Emergence of HPV 16 and sexually transmiitted oral cancer

Source: communities.washingtontimes.com
Author: Dr. Ali by Ali Forghani

The human papilloma virus (HPV) is the second leading cause of oral cancer. HPV is certainly not a newcomer to the disease world. It is one of the most common sexually transmitted disease on the planet. As of this writing, over 120 variations of the virus have been discovered, with different strands of HPV affecting different areas of the body. Many people contract HPV daily without realizing they have a virus, as it is very possible to carry a strand while displaying no noticeable symptoms.


HPV 16 Virus

HPV is a virus that is mainly focused on the outer surface of the body, the skin, as well as the mucus secreting areas. The most noticeable effect from certain strands of the virus is the appearance of warts on the skin, mainly concentrated on the arms, legs and hands.

Condylomata acuminatum, also called genital warts, are the strands of this virus found most commonly on individuals and are generally believed to be caused by the HPV strands 6 and 11. These particular strands of HPV are very common and easily treatable.

One of the prime reasons HPV is found so commonly in the world is the ease of transmission of the virus. HPV can be spread simply by contact of the skin, with certain strands branching out to be sexually transmitted.

These particular strands are the strands that should be of the most concern today due to the discoveries being made about the HPV STD strands. HPV 16, 18, 31, and 45 are the current strands associated with cancer and can be identified by the difference in physical markers they cause. These particular strands have growths that are flat and nearly invisible to the eye as opposed to the more conventional warts people are accustomed to recognizing.

The two strands of importance here are HPV 16 and 18, as these two have been determined to be strong causes of many of the cervical cancers of the world. Recent studies have linked HPV 16 to causing oral cancer in ever rising numbers. The oral cancers linked to HPV16 develop tumors in a different set of locations than non-HPV cancers, providing an easy method of identification.

HPV16 is often seen to manifest in the back of the throat, inside the mouth, the tonsillar pillars, and the tonsils themselves. Non-HPV tumors tend to be on the anterior tongue, the floor of the mouth and the mucosa of the cheeks. HPV16 is currently being spoken of as the second primary cause of oral cancer, and likely, will soon overpass alcohol and tobacco as being the primary cause.

There are two alarming concerns with HPV 16: The age of the victims that contract the virus and the method in which it is often transmitted. Oral cancer contracted via the ingestion of alcohol and tobacco is most often associated with individuals who are well into life, often over the age of forty. These people have often been smoking or drinking for the better part of their adult lives, and the cancer has built up over many years.

HPV 16 varies from this immensely as it most often found in people in their 20s with no traces of alcohol or tobacco consumption, although there is an additive link between consumption of these and HPV 16. The ease of which HPV 16 is unknowingly transmitted lies in the fact that it is mainly transmitted by sexual contact. Remember that the virus resides on the skin, and this includes the skin of the anus, vagina and penis.

Often oral contact of these areas allows the HPV to transfer directly to the oral cavity. It is usually the case that the carrier of HPV 16 is not even aware and spreads the virus unknowingly to their partner.

April, 2013|Oral Cancer News|

DNA alone inadequate to identify HPV-related cancers

Source: www.oncologypractice.com
Author: Mary Ann Moon

Testing for the presence of human papillomavirus DNA alone, especially using polymerase chain reaction methods, is not adequate to identify which head and neck squamous cell carcinomas are caused by the virus, according to two studies published online Sept. 18 in Cancer Research.

Identifying HPV-driven malignancies is important because they respond better to treatment and have better outcomes than those unrelated to HPV infection. Indeed, treatment of head and neck squamous cell carcinoma (HNSCC) may soon be guided by the tumor’s HPV status, since trials are now underway to determine whether de-escalation of chemo- and radiotherapy is safe and effective in such patients.

At present, however, the biomarkers that are best suited to making this identification are unclear.

Case Series Assesses Biomarkers
In the first study, researchers assessed the usefulness of four biomarkers in determining which HNSCCs in a case series were driven by HPV. They began by examining fresh-frozen tumor biopsy samples from 199 German adults diagnosed as having oropharyngeal squamous cell cancer between 1990 and 2008.

The four biomarkers were HPV-16 viral load, viral oncogene RNA (E6 and E7), p16INK4a, and RNA patterns similar to those characteristic of cervical carcinomas (CxCa RNA), said Dr. Dana Holzinger of the German Cancer Research Center at Heidelberg (Germany) University and her associates.

The simple presence of HPV DNA in a tumor sample was found to be a poor indicator of prognosis, likely because it often signaled past HPV infections or recent oral exposure, rather than active HPV infection that progressed to malignancy, the investigators said (Cancer Res. 2012 Sept. 18).

Instead, “we showed that high viral load and a cancer-specific pattern of viral gene expression are most suited to identify patients with HPV-driven tumors among patients with oropharyngeal cancer. Viral expression pattern is a completely new marker in this field, and viral load has hardly been analyzed before,” Dr. Holzinger said in a press statement accompanying the publication of these findings.

“Once standardized assays for these markers, applicable in routine clinical laboratories, are established, they will allow precise identification” of cancers that are or are not HPV-driven, which will in turn influence prognosis and treatment, she added.

Results Back Combination Approach
In the second study, Dr. Caihua Liang of Brown University, Providence, R.I., and her associates examined 488 HNSCC samples as well as serum samples collected in a population-based study in the Boston area during 1999-2003.

As in the first study, these investigators found that the mere presence of HPV-16 DNA in these tumors, particularly when detected by PCR analysis, did not accurately predict overall survival or progression-free survival.

Instead, “our study strongly suggests that the combination of detection of HPV-16 DNA in HNSCC tumors [plus] p16 immunostaining with E6/E7 antibodies represents the most clinically valuable surrogate marker for the identification of patients . . . who have a better prognosis,” they said (Cancer Res. 2012 Sept. 28).

“Assessment of HPV DNA using polymerase chain reaction methods as a biomarker in individual head and neck cancers is a poor predictor of outcome, and is also poorly associated with antibody response indicative of exposure and/or infection by HPV,” senior author Dr. Karl T. Kelsey added in the press statement.

