oropharyngeal cancer

Study finds Oral HPV Infection Lasts Longer in Older Men

Author: Staff
Source: winnipegfreepress.com
 

FRIDAY, Jan. 9, 2015 (HealthDay News) — One type of oral HPV (human papillomavirus) infection, HPV16, seems to last a year or longer in men over the age of 45 than it does in younger men, new research indicates.

HPV16 is the form of HPV often associated with the onset of head and neck cancers (oropharyngeal), the study team noted.

“Oral HPV16 is the HPV type most commonly found in HPV-driven oropharyngeal cancers, which have been increasing in incidence recently in the United States,” said study author Christine Pierce Campbell in a American Association for Cancer Research news release. She is an assistant member in the department of Cancer Epidemiology and Center for Infection Research in Cancer at the Moffitt Cancer Center in Tampa, Fla.

“We don’t know how long oral HPV infection must persist to increase risk for head and neck cancer,” she added, “but we assume it would be similar to cervical infection, where it is generally believed that infections persisting beyond two years greatly increase the risk of developing cervical cancer.”

The study was released online on Jan. 9 in Cancer Prevention Research.

The researchers analyzed four years of samples from more than 1,600 men. The samples were collected every six months.

During the study, 23 men had two or more positive oral HPV16 samples. Of these, 10 had HPV16 when the study began.

In the group that had HPV16 at the start of the study, nine had infections that lasted a year or more. Additionally, the researchers found that eight of these infections lasted two years or more, and two lasted four years or more, the researchers found.

In those who developed infections during the study, the team found that infections in men older than 45 all lasted one year or more. By contrast, just half the infections among men 31 to 44 years persisted for one year or longer. And none of the infections detected among men 18 to 31 years lasted for a year, according to the researchers.

“Our results show that some oral HPV16 infections persist in men for four years or more and that persistence seemed to increase with age,” Pierce Campbell said.

She also noted that genital HPV infections usually clear up in two years or less. This study’s findings suggest that oral infections may be more persistent than genital HPV.

More information

For more information on oral HPV, visit the The Oral Cancer Foundation.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
January, 2015|Oral Cancer News|

Doctors Trying To Remind Americans That The HPV Vaccine Isn’t All About Sex

Source: thinkprogress.org
Author: Tara Culp-Ressler

 

Dr. Ronald A. DePinho is on a mission.

 
DePinho, who’s been a cancer researcher for decades and currently serves as the president of the University of Texas MD Anderson Cancer Center, wants to reframe the national conversation about the HPV vaccine to drive home a fundamental point.

 
“It’s important to appreciate that this is a cancer vaccine. A cancer vaccine!” DePinho said in an interview with ThinkProgress. “It’s a dream come true that we’ve converted knowledge into something that can actually save lives and avoid getting cancer in the first place. It’s really what we have been hoping for, and now we have it.”
Since the introduction of the HPV vaccine in 2006, the rate of human papillomavirus in teenage girls has plummeted. And the research in this field continues to advance. On Thursday, the Food and Drug Administration approved an updated version of the Gardasil vaccine that protects against nine strains of the cancer-causing virus — more than twice as many as the 2006 version, which covered just four strains.

 
According to DePinho, that’s a really significant advance for cancer care. He doesn’t want it to get lost in the ongoing controversy about HPV vaccination, a round of shots that some parents still worry is unsafe or inappropriate for their kids.
There’s a persistent myth, for instance, that giving teen girls the shots will spur them to become more “promiscuous” because they know they’ll be protected from a sexually transmitted infection. Large scientific studies have debunked the notion that there’s any link between the HPV vaccine and sexual activity, but inoculation rates still lag behind in some of the Southern states that are wary to provide teens with preventative tools to protect their sexual health.
In general, HPV vaccination rates in the U.S. are still much too low, hovering around 30 percent. Public health professionals are aiming to increase those rates dramatically, to at least 80 percent — closer to the percentage of people who get vaccinated against the virus in other developed countries.

 
To accomplish that, the health professionals who have dedicated their lives to treating HPV-related cancers want to move the conversation away from sexuality altogether. Instead of framing Gardasil as vaccine that protects against an STD — which might give some Americans the impression that they don’t need to worry about it — they want to present it as a vaccine that protects against cancer.

