human papillomavirus

World Trade Center responders might face greater risk of HPV throat and tongue cancer

Source: medicalxpress.com
Author: provided by Rutgers University

Firefighters at the World Trade Center were exposed to tons of toxic dust and debris that blanketed Manhattan on 9/11. Credit: Shutterstock

Researchers at Rutgers University – investigating the causes of head and neck cancers in World Trade Center rescue and recovery workers – will take the lead in a study to determine whether the responders are at a greater risk for human papillomavirus (HPV)-related throat and tongue cancer because of their exposure to toxic dust and debris.

“If we find that the prevalence of HPV is higher in World Trade Center exposed rescue workers it could mean that they have an increased likelihood of infection with HPV or have less of an ability to be able to clear this common infection naturally,” said Judith Graber, assistant professor of epidemiology in the School of Public Health.

HPV is the most common sexually transmitted infection in the United States, according to the Centers for Disease Control and Prevention, with most infections going away on their own. There is also now a vaccine to prevent HPV given to adolescents and teens. This is a new vaccine not given to adults and rates of vaccination have been low in the US.

While HPV-related oropharyngeal cancer, which includes throat, tonsils, back of tongue and soft palate, is relatively small, the number of HPV throat and tongue cancers are expected to increase and surpass HPV-related cervical cancers by 2020.

Graber said oropharyngeal cancer – which has a lower survival rate – is among the diseases which pose great risk for WTC rescue and recovery workers, who appear to have a greater incidence of throat and tongue cancer. Surviving patients, often left disfigured after treatments, are at a higher rate for depression, unemployment and suicide compared with other cancer patients, according to the study.

While the prevalence of HPV in the United States among people age 69 and younger is estimated at less than 10 percent, Graber said research indicates that 80 percent of all tumors found in this type of cancer are infected with HPV, some which can cause cancer.

“The symptoms, risk factors and exposure history could help in early prevention of this very devastating cancer,” said Graber.

The new Rutgers study will use tissue samples provided by the World Trade Center Biorepository at Mount Sinai from WTC workers diagnosed with oropharyngeal cancer and compare to tissue samples of people being treated for the disease at University Hospital in Newark.

This research is a spinoff of a two-year federally funded study examining risk factors for all head and neck cancers among WTC responders. Graber and her colleagues, including co-principal investigator, Mark Einstein, professor and chair department of OBGYN & Women’s Health at Rutgers New Jersey Medical School, are hoping to discover opportunities for early detection for these potentially debilitating diseases.

“HPV is very common, but cancers related to HPV are uncommon,” said Einstein. “Understanding the relationship between HPV and the development of oropharyngeal cancer is of critical importance so we can prevent and target this cancer better with novel therapies”.

What researchers need to determine in this new study, Graber said, is whether the higher incidence of the throat and tongue cancer is due to the fact that this group is being closely monitored, because of respiratory exposure after 9/11 or as a result of an HPV infection that creates a problem for a weakened immune system.

The information is critical, Graber said, in the quest to design a more definitive study to determine how and why these cancers are developing among those exposed during the rescue, recovery and clean-up efforts at the World Trade Cente

September, 2017|Oral Cancer News|

What’s next after creating a cancer-prevention vaccine?

Source: www.scientificamerican.com
Author: Dina Fine Maron

A winner of this year’s Lasker Awards talks about his work with HPV

Imagine a vaccine that protects against more than a half-dozen types of cancer—and has a decade of data and experience behind it.

We have one. It’s the human papillomavirus (HPV) vaccine, and it was approved for the U.S. market back in June 2006. It can prevent almost all cervical cancers and protect against cancers of the mouth, throat and anus. It also combats the sexually transmitted genital warts that some forms of the virus can cause.

On Wednesday, two researchers who completed fundamental work on these vaccines received one of this year’s prestigious Lasker Awards, a group of medical prizes sometimes called the “American Nobels.” Douglas Lowy and John Schiller, whose research provided the basis for the HPV vaccine, were selected alongside a researcher who separately unraveled key aspects of metabolic control of cell growth. Planned Parenthood was also given an award, for its public service. Lowy and Schiller, who both work at the U.S. National Cancer Institute (NCI), received the Lasker for their research on animal and human papillomaviruses—work that enabled the development of a vaccine against HPV-16 type, a form of the virus that fuels many HPV malignancies. The duo’s experiments proved that the vaccine is effective in animals, and they also conducted the first clinical trial of an HPV-16 vaccine in humans. That gave pharmaceutical companies the evidence they needed to invest in their own vaccines designed to protect against multiple kinds of HPV, and ultimately led to the versions administered around the world today.

Yet HPV shots have had a difficult run. Despite overwhelming evidence of their safety and effectiveness, in some developed countries—including the U.S.—HPV inoculations face opposition from individuals and groups that fear the shots are still too new and unproved to use on their children. The HPV vaccine also faces another hurdle beyond other routine pediatric shots: the virus is transmitted via sexual contact—which some parents and communities believe teens should not or will not have, and thus that the shots should not be mandatory. (The U.S. Centers for Disease Control and Prevention [CDC] currently recommends administering two doses of the vaccines to children 11 to 12 years old, administered at least six months apart.)

Scientific American spoke with Schiller, a virologist, about his and Lowy’s award-winning HPV research, their future plans and how to combat anti-vaccine attitudes.

