CDC

HPV, is it running rampant?

Source: WebMD
Author: Bill Hendrick

Jan. 14, 2010 — Cancer-causing human papillomavirus (HPV) spreads readily and quickly among partners in new sexual relationships, new research indicates.

Scientists at McGill University, reporting in the journal Epidemiology, say they detected the virus in 64% of couples who reported engaging in vaginal sex for a median of 3.9 months.

In 41% of 263 college couples studied, both partners had the same type of HPV, a surprising finding “far more frequent than [the 11%] expected by chance” even though the virus is the most common sexually transmitted infection, the authors write.

“[D]etection of the same type in persons initiating a sex relationship would be rare given type-specific prevalence rates,” says the study, whose lead author is Ann N. Burchell, PhD, of the division of cancer epidemiology, departments of oncology and epidemiology and biostatistics at McGill University in Montreal.

Along with colleagues from the University of Montreal, Burchell and Eduardo Franco, DrPH, MPH, director of McGill’s Cancer Epidemiology Unit, analyzed self-reported data from partners of 263 couples.

The women, college students between 18 and 24, enrolled in the study with their male partners. Women were sexually active with their male partners for no more than six months. Most used condoms, but 9% never used condoms. Self-collected vaginal swabs and clinician-collected swabs from the penis and scrotum were tested for 36 strains of HPV.

Among 169 couples for whom at least one partner was infected, the scientists identified 583 type-specific HPV infections. Twenty-five percent of monogamous partners had the same virus type after engaging in vaginal sex for less than two months, the authors write.

That rose to 68% among those who’d been having sex for five to six months.

“Due to its sexually transmitted nature, the study of HPV at the level of sexual partnership is fundamental to our understanding of the epidemiology of these infections,” the researchers write. “The observation that HPV occurs more commonly in sexual partners than expected by chance provides evidence for the sexual transmission of HPV.”

Transmission is likely early in sexual relationships, and having a new sex partner is an important risk factor for infection in both women and men, the researchers write.

HPV causes cervical cancer, as well as cancers of the vulva, vagina, anus, penis, and head and neck. HPV also causes genital warts. Although HPV infections are extremely common, with at least 50% of sexually active women and men contracting this type of infection at some point, most have no symptoms and clear the infection on their own, according to the CDC.

Another article from the researchers using data from the same group of participants was published in the January 2010 issue of the journal Sexually Transmitted Diseases.

The second analysis found that the greatest risk factor for genital HPV infection was infection in a person’s current sexual partner. Condoms were tied to a more protective effect for men than for women.

“These results build on our knowledge that HPV infection is very common among young adults, and underline the importance of prevention programs for HPV-associated diseases,” Burchell says in the McGill news release. “Our results also suggest that HPV is an easy virus to get and to transmit.”

Francois Coutlee, MD, a professor at the University of Montreal’s department of microbiology and immunology and co-author on both articles, says the results suggest that many HPV transmissions occur at the start of new relationships, “which reinforces the need for prevention.”

January, 2010|Oral Cancer News|

U.S. smoking rates remain steady, but vary widely by state

Source: Medical News
Author: John Gever

National rates of cigarette smoking showed little change in 2008 from a year earlier, the CDC reported, though states vary widely both in rates of current smoking and exposures of nonsmokers to secondhand smoke.

Some 20.6% of Americans were current smokers in 2008 (95% CI 19.9% to 21.4%), not significantly different from the 19.8% found in 2007 (95% CI 19.0% to 20.6%) according to the the government’s ongoing National Health Interview Survey, detailed by Shanta R. Dube, PhD, and other CDC researchers in the Nov. 13 issue ofMorbidity and Mortality Weekly Report.

But analysis of a another data set in MMWR — the 2008 results from the Behavioral Risk Factor Surveillance System (BRFSS) — revealed a twofold variation in rates among states.

Utah had by far the lowest rate of current cigarette smoking, at 9.2%, followed by California (14.0%), New Jersey (14.8%) and Maryland (14.9%), according to Ann M. Malarcher, PhD, and CDC colleagues.

