16 and 18 that cause 70% of cervical cancers, 80% of anal cancers and other cancers of the mouth, throat, penis, vagina and vulva. It also protects against infection from HPV types 6 and 11 that cause about 90% of cases of genital warts.

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Cancer patient has his mouth and tongue rebuilt using tissue from arm

Tue, Jul 7, 2015

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Source: www.dailymail.co.uk
Author: Madlen Davies

When David Barwell was diagnosed with the advanced mouth cancer, he feared he would never speak or eat again. But now, British surgeons have rebuilt his entire oral cavity using tissue from his arm, in a 15-hour operation.
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They had to remove a tumour the size of a plum from his throat, forcing them to cut away the bottom of his mouth and tongue. But medics were able to use skin and blood vessels from his arm to rebuild the oral cavity, and re-model his tongue.

The operation will allow him to eat, drink and one day speak again, they hope. British-born Mr Barwell, who was living in Poland when he was diagnosed, travelled across Europe in a campervan to come back to Britain for treatment. Now recovering from the operation, he and his wife of 28 years, Barbara, have praised the NHS and its staff as ‘incredible’. Mrs Barwell, a 67-year-old mother-of-one, was fought back tears as she thanked the NHS for its work.

She said: ‘These people are amazing. After working for 15 hours to save David’s life and rebuild his mouth the surgeon, Mr McVicar, called me personally to tell me the operation had worked, and I could not believe it. I have never seen treatment so good, not anywhere in Europe.’

Mrs Barwell, who grew up in Poland but moved to Nottingham in the 1980s to study, added:
‘We used to make plans, both as a family and a business, but now we just can’t. We just want to take one day at a time and build a new life and start again. It will be different but we just have to hope that the cancer in his mouth will be totally gone and won’t come back. Usually people give cards to staff, and I will, but these wards are so incredible that I want to say more to thank them. The whole team are the best; it’s a very special world in here, one of hope and kindness.’

‘David writes me a note every day saying he loves me and thanking me for my devotion to him. We are so happy together and I am so thankful to the staff.’

Now recovering from the operation, Mr Barwell is fed through a tube into his stomach and uses a suction pipe to control his saliva. He is not yet able to speak properly, but he has expressed his thanks to staff at Nottingham’s Queen’s Medical Centre in a heartfelt note.

He wrote: ‘I am very grateful to Mr McVicar and his team for their help and support during this terrible illness. The treatment I have received has been first-class.’

Mr Barwell, who owns a Nottingham packaging company with his wife, began feeling unwell in October last year. But his illness initially misdiagnosed by doctors in Spain and Poland, where the couple had been living for nine years, and he was treated for an infection and given antibiotics. Finally, he was diagnosed with T4 mouth cancer in Poland in March, after losing almost four stone (25kg) in less than three months.

A T4 tumour is the most serious and hard-to-treat stage of the disease, because the cancer has spread from the mouth into nearby muscles, bones or skin. When doctors in Poland were unable to treat the disease, Mr Barwell drove back to Nottingham in a campervan to receive NHS care. Mr Iain McVicar, consultant maxillofacial surgeon for Nottingham University Hospitals, who operated on Mr Barwell, said: ‘It was a complicated situation with him living in Poland.

‘It might have been a much smaller procedure if it had been six or eight months before.
‘It [the tumour] would have got bigger and would have killed him.’

He added: ‘When you wake up you are just grateful you are alive because this kind of surgery carries a risk of death.

‘But he’s made the first leap and he’s done very well.’

Doctors are currently assessing whether Mr Barwell will need any further treatment or surgery.

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‘This is only the first part of the treatment, he’s probably going to need radiotherapy. It’s quite a complicated problem,’ said Mr McVicar.

‘It’s a very big operation and he’s not out of the woods yet but, hopefully, the tumour has been completely removed.
‘Hopefully he will ultimately be able to eat, drink and talk freely.’

It is also hoped he will be able to speak again with the help of therapists. Both Mr Barwell’s family and hospital staff say people need to be more aware of any changes in their mouths and more willing to go to a doctor or dentist to get help.

Mrs Barwell said: ‘I want people to be more forceful, and not just sit back and take antibiotics and ignore it. If it’s worrying you should see a doctor.

‘They need to be aware of what is wrong with them and look after themselves.’

Mr McVicar agreed, saying: ‘If people have something not right in their mouth for more than two weeks they should get it looked at.’

