drinking

Cancer waiting times ‘could cost lives’

Source: www.rochdaleonline.co.uk
Author: staff

Statistics released by the Department of Health reveal costly delays that could jeopardize the lives of suspected head and neck cancer patients.

According to the 2012/13 Cancer Waiting Times annual report1, 1,252 suspected head and neck cancer patients had to wait longer than three weeks to be seen by a specialist, a delay that could potentially cost lives.

With mouth cancer cases on the increase, campaigners the British Dental Health Foundation are calling for suspected head and neck cancer patients to be seen within the two-week referral target due to the very nature of the disease. Without early detection, the five year survival rate for mouth cancer is only 50 per cent. If it is caught early, survival rates over five years can dramatically improve to up to 90 per cent.

Between April 2012 and March 2013 over one million patients were seen by cancer specialists following an urgent referral. A total of 96.1 per cent of suspected head and neck cancer were seen within 14 days of referral, compared to 96.3 per cent in 2010-20112. More than 50,000 patients were not seen within 14 days of referral.

Cancer waiting times are monitored carefully by the Foundation, which organises the Mouth Cancer Action Month campaign, sponsored by Denplan also supported by Dentists’ Provident and the Association of Dental Groups (ADG), in November each year to help raise awareness of the disease and its symptoms. Tobacco use, drinking alcohol to excess, smoking, poor diet and the human papillomavirus (HPV), transmitted via oral sex, are all known risk factors for mouth cancer, which is forecast to affect 60,000 people in the UK over the next decade.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, said: “The challenge in relation to mouth cancer is to ensure that, due to the very nature of the disease, patients are seen quickly. Most people with mouth cancer present late as stage 4 – the most advanced stage where time is of the essence in potentially saving a life.

“It is pleasing to see such a high percentage of suspected cancer patients seen within two weeks, but mouth cancer patients in particular should not have to wait more than three weeks.

“More people died from mouth cancer in 2010 than from cervical and testicular cancer combined. Early detection saves lives, so be aware that ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the mouth are early warning signs of mouth cancer.

“Our message to everyone is simple – ‘If in doubt, get checked out.’”

September, 2013|Oral Cancer News|

Celebrity confession linking sex to oral cancer raises local awareness

Source: www.vancouversun.com
Author: Pamela Fayerman

Michael Douglas is credited for raising awareness about the links between oral sex and oral cancer, but experts worry his disclosure could cause public panic and stigmatize the disease to the point of bringing shame to those afflicted. Or worse, prevent patients with symptoms from getting examined promptly.

Miriam Rosin, a BC Cancer Agency scientist, said the actor’s candid revelation that his throat cancer was caused by human papillomavirus (HPV), which he picked up from performing cunnilingus, is raising awareness of a growing problem around the world, and in B.C. “It’s created a lot of noise. I think it’s important to talk about this disease … but not in a headline-grabbing way, which may damage the cause by labelling it as a sexually transmitted disease,” said Rosin, who is also a Simon Fraser University professor.

Regardless, the public is finally getting the message that HPV, the most common sexually transmitted virus in the world – and the one that causes virtually all cases of cervical cancer – is accounting for the surge in throat cancers located at the back of the throat.

In B.C., if trends continue, HPV-caused throat cancers are expected to overtake cervical cancers in incidence. About 150 cases of cervical cancers are reported annually in this province. Of about 500 head and neck cancers, 115 are HPVcaused throat cancers, according to the BCCA.

Douglas’s interview with The Guardian newspaper last month was followed by an avalanche of sensational media reports that apparently gave the Hollywood celebrity a twinge of regret. Douglas’s publicist later claimed the 68-year-old meant only that oral sex and HPV were a potential cause of such cancers while not specifically referring to his own. The U.K. newspaper, however, stood by the story and released an audio of the interview to rebut Douglas’s backtracking. Excessive smoking and drinking alcohol are also risk factors for various forms of oral cancer, and when the actor was first diagnosed in 2010, he had previously blamed his cancer on many years of indulgence in those habits.

Up to 70 per cent of throat cancers are HPV-related. There are numerous places to get oral cancers – such as the lips, cheeks, gums, palate, tongue and tonsils – and while smokers and drinkers once fit the typical profile of an oral cancer patient, now, because of waning smoking prevalence, HPV infections have emerged as the dominant risk factor for throat tumours such as the one Douglas had.

Rosin said there was a whopping 300-per-cent increase in the age-adjusted incidence rate for throat cancers in B.C. between 1980 and 2010. It’s more commonly diagnosed in mid-life, and the ratio of males to females getting such cancers is three-to-one.

Earlier this year, the American Cancer Society issued a report showing the proportion of HPV-linked oral cancers has risen from 16 per cent of all oral cancers in the mid-1980s to 72 per cent two decades later.

Dr. John Hay, a radiation oncologist at the BC Cancer Agency and an expert in oral cancers, said HPV tumours are squamous cell clusters that surface in places where skin tissue is thin and delicate.

