National Cancer Institute

The Oral Cancer Foundation Helps Sponsor HPV/Oral Cancer Study

Source: Jada.org

An increase in the incidence and survival of oropharyngeal cancer in the United States since 1984 can be attributed to the human papilloma-virus (HPV) infection, say researchers in an article published online Oct. 3 in Journal of Clinical Oncology.

The results of previous studies have shown that oropharyngeal cancers can be divided into two separate diseases with distinct causes: HPV-negative cancers, which are associated with tobacco and alcohol use; and HPV-positive cancers, which are linked to certain types of HPV, a sexually transmitted virus.

Patients with HPV-positive oropharyngeal cancer tend to be younger than and to have better survival rates than patients with HPV-negative cancer.

To determine HPV infection’s role, researchers led by Anil K. Chaturvedi, PhD, National Cancer Institute, National Institutes of Health, Bethesda, Md., tested for HPV infection 271 archived samples of cancerous oropharyngeal tissue collected between 1984 and 2004 at three population-based cancer registries located in Hawaii, Iowa and Los Angeles in the National Cancer Institute’s Surveillance, Epidemiology and End Results Residual Tissue Repositories Program. By using a variety of molecular assays, researchers found that the proportion of oropharyngeal cancers that were HPV-positive—particularly among men—increased over time, from 16.3 percent for cancers diagnosed from 1984 to 1989 to 72.7 percent for cancers diagnosed from 2000 to 2004. They also found that the incidence of HPV-negative oropharyngeal cancers declined by 50 percent between 1988 and 2004, likely due to declines in smoking and tobacco use.

According to senior author Maura Gillison, MD, PhD, a professor of medicine at The Ohio State University Comprehensive Cancer Center in Columbus, the study’s results suggest that if these trends continue, HPV-positive oropharyngeal cancer will become the major form of head and neck cancer and the leading HPV-associated cancer in the United States by 2020, surpassing cervical cancer.

“These increases may reflect increases in sexual behavior, including increases in oral sex,” said Dr. Gillison. She noted that approximately 90 to 95 percent of HPV-positive oropharyngeal cancers were caused by one HPV type—HPV16, which is targeted by vaccines for cervical cancer.

“With HPV vaccines, we have a great opportunity to potentially prevent oropharynx cancers in future generations, including in boys and men, but studies need to be done to evaluate the efficacy of HPV vaccines in preventing oral HPV infections,” Dr. Gillison said.

This study was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health; The James Comprehensive Cancer Center; The Ohio State University; and the Oral Cancer Foundation.

Systems Strategies To Support Cancer Screening in U.S. Primary Care Practice

Cancer Epidemiol Biomarkers Prev. 2011 Oct 5

Yabroff R, Zapka JM, Klabunde C, Yuan G, Buckman D, Haggstrom D,  Clauser S, Miller JW, Taplin S.

Source

Division of Cancer Control and Population Sciences, National Cancer  Institute.

Abstract

BACKGROUND:

Although systems strategies are effective in improving health care  delivery, little is known about their use for cancer screening in U.S. primary care practice.

METHODS:

We assessed primary care physicians’ (n=2475) use of systems strategies for breast, cervical and colorectal cancer (CRC) screening  in a national survey conducted in 2007. Systems strategies included patient and physician screening reminders, performance reports of screening rates, electronic medical records, implementation of  in-practice guidelines, and use of nurse practitioners/physician assistants. We evaluated use of both patient and physician screening reminders with other strategies in separate models by screening type, adjusted for the effects of physician and practice characteristics with multivariate logistic regression.

RESULTS:

Fewer than 10% of physicians used a comprehensive set of systems strategies to support cancer screening; use was greater for mammography and Pap testing than for CRC screening. In adjusted analyses, performance reports of cancer screening rates, medical record type, and in-practice guidelines were associated with use of both patient and physician screening reminders for mammography, Pap testing, and CRC screening (p<0.05).

CONCLUSION:

Despite evidence supporting use of systems strategies in primary care, few physicians report using a comprehensive set of strategies to support cancer screening. Impact: Current health policy initiatives underscore the importance of increased implementation of systems strategies in primary care to improve the use and quality of cancer screening in the U.S.

October, 2011|Oral Cancer News|

New Study on Tonsillar Squamous Cell Carcinoma

Source: SAGE Journals Online

Objective. To analyze outcomes in patients with squamous cell carcinoma (SCCA) of the tonsil from the years 1998 to 2006. To assess factors that may affect disease-specific survival, such as patient characteristics and/or treatment modality.