“We may not be diagnosing these tumors as accurately and precisely as we need to for adjusting treatments,” said Dr. Kelsey, a professor in the department of epidemiology and the department of pathology and laboratory medicine at Brown University.

Dr. Holzinger’s study was funded in part by the European Commission, BMBG/HGAF-Canceropole Grand-Est, and the German Research Foundation. Her associates reported ties to Qiagen and Roche. Dr. Liang’s study was supported by the National Institutes of Health and the Flight Attendant Medical Research Institute, and one associate reported ties to Bristol-Myers Squibb.

September, 2012|Oral Cancer News|

Facing the facts: HPV-associated head and neck cancers get a second look

Source: www.curetoday.com
Author: Charlotte Huff

Kevin Pruyne knew he didn’t fit the stereotype of a hard drinker or heavy smoker who one day develops an oral cancer.

The 52-year-old mechanic had been working a three-week stint in a remote section of northern Alaska, repairing trucks on an oil field, when he noticed a hard lump beneath his jaw while shaving. For nearly three months, as Pruyne was prescribed antibiotics for a possible infection and then later shuttled between physician specialists, he kept hearing the same thing: the lump could not be cancer.

Pruyne only occasionally consumed alcohol and had never smoked. His wife, Kathy, began researching her husband’s symptoms, which included repetitive throat clearing, a nagging sensation that something was lodged in his throat and ringing in his ears. And the lump, which looked like the top half of an egg, felt solid to the touch.

This wasn’t some inflamed lymph node from a lingering head cold, Kathy Pruyne says. “He had every symptom [of cancer], but nobody would listen to me.”

Pruyne received a diagnosis of stage 4 oral cancer, which started with a tumor at the base of his tongue. He had already begun chemotherapy when he learned that researchers had discovered an association between the human papillomavirus (HPV) and increasing rates of oropharyngeal cancers. He asked that his tissue be tested; the results came back positive. Pruyne says he wanted to know whether his cancer was caused by HPV because “the prognosis is considerably better with HPV-positive cancer.” He adds he “wanted to hear that there was a better chance of a cure.”

An Explosion of Cases

For researchers and clinicians alike, determining appropriate treatment has taken on new urgency: HPV-positive oropharyngeal malignancies—most typically found on the tonsils or at the base of the tongue—increased 225 percent from 1988 to 2004. If current trends continue, HPV-positive oral cancer cases could soon surpass cervical cancer diagnoses, according to a 2011 study published in the Journal of Clinical Oncology.

As researchers have revisited data from prior oral cancer treatment studies, they’re realizing that patients with HPV-positive tumors respond better to chemotherapy and radiation. One study, which retrospectively analyzed treatment outcomes for stage 3 and stage 4 oropharyngeal patients based on their HPV status, found that the three-year overall survival rate was 82.4 percent in patients with HPV-positive tumors. Among those who tested negative, the three-year overall survival rate was 57.1 percent, according to the findings published in 2010 in The New England Journal of Medicine.

With that in mind, research trials are being launched to determine whether treatment can be modified in some way or even dialed back. The goal? To achieve the same survival with fewer of the swallowing difficulties, taste problems and other debilitating side effects.

“For a subset of patients, we’ve actually achieved a pretty high cure rate,” says James Rocco, MD, PhD, a head and neck surgeon at Massachusetts Eye and Ear Infirmary, and director of head and neck cancer research at Massachusetts General Hospital. “And the question is: Can we maintain that cure and reduce some of the major side effects of treatment?”

But researchers and oncologists have only just begun to understand HPV-positive malignancies. “It’s very clear that HPV-positive oropharyngeal cancer is a completely different entity from HPV-negative,” says Stephen Liu, MD, a head and neck cancer specialist, and an assistant professor of medicine at the University of Southern California.

“We think that it’s going to impact treatment in the future,” Liu adds. But, he stresses, outside of a clinical trial, he “would really discourage anyone from receiving less treatment because their tumor is HPV-positive.”

Identifying the Virus

Traditionally, tobacco and alcohol use have been the primary culprits for triggering cancers in the oropharynx and nearby areas of the mouth, as well as other structures in the throat, such as the larynx. Each year, nearly 40,000 Americans develop cancer of the oral cavity or pharynx. Men are more than twice as likely to receive a diagnosis.

But, until recent years, not someone like David Hastings. The certified public accountant was 58 years old, a lean cyclist who rode some 100 miles each week, when he learned six years ago that he had stage 4 oropharyngeal cancer located at the base of his tongue. Clinicians at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., also were puzzled, as the Gulfport resident tells it. “They said the typical oral cancer patient is a man in his 60s or 70s who sits in a bar all day and drinks and smokes.”

The association with HPV emerged from a perplexing conundrum, says Kian Ang, MD, PhD, a professor in the department of radiation oncology at M.D. Anderson Cancer Center in Houston. As cigarette smoking has declined in recent decades, so have head and neck cancers, with the exception of tumors in the oropharynx. (The region encompasses the middle section of the throat, along with the back portion of the tongue, the soft palate and the tonsils.) That statistical anomaly, Ang says, “gave us the first clue that something else might be going on.”


Starting with a pivotal study published in 2000, researchers began honing in on the role of HPV. Of the 150-plus strains in the HPV family, more than 40 are believed to be transmitted through sexual contact, including anal, genital and oral, according to the National Cancer Institute. The body’s immune system typically eradicates the viruses in a few years before any symptoms emerge (but, in some cases, the cells remain molecularly altered forever). Several of the HPV strains to date, most frequently HPV type 16, have been linked to oral malignancies.

Increasingly, HPV-16 has become a major player in those oral malignancies, according to last year’s Journal of Clinical Oncology study, which projected an explosion in cases in the decades to come.