There are more than 100 strains of HPV. Some are benign, causing common skin warts, but high-risk strains cause cervical and oral cancers, vaginal and vulva cancers, penis and anus cancers, and genital warts. HPV infections and their links to cancer are a relatively new scientific area of study so there are many questions still to be answered, including whether the relatively new HPV vaccine will prevent future generations from getting throat cancers.

The Vancouver Sun has reviewed the latest research and developments to address expected curiosity on the subject.

How common is HPV?
Very. By age 25, a quarter of Canadian women are infected by it, and by age 50, about 85 per cent of sexually active people (males and females) have been exposed to it at one time or another. The vast majority of the time, the immune system knocks the virus out within a few years. In a minority of individuals, the virus persists, potentially leading to an HPV-linked cancer.

What is fuelling the rise in HPV over the past three or four decades?
Experts believe the advent of oral contraceptives. (The Pill) five decades ago unleashed sexual freedom and changes in sexual behaviours: more sexual partners and consequently more sexually transmitted infections, including HPV. Hay said before oral contraceptives came along, condoms were the common barrier method. “Condoms keep things in and they keep things out,” he said, referring to the fact that condoms can help prevent sexually transmitted infections while oral contraceptives do not.

Is the massive increase in throat cancers attributable to better detection methods or an increase in HPV infections?
Experts say they are seeing a true increase in the proportion of throat cancers caused by HPV. Hay said typical patients are 45 to 65 years old who may have been infected with HPV up to 20 years earlier.

Does oral sex really cause throat cancer?
The HPV virus is very common; nearly everyone who has sex will get it at one point or another. The HPV micro-organisms can reside in the cervix or other body canals (anus) and the virus can also be transmitted through skin contact and saliva. One Finnish study showed that HPV could even be detected in babies under one year, possibly through skin-to-skin contact during breastfeeding.

Men are more likely to get throat cancer and one theory is that there may be more HPV in vaginal fluid than other genital areas.

“We don’t well understand how oral HPV is transmitted except to know that oral sex is the most likely way of transmitting HPV to the mouth,” said Gypsyamber D’Souza, an epidemiologist and viral cancer expert from Johns Hopkins Bloomberg School of Public Health, at the recent annual meeting of the American Society of Clinical Oncology.

What are the risk factors for contracting HPV?
Studies have shown that men are three times more likely to get HPV-related throat cancers than women, but risk for both genders goes up in those with more sexual partners. Those who’ve had six or more oral sex partners over a lifetime are 8.6 times more likely to get HPV throat cancers, compared with those who have never had oral sex. HPV is more prevalent in sexually promiscuous individuals and those already carrying other sexually transmitted infections (STI). A B.C. study done on men attending a Vancouver STI clinic found that 70 per cent were HPVpositive.

What are some of the most common symptoms of throat and other oral cancers?
Hoarseness, chronic sore throat, pain or difficulty swallowing, a painless lump in the neck area, swollen lymph nodes in the neck, ear pain and mouth sores that don’t heal.

Who should get the HPV vaccine?
There are two HPV vaccines licensed for use in Canada: Gardasil and Cervarix. Neither will wipe out infections once individuals have been exposed, so it’s best to get the vaccine before becoming sexually active. B.C. research has shown that HPV is most prevalent in women under 20, suggesting that the risky period for getting infected is when females first start having sex.

Gardasil (which protects against multiple high-risk HPV strains as well as genital warts) is approved for women aged nine to 45 and males nine to 26. Health Canada approved the vaccine for girls in 2006 and for boys a few years ago. It’s part of school-based immunization programs, but the major focus of public funding is on Grade 6 girls in B.C. The series of three shots costs up to $500 if purchased at pharmacies by parents wishing to vaccinate boys or older children who missed getting vaccinated.

The vaccine is also licensed for males up to age 25. As with girls, experts recommend boys get vaccinated before they become sexually active. Only a few provinces are considering public coverage of the vaccine for males; B.C. is not one of them at this time.

Dr. Perry Kendall, chief medical health officer for B.C., said studies have not yet proven it would be cost effective to extend public funding for vaccination of boys. “Ninety-nine per cent of cervical cancers are caused by HPV, and 70 per cent of vaginal cancers,” he said, while noting that HPV is “attributable” to about twothirds of throat cancers. B.C. spends about $3 million a year on HPV vaccines and about 60 to 70 per cent of eligible girls (Grade 6 cohorts) have been vaccinated so far, but it could take decades for the vaccine to have a significant effect in reducing both cervical and oral cancers in the younger generations.

Is the vaccine safe and effective?
A Universit y of B. C. researcher Dr. Simon Dobson has called Gardasil an “excellent vaccine.” HPV-infection suppression rates range from 70 to 90 per cent, with the highest immunity response occurring in those who get the vaccine at the youngest age.

Minor side effects such as pain at the site of injection, swelling, dizziness, nausea and headache have been reported in about six per cent of subjects, according to Dr. Monika Naus of the B.C. Centre for Disease Control in a report in the BC Medical Journal. Rare, serious adverse effects – such as deaths, stroke, embolisms and seizures – have not been directly linked to the vaccine.