Study Design and Setting. National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program.

Subjects and Methods. The SEER database was used to perform a population-based cohort analysis for patients diagnosed with SCCA of the tonsil from 1998 to 2006. Disease-specific survival was correlated with sex, age, ethnicity, year of diagnosis, and treatment modality in a univariate Cox proportional hazards analysis and a multiple Cox-regression model with and without interaction effect.

Results. Applied inclusion criteria resulted in 8378 patients. Of this patient cohort, 80% were male and 85% were white. The mean patient age at diagnosis was 58.1 years. On univariate and multivariate analyses, ethnicities other than white carried a significantly higher rate of disease-specific death (hazard ratio = 1.71, P < .001). Each additional year of age at the time of diagnosis carried approximately a 4% increase in likelihood of disease-specific death. With each passing year of time at diagnosis, patients carried a decreased risk of disease-specific death (P < .001); this value was significant in all 3 statistical models. Patients who underwent external-beam radiation had a higher likelihood of disease-specific survival with each passing year at time of diagnosis. Conclusion. Population analysis based on the SEER database reveals increased disease-specific survival from tonsillar SCCA in more recent years. This may be because of earlier diagnosis, an increase in less aggressive subtypes of SCCA, and more effective treatment modalities. This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

August, 2011|Oral Cancer News|

HPV Vaccine- Should it be Available for Boys?

Source: Dr.Bicuspid.com

July 14, 2011 — With the alarming rise in the rate of oropharyngeal cancer among men being linked to the human papillomavirus (HPV), the U.S. Centers for Disease Control and Prevention (CDC) is considering whether to also recommend the HPV vaccine for boys.

Two vaccines (Cervarix and Gardasil) are currently available to protect females against the HPV types that cause most cervical cancers. The CDC currently recommends both for 11- and 12-year-old girls and for females 13 through 26 years old who did not get the three recommended doses when they were younger.

The number of HPV-related oral cancers cases among men in the U.S. is increasing so quickly they could surpass the number of cases of cervical cancers in women by 2020, according to research presented last month at the American Society of Clinical Oncology annual meeting in Chicago.

Between 1984 and 1989, only 16% of oropharyngeal cancers were linked to HPV. But by 2000-2004, HPV was related to 75% of oropharyngeal cancers, according to the National Cancer Institute (NCI). In 2010, the institute estimated that there were 12,660 cases of oropharyngeal cancer, resulting in 2,410 deaths. About half of those cases were among males and at least 75% were caused by HPV, according to NCI researchers.

Several studies and oral cancer specialists have attributed the sharp rise in HPV-positive oropharyngeal cancers to an increasing prevalence of oral sex among young people.

For the past few years, the CDC’s Advisory Committee on Immunization Practices (ACIP) has been mulling whether to recommend the HPV vaccine for boys, as is now suggested for girls and young women to prevent cervical cancer.

At the ACIP’s June meeting in Atlanta, the panel again discussed the issue, including the cost-effectiveness for male vaccination. The 15-member group did not vote on the matter, but it is expected to do so when it meets again in October.

More research needed?

While some panel members think the vaccine should be recommended for boys now, others say more definitive research is needed first.

HPV cancers in males account for 7,000 cases a year, according to ACIP member Mark H. Sawyer, MD, a professor of pediatrics and an infectious disease specialist at the University of California, San Diego. He agrees with some oral cancer specialists who feel that the vaccine should be given to boys now, given the alarming rise in HPV-related oral cancers among males.

“I think it’s reasonable to recommend the vaccine for boys,” Dr. Sawyer told DrBicuspid.com. “Giving them the vaccine before they become sexually active makes sense. Children and parents could get used to the idea that you go in and get a series of vaccines for adolescents.”

Dr. Sawyer said there was a “mixed point of view” during last month’s meeting regarding recommending the vaccine for boys.

CDC researcher Eileen Dunne, MD, MPH, told DrBicuspid.com that most members of the ACIP’s HPV working group favor routine vaccination of all males when they become sexually active.

Dong Moon Shin, MD, a professor of hematology and medical oncology at the Winship Cancer Center of Emory University in Atlanta, agrees that the time has come to vaccinate both boys and girls for HPV.

“This vaccination should be given to young boys and girls before they become sexually active,” he told DrBicuspid.com. “I think it is critically important to prevent HPV infections, which can develop into cancer.”

The prevalence of oropharyngeal cancer has significantly increased annually during the last decade, Dr. Shin noted.