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Hey, Ontario — boys deserve protection from HPV, too

Fri, Jul 3, 2015

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Source: news.nationalpost.com
Author: Robyn Urback

For years now, groups including the Canadian Medical Association, the Canadian Cancer Society and the National Advisory Committee on Immunization have been petitioning the Ontario government to cover the cost of the HPV vaccine for boys. Since 2007, the province has paid to immunize girls against the common sexually transmitted infection — which is known to cause cervical, vaginal and other cancers in women, and mouth and throat cancers in men — but boys still have to shell out around $400 or more for three doses (though recent studies show that two doses may be sufficient) of the demonstrably effective, safe vaccine.

HPV Vaccinations Back In Spotlight After Perry Joins Presidential Race

Alberta and Prince Edward Island already cover the cost of the immunizations for both boys and girls, and so too will Nova Scotia as of this coming fall. And there’s good reason for that: doctors say that the rates of oral cancers among men have risen dramatically over the past several years, with HPV present in about two-thirds of cases. The good news is that the survival rate of these HPV-positive cancers is about 80 per cent; the bad news is that there can be lifelong effects, including problems with swallowing, hearing, tasting and in extreme cases, dependence on a feeding tube.

But here’s more good news: we know the HPV vaccine works. In the U.S., for example, it has been shown to reduce the rates of infection among 14- to 19-year-old girls by more than 56 per cent since it was introduced in 2007, and there are indications it might be similarly successful among boys. So with such obvious benefits, why would Ontario choose to leave half of its young population exposed?

Money. Obviously. According to a statement released by the Ministry of Health a couple of weeks ago, the province has put off expanding its vaccination program to boys in order to evaluate “economic and societal factors.”

There’s no question that these vaccines don’t come cheap, but they certainly don’t cost as much as treating a patient with oropharyngeal cancer, and indeed there may long-term savings — anywhere from $8 million to $28 million per year, as a recent study has shown. Furthermore, the immunization program in Ontario now depends on the notion of “herd” immunity, whereby the spread of the infection is contained if a large enough proportion of the population is inoculated. That means, essentially, that 15-year-old boys in Ontario today are left to either trust that the girls around them have been vaccinated, or to fork over the money in order to protect themselves. (This also leaves boys who might contract the virus from other boys completely exposed to the infection).

It is true that the prevalence of throat cancers among men in Ontario is still relatively low, but according to a 2011 study published in the Journal of Clinical Oncology, if trends continue the way the are, the rates of HPV-positive oropharyngeal cancer in the U.S. will surpass that of cervical cancer by the year 2020. It’s also likely that the cost of the vaccine will come down over the next few years (indeed, it used to be prohibitively expensive at more than $500 for a full course), especially as old patents expire and new versions of the vaccine become available. But here’s the most compelling reason why Ontario should expand its HPV vaccination: boys deserve to be protected from a cancer-causing infection, too. Alberta, Nova Scotia and PEI get that; it’s a shame Ontario still needs to think it over.

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U.S. Chamber of Commerce Works Globally to Fight Antismoking Measures

Tue, Jun 30, 2015

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Source: www.nytimes.com
Author: Danny Hakim
 
01cigarette-web2-master675A demonstration against World No Tobacco Day in Jakarta, Indonesia, in 2013. The U.S. Chamber of Commerce and its foreign affiliates have joined efforts to fight antismoking laws around the world. Credit Romeo Gacad/Agence France-Presse — Getty Images

KIEV, Ukraine — A parliamentary hearing was convened here in March to consider an odd remnant of Ukraine’s corrupt, pre-revolutionary government.

Three years ago, Ukraine filed an international legal challenge against Australia, over Australia’s right to enact antismoking laws on its own soil. To a number of lawmakers, the case seemed absurd, and they wanted to investigate why it was even being pursued.

When it came time to defend the tobacco industry, a man named Taras Kachka spoke up. He argued that several “fantastic tobacco companies” had bought up Soviet-era factories and modernized them, and now they were exporting tobacco to many other countries. It was in Ukraine’s national interest, he said, to support investors in the country, even though they do not sell tobacco to Australia.

Mr. Kachka was not a tobacco lobbyist or farmer or factory owner. He was the head of a Ukrainian affiliate of the U.S. Chamber of Commerce, America’s largest trade group.