How can you get tested for HPV?
Doctors scrape cells from the cervix area, similar to the way specimens are collected during a Pap smear. The test is not covered by the public medical plan so private labs charge about $90. It is not possible to swab the back-of-throat area for HPV because of gag and vomit reflexes. Saliva tests are used to detect throat HPV infections only for research purposes so far.

In women and men, swabs can be taken of the anal cavity to detect pre-cancerous changes.

Is there a treatment for HPV?
There’s no treatment for the infection but there are for the serious cancers that may result from it, such as surgery, chemotherapy and radiation.

What’s the prognosis for someone who gets HPV oral cancer?
Even those who get advanced HPV-caused throat cancers, such as actor Michael Douglas, have a fiveyear survival rate of at least 80 per cent, whereas advanced non-HPV linked oral cancers – those caused by smoking and alcohol – have a survival rate about half that. Non-HPV cancers usually affect the front of the tongue, floor of the mouth, cheeks and gums, while HPV cancers tend to affect the back regions of the mouth: the base of the tongue and tonsil area.

Is there a screening program for HPV-related oral cancers?
There’s no way to screen for HPV-related throat cancers, but a B.C.-developed device called the VELscope is used by some dentists to detect abnormalities in the front parts of the oral cavity. The device utilizes special light to detect suspicious cells, but it has not yet been shown to find HPVtype cancers in the furthest reaches of the throat. The tonsil area has folds and crevices where HPV tumours can hide out. BC Cancer Agency scientists are trying to improve the imaging system for the hardto-reach sites at the back of the throat and tonsil area.

Does it take a long time for an HPV infection to arise or should you blame the last person you had sex with?
If you do get HPV, you can’t necessarily point the finger at the last individual you had sex with. HPV infections wax and wane over lifetimes so getting an HPV-linked cancer may be more likely caused by the “sum total of your life experiences,” according to Rosin. A 2010 study in the British Medical Journal found that in those who developed throat cancers, a third had HPV antibodies (meaning they had been exposed to the virus) up to 12 years before the onset of disease.

How can one prevent or lower the chances of getting HPV-related cancers?
Talk to your doctor about getting vaccinated against the high-risk strains of HPV, reduce intake of alcohol and tobacco, limit your number of sexual partners, get tested for HPV if you have any symptoms or concerns. Women should get Pap smear tests of their cervix, which can show abnormal cellular changes that point to a possible HPV infection.

How prevalent is the oral HPV virus in the general population?
A recent snapshot-in-time U.S. study published in the Journal of the American Medical Association found that about seven per cent of Americans aged 14 to 69 are infected by HPV. But only one per cent of the 5,500 people in the study had HPV-16, the most strongly linked strain to oral and cervical cancers. If the figure is extrapolated to the whole population, it would mean that millions have HPV, but fewer than 15,000 Americans develop HPV-linked throat cancers each year. Lead author Dr. Maura Gillison, of Ohio State University, said that should be seen as reassuring; most people with oral HPV don’t get throat cancer.

The same study found that oral HPV infection was more common in men (10 per cent) than women (four per cent). HPV infection was most common in people aged 55 to 59.

How common is oral sex?
The Canadian Youth, Sexual Health and HIV/AIDS study, along with other studies and surveys in the U.S. and Canada, have shown that oral sex is enjoyed by two-thirds of adults. Results have shown it’s increasingly popular among Canadian teenagers. In 1994, nearly half of Grade 11 students (47.5 per cent) reported having oral sex at least once. When the survey was repeated in the same age group in 2002, more than half (52.5 per cent) indicated they had done so.

Should you swear off oral sex?
Since there is a long latency period for HPV infections to inflict serious damage, it’s unlikely there’s any benefit for adults to change sexual practices and preferences, especially if they are in monogamous relationships. But Rosin and Hay agree it may be prudent for individuals to be discriminating when it comes to sexual partners. They can consider asking partners about whether they’ve had HPV, if they’ve been vaccinated against HPV, or about their health and sexual histories.

July, 2013|Oral Cancer News|

Fact check: Michael Douglas on HPV and throat cancer

Source: www.huffingtonpost.com
Author: Meredith Melnick

A Michael Douglas interview in The Guardian caused waves when the publication reported that the “Behind the Candelabra” star revealed HPV, the human papilloma virus, to be the cause of his stage-4 throat cancer diagnosis in 2010.

“Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus,” Douglas allegedly told The Guardian.

Douglas, through his publicist, has said that the statement was misinterpreted: He wasn’t saying that his cancer was caused by the sexually transmitted disease — merely that many cancers like his are HPV-positive. As The Daily Beast points out, there is scant research evidence to directly link the act of cunnilingus with HPV infection. But regardless of the details of his own cancer, the actor is right about one thing: A growing majority of oral cancer cases are caused by HPV.

While most strains of HPV clear up on their own, the sexually transmitted disease is responsible for an array of cancers. As Douglas describes, it’s true that oral sex is an avenue through which a person can contract HPV and especially the strains, HPV-18 and HPV-16, the latter of which is responsible for half of oral cancer cases, according to the National Cancer Institute. HPV-16, HPV-18 and some less-common strains can also cause cancers of the cervix, vagina, vulva, anus and penis.