 
“It doesn’t seem like it makes sense to see it in terms of a vaccine for a sexually transmitted disease necessarily,” Dr. Erich Sturgis, an expert in head and throat cancer who works as the program director for the MD Anderson Oropharynx Program, said in an interview with ThinkProgress. “Most of us will have an HPV infection at some point in our lifetime and we’ll never know it.”
Nearly all sexually active Americans get HPV at some point in their lives, according to the Centers for Disease Control and Prevention. An estimated 80 percent of people are infected at some point, and most never realize it because the infection resolves itself on its own. But certain strains of the virus go on to cause cervical, vulvar, anal, penile, and oropharyngeal cancers.

 
Without the HPV vaccine, men in particular are put at risk of developing neck and throat cancers. Unlike cervical cancers, which can be detected with regular Pap smears, there’s no way to screen men.

 

Sturgis treats mostly middle aged male patients, and he estimated that about 60 percent of the cancers he deals with are caused by HPV. He said it’s important to increase the rates of vaccination among both girls and boys because it will be another 30 to 40 years before today’s kids hit the point when these type of throat cancers may start displaying themselves.
“To let your kids potentially suffer later in life is just a tragedy. That’s really the message here,” he said.

 
Both cancer doctors are optimistic that once more parents are educated about what’s at stake, they’ll start vaccinating their kids at higher rates. There’s a big information gap — one recent study found that 70 percent of U.S. adults didn’t realize the HPV vaccine has any connection to cancer whatsoever — that they believe can be corrected with more investment from primary care doctors who are on the front lines of recommending the shots.

 
“It’s really about empowering parents and health care professionals, and making them recognize that this is a childcare responsibility and a priority for all of us,” DePinho said. “It begins with interviews like this and just having the media getting this information out there.”

 
“Doctors are probably not as good at messaging to the public as we could be. We need some help,” Sturgis agreed.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
December, 2014|Oral Cancer News|

Immune-related gene may predispose to HPV-related cancer

Source: bcm.edu
Author: Julia Parsons
 

An international coalition of cancer specialists led by a researcher now at Baylor College of Medicine has identified an immune related gene called transforming growth factor beta receptor 1 (TGFBR1) that appears to play an important role in determining whether a person develops a cancer related to human papilloma virus (HPV). HPV is, in particular, associated with anal cancer and cancers of the cervix, and the head and neck.

Their findings appear in the journal Cancer Research.

Until recently, head and neck cancer has been found primarily in smokers, but there has been a rise in HPV-associated head and neck cancer in nonsmokers. The head and neck cancer most-associated with HPV is oropharyngeal cancer, involving the tonsils and base of the tongue.

HPV is also one of the most common sexually transmitted diseases, with certain strains known to cause head and neck and/or cervical cancer.

The National Cancer Institute predicts that HPV-positive oropharyngeal cancer will likely surpass cervical cancer as the most common HPV-associated cancer in the United States by 2020.

“The real mystery is that in western countries, pretty much everyone is exposed to HPV but only a small number of people get HPV-related cancers,” said Dr. Andrew Sikora, vice-chair for research in the Department of Otolaryngology Head and Neck Surgery at Baylor. “We are trying to figure out what makes the people who actually get the cancer different from those who don’t, given that so many people are exposed.”

Using data collected as part of a genome-wide association study of head and neck cancer performed by the INHANCE consortium, the researchers were able to associate alterations in a number of immune-related genes with oropharyngeal cancer. One of these genes, TGFBR1, was found to be deregulated in patients with both oropharyngeal and cervical cancer.

“The fact that we were able to independently replicate our findings in two-different HPV-related cancers is exciting because it suggests that we have found something that is critical to the biology of how HPV causes cancer,” said Sikora, also co-director of the head and neck cancer program in the NCI-designated Dan L. Duncan Cancer Center Baylor.

“We hope to learn more about this gene and how it affects cancer,” Sikora added. “In the future we hope to develop a tool to identify who is more susceptible to HPV-related cancers.”

Sikora conducted the study while on faculty at the Icahn School of Medicine at Mount Sinai in New York prior to joining the Baylor faculty in July 2014. Co-author, Paolo Boffetta, director of the Institute for Translational Epidemiology at ISMMS was one of the investigators for the original INHANCE study.