West Virginia led the other end of the list at 26.6%. Other states with current smoking rates of 25% or more included Indiana, Kentucky, and Missouri.

West Virginia had several other smoking distinctions.

It was the only state in which the current smoking rate was higher among women than men — 27.1% versus 26.1% — although the difference was not statistically significant.

The BRFSS data showed the Mountain State had the highest rate of home exposure to secondhand smoke among 12 states and territories for which data were available.

Some 10.6% of West Virginia adults said there was secondhand smoke in their homes (95% CI 9.2% to 12.0%), while the lowest rate was in Arizona (3.2%, 95% CI 2.3% to 4.1%). The national median was 7.8%

West Virginia respondents were also least likely to report that smoking was banned inside their homes, at 68.8% (95% CI 67.0% to 70.6%).

The U.S. Virgin Islands sported the highest home smoking ban figure, 85.7% (95% CI 83.8% to 87.6%), a statistical tie with Arizona’s 85.6%. The national median was 78.1%.

Similar variation in workplace exposure to secondhand smoke was apparent in the result, though with a different pattern of highs and lows.

Tennessee had the lowest rate, with 6.0% of survey respondents saying there was secondhand smoke at work (95% CI 4.0% to 8.0%). Mississippi had the highest, at 15.8% (95% CI 13.7% to 17.9%). The national median was 8.6%.

As in previous surveys, the 2008 National Health Interview data showed that smoking rates were markedly higher among individuals with a high school education or less (27.5%, 95% CI 25.5% to 29.6%) compared with those with more education.

People with “some college” had a 2008 smoking rate of 22.7% (95% CI 21.3% to 24.2%) while just 5.7% of those holding graduate degrees were current smokers (95% CI 4.6% to 7.1%).

Dube and colleagues also found substantial racial-ethnic differences in 2008 smoking rates, similar to those seen in previous years:

  • Non-Hispanic whites: 22.0%
  • Non-Hispanic blacks: 21.3%
  • Hispanics: 15.8%
  • American Indian/Alaska native: 32.4%
  • Asian: 9.9%

In an unsigned commentary, MMWR editors noted that the national prevalence of smoking has declined significantly since 1998, when 24.1% of adults smoked. That was the year when the “master settlement agreement” with tobacco companies began limiting their marketing activities, the editors said.

But year-to-year decreases have been sporadic, they added.

“Although comprehensive tobacco control programs have been effective in decreasing tobacco use in the U.S., they remain underfunded,” the editors wrote.

The editors added that state-level tobacco control programs “need to continue to encourage the public to make their homes smoke-free.”

More states also need to legislate smoking bans in restaurants, bars, and other workplaces, they said, as the patchwork nature of such bans appears to be a major factor in the state-to-state variation in exposure to secondhand smoke on the job.

No external funding for the CDC studies was reported.

No potential conflicts of interest were reported.

November, 2009|Oral Cancer News|

“French” kissing ups risk of oral HPV infection

Source: The Journal of Infectious Diseases
Author: Staff

NEW YORK (Reuters Health) – Oral sex and open-mouthed “French” kissing increase the risk of acquiring oral infections of human papillomavirus, or HPV, a study shows.

“Performing oral sex is not without risks,” Dr. Maura L. Gillison told Reuters Health.

It is associated with gonorrheal pharyngitis – a sexually transmitted infection of the tonsils and back of the throat that immediately causes symptoms, she noted, and now is associated with mouth HPV infections that are silent “yet may lead to oral cancer 10 to 20 years later.”

Gillison from The Ohio State University, Columbus, and colleagues explored whether sexual behaviors were associated with the odds of oral HPV infection in 332 adults and in 210 college-aged men. They found that 4.8 percent of the adults and 2.9 percent of college-aged men had oral HPV infection.

Among adults, the odds of oral HPV infection were significantly elevated among current tobacco smokers and among individuals who reported having either more than 10 oral or more than 25 vaginal sex partners during their lifetime.