Douglas’ experience follows trends in cancer diagnosis, according to a January report from the American Cancer Society, which found a rise in oral cancer caused by HPV in both women and men. As the report said, as of 2004, 72 percent of oral cancer tumors were HPV-positive — up from 16 percent of tumors in data collected between 1984 and 1989.

Previously, excessive drinking and tobacco use were the most common causes of the throat cancer Douglas developed, but HPV has replaced tobacco as the leading cause of throat cancers. HPV’s rise as the leading cause of oral cancer is not just the result of growing rates of the virus — it is also explained by drops in smoking, thanks to public health campaigns that describe the dangers of cigarette use.

HPV-16 and 18 are targeted by the vaccine Cervarix and are two of the four strains targeted by Gardasil, the other of the two approved vaccines against HPV. Gardasil is currently recommended for boys between the ages of 13 and 21 and both Cervarix and Gardasil are recommended for girls, aged 13 to 26, according to the Centers for Disease Control and Prevention. HPV-6 and HPV-11, both of which the Gardasil vaccine immunizes against, cause about 90 percent of genital warts cases.

Despite the growing rates of oral cancer, cases like Douglas’ are still relatively rare, with about 7,100 new cases each year, reported USA Today. But that doesn’t mean oral HPV infection is rare: According to a 2012 study of Americans, aged 14 to 69, about 10 percent of men and 3.6 percent of women currently have an oral HPV infection.

According to the CDC, there is no screening test to determine overall HPV status. While women are screened for HPV-associated cervical cancer via a Pap-smear test, other HPV-associated cancers don’t have a specific screening test. Despite the fact that there are no uniform screening techniques for oral cancer, the prognosis for the disease is good, with an 80 to 90 percent survival rate, according to The Oral Cancer Foundation.

Heartburn and throat cancer: is there a link?

Source: www.huffingtonpost.com
Author: staff

Heartburn may raise a person’s risk for throat cancer, but it seems that antacids could have a protective effect, according to a new study.

heartburn

The research, published in the journal Cancer Epidemiology, Biomarkers & Prevention, shows that people with a history of frequent heartburn, also known as acid reflux, have a 78 percent higher risk of developing vocal cord or throat cancers.

But they also found that for people with frequent heartburn, taking antacids can lower risk of these cancers by 41 percent.

“Additional studies are needed to validate the chemopreventive effects of antacids among patients with frequent heartburn,” study researcher Scott M. Langevin, Ph.D., a postdoctoral research fellow at Brown University, said in a statement. “The identification of gastric reflux as a risk factor for throat and vocal cord cancers, however, may have implications in terms of risk stratification and identification of high-risk patients.”

The study included 631 people who were part of a case-control study in Boston, 468 of whom had throat cancer and 163 of whom had vocal cord cancer, as well as 1,234 people with no cancer history. Researchers analyzed family history of cancer, smoking history and drinking history of all the study participants, as well as presence of HPV 16 viral protein antigens since HPV can cause some head and neck cancers.

Researchers found that the increased risk for throat and vocal cord cancers was higher among the people experiencing frequent heartburn, even when they had no history of smoking or drinking. Also, prescription drugs or home remedies didn’t seem to be protective against the increased cancer risk from heartburn.

“Our data show that gastric reflux is an independent risk factor for squamous cancers of the pharynx and larynx,” researchers wrote in the study. “Further studies are needed to clarify the possible chemopreventive role of antacid use for patients with gastric reflux.”

However, it’s important to note that long-term antacid use doesn’t come without risks. Everyday Health reported that chronic use of over-the-counter antacids may raise esophageal cancer risk. And a type of gastroesophageal reflux disease medicine called proton-pump inhibitors may weaken bone density; therefore, people with heartburn who are taking antacids should talk to their doctors about the best options for them.

In a Q&A in the Chicago Tribune, the Mayo Clinic noted that antacids should usually only be used for short amounts of time. And of course, the best way to avoid all these risks — both of heartburn and of long-term antacid use — is to try to solve the root of the heartburn.

Spike in oral cancers puzzles experts

Source: www.turnto23.com
Author: Victoria Colliver/San Francisco Chronicle

Christine Schulz has never visited England, but she speaks with the clipped inflection of a vaguely British accent. It’s not an affectation but, rather, the mystifying after-effect of an 18-hour surgery she endured in 2009 to remove about half her tongue due to a cancerous growth that had spread to her lymph nodes.

Surgeons used skin from her wrist and upper leg to re-create the missing portions of her tongue. Through long term speech therapy, Schulz, 47, of Hollister, Calif., re-learned how to eat and talk with her reconstructed tongue. If she sounds as if she’s from a different country, Schulz isn’t complaining.

“At the moment I woke up from surgery, I realized exactly what a huge deal it was,” she said, describing how she had an incision in her throat to allow her to breathe and was prohibited to speak in her earliest days of healing.