Others who took part in this study include:  Chaya Levovitz; John Finnigan; Sara Alshawish; Marshal R. Posner; Weija Zhang; Eric E. Schadt; Eric M. Genden and Paolo Bofetta; The Icahn School of Medicine at Mount Sinai in New York; Dan Chen and Emma Ivansson of Uppsala University, Uppsala, Sweden.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
October, 2014|Oral Cancer News|

Oscar Award winning composer Ryuichi Sakamoto is diagnosed with Throat Cancer

Author: Jun Hongo
Source: blogs.wsj.com/japanrealtime
 

World-renowned Japanese musician and composer Ryuichi Sakamoto says he has throat cancer and has canceled his scheduled shows and activities.

The Oscar-winning composer and anti-nuclear activist said Thursday that he was diagnosed with oropharyngeal cancer at the end of June.

“After much thought and consideration, I have decided to take time off of work in order to concentrate on treating it,” the 62-year-old said in a statement. “I promise to return after a full recovery.”

According to his management agency Avex Music Creative Inc., Mr. Sakamoto will step down as one of the directors of the Sapporo International Art Festival 2014, scheduled to start next week. He will also cancel live shows including a performance at Park Hyatt Tokyo on July 30.

Avex Music Creative said there is no time frame set for Mr. Sakamoto’s return, and that the artist will “dedicate all his time to treatment.” The agency declined to offer details on the current stage of Mr. Sakamoto’s cancer.

The pioneering musician debuted as a member of Yellow Magic Orchestra in 1978, playing a role in the emergence of electro pop and providing inspiration for a generation of electronic music and hip-hop producers. His creativity and prowess as a keyboard player, producer and composer extends to a large swath of genres and styles from pop rock to bossa nova. He won an Academy Award for composing the score music for Bernardo Bertolucci’s 1987 film “The Last Emperor,” a movie he also appeared in as an actor.

Among international honors bestowed on Mr. Sakamoto, he was named an Officier of the Ordre des Arts et des Lettres from the French government in 2009.

In addition to his work in music, producing and acting, Mr. Sakamoto has been one of the most vocal activists against nuclear power following the Great East Japan Earthquake in 2011.

He has also been a leading figure in recent moves to prevent outdated legislation being used to stop people dancing at nightclubs in Japan.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
July, 2014|Oral Cancer News|

High-Risk HPV Prevalent in Oropharyngeal Cancers

Author: Roxanne Nelson
Source: medscape.com
 

A larger percentage of oropharyngeal cancers might be related to human papillomavirus (HPV) than previously thought. The Centers for Disease Control and Prevention (CDC) reports that in a large sample of invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% were positive for high-risk HPV types 16 and 18, which are covered by the 2 commercially available vaccines (Gardasil, Merck & Co.;Cervarix, GlaxoSmithKline).

On the basis of these data, the CDC researchers suggest that vaccines could prevent most oropharyngeal cancers in the United States.

The vaccines are marketed mainly for the prevention of cervical cancer, but there is hope, and some evidence, that the vaccines might also protect against oropharyngeal cancer. For example, last year, the Costa Rica HPV Vaccine Trial found that the Cervarix vaccine reduced oral HPV infections in women by more than 90%.

However, the effect of the vaccines could vary by demographic factors; HPV prevalence differed by sex and race/ethnicity, the researchers note.

In their study, Martin Steinau, PhD, senior scientist at the CDC, and colleagues report that the current global incidence of oropharyngeal cancers is estimated to be 85,000 annually, although there is considerable geographic variation. In the United States, there are about 12,000 new cases diagnosed every year, and most are classified histologically as squamous cell carcinoma (OPSCC).

The retrospective analysis was published in the May issue of Emerging Infectious Diseases.

Study Details

Dr. Steinau and colleagues sought to determine prevalence of HPV types detected in oropharyngeal cancers in the American population, and to establish a prevaccine baseline for monitoring the impact of vaccination.

They examined oropharyngeal tumors from 588 patients.