[An edited transcript of the interview follows.]

What’s the biggest hurdle to getting more coverage with the HPV vaccine?
The biggest problem is actually not in the West or most developed countries; it is in the lower- and middle-income countries because of availability there and vaccine prices that limit availability. In those settings vaccine acceptance is actually very high. But those settings present the biggest problem, since some 85 percent of cervical cancers occur in low-resource settings. In the more developed countries there are many different factors involved [in vaccine hesitancy], and they differ by country. In the U.S. it is more about fear of vaccines in general. And there are some issues with HPV vaccines specifically related to this being about a sexually transmitted disease.

So far, more than 270 million doses of HPV vaccines have been distributed worldwide. But in the United States, by 2015 only 28 percent of teen males and 42 percent of teen girls had received the full course of three shots then recommended by the CDC. How can the science community help combat HPV vaccine hesitancy?
There are quite a few studies that show one of the biggest issues is that the vaccine is not being promoted sufficiently by pediatricians and general practitioners. If you look at other vaccines like for meningitis and hepatitis B—which are also administered to adolescents and could be given in the same visit as HPV—they are given at greater rates than HPV. So, there is some disconnect in communication between pediatricians and parents there. Part of the problem here is that the HPV vaccine is a prophylactic vaccine to prevent a disease—cervical cancer—that those providers never see. Obstetrician-gynecologists see it, but pediatricians don’t, which is the opposite of most other childhood or pediatric vaccines. Right now it’s being singled out as something special instead of treated as a routine childhood or adolescent vaccine. But we’ve had this vaccine for 10 years now and it’s not the new kid on the block anymore.

Mounting evidence suggests that among people who feel vaccines are unsafe, any new data showing that they arereally safe does not move the needle to convince them. So, what can be done?
My feeling is that there is a certain percentage of people who, no matter what facts you present to them, they are just not going to be convinced. Quite frankly it doesn’t pay to spend a lot of resources trying to convince that relatively small fraction. What we need to focus on is a much larger fraction of the population who aren’t having their kids vaccinated for reasons like convenience—like it’s a hassle—or they just need a bit more information to make them comfortable. People against all vaccines, those people would not be convinced to get an HPV vaccine so it’s not worth spending a lot of resources on them. I think one of the things that would increase HPV vaccine coverage would be allowing people to get them at their local CVS. I’m not an expert on this, but I have a daughter who as a teen spent much more time at the local CVS than at her local Kaiser clinic. Different states have different laws about which vaccines can and can’t be delivered at pharmacies—but if someone could go get an HPV vaccine at the same place they get their flu vaccine, presumably it would lead to an uptick.

I see you studied molecular biology as an undergrad at the University of Wisconsin–Madison. Did you always want to work on vaccines?
No, absolutely not. When I first started out I was an academic purist and thought you should study knowledge for its own sake. I was fascinated by molecular biology. When I first heard about the way metabolism works in bacteria, plants and humans, that just wowed me because that was a common feature of all life. I just wanted to study that. I thought people who did translational work were sort of selling out to the man—this was in the 1970s. I didn’t get interested in vaccines until much later. Now, I’m very fascinated with translational research.

So, what changed?
It was a very gradual thing. To this day we still do basic research, and it’s still intrinsically valuable to do basic research because you don’t know when it will lead to a transformational breakthrough.

What led you to work on HPV?
When I had just joined the field, suddenly there was this discovery that made papilloma viruses important for human health as opposed to just an understanding of how cells become cancerous. I had joined Doug Lowy’s lab at the National Cancer Institute as a postdoc back in 1983, and the second lecture I went to there was by Harald zur Hausen—who later won the Nobel Prize—and his lecture was saying “eureka! We found a virus that seems to cause 50 percent of cervical cancers”—and that virus turned out to be a human papilloma virus strain, HPV-16. So basically we went from looking at a model about how a normal cell transforms to become carcinogenic to something probably involved in causing human cancer. It was somewhat serendipitous.

What are you working on now?
One thing we are doing at the NCI, and cosponsored by the Bill & Melinda Gates Foundation, is testing if one dose of HPV vaccine is enough to provide long-term protection. It would be transformative, especially in the developing country setting, if you could just have one dose at a younger age. This new trial is going to be done in Costa Rica in collaboration with the Costa Rican government. That’s the site where we had done a prior pilot trial that suggested one dose may be enough.

We are also looking into cancer immunotherapy work. It turns out that these virus-like particles that we work with for the HPV vaccine—these are typically the outer shell of a virus, like from the HPV-16 strain or other animal, or human papilloma virus particles—have a unique ability to infect tumor cells and bind to them specifically. So we are using that knowledge to develop cancer therapies that are broad-spectrum. It turns out these cancers, like melanoma, do bind these particles, specifically.

One other thing we are doing is trying to develop vaccines that would treat herpes simplex infections and HPV infections in the female genital tract. Again, this would take advantage of these virus-like particles’ structures.