Oral cancers, which include those of the mouth and tongue, are most common in men over 60 with a long history of smoking or chewing tobacco, often combined with heavy drinking. But in recent years, a spike in the incidence of oral cancers is being attributed to human papilloma virus or HPV.

But Schulz’s cancer was neither HPV– nor tobacco-related. That puts her in a camp of fewer than 7 percent of all oral cancers that have no identifiable cause, according to the Oral Cancer Foundation, an advocacy group based in Newport Beach, Calif.

“Surprisingly, a high percentage of tongue cancers — 45 percent — is not related to the virus. The cause, we don’t know,” said Dr. Steven Wang, a head and neck surgeon at the University of California San Francisco with expertise in microvascular reconstructive surgery.

Tongue cancer is relatively rare, diagnosed last year in about 13,000 U.S. patients — more than 9,000 men and 3,700 women. It leads to some 2,000 annual deaths, according to the National Cancer Institute. Overall, there were 42,000 diagnoses of the broader category of oral cancers, which include the mouth cavity, lips and the oropharynx, or the part of the throat at the back of the mouth. Oral cancers combined kill about 8,000 each year.

While statistics show many cancer types leveling off or even decreasing in recent years, the incidence of oral cancer has increased, due in large part to HPV. Between 1988 and 2004, the percentage of HPV-related oropharynx cancers skyrocketed by 225 percent, according to a 2011 study published in the Journal of Clinical Oncology. But that doesn’t explain the rise in oral cancers among patients with no known cause.

“It could be a genetic predisposition or it could be an outside source, a causal agent that hasn’t been discovered yet,” said Brian Hill, the Oral Cancer Foundation’s executive director.

Wang, who reconstructed Schulz’s tongue, said nonsmoking-related oral cancers tend to be less responsive to chemotherapy and radiation than HPV- and smoking-related tongue cancers. And often the symptoms are overlooked. His latest research, to be published in the journal Otolaryngology — Head and Neck Surgery, found that former or current smokers with a form or tongue cancer called squamous cell carcinoma had a better chance of surviving than patients with the same cancer who never smoked.

“People always notice the sore or the ulcer in the mouth, but they’re not thinking it’s cancer,” he said. “They’re thinking, ‘I’ve never smoked, I’m too young.’ And, unfortunately, their doctors are thinking the same thing.”

Because treatment is frequently delayed, Wang said nonsmokers with tongue cancer are more likely to have the disease treated aggressively. Surgeons are able to reconstruct the tongue, but they have yet to find a way to re-create its function.

For Schulz, what started as a bump in the back of her tongue that wouldn’t go away turned into a life-altering experience. Her marathon surgery and reconstruction was followed by chemotherapy, radiation and a year and a half of speech therapy.

Most extremely sweet foods do not register on what’s left of her taste buds, although she loves chocolate more than ever. She avoids bread and crackers because those kinds of foods turn to cement in her mouth, and she finds salads just too much work.

“Putting food in my mouth still feels foreign,” she said, adding that it takes her a long time to eat. “I have to chew it. I have to have a thought about where it is inside my mouth and make sure it stays there, chew enough so I know I have to swallow and then I have to have water.”

Here are some signs and symptoms of the disease:

– Patches inside your mouth or on your lips
– A sore on your lip or in your mouth that doesn’t heal
– Bleeding in your mouth
– Loose teeth
– Difficulty or pain when swallowing
– Difficulty wearing dentures
– A lump in your neck
– An earache that doesn’t go away
– Numbness of lower lip and chin

Sources: National Cancer Institute; Oral Cancer Foundation

March, 2013|Oral Cancer News|

Team approach improves oral cancer outcomes

Source: www.drbicuspid.com
Author: Donna Domino, Features Editor

Providence Cancer Center in Portland, OR, is one of a growing number of facilities that is working to improve care for patients with oral cancer and head and neck cancers through a multidisciplinary program that brings together a spectrum of treatment providers.

To illustrate the challenges many oral cancer patients face, R. Bryan Bell, MD, DDS, medical director of the Oral, Head and Neck Cancer Program at Providence, described the extreme effects the illness and its treatment had on one of his patients. The woman had undergone surgery, chemotherapy, and radiation for her oral cavity cancer.

“This was a beautiful 32-year-old woman who had lost all her teeth and couldn’t chew,” Dr. Bell told DrBicuspid.com. “She had aged about 40 years during treatment, and she just looked awful. But she had no means of affording needed dental rehabilitation, which would have cost about $60,000. People need to see what happens when you don’t restore these patients.”

Dr. Bell used the woman’s case to convince officials at Providence Health, which oversees the medical center, of the need for a multidisciplinary approach for these patients. The new cancer treatment center, which opened last month, is a unique collaboration between dental and medical oncology specialists.

The center provides coordinated care for oral cancer patients who often need expensive and complex dental rehabilitation, regardless of their ability to pay, according to Dr. Bell. His team includes head and neck surgical oncologists, radiation oncologists, medical oncologists, otolaryngologists, neuro-otologists, and a maxillofacial prosthodontist. The hospital gets some money from Medicaid, but the program is aided by the fact that Providence is one of the biggest healthcare providers in the U.S.

