smoking

Management strategies for oral potentially malignant disorders

Source: www.medscape.com
Author: Joel M. Laudenbach, DMD

Oral potentially malignant disorders (OPMDs) include oral leukoplakia (OL), oral erythroplakia, oral submucous fibrosis, oral lichen planus, proliferative verrucous leukoplakia, and actinic keratosis. Once an OPMD has been clinically diagnosed, execution of management strategy is critical. When formulating the strategy, healthcare providers should consider histopathology, lesion characteristics (ie, surface texture, unifocal, multifocal), lesion location in the mouth (ie, tongue, floor of mouth), patient risk factor assessment, and a detailed medical/cancer history.

In this newly published article, Nadeau and Kerr[1] detail various parameters surrounding evaluation and management of OPMDs. The authors make it clear that OPMDs are challenging, each with their own nuances regarding risk for malignant transformation. For example, when OL is unifocal, nonhomogeneous, nodular, or verrucous, there is a much higher chance of the OL becoming dysplastic (12.63-fold) or demonstrating a focus of carcinoma (8.9-fold) when compared with homogeneous types of OLs.[1]

Provider knowledge of these variables is critical when counseling patients about their diagnosis and management options and when selecting interventions along with follow-up care. Although progression to malignancy is difficult to predict with OPMDs, clinicians can account for multiple risk factors such as smoking/alcohol status, high-risk location in the oral cavity, and size of lesion (>200 mm2) to help formulate a tailored management plan for each patient. Consultation with an oral pathologist to discuss the histologic appearance in the context of specific patient history and lesion characteristics can provide additional perspective and/or recommendations.

Modifiable oral cavity cancer risks related to tobacco and heavy alcohol use should be communicated to patients with OPMDs so that they are able to make changes that may lead to regression/disappearance of certain lesions such as OL. Providers confronted with patients who use tobacco and/or heavy alcohol can integrate recommendations for cessation of tobacco[2] and alcohol[3] because they are both established, independent, causative agents for oral cavity cancer and OPMDs.

Available treatment strategies for OPMDs include surgical removal/ablation, photodynamic therapy, and surveillance. The authors make a clear point with supportive studies that traditional surgical excision of dysplastic OPMDs may decrease malignant transformation (MT) risk, yet it does not fully eliminate that risk and, in some instances, has not changed the MT risk when compared with surveillance alone. Appropriate surgical margin identification for OPMDs is clinically challenging. The authors note that smaller excisional margin sizes (1-2 mm) without marginal histologic assessment are common surgical management goals for OPMDs.[1]

Viewpoint
Nadeau and Kerr carefully outline updated considerations for all OPMDs. Healthcare providers involved in screening, diagnosing, referring, and/or managing patients with OPMDs should be well versed in standards of care, including baseline biopsy goals, tobacco/alcohol cessation, currently available interventions, and surveillance care.

Clinicians should also develop a local team of practitioners who are experts in diagnosis and management of OPMDs to help patients obtain the best opportunity for positive outcomes. I encourage readers with interest to retrieve and review the full article by Nadeau and Kerr as a strategy to update your knowledge base and to continue to improve overall morbidity, mortality, and survival rates related to OPMDs.

References:
1. Nadeau C, Kerr AR. Evaluation and management of oral potentially malignant disorders. Dent Clin North Am. 2018;62:1-27.

2. US Preventive Services Task Force. Final recommendation statement. Tobacco smoking cessation in adults, including pregnant women: behavioral and pharmacotherapy interventions. September 2015. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions1 Accessed March 1, 2018.

3. US Preventive Services Task Force. Final recommendation statement. Alcohol misuse: screening and behavioral counseling interventions in primary care. May 2013. https://www.uspreventiveservicestaskforce.org/Page/Document
/RecommendationStatementFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care Accessed March 1, 2018.

March, 2018|Oral Cancer News|

HPV is causing an oral cancer epidemic in men by outwitting natural defenses

Source: www.philly.com
Author: Marie McCullough, staff writer

Five years ago, when actor Michael Douglas candidly revealed that his throat cancer was linked to having oral sex, two things happened.

He made headlines that mortified his family. And he helped publicize the fact that a pervasive, sexually transmitted virus called HPV was unleashing an epidemic of oral cancer among men.