“We have learned that it is clearly associated with the HPV virus, particularly types 16 and 18, which is exactly the same virus that causes cervical cancer among women,” he noted.

However, while HPV infection is now quite common, it rarely develops into cancer, Dr. Shin added.

“We still don’t know what causes the virus infection to transform to cancer, so therefore we believe multiple molecular mechanisms should be studied,” he said. “We need more study, but we don’t need to wait that long to understand the carcinogenesis process, and the vaccine should be given as more studies are done.”

Benefits vs. side effects

Aimee Kreimer, PhD, an expert in head and neck cancer at the National Cancer Institute who gave a presentation at the ACIP meeting, says more research is needed before routine HPV vaccinations are given to young people. While the proportion of HPV-positive oropharyngeal cancer is increasing, the overall numbers are still rare relative to other cancers such as breast and prostate cancers, she noted.

“When considering the vaccine, we can’t just think about the number of cases attributed to the HPV virus because, in fact, direct evidence that the vaccine will work to prevent these cancers is lacking,” Kreimer told DrBicuspid.com. “This is a very safe vaccine, but when you start to vaccinate millions of people, it is important to balance the benefit of the cancer prevention with possible side effects of the vaccine.”

While Kreimer prefers to see evidence of the vaccine’s efficacy, she is cautiously hopeful about its prophylactic value.

“If the vaccine were given to men, I would be optimistic that it would reduce the rates of oropharyngeal cancer, but I still like to base decisions on hard data,” she noted. “We want to be sure the balance tips the scales toward societal benefit in terms of cancer prevention.”

Sol Silverman Jr., DDS, a professor of oral medicine in the University of California, San Francisco School of Dentistry, concurs with Kreimer’s assessment that more research is needed before the HPV vaccine is recommended for boys as well as girls.

“It’s not evidence-based, but it’s obvious that boys who are HPV-negative, if they were vaccinated, probably in the long run it would, to some degree, reduce the risk of transmission of the virus,” he said in a recent interview with DrBicuspid.com. “When you have these public health issues that have personal priorities, they’re expensive and you have to have pretty good evidence that it’s going to be helpful.”

Can HPV Vaccine Prevent Oral Cancer?

Source: WebMD.com

June 23, 2011 — Can HPV vaccines stop the explosive rise of HPV-related head and neck cancer?

HPV (human papillomavirus) vaccines protect against the sexually transmitted strains of HPV that cause cervical cancer. The same HPV strains — spread by kissing and by oral sex — cause oropharyngeal (OP) cancer, the form of head and neck cancer that affects the back and sides of the throat, the base of the tongue, and the tonsils.

There’s strong evidence that HPV vaccines prevent cervical cancer. There’s no direct proof that these vaccines prevent throat cancer, but the rapid rise in cases among young people has some experts wanting to vaccinate first and get proof later.

“We don’t need to wait until all these molecular events are understood,” Dong Moon Shin, MD, of Emory University’s Winship Cancer Center, tells WebMD. “The time is now. For the HPV vaccine, cost is the only issue as side effects are minimal. Routine HPV vaccination has to be implemented very soon, for both boys and girls.”

In the U.S., that recommendation is made by the Advisory Committee on Immunization Practices (ACIP). The ACIP now recommends routine HPV vaccination only for girls and young women in order to prevent cervical cancer. It permits vaccination of boys who want protection against HPV-caused genital warts.

For two years, the ACIP has been mulling whether to recommend the HPV vaccine for boys. This would help prevent cervical cancer in unvaccinated women. It also would prevent HPV-related anal cancer and genital warts in both men and women, as well as HPV-related cancer of the penis.

But HPV causes anal cancer and penile cancer far less often than it causes cervical cancer, and if enough girls were to get the HPV vaccine — about 50% — it wouldn’t be cost-effective to vaccinate boys.

Throat cancer is rapidly changing this scenario.
Throat Cancer Tipping Scales Toward HPV Vaccination of Boys

At yesterday’s meeting, the ACIP heard a disturbing report from Aimee Kreimer, PhD, an expert in head and neck cancer at the National Cancer Institute.

“At some point … it is projected that there will be the same incidence of OP cancer in men as cervical cancer in women,” Kreimer said. “If current trends continue, OP cancer in men will pass cervical cancer in 2025.”

And HPV is to blame. Only a few decades ago, the major risk factors for throat cancer were smoking and alcohol. Not any more. In the five-year period of 1984-1989, only 16% of OP cancers were linked to HPV. By 2000-2004, HPV was behind 75% of OP cancers.