“That’s what really makes us unique,” Dr. Bell explained. “We’re integrating dentistry into the multidisciplinary head and neck cancer treatment team.” In fact, Oregon is at the forefront of implementing coordinated care organizations, which are designed to deliver Medicaid services throughout the state, he added.

The unusual approach bridges the gap for patients dealing with the broad-ranging aftereffects of cancers of the oral cavity, head, and neck.

“We have a disconnect in this country regarding medical and dental care, and it’s particularly acute regarding cancer patients,” Dr. Bell observed.

Most people have affordable access to care for common dental procedures such as restorations and root canals, he noted, but oral cancer patients often need extensive and expensive oral treatment.

“A majority of patients undergoing head and neck cancer treatment, and cancer treatment in general, will have some sort of oral health problem, and many need significant dental care — whether it’s as simple as a filling or crown or as complicated as bone graft reconstruction with implant supported prosthetic rehabilitation,” Dr. Bell said. “For many of these patients, the price tag is in excess of $40,000 to $50,000.”

Changing risk factors
The Providence center treats more than 200 head and neck cancer patients annually; of these, about 150 involve cancers of the oral cavity. The youngest oral cancer patient was 19, and the oldest was 100, Dr. Bell said.

Becky Roth, 49, is one of a growing number of patients that Dr. Bell sees who develop oral cancer despite having no traditional risk factors, such as smoking and drinking. Surgeons removed most of her tongue and the lower segment of her mandible. Microvascular surgery was done to harvest her fibula to reconstruct her mandible; her second fibula was removed when Roth’s cancer recurred. A titanium plate was used to hold the fibula in place.

“We take a large segment of fibula bone with the muscle, soft tissue, and skin attached to it and do some carpentry on it to fashion it in the shape of a mandible as best we can,” Dr. Bell explained.

Surgeons often use the fibula osteocutaneous free flap, which is very common in head and neck centers, he added.

Despite losing both fibulas, Roth has been able to resume one of her passions — running — and has posted some of her personal best times. “She’s just a remarkable person,” Dr. Bell said.

Dr. Bell has noticed a growing number of oral cancer patients, particularly with cancers in the oropharynx and oral cavity. “That’s where we’re really seeing a difference in the change of demographics,” he said. “We’re seeing more younger patients — men and women who never smoked or rarely drank alcohol, like Becky.”

The majority of patients with oropharyngeal cancer have human papilloma (HPV)-driven cancers, but that’s not necessarily the same with oral cavity cancer, he noted.

“It is clear from data that HPV is a sexually transmitted disease, it is clear that HPV causes oropharynx cancer, and it is clear the risk for developing HPV-driven oropharynx cancer increases with the number of sexual partners,” he said. “But presumably people have been having oral sex longer than the last 15 years. Just because we haven’t identified what else is involved doesn’t mean there are no other contributing factors.”

Dr. Bell supports the use of HPV vaccines for young girls and boys. “I have an 8-year-old son, and I’ll certainly get him vaccinated in the next six or seven years.”

New technology, new treatments
New technology and multidiscipline treatments have vastly improved the quality of life for oral cancer patients, Dr. Bell pointed out.

“I think that’s where we’ve really come a long way in the last couple of decades,” he said. “While we’ve made only modest improvements in overall survival rates — 58% of such patients will be alive in five years, which hasn’t changed much in the last 50 years — where we have made tremendous strides is in our ability to restore patients to form and function. Patients are now living longer with their cancer, and they’re living much more functional lives.”

Dr. Bell described how improved treatments have affected patients like Roth. “We can remove two-thirds of her mandible and reconstruct it with vascularized tissue and implants, and give her teeth to chew with, to speak with, to swallow — all those things,” he said.

New technology and surgical methods are decreasing the adverse effects of chemotherapy and radiation therapy in a personalized way, he added.

“We’re trying to match the disease with the cure,” he said — by using robotic surgery, for example.

“We are now able to approach tumors in the back of the throat and base of the tongue with a surgical robot in a manner that used to take a much larger operation and splitting the jaw,” Dr. Bell explained.

Transoral robotic surgery (TORS) has allowed reduced doses of radiation therapy and even the elimination of chemotherapy in a significant number of patients, he noted. Dr. Bell was among the first surgeons in Oregon to use TORS after it was approved by the U.S. Food and Drug Administration.

One area that still needs improvement, however, is the routine refusal of most insurers to cover the dental care many oral cancer patients need.

“If you have your leg cut off from sarcoma, Medicaid, Medicare, or medical insurance would invest the $40,000 or $50,000 to give that patient a prosthesis,” he said. “So why doesn’t that occur in the oral cavity just because it’s a dental problem? Patients and healthcare providers need to be advocates to our policymakers to carve these areas out of dentistry.”

