smoking

U.S. Chamber of Commerce Works Globally to Fight Antismoking Measures

Source: www.nytimes.com
Author: Danny Hakim
 
01cigarette-web2-master675A demonstration against World No Tobacco Day in Jakarta, Indonesia, in 2013. The U.S. Chamber of Commerce and its foreign affiliates have joined efforts to fight antismoking laws around the world. Credit Romeo Gacad/Agence France-Presse — Getty Images

KIEV, Ukraine — A parliamentary hearing was convened here in March to consider an odd remnant of Ukraine’s corrupt, pre-revolutionary government.

Three years ago, Ukraine filed an international legal challenge against Australia, over Australia’s right to enact antismoking laws on its own soil. To a number of lawmakers, the case seemed absurd, and they wanted to investigate why it was even being pursued.

When it came time to defend the tobacco industry, a man named Taras Kachka spoke up. He argued that several “fantastic tobacco companies” had bought up Soviet-era factories and modernized them, and now they were exporting tobacco to many other countries. It was in Ukraine’s national interest, he said, to support investors in the country, even though they do not sell tobacco to Australia.

Mr. Kachka was not a tobacco lobbyist or farmer or factory owner. He was the head of a Ukrainian affiliate of the U.S. Chamber of Commerce, America’s largest trade group.

From Ukraine to Uruguay, Moldova to the Philippines, the U.S. Chamber of Commerce and its foreign affiliates have become the hammer for the tobacco industry, engaging in a worldwide effort to fight antismoking laws of all kinds, according to interviews with government ministers, lobbyists, lawmakers and public health groups in Asia, Europe, Latin America and the United States.

The U.S. Chamber’s work in support of the tobacco industry in recent years has emerged as a priority at the same time the industry has faced one of the most serious threats in its history. A global treaty, negotiated through the World Health Organization, mandates anti-smoking measures and also seeks to curb the influence of the tobacco industry in policy making. The treaty, which took effect in 2005, has been ratified by 179 countries; holdouts include Cuba, Haiti and the United States.

Facing a wave of new legislation around the world, the tobacco lobby has turned for help to the U.S. Chamber of Commerce, with the weight of American business behind it. While the chamber’s global tobacco lobbying has been largely hidden from public view, its influence has been widely felt.

Letters, emails and other documents from foreign governments, the chamber’s affiliates and antismoking groups, which were reviewed by The New York Times, show how the chamber has embraced the challenge, undertaking a three-pronged strategy in its global campaign to advance the interests of the tobacco industry.

In the capitals of far-flung nations, the chamber lobbies alongside its foreign affiliates to beat back antismoking laws.

In trade forums, the chamber pits countries against one another. The Ukrainian prime minister, Arseniy Yatsenyuk, recently revealed that his country’s case against Australia was prompted by a complaint from the U.S. Chamber.

And in Washington, Thomas J. Donohue, the chief executive of the chamber, has personally taken part in lobbying to defend the ability of the tobacco industry to sue under future international treaties, notably the Trans-Pacific Partnership, a trade agreement being negotiated between the United States and several Pacific Rim nations.

“They represent the interests of the tobacco industry,” said Dr. Vera Luiza da Costa e Silva, the head of the Secretariat that oversees the W.H.O treaty, called the Framework Convention on Tobacco Control. “They are putting their feet everywhere where there are stronger regulations coming up.”

01cigarette-web1-master315Thomas J. Donohue, the head of the U.S. Chamber of Commerce, has defended the tobacco industry’s right to sue under future international treaties. Credit Brendan Hoffman for The New York Times

The increasing global advocacy highlights the chamber’s enduring ties to the tobacco industry, which in years past centered on American regulation of cigarettes. A top executive at the tobacco giant Altria Group serves on the chamber’s board. Philip Morris International plays a leading role in the global campaign; one executive drafted a position paper used by a chamber affiliate in Brussels, while another accompanied a chamber executive to a meeting with the Philippine ambassador in Washington to lobby against a cigarette-tax increase. The cigarette makers’ payments to the chamber are not disclosed.

It is not clear how the chamber’s campaign reflects the interests of its broader membership, which includes technology companies like Google, pharmaceutical giants like Pfizer and health insurers like Anthem. And the chamber’s record in its tobacco fight is mixed, often leaving American business as the face of a losing cause, pushing a well-known toxin on poor populations whose leaders are determined to curb smoking.

The U.S. Chamber issued brief statements in response to inquiries. “The Chamber regularly reaches out to governments around the world to urge them to avoid measures that discriminate against particular companies or industries, undermine their trademarks or brands, or destroy their intellectual property,” the statement said, adding, “we’ve worked with a broad array of business organizations at home and abroad to defend these principles.”

The chamber declined to say if it supported any measures to curb smoking.

The chamber, a private nonprofit that has more than three million members and annual revenue of $165 million, spends more on lobbying than any other interest group in America. For decades, it has taken positions aimed at bolstering its members’ fortunes.

While the chamber has local outposts across the United States, it also has more than 100 affiliates around the world. Foreign branches pay dues and typically hew to the U.S. Chamber’s strategy, often advancing it on the ground. Members include both American and foreign businesses, a symbiotic relationship that magnifies the chamber’s clout.