HPV was detected in 403 of the 557 patients with OPSCC (72.4%), and 396 (71.1%) were positive for only 1 or no high-risk types. A single HPV type was detected in 68.4% of cases, and 3.9% of samples contained 2 types. In 7 cases, only low-risk HPV types were detected. High-risk HPV16 was present in 337 (60.5%) cases, HPV18 was present in 14 (2.5%) cases, and 331 (59.4%) cases were exclusively positive for these 2 types.

Other high-risk types, including HPV31, 33, 35, 39, 45, and 52, were found at low frequency, the researchers point out.

There were differences in prevalence based on sex and race/ethnicity. The prevalence of the high-risk HPV16 and HPV18 was lower in women than in men (53%vs 66%), and in non-Hispanic black than other racial/ethnic groups (31% vs 68% to 80%).

When the researchers conducted a multivariate analysis for high-risk HPV, only race/ethnicity emerged as a significant independent factor (P = .003). The odds for high-risk HPV infections were significantly higher for all other race groups than for non-Hispanic black patients (P < .001).

When only HPV16/18 detection was considered, there were significant differences between those infected and those not infected for sex (P = .009) and race/ethnicity (P < .001), but not for age (P = .063).

“Future assessments are needed to monitor general prevalence and possible type-specific shifts,” the researchers conclude. “Data from the present and future studies will provide a baseline for early assessment of vaccine effects.”

This project was supported in part by CDC grants and federal funds for Residual Tissue Repositories from the National Cancer Institute SEER Population-based Registry Program, National Institutes of Health, Department of Health and Human Services. Coauthor Brenda Y. Hernandez reports receiving consultation and speaker fees from Merck and Co.

 

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

May, 2014|Oral Cancer News|

Study finds the prognosis of HPV positive tumors in head and neck cancer patients to vary depending on site

Source: sciencecodex.com
Author: Staff

 

Vienna, Austria: Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown. Danish researchers have now shown that HPV status appears to have no prognostic effect on the outcome of primary radiotherapy in head and neck cancer outside the oropharynx (the part of the throat located behind the mouth, and which contains the soft palate and the base of the tongue), the ESTRO 33 congress will hear today (Sunday).

Presenting her results to the congress, Dr Pernille Lassen, MD, PhD, from the Aarhus University Hospital, Aarhus, Denmark, will say that head and neck cancers located outside the oropharynx should probably not be treated with the less intensive treatment strategies that are currently being investigated in clinical trials for HPV+ oropharyngeal tumours.

“HPV status has a very potent prognostic impact in radiotherapy for oropharyngeal cancer, and DNA from HPV has been found in all types of head and neck cancer, although it is far more common in oropharyngeal tumours. We decided to investigate the impact of HPV status in non-oropharyngeal cancers in the DAHANCA database, which includes all Danish head and neck cancer patients,” Dr Lassen will say.

The researchers searched the database to identify patients with locally advanced cancers who had been treated primarily with radiotherapy, and identified 1606 patients with larynx and pharynx carcinomas. Overall, 40% of the tumours were HPV positive, and the frequency was significantly higher in oropharyngeal cancer (57%), than in non-oropharyngeal (13%).

Being positive for HPV significantly improved tumour control (81% as opposed to 55%), as well as survival from the cancer (89% and 55% respectively), and death from any cause (82% and 38% respectively), after five years.

“In non-oropharyngeal cancers we found no prognostic impact of being HPV positive in any of these endpoints,” Dr Lassen will say. “This indicates that HPV status does not help us in predicting response to treatment, and hence the outcome of these cancers.

“We know from laboratory studies that HPV positive tumour cells are much more sensitive to radiation therapy than HPV negative cells, so until now we believed that they would behave similarly irrespective of site,” Dr Lassen will say. “However, these data indicate that this is not the case, and at present we do not understand why this should be, though it probably can be ascribed to other biological/genetic differences between the tumours rather than the HPV status. We would now like to try to elucidate the underlying mechanisms behind these different outcomes.”

There could be, for example, biological and/or genetic differences between the tumours other than the HPV status, the researchers say; for example, genetic changes caused by smoking tobacco, differences due to tumours of mixed make-up (for example, a combination of HPV+ and tobacco), or perhaps simply differences due to the site. “Such tumours with a combination of causes represent a challenge in our clinical daily practice,” Dr Lassen will say.