January, 2013|Oral Cancer News|

Periodontitis increases risk of oral leukoplakia

Source: www.drbicuspid.com
Author: Donna Domino, Features Editor

Periodontitis increases the risk of developing oral leukoplakia and mucosal lesions that are predisposed to become oral cancer, according to a study in Oral Oncology (September 2012, Vol. 48:9, pp. 859-863).

The findings provide clues into the complex relationship between systemic and local disease, noted the study authors from the University of Greifswald in Germany.

The development of oral cancer proceeds through discrete molecular changes that are acquired from loss of genomic integrity after continued exposure to environmental risk factors. It is preceded in the majority of cases by clinically evident, potentially malignant oral disorders, the most common of which is leukoplakia, the researchers noted.

Leukoplakia is an asymptomatic lesion in the oral mucosa. Oral cancer — especially oral squamous cell carcinoma — often develops out of these lesions, they added. Studies have shown that as many as 18% of oral premalignant lesions will develop into oral cancer. In addition, periodontal sites are often involved in proliferative types of leukoplakia.

The oral cancer rate attributed to leukoplakia is between six and 29 per 100,000, according to the authors. Smoking and drinking alcohol are the main risk factors for this disease, but acute infections in the oral cavity may contribute to the risk.

Inflammatory markers
The study evaluated 4,310 German residents ages 20 to79 from 1997 to 2001. After five years, 3,300 participants were available for follow-up.

The periodontal assessment included probing depth, clinical attachment loss, plaque, bleeding on probing, and the number of teeth. Among the study population, 123 (2.9%) of the participants had oral leukoplakia, compared with 246 people in the control group who did not have oral lesions.

Patients with oral leukoplakia showed significantly higher measures of periodontal parameters, especially bleeding on probing and gingival attachment loss, the study found. Despite a high variance, the leukoplakia group also exhibited a higher incidence of tooth loss, and there were more diabetics than in the control group (22% versus 13%).

Gingivitis (as characterized by bleeding on probing) is associated with the occurrence of leukoplakia in a dose-dependent manner, the researchers found.

“From the results it may be concluded that there is a continuously increasing risk of leukoplakia with increasing severity of periodontitis or gingivitis,” they wrote. “Increased concentrations of inflammatory markers suggest that tissues irritated by defense processes such as periodontitis are vulnerable to premalignant transformations.”

These study findings echo a 2011 study by researchers in India that showed elevated levels of salivary interleukin-6 — which was used as a marker of malignant progression — among patients with leukoplakia and periodontitis (Clinical Oral Investigations, October 2011, Vol. 15:5, pp. 705-714). Excluding people with periodontitis, the researchers found the leukoplakia cases still had elevated levels of systemic markers of inflammation. Good oral hygiene (brushing at least twice a day) was associated with decreased risk.

One limitation of the German study was that the oral lesions were not biopsied, the researchers noted.

“Our findings give new hints into the complex interrelationship between systemic and local diseases,” they concluded. “Periodontal inflammation may be considered an additional risk acting synergistically with smoking and/or metabolic factors.”

October, 2012|Oral Cancer News|

Dentists asked to help in curbing mouth cancer

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The increasing cases of oral cancer have pushed the Cancer Research UK to ask dentists to look for cancer related symptoms in their patients. By checking the mouth properly, dentists can gauge whether or not a person is prone of developing mouth cancer.

Mouth cancer can be lethal if timely treatment isn’t provided to the patients. Smoking and heavy drinking could be one of the reasons behind causing mouth cancer. Chewing tobacco is yet again contributing to mouth cancer. While examining the patients, the dentists have been advised to look for cancer contributing factors.

It is estimated that by 2030 there will be an increase in the number of mouth cancer patients. People under the age group of 50 years are growing becoming victim of mouth cancer. Oral sex is yet another factor that could lead to mouth cancer.

People need to be made aware about the growing incidences of mouth cancer so that innocent lives could be saved. Avoiding heavy drinking, smoke and unhygienic oral sex can help in preventing mouth cancer. Besides, dentists can also help in saving lives by detecting mouth cancer earlier through regular checkups. It is hoped that the dentists will take serious note of the recommendations.

September, 2012|Oral Cancer News|

Rating HPV biomarkers in head, neck cancers

Source: www.sciencecodex.com

Not all head and neck cancers are created equal. Those started by infection with the human papillomavirus are less often fatal than those with other causes, such as smoking. Detection of a reliable fingerprint for HPV could help patients avoid unnecessarily harsh treatment. A new study finds that while one popular biomarker for HPV is not a reliable predictor of mortality from the cancers alone, combinations of some biomarkers showed much more promise.

“Everybody who has studied it has shown that people with virally associated disease do better,” said Karl Kelsey, aprofessor of epidemiology and pathology and laboratory medicine at Brown University, and corresponding author of the study in Cancer Research. “There are now clinical trials underway to determine if they should be treated differently. The problem is that you need to appropriately diagnose virally related disease, and our data suggests that people need to take a close look at that.”

In the study, Kelsey and his multi-institutional team of co-authors measured the ability of a variety of biomarkers to predict mortality from head and neck squamous cell carcinoma (HNSCC). Their data came from hundreds of adult head and neck cancer patients in the Boston area that they have been tracking since late 1999. As part of that data set, they were able to look at blood serology and tumor tissue samples, and they interviewed participants about risk behaviors such as smoking and drinking.