For foreign companies, membership comes with “access to the U.S. Embassy” according to the Cambodian branch, and entree to “the U.S. government,” according to the Azerbaijan branch. Members in Hanoi get an invitation to an annual trip to “lobby Congress and the administration” in Washington.

Since Mr. Donohue took over in 1997, he has steered the chamber into positions that have alienated some members. In 2009, the chamber threatened to sue if the Environmental Protection Agency regulated greenhouse gas emissions, disputing its authority to act on climate change. That led Nike to step down from the chamber’s board, and to Apple’s departure from the group. In 2013, the American arm of the Swedish construction giant Skanska resigned, protesting the chamber’s support for what Skanska called a “chemical industry-led initiative” to lobby against green building codes.

The chamber’s tobacco lobbying has led to confusion for many countries, Dr. da Costa e Silva said, adding “there is a misconception that the American chamber of commerce represents the government of the U.S.” In some places like Estonia, the lines are blurred. The United States ambassador there, Jeffrey Levine, serves as honorary president of the chamber’s local affiliate; the affiliate quoted Philip Morris in a publication outlining its priorities.

The tobacco industry has increasingly turned to international courts to challenge antismoking laws that countries have enacted after the passage of the W.H.O. treaty. Early this year, Michael R. Bloomberg and Bill Gates set up an international fund to fight such suits. Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that administers the fund, called the chamber “the tobacco industry’s most formidable front group,” adding, “it pops up everywhere.”

In Ukraine, the chamber’s involvement was no surprise to Hanna Hopko, the lawmaker who led the hearing in Parliament. She said the chamber there had fought against antismoking laws for years.

“They were against the tobacco tax increase, they were against placing warning labels on cigarettes,” she said. “This is just business as usual for them.”

01cigarette-web3-articleLargePlain packaged tobacco products with health warnings in Sydney, Australia. Credit Andrew Quilty for The New York Times

 

Country-by-Country Strategy

More than 3,000 miles away, in Nepal, the health ministry proposed a law last year to increase the size of graphic warning labels from covering three-fourths of a cigarette pack to 90 percent. Countries like Nepal that have ratified the W.H.O. treaty are supposed to take steps to make cigarette packs less appealing.

Not long afterward, one of Nepal’s top officials, Lilamani Poudel, said he received an email from a representative of the chamber’s local affiliate in the country, warning that the proposal “would negate foreign investment” and “invite instability.”

In January, the U.S. Chamber itself weighed in. In a letter to Nepal’s deputy prime minister, a senior vice president at the chamber, Tami Overby, wrote that she was “not aware of any science-based evidence” that larger warning labels “will have any discernible impact on reducing or discouraging tobacco use.”

A 2013 Harvard study found that graphic warning labels “play a lifesaving role in highlighting the dangers of smoking and encouraging smokers to quit.”

While Nepal eventually mandated the change in warning labels, cigarette companies filed for an extension and compliance has stalled.

“Since we have to focus on responding to the devastating earthquake, we have not been able to monitor the state of law enforcement effectively,” said Shanta Bahadur Shrestha, a senior health ministry official.

The episode reflects the chamber’s country-by-country lobbying strategy. A pattern emerged in letters to seven nations: Written by either the chamber’s top international executive, Myron Brilliant, or his deputies, they introduced the chamber as “the world’s largest business federation.”

Then the letters mention a matter “of concern.” In Jamaica and Nepal, it was graphic health warnings on packages. In Uruguay, it was a plan to bar cigarettes from being displayed by retailers. The Moldovan president was warned against “extreme measures” in his country, though they included common steps like restricting smoking in public places and banning advertising where cigarettes are sold.

A proposal to raise cigarette taxes in the Philippines would open the floodgates to smugglers, the government there was told. Tax revenue has increased since the proposal became law.

“We are not cowed by them,” said Jeremias Paul, the country’s under secretary of finance. “We meet with these guys when we’re trying to encourage investment in the Philippines, so clearly they are very influential, but that doesn’t mean they will dictate their ways.”

Protecting tobacco companies is portrayed by the chamber as vital for a nation’s economic health. Uruguay’s president is warned that antismoking laws will “have a disruptive effect on the formal economy.” El Salvador’s vice president is told that “arbitrary actions” like requiring graphic health warnings in advertisements undermine “investment and economic growth.”

On the ground, the chamber’s local affiliates use hands-on tactics.

After Moldova’s health ministry proposed measures in 2013, Serghei Toncu, the head of the American Chamber of Commerce in Moldova, laid out his objections in a series of meetings held by a regulatory review panel.

“The consumption of alcohol and cigarettes is at the discretion of each person,” Mr. Toncu said at one meeting, adding that the discussion should not be about “whether smoking is harmful.”

“You do not respect us,” he told the health ministry at another.

At a third, he called the ministry’s research “flawed from the start.”

His objections were not merely plaintive cries. The American chamber has a seat on Moldova’s regulatory review panel giving it direct influence over policy making in the small country.