When researchers studied 271 tissue samples in previously diagnosed patients, HPV prevalence was identified in only 16.3 percent of those collected between 1984 and 1989. Between 2000 and 2004, 72.7 percent of specimens tested positive, a trend that also perhaps correlates with population-wide increases in oral sex, the researchers wrote.

The analysis also highlighted survival differences. If tumors tested HPV-positive, the median survival was nearly 11 years versus 1.6 years for people whose tumors didn’t carry the virus.

Some of the strides in oral cancer treatment that physicians thought they were achieving can at least be partially explained by the emergence of a less aggressive form of cancer, Ang says. “The other part of the improvement,” he says, “is really due to the addition of chemotherapy and the use of high-precision radiation.”

Multifaceted Treatment

Cancers located in the tonsils or at the base of the tongue can sometimes spread undetected, not becoming visible until they’ve reached the nearby lymph nodes. Some early symptoms include swallowing difficulties or a sudden change or hoarseness in the voice. Like Pruyne, Hastings first became concerned when he felt a mysterious lump while shaving. “Totally painless, no sore throat—nothing,” he says.

Oropharyngeal tumors can be classified as stage 3 or 4 but still be considered localized, as long as they have not spread beyond lymph nodes and structures in the head and neck. Pruyne, whose cancer had migrated to numerous nodes on his neck’s right side, recalls how his oncologist hurried out of the room when his imaging test results became available.

The doctor had already warned Pruyne that he could offer relatively little help if the cancer had spread to his chest. “When he came back up, he was visibly relieved,” Pruyne recalls. “And he said, ‘Your lungs are clear.’”

To thwart oropharyngeal malignancies, cancer specialists may incorporate a mix of treatments, including surgery, radiation and chemotherapy, depending upon the location and the aggressiveness of the tumor involved. Ang estimates that only about one-third of patients will undergo surgery. If the tumor can be removed and there’s no evidence that it’s spread to lymph nodes, radiation may not be needed, he says.


But if there’s any concern, patients may receive six weeks of radiation for smaller tumors and seven weeks for larger ones, Ang says. Intensity-modulated radiation therapy (IMRT) is used because it better targets the radiation and thus can limit damage to the salivary glands, reducing dry mouth, as well as damage to other normal tissues, Ang says.

For larger and more aggressive tumors, adding chemotherapy to radiation therapy has been shown to extend survival. One meta-analysis published last year, based on 87 studies involving more than 16,000 patients, analyzed results by tumor location. Researchers found that the combination approach increased five-year overall survival by 8.1 percent in oropharyngeal patients compared with those who didn’t receive any chemotherapy.

The chemotherapy is believed to boost the effectiveness of the radiation, but at a cost—amplified side effects for the patient. The list of potential side effects is lengthy, with so many vulnerable structures and nerves packed into the head and neck area, Liu says. Patients can develop ulcers in their mouth and down their throat, he says. Their salivary glands can generate thick secretions that make it difficult to swallow and to eat.

“The ability to taste, to speak, to salivate,” says Liu, ticking off several more. “Dry mouth. These things can often be permanent. It’s a necessary evil right now because we do what we need to do to cure the cancer.”

Pruyne received two cycles of a cisplatin-based protocol that also included Taxotere (docetaxel) and 5-FU (fluorouracil). Then he started the biologic agent Erbitux (cetuximab) along with hefty doses of IMRT, delivered twice daily for six weeks.

Pruyne’s oncologist warned him that the treatment would be difficult, and it was. He endured radiation burns around the right side of his neck and had to use a feeding tube for two months.

Dialing Back

Although radiation and chemotherapy can be difficult, some patients prefer to take that route, rather than run the risks of surgery, Rocco says. “For advanced local disease, removing the back of the tongue or the soft palate has huge consequences for people,” Rocco says. “They can’t eat. They don’t speak so well.”

But given that patients with HPV-positive tumors are typically diagnosed at a younger age, with potentially decades ahead of them to cope with long-term side effects, the aggressiveness of today’s chemotherapy and radiation regimens are also questionable, he says.

Clinical trials are recruiting patients to answer a question that’s relatively rare in cancer: Can treatment be ramped down? One closely watched phase 3 trial will assess whether Erbitux works as well in HPV-positive patients as the long-standing cisplatin-based chemotherapy regimen.

Cisplatin has been one of the standard drugs used in head and neck cancer, but it’s “very toxic,” says Andy Trotti III, MD, the study’s principal investigator and director of radiation oncology clinical research at Moffitt Cancer Center. The platinum-based drug can impact kidney function and sometimes damage hearing, among other side effects, he says.

Erbitux, which targets the epidermal growth factor receptor (EGFR), primarily affects the skin, Trotti says. In the phase 3 trial, now recruiting HPV-positive patients, the five-year overall survival of patients on Erbitux will be compared with those taking cisplatin. Both groups will receive IMRT.

Another ongoing trial is looking at whether the IMRT regimen can be shortened from six to five weeks, thereby delivering a lower dose of radiation in HPV-positive patients. The patients enrolled in that phase 2 trial, who also will receive cisplatin,  paclitaxel and Erbitux, will be followed for two years.

The study represents a “first step” toward learning whether less radiation can be safely prescribed for HPV-positive patients, Liu says. Since radiation’s effects are cumulative, the extra week of radiation adds “a significant amount of toxicity.”

A New Era in Treatment

Meanwhile, the impact of HPV status on surgical decisions appears to be the subject of some unresolved debate. Given that HPV-positive oropharyngeal malignancies respond well to chemotherapy and radiation, Trotti says, “there has been a real trend away from surgery.”

But new surgical techniques are providing other options for HPV-positive patients who might prefer to limit the long-term side effects of chemotherapy and radiation, says Bert O’Malley, Jr., MD, chairman of the department of otorhinolaryngology of the University of Pennsylvania Health System.

Along with a physician colleague, O’Malley has developed a robotic surgery protocol called TransOral Robotic Surgery. With the assistance of tiny robotic arms and three-dimensional cameras, O’Malley operates through the patient’s mouth, enabling him to remove difficult-to-reach tumors.