Since then, scientists have made headway in figuring out why HPV, the human papillomavirus, has this glaring gender bias. Men are four times more likely than women to be diagnosed with oral cancer, a hard-to-detect, hard-to-treat disease that has overtaken cervical cancer as the most common HPV-related malignancy in the United States.

To be sure, changes in sexual norms over the last few generations have played a role in this alarming trend. But research increasingly shows the real problem is something men have practically no control over: their immune response.

Compared with women, men are more likely to get infected with HPV — including “high-risk” cancer-causing strains. They also are less able to wipe out infection on their own, and more likely to get reinfected. The reasons are unclear.

“There is good evidence that men acquire oral infections more readily than women, even if they have similar sex practices,” said Ashish A. Deshmukh, a University of Florida HPV researcher. “And more than the acquisition, it’s the persistence of the virus. The clearance rate is not that fast in men.”

Michael Becker of Yardley has stepped up as the face of this immunological inequity. The 49-year-old former biotech executive is health-conscious, clean-living, happily married for 26 years – and battling terminal oropharyngeal cancer, the medical term for malignancies in parts of the mouth and throat.

He’s also battling the misconceptions and ignorance that keep too many parents from protecting their pubescent children — especially boys — against HPV-driven cancers. Two shots. That’s all it takes for the leading vaccine, Gardasil, to prevent most cervical cancers, less common genital malignancies, and the disease that is killing Becker.

“I can’t tell you how many emails I got from parents after the CBS segment,” he said, referring to a national television interview last month. “They said, ‘What do you mean this vaccine is for boys?’ and ‘What do you mean oral cancer incidence has eclipsed cervical cancer?’ ”

An inescapable virus
HPV is a family of more than 100 virus types that can live in the flat, thin cells on the surface of the skin, cervix, vagina, anus, vulva, penis, mouth, and throat. The virus is spread through contact with infected skin, mucous membranes, and bodily fluids. Some types can be passed during intercourse or — as Douglas pointed out — oral sex. While virtually all sexually active people will get infected at some point, the virus is usually wiped out by the immune system without so much as a symptom.

But not always.

In the cervix, persistent infection with high-risk HPV types can lead to precancerous changes that, left alone, slowly turn malignant. Fortunately, the Pap smear enables the detection and removal of abnormal cells before cancer develops. What’s more, age-related changes in cervical cells reduce the risk that HPV will take hold there as women get older.

No such screening test exists for oropharyngeal sites – the tongue, soft palate, tonsils, the throat behind the nasal cavity – and symptoms usually don’t appear until cancer is advanced. Becker, for example, had metastatic disease by the time he noticed a lump under his jaw line in late 2015.

Traditionally, smoking and heavy alcohol use are the big risk factors for oral cancer, but the non-HPV tumors linked to these bad habits have been declining in recent years. HPV-related tumors, in contrast, have increased more than 300 percent over the last 20 years. The virus is now found in 70 percent of all new oral cancers.

About 13,200 new HPV oral cancers are diagnosed in U.S. men each year, compared with 3,200 in women, according to federal data. Treatment — surgery, chemotherapy, radiation — can have disfiguring, disabling side effects. About half of late-stage patients die within five years.

Natural defenses go awry
Oral HPV infection rates are skewed by gender, just like the resulting cancers. The latest national estimates of this disparity, published in October, come from Deshmukh and his University of Florida colleagues. They used a federal health survey that collected DNA specimens to estimate that 7.3 percent of men and 1.4 percent of women have oral infections with high-risk HPV types. That translates to 7 million men and 1.4 million women.

The chance of oral infection increases for women as well as men who have simultaneous genital HPV infections or a history of many sex partners, but male infection rates still far surpass female rates.

Patti Gravitt, an HPV researcher at George Washington University, believes these estimates are a bit oversimplified because women counted as uninfected may actually have undetectably low virus levels, or HPV may be hiding in a dormant state in their cells.

Still, Gravitt said the study is in line with others that suggest “men are more susceptible to HPV viral infection than women.”

In women, an HPV infection usually sets off the body’s defense mechanisms. The immune system makes antibodies that kill off the invader, then immune cells remain on guard, ready to attack if the virus reappears.

But in men, something goes awry. The HIM study — for HPV in Men — documented this by collecting genital, anal, and oral samples from 4,100 unvaccinated men in Florida, Mexico and Brazil between 2005 and 2009. The samples were tested for the presence of two high-risk HPV types and two that cause genital warts.