“We have started following up our work by analysing all the tumour samples using polymerase chain reaction, a way of amplifying DNA in order to be able to analyse changes in genetic information. We hope this will enable us to understand more about why the role of HPV in non-oropharyngeal tumours is so different. There are few data available on this subject at present, so finding out will be an important step towards optimising treatment for these patients.”

President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: “These findings will have an important impact on the treatment of HPV+ head and neck cancers, and are likely to lead to a change in current practice.”

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

April, 2014|Oral Cancer News|

Effects of Chemoradiation on Voice and Speech Quality of H&N Cancer Patients

Source: Med Page Today
Published: February 23, 2014
By: Charles Bankhead
 

 

SCOTTSDALE, Ariz. — Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed.

Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%.

The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at the Multidisciplinary Head and Neck Cancer Symposium.

“Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients,” Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing.

Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said.

To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to 6 months after finishing treatment, patients completed two validated questionnaires: Head and Neck Quality of Life (HNQOL) and University of Washington Quality of Life (UWQOL).

At the same intervals, the patients’ physicians reported their assessments in accordance with the Common Terminology Criteria for Adverse Events.

All of the patients had locally advanced stage III/IV oropharyngeal cancer and received treatment in two clinical trials of organ-sparing IMRT. Radiation therapy protocols were designed to minimize the radiation dose to the pharyngeal constrictors, salivary glands, oral cavity, glottic larynx, supraglottic larynx, and esophagus.

Vainshtein and colleagues analyzed patient questionnaires to identify factors associated with voice and speech impairment, in addition to the frequency of impairment.

By the HNQOL communication domain and speech impairment domain of the UWQOL, radiotherapy-induced speech impairment reached a maximum in the first month after treatment. Impairment then decreased in subsequent assessments, stabilizing at 12 to 18 months.

The proportion of patients reporting post-treatment speech and voice impairment followed a time pattern consistent with speech impairment reflected in answers to the questionnaires. By the HNQOL, 68% of patients said their voice and speech quality were impaired versus baseline, decreasing to 56% at 3 months, 46% at 6 months, 33% at 12 months, 31% at 18 months, and 24% at 24 months.

By the UWQOL, the proportion of patients reporting worsening of voice and speech quality after treatment was 41%, 26%, 29%, 28%, 15%, and 22% at the assessments from 1 to 24 months after finishing therapy.

In contrast, few physicians included voice and speech impairment in their adverse event reports. Vainshtein said 7% of physicians reported grade 1 toxicity with respect to worsening of voice and speech at 3 months, 5% at 6 months, and 0% thereafter.

Comparing treatment characteristics and patient-reported voice quality worsening, investigators found an association between radiation dose to the larynx and patient-reported impairment at 6 and 12 months. Reported impairment at 6 months increased from 25% with a cumulative radiation dose of <20 Gy to 59% at >30-40 Gy, 50% at 40-50 Gy, and 64% with laryngeal doses >50 Gy (P=0.02).

A similar pattern emerged from the analysis of 12-month outcomes, as the proportion of patients reporting worsening of voice quality from baseline increased from 10% for laryngeal radiation doses <20 Gy to 63% of patients for cumulative doses >50 Gy (P=0.011).

“We observed similar findings for patient-reported voice quality worsening and speech impairment,” Vainshtein said. “The results were independent of other patient and treatment factors.”

Press briefing moderator Mitchell Machtay, MD, said he found the study eye opening.

“If you looked at radiation dose to larynx, not the area where the tumor was, I was struck by how doses of 20 to 30 Gy, which we don’t normally consider as very toxic high doses that can damage the voicebox, still caused a fair amount of damage,” said Machtay, of University Hospitals Case Medical Center in Cleveland.

The magnitude of disconnect between patient and physician assessments was one of the more surprising findings in the study.

“I don’t think it’s unique to head and neck cancer. I don’t think it’s unique to our study. I don’t think it’s unique to medicine,” Vainshtein said. “I think physicians tend to underestimate the effect of their treatment — whatever it is — on our patients.”

Some adverse effects can be subtle and do not become apparent during conversations with physicians, he continued. When the patients express their sentiments in a more formal manner, such as a questionnaire, the effects do emerge.