A surgery that previously required between six and 16 hours might only take two, he says. Also the approach results in less scarring and fewer surgical complications than the traditional surgery, which may require the jaw to be split, he says.

It’s a new era in HPV-positive treatment, Rocco says. To make his point, he tells of a patient who recently walked in asking to be referred for robotic surgery. The gold standard is still to wait for clinical trial results, but that could take five-plus years, he adds.

HPV-positive patients are frequently “savvy young professionals in the prime of life,” who sort through the latest research online, Rocco points out.

“There are people who are risk-takers,” he says. “They’ll look at the data, and they’ll make a decision, weighing cure and long-term side effects.”

Despite the rigors of treatment, Pruyne was able to resume his job near the Arctic Circle within a few months. He hopes to soon be telling a tale similar to Hastings’, who returned to his biking routine about a year after wrapping up treatment.

Hastings still copes with dry mouth and a reduced ability to taste. But the last time he visited Moffitt for an annual checkup, it felt more like a social call. After some chatting, he quips: “They said, ‘Get out of here. We need to spend more time with people who are sick.’”


Actor Michael Douglas Partners With Oral Cancer Foundation For Early Detection PSA Campaign

LOS ANGELES, May 14, 2012 /PRNewswire-USNewswire/ — Actor and producer Michael Douglas has donated his time to help create a television public service announcement (PSA) on behalf of the Oral Cancer Foundation (OCF), a non-profit organization dedicated to helping those affected by the disease. The PSA will support the Foundation’s efforts to educate the public about the need for annual screenings to catch oral cancers in their early, most survivable stages. The public service announcement will begin airing in June, and will continue to air nationwide through summer and autumn.

Approximately 40,000 people in the US will be newly diagnosed with oral cancer in 2012. This includes those cancers that occur in the mouth itself, in the very back of the mouth known as the oropharynx, and on the exterior lip of the mouth. There are two distinct pathways by which most people come to oral cancer. One is through the use of tobacco and alcohol, and the other is through exposure to the HPV-16 virus (human papilloma virus version 16), a newly identified etiology, and the same virus which is responsible for the vast majority of cervical cancers in women. While oral cancer has historically been linked to tobacco and alcohol use, this is not simply a smoker’s disease any longer. New data shows that the fastest-growing segment of newly diagnosed cases is now young, non-smokers. Most startling, is the fact that while many other cancers have been in decline in recent years, the occurrence of oral / oropharyngeal cancers has increased each of the last six years, and peer reviewed published data shows that the numbers of HPV-related oral cancers will surpass cervical cancers in the near future.

Caught early, oral cancer can be treatable, but many people do not know they have it until it has already turned into a killer. In the U.S., a person dies from oral cancer every hour of every day. The death toll is particularly high due to lack of public awareness, combined with infrequent screenings for the condition by medical and dental professionals. When found in the early stages of development, oral cancers have an 80 to 90% survival rate. Unfortunately at this time, two-thirds are found as late-stage, advanced cancers, and this accounts for the high death rate of approximately 45% at five years from diagnosis. Death rates from cancers such as that of the cervix, skin, and prostate, have decreased as annual checks for those diseases have been adopted–this could also be the case with oral cancer, if the simple and painless screening procedure were to be made a routine part of dental or physical examinations.

Michael Douglas first sought medical help in 2010 after experiencing a sore throat that persisted for a protracted period of time. After several visits to doctors, a tumor on the base of his tongue was discovered. With further analysis, it was determined that Mr. Douglas had stage IV squamous cell carcinoma oral cancer. He immediately began both radiation and chemotherapy treatments. After a long and difficult battle, Michael is now cancer free and in good health. He continues to have regular check-ups to monitor his remission.

“The Foundation is indebted to Michael Douglas for partnering with us in the battle against oral cancer,” said OCF Founder and Executive Director Brian Hill, who is a survivor of the same cancer Mr. Douglas had. “Michael is a highly visible, well known actor, and a consummate professional. Those qualities, when coupled with his personal cancer experience, yield a respected voice to this fight. His willingness right from the beginning of his journey, to openly talk about his difficult personal experience with oral cancer on TV and in print, has certainly created awareness in the public of a cancer too few have even heard of. That impact will be multiplied through this partnership with the foundation, and translate into increased early recognition of problems, avoidance of risk factors, and participation in annual opportunistic screenings by the public. His involvement will create a tipping point that will ultimately save lives.”

About the Oral Cancer Foundation: The Oral Cancer Foundation is a non-profit 501(c) 3, public service charity with a mission to reduce suffering and save lives through prevention, education, sponsorship of research, advocacy, and patient support activities. Oral cancer is the largest group of those cancers which fall into the head and neck cancer category. Approximately 40,000 people in the US will be newly diagnosed with oral cancer in 2012. Supporting the foundation’s goals is a scientific advisory board composed of leading cancer authorities from varied medical and dental specialties, and from prominent cancer educational, treatment, and research institutions in the United States. To learn more about the Foundation, please visit: www.oralcancer.org.

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

HPV exposure increases men’s risk of cancer

Source: http://news.medill.northwestern.edu/
Author: Zen Vuong

“We’re at the precipice of this epidemic,” said Dr. Ezra Cohen, who specializes in head and neck cancers.

The culprit is sexually-transmitted human papillomavirus-16. Human papillomavirus-positive head and neck cancer cases have been rising about 3 percent every year for the last three decades, said Cohen of The University of Chicago Medicine, an institution that includes the University of Chicago Hospitals. HPV-16 infection is three times more likely in men than in women, he added.

Cells of the upper respiratory system of both men and women are very similar to the surface of the cervix in women, said Dr. Kenneth Alexander, chief of infectious diseases at The University of Chicago Medicine.

HPV is linked to cervical cancer as well.

The Centers for Disease Control and Prevention estimates 10,800 new cases of HPV-associated cervical cancer in the United States each year. This number is nearly 35 percent larger than the 7,100 cases of HPV-associated head and neck cancers found in the United States each year.