DNA alone not reliable
One of the most important findings of the study, Kelsey said, is that extracting and amplifying the DNA of HPV in tumors, a popular notion among doctors given its success in confirming HPV’s role in cervical cancers, is not particularly helpful in predicting eventual mortality from head and neck cancer.

For example, among 94 patients for whom the researchers could assess the predictive value of all the biomarkers in the study, HPV DNA was present in tumors of 59 patients and absent in 35. Among the 59 who had the DNA, 23 of them, or 39 percent, had died. Among the 35 without the DNA, 13 of them, or 37 percent had died.

“You can’t just do PCR [a DNA amplification technique] of the virus in the tumor and assume it means much,” Kelsey said.

More promising combinations
Among several other potential HPV biomarkers in patients, the most reliable predictors of mortality turned out to be certain combinations of them, particularly antibodies to the E6 and E7 proteins that are expressed by the virus and have the effect of turning off cells’ ability to suppress tumors.

Kelsey and his colleagues found that measuring blood serum levels of antibodies that respond to E6 and E7 helped to assign meaning to measures of HPV DNA in tumors. Among people who had both HPV DNA and E6/E7 measurements, those with HPV DNA in tumors who were E6/E7 negative died in 30 of 56 cases, while those with HPV DNA in tumors who were E6/E7 positive died in only eight of 55 cases.

Levels of E6 and E7 antibodies in blood also proved telling in combination with staining tumors to detect the p16 protein, which indicates that tumor-suppression has been inactivated. Among patients in whom both those tests were both run, those with p16 overexpression who were E6/E7 negative had a much higher rate of death (11 in 17 cases) than people who did not overexpress p16 and were E6/E7 positive (3 in 9 cases) or those who overexpressed p16 and who were also E6/E7 positive (6 in 37 cases).

“Our study strongly suggests that the combination of detection of HPV 16 DNA in HNSCC tumors or p16 immunostaining with E6/E7 antibodies represents the most clinically valuable surrogate markers for the identification of patients with HNSCC who have a better prognosis,” Kelsey and his co-authors concluded.

In a companion paper published simultaneously in Cancer Research another team found that measuring viral load and patterns of viral gene expression were also useful markers.

Source: Brown University

September, 2012|Oral Cancer News|

Even one drink can raise cancer risk – research

Source: www.nzherald.co.nz

Just one alcoholic drink a day may increase the risk of cancer, according to a new study, which estimates that light drinking is responsible for 34,000 deaths a year worldwide.

New research based on more than 150,000 men and women shows that light drinking increases the likelihood of cancer of the mouth, pharynx, oesophagus and breast.

One drink a day increased the risk of cancer of the oesophagus by almost a third, according to the study being reported in the Annals of Oncology, which analysed data from more than 200 research projects. Low alcohol intake increased the risk of oral cavity and pharynx cancer by 17 per cent, and breast cancer in women by 5 per cent.

“Alcohol increases the risk of cancer even at low doses,” say the researchers.

“Given the high proportion of light drinkers in the population, and the high prevalence of these tumours, especially of breast cancer, even small increases in cancer risk are of great public health relevance.”

When it comes to enjoying your favourite drink and looking after your health, advice has often been complicated. Evidence suggests that drinking in moderation may decrease the risk of heart disease, type-2 diabetes and dementia, leading many to believe a glass of wine a day is good for you.

But the damaging effects of drinking are well known. An estimated 2.2 million deaths a year worldwide are linked to alcohol, according to the report, and 3.6 per cent of all cancers are attributable to drinking alcohol.

Until now, almost all the evidence has come from studies that focused on people drinking moderate or large amounts of alcohol, or binge drinkers, and not those who drink less.

In the new study, researchers from the University of Milan and other centres in the US, France, Canada, Iran and Sweden, estimated that, in one year alone, 24,000 deaths from oesophageal cancer, 5000 from oral and pharyngeal, and 5000 from breast cancer, were due to light drinking.

The study defined light drinking as up to one drink a day or 12.5g or less of ethanol. Data on 92,000 light drinkers and 60,000 non-drinkers was used to calculate the overall cancer risk. No link was found with other cancers that have been associated with heavier drinking, including colon, liver and larynx.

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “This study adds to the evidence linking alcohol consumption to several types of cancer, and confirms that even light drinkers have a small but definite increase in the risk, particularly for those parts of the body, such as the throat and oesophagus, that come into direct contact with alcohol.

“People who wish to minimise their risk of cancer can help by cutting down on their drinking.”

Just why light intake increases the risk of some cancers and not others, is unclear. The researchers suggest that with cancer of the mouth, pharynx and oesophagus it may be because the alcohol comes into direct contact with the affected tissue. They suggest the rise in risk for breast cancer may be associated with increased levels of oestrogen, or higher levels of insulin-like growth factors that are produced by the liver after drinking alcohol.

August, 2012|Oral Cancer News|