Similar risk factors applied to the college-aged men. For them, having at least six recent oral sex or open-mouthed kissing partners were independently associated with increased odds of developing oral HPV infection.

For the 28 percent of college-aged men who reported never having performed oral sex, having at least 10 lifetime or at least five recent open-mouthed kissing partners was associated with a significantly higher risk of developing oral HPV infection.

“Our data suggest that oral HPV infections that could predispose to cancer may be transmitted by very common behaviors such as open-mouth or ‘French’ kissing,” Gillison concluded.

Given that the HPV vaccine does not have any therapeutic value against pre-existing HPV infections, “this may be relevant to the timing of administration of vaccination,” Gillison said.

Although the CDC recommends that the vaccine be administered between the ages of 9 and 12 ideally, in practice, she noted, it is often administered to girls between the age of 14 and 16. Oral exposure to HPV may have occurred prior to that age.

SOURCE: The Journal of Infectious Diseases, November 9, 2009.

November, 2009|Oral Cancer News|

Males can get HPV vaccine Gardasil thanks, in part, to Gulfport cancer survivor

Source: St. Petersburg Times

Author: John Barry

David Hastings’ crusade to inoculate boys against a cancer-causing virus that afflicts women — but threatened him, too — has scored a victory. But it’s not quite the one he has been fighting for in the past three years.

A panel of the Centers for Disease Control and Prevention last week allowed a vaccine to be given to boys and young men that is already used to protect girls and young women from human papillomavirus, HPV, which causes cervical cancer.

The panel’s vote followed the Food and Drug Administration’s recent okay of the vaccine for boys as a protection against genital warts.

The vaccine, Gardasil, was approved only for females, ages 9 to 26, in 2006. But research has since linked HPV to many oral cancers in men.

Hastings, who owns the Habana Cafe in Gulfport with his wife, Josefa, testified before the CDC’s Advisory Committee on Immunization Practices. He told them how HPV was found in a deadly carcinoma in his throat in 2006. It took seven weeks of simultaneous chemotherapy and radiation at the H. Lee Moffitt Cancer Center in Tampa to arrest the cancer.

Ever since, he has spread the message that HPV is a threat to men. He urged the CDC panel to recommend routine vaccinations for boys, as it already does for girls.

Hastings and other proponents argued that only 17 percent of girls are completing the series of three doses needed for protection. “We rely on females getting vaccinated to protect males,” he said. “If they don’t, too bad.”

But the panel voted only to allow the vaccinations for boys and men, ages 9 to 26, at their doctors’ discretion. It did not recommend routine use of Gardasil for boys, nor did the panel require doctors to tell parents about it. Insurance companies won’t be obligated to pay for the three doses, which cost about $130 each.

The decision was partly based on the fact that Merck, the vaccine’s maker, had conducted a clinical trial among men only of the vaccine’s effectiveness in treating genital warts, which are not life-threatening.

The committee said it would consider Gardasil’s effectiveness against male cancers in February. Merck plans to present studies next year on Gardasil’s potential as protection against anal cancers among gay men.

“We’re only halfway through the battle,” Hastings said, “but we’re spreading awareness.”

Information from Times wires was used in this report. John Barry can be reached at (727) 892-2258 or jbarry@sptimes.com.



October, 2009|Oral Cancer News|

CDC finds poisons in dissolvable tobacco products

Source: Notobacco

Author: Staff

Since the beginning of this year, Indianapolis has been a test market for new dissolvable tobacco products, mostly from Camel. These are smokeless, spit-free, made from finely milled tobacco, and held together by food-grade 41887-Camel_Dissolvablesbinders. They look like breath mints, breath strips, or toothpicks, and are designed to be placed in the mouth, on the tongue or between the cheek and gum, where they dissolve to release tobacco.

Dissolvable tobacco products are now available in Daviess County in the form of Stonewall dissolvable tablets. The manufacturer, Star Scientific, states that Stonewalls are designed for heavy smokers and spit tobacco users. This company also makes Ariva brand dissolvable tablets.