Oral sex is “probably the most important risk factor” in contracting HPV-16-related head and neck cancer, which “will become more common than cervical cancer in this decade,” he added.

Some 5,600 men are diagnosed with HPV-associated head and neck cancers each year, whereas only 1,500 women suffer the same fate, according to the CDC.

HPV-16, one of more than 150 strains, is a sexually transmitted condition. More than 40 HPV types can be sexually transmitted, according to the National Cancer Institute.

HPV-18 and HPV-16 account for 80 percent of cervical cancers, but the number of these cases is decreasing because regular Pap smears have enabled early detection of precancerous cells, Alexander said.

That’s because screening processes of oropharyngeal, or head and neck cancers, do not yet exist. Problems arise because HPV-infected cells are generally snuggled into tonsil crevices or crypts.

“The tonsil, instead of being smooth like a piece of leather, looks more like the inside of an English muffin,” Alexander said, making it hard get to the HPV-infected specimen by sampling the surface of the tonsil or base of the tongue.

Kevin McConnell, 51, a business developer who lives in Annapolis, Md., discovered he had a tumor in the back of his tongue six years ago. He said he ignored a sore throat and earache for nearly a month, but finally went to see his doctor when his tongue started hurting.

“You have a small lesion in the back of your tongue. It’s not a big deal,” he recalls the physician saying

But McConnell had researched his symptoms online and said he believed he had throat cancer, so he went to The John Hopkins Hospital. Doctors told him he could have surgery to replace the right side of his tongue with a part of his thigh or be treated with chemotherapy and radiation, he said.

He chose not to slice his tongue. Even though McConnell is now in remission, he said he still has discomfort in his tongue and said he probably always will.

“I have trouble swallowing. There are only certain things I can eat [because] my salivary glands were fried by the radiation,” McConnell said. He mostly eats foods with a lot of sauce or juice, he said.

HPV-positive head and throat cancer patients have a 50 percent increased chance of being cured than other types of oropharyngeal cancers, Cohen said. Yet HPV-16-infected cells do not inevitably become abnormal, cancerous cells.

“The great majority of patients who are infected never develop cancer,” he said.

In 90 percent of cases, the immune system naturally eradicates HPV from the body within two years, according to the CDC. But the remaining 10 percent adds up to about 13,700 newly diagnosed cases of all HPV-associated cancers, including cervical, anal and vulvar, reported the CDC.

Although there isn’t a specific vaccine for HPV-16-based oropharyngeal cancer, HPV-associated cancers could be reduced if more people between the ages 9 and 26 complete a three-shot series of the human papillomavirus vaccine. Even though there are two types of vaccine for women, only Gardasil has been tested and licensed for use in males.

Gardasil, also protects against HPV types 6 and 11, the two strains that cause most genital warts in men and women.

Social conservatives such as Michele Bachmann say the vaccine encourages promiscuity. One of them, But Alexander said this political stance is taken because people “don’t understand the epidemiology of the disease.

“Some parents and policymakers underestimate the intelligence of our young people. Young people understand that a dose of vaccine is not permission to go out and have unsafe sex,” he said.

An American’s lifetime risk of contracting a genital HPV infection is 80 percent, Alexander said. “I’m pretty sure 80 percent of us are not immoral,” he said.

March, 2012|Oral Cancer News|

Use and Acceptance of HPV Vaccine Still a Work in Progress

Source: National Cancer Institute

A bellwether moment in the history of cancer prevention came in 2006 when the Food and Drug Administration (FDA) approved the first vaccine to prevent cervical cancer. The vaccine, Gardasil, protects against the two primary cancer-causing, or oncogenic, types of the human papillomavirus (HPV)—HPV-16 and HPV-18. These types are responsible for more than 70 percent of cervical cancer cases worldwide. In 2009, the FDA approved a second HPV vaccine, Cervarix, which also targets HPV-16 and HPV-18.

Gardasil and Cervarix, vaccines that protect against the two primary cancer-causing types of the human papillomavirus (HPV), entail a three-shot regimen, with each dose delivered several months apart.

But what has transpired since these two vaccines received regulatory blessing in the United States has reaffirmed something that cancer and public health researchers have appreciated for some time: The translation of basic research to the clinic doesn’t end with FDA approval of a new drug or treatment. In many respects, FDA approval is just a beginning.

In March 2007, the CDC’s Advisory Committee on Immunization Practices (ACIP) gave its strongest recommendation for HPV vaccination for females ages 9 to 26, which is the FDA-approved indication for Gardasil. Cervarix is approved for females ages 10 to 25. Both vaccines entail a three-shot regimen, with the doses delivered several months apart. According to the most recent data, only 44 percent of adolescent girls 13 to 17 years of age have received at least one dose of the vaccine. Completion rates for the three-shot regimen are substantially lower, with only 27 percent of adolescent girls receiving all three doses.

“Uptake is low because of problems with policy, problems with clinical encounters, and problems with parents’ decisions,” said Dr. Noel Brewer of the University of North Carolina Gillings School of Global Public Health. These obstacles are by no means insurmountable, but addressing each obstacle will take time, patience, and research, say investigators working in this area. And a good bit of that research can be grouped into two categories: missed opportunities and teachable moments.

HPV Vaccines for Boys

Gardasil has also been approved by the FDA for use in boys. The initial approval in boys, in 2009, was for the prevention of genital warts because Gardasil, unlike Cervarix, also protects against two other HPV types—HPV-6 and HPV-11—that are the primary cause of genital warts.

But, in December 2010, the approval was expanded to include the prevention of anal cancer, another disease associated with HPV-16 and HPV-18 infection. Because the approval for boys is so recent, this article focuses only on the uptake of the HPV vaccines by females.

No vaccine has an uptake rate of 100 percent, although when vaccines are mandated, such as those required for school attendance, vaccination rates can reach 80 to 90 percent. Although there has been a flurry of legislative activity at the state level since Gardasil was approved in 2006, only Virginia and Washington, DC, require HPV vaccination for school entry, and Virginia’s law includes a provision that allows parents to opt out of the requirement.