Last year I interviewed Michael Sofia, who won a Lasker Award for his hepatitis C vaccine work. The name of that vaccine, sofosbuvir—brand name Sovaldi—is a nod to his last name. But the National Institutes of Health (NIH) do a lot of early-stage research, and then it’s passed off to private companies that develop it further. Your name isn’t part of the HPV vaccines Gardasil or Cervarix, for example. Is it frustrating doing a lot of that behind-the-scenes work?
It’s funny because I would never have thought of that. It would have never entered my mind to name a vaccine after ourselves. We are so used to doing this translational work. My job is to move a project along so it’s interesting enough for a company to invest hundreds of millions of dollars for the benefit of large numbers of people. NIH doesn’t have the money to do phase III trials for lots of drugs, and even if they did it wouldn’t lead to all the drugs we need—because NIH wouldn’t have the money to develop them. This translational and basic research is what NIH does best. That work is way too fraught with failure for companies to do it all. It has to be done in the public sector, and then when things look more promising companies can take it over.

What advice would you offer someone considering becoming a scientist now?

It’s got to be a passion because being a scientist—especially early in your career—is more a lifestyle than occupation. You have to really want to do it, because there is a lot of uncertainty—especially about running your own lab and getting funding. Success and failure can be on a knife’s edge sometimes. The other thing is that you need to be strategic about thinking of what you want to go into, and that’s hard for young people because they don’t have the perspective: There are some fields just opening up ripe for discoveries. And there are some areas that are very mature, that we have been working on for a long time, where there are a lot of scientists working already—so the chances of making a big impact are lower. From my own life, this is like when we started with human papilloma viruses. When I went into this field, we had just been given the tools to study them and so it seemed like a great opportunity to get involved. In some ways it’s best if you can pick an emerging field with new tools to answer big questions. But you have to pick something you are really interested in and go with it.

The other thing I’d say is read a lot. Now with PubMed and access to all these journals there is no excuse for not knowing the background in something that basically has already been done. Young people tend to want to get out and do experiments, but a few days searching PubMed may save someone years of work trying to reinvent the wheel.

Right now, what would you say is the biggest challenge—or one of the biggest challenges—that needs to be solved?
That’s a really tough one. I think as scientists we are all sort of locked into the things we study. I could say cancer, obviously. But Alzheimer’s is something we obviously need to solve. HIV infection. All these different things. One of the things that really needs to be solved in terms of the whole scientific enterprise now is stable funding. Right now we are in a situation where there are too many good scientists—especially young scientists—competing for a limited pot of money. So you lose some good people because there’s not enough money to go around. Also, people are forced to do relatively mundane things that are really a methodological extension of something they’ve done before instead of something truly transformative that would have a large chance of failure. Grant reviewers are looking at something likely to succeed and move the field incrementally, or something transformative that may have a high chance of failure, and have to make those decisions. This is an issue across the sciences. The obvious solution would be to have more funding, but then that raises the question about how to do that. And I’m not a politician.

What, if anything, does this Lasker Award do for your work?
Quite honestly, probably nothing, because one of the nice things about being part of intramural research [at NIH] is that I have stable funding. I’ve had six people in my lab for the last 25 years, so this won’t lead to more grants or me doubling the size of my lab, or anything like that. I’m happy with my moderate-sized lab and collaborations with a lot of great people. That’s why I’m here. Every four years we have a site visit, which is a retrospective review of “what have you done for us lately,” and if it’s reasonable I will continue to get funding. So the award won’t affect my research career much at all.

Right now, some in the scientific community fear amid this political climate that facts matter less than they once did and thus science matters less. What’s your take on that?
Obviously, my perspective is science matters a lot. I really can’t comment on what’s happening in the country overall—and whether this is something that is pervasive where science is really held in less esteem, or it’s that there is a vocal minority being heard a lot now. I would hope it’s the latter.

September, 2017|Oral Cancer News|

HPV-related oral cancers have risen significantly in Canada

Source: www.ctvnews.ca
Author: Sheryl Ubelacker, The Canadian Press

The proportion of oral cancers caused by the human papillomavirus has risen significantly in Canada, say researchers, who suggest the infection is now behind an estimated three-quarters of all such malignancies. In a cross-Canada study, published Monday in the Canadian Medical Association Journal, the researchers found the incidence of HPV-related oropharyngeal cancers increased by about 50 per cent between 2000 and 2012.

“It’s a snapshot of looking at the disease burden and the time trend to see how the speed of the increase of this disease (is changing),” said co-author Sophie Huang, a research radiation therapist at Princess Margaret Cancer Centre in Toronto.

Researchers looked at data from specialized cancer centres in British Columbia, Alberta, Ontario and Nova Scotia to determine rates of HPV-related tumours among 3,643 patients aged 18 years or older who had been diagnosed with squamous cell oropharyngeal cancer between 2000 and 2012.

HPV is the most common sexually transmitted infection worldwide. Most people never develop symptoms and the infection resolves on its own within about two years.

“In 2000, the proportion of throat cancer caused by HPV was estimated at 47 per cent,” said Huang. “But in 2012, the proportion became 74 per cent … about a 50 per cent increase.”

Statistics from a Canadian Cancer Society report last fall showed 1,335 Canadians were diagnosed in 2012 with HPV-related oropharyngeal cancer and 372 died from the disease.

HPV is the most common sexually transmitted infection worldwide. Most people never develop symptoms and the infection resolves on its own within about two years. But in some people, the infection can persist, leading to cervical cancer in women, penile cancer in men and oropharyngeal cancer in both sexes.