Some of the disconnect reflects differences in patients’ approaches to their illness and adverse effects of treatment, said Wade Thorstad, MD, of Washington University in St. Louis.

“There’s a group of patients, when you’re interviewing them about their symptoms, will tell it like it is and really explain things well,” said Thorstad, another participant in the press briefing. “There’s another group that is stoic, and they really underplay their issues before [their physician]. However, when they are filling out a questionnaire about their feelings about quality of life, I think you get a more honest assessment.”

 

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

 

February, 2014|Oral Cancer News|

Katie Couric show on HPV vaccine sparks backlash

Source: CBS News
Published: Thursday, January 5, 2013
By: Ryan Jaslow

 

Katie Couric’s talk show “Katie” has drawn ire from doctors and journalists for a recent segment on the HPV vaccine that presented what it called “both sides” of the “HPV controversy.”

The segment included personal stories from two moms who claim their daughters suffered serious harm from the vaccine (one of them died). In addition, the show featured two physicians: one who researched the vaccine and thinks its long-term protection benefits are oversold, and one who recommends it to her patients, in line with recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

Ahead of the show, which aired Dec. 4, Couric tweeted:

Screen shot 2013-12-06 at 12.01.48 PM

Dr. Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center in New York City, did not feel it was appropriate to juxtapose the anecdotal stories with the medical evidence. He had hoped more weight would be given to the scientific evidence of the vaccine’s safety profile and effectiveness at preventing cervical cancer.

“The show was kind of inexcusable in terms of damage done versus positive contribution,” he told CBS News.

Any time you’re vaccinating hundreds of thousands of people, Caplan said, you can expect that some people in that population will have health incidents occur. But their ailments may not necessarily be connected to the vaccine. What needs to be weighed is the cause and effect, versus what may be just coincidence. Mentioning such incidents in that context would have been one thing, but giving them more air-time than the bevy of evidence about safety and efficacy is another.

“The problem in TV and all media, (is) the human interest drives the story,” said Caplan. “In science and public health, it doesn’t, or it’s at risk of grave harm.”

“If you want to do a show every day that spotlights anecdotal claims about the health effects of cell phones or curative powers of megavitamins or dangers of airplane contrail vapors, you can certainly fill up lots of programming,” said added. “But I don’t think you’re doing anyone a service.”

While the show has certainly sparked debate, what’s not debatable is that HPV is a significant factor in cancer cases in the United States.

Human papillomavirus, or HPV, is an infection that is so common that it will occur in virtually all sexually-active people at one point or another. About 79 million Americans are currently infected with HPV, according to federal estimates.

There are more than 150 related viruses that make up HPV, but about 40 can be transmitted sexually, and some play a bigger role in causing genital warts while others increase risk for cancers of the cervix, anus, oropharynx (throat and back of the tongue), vulva, vagina and penis.

About 90 percent of genital warts are caused by the HPV 6 and 11 strains, while the majority of cancers related to the infection — about 70 percent — are caused by strains 16 and 18.

But most people won’t have a problem. The CDC points out 90 percent of all HPV infections, including the cancer-causing strains, will be cleared or undetectable in two years without any treatment, with many leaving the body within six months due natural immunity.

It’s the ones that don’t clear that are worrisome. Virtually all cervical cancer cases each year – there are 12,340 new ones expected in 2013 — are caused by high-risk strains of HPV, according to the National Cancer Institute.

Rates of oropharyngeal cancer have soared in recent years, studies have found, and HPV from oral sex is thought to be to blame, as Michael Douglas spotlighted in June by disclosing his throat cancer was caused by the infection.

That’s where vaccines aim to help, by preventing HPV in the first place. The two approved vaccines are Cervarix, which prevents HPV types 16 and 18, and Gardasil, which prevents HPV 16 and 18 as well as the genital-wart causing HPV 6 and 11 strains.

Both vaccines are given in three doses over a six-month period, recommended for females aged 13 through 26, and males between 13 and 21 years old.

“The vaccines that are available right now are one of our only protections against HPV,” Dr. Nieca Goldberg, director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center, told CBS News in June.

A CDC study in June reported rates of HPV strains related to genital warts and some cancers have dropped 56 percent among American teen girls since a vaccine was introduced in 2006, from 11.5 percent of 19-year-olds infected before the vaccine was introduced, to 5 percent by 2010.

