HPV

Men with more than two oral sex partners are more likely to contract HPV

Source: www.nzherald.co.nz
Author: Rebecca Sullivan

Men who have had more than two oral sex partners are “significantly” more likely to contract HPV, a viral infection that can develop into oesophageal cancer, a new study has found.

HPV, or the human papillomavirus, causes about 20-25 per cent of oesophageal cancer cases, said Professor Shan Rajendra from UNSW’s Ingham Institute.

Men are three times more likely than women to contract HPV through oral sex. Smoking and drinking are also big risk factors causing oesophageal cancer, reports news.com.au.

Actor Michael Douglas, who smoked and drank excessively, famously went public about the cause of his own oesophageal cancer after being diagnosed in August 2010.

“This particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.” Douglas, the husband of Catherine Zeta Jones, told The Guardian in 2013. “It’s a sexually transmitted disease that causes cancer.”

The study was presented at the Gastroenterological Society’s annual Australian Gastroenterology Week last weekend and was also published in the academic journal Diseases of the Oesophagus.

“What we found was that if you had more than two oral sex partners in your lifetime, then you increase your risk of HPV-associated esophageal cancer significantly,” Professor Rajendra said.

“It’s sexually transmitted. You swallow the virus and it gets absorbed by the body and gets into the lining of the oesophagus. In some people it doesn’t get cleared by the immune system. In most people it gets cleared but if it doesn’t get cleared it can cause cancers of the head and neck,” he said.

Straight men who perform cunnilingus are three times more likely than women to contract the virus, because vaginal fluid has a higher viral load and men’s bodies are less able to clear the virus, Prof Rajendra said.

Australia was the first country in the world to offer a vaccine for HPV. Introduced in 2008, it was a compulsory vaccine for teenage girls in years 11 and 12.

But the good news is the treatment success rates of oesophageal cancer are actually higher among those who contracted the disease via HPV. The prognosis is not as good for people whose throat cancer is caused by poor lifestyle choices such as smoking and drinking.

Professor Shan Rajendra’s study of 142 patients with esophageal cancer found those who were “virus positive” — meaning they developed the disease through having HPV — had the earliest stage cancers and responded best to treatment.

“They were responding to surgery or endoscopic treatments so much better than those who were virus negative. They also responded better to chemotherapy and radiotherapy,” he said.

“People with the virus live longer because their cancer proteins knock off the normal conventional pathway to cancer. That gives a favourable prognosis.”

September, 2018|Oral Cancer News|

Scientists map interactions between head and neck cancer and HPV virus

Source: medicalxpress.com
Author: staff, Gladstone Institutes

Human papillomavirus (HPV) is widely known to cause nearly all cases of cervical cancer. However, you might not know that HPV also causes 70 percent of oropharyngeal cancer, a subset of head and neck cancers that affect the mouth, tongue, and tonsils. Although vaccines that protect against HPV infection are now available, they are not yet widespread, especially in men, nor do they address the large number of currently infected cancer patients.

Patients with head and neck cancer caused by HPV respond very differently to treatments than those whose cancer is associated with the consumption of tobacco products. The first group generally has better outcomes, with almost 80 percent of patients surviving longer than 5 years after diagnosis, compared to only 45-50 percent for patients with tobacco-related cancers.

To better understand what might cause these differences, a team of scientists led by Nevan J. Krogan, Ph.D., senior investigator at the Gladstone Institutes, is taking a unique approach by focusing on the cancer-causing virus. They recently mapped the interactions between all HPV proteins and human proteins for the first time. Their findings are published today in the journal Cancer Discovery.

“With our study, we identified several new protein interactions that were previously not known to cause cancer, expanding our knowledge of the oncogenic roles of the HPV virus” said Krogan, who is also a professor of cellular and molecular pharmacology at UC San Francisco (UCSF) and the director of the Quantitative Biosciences Institute (QBI) at UCSF. “The human proteins we found interacting with HPV are involved in both virus- and tobacco-related cancers, which means they could be potential targets for the development of new drugs or therapies.”

A Complete Picture of Virus-Cancer Connections
Krogan and Manon Eckhardt, Ph.D., a postdoctoral scholar in his laboratory at Gladstone, developed an integrated strategy to identify all the interactions between HPV proteins and human proteins. First, using a method called mass spectrometry, they discovered a total of 137 interactions between HPV and human proteins.

Then, in collaboration with computational biologist Wei Zhang, Ph.D., in the laboratory of Trey Ideker, Ph.D., at UC San Diego School of Medicine, they looked at entire networks of each protein—rather than only individual proteins—to detect the most important players. They also compared their list of proteins with data from HPV-associated cancer samples published by The Cancer Genome Atlas project. This large consortium catalogued genetic mutations in tumors of various cancers.