From Ukraine to Uruguay, Moldova to the Philippines, the U.S. Chamber of Commerce and its foreign affiliates have become the hammer for the tobacco industry, engaging in a worldwide effort to fight antismoking laws of all kinds, according to interviews with government ministers, lobbyists, lawmakers and public health groups in Asia, Europe, Latin America and the United States.

The U.S. Chamber’s work in support of the tobacco industry in recent years has emerged as a priority at the same time the industry has faced one of the most serious threats in its history. A global treaty, negotiated through the World Health Organization, mandates anti-smoking measures and also seeks to curb the influence of the tobacco industry in policy making. The treaty, which took effect in 2005, has been ratified by 179 countries; holdouts include Cuba, Haiti and the United States.

Facing a wave of new legislation around the world, the tobacco lobby has turned for help to the U.S. Chamber of Commerce, with the weight of American business behind it. While the chamber’s global tobacco lobbying has been largely hidden from public view, its influence has been widely felt.

Letters, emails and other documents from foreign governments, the chamber’s affiliates and antismoking groups, which were reviewed by The New York Times, show how the chamber has embraced the challenge, undertaking a three-pronged strategy in its global campaign to advance the interests of the tobacco industry.

In the capitals of far-flung nations, the chamber lobbies alongside its foreign affiliates to beat back antismoking laws.

In trade forums, the chamber pits countries against one another. The Ukrainian prime minister, Arseniy Yatsenyuk, recently revealed that his country’s case against Australia was prompted by a complaint from the U.S. Chamber.

And in Washington, Thomas J. Donohue, the chief executive of the chamber, has personally taken part in lobbying to defend the ability of the tobacco industry to sue under future international treaties, notably the Trans-Pacific Partnership, a trade agreement being negotiated between the United States and several Pacific Rim nations.

“They represent the interests of the tobacco industry,” said Dr. Vera Luiza da Costa e Silva, the head of the Secretariat that oversees the W.H.O treaty, called the Framework Convention on Tobacco Control. “They are putting their feet everywhere where there are stronger regulations coming up.”

01cigarette-web1-master315Thomas J. Donohue, the head of the U.S. Chamber of Commerce, has defended the tobacco industry’s right to sue under future international treaties. Credit Brendan Hoffman for The New York Times

The increasing global advocacy highlights the chamber’s enduring ties to the tobacco industry, which in years past centered on American regulation of cigarettes. A top executive at the tobacco giant Altria Group serves on the chamber’s board. Philip Morris International plays a leading role in the global campaign; one executive drafted a position paper used by a chamber affiliate in Brussels, while another accompanied a chamber executive to a meeting with the Philippine ambassador in Washington to lobby against a cigarette-tax increase. The cigarette makers’ payments to the chamber are not disclosed.

It is not clear how the chamber’s campaign reflects the interests of its broader membership, which includes technology companies like Google, pharmaceutical giants like Pfizer and health insurers like Anthem. And the chamber’s record in its tobacco fight is mixed, often leaving American business as the face of a losing cause, pushing a well-known toxin on poor populations whose leaders are determined to curb smoking.

The U.S. Chamber issued brief statements in response to inquiries. “The Chamber regularly reaches out to governments around the world to urge them to avoid measures that discriminate against particular companies or industries, undermine their trademarks or brands, or destroy their intellectual property,” the statement said, adding, “we’ve worked with a broad array of business organizations at home and abroad to defend these principles.”

The chamber declined to say if it supported any measures to curb smoking.

The chamber, a private nonprofit that has more than three million members and annual revenue of $165 million, spends more on lobbying than any other interest group in America. For decades, it has taken positions aimed at bolstering its members’ fortunes.

While the chamber has local outposts across the United States, it also has more than 100 affiliates around the world. Foreign branches pay dues and typically hew to the U.S. Chamber’s strategy, often advancing it on the ground. Members include both American and foreign businesses, a symbiotic relationship that magnifies the chamber’s clout.

For foreign companies, membership comes with “access to the U.S. Embassy” according to the Cambodian branch, and entree to “the U.S. government,” according to the Azerbaijan branch. Members in Hanoi get an invitation to an annual trip to “lobby Congress and the administration” in Washington.

Since Mr. Donohue took over in 1997, he has steered the chamber into positions that have alienated some members. In 2009, the chamber threatened to sue if the Environmental Protection Agency regulated greenhouse gas emissions, disputing its authority to act on climate change. That led Nike to step down from the chamber’s board, and to Apple’s departure from the group. In 2013, the American arm of the Swedish construction giant Skanska resigned, protesting the chamber’s support for what Skanska called a “chemical industry-led initiative” to lobby against green building codes.