Indiana Tobacco Prevention and Cessation agency feels the tobacco companies are illegally using Hoosiers as unwitting participants in a potentially dangerous clinical trial of these products since they were not tested for safety before being sold to the public, as food products, drugs, and cosmetics would be.

StonewallsDissolvable tobacco products may contain up to three times the amount of nicotine found in one cigarette. A cigarette smoker typically takes in about 1 milligram of nicotine. Camel dissolvable products are said to deliver about 0.6 to 3.1 milligrams of nicotine each, Ariva tablets have about 1.5 millgrams of nicotine each, and Stonewall tablets have about 4 milligrams of nicotine each.

People who use these products may get a higher dose of nicotine than they are used to, possibly resulting in nicotine poisoning, which manifests through adverse reactions such as tremors, nausea, vomiting, agitation, and in more extreme cases, seizures, coma, and death. The high nicotine content combined with the nature of the products and the ease of use is a potentially deadly combination for both adults and children. For example, users may be tempted to ingest multiple tablets at one time, like they would breath mints.

Less than a milligram of nicotine is enough to kill a child, depending on age and weight. Indiana Poison Control has already received calls regarding nicotine poisoning associated with dissolvable tobacco use.

Dissolvable tobacco is not a safe alternate to cigarettes, even though tobacco companies are marketing them as a safer alternative with fewer toxins. People who use spit tobacco are at risk of many health problems including cancers and mouth diseases, and we have no reason to believe dissolvable products are any safer.

Collaboration between ITPC and Dr. Jeffery Wigand, a former tobacco company researcher who achieved national prominence when he became the tobacco industry’s highest ranking former executive to address public health and smoking issues, has resulted in a preliminary CDC study of Camel Orbs dissolvable products.

mouth_cancer2.jpg

The study found two questionable ingredients in Orbs: cinnamaldehyde, a toxic insecticide, fungicide, corrosion inhibitor, and severe skin irritant; and coumarin, which the FDA banned as a food additive in 1978 and as a cigarette additive in 1997. Since this was only a preliminary study, we don’t know what other chemicals and toxins may be present in Camel, Stonewall, or Ariva dissolvable tobacco products.

In a presentation to ITPC representatives recently, Dr. Wigand said the tobacco companies are doing clinical testing on people without their consent by selling dissolvable tobacco products that have not undergone safety testing. He said that formulas of Camel dissolvable products vary by test market; the Camel dissolvable products being sold in Indianapolis and surrounding counties have the highest levels of nicotine.

I’d like to ask each of you to take action by writing to the attorney general and the FDA. Ask them to remove dissolvable products from our stores and test them for safety.

Write to the attorney general at Consumer Protection Division, 302 West Washington Street, 5th Floor, Indianapolis, IN 46204 or call 317-232-6330.

Submit comments online to the FDA through www.regulations.gov or by mail to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, MD 20852.

October, 2009|Oral Cancer News|

Noted Hopkins scientist says research indicates need for effective HPV vaccine for women and men and a simple HPV screening test

Source: www.hopkinskimmelcancercenter.org/news
Author: press release

A call to explore a broader use of HPV (human papillomavirus) vaccines and the validation of a simple oral screening test for HPV-caused oral cancers are reported in two studies by a Johns Hopkins Kimmel Cancer Center investigator.

Leading HPV expert Maura Gillison, M.D., Ph.D., the first to identify HPV infection as the cause of certain oral cancers and who identified multiple sex partners as the most important risk factor for these cancers, reports her latest work in the November 3, 2008, journal Clinical Cancer Research and in a Centers for Disease Control and Prevention (CDC) monograph. The CDC report on HPV-associated cancers appears on line November 3 and in the November 15, 2008, supplement edition of Cancer.