Dr. Diane Harper, chair of family medicine at the University of Louisville who researched the vaccine, told Couric that the vaccine’s protection wears off after five years, so men and women could still be at risk for HPV down the road.

The CDC, however, says studies with up to six years of follow-up data have found no evidence of waning effectiveness from the vaccine, a point Caplan also emphasized. One study found even one dose was 82 percent effective, though all three doses are recommended.

The CDC adds that if 80 percent of teens got all three doses of the vaccine, an estimated 53,000 additional cases of cervical cancer could be prevented over the lifetimes of girls aged 12 and older. For every year that increases in coverage are delayed, another 4,400 women will go on to develop the disease.

That’s not to that say the HPV vaccine, or any vaccine, can’t cause side effects.

The CDC’s Vaccine Adverse Event Reporting System (VAERS) has received at least 22,000 reports of adverse events in girls and women who got the vaccine between June 2006 through March 2013. Over this time, about 57 million doses of the vaccine were distributed in the United States.

Ninety-two percent of the reported side effects were considered nonserious. They included injection-site pain and swelling, fainting, dizziness, nausea, headache, fever and hives.

The other almost 8 percent of serious side effects included headache, nausea, vomiting, fatigue, dizziness, fainting and generalized weakness.

“Editors, producers want a face,” said Caplan. “Public health wants data, statistics, and boring compilations.”

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

 

http://worldofdtcmarketing.com/irresponsible-journalism-that-can-cause-loss-of-life/in-the-news/

http://www.forbes.com/sites/matthewherper/2012/05/03/here-is-how-we-know-gardasil-has-not-killed-100-people/

 

 

December, 2013|Oral Cancer News|

Incidence of oropharyngeal cancer on the rise

Source: News-Medical.net
Published: November 22, 2013

 

NCI scientists report that the incidence of oropharyngeal cancer significantly increased during the period 1983-2002 among people in countries that are economically developed. Oropharyngeal cancer occurs primarily in the middle part of the throat behind the mouth, including the base of the tongue, the side and back walls of the throat, and the tonsils. The results of this study, by Anil K. Chaturvedi, Ph.D., Division of Cancer Epidemiology and Genetics, NCI, and his colleagues, appeared online in the Journal of Clinical Oncology, Nov. 18, 2013.

Recent studies from several countries have reported rising incidence of oropharyngeal cancers and subsequent studies have shown the human papilloma virus (HPV) as the potential cause. However, it has been unclear whether this increase in oropharyngeal cancer incidence represents a global phenomenon. Chaturvedi and his collaborators at Ohio State University and the International Agency for Research on Cancer evaluated incidence trends for oropharyngeal and oral cavity cancers. Their analysis was based on cancer registry data from more than 180,000 patients in 23 countries. They found that oropharyngeal cancer incidence increased overall among both women and men from 1983 to 2002, almost exclusively in economically developed countries. Among women, in all countries with significant increases in oropharyngeal cancer incidence, there was also an increase in incidence of both oral cancer and lung cancer, two cancers strongly associated with smoking. In contrast, among men, rising oropharyngeal cancer incidence was generally accompanied by decreases for oral cancer and lung cancer. These observations among men suggest some factor other than smoking, perhaps infection with HPV, as a potential explanation for rising oropharyngeal cancer incidence. Researchers note that prophylactic HPV vaccine has been shown to protect against oral HPV infection, suggesting an additional benefit of vaccination programs for both women and men.

 

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

 

November, 2013|Oral Cancer News|

HPV Oral Cancer: Low Risk for HPV Transmission

Source: MedScape
By: Zosia Chustecka
Published: June 6, 2013

 

CHICAGO, Illinois — Because human papillomavirus (HPV) is transmitted through sexual contact, patients with HPV-related cancer often ask whether their partners are at risk and whether they should they change their sexual practices.

For patients with HPV-related oral cancers, data from the Human Oral Papillomavirus Transmission in Partners Over Time (HOTSPOT) study, presented here at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO®), will be reassuring.

In the small pilot study of 166 patients with HPV-related oral cancer and 94 long-term partners, researchers measured HPV DNA in oral rinse samples taken at baseline and at 1-year follow-up. The results show that the partners do not appear to be at increased risk for HPV infection, so they are not at increased risk for HPV-related oral cancer, the researchers conclude.