Most cases of HPV-related oral cancer are linked to oral sex, said Huang, noting that about 85 per cent of the cases in the CMAJ study were men.

HPV-related tumours respond better to treatment and have a higher survival rate than those linked to tobacco and alcohol use, the other major cause of oral cancer, she said, adding that early identification of a tumour’s cause is important to ensure appropriate and effective treatment.

While some centres in Canada routinely test oral tumours to determine their HPV status, such testing is not consistent across the country, the researchers say.

In the past, physicians generally tended to reserve tumour testing for cases most likely to be caused by HPV – among them younger males with no history of smoking and with light alcohol consumption – to prevent an unnecessary burden on pathology labs.

“Only as accumulating data have supported the clinical importance of HPV testing has routine testing been implemented in most (though not all) Canadian centres,” the researchers write.

The study showed that the proportion of new HPV-related oral cancers rose as those caused by non-HPV-related tumours fell between 2000 and 2012 – likely the result of steadily declining smoking rates.

Huang said males tend to have a weaker immune response to HPV than do females, which may in part explain the higher incidence of oral cancers linked to the virus in men.

HPV vaccines given to young people before they become sexually active can prevent infection – and the researchers say both boys and girls should be inoculated.

Currently, six provinces provide HPV immunization to Grade 6 boys as well as girls, with the other four provinces set to add males to vaccination programs this fall, said Huang.

“So vaccinating boys is very important because, if you look at Canadian Cancer Society statistics (for 2012), HPV- related oropharyngeal cancer in total numbers has already surpassed cervical cancers,” she said.
“The increase of HPV-related cancer is real, and it’s striking that there’s no sign of a slowdown.”

August, 2017|Oral Cancer News|

Thirty-second oral cancer test could save your life

Source: savannahnow.com
Author: Angela C. Canfield, DDS

Every 60 minutes, a person dies from oral cancer. The disease is typically associated with long-term tobacco use, but it is becoming more frequent in young adults who have never smoked.

According to the National Cancer Institute, 40 percent of those diagnosed with oral cancers will die within five years.

Besides tobacco use, the risk factors that could lead to oral cancer include DNA abnormalities or family history. But the main cause of oral cancers, especially in young adults who don’t smoke, is the human papillomavirus (HPV), which may be spread by sexually active people through intimate or even close contact.

HPV is the leading cause of cervical cancer, which used to be the leading cause of cancer deaths for women in the United States. Now that more women routinely get PAP tests that provide early detection of conditions that could lead to cervical cancer, those cancer rates are on the decline. In fact, these days, a person is three times more likely to die from oral cancer than cervical cancer.

According to the National Cancer Institute, 40 percent of those diagnosed with oral cancers will die within five years. While the disease has few, if any, early symptoms, early detection can make a dramatic difference, increasing survival rates to as much as 90 percent. Now, a routine test that takes only 30 seconds is available to provide that early detection and even offer prevention from the disease itself.

The test is basically a minty mouthwash or saline solution administered by a dentist or other oral health care provider. You swish and gargle and spit it back into the test cup. It’s that simple.

Oral cancer signs

While easily administered, this genetic test has a complex function, looking for oral cancer risk on a molecular level in three ways:

• Cell abnormalities. Changes to your cells could mean a precancerous condition or infection exists.

• HPV. This virus can lead to some cases of oral cancer, or clear up on its own. In either case, I monitor and test my patients more frequently, especially if an infection tends to linger.

• DNA damage. People with certain DNA damage seem to be at a higher risk for oral cancer. These abnormalities don’t mean you have oral cancer or that you are destined to get it, but more frequent monitoring is usually necessary, just to be safe.

While not always present, possible signs of oral cancer could include a mouth sore that bleeds easily and does not heal within two weeks, a lump or thickening in the oral soft tissues, soreness or a feeling that something is caught in the throat, difficulty chewing or swallowing, ear pain, difficulty moving the jaw or tongue, hoarseness, or numbness of the tongue. Some signs of oral cancer might also easily be mistaken for a toothache or a cold.

I recommend to my patients aged 18 and older that they be tested annually for oral cancer. Results can vary from negative to being high risk or positive. For patients who test positive for precancerous cells, I usually suggest a follow-up visit with an ear, nose and throat specialist, depending on the levels found. I will continue to monitor high-risk patients and administer follow-up tests as needed.

Please talk with your oral health care provider about your risk factors and the advantages of oral cancer screening.

Angela Canfield, DDS, is licensed by the Georgia Board of Dentistry and the National Board of Dentists.

Novel vaccine therapy can generate immune responses in patients with HPV-related head and neck cancer

Source: www.news-medical.net
Author: staff

A novel vaccine therapy can generate immune responses in patients with head and neck squamous cell carcinoma (HNSCCa), according to researchers at the Abramson Cancer Center of the University of Pennsylvania. The treatment specifically targets human papillomavirus (HPV), which is frequently associated with HNSCCa, to trigger the immune response. Researchers will present the results of their pilot study during the 2017 American Society of Clinical Oncology Annual Meeting in Chicago (Abstract #6073).