“We integrated together these two sets of data to get a comprehensive look at potential cancer-causing interactions between HPV and head and neck cancers,” said Krogan, who is co-director of the Cancer Cell Map Initiative. “This combined proteomic and genetic approach provided us with a systematic way to study the cellular mechanisms hijacked by virally induced cancers.”

Common Pathways in HPV-Induced and Smoking-Related Cancers
By overlaying the protein interaction and genomics data, the scientists discovered that the HPV virus targets the same human proteins that are frequently mutated in smoking-related cancers. Interestingly, those proteins are not mutated in HPV-positive cancers.

For example, their findings reconfirmed a well-established interaction between the human protein p53 and an HPV protein called E6. In HPV-negative cancers (those related to smoking), p53 is mutated in nearly all cases. However, the same protein is rarely ever mutated in HPV-positive cancer patients.

“In both cases, when p53 is inactivated, it leads to cancer,” explained Eckhardt, one of the first authors of the paper. “The difference is that the HPV virus finds a different way of attacking the same protein.”

In smoking-related cancers, p53 is mutated, which causes the cancer. Instead, in HPV-positive cancers, the viral protein E6 interacts with p53 and inactivates it, resulting in the same cancer, but without the mutation. This suggests the establishment of the viral infection and the development of tumors share common pathways.

“We thought there must be more proteins that can cause cancer either by being mutated or hijacked by HPV, so we developed a new method to detect them,” added Eckhardt. “Our study highlighted two interesting instances where the interaction of HPV and human proteins play a role in the development or invasiveness of the cancer.”

Eckhardt showed that the HPV protein E1 interacts with the human protein KEAP1, which is often mutated in smoking-related cancers. In HPV-positive cancers, KEAP1 is not mutated. But, through its interaction with the protein E1, KEAP1 is inactivated, which helps cancer cells survive.

The researchers also found that the HPV protein L2, which is part of the virus’s packaging, interacts with two human proteins called RNF20 and RNF40. They demonstrated that in HPV-positive cancers, this protein interaction increases the tumor’s ability to spread and invade new parts of the body.

These results confirm that the HPV virus causes head and neck cancer by targeting the same proteins that go awry in response to smoking-induced mutations.

Connecting Cancer and Infectious Diseases
Krogan and his collaborators have shown that integrating HPV-human interaction with tumor genome data, and focusing on genes that are mutated in HPV-negative but not HPV-positive tumors, constitutes a powerful approach to identify proteins that serve as both viral targets and genetic drivers of cancer.

The scientists’ work should lay the groundwork to find better therapeutic options for both HPV-negative and HPV-positive head and neck cancers. In addition, Krogan’s long-term goal is to define a pipeline that will enable the study of many other virally induced cancers, including those linked to Hepatitis B and C, Epstein-Barr virus, and adenoviruses.

“Science can be siloed, and through these unbiased, holistic approaches we can start to find common pathways between different systems,” said Krogan, who also leads the Host Pathogen Map Initiative, which aims to compare protein and genetic interactions across many pathogens and identify similarities. “Our work is helping connect the dots between cancer and infectious diseases in ways that have never been considered.”

September, 2018|Oral Cancer News|

Why I tell Everyone I have HPV

Source: bustle.com
Author: Emma McGowen

I have HPV. Or, to be more accurate, I was diagnosed with HPV when I was 19 and found a little bump on my vulva in an area where there was no chance it could be an ingrown hair. The nurse at the health clinic at my college put acid on it, watched while it turned white, and told me it was definitely a wart. That was the one and only “outbreak” I’ve ever had, but it was enough for me to say, sure, I have HPV. And I’m not shy about telling people that.

But I wasn’t always this chill about it. When I was diagnosed, I basically lost it. I fell right down the slut-shaming hole. I told myself that was “what I get” for sleeping around, and cycled through the usual you can never have sex again/HPV doesn’t go away/your vagina is going to be covered in hideous warts/YOU’RE A TERRIBLE PERSON thoughts that so many of us go through when we get an STI diagnosis. Mid-freak out, I called a close friend. “Oh yeah, I have it, too,” she said. I got the same response from a female family member. And that’s when I calmed down and realized — HPV isn’t a big deal.

Or, at least, the type of HPV I have isn’t a big deal. What I didn’t know at the time of diagnosis — but learned with a little Googling and had reinforced since, in my training as a sex educator — is that the strains of HPV that cause warts don’t have any other negative health effects. Specifically, if you have a strain of HPV that causes warts, it won’t cause cancer. And the strains that cause cancer don’t cause warts. So while the kind that I was diagnosed with has a visible component, it’s really no more annoying than the occasional pimple. And I’ve had way more pimples since I was 19 than I’ve had warts.