Based on surveys that Dr. Brewer and his colleagues have conducted, concerns that HPV vaccination will encourage sexual activity seem to have had little to do with the lagging vaccination rates. Nor, he continued, has uptake of the vaccines been substantially affected by the antivaccine movement that was spurred by fears raised about the now-discredited links between autism and childhood vaccines.

In general, concerns about safety and other issues with vaccines “are not specific to the HPV vaccine,” said Dr. Gregory Zimet of the Indiana University Melvin and Bren Simon Cancer Center. “There is a general vaccine hesitancy that affects a lot of parents.”

The Power of Physician Recommendations

Factors affecting vaccination rates have “definitely been a mixed bag,” agreed Veronica Chollette, who oversees a portfolio of HPV vaccine-related research in NCI’s Division of Cancer Control and Population Sciences. Cultural issues, lack of awareness, and, initially, reimbursement issues that limited the amount of vaccine physicians were willing to keep in stock have all played a role, she noted.

Physician encounters have also had an effect in an entirely different way. In a study published last year, less than 60 percent of pediatricians reported that they strongly recommended HPV vaccination for their 11- to 12-year-old patients. Another study of women ages 19 to 26 showed that, among women whose doctors did not recommend HPV vaccination, only 5 percent were vaccinated. Among those who did receive a recommendation, 85 percent were vaccinated.

“Pediatricians and family physicians are missing a lot of opportunities when patients come in for office visits,” said Dr. Brewer. Part of the problem, he added, is a systemic issue: health care providers are not flagging the charts of patients who are eligible for the vaccines or using reminder systems in electronic medical records, for example.

Interactions with the health care system drop precipitously once kids reach adolescence, he continued. “So it’s a big deal to miss those chances.”

Sociocultural factors are also important to consider. A study conducted in Appalachia, for example, found that conservative religious beliefs and a mistrust of outside influences played a prominent role in the vaccines’ acceptability. Meanwhile, studies of college-age women have shown that, even when receipt of the initial HPV vaccine dose was similar among white and black women, completion rates for all three doses were substantially lower among black women.

The disparity is noteworthy, Chollette stressed, because black women and Hispanic women have significantly higher cervical cancer incidence and death rates than white women.

In some cases insurance status can affect vaccine uptake and adherence. But, because federal and state-level programs, such as the Vaccines for Children program, make the vaccines available for free or for a minimal charge to low-income children, it may not contribute as much to the disparities in vaccination rates, said Dr. Ruth Carlos of the University of Michigan Medical Center. In fact, a higher percentage of 13- to 17-year-old girls from families below the poverty line have received at least one dose of the vaccine compared with girls from families above the poverty line (52 percent versus 42 percent). Also, a provision in the federal health care reform law requires private insurers to cover all ACIP-recommended vaccines with no co-pay requirements.

It’s a complex problem, acknowledged Dr. Zimet. For example, based on studies he has done involving the hepatitis B vaccine, he explained, “practical obstacles, like transportation to the clinic and how many children the mom is taking care of at home” can have an impact, particularly on adherence to the three-shot regimen.

A variety of approaches are being tested to increase vaccination rates, many of which are focused on moments or interactions that can influence awareness and decision making. Drs. Zimet and Brewer lead initiatives in their respective states that are part of the national Cervical Cancer-Free America campaign. In North Carolina, Dr. Brewer said, they are focusing their efforts on school-located health centers, where many children already receive other vaccines.

Other studies and programs are testing whether social media and text messaging can be used as educational platforms and reminder systems for adolescents and women.

A Mother’s Attitude Is Key

For younger girls, the available data strongly indicate that a single factor heavily influences whether they get vaccinated: their mother. “The gateway to adoption of the vaccine[s] is through the parents,” Chollette stressed. In particular, she continued, mothers are the key. “The mother’s values play a prominent role in whether girls go to the doctor and get all three doses according to schedule.”

Dr. Carlos and her colleagues are attempting to use cancer screening appointments as “teachable moments” for mothers of adolescent girls. In two separate studies, women undergoing breast and cervical cancer screenings who have adolescent daughters will receive tailored information about cervical cancer and the HPV vaccines. The studies will test different means of providing the information, including using a Web-based platform, and vaccination rates will be tracked via electronic medical records.

“From a public health perspective, it makes perfect sense to target mothers who come in for cancer screening,” Dr. Carlos said. Women undergoing their own cancer screenings “may be more receptive to acting on educational information about HPV prevention,” she continued. “Part of what this study is doing is encouraging this receptivity after being screened, and using that to encourage them to get their daughters vaccinated. The message is: ‘You’ve done something to protect yourself against cancer, so why not protect your daughter against HPV?’”

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

November, 2011|Oral Cancer News|

Trial Confirms Efficacy of HPV Vaccine, Shows Cross-Protection

Source: National Cancer Institute

End-of-trial results from a trial testing Cervarix, a vaccine against human papillomavirus (HPV) types 16 and 18, showed that the vaccine continued to provide substantial protection against cervical precancers 4 years after vaccination. Cervarix provided almost complete protection in young women who had no evidence of exposure to HPV at the time of vaccination. The vaccine provided less protection for the total vaccinated cohort and was less effective with increasing age at vaccination. These findings reflect the vaccine’s lack of effectiveness against infections acquired before vaccination.

The vaccine also partially protected women against four types of HPV that are not targeted by the vaccine. (Although HPV-16 and -18 cause about 70 percent of cervical cancers worldwide, as many as 15 HPV types can cause cancer.) These results from the PATRICIA trial (Papilloma Trial against Cancer in Young Adults) were published online November 9 in Lancet Oncology in two separate papers, available here and here.

The PATRICIA trial enrolled 18,644 young women between the ages of 15 and 25 from 14 countries. The participants were randomly assigned to receive either three doses of Cervarix or three doses of a hepatitis A vaccine as a control. Results from the interim analysis, published in July 2009, showed that the vaccine greatly reduced the risk of grade 2 cervical intraepithelial neoplasias and higher (CIN2+).