HNSCCa is a cancer that develops in the mucous membranes of the mouth, and throat. While smoking and tobacco use are known causes, the number of cases related to HPV infection – a sexually transmitted infection that is so common, the Centers for Disease Control says almost all sexually active adults will contract it at some point in their lifetimes – is on the rise. The CDC now estimates 70 percent of all throat cancers in the United States are HPV-related. Sixty percent are caused by the subtype known as HPV 16/18.

“This is the subtype we target with this new therapy, and we’re the only site in the country to demonstrate immune activation with this DNA based immunotherapeutic vaccine for HPV 16/18 associated head and neck cancer,” said the study’s lead author Charu Aggarwal, MD, MPH, an assistant professor of Hematology Oncology in the Perelman School of Medicine at the University of Pennsylvania.

The vaccine is delivered as an injection of antigens – which leads the immune system to start producing antibodies and activate immune cells. At the time of injection, physicians use a special device to deliver a pulse of electricity to the area, which stimulates the muscles and speeds the intake of the antigens. Aggarwal noted that this study represents a multidisciplinary approach involving the lab and the clinic.

“This is truly bench-to-bedside and shows the value of translational medicine within an academic medical center,” Aggarwal said.

Penn researchers treated 22 patients with the vaccine. All of the patients had already received therapy that was intended to be curative – either surgery or chemotherapy and radiation. When doctors followed up an average of 16 months later, 18 of those patients showed elevated T cell activity that was specific to HPV 16/18. All of the patients in the study are still alive, and none reported any serious side effects.

“The data show the therapy is targeted and specific, but also safe and well-tolerated,” Aggarwal said.

Because of the positive activity, Aggarwal says the next step is to try this therapy in patients with metastatic disease. A multi-site trial will open soon that combines the vaccine with PD-L1 inhibitors, which target a protein that weakens the body’s immune response by suppressing T-cell production.

More patients presenting with HPV-associated oral cancers in Lubbock, TX

Source: lubbockonline.com
Author: Ellysa Harris

Detecting oral cancers in patients in their 50s and 60s has never been uncommon. But local dentists and doctors say finding it in younger patient populations has become a new norm.

Oral cancers driven by Human Papillomavirus are now the fastest growing oral and oropharyngeal cancers, according to the Oral Cancer Foundation website. And local health officials say they’ve seen a few more cases than usual.

Dr. Joehassin Cordero, FACS, professor, chairman and program director ofTexas Tech’s Health Sciences Center Department of Otolaryngology-Head & Neck Surgery, said less people are smoking and that has contributed to the decrease in the number of cases of oral cancers in the past two decades.

“In that same period, we have seen an increase in the HPV oropharyngeal cancer,” he said. “And oropharyngeal cancer — what it means it’s affecting the base of your tongue and tonsils.”

Dr. Brian Herring, a Lubbock dentist, chalks the increase up to increased awareness.

“I’m assuming probably for years and years and years it has affected the mouth but we didn’t know that,” he said. “As we get better at cellular diagnostics and molecular diagnostics, things like that, we’re finding that there is a large portion of cancers that do have an HPV component.”

What’s more alarming, said Dr. Ryan Higley, oral surgeon with West Texas Oral Facial Surgery, is it’s being diagnosed in younger people.

Higley said oral cancers are generally diagnosed between the ages of 55 and 65, mostly in women.

“With HPV-associated cancers, we see those four to 10 years before that,” he said. “It’s a younger patient population.”

Cordero said the oral cancers are often caused by exposure to HPV from years before.It starts with exposure to the HPV infection. One in four people in the United States are currently infected, according to the Centers for Disease Control and Prevention website.

“It’s truly considered a sexually transmitted disease,” Cordero said. “It has to do with not so much kissing, but oral sex.”

It’s passed on when somebody with an active lesion engages in sexual activities with another person, he said.

Nine out of 10 infections will disappear on their own, according to the CDC, but infections that linger for longer than about two years can lead to cancer.

“That doesn’t mean they’ll have cancer next week,” Cordero said.

Researchers are still trying to figure out why and how long after HPV exposure it takes for cancer to develop, he said.

“We don’t know the true mechanism because most of these people were not exposed a year ago,” he said. “They were not exposed six months ago. They were exposed a long time before that.”

When it does present, he said, there generally aren’t any noticeable symptoms.Because of that, it’s often diagnosed in later stages, Herring said.

“What we’re finding is because the demographic is changing, they’re not getting diagnosed as early because they’re not expecting to have this problem,” he said.

Screenings for oral HPV exist.

“The gold standard examination is your typical dental exam,” Herring said. If your dentist detects something unusual that might need further examination, he or she will make a referral to an oral surgeon.

Higley said oral HPV cancer presents as a lesion that looks like a kanker that won’t heal.

“However, cancerous lesions can have multiple presentations so that’s not exclusive,” he said. “So oftentimes, we’ll have a patient present with a hard nodule underneath their jaw line or in their neck. Sometimes they’ll just have red or white lesions within the mouth, hoarseness in their voice or difficulty swallowing. All those are things that need to be checked.”

The cancer seems to be more treatable, he said, but it’s hard to pinpoint why.

“We really don’t know if they’re more responsive to treatment because we’re treating a little bit younger patient population who is overall more healthy or if it’s inherant in the tumor itself,” Higley said.

Cordero said he hopes the HPV vaccine, which is recommended for both girls and boys 11 or 12 years old and people up to 26 years old, provides a measure of protection against the infection.