The other thing I’ve realized about HPV is that it’s ridiculously common. Because HPV is a skin-to-skin STI, there’s no way to protect 100 percent against it, other than never touching another human being again. Also, most people with penises carry the virus, but don’t show any symptoms — and can still spread it. So there’s no way for them to know if they have it and no way for the people who are sleeping with them to know, either. As a result of all of these factors, the CDC estimates that anyone not vaccinated against HPV will have it at some point in their lives.

Did you catch that? I’m going to repeat it, really loudly, just in case: the CDC says that anyone who is not vaccinated against HPV will have it at some points in their lives.

And here’s another fun fact: Contrary to the popular belief that HPV “never goes away,” many people actually clear the virus. That’s especially true for young people — which is the group in which the virus shows up most frequently — who get it. It’s also why the CDC doesn’t say “everyone has HPV” but that everyone who isn’t vaccinated “will get HPV at some time in their life.” So even though I was diagnosedwith HPV when I was 19, I don’t necessarily have it now, at 31. Does that mean I for sure don’t? Nope. Does that mean I for sure don’t carry other strains of the virus, including the cancer-causing ones? Nope. And that’s why I go regularly for Pap tests, which are a great method of early detection of irregular cells caused by HPV that can morph into cervical cancer. And also another reason why I honestly DGAF about my HPV status.

So if everyone will get it at some point or another, why do we still freak out about it? The answer is simultaneously really simple and really complicated: STI stigma. STI stigma is the overblown fear and shame so many of us carry about STIs. It’s the idea that getting an STI somehow means a person is “dirty” or “immoral” or a “slut.” It’s the idea that an STI is somehow worse than any other illness that one human picks up from another human. And you know why so many of us believe that? Because our culture teaches us that sex — especially for pleasure or outside of heterosexual marriage — is wrong.

With that in mind, my challenge to you is this. Ask yourself: Do I think sex outside of heterosexual marriage is wrong? Do I think sex for pleasure is wrong? Do I think people who have that kind of sex are bad? If the answer is yes, then you will probably continue thinking that people with STIs are dirty or immoral. And while I disagree with you, that’s your choice.

But if the answer is no, then I ask you: What makes an STI so much more morally wrong than any other illness? Nothing. And when you think about it that way, STI stigma and freaking out about an STI diagnosis — the way I did when I was 19 — just doesn’t make any logical sense. I don’t beat myself up when I get a cold, so why would I beat myself up for getting HPV? In both cases, there are things I could have done to be “safer” and protect myself against the virus but, hey, life happens.

So, yeah, I tell everyone I have HPV. Because, ultimately, it’s not a big deal, and because talking about it can help to eliminate some of that stigma. I also carry many forms of the common cold virus. Want to talk about that, too?

September, 2018|Oral Cancer News|

Italy Is Living Through What Happens When Politicians Embrace Anti-Vaxxers

Source: Huffingtonpost.com
Author: Nick Robins-Early

Italy’s Five Star movement, which was founded by a man who once called HIV a hoax, campaigned against mandatory vaccinations ahead of the country’s elections in March — and won. Last month, party leaders pushed through a law that ended compulsory immunizations for children attending public school.

The new law has made Italy the darling of the global anti-vaxxer movement. But now the country is struggling to stop a measles outbreak that has already infected thousands of people, and Europe is recording its highest number of cases in a decade — an inevitable and foreseeable result of anti-vaccine policies and rhetoric, experts say.

“Europe now is a good example of what happens when coverage of vaccinations is in decline,” said Vytenis Andriukaitis, the European Commissioner for Health and Food Safety.

The efforts of Five Star and its far-right coalition partner, the League, have particularly complicated the global campaign to combat measles, an extremely contagious virus that often spreads among children and can result in severe complications, including pneumonia and encephalitis. The World Health Organization in 2012 set the goal for Europe to eliminate the disease by 2015. Instead, an estimated 41,000 people across the continent have been infected in the first six months of this year.

Even a slight dip in a population’s vaccination rate can have disastrous effects: Countries need at least a 95 percent coverage rate to be measles-free. So when fewer people get vaccinated, kids get sick.

“We’ve got this terrible self-inflicted wound where you’re reversing public health gains in Europe and the U.S.,” said Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine.

Five Star and the League have sometimes framed their efforts to do away with compulsory immunizations as a way for parents to make their own health decisions, rather than limiting vaccinations in the country. And Luigi Di Maio, Five Star’s current party leader, has recently tried to tamp down on outright anti-vaccine conspiracies.

But the rhetoric and proposals of other prominent party figures and their allies are much more radical. One top Five Star official, Paola Taverna, last month backed hazardous “measles parties” where children gather to infect each other and build up immunity. League party leader Matteo Salvini described mandatory vaccinations as “useless and in many cases dangerous” in June. Some party candidates and top officials went further, falsely claiming vaccines cause autism and referring to state-funded vaccination as “free genocide.”