In the CDC report, believed to be the first and most comprehensive assessment of HPV-associated cancer data in the United States, investigators analyzed cancer registry data from 1998-2003 and found 25,000 cancer cases each year occurred at cancer sites associated with HPV infection. In additional analysis, Gillison and colleagues at the National Cancer Institute identified HPV infection as the underlying cause of approximately 20,000 of these cancers.

Gillison and team found approximately 20,000 cases of cancer in the United States each year are caused by HPV infection. Oral cancers are the second most common type of HPV-associated cancers and are increasing in incidence in the U.S., particularly among men. Add to that anal, penile, vaginal, and vulvar cancers that are also linked to HPV infection, and Gillison says these cancers, when combined, equal the number of cervical cancers, the most common and well known of the cancers caused by HPV.

While about one-quarter of HPV-linked cancers occur in men, vaccines are currently approved only for use in girls and young women for cervical cancer prevention. “We need to have a more comprehensive discussion of the potential impact the HPV vaccine could have on cancer rates among men and women in this country,” says Gillison, associate professor of oncology. “Currently available HPV vaccines have the potential to reduce the rates of HPV-associated cancers, like oral and anal cancers, that are currently on the rise and for which there no effective or widely-applied screening programs.” Gillison notes, however, that studies are needed to confirm that the vaccine effectively prevents HPV infections that lead to oral and anal cancers.

Gillison’s findings were part of a project known as ABHACUS (Assessing the Burden of Human Papillomavirus-Associated Cancers). The data studied came from the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. More than 80 investigators from across the country participated in the project, which addressed a variety of HPV-cancer associated issues, including racial disparity, economic impact, behavioral risk factors, and cancer mortality.

Other then prevention, early detection is held by cancer experts as the best way to control cancer. In the Clinical Cancer Research study, the first to track the disease and related oral infections over an extended period, Gillison found that simple “swish and spit” oral rinses can successfully track oral HPV infection over time. These findings open the door to a potential, non-invasive screening test to detect the disease and monitor for tumor recurrence. Head and neck cancer is the broad term for a variety of cancers of the oral cavity, including the tonsils, base of the tongue, and the side and back wall of the throat.

The study found that oral rinses successfully detected high-risk HPV infections in patients with HPV 16-positive head and neck cancers for up to five years after treatment for their cancer. Gillison says the findings indicate a high rate of persistent infection and reaffirms the connection between high-risk types of HPV and HPV-positive head and neck cancers.

In the study, the researchers used oral rinses to collect cells shed from inside the mouths of 135 head and neck cancer patients. The researchers genetically sequenced the DNA obtained from the rinses and tumor samples to identify those with HPV-positive cancers and determine the HPV type. There are approximately 120 types of HPV, but HPV 16 is one of the two most common associated with cancer.

The analysis revealed 44 patients with HPV 16-positive tumors and found that these patients were more likely to have continuing oral HPV 16 infections both before and after cancer treatment. While this study did not link the continued post-treatment infections to tumor recurrence, it was noted that patients with high-risk oral HPV infections prior to therapy, maintained high rates of infection after completing therapy. The team plans further, long-term research to determine if this continued infection leads to cancer recurrence.

In 2000, Gillison identified HPV-positive head and neck cancer as a distinct subtype of the disease and linked it to improved survival.

“There is no question of cause,” says Gillison. “It has now become a question of tracking the infection over time to identify those at risk of developing cancer or cancer recurrence.”

Other researchers participating in the study include Yuri Agrawal, Wayne M. Koch, Weihong Xiao, William H. Westra, Anna L. Trivett, and David E. Symer.

The research was funded by the Oral Cancer Foundation, the National Institute of Dental and Craniofacial Research, and the National Cancer Institute.

Adult smoking is at record low

Source: www2.journalnow.com
Author: Richard Craver

A rate below 20 percent has more symbolic than commercial significance, tobacco analyst says Smoking among U.S. adults hit a record low during 2007, with less than one in five lighting up.