“We’re hoping in the next 10 to 20 years that head and neck cancer caused by HPV will be completely gone,” he said.

American Dental Association and The University of Texas MD Anderson Cancer Center announce collaboration

Source: www.prnewswire.com
Author: press release

The American Dental Association (ADA) and The University of Texas MD Anderson Cancer Center today announced a joint effort to improve patient outcomes through programs aimed at dental and medical professionals and the public to increase human papillomavirus (HPV) vaccinations and tobacco cessation for oral cancer prevention.

“ADA member dentists promise to put patients first, and as a profession we look for innovative ways to treat and prevent disease, and promote wellness,” said ADA President Gary Roberts, D.D.S. “Together with MD Anderson, one of the most respected cancer centers in the world, we are excited to pioneer new programs to help our patients live healthy and disease-free lives.”

Both organizations agree that increasing the percentage of children and young adults vaccinated for HPV is critical to improving their health and reducing risk of several related cancers, including those of the oropharynx (the part of the throat just behind the mouth which includes the back third of the tongue; the back part of the roof of the mouth, also known as the soft palate; the tonsils, and the side and back wall of the throat). In addition, programs aimed at preventing children and young adults from starting to smoke while encouraging current smokers to quit are another key component of the collaboration.

“MD Anderson is pleased to partner with the ADA to develop innovative educational programs that will increase awareness about the prevention and early detection of oral cancers,” said Marshall E. Hicks, M.D., president ad interim, MD Anderson. “Tobacco use and HPV infection remain the leading causes of oral cancers. Through this collaboration, we have a significant opportunity to inform care providers and the public about the associated risks, and we can make a difference in the fight to end cancer.”

According to the American Cancer Society, an estimated 50,000 cancers of the oral cavity and pharynx will be diagnosed this year in the U.S., and rates in men are more than twice as high as in women. These cancers are often not diagnosed until late stages, when treatment is less effective.

Tobacco use remains the leading preventable cause of cancers in the U.S., responsible for roughly one-third of all cases. HPV infections are responsible for approximately 70 percent of all oropharyngeal cancers, about 9,000 annually, as well as the majority of cervical, anal and genital cancers. HPV-related oropharyngeal cancers are four times more common in men than women, and the incidence rate of these cancers has risen significantly in recent years.

About the American Dental Association
The not-for-profit ADA is the nation’s largest dental association, representing more than 161,000 dentist members. The premier source of oral health information, the ADA has advocated for the public’s health and promoted the art and science of dentistry since 1859. The ADA’s state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA’s flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit ADA.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA’s consumer website MouthHealthy.org.

About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. The institution’s sole mission is to end cancer for patients and their families around the world. MD Anderson is one of only 47 comprehensive cancer centers designated by the National Cancer Institute (NCI). MD Anderson is ranked No.1 for cancer care in U.S. News & World Report’s “Best Hospitals” survey. It has ranked as one of the nation’s top two hospitals since the survey began in 1990, and has ranked first for nine of the past 10 years. MD Anderson receives a cancer center support grant from the NCI of the National Institutes of Health (P30 CA016672).

HPV vaccine; cancer prevention

Source: www.nujournal.com
Author: staff

Human papillomavirus (HPV) is a sexually transmitted infection, of several strains, most associated with cervical cancers. The virus is so common that nearly all males and females have been infected at some time in their life. One in four is currently infected in the nation.

Signs and symptoms of HPV are variable. Most will recover from the virus within two years without ever knowing they were infected, making HPV easy to spread. Occasionally, the virus lasts much longer in the body which can cause cells to change and lead to cancer. Fortunately, we have a vaccine to prevent cancer caused by HPV.

The Food and Drug Administration (FDA) has approved three vaccines for HPV; Cervarix, Gardasil, and Gardasil 9. These vaccines are tested and proven to be safe and effective.

Prevention is important with HPV. The vaccine should be administered before exposure to the virus for stronger protection against cervical, vaginal, vulvar, penile, and some mouth or throat cancers. (Gardasil and Gardasil 9 also prevent genital warts and anal cancer.) The best age to obtain maximum potential of the vaccine is at 11 or 12 years old. At this age, the body’s immune system is the most receptive to the vaccination’s virus-like particles and the body produces higher amounts of antibodies in defense, protecting the adolescent for his or her future. Both girls and boys should get the HPV vaccine. For ages 9-14, two doses – six to twelve months apart, are recommended. For 15-26 year olds, three doses are recommended. Side effects may include brief soreness, or redness or swelling at the injection site.

The HPV vaccine does prevent cancer, limiting biopsies and invasive procedures thus cutting potential health care costs. Most private insurance companies cover preventive vaccinations, it is best to call your carrier for more information. The HPV vaccine is covered by Minnesota Health Plans. Uninsured individuals may be eligible to get the vaccine at their local public health office.

Schedule your adolescent’s annual health exam today and ask which HPV vaccine is best for the child in your life.