What are the risk factors? Not all are known, but HPV-related throat cancer risk goes up with increased oral sex and kissing, Kreimer said. Current tobacco use and HIV infection also are risks.

Fortunately, oral HPV infection appears to be much less common than genital HPV infection. Among healthy individuals infected with HPV, fewer than one in 20 has detectable HPV in the oral cavity.

But there are disturbing trends. Husbands of women with cervical cancer have a threefold higher risk of tonsil cancer. And people who have anal cancer have a fourfold to sixfold higher risk of tonsil cancer.

These findings are tipping the ACIP in favor of recommending routine HPV vaccination for boys.

“Most members of the [ACIP] HPV working group favor the strategy of routine vaccination of all males at the age at which they get the most benefit,” Eileen Dunne, MD, MPH, a CDC researcher assisting the working group, said in a presentation to the full ACIP.

But the ACIP did not vote on the issue at the June meeting. Some members of the panel expressed frustration with the process.

“HPV cancers in males account for 7,000 cases a year,” said ACIP member Mark H. Sawyer, MD, professor of pediatrics at the University of California, San Diego. “That is not a trivial number, and we are sitting around here wondering whether to immunize them. But it is not a trivial question.”

The National Cancer Institute estimated that in 2010, there were 12,660 cases of OP cancer — and 2,410 deaths. About half of those cases would have been male; at least three-fourths would have been caused by HPV.

The full ACIP likely will vote on the issue at its October meeting.

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

HPV related oral cancers continue to increase in the US

Source: International Medicine News

CHICAGO – Human papillomavirus infection was firmly linked to the recent rise in oropharyngeal cancers in the United States, based on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program.

If current trends continue, the incidence of HPV-related oral cancers will soon surpass that of cervical cancers, senior author Dr. Maura Gillison reported at the annual meeting of the American Society of Clinical Oncology.

The incidence of HPV-positive oropharyngeal cancers increased 225% – from 0.8 per 100,000 to 2.8 per 100,000 – between 1988 and 2004, the researchers found. At the same time, the incidence rate for HPV-negative oropharyngeal cancers, which are strongly related to tobacco and alcohol use, declined by 50% – from 2.0 per 100,000 to 1.0 per 100,000.

Consequently, the overall incidence of oropharyngeal cancers increased 28%.

Even by the conservative estimate that 70% of oropharyngeal cancers in 2020 will be HPV positive, the annual number of HPV-positive oral squamous cell carcinomas (8,653 cases) is expected to surpass cervical cancers (7,726 cases). Further, the majority will occur among men (7,426 cases), said Dr. Gillison, a medical oncologist and the Jeg Coughlin Chair in Cancer Research at Ohio State University Comprehensive Cancer Center in Columbus.

Changes in sexual behavior among recent birth cohorts and increased oral HPV exposure probably influenced the increases in incidence and prevalence, Dr. Gillison speculated. Having a high lifetime number of sexual partners is a known risk factor for HPV infection.

Although the rise in oral cancers in the United States has been attributed to HPV infection, the empirical evidence to back the contention was uncovered prior to the SEER study. A previous study by Dr. Gillison and her colleagues helped to establish that HPV infection causes an epidemiologically and clinically different form of oral cancer. Their findings documented a major increase in the incidence of HPV-related oral cancers in the United States, particularly among young, white men, and that survival rates are significantly higher in patients with HPV-related oral cancers than in those with HPV-negative cancers (J. Clin. Oncol. 2008;26:612-9).

The evidence surrounding HPV-related oral cancers has been mounting, “but I don’t think there is a lot of awareness in the general medical community,” Dr. Gillison said in an interview. Most of her head-and-neck cancer patients who are nonsmokers were referred to her after undergoing months of antibiotic therapy for presumed tonsillitis.

Screening the sexual partners of oropharyngeal cancer patients has been discussed, but there is no evidence to support the practice. The risk for oral cancer is fourfold higher in HPV-positive patients’ partners, but the absolute risk is low, Dr. Gillison said. Alternatively, there are now three or four case reports of husband-wife couples with HPV16-positive tonsillar cancer.

“Probably 80% of people have HPV exposures in their life and 99.1% clear the infections without consequence,” she said. “So, whatever [stable sexual partners] have swapped in terms of infection, they’ve already swapped. Just because they suddenly found that one of them got cancer from it doesn’t mean the other one will.”

The researchers called for more studies to evaluate the efficacy of HPV vaccines in preventing oral HPV infections.