These politicians’ rhetoric is in line with anti-vaccine groups that couch conspiracies and opposition to vaccinations in appeals to personal choice and pseudoscience. “They use these phony terms that really have no meaning … like medical freedom and vaccine choice,” Hotez said. “What these [anti-vaccine] groups are really doing is depriving children of fundamental rights.”

In a little over three months in office, Five Star and the League have furthered the goals of a small but vocal anti-vaccine community.

Just a year ago, Italy looked like it was on a path to solving its measles outbreak. The country’s previous government passed a law that required children to receive 10 vaccinations in order to attend state-run schools.

The law received the backing from infectious disease experts from the World Health Organization and Italian doctors, but was fiercely opposed by Europe’s well-organized anti-vaccine movement.

“It’s quantitatively a very small group, but qualitatively they are noisy and very, very aggressive,” said Walter Ricciardi, president of the Italian National Institute of Health.

Anti-vaccine protesters attacked government deputies outside of the Italian parliament. They held rallies in the streets of Rome. A group of 130 families wrote to Italy’s president claiming they would seek asylum in Austria to avoid the vaccinations. At one of Health Minister Beatrice Lorenzin’s events promoting her book, activists screamed accusations that she was killing children.

Prominent international anti-vaxxer organizations, a network made up of activists and even some disgraced doctors, latched on to Italy as a symbol of resistance, and posts on anti-vaxx forums lauded the demonstrations. The League and Five Star parties capitalized on the unrest and criticized the law as government overreach.

“The law was good and it was working, then the major leaders of the two parties made unscientific comments on vaccines,” Ricciardi said.

Stopping the outbreak became less important to Five Star and the League than appealing to the anti-establishment sentiment that ushered the parties into power, critics allege.

“They wanted the votes of anti-vaxxers and people that consider the law of compulsory vaccination a violation of personal freedom,” said Stefano Zona, a doctor of infectious diseases and member of IoVaccino, an Italian nonprofit that seeks to correct misinformation around vaccines.

“They are feeding the anti-vaxxer movement,” he said.

The U.S. has also had several major measles outbreaks in recent years, in part driven by anti-vaccine activists and linked to lower vaccination rates in some communities. And American politicians aren’t much more restrained than their Italian counterparts in fueling vaccine skepticism. President Donald Trump questioned the safety of vaccines during a 2015 Republican presidential debate and spent years promoting anti-vaxxer conspiracies.

September, 2018|Oral Cancer News|

Study: HPV cancer survivors at risk for second HPV cancer

Source: www.bcm.edu
Author: Dipali Pathak

A retrospective study led by researchers at Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth) School of Public Health found that survivors of HPV-associated cancers have a high incidence of developing second HPV-related cancers. Their findings, which were reported today in JAMA Network Open, suggest the need for increased screening for HPV-associated precancerous and early cancerous lesions among people who are survivors of the disease.

Human papillomavirus, or HPV, is a sexually transmitted infection that can lead to gynecological (cervical, vaginal and vulvar), anogenital (anal and penile) and oropharyngeal (throat and mouth) cancers. Cervical cancer is the most common HPV-associated cancer in women, and oropharyngeal cancers are the most common in men.

“HPV is a virally mediated cancer, so it makes sense if somebody is infected in one site with the virus that they would be infected in other sites as well. It is important for people who have had one HPV-related cancer to know that they are at increased risk for HPV-related cancers in another site, and they are encouraged to have screening for these other cancers, if screening is available. Currently, screening is available for cervical and anal precancers,” said Dr. Elizabeth Chiao, professor of medicine in the section of infectious diseases at Baylor and with the Houston VA Center for Innovations in Quality, Effectiveness and Safety.

Chiao also is a member of the NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine.

For the study, researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program database, which collects cancer incidence data from registries across the United States. They identified survivors of HPV-associated cancers diagnosed from January 1973 to December 2014 and looked at patients who developed a second primary HPV-associated cancer at the same site or a different site at least two months after the diagnosis.

They found that individuals who had primary HPV-related cancer had an increased risk of HPV-related cancer in other sites later in life.

According to the study, the risk for most types of second primary HPV-associated cancers is high after 1) initial vaginal and vulvar cancers in women, 2) after initial penile cancer in men and 3) after anal cancer in both women and men. The researchers found no association with secondary non-HPV associated cancers.

“Future research needs to be prioritized to determine effective as well as cost-effective ways to screen for HPV-associated second cancers in this high-risk group,” said Dr. Ashish Deshmukh, assistant professor in the department of management, policy and community health at UTHealth School of Public Health in Houston.