“Every year in the United States, HPV causes 30,700 cancers in men and women. HPV vaccination can prevent most of the cancers (about 28,000) from occurring.” (CDC, December, 2016)

Learn more at www.cdc.gov/hpv or www.cancer.gov

April, 2017|Oral Cancer News|

Beating HPV-positive throat cancer

Source: www.huffingtonpost.com
Author: Pamela Tom, Contributor

National Oral, Head, and Neck Cancer Awareness Week is April 12-18, 2017

For at least two years, 47 year-old Rob Clinton of Rochester, NY, would choke on post nasal drip in the shower. He knew something was wrong in his throat but he didn’t feel any pain.

Did he have cancer? Clinton smoked cigarettes for 30 years and worked in an auto body shop where he was regularly exposed to carcinogens, but he wasn’t experiencing the typical symptoms of throat cancer. These include hoarseness or a change in the voice, difficulty swallowing, a persistent sore throat, ear pain, a lump in the neck, cough, breathing problems, and unexplained weight loss.

In November 2015, Clinton went to the dentist to have his teeth cleaned. His dentist felt Clinton’s swollen neck and recommended that he visit a medical doctor. Clinton heeded the advice and sought the opinion of an ear, nose, and throat specialist at Strong Memorial Hospital in Rochester, NY.

The ENT doctor sent Clinton to have a CAT scan and when he scoped Clinton’s throat, the doctor said, “I see something in there.”

What he saw was a tumor and there were a few other things going on too.

The Diagnosis
The biopsy showed that Clinton had Stage IVa oral squamous cell carcinoma (OSCC) at the base of his tongue—and the cancer was HPV positive. HPV stands for the human papillomavirus and a recent survey found that more than 42% of Americans are infected with HPV. While most people’s bodies naturally clear HPV after two years, some people’s immune systems do not recognize the virus and consequently, HPV can harbor in the body for decades. HPV-related throat cancer has been linked to oral sex.

The Treatment
On December 4, 2015, Clinton underwent neck dissection surgery at Roswell Park Cancer Institute in Buffalo, NY. Dr. Hassan Arshad, a head and neck cancer surgeon, removed 30 lymph nodes; two had cancer and one tumor was the size of a golf ball. One lymph node on the other side of neck and a tongue tumor would be treated with radiation.

The first of 35 radiation treatments began one month later in conjunction with Cisplatin chemotherapy infusions. That’s seven weeks of simultaneous radiation and chemo.

“I drove myself to treatment for the first five weeks. Up until the last week of treatment, it wasn’t too terrible,” Clinton says. “But then I started getting tired and my mother took me to the cancer center.”

Clinton had decided not to get a feeding tube prior to or during treatment and as the radiation and chemo attacked his cancer, he began to lose weight. The treatment reduced Clinton’s appetite because foods began to taste different. For two weeks, he also felt a burning sensation in his mouth and says his saliva tasted like hot sauce.

“It was excruciating and the worst thing I dealt with during treatment.”

Furthermore when radiation makes the throat feel tender and raw, it becomes nearly impossible to eat normally through the mouth.

Clinton was 215 pounds before treatment. After treatment, he weighed in at a mere 165 pounds. A loss of 50 pounds. In hindsight, Clinton wishes he had the feeding tube inserted while he was still strong.

“Don’t be afraid of the treatment. It’s manageable and you can get through it. I recommend a feeding tube because it’s a comfort knowing you have an option,” says Clinton.

The Recovery
While it took a month for Clinton to recover from the initial surgery, doctors say it takes at least a year for HPV+ throat cancer patients to find their “new normal”—regaining strength, adapting to lingering side effects.

Following chemo, Clinton experienced “chemo brain” or “chemo fog,” known as a cognitive impairment that can occur after chemotherapy. The patient may experience memory loss or dysfunction, and have difficulty concentrating or multi-tasking.

The radiation also took its toll on Clinton. He researched and found a salve made of calendula flowers, olive oil, beeswax, and Vitamin E oil to soothe his parched skin. Trying to gain weight was a bigger challenge. First, his taste went “totally upside down” and spicy foods were intolerable.

“A vanilla cookie tasted like black pepper,” Clinton says. “Only frozen peas and parsley tasted normal.”

And dry mouth is a common result of the radiation treatment. While both sides of Clinton’s neck received radiation, he had less saliva production on his left side. At night he would have to wake up every 40 minutes to drink water. Clinton must make certain not to become dehydrated because it causes the dry mouth to worsen. Now he chews gum almost non-stop.

In his search to combat dry mouth, Clinton says he researched solutions online and found ALTENS, or acupuncture-like transcutaneous electrical nerve stimulation. A study led by Dr. Raimond Wong, an associate professor of oncology at McMaster University in Ontario, Canada, found evidence that ALTENS may reduce patient-reported xerostomia, the medical term for dry mouth.

Clinton joined Dr. Wong’s clinical trial to determine whether ALTENS for six weeks/four days a week would be as effective as treatment for 12 weeks/two times a week.

“Four days a week, the researchers put pads on the inside of my ankles, the outside of my knee, back of my hands, between my thumb and forefingers, and between my chin and bottom lip,” says Clinton.

Clinton says ALTENS felt like little shocks and the acupuncture-like stimulation improved his saliva production by 80 percent. “Even after I stopped ALTENS, my saliva kept improving,” says Clinton.

The Survivor
Two years after cancer treatment, regular PET scans show that Rob Clinton has no evidence of cancer. In fact, the prognosis for HPV-related throat cancer is 85 to 90 percent positive if caught early. In contrast, patients who battle advanced throat cancer caused by excessive smoking and alcohol have a five-year survival rate of 25 to 40 percent.