The new analysis shows that, 4 years after vaccination, Cervarix provided complete protection against grade 3 cervical intraepithelial neoplasias or higher (CIN3+) associated with HPV-16 and -18 among women who had no evidence of exposure to HPV. The vaccine provided strong protection against CIN3+ caused by other HPV types in this same group of women. Among the total cohort of women who received at least one dose of Cervarix, some of whom may have had prior exposure to HPV, the vaccine provided some protection. (See the table below.)

Cervarix Vaccine Efficacy among Women Who Received at Least One Dose of Cervarix

Women with no evidence of HPV exposure at baseline Women who may have had prior exposure to HPV

Against CIN3+ associated with HPV-16 and -18


100 percent


45.7 percent


Against all CIN3+, regardless of HPV type


93.2 percent


45.6 percent


Against all adenocarcinoma in situ


100 percent


76.9 percent

The vaccine provided cross-protection against HPV-33, HPV-31, HPV-45, and HPV-51, all cancer-causing types of the virus. The researchers speculate that the observed cross-protection may be due either to the vaccine adjuvant (a substance that stimulates the immune system) or to similarities among proteins found on the surfaces of different HPV types.

In an accompanying editorial, Drs. Mark Schiffman and Sholom Wacholder of NCI’s Division of Cancer Epidemiology and Genetics, who were involved with the NCI Costa Rica HPV vaccine trial, noted the importance of the PATRICIA trial results. They also stated that “the practical aspects of vaccine uptake are now the most important issue in HPV vaccine research from a public health perspective.” To increase vaccine uptake in the developing world, where 90 percent of cervical cancer cases occur, next-generation HPV vaccines will need to be less expensive, provide protection in a single dose, and/or be stable without refrigeration, they explained.

Further reading: “Second Cervical Cancer Vaccine Protects against Additional HPV Types” and “Use and Acceptance of HPV Vaccine Still a Work in Progress

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

November, 2011|Oral Cancer News|

Protein inhibitor may supply contemporary HPV treatment

Source: Dr.Bicuspid.com

Researchers from Tufts University School of Medicine have developed a protein-based inhibitor that could provide a topical treatment for HPV as an alternative to surgical and harsh chemical treatments (FASEB Journal, April 11, 2011).

HPV affects about 20 million people in the U.S., making it the most common sexually transmitted infection. There are more than 100 types of HPV, of which more than 40 are sexually transmitted. These include two high-risk types, HPV-16 and HPV-18, which cause the majority of cervical and anogenital cancers, and some portion of head and neck cancers, particularly oral cavity and oropharynx cancers.

“Currently, there is no cure for HPV, and the available treatment options involve destroying the affected tissue. We have developed a protein inhibitor that blocks HPV protein expression in cell culture, a first step toward a topically applied treatment for this cancer-causing virus,” said senior author James Baleja, PhD, an associate professor of biochemistry at Tufts University School of Medicine.

In their efforts to inhibit HPV, Baleja and his team zeroed in on the viral protein E2, which controls viral activities including DNA replication and the activation of cancer-causing genes. Using structure-guided design, the team developed a protein called E2R that prevents E2 from functioning normally. When the researchers applied E2R to a cell model of HPV biology, viral gene transcription was halted. Because HPV infects epithelial cells, the outermost layer of the skin, and the mucous membranes, protein inhibitors such as E2R could be applied in a topical form.

Baleja and colleagues used biophysical tools including circular dichroism spectroscopy and x-ray crystallography to test the structure and stability of different inhibitors. The most stable inhibitor was then tested in mammalian cells and was found to inhibit the E2 protein of HPV-16, the high-risk strain that is most commonly associated with cancers. The data in this study suggest that the inhibitor may also be effective against another high-risk virus, HPV-18, as well as a low-risk virus, HPV-6a, which causes warts.

“Vaccines are helping to lower the incidence of HPV, but vaccines will not help the millions of women and men who currently have an infection, especially those who have high-risk and persistent infections,” Baleja said. “Social and economic challenges make widespread administration of a vaccine difficult, particularly in developing countries. A topical treatment for HPV could provide an economical option,” he added.


April, 2011|Oral Cancer News|

Oral cancer: How discovery devices assist screenings

Source: www.dentistryiq.com
Author: Nick Efthimiadis, Vice President, Sales & Marketing, LED Dental Inc.

As the intense media attention surrounding Michael Douglas’s illness clearly demonstrated, oral cancer is increasingly in the news these days. With the unfortunate growth in the number of relatively young people contracting the disease due to exposure to the sexually-transmitted human papilla virus — specifically, the HPV-16 strain — oral cancer will only become a bigger concern for both patients and dental practices over time. In fact, the Oral Cancer Foundation recently announced that HPV-16 has now replaced tobacco as the leading cause of this disease.

Sadly, one North American dies every hour of every day from oral cancer, and many of those who survive the disease are forced to deal with lengthy, painful treatment and permanent disfigurement. The main problem is that oral cancer is typically discovered in late stages, when the five-year survival rate is only around 30%.

The good news: when discovered early, the survival rate leaps to 80%-to-90%.

The key to early discovery is the dental practice. Ideally, each and every practice should be conducting a two-step oral cancer screening on all adult patients as part of their annual or semi-annual hygiene checkup. The first step consists of a conventional “white light” exam comprising visual inspection and palpation. The second step consists of examination with an adjunctive screening device. Fortunately, the two steps should take no more than five minutes combined.

Palpation as part of the "white light" exam

For the past several years, the adjunctive device that has been used for more screenings than any other is the VELscope system. It is the first technology to be approved by the FDA and Health Canada to help clinicians detect cancerous and pre-cancerous lesions that might not be apparent to the naked eye. What made this possible is that the VELscope was also the first product to bring tissue fluorescence visualization technology to dentistry, and it is still the industry’s gold standard. In fact, since its 2006 launch, VELscope devices have been used to conduct over 10 million exams.