The chamber’s tobacco lobbying has led to confusion for many countries, Dr. da Costa e Silva said, adding “there is a misconception that the American chamber of commerce represents the government of the U.S.” In some places like Estonia, the lines are blurred. The United States ambassador there, Jeffrey Levine, serves as honorary president of the chamber’s local affiliate; the affiliate quoted Philip Morris in a publication outlining its priorities.

The tobacco industry has increasingly turned to international courts to challenge antismoking laws that countries have enacted after the passage of the W.H.O. treaty. Early this year, Michael R. Bloomberg and Bill Gates set up an international fund to fight such suits. Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that administers the fund, called the chamber “the tobacco industry’s most formidable front group,” adding, “it pops up everywhere.”

In Ukraine, the chamber’s involvement was no surprise to Hanna Hopko, the lawmaker who led the hearing in Parliament. She said the chamber there had fought against antismoking laws for years.

“They were against the tobacco tax increase, they were against placing warning labels on cigarettes,” she said. “This is just business as usual for them.”

01cigarette-web3-articleLargePlain packaged tobacco products with health warnings in Sydney, Australia. Credit Andrew Quilty for The New York Times

 

Country-by-Country Strategy

More than 3,000 miles away, in Nepal, the health ministry proposed a law last year to increase the size of graphic warning labels from covering three-fourths of a cigarette pack to 90 percent. Countries like Nepal that have ratified the W.H.O. treaty are supposed to take steps to make cigarette packs less appealing.

Not long afterward, one of Nepal’s top officials, Lilamani Poudel, said he received an email from a representative of the chamber’s local affiliate in the country, warning that the proposal “would negate foreign investment” and “invite instability.”

In January, the U.S. Chamber itself weighed in. In a letter to Nepal’s deputy prime minister, a senior vice president at the chamber, Tami Overby, wrote that she was “not aware of any science-based evidence” that larger warning labels “will have any discernible impact on reducing or discouraging tobacco use.”

A 2013 Harvard study found that graphic warning labels “play a lifesaving role in highlighting the dangers of smoking and encouraging smokers to quit.”

While Nepal eventually mandated the change in warning labels, cigarette companies filed for an extension and compliance has stalled.

“Since we have to focus on responding to the devastating earthquake, we have not been able to monitor the state of law enforcement effectively,” said Shanta Bahadur Shrestha, a senior health ministry official.

The episode reflects the chamber’s country-by-country lobbying strategy. A pattern emerged in letters to seven nations: Written by either the chamber’s top international executive, Myron Brilliant, or his deputies, they introduced the chamber as “the world’s largest business federation.”

Then the letters mention a matter “of concern.” In Jamaica and Nepal, it was graphic health warnings on packages. In Uruguay, it was a plan to bar cigarettes from being displayed by retailers. The Moldovan president was warned against “extreme measures” in his country, though they included common steps like restricting smoking in public places and banning advertising where cigarettes are sold.

A proposal to raise cigarette taxes in the Philippines would open the floodgates to smugglers, the government there was told. Tax revenue has increased since the proposal became law.

“We are not cowed by them,” said Jeremias Paul, the country’s under secretary of finance. “We meet with these guys when we’re trying to encourage investment in the Philippines, so clearly they are very influential, but that doesn’t mean they will dictate their ways.”

Protecting tobacco companies is portrayed by the chamber as vital for a nation’s economic health. Uruguay’s president is warned that antismoking laws will “have a disruptive effect on the formal economy.” El Salvador’s vice president is told that “arbitrary actions” like requiring graphic health warnings in advertisements undermine “investment and economic growth.”

On the ground, the chamber’s local affiliates use hands-on tactics.

After Moldova’s health ministry proposed measures in 2013, Serghei Toncu, the head of the American Chamber of Commerce in Moldova, laid out his objections in a series of meetings held by a regulatory review panel.

“The consumption of alcohol and cigarettes is at the discretion of each person,” Mr. Toncu said at one meeting, adding that the discussion should not be about “whether smoking is harmful.”

“You do not respect us,” he told the health ministry at another.

At a third, he called the ministry’s research “flawed from the start.”