Dr. Arshad, Clinton’s surgeon at the Roswell Park Cancer Institute, explained why.

“The majority of tonsil and tongue base (“throat”) cancers are HPV-positive, but smoking is still a major risk factor. Typically, non-smoking patients with HPV-positive tonsil/tongue base cancers present with a lump in the neck, implying that the cancer has already spread to lymph nodes. This used to mean that the patient would have a reduced chance of long-term survival,” Arshad says. “We now know that for nonsmokers who have HPV-positive cancers, metastasis to lymph nodes doesn’t carry the same poor prognosis. The newest staging system reflects that change, i.e. Some of those patients who were previously classified as stage IV are now at stage II if the cancer is HPV-positive.”

Clinton is not only faring well physically, surviving cancer changed his outlook and lifestyle.

“My life is pretty much back to normal. I get a little nervous each time I get a PET scan but so far, it shows I am free of cancer,” Clinton says. “I have a better appreciation of things. I live healthy in terms of diet and recreation. I don’t smoke or drink heavily.”

The Future of HPV+ Oropharyngeal Cancer
De-stigmatizing HPV is a key component to building public awareness and acceptance of HPV infection, and the ability to recognize the early symptoms of HPV-related throat cancer. As more and more people are diagnosed with HPV-related throat cancer, the social stigma surrounding the virus is a disturbing deterrent because HPV cancer patients are often reticent to disclose the HPV connection.

In a 2015 public service announcement, actor Michael Douglas who was treated HPV+ base of tongue cancer called for oral screenings but never said “HPV” by name. “A very common virus, one responsible for the vast majority of cervical cancers is now identified as the cause of this rapid rise in oral cancers,” said Douglas.

In the early years of the AIDS crisis, people associated infection with illness, fear, and death. It took a decade to generate a movement and begin to change the public sentiment. Now after continual education, AIDS is accepted and the focus centers on hope instead of ostracization.

Clinton hopes more people will accept that HPV infection is common—the most common sexually-transmitted infection in the U.S., according to the CDC. The American Society of Clinical Oncologists also found that by 2020, the annual number of HPV-related oropharyngeal in nonsmoking, middle-aged men will surpass the number of cervical cancer cases.

“HPV is not a shameful thing. It’s very common. It’s just that some people can’t clear the virus from their bodies,” Clinton says. “This type of cancer is the next epidemic. I feel fortunate every day that I came through it as well as I did.”

April, 2017|Oral Cancer News|

More than 1 In 5 Americans have a potentially cancer-causing HPV infection

Source: www.huffingtonpost.com
Author: Erin Schumaker

More than 42 percent of adults in the United States are infected with human papillomavirus ― and nearly 23 percent are infected with a high-risk strand of the virus that can cause cancer, according to a report published by the National Center for Health Statistics on Thursday.

“We tend to overlook the fact that 20 percent of us are carrying the virus that can cause cancer (indluding oral cancer – OCF news editor),” Geraldine McQuillan, lead author of the report and an epidemiologist at the U.S. Centers for Disease Control and Prevention, told The Washington Post.

“People really need to realize that this is a serious concern.”

The report, which examined U.S. adults ages 18 to 59, marks the first time the CDC has recorded HPV rates in men as well as women. There is no FDA-approved HPV test for men, but the CDC developed its own test for the research. “We did penile swabs which we tested for HPV DNA,” McQuillan told The Huffington Post.

HPV is the most common sexually transmitted disease in the country, and nearly every sexually active American will be exposed to it by their early 20s. Although 90 percent of HPV infections clear the body within two years, that’s not always the case. High-risk strains are linked to cervix, vaginal, penile, anus and throat cancers, as well as genital warts.

In fact, two high-risk strains, HPV-16 and -18, cause nearly all cervical cancer cases.

Not all Americans have the same risk of contracting high-risk HPV. Asian-Americans had the lowest HPV rate (12 percent), followed by whites and Hispanics (22 percent). Black Americans had the highest HPV prevalence (34 percent), according to the report. Overall, men were more likely to have high-risk genital HPV than women.

The best defense against HPV is getting the HPV vaccine before being exposed to the virus. The CDC strongly recommends the HPV vaccine as a cancer-prevention method for boys and girls starting at age 11, before they are exposed to the virus through sex.

“I commonly hear parents thinking that it’s better to wait until their children are sexually active before immunizing,” Dr. Dean Blumberg, associate professor and chief of pediatric infectious diseases at UC Davis Children’s Hospital, previously told The Huffington Post.

“Younger children have a more robust immune response to HPV vaccine compared to older children and young adults,” Blumberg said. “Specifically, children 9 to 15 years of age develop higher antibody levels after the vaccine series compared to 16- to 26-year-olds.”

While there’s no treatment for HPV itself (just for some symptoms, such as genital warts), routine Pap smears can catch cancer caused by the virus in its early stages. People with HPV should also use a condom to avoid passing the disease to a partner.

The CDC recommends cervical cancer screening for women ages 21 and older. The FDA approved an HPV test for women in 2003, but only 39 percent of clinicians ordered the test during a study of five Michigan health clinics from January 2008 to April 2011.

April, 2017|Oral Cancer News|