The researchers recommend investigating the efficacy of screening and prevention measures for survivors of HPV-associated cancers. They also recommend being vaccinated against HPV. The vaccination series can begin at 9 years of age in males and females and can go through age 26 for females and age 21 in males.

Others who took part in the study include Ryan Suk and Dr. Kalyani Sonawane with UTHealth School of Public Health; Dr. Parag Mahale with the National Cancer Institute; Dr. Andrew G. Sikora with Baylor College of Medicine; Dr. Jagpreet Chhatwal with Harvard Medical School; Dr. Kathleen Schmeler and Dr. Scott B. Cantor with The University of Texas MD Anderson Cancer Center and Dr. Keith Sigel with the Icahn School of Medicine at Mount Sinai.

Note: This work was supported by grants K07180782 and R01 CA163103 from the National Cancer Institute, part of the National Institutes of Health.

September, 2018|Oral Cancer News|

Head and neck cancer: An overview of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Welcome to this CURE Connections® program titled “Head and Neck Cancer: Through the Eyes of a Patient.” I’m Meryl Kaufman, a certified speech-language pathologist and founder of Georgia Speech and Swallowing LLC. I am joined today by Dr. Itzhak Brook, a professor of pediatrics and medicine at Georgetown University School of Medicine, who was diagnosed with throat cancer in 2006. Together we will discuss the prevalence of head and neck cancer, what unique challenges patients may face and how one can adjust to life after receiving treatment for their disease. Dr. Brook and I also serve as board members on the Head and Cancer Alliance.

Dr. Brook, let’s talk about head and neck cancer in general. What’s the difference between head and neck cancer associated with the traditional risk factors, such as smoking and drinking, and HPV-related head and neck cancers?

Itzhak Brook, M.D., M.Sc.: The traditional head and neck cancer is related to smoking and alcohol consumption. It’s usually associated with a high rate of laryngeal cancer. And HPV-related cancer is a relatively new arrival on the scene of head and neck cancer, and it’s associated with a condition of infection by a venereal disease. The virus HPV is usually associated with a posterior tongue cancer or an oropharyngeal cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly, yes. So the HPV viruses typically in the oropharynx, the tonsil and the tongue basis are certainly rising in incidence as compared with the traditional head and neck cancers, which are decreasing in incidence. In fact, it’s anticipated that in the year 2020, the HPV-related oropharyngeal cancers are going to surpass HPV-related cervical cancers, which are typically what you think of with the HPV virus. So that is a new patient population, but the good news is that the survival rates are better for the HPV-related head and neck cancers versus the non-HPV-related cancers. Can you speak a little bit about the incidence of the two?

Itzhak Brook, M.D., M.Sc.: The incidence of head and neck cancer is not as high as others like colon cancer, breast cancer in women or lung cancer, but it’s around the ninth or 10th cause of cancer in the world in this country. In countries where there is smoking and alcohol consumption, it’s a higher rate. HPV is usually happening in younger people, in the late 30s or early 40s. And fortunately, we hope that it could be prevented by vaccination. Although it’s approved that it can, it’s not yet available because the incubation period for the cancer, as you may call it, takes 20, 30 years, so we don’t really know. Fortunately, even though HPV is very common, the occurrence of HPV-related cancer is very, very rare.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Correct. In terms of the vaccination for the HPV virus, I agree, the proof certainly isn’t definitively out there yet, but the vaccine protects against the strain of virus that ultimately can lead to head and neck cancer. So the thought is that by preventing the contraction of the virus, hopefully we can also prevent these head and neck cancers, which is why the American Academy of Pediatrics and the CDC (Centers for Disease Control and Prevention) recommend that children between the ages of 11 and 12, female and males, are vaccinated prior to sexual debut in the hopes of preventing these cancers down the road, certainly. So yes, head and neck cancer does account for about 6 percent of all cancers worldwide, with about 500,000 cases worldwide. And in the United States, we anticipate about 65,000 a year, I believe, and they do occur more frequently in men, almost twice as often in men than in women and typically in people over the age of 50 in the traditional head and neck cancers. But certainly, there is a change in that with the introduction of the HPV-related cancers. Can you talk a little bit about prevention in terms of things that we can do to prevent the risky behaviors?

Itzhak Brook, M.D., M.Sc.: Of course, with the traditional cancers, it can be prevented by not smoking or drinking alcohol in high quantities. But there’s the behavioral changes that men and women can change that can reduce the risk of acquiring it. It’s a sexually transmitted disease. Oral sex has been the No. 1 cause, so you think of condoms or men using them also when having oral sex may prevent it.