Dr. Gillison worked for 3 years with Merck & Co., the maker of the HPV vaccine Gardasil, and commented that Merck will not likely pursue this indication. Merck was interested in studying the vaccine in prevention of oral cancers but saw the endeavor as too much of an uphill battle in part because oral cancers are not readily accessible visibly or through biopsy. Merck instead successfully opted to seek approval for the prevention of anal cancers, an indication that was approved in December 2010 for male and females 9-26 years old.

It was already approved in the same age groups for the prevention of cervical, vulvar, and vaginal cancer and of genital warts caused by HPV types 6, 11, 16, and 18 in females and for the prevention of genital warts caused by HPV types 6 and 11 in males.

Invited discussant Dr. Lisa Licitra of Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, said that oral cancers are on the rise in Europe in both men and women and that a vaccine should be pursued. Data on oropharyngeal cancer from her institute did not find a greater contribution from men.

“A preventive vaccine is worth considering,” she said. “In particular, when we consider the European data, I think that in this direction, action should be taken.”

In their study, Dr. Gillison and her colleagues used four different assays to determine the HPV status for 271 oropharyngeal cancer cases collected from 1984 to 2004 by three population-based cancer registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results program in Hawaii, Iowa, and Los Angeles. Trends in HPV prevalence across four calendar periods were estimated using logistic regression.

The HPV prevalence in oropharyngeal cancer significantly increased across the time period, regardless of the assay used, and remained statistically significant, even after correcting for potential loss in assay sensitivity, Dr. Gillison reported. Genotyping with the Inno-LiPA assay appeared to be the most precise, detecting more than a fourfold increase in HPV prevalence from 16.3% in 1984-1989 to 72.7% in 2000-2004.

Median survival was significantly better for patients with HPV-positive cancer at 131 months vs. 20 months for HPV-negative patients (log rank P value less than .001). HPV-positive cases on all assays had a significant reduction in hazard of death compared with HPV-negative cases after adjustment for age, sex, race, registry, calendar period, stage, surgery, chemotherapy, and radiotherapy.

Survival of HPV-positive cases increased over the study period but remained unchanged for HPV-negative cases. Consequently, survival of all oropharyngeal cancer cases improved over time, according to the results of the study, which was led by Dr. Amil Chaturvedi, an investigator with the division of cancer epidemiology and genetics at the National Cancer Institute, Rockville, Md.

Dr. Gillison and Dr. Chaturvedi reported no conflicts of interest. A coauthor disclosed consultancy, research funding, and honoraria from Merck.

View on The News

‘Massive Increase’ Seen

The study demonstrates the massive increase taking place in the United States in HPV-related oropharyngeal cancer, and that this really will be the major form of head and neck cancer in the next decade.

The findings also support previous work from Sweden, although the two studies are not mirror images.

These are the kind of data that we need to inform the National Cancer Institute and the Centers for Disease Control and Prevention that more research support is needed to identify risks for this disease, to develop therapeutic vaccines, and to understand the immunity and carcinogenesis of this disease.

This disease really deserves research funding, because it is curable today with tools that are available and have not been effectively applied.

Dr. Marshall Posner is director of head and neck medical oncology and the office of cancer clinical trials at the Tisch Cancer Institute, Mount Sinai School of Medicine, New York. He made these comments in an interview and has no relevant financial conflicts of interest.

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

Low-Dose Sorafenib may Boost Treatment for Head and Neck Cancer

Source:
Darrell E. Ward
Ohio State University Medical Center

Adding low doses of the targeted agent sorafenib to the chemotherapy and radiation now often used to treat head and neck cancer might significantly improve patient care and quality of life, according to a new study by researchers at the Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

The findings suggest that adding sorafenib would maintain treatment efficacy while permitting the use of lower doses of chemotherapy and radiation and decreasing the treatment’s harsh side effects. The triple combination was well-tolerated in an animal model.

About 49,200 new cases of head and neck cancer are expected in the U.S. this year, and 11,500 people are expected to die of the disease. Treatment is often unsuccessful because the tumors become resistant to both chemotherapy and radiation therapy.

“This pre-clinical study suggests that using low-dose sorafenib along with chemotherapy and radiation could have significantly milder side effects while maintaining effectiveness,” says researcher and principal investigator Dr. Pawan Kumar, assistant professor of otolaryngology and a neck surgeon at the OSUCCC – James.

“Our findings provide a scientific rationale to evaluate this combination strategy through a clinical trial,” Kumar added.