Although breaking through the 20 percent threshold was applauded by anti-smoking groups last week, they acknowledged that an ambitious goal of a 12 percent adult-smoking rate by 2010 is not likely to happen. The goal was set in November 2000 as part of the Healthy People 2010 project.

“If we want to see far more people quit smoking, we need expanded access to stop-smoking programs, continued progress in eliminating secondhand smoke exposure and ongoing investment in programs that work,” said Dr. Matthew McKenna, the director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention.

The agency reported that 43.4 million U.S. adults smoked in 2007, or 19.8 percent, compared with 45.3 million in 2006, or 20.8 percent. The rate essentially was unchanged from 2004 through 2006.

The peak of U.S. adult smokers was 53.5 million in 1983, according to U.S. government figures.

The number of adult men who smoke still exceeds women — 22 percent of men smoke, compared with 17.4 percent of women. The number of white adult smokers was 21.4 percent, compared with 19.8 percent for blacks and 13.3 percent for Hispanics.

The report also found that the percentage of everyday smokers who have tried to quit smoking has dropped from 47 percent in 1993 to nearly 40 percent in 2007. Older smokers were less likely to quit than those ages 18 to 24.

“If, starting in 2009, all states were to fully implement tobacco-control programs at CDC-recommended levels of investment,” McKenna said, “an estimated 5 million fewer people in this country would smoke within five years, and hundreds of thousands of premature tobacco-related deaths would be prevented each year.”

Other health-advocacy officials said that about 80 percent of smokers who successfully quit cigarettes tend to do it “cold turkey” rather than through stop-smoking products or programs.

The CDC reported that from 2000 to 2004, at least 443,000 Americans died prematurely each year as a result of smoking and exposure to secondhand smoke. It also found that smoking costs the nation $96 billion in health-care costs and $96.8 billion in productivity losses.

The decline of the U.S. adult- smoking rate to less than 20 percent comes at a time when U.S. tobacco manufacturers, particularly R.J. Reynolds Tobacco Co., are putting more emphasis on smokeless tobacco products. On the front lines of the migration are innovations from Reynolds — such as Camel Snus, a spitless product; dissolvable Camel products that feature a pellet; a twisted stick; and a film strip for the tongue.

But health-advocacy groups, having won the day with bans on smoking in most public venues after a 16-year fight, are gearing up their efforts and rhetoric to try to prevent those products from taking root.

The debate is pitting more health-care and anti-smoking officials on both sides of the smokeless debate because it’s not clear whether smokeless tobacco equals reduced risk, particularly involving cancer.

The decline in smoking also has major job implications for the manufacturers, who are struggling to find a balance between company size and consumer demand for their products.

Altria Group and Philip Morris USA said Tuesday that they were was cutting an unidentified number of jobs between now and February. Reynolds said on Sept. 9 that it was cutting 570 white-collar jobs between itself and its parent company, Reynolds American Inc., through early 2010.

“Just think how hard the tobacco majors are having to work to make any progress — snus, moist tobacco, cutbacks in Richmond, reorganization at Reynolds,” said Bruce Davidson, a tobacco analyst for Blue Oar Securities PLC of London. “This is an industry under pressure.”

Davidson said that dropping below a 20 percent adult-smoker rate is “more of a symbolic milestone “rather than marking some sort of breakthrough a commercially important barrier.”

David Howard, a spokesman for Reynolds, said that company policy states “the best course of action for tobacco consumers concerned about their health is to quit.”

Matthew Myers, the executive director of the Campaign for Tobacco-Free Kids, used the study’s results to push again for Food and Drug Administration regulation of the tobacco industry.

Myers also focuses on a significant increase in federal and state-tobacco taxes to reduce the number of adult smokers. There is growing expectation that Congress will pass early next year an expansion of the State Children’s Health Insurance program, financed primarily through a 61-cent increase in the federal excise tax on cigarettes.

“We know how to win the fight against tobacco use,” Myers said. “But we will not win it — and our progress could even reverse — without the political leadership to implement proven solutions at all levels of government.”

November, 2008|Oral Cancer News|