In many practices, both the conventional and VELscope screenings are conducted by the hygienist.

Hygienist uses adjunctive device as part of oral cancer screening

The VELscope handpiece shines a safe blue light into the oral cavity. When viewed through the VELscope’s patented filters, healthy tissue fluoresces green. Suspicious tissue, such as oral abnormalities that may be or may lead to dysplasia and oral cancer, has a different fluorescence signature and generally appears as a dark, irregularly shaped patch. If a suspicious lesion is detected, the hygienist will normally have the dentist view it using the VELscope as well. In some cases, questioning of the patient may reveal a logical explanation, such as a burn from hot coffee. If the lesion cannot be explained, the dentist will normally ask the patient to return for a follow-up screening in two or three weeks. If the condition has not improved, the dentist will usually perform a surgical biopsy or refer the patient to a specialist for a biopsy.

Doctor checks suspicious lesion

It is important to note that the VELscope is a discovery device, not a diagnostic device. Only a surgical biopsy can provide an accurate diagnosis of a lesion. In some cases the diagnosis will be cancer, pre-cancer or dysplasia, but more often some other type of oral disease will be diagnosed. Examples include lichen planus and bacterial, viral and fungal infections. While these conditions are clearly much less serious than cancer, they are conditions that need to be discovered and treated.

The latest and most advanced generation of VELscope technology was recently introduced. The VELscope Vx Enhanced Oral Assessment system does everything prior generations did, but features two dramatic improvements. First, it is cordless and lightweight, making it exceptionally portable. Second, the price has been cut roughly in half; in fact, its $2,499.99 regular price makes it possible for many practices to have a VELscope Vx in every operatory.

There are many other advantages of the VELscope Vx system:

* It is easy to incorporate into the practice.
* It is completely noninvasive for the patient, with no rinses, dyes or discomfort.
* Any suspicious lesions can be easily photo-documented and shared with specialists who might be conducting surgical biopsies.
* It gives the patient wonderful peace of mind, since the vast majority will be shown to have no issues.
* It reinforces the image of a state-of-the-art, caring dental practice concerned for the oral and systemic health of it patients.
* It is affordable for patients, as practices can charge $15 or even less per screening.
* It can easily pay for itself in two months or less, and after that it can earn the practice $10,000-to-$20,000 in extra profit each year.
* Most important, it just might help you save a patient’s life.

In addition, LED Dental has a comprehensive education program for practices that are considering purchasing the VELscope Vx, and an extensive training program for practices that have purchased the system.

Every day of their careers, hygienists provide a variety of very important services for their patients. Now those patients are potentially vulnerable to a very serious health threat, and many of those patients have no idea that this threat exists. And, as a result, hygienists now have an opportunity to have a more profound impact on the health and lives of their patients than ever before.

Source: DentistryIQ

April, 2011|Oral Cancer News|

AAOMS Supports Goals of Oral Cancer Awareness Week

ROSEMONT, Ill., April 1, 2011 /PRNewswire-USNewswire/ — The 2011 Oral Cancer Awareness Week, set for April 11-15, is intended to educate people of all ages and socio-economic levels about the risk factors and symptoms of oral, head and neck cancer and the importance of early detection. The American Association of Oral and Maxillofacial Surgeons (AAOMS) agrees with the Oral Cancer Foundation, which conceived the awareness week observance, that it is critical oral cancers receive the national media attention necessary to raise public awareness.

The Oral Cancer Foundation points out that the high death rate traditionally associated with oral cancer is not because it is hard to discover or diagnose, but because the cancer has historically been discovered late in its development.  In its early stages, oral cancer may – and often does – go unnoticed because there are no blatant symptoms or pain.  This only underscores the importance of establishing a regimen to include regular self-examinations and examination by a dentist or oral and maxillofacial surgeon at least annually.

The mouth is one of the easiest parts of your body to examine yourself. Also, changes in the mouth can be easily seen, so oral cancer can be detected in its early stages. The key to early detection is performing a self-examination regularly. Examining your mouth each month will help you identify changes or new growths early. And, early detection is important in increasing the chance of a cure.

Factors That May Cause Cancer

According to the National Institutes of Health, approximately 35,000 people will be diagnosed with oral cancer each year.  The disease will strike two men for every woman, and will occur twice as often in the African American community.

Research has identified a number of factors that may lead to oral cancer. Of these, lifestyle choices, including use of tobacco and alcohol, remain the biggest cause of oral cancer. Other common factors include poor oral hygiene, irritation caused by ill-fitting dentures and rough surfaces on teeth, poor nutrition, some chronic infections and combinations of these factors. And, in recent years, the sexually transmitted HPV16 virus has been a rising factor in oral cancer, especially among younger adults. It is important to note, however, that about 25% of oral cancer patients have no known risk factors.

Studies have shown that the death rate from oral cancer is about four times higher for cigarette smokers than for nonsmokers. Those who both drink alcohol and smoke are 15 times more likely to develop the disease than those who engage in only one of these activities.

It is widely believed in the medical field that the heat generated by smoking pipes and cigars irritates the mouth and can lead to lip cancer. Prolonged sun or tanning bed exposure also puts you at risk for lip cancer.

Those at an especially high risk of developing oral cancer are over 40 years of age, heavy drinkers and smokers, or users of smokeless tobacco, including snuff. However, the number of people under 40 who have been diagnosed with oral cancer has been increasing.

Perform a Self-Exam Monthly

Oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. If you are at high risk for oral cancer — smoker, consumer of alcohol, user of smokeless tobacco, or snuff — you should also see your general dentist or oral and maxillofacial surgeon for an annual exam.

Visit the media page at aaoms.org for tips on how to perform a self-examination and what to look for.

Saving Faces, Changing Lives® — The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 9,000 oral and maxillofacial surgeons in the United States, supports its fellows’ and members’ ability to practice their specialty through education, research and advocacy. AAOMS fellows and members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.

SOURCE American Association of Oral & Maxillofacial Surgeons