The results of the laboratory and animal study are published online in the journal Molecular Cancer Therapeutics, and they include the following:

  • Sorafenib sensitized tumor cells to chemotherapy and radiation treatment by down-regulating DNA repair proteins (ERCC-1 and XRCC-1), and it decreased tumor angiogenesis by inhibiting VEGF-mediated signaling.
  • The combination treatment was well tolerated in a mouse model and significantly inhibited tumor growth and tumor angiogenesis; low-dose sorafenib alone was an effective maintenance regimen.
  • The combination treatment significantly inhibited tumor-cell migration, invasion and the formation of new tumor blood vessels in laboratory studies.

“Taken together, our results suggest a potentially novel strategy in which sorafenib combined with low doses of chemotherapy, radiation therapy, or both is as effective in the treatment of head and neck cancer as much higher doses used in existing treatment approaches,” says study co-author Dr. Theodoros N. Teknos, professor of otolaryngology, director of head and neck oncologic surgery, and the David E. and Carole H. Schuller Chair in Head and Neck Oncologic Surgery. “As a result, it may be possible to design new treatment regimens that limit side effects of therapy without decreasing cure rates.”

Funding from the National Cancer Institute and Joan’s Fund supported this research.

Other Ohio State researchers involved in this study were Arti Yadav and Bhavna Kumar.

 

Spouses of Head/Neck Cancer Patients More Inclined to PTSD

Source: MedScape Today

Partners of patients with newly diagnosed head and neck cancer are significantly more likely to meet research criteria for post-traumatic stress disorder (PTSD) than patients themselves, according to a study presented here at the Society of Behavioral Medicine 32nd Annual Meeting and Scientific Sessions.

Donna Posluszny, PhD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and colleagues from there and from the University of Texas, Arlington, Texas, found that 8 of 20 partners of patients with head and neck cancer (20%) had a mean score on the PTSD Checklist (also known as the PCL) of 50 or higher, compared with only 2 of 40 patients (5%). Patients who score at least 50 on the PCL meet the criteria for PTSD.

“This is not a formal diagnosis of PTSD but for research purposes, a score of 50 or higher is meaningful,” Dr. Posluszny told delegates. “And we were very surprised to find that partners of patients with newly diagnosed head and neck cancer experience greater amounts of traumatic stress than patients themselves do.”

For the study, investigators recruited 40 dyads (2 individuals regarded as a pair) where the partner was considered to be a “romantic” partner. Some 78% of the patients were male, while most partners were female; all but a small minority were married.

Almost all were white, and, as a cohort, they were somewhat better educated and made more money than the majority of patients with head and neck cancer.

Sixty-five percent of them also had stage IV head and neck cancer, she added. At the time of assessment, 43% had undergone surgery; 7% surgery plus radiation; 15% surgery plus chemoradiation; and 35% chemoradiation. Patients had been diagnosed with cancer anywhere from the larynx on up, but none had distant metastases.

On the 17-item PCL, questions elicited whether patients or their partners were experiencing traumatic stress symptoms, whether patients or their partners found their own or their partner’s diagnosis of cancer life-threatening, and whose fault the cancer might be.

Cancer Stage Not a Factor

“You would think that the presence of traumatic symptoms would be higher or at least as high in patients as in partners, but we found that partners reported more traumatic stress symptoms than patients, with a mean score of 35.9 for partners vs a mean score of 29.9 for patients, which was significant,” Dr. Posluszny said. PCL scores were also higher among partners who perceived the diagnosis as a threat and who blamed tobacco and alcohol use as its cause.

In contrast, cancer stage did not predict PCL scores for patients or their partners. As Dr. Posluszny noted, it might be logical to think that because the majority of partners were women, women might be simply more susceptible to stress.

“But there were actually no gender differences [behind this],” she observed. In fact, male patients and male partners had similar PCL scores (in the 30s) but female patients had lower scores than male patients, “so for some reason, female patients were doing better,” she said.

Patients and partners did agree on both how life-threatening their disease was, whose fault it was, and whether the cancer was due to tobacco and alcohol use.

Asked why partners of patients with head and neck cancer might be more distressed than the patient themselves, Dr. Posluszny told Medscape Medical News that the researchers really didn’t know.

“It’s not gender,” she said, “but maybe it’s because the partner needs to keep up with whatever the home situation is; maybe they need to keep working to keep the insurance, and on top of it, they are thinking, maybe I am going to lose my partner. So there are all sorts of things that could be affecting the partner. We just haven’t tapped into what exactly it is yet.”

Caregiver Burden?

Commenting on the study, session co-chair John Salsman, PhD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, told Medscape Medical News that investigators analyzed “reported distress” and a lot of males do not report high levels of distress, even if they are highly distressed.