Among 384 men who developed infections during a 24-month period, only 8 percent produced antibodies. But this response rate varied depending on the site of infection; none of the small number of orally infected men produced antibodies.

Rather than putting the immune system on guard and protecting men from the virus, infection sharply increased the chance of getting infected again with the exact same HPV type. And many men who got reinfected were celibate at the time.

How could this be? Anna R. Giuliano, the researcher at the Moffitt Cancer Center in Tampa, Fla., who led the HIM study, said recurring infections may be due to reactivation of dormant virus, or to auto-inoculation – the man spreads infection from one part of his body to another. Or to something else entirely.

While the scientific understanding of this puzzle is evolving, one implication is clear. “HPV vaccination is the only reliable method to ensure immune protection against new HPV infections and subsequent disease in males,” Giuliano and her co-authors declared in a recent paper.

Becker hammers that message – when he is not being hammered by chemotherapy – using his self-published memoir and his blog. This week’s blog gave a shout-out to Sunday’s first-ever International HPV Awareness Day, declared by Giuliano and other members of the International Papillomavirus Society.

Becker realizes that the novelty of the vaccine, the complexity of HPV, and its link to sex are obstacles to immunization. But he focuses on the life-saving aspect.

“Parents are being asked to vaccinate their 11-year-old child and they can’t imagine 30 or 40 years down the line, it will prevent cancer,” Becker said. “If you don’t know it’s connected to six cancers, you’re not going to care. So it really should be cast as an anti-cancer vaccine.”

March, 2018|Oral Cancer News|

Chronic heartburn might increase chance of neck, head cancers

Source: www.upi.com
Author: HealthDay News

Millions of American seniors suffer the discomfort of chronic acid reflux. Now, new research suggests the condition might raise their odds for even more dangerous foes — head and neck cancers.

The research can’t prove cause-and-effect, and the odds of any one person with chronic heartburn developing one of these relatively rare cancers remains low, experts noted.

But the study of nearly 28,000 Americans over the age of 65 did show a heightened risk.

Overall, a history of gastroesophageal reflux disease — the clinical term for chronic heartburn — was linked to nearly triple the odds of developing cancers of the voice box (larynx); about a 2.5 greater odds for cancers of the pharynx (top of the throat); a doubling of risk for cancers of the tonsils; and a 40 percent higher odds for cancers in the sinuses.

Head and neck cancers of the respiratory and upper digestive tracts cause more than 360,000 deaths worldwide each year, the researchers noted.

The new study was led by Dr. Edward McCoul, of the Ochsner Clinic Foundation in New Orleans, and published Thursday in the journal JAMA Otolaryngology Head & Neck Surgery.

One gastroenterologist said the findings aren’t surprising, given what’s known about the effect of acid reflux on sensitive tissues.

“Reflux material from the stomach can rise high in to the esophagus, the food tube between the mouth and the stomach,” explained Dr. Anthony Starpoli. He said the same juices “can invade the throat, sinus passages and the lungs, causing [chronic] inflammation.”

The link between GERD and another tumor type, esophageal cancer, is already well-known, said Starpoli, associate director for esophageal endotherapy at Lenox Hill Hospital in New York City.

In the new study, McCoul’s team tracked data from 13,805 U.S. seniors who’d had cancers of the respiratory and upper digestive tracts between 2003 and 2011. Their medical histories were then compared to the same number of similarly aged people without cancer.

While the study found an association between GERD and head-and-neck cancers, McCoul’s team stressed that the data they sourced did not include information about each patient’s smoking and drinking history. Both of those habits are major risk factors for head and neck cancers, the study authors noted, so more investigation is needed to tease out the findings.

Dr. David Hiltzik directs otolaryngology at Staten Island University Hospital in New York City. Reading over the findings, he agreed that the study wasn’t designed to prove cause-and-effect.

But Hiltzik believes chronic heartburn remains a potential carcinogen and needs to be treated when it occurs.

“We know clinically that acid reflux causes problems throughout life in these areas in the head and neck,” he said. “This study reinforces the fact that we need to address these issues early and perhaps more aggressively. I believe patients should be more aware of how their daily diet and behavioral habits can have serious long-term effects.”

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on acid reflux.