“This is reassuring for patients and their partners,” said lead author Gypsyamber D’Souza, PhD, MPH, MS, from the John Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

At a press briefing, she explained that patients are often anxious about this issue, and has heard of instances where it has led to divorce.

“Couples who have been together for several years have likely already shared whatever infections they have and no changes in their physical intimacy are needed.” However, “with new partners, caution is always advised,” she added.

Results Not Surprising

The results are not surprising, Otis Brawley, MD, chief medical officer for the American Cancer Society, told Medscape Medical News.

The median age of the patients in this study was 56 years; presumably, the partners were also in this age range. By that time, individuals have built up a natural immunity against HPV, Dr. Brawley said.

The main window for HPV transmission is in the first 5 years after initiation of sexual activity, he explained, which is usually in the teenage and early adult years.

Dr. Brawley cited a study of female college freshmen. At college entry, about 15% had been exposed to HPV; this had risen to 80% by the time of graduation. “Sexual activity in the late teenage years in the United States almost always leads to HPV infection, which is one of the reasons HPV vaccines are directed at girls 9 to 12 years of age,” he explained. “Once they have HPV in their body, the vaccine doesn’t work as well. It may lower certain subtypes, but it usually doesn’t work very well.”

Transmission From Genitals

For the HPV that causes oropharyngeal cancer (mainly HPV type 16), the main route of transmission appears to be from the genitals to mouth, Dr. Brawley noted.

This point was also made by study discussant Quynh-Thu Le, MD, from Stanford University in California. Previous studies have shown that male partners of women who have cervical cancer are at increased risk for tonsil cancer, she noted.

In the HOTSPOT study, 3 of the patients had previous spouses with cervical cancer and 2 of the partners reported a history of cervical precancer, but Dr. D’Souza and colleagues note that “these were self-reported, unconfirmed cases.”

The recent sharp increase in HPV-related oropharyngeal cancers has been linked to an increase in oral sex during the 1960s, as previously reported by Medscape Medical News. However, studies of sexual behavior suggest that oral sex is not the whole answer, Dr. Le said.

More research is needed to determine the time line of progression for HPV-related oral cancers and the way HPV is transmitted and suppressed by the immune system, she explained.

HPV in the Throat for Many Years

Dr. Brawley emphasized that the window for HPV transmission is early on, and said that the study patients in their 50s who had HPV-related oral cancer probably had the HPV infection in their throat for 30 years or more.

This issue recently caused a furor in celebrity news outlets after Oscar-winning actor Michael Douglas said that his throat cancer was the result of HPV contracted after he engaged in oral sex.

The comment, made during an interview with the Guardian, was later released by the newspaper as an audioclip because the actor denied he had said it.

The actor backtracked because of the huge embarrassment to his wife, Catherine Zeta-Jones, and his ex-wife, Diandra Douglas, both of whom then said publicly that they do not have the HPV infection. It also highlighted his past antics as a self-confessed womanizer, which led him to seek treatment for his “sex addiction.”

Later the same day, Michael Douglas appeared at an event hosted by the American Cancer Society, and joked that he had become “a poster boy” for oral cancer. “Just so you all understand, I think we would all love to know where our cancer comes from,” he added.

Pilot Study

In the HOTSPOT study, 55% of the patients with HPV-related oral cancer had an oral HPV infection when they were diagnosed, but only 7% still had the infection a year after having undergone cancer treatment.

Among the 94 partners, 6 had oral HPV infections (6.5%) and 2 had infection with HPV 16. No oral cancers were detected in the 60 partners who underwent a visual examination. These infections were “at very low levels,” and were not detectable a year later, the researchers note.

“They had it, and then they cleared the virus,” Dr. D’Souza said. “HPV infection is common and most individuals do not get cancer,” he added.

The study was funded by the Johns Hopkins Innovation Fund and the Richard Gelb Cancer prevention Award. Dr. D’Souza reports receiving research funding from Merck.

2013 Annual Meeting of the American Society of Clinical Oncology: Abstract CRA6031. Presented June 1, 2013.

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
November, 2013|Oral Cancer News|