Nevertheless, he also pointed out that when the National Cancer Institute developed their definition of a cancer survivor, “it’s not just the individual patient but the family entity, the partners and the caregivers, that we have to think about.” This study is therefore important, he added, because it looked at the psychosocial adjustment not only a patient has to make when newly diagnosed with head and neck cancer but partner adaptation to the diagnosis as well.

“The greater level of distress seen in partners of patients with head and neck cancer may also reflect the fact that partners are susceptible to caregiver burden, especially as the disease progresses or treatment continues. Inevitability, there is the challenge of additional symptoms and the level of support that partners are required to give to patients may be compromised,” Dr. Salsman said.

 

Oral Cancer…what does sex have to do with it?

Source: DentistryIQ.com

The answer is … plenty! This issue will focus on oral cancer awareness. While there are many topics we can delve into regarding this dreadful disease, we will focus on a few topics.

We will share two personal and very poignant stories. Kim Anzalotti, Bill Wislon, and Eva Grayzel impart information that will move you and make you think about your daily in-office procedures. JoAnn Gurenlian, RDH, PhD, will share insights on the human papillomavirus, or HPV, a sexually transmitted virus, and its relationship to oral cancer. And last, but certainly not least, Jamie O’Day, Treatment Facilities Coordinator, The Oral Cancer Foundation Inc., The Bruce Paltrow Oral Cancer Fund, will share her insight on oral cancer screening and the need for a thorough examination.

One personal story is shared by Eva Grazel, an international motivational speaker, author, performer, and cancer survivor. I had the pleasure of meeting Eva a number of years ago. In 1998 at age 33, Eva, a non-smoker, saw a number of dentists and physicians for over two years for an “ulcer” on her tongue that became larger and more painful, without any resolution. She was finally diagnosed with advanced oral cancer, Stage IV squamous cell carcinoma, on the lateral border of her tongue.

After the many missed opportunities for diagnosis, Eva was given a 15% chance of survival. While her late stage diagnosis is not uncommon, her recovery was unique, as she beat the odds. After diagnosis, Eva underwent a partial tongue reconstruction, a modified radical neck dissection, and a maximum dose of radiation therapy. The good news is that Eva is very much alive today, and helps to motivate professionals and patients about oral cancer examinations and risk factors. She also authored the Talk4Hope book series, written to inspire children and parents who have a family member with cancer.This Family Book Series helps families cope with their feelings about cancer, enlightens parents on how to communicate with their children, and creates special moments to cherish. Read Eva’s contribution in this eVillage FOCUS issue.

For the 12th year in a row, April was the official oral cancer awareness month in the U.S. Oral cancer awareness means raising public awareness through group collaboration to ensure that oral cancers get the national media attention necessary to highlight risk factors and oral cancer screening. Free oral cancer screenings were held throughout the country. But it does not have to be a special month to conduct oral cancer screenings in the community. There are a variety of forms for editable press releases for events. Conduct your community activity when it is convenient for you.

Rates of oral cancer are on the rise among men, and researchers say the cause is not the use of tobacco and alcohol, risk factors we have been aware of for years. The number of smokers in the U.S. has steadily declined in the past 50 years, according to the CDC, yet the rate of oral cancer has remained relatively steady, and has recently been on the increase. The culprit is the human papillomavirus, or HPV, the sexually transmitted virus responsible for the majority of cases of cervical cancer in women. Approximately 65 percent of oral cancer tumors were linked to HPV in 2007, according to the National Cancer Institute.

The profile of these new cases of oral cancer is non-smokers who are predominantly white, upper middle class, college-educated men. HPV-16, the strain of the virus that causes cervical cancer in women, has become the leading cause of oral cancer in non-smoking men. Oral HPV infection was strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use in this case-controlled study. An even greater than-additive risk has been reported, although inconsistently, for patients exposed to both HPV and tobacco and those exposed to both HPV and alcohol.

A University of North Carolina (UNC) study found the incidence of oral tongue cancer increasing in young, white females, even though overall, incidence of oral cavity squamous cell carcinoma (OCSCC) was decreasing for all ages. The increasing incidence was most dramatic for white females ages 18 to 44. They had a percentage change of 111 percent.

Interestingly, the incidence decreased for African American and other racial groups. They analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and oral tongue squamous cell carcinoma (OTSCC).