December, 2017|Oral Cancer News|

Oral sex increases men’s risk of cancer, new study finds

Source: www.deccanchronicle.com
Author: staff

An alarming new study found men who have performed oral sex on five or more partners are at risk of head and neck cancer related to HPV, according to a report by the Daily Mail.

Johns Hopkins researchers warn men may not be aware of this risk, particularly if they smoke. “Among men who did not smoke, cancer-causing oral HPV was rare among everyone who had less than five oral sex partners, although the chances of having oral HPV infection did increase with number of oral sexual partners, and with smoking,” lead author Dr Amber D’Souza, associate professor at the Johns Hopkins Bloomberg School of Public Health told the Daily Mail.

For the study, data was analysed of 13,089 people part of the National Health and Nutrition Examination Survey (NHANES) and tested for oral HPV. That information was compared to data with federal figures on oropharyngeal cancer diagnoses. The results indicated that men had a higher risk of developing the disease compared to women.

The new study’s findings suggest it is crucial for boys to get the HPV vaccine.

While there are 100 different kinds of HPV, only few cause cancer. HPV strains 16 and 18 trigger most cervical cancer. HPV16 also causes oropharyngeal cancer.

Identifying who is at risk is will help curb the disease. “For these reasons, it would be useful to be able to identify healthy people who are most at risk of developing oropharyngeal cancer in order to inform potential screening strategies, if effective screening tests could be developed,” Dr D’Souza told the Daily Mail.

Further research to explore oral HPV infection in young healthy men is currently being conducted.

The study was originally published in the journal Annals of Oncology.

October, 2017|Oral Cancer News|

Halving radiation therapy for HPV-related throat cancer offers fewer side effects, similar outcomes

Source: www.eurekalert.org
Author: Mayo Clinic press release

Mayo Clinic researchers have found that a 50 percent reduction in the intensity and dose of radiation therapy for patients with HPV-related throat cancer reduced side effects with no loss in survival and no decrease in cure rates. Results of a phase II study were presented today at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego by Daniel Ma, M.D. a radiation oncologist at Mayo Clinic.

“A common approach for treating HPV-related throat cancer is a combination of surgery followed by daily radiation therapy for six to 6½ weeks,” says Dr. Ma. “However, the radiation treatment can cause a high degree of side effects, including altered taste, difficulty swallowing, dry mouth, stiff neck and damage to the jaw bone.” Dr. Ma says that patients with HPV-related throat cancer tend to be young and, once treated, are likely to live a long time with possibly life-altering side effects from the standard treatment. “The goal of our trial was to see if an aggressive reduction of radiation therapy (two weeks of radiation twice daily) could maintain excellent cure rates, while significantly reducing posttreatment side effects, improving quality of life and lowering treatment costs.”

Researchers followed 80 patients with HPV-related oropharyngeal squamous cell cancer with no evidence of residual disease following surgery and a smoking history of 10 or fewer pack years. That’s the number of years smoking multiplied by the average packs of cigarettes smoked per day.

At two years following the aggressively de-escalated treatment, the rate of tumor control in the oropharynx (throat) and surrounding region was 95 percent. Of the 80 patients in the trial, only three experienced a local cancer recurrence. One patient experienced a regional cancer recurrence. Patient quality of life largely improved or did not change following treatment, except for some dry mouth.

“Patients in our trial had a very dramatic reduction in side effects, compared with standard treatment,” says Dr. Ma. “For example, no patient in our trial needed a feeding tube placed during dose-reduced treatment; whereas, close to a third of patients had feeding tubes placed with traditional radiation therapy doses on other recent clinical trials.” Dr. Ma says the reduction in side effects did not lead to any reduction in cure rate, as survival rates were similar to traditional survival rates for HPV-related throat cancer.

September, 2017|Oral Cancer News|

Big tobacco fuels nicotine replacement addiction, UCSF study shows

Source: http://www.sfgate.com
Author: Lizzie Johnson
Date: August 17, 2017

Nicotine patches, lozenges, inhalers and gum have long been marketed as ways of helping addicts break the habit. But such products by themselves won’t do the job — something tobacco companies themselves have taken advantage of to boost their profits, new research from UCSF says.

Nicotine replacement therapy products, which have been sold over the counter at drugstores since 1996, are effective only when paired with counseling, according to a UCSF study released Thursday. Without that, relying on such products can actually make it harder to kick tobacco, the study found.