September, 2018|Oral Cancer News|

Head and neck cancer: Getting a diagnosis of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss which symptoms should lead one to seek a diagnosis of head and neck cancer and which tests are available to aid in evaluation.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: When we talk about the HPV-related cancers, those are primarily in the oropharynx, which is the tongue base and the tonsil. But the traditional cancers typically can also involve the tongue, the lips, the floor of the mouth, the jaw, the gums and the hard palate. And the pharynx; that includes the nasopharynx behind the nose. We’ve addressed the oropharynx but also the hypopharynx, near the larynx. And in your case, laryngeal cancer that involves the larynx, the voice box, and the epiglottis. So, head and neck cancers can occur in any of those places. Can you talk about some of the signs and symptoms people can look out for in those areas?

Itzhak Brook, M.D., M.Sc.: Well, the important signs that are common to oral cancers are having a sore throat, a feeling that you cannot swallow and difficulty in swallowing. In advanced stages, it can interfere with breathing. If you have increased lymph glands in the neck and are also feeling like a lump or something is stuck in your mouth, those could be a sign. Sometimes they have symptoms such as pain in the ear or pain in the throat. And there are specific cancers such as sinuses and lips. If there is an area of the mouth where there’s a red or ulcerating lesion in the oropharynx, this can indicate that there is a cancer risk.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. Can you talk about your initial presentation? What symptoms did you experience?

Itzhak Brook, M.D., M.Sc.: I experienced something stuck in my mouth, and when it didn’t go away after a week or so, I went to see my doctors, and they discovered it very early. And I was fortunate that it was possible to remove it by a simple biopsy. And then, unfortunately for me, even though I got radiation, the cancer came back about a year and a half later, and I required a laryngectomy to remove the cancer because it had moved to other places, the throat. And that was a way to treat it initially, but being vigilant and recognizing early that there’s something wrong, something is happening, can definitely save many lives.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And quality of life, right?

Itzhak Brook, M.D., M.Sc.: Right.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: What were some of the tests exactly that you underwent in trying to find this cancer and making a diagnosis?

Itzhak Brook, M.D., M.Sc.: Well, I got obviously the most important thing, which was to have a good otolaryngological examination with endoscopy, where they put the tube into your throat or through the nose to try to detect and see what’s going on through direct examination. The other tests that I am aware of are MRI and then CT. But the most important thing in my case was a good physical examination because in my case, the MRI and CT didn’t show anything wrong because you need the cancer to be larger than about a half an inch, and mine wasn’t yet. So, seeing your doctor is the most important thing a person can do to catch the cancer early.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. And one of the things the Head and Neck Cancer Alliance does and promotes is free screenings throughout the country and throughout the world. And traditionally, the Head and Neck Cancer Alliance has done that during oral head and neck cancer awareness week, which occurs in April every year. But there has been a push in the past couple of years to really spread that out throughout the year and help raise awareness to these signs and symptoms that you addressed, as well as direct patients to facilities that can provide a screening. And a screening is simple and easy, and it does involve a physical examination—feeling the neck, looking for signs and symptoms and talking about signs and symptoms. So. certainly, if any listeners were to identify any of these risk factors that you address, such as a change in swallowing, a change in voice, a lump in the neck, pain in the ear or difficulty breathing, then certainly looking to some of these screening sites or reaching out to your doctor is a good way to really find those cancers early and help minimize the intensity of the treatment that might result.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. And in terms of staging head and neck cancers, one of the important pieces of that work-up when you had the endoscopy and the scans was to come up with a TNM stage for that head and neck cancer that really kind of directs the treatment. Part of that also is being evaluated by a multidisciplinary team, and I think it’s really important in the management of head and neck cancer that there are multiple specialists, including the otolaryngologist, who’s often the first person to make the diagnosis. But a team of specialists, including radiation oncologists, hematology, oncology, speech pathology, nutrition, social work and pathology—there are so many professionals involved. Was there a multidisciplinary team involved in your care?

Itzhak Brook, M.D., M.Sc.: Yes. Fortunately, I had been examined by all those experts. In addition to it, I also, when I finally had the laryngectomy, met and represented several patients who wanted and got that procedure, and meeting them prepared me more than anything else in our life for what a laryngectomy would be.

September, 2018|Oral Cancer News|

DCD: Oropharyngeal squamous cell carcinoma now and most common HPV associated with cancer

In 2015, oropharyngeal squamous cell carcinoma surpassed cervical cancer as the most common HPV-associated cancer in the U.S., with 15,479 cases among men and 3,438 cases among women, according to data from the CDC published in Morbidity and Mortality Weekly Report.

The report also showed that rates of HPV-related anal squamous cell carcinoma and vulvar cancer increased over the past 15 years, whereas rates of HPV-related cervical cancer and vaginal squamous cell carcinoma decreased.