 

There is an enormous effort to vaccinate girls and women between the ages of 11 and 26 against HPV, and according to experts, should have included boys and men from the beginning. Gardasil (Merck), one of the two major vaccines used to prevent HPV infection, wasn’t approved for use in males in the United States until 2009, three years after it was approved for women. Men have a greater chance of contracting the HPV virus from oral sex than women do from the same behavior, though researchers are not clear on the reason for this phenomenon. For CDC information on HPV vaccines, visit their website.

 

The other vaccine is Cervarix (GlaxoSmithKline). According to the CDC, both vaccines are very safe, and are made with very small parts of the human papillomavirus (HPV) that cannot cause infection. As with any pharmaceuticals, there can be side effects. For a recently updated Q & A page on these vaccines, visit the CDC website.

In girls and young women ages 9 to 26, Gardasil® helps protect against two types of HPV that cause about 75% of cervical cancer cases, and two more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, Gardasil helps protect against 90% of genital warts cases. Gardasil also helps protect girls and young women ages 9 to 26 against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

While the vaccines available are not approved for prevention of oral cancer, the impact the vaccines may have on oral cancer should be considered. The Oral Cancer Foundation believes that elimination of a causative agent (HPV16), by preventing infection from it by use of a vaccine, will subsequently prevent any disease that agent may have produced in the protected individual. This is simple scientific extrapolation, and a view shared by many in the science community. Makes sense to me!

Oral cancer has a low survival rate because it is generally not discovered until it has spread to other areas, according to the CDC. Only half of people who’ve been diagnosed with oral cancer will live longer than five years. Prevention is the name of the game. Do not use tobacco products, use alcohol in moderation, limit the number of sexual partners and use protection, and screen (or be screened) annually for oral cancer. Anyone old enough to have engaged in sexual behaviors which are capable of transferring the HPV needs to be screened annually for oral cancer. There are many cancer screening protocols available. Education, prevention, screening and early intervention can save lives.

 

Oral sex is a major risk factor for oral cancer in men

Source: AOL News

Rates of oral cancer are on the rise among men, and researchers say the culprit isn’t the devil you might think.

The rising rates of oral cancer aren’t being caused by tobacco, experts say, but by HPV, the same sexually transmitted virus responsible for the vast majority of cases of cervical cancer in women.

Millions of women and girls have been vaccinated against HPV, or human papillomavirus, but doctors now say men exposed to the STD during oral sex are at risk as well and may have higher chances of developing oral cancer.

Dental hygiene student Audrey Rayniak gives an oral cancer screening to Kevin Smith at a free dental clinic on September 11, 2009 in Brighton, Colorado.

John Moore, Getty Images
About 65 percent of oral cancer tumors were linked to HPV in 2007, according to the National Cancer Institute. And the uptick isn’t occurring among tobacco smokers. “We’re looking at non-smokers who are predominantly white, upper middle class, college-educated men,” Brian Hill, the executive director of the Oral Cancer Foundation, told AOL News by phone.

Tobacco use has declined over the past decade, but rates of HPV infections have risen and affect at least 50 percent of the sexually active American population, according to the Centers for Disease Control.

HPV-16, the strain of the virus that causes cervical cancer in women, has become the leading cause of oral cancer in non-smoking men, Hill said, citing research in the New England Journal of Medicine.

“When the No. 1 cause of your disease goes down [tobacco use], you would expect that the incidence of disease would go down, but that hasn’t happened,” he said. “In our world, this is an epidemic.”

Dr. Jennifer Grandis, the vice chairwoman for research at the University of Pittsburgh and an expert on head and neck cancers, said doctors have been seeing the HPV virus in most oral cancer tumors. She said the massive push to vaccinate girls and women between the ages of 11 and 26 against HPV should have included boys and men from the beginning. Gardasil, one of the two major vaccines used to prevent HPV, wasn’t approved for use in males in the United States until 2009, three years after it was approved for women.

An oral cancer screening is given at a free dental clinic in Brighton, Colo. The incidence of the disease is increasing among men who are exposed to the sexually transmitted virus HPV during oral sex.

“The thinking is changing,” Grandis told AOL News in a phone interview. “But at the time [the vaccine] was licensed, there wasn’t such an awareness about head or oral cancers or a willingness to accept that males played a part in the transmission of the virus,” she said. “I think this idea that we only protect our daughters with the vaccine is nuts anyway, particularly because they’re having sex with our boys.”

Men have a greater chance of contracting the HPV virus from oral sex than women do from the same behavior, though researchers aren’t exactly sure why. Oral cancer has a low survival rate because it is generally not discovered until it has spread to other areas, according to the CDC. Only half of people who’ve been diagnosed with oral cancer will live longer than five years.