His objections were not merely plaintive cries. The American chamber has a seat on Moldova’s regulatory review panel giving it direct influence over policy making in the small country.

“The American Chamber of Commerce is a very powerful and active organization,” said Oleg Chelaru, a team leader on the staff that assists the review panel. “They played a very crucial role in analyzing and giving an opinion on this initiative.”

Mr. Toncu, who has since left the chamber, declined to comment. Mila Malairau, the chamber’s executive director, said its main objective was to make sure the industry “was consulted” in “a transparent and predictable manner.”

After recently passing in Parliament, the long-stalled measures were subject to fresh objections from the chamber and others, and have not yet been enacted.

01cigarette-web4-articleLargeProtesters displayed fake body bags at a tobacco trade show at Pasay, the Philippines, in 2013. Credit Bullit Marquez/Associated Press

 

Fighting a Trade Exception

In Washington, the U.S. Chamber’s tobacco lobbying has been visible in the negotiations over the Trans-Pacific Partnership, a priority of the Obama administration that recently received critical backing in Congress.

One of the more controversial proposals would expand the power of companies to sue countries if they violate trade rules. The U.S. Chamber has openly opposed plans to withhold such powers from tobacco companies, curbing their ability to challenge national antismoking laws. The chamber says on its website that “singling out tobacco” will “open a Pandora’s box as other governments go after their particular bêtes noires.”

The issue is still unresolved. A spokesman for the United States trade representative said negotiators would ensure that governments “can implement regulations to protect public health” while also “ensuring that our farmers are not discriminated against.”

Email traffic shows that Mr. Donohue, the chamber’s head, sought to raise the issue in 2012 directly with Ron Kirk, who was then the United States trade representative. In email exchanges between staff members of the two, Mr. Donohue specifically sought to discuss the role of tobacco in the trade agreement.

“Tom had a couple of things to raise, including urging that the tobacco text not be submitted at this round,” one of Mr. Donohue’s staff members wrote to Mr. Kirk’s staff. The emails were produced in response to a Freedom of Information request filed by the Campaign for Tobacco-Free Kids, which provided them to The Times.

Mr. Kirk is now a senior lawyer at Gibson, Dunn, a firm that counts the tobacco industry as a client. He said in an interview that during his tenure as trade representative, he met periodically with Mr. Donohue but could not recall a specific conversation on tobacco.

He said trade groups were generally concerned about “treating one industry different than you would treat anyone else, more so than doing tobacco’s bidding.”

The chamber declined to make Mr. Donohue available for an interview.

A Face-Saving Measure

In Ukraine, it was Valeriy Pyatnytskiy who signed off on the complaint against Australia in 2012, which was filed with the World Trade Organization. At the time, he was Ukraine’s chief negotiator to the W.T.O. His political career has survived the revolution and he is now an adviser to the Ukrainian prime minister, Mr. Yatsenyuk.

In a recent interview, he said that for Ukraine, the case was a matter of principle. It was about respecting the rules.

He offered a hypothetical: If Ukraine allowed Australia to use plain packaging on cigarettes, what would stop Ukraine from introducing plain packaging for wine? Then Ukrainian winemakers could better compete with French wines, because they would all be in plain bags marked red or white.

“We had this in the Soviet times,” he said. “It was absolutely plain packaging everywhere.”

Some Ukrainian officials have long been troubled by the case.

“It has nothing to do with trade laws,” said Pavlo Sheremeta, who briefly served as Ukraine’s economic minister after the revolution. “We have zero exports of tobacco to Australia, so what do we have to do with this?”

Last year, he urged the American Chamber in Kiev to reconsider.

“I wrote a formal letter, asking them, ‘Do you still keep the same position?’ ” Mr. Sheremeta said. “Basically I was suggesting a face-saving way out of this.” But when he met with chamber officials, the plain packaging case was outlined as a top priority.

They refused to back down. After Mr. Pyatnytskiy, a tobacco ally, was installed as his deputy, Mr. Sheremeta resigned.

“The world was laughing at us,” he said of the case.

Shortly after The Times discussed the case with Ukrainian government officials, there were new protests from activists. Mr. Yatsenyuk called for a review of the matter. Ukraine has since suspended its involvement, but other countries including Cuba and Honduras are continuing to pursue the case against Australia.

Andy Hunder, who took over as president of the American Chamber of Commerce in Kiev in April, said the organization was moving on, adding, “We are looking forward now.”

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

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