“Although smoking is a risk factor for oropharyngeal cancers, smoking rates have been declining in the United States, and studies have indicated that the increase in oropharyngeal cancer is attributable to HPV,” Elizabeth A. Van Dyne, MD, epidemic intelligence services officer in division of cancer prevention and control at the National Center for Chronic Disease Prevention and Health Promotion of the CDC, and colleagues wrote.

“In contrast to cervical cancer, there currently is no U.S. Preventive Services Task Force recommended screening for other HPV-associated cancers,” they added.

The trends in HPV-related cancers report included data from 1999 to 2015 from cancer registries — CDC’s National Program of Cancer Registries and NCI’s SEER program — covering 97.8% of the U.S. population.

The CDC reported 30,115 new cases of HPV-associated cancers in 1999 compared with 43,371 new cases in 2015.

During the study period, researchers observed a 2.7% increase in rates of oropharyngeal squamous cell carcinoma among men and a 0.8% increase among women. Rates of anal squamous cell carcinoma increased by 2.1% among men and 2.9% among women.

Among women, researchers observed a 1.6% decrease in HPV-related cervical cancer and a 0.6% decrease in rates of HPV-related vaginal squamous cell carcinoma. Rates of vulvar squamous cell carcinoma increased by 1.3%.

Rates of penile squamous cell carcinoma remained stable from 1999 to 2015.

Overall, rates of HPV-related cancers varied by age and race/ethnicity.

Researchers observed a 4% increase in the rate of oropharyngeal squamous cell carcinoma among men aged 60 to 69 years compared with a 0.8% increase among men aged 40 to 49 years.

For anal squamous cell carcinoma, the largest increases occurred among women aged 50 to 69 years (4.6% to 4.8%) and men aged 50 to 59 years (4%).

Several factors contribute to the increased incidence of oropharyngeal and anal squamous cell carcinomas, including changes in sexual behavior.

“Unprotected oral sex and receptive anal sex are risk factors for HPV infection,” the researchers wrote. “White men have the highest number of lifetime oral sex partners and report first performing oral sex at a younger age compared with other racial/ethnic groups; these risk factors could be contributing to a higher rate of oropharyngeal squamous cell carcinoma among white men than other racial/ethnic groups.”

Cervical cancer rates remained stable among women aged 35 to 39 years; however, younger and older woman demonstrated decreases ranging from 1.2% to 4.2%.

Cervical carcinoma rates decreased across all racial/ethnic groups, although decreases appeared more prominent among Hispanics than non-Hispanics (3.4% vs. 1.5%).

“The decline in cervical cancer from 1999 to 2015 represents a continued trend since the 1950s as a result of cancer screening,” the researchers wrote. “Rates of cervical carcinoma in this report decreased more among Hispanics, American Indian/Alaska Natives and blacks than other groups; however, incidence rates were still higher among Hispanics and blacks than among whites in 2015. These persistent disparities in incidence suggest that health care delivery needs of some groups are not fully met.”

The limitations of the report included the fact that the cancer registries do not routinely determine the HPV status of cancers and that race/ethnicity data was derived from medical records.

“Further research to understand the progression from HPV infection to oropharyngeal cancer would be beneficial,” the researchers wrote. “Continued surveillance through high-quality registries is important to monitor changes in HPV-associated cancer incidence.” – by Cassie Homer

August, 2018|Oral Cancer News|

Study: Cetuximab, radiation inferior to standard HPV throat cancer treatment

Source: upi.com
Author: Allen Cone

Treating HPV-positive throat cancer with cetuximab and radiation had worse overall and progression-free survival results compared with the current method of treatment with radiation and cisplatin, the National Institutes of Health revealed Tuesday.

The trial, which was funded by the National Cancer Institute, was intended to test whether the combination would be less toxic than cisplatin but be just as effective for human papillomavirus-positive oropharyngeal cancer. The trial, which began in 2011, enrolled 849 patients at least 18 years old with the cancer to receive cetuximab or cisplatin with radiation. The trial is expected to finish in 2020.

Cetuximab, which is manufactured under the brand name Erbitux by Eli Lilly, and cisplatin, which as sold as Platinol by Pfizer, are used in chemotherapy.

The U.S. Food and Drug Administration had approved cetuximab with radiation for patients with head and neck cancer, including oropharyngeal cancer.

HPV, which is transmitted through intimate skin-to-skin contact, is the leading cause of oropharynx cancers, which are the throat at the back of the mouth, including the soft palate, the base of the tongue and the tonsils. Most people at risk are white, non-smoking males age 35 to 55 — including a 4-to-1 male ratio over females — according to The Oral Cancer Foundation.

The NIH released the trial results after an interim analysis showed that cetuximab with radiation wasn’t as effective.