UCSF researchers who reviewed millions of pages of internal tobacco company documents said the firms have long known that such products by themselves don’t wean users off cigarettes, and market their own smokeless nicotine to keep users addicted.

“Those products should not be used unless they are done in the proper way,” said Stanton Glantz, an author of the study, professor of medicine at UCSF and the director of the Center for Tobacco Control Research and Education.

“The problem is, without the behavioral support, they actually inhibit quitting,” he said. “Unfortunately, a lot of people think they are making progress and quitting when that’s not so. That’s what tobacco companies have known for decades. They’re developing products under the guise of nicotine replacement therapy.”

Some of the biggest tobacco companies, including RJ Reynolds, Philip Morris and British American Tobacco, have developed nicotine accessories. Many corner stores stock the products, some of them in brightly colored packages, next to chocolate bars and other candy near the cash register.

Medi-Cal and many private health insurance policies cover the cost of quitting aids. State-subsidized insurance will pay for two annual courses of treatment with pills such as Chantix and Zyban, Nicorette lozenges, Nicorette gum and NicoDerm CQ Patches.

But people are more likely to use those products as complements to smoking — at work or in airplanes when cigarettes are banned — instead of as a tool to quit, the UCSF study found. Nicotine replacement products can be effective if people combine them with counseling and consultation with a doctor, but the majority of consumers don’t use them that way, researchers said.

Randomized clinical trials cited in the study showed that people who went to counseling and tapered their use of nicotine replacement therapy products over time were successful. Those who didn’t were not.

A 2009 study in the BMJ — formerly known as the British Medical Journal — found that of the 2,767 smokers tested, only 6.75 percent were able to abstain from cigarettes for six months while using nicotine replacement therapy products.

Nicotine patches and gum were first approved by the U.S. Food and Drug Administration in 1984, and the tobacco industry originally saw them as a threat, the UCSF study said. By 1992, however, company executives determined such products would not help smokers quit, and that there was money to be made from them. By 2009, tobacco companies were selling their own nicotine patches, lozenges and e-cigarettes.

“It was surprising to discover the industry came to view NRT (nicotine replacement therapy) as just another product,” said Dorie Apollonio, an associate professor in clinical pharmacy at UCSF and lead author of the study. “The tobacco companies want people to get nicotine — and they’re open-minded about how they get it.”

Representatives of RJ Reynolds, Philip Morris and British American Tobacco did not respond to requests for comment.

Apollonio’s researchers analyzed 90 million pages of documents from seven tobacco companies dating back as far as 1960, obtained in litigation against the tobacco industry.

Those papers showed that the tobacco industry began developing its own nicotine replacement products after its research showed that some smokers used them in addition to tobacco.

“The way the marketing is framed, it is explicitly discouraging quitting,” Glantz said. “The tobacco companies know more about tobacco products than anybody else. Now they are selling these products in a way that protects their market. I do not think most health professionals are aware of this.”

But some are. Derek Smith, director of the San Francisco Department of Public Health’s Tobacco Free Project, said he encourages smokers to check with their pharmacists or doctors before trying a nicotine replacement therapy like a patch or pill.

“You can’t plop on a patch and expect to quit smoking,” he said. “It’s part of the arsenal to tackle this complicated addiction. Smokers know better than anyone how hard it is to quit. It takes eight or 10 times before it sticks. In my experience, they are really aware what a tough addiction it is and how a patch isn’t the magical solution.”

A free smoking cessation program offered by the city at San Francisco General Hospital funnels smokers through a seven-class session. The weekly meetings teach participants how to create a plan with a quit date and identify stressful situations that lead to smoking. Instructors teach them to drink more water and improve their diet to help cope with cravings.

Patches, gum and e-cigarettes can be useful tools, Smith said. It didn’t surprise him that the tobacco industry had started creating its own products.

“Those internal documents reveal their intentions,” he said. “It’s always fascinating to see how the tobacco industry is thinking. They have an opportunistic assessment of the market. It never ceases to amaze me.”

August, 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|

Calgary cancer patient asks why smokers are near hospitals if grounds are supposed to be ‘smoke-free’

Source: globalnews.ca
Author: Heather Yourex-West

At just 47-years-old, Tim Allsopp is battling throat cancer. He doesn’t smoke but during he’s his treatment, he says, he’s been exposed to second-hand cigarette smoke more often because he often passes by people smoking on his way to treatment at Calgary’s Tom Baker Cancer Centre.

“Everyday when we come to therapy, we notice that there’s people smoking outside the building,” Allsopp said. “That’s confusing to me because the policy states, no smoking on Alberta Health Services property, this includes buildings, grounds and parking lots.”

“I’m at the point now where I’m very susceptible to infection and that could land me in the emergency department in almost life threatening condition.”

While AHS has had a smoke-free hospital grounds policy for years, it doesn’t take long to spot people lighting up. AHS says it tries to enforce its policy, but it’s not easy.

WATCH: Smokers ignore no smoking signs in front of Winnipeg hospitals

“Our protective services people try to use an educational approach first but if that’s not successful, then they have the power to issue a ticket,” said Dr. Brent Friesen, lead medical officer of health for Alberta Health Services’ tobacco reduction strategy.

Friesen says the problem is that AHS can only issue tickets for people breaking either provincial law or city by-law, not AHS policy. That means, while AHS may say no smoking is allowed on hospital grounds, the province only requires people keep a five-metre distance from hospital doors.

“If they’re further than five metres away, the option that’s available for our protective staff is to charge the person with trespassing but that’s a cumbersome approach in terms of having to get a court order and it (also) starts to raise concerns in terms of what implications that might have for that individual, if they want to seek care in the future.”

It’s a similar situation for hospitals across the country. Provincial rules in B.C. require smokers keep a distance of six metres from hospital entrance ways, in Winnipeg eight metres is required and Ontario and Quebec require nine metres between hospital doors and anyone lighting up. Next year, however, Ontario will become the first province to ban smoking entirely on hospital grounds. Anyone caught violating the rule could face a $1,000 fine.

Friesen says Alberta Health Services would like Alberta’s provincial government to follow Ontario’s lead but Alberta health minister, Sarah Hoffman, says patients who are addicted to nicotine deserve compassion as well.

“I think its challenging who are living in hospital who may be in difficult health situations -maybe even at end of life – and to ask them to quit at that point would be very challenging for them but we do need to make sure that if they are going to be using substance that they do so without impacting other patients and staff.”

Teens drink less if they know alcohol causes cancer — but most don’t — study finds

Source: http://www.adelaidenow.com.au/
Author: Tim Williams, Education Reporter

Teens are less likely to drink if they know that alcohol is a major cause of cancer, but most are unaware of the link, a South Australian study has found. More than 2800 school students aged 12-17 were surveyed about their drinking behaviour by Adelaide University and South Australian Health and Medical Research Institute (SAHMRI) researchers.

Those aged 14-17 were deterred from drinking if they knew about the link between alcohol and cancer, but only 28 per cent of students were aware of the connection. Parental disapproval was another deterrent, while smoking and approval from friends resulted in higher rates of drinking. Most students had tried alcohol by age 16 and a third drank at least occasionally. Wealthy students were more likely to drink.

Cancer Council SA chief executive Lincoln Size said there was clear evidence drinking caused cancers of the mouth, pharynx, larynx and oesophagus, as well as bowel cancer in men and breast cancer in women. It likely raised the risk of liver cancer and bowel cancer in women too.

“Any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption,” he said.

“This latest evidence highlights the need to educate young people about the consequences of alcohol consumption and for parents to demonstrate responsible drinking behaviour.

“We need to get the message through that what may be considered harmless fun actually has lifelong consequences.”

Lead author Jacqueline Bowden, a behavioural scientist with both the uni and SAHMRI, said drinking patterns were often set in adolescence.

“With alcohol contributing to four of the top five causes of death in young people, and a leading cause of cancer in our community, it’s important for us to better understand drinking behaviour among young people so we can help to prevent or delay it,” Ms Bowden said.

“One of the major messages from our study is that parents have more influence on their teenagers’ decisions regarding alcohol than they probably realise.

“Parental behaviour and attitudes towards alcohol really do make a difference, and can help prevent children from drinking at an early age.

“Many parents believe providing their children with alcohol in the safe environment of their home teaches them to drink responsibly.

“However, the weight of evidence suggests that this increases consumption, and is not recommended.

“Our results also found that those adolescents who thought they could buy alcohol easily were more likely to drink regularly. The issue of availability — including price — and marketing of alcohol in the community is a major hurdle to be overcome.”

The findings of the study, which was supported by Cancer Council SA and the State Government, have been published in the journal BMC Public Health.

Trans oral robotic surgery saves public Australian hospital patients from disfiguring procedure

Source: www.smh.com.au
Author: Kate Aubusson

The cancerous tumour growing at the back of Brian Hodge’s tongue was about as hard-to-reach as cancers get. The 73-year-old was told he’d need radical, invasive surgery to remove the 50¢-sized tumour. His surgeon would make an incision almost from ear-to-ear and split his jaw in two for the 10-12 hour surgery.

After five days in intensive care, another three weeks in hospital and four to six months recovery, re-learning how to eat and talk Mr Hodge would have been left with disfiguring scars, and a voice that he may not recognise as his own.

“My kids didn’t want me to have it,” Mr Hodge said. “But I’m not one to throw in the towel … Then the unbelievable happened,” he said.

Mr Hodge became one of the first public patients to undergo robotic surgery for head, neck and throat cancer at Nepean Hospital, the state’s only hospital offering the service to patients who can’t afford private healthcare.

Mr Hodge’s surgeon, Associate Professor Ronald Chin, performed the trans oral robotic surgery (TORS) by guiding the robot’s arm into his patient’s open mouth to remove the cancerous tumour.

“I went in on Monday morning for the surgery and I was discharged Tuesday night,” Mr Hodge said of his surgery performed on June 19.

“It’s just amazing. Two days compared to six months recovering.

“What’s got me is that before it was only available to people who could pay the big money. I’ve worked all my life, I’ve paid tax and I think, why can’t we people get this surgery as well,” he said.

TORS is available for private health patients in other NSW hospitals, but its use at a major tertiary hospital in Sydney’s west – surrounded by suburbs with some of the highest smoking rates and lowest private health insurance rates in Sydney – was significant.

“It’s an enormous step forward to be able to offer this state-of-the-art treatment with such obvious benefits both cost-wise and [avoiding] disfigurement-wise … to patients who may not have previously had the resources to access it,” Dr Chin said.

The da Vinci robot Dr Chin used was the same one Nepean Hospital’s urological surgeons use to perform prostatectomies on prostate cancers. The TORS procedure takes about 45 minutes.

“Traditionally surgery is incredibly invasive. We had to make very large incisions across the neck, then lift the skin well above the lower lip and cut the jaw open,” said the otolaryngology, head and neck surgeon.

“We’re talking about a massive operation. Then reconstruction is very difficult.

“Not only did people face a horrendously long operation, they had to deal with long post-operative recovery and rehabilitation to regain speech, language, voice and the ability to eat and drink.

“With TORS, patients can go home the next day [with minimal discomfort],” he said.

More than 400,000 cases of oropharyngeal squamous cell carcinomas are diagnosed each year worldwide. The five-year survival rate for head and neck cancer in Australia is 69 per cent, according to government estimates.

Nepean Hospital would see between 10 and 15 patients with head and neck cancers per year who would be suitable for TORS, Dr Chin said. The cancerous tumours, usually linked to smoking and excessive drinking as well as the human papilloma virus, were “extraordinarily difficult to access, almost impossible”, said Dr Chin.

Robotic surgery costs significantly more than traditional surgeries. But Dr Chin said TORS could save the public health system up to $100,000 per procedure, where patients no longer needed to spend days in ICU, costing more than $3000 per night, or weeks in hospital. The robotic surgery is primarily indicated for patients with oropharyngeal carcinomas of up to four centimetres in size. Roughly one-third of TORS patients will not need chemo and radiotherapy.

“The early evidence available on trans oral robotic surgery for oropharyngeal cancer is promising,” said Dr Tina Chen, medical and scientific adviser at the Cancer Institute NSW.

“However, higher-quality research is needed to definitively say whether it means better clinical outcomes for patients, compared to other treatments already available,” she said.

There was currently no high-quality evidence from randomised controlled trials comparing TORS to chemotherapy and radiotherapy for these types of cancers, a 2016 Cochrane review concluded. It noted “data are mounting”.

Mr Hodge will soon be able to swap the pureed food he has eaten since the day after his surgery for his favourite meal, barbecue chicken, and the avid karaoke singer is already planning his first post-surgery crooning set-list. First, Engelbert Humperdinck’s Please Release Me, and the song he has been singing to his wife for decades, Anne Murray’s Could I Have This Dance.