“The American Chamber of Commerce is a very powerful and active organization,” said Oleg Chelaru, a team leader on the staff that assists the review panel. “They played a very crucial role in analyzing and giving an opinion on this initiative.”

Mr. Toncu, who has since left the chamber, declined to comment. Mila Malairau, the chamber’s executive director, said its main objective was to make sure the industry “was consulted” in “a transparent and predictable manner.”

After recently passing in Parliament, the long-stalled measures were subject to fresh objections from the chamber and others, and have not yet been enacted.

01cigarette-web4-articleLargeProtesters displayed fake body bags at a tobacco trade show at Pasay, the Philippines, in 2013. Credit Bullit Marquez/Associated Press

 

Fighting a Trade Exception

In Washington, the U.S. Chamber’s tobacco lobbying has been visible in the negotiations over the Trans-Pacific Partnership, a priority of the Obama administration that recently received critical backing in Congress.

One of the more controversial proposals would expand the power of companies to sue countries if they violate trade rules. The U.S. Chamber has openly opposed plans to withhold such powers from tobacco companies, curbing their ability to challenge national antismoking laws. The chamber says on its website that “singling out tobacco” will “open a Pandora’s box as other governments go after their particular bêtes noires.”

The issue is still unresolved. A spokesman for the United States trade representative said negotiators would ensure that governments “can implement regulations to protect public health” while also “ensuring that our farmers are not discriminated against.”

Email traffic shows that Mr. Donohue, the chamber’s head, sought to raise the issue in 2012 directly with Ron Kirk, who was then the United States trade representative. In email exchanges between staff members of the two, Mr. Donohue specifically sought to discuss the role of tobacco in the trade agreement.

“Tom had a couple of things to raise, including urging that the tobacco text not be submitted at this round,” one of Mr. Donohue’s staff members wrote to Mr. Kirk’s staff. The emails were produced in response to a Freedom of Information request filed by the Campaign for Tobacco-Free Kids, which provided them to The Times.

Mr. Kirk is now a senior lawyer at Gibson, Dunn, a firm that counts the tobacco industry as a client. He said in an interview that during his tenure as trade representative, he met periodically with Mr. Donohue but could not recall a specific conversation on tobacco.

He said trade groups were generally concerned about “treating one industry different than you would treat anyone else, more so than doing tobacco’s bidding.”

The chamber declined to make Mr. Donohue available for an interview.

A Face-Saving Measure

In Ukraine, it was Valeriy Pyatnytskiy who signed off on the complaint against Australia in 2012, which was filed with the World Trade Organization. At the time, he was Ukraine’s chief negotiator to the W.T.O. His political career has survived the revolution and he is now an adviser to the Ukrainian prime minister, Mr. Yatsenyuk.

In a recent interview, he said that for Ukraine, the case was a matter of principle. It was about respecting the rules.

He offered a hypothetical: If Ukraine allowed Australia to use plain packaging on cigarettes, what would stop Ukraine from introducing plain packaging for wine? Then Ukrainian winemakers could better compete with French wines, because they would all be in plain bags marked red or white.

“We had this in the Soviet times,” he said. “It was absolutely plain packaging everywhere.”

Some Ukrainian officials have long been troubled by the case.

“It has nothing to do with trade laws,” said Pavlo Sheremeta, who briefly served as Ukraine’s economic minister after the revolution. “We have zero exports of tobacco to Australia, so what do we have to do with this?”

Last year, he urged the American Chamber in Kiev to reconsider.

“I wrote a formal letter, asking them, ‘Do you still keep the same position?’ ” Mr. Sheremeta said. “Basically I was suggesting a face-saving way out of this.” But when he met with chamber officials, the plain packaging case was outlined as a top priority.

They refused to back down. After Mr. Pyatnytskiy, a tobacco ally, was installed as his deputy, Mr. Sheremeta resigned.

“The world was laughing at us,” he said of the case.

Shortly after The Times discussed the case with Ukrainian government officials, there were new protests from activists. Mr. Yatsenyuk called for a review of the matter. Ukraine has since suspended its involvement, but other countries including Cuba and Honduras are continuing to pursue the case against Australia.

Andy Hunder, who took over as president of the American Chamber of Commerce in Kiev in April, said the organization was moving on, adding, “We are looking forward now.”

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

Head and neck cancer on rise in young men

Source: www.healthcanal.com
Author: staff

“The head and neck cancers we have found in younger men with no known risk factors such as smoking are very frequently associated with the same HPV virus that causes cervical cancer in women.” said Kerstin Stenson, MD, a head and neck cancer surgeon at Rush and a professor of otolaryngology at Rush University. The cancer develops from an HPV infection, likely acquired several years earlier from oral sex.

“Men are more susceptible to these cancers because they don’t seem to have the same immune response as women and do not shed the virus like women do,” Stenson said.

‘Epidemic proportions’
According to the Centers for Disease Control and Prevention, cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils) are usually caused by tobacco and alcohol, but recent studies show that about 72 percent of oropharyngeal cancers are caused by HPV.

“There has been significant change in the last decade. Overall, head and neck cancers account for