In a median follow-up of 4.5 years, the test combination was found to be “significantly inferior” to the cisplatin method.

“Clinical trials designed to test less toxic treatment strategies for patients without compromising clinical benefit are a very important area of interest for NCI and the cancer research community,” said Dr. Shakun Malik, of NCI’s Division of Cancer Treatment and Diagnosis.

Toxic side effects were different, with adverse events of renal toxicity, hearing loss and bone marrow suppression more common in patients in the cisplatin group and body rash more frequent in the cetuximab method.

For patients who cannot tolerate cisplatin, cetuximab with radiation is an accepted standard of care.

“The goal of this trial was to find an alternative to cisplatin that would be as effective at controlling the cancer, but with fewer side effects,” lead investigator Dr. Andy Trotti, of the Moffitt Cancer Center in Tampa, Fla., said in a press release. “We were surprised by the loss of tumor control with cetuximab.”

August, 2018|Oral Cancer News|

The surge in throat cancer, especially in men

Source: newswise.com
Author: UC Davis Comprehensive Cancer Center

Humanpapilloma virus (HPV) is now the leading cause of certain types of throat cancer. Dr. Michael Moore, director of head and neck surgery at UC Davis and an HPV-related cancer expert, answers some tough questions about the trend and what can be done about it.

Q: What is HPV and how is it related to head and neck cancers?

A: There are about 150 different types of HPV, but HPV 16 is the one that most frequently causes cancers that affect the tissue in the oropharynx, which includes back of the throat, soft palate, tonsils and the back or base of the tongue. You can get non-cancerous lesions from other types of HPV that look like warts in the nose, mouth or throat, called papillomas. Some can develop in childhood just from exposure early in life. Some develop later in life and only occasionally turn into cancer.

Q: How do you get HPV?

A: HPV can spread from mother to her baby around the time of delivery. It also spreads through unprotected vaginal, anal or oral sex, and even open-mouth kissing. Some people have been found to be infected without an obvious cause.

Q: How does HPV cause cancer?

A: Most people who are infected clear the virus on their own. In a small group of people it hangs around and causes a persistent infection. Around 1% of US adults have a persistent HPV 16 infection, and in a small subset of these individuals the DNA of the virus incorporates itself into the DNA of the person infected and can start to make proteins that then predispose that person to developing cancer.

Q: How prevalent are HPV-related throat cancers?

A: Traditionally, the risk factors for head and neck cancers were tobacco and alcohol use, but over the last 20 or 30 years we found the rates of those cancers going down because smoking rates have gone down. Meanwhile, the incidence of head and neck cancers related to HPV has gone up more than 200 percent over this time period. This increase has been so dramatic that HPV-related throat cancer has recently surpassed cervical cancer as the most common HPV-related cancer in the United States.

Q: Why are the rates going up?

A: Unlike with cervical cancer, in which the PAP smear is highly effective at finding potentially cancerous or pre-cancerous cells, there is no good screening test for these head and neck cancers. Currently, the use of swab tests for HPV is effective in finding out if you have an HPV infection, but not in determining if the infection will be persistent or if you will ever develop cancer. As a result, such tests are not endorsed as a way to screen for these tumors.

Q: Do both men and women get thee cancers?

A: Men are four times more likely to be diagnosed with an HPV-related head and neck cancer. Researchers don’t yet know why. It may have to do with sexual practices or related to the types of exposure they receive. The local or systemic immune system may also play a role.

Q: Can HPV-related head and neck cancers be prevented?

A: We have a very effective vaccine against HPV, and we know the vaccine can prevent oral HPV infections. In fact, studies have shown that the vaccine is 93 percent effective in preventing the oral infections that cause head and neck cancers. We recommend two injections for adolescents under age 15 and three for those over 15. The vaccine is recommended for children age 10-11, but vaccination can start in children as young as age 9, and in boys as late as age 21 and in girls as late as 26. It is also important to maintain safe sexual practices and avoid other potentially cancer-causing exposures such as tobacco, alcohol and marijuana.

Q: What are the main barriers to vaccination?

A: Studies have shown that the biggest reason kids don’t get it is lack of physician endorsement or recommendation. The American Cancer Society is trying to change that, asking physicians to introduce it to parents when they discuss other adolescent vaccines. There has also been concern that parents aren’t comfortable talking about sexuality with their children, and some have worried that if the child gets the vaccine they are more likely to be sexually active. That theory has been debunked in scientific studies.

Q: How safe and effective is the HPV vaccine?

A: It has a very safe track record and is continually undergoing evaluation to look for potential side effects. While there are some risks with any vaccine, one of the most common side effects is that patients may feel light headed after being vaccinated, and it is recommended they are observed for 15 minutes afterward.

August, 2018|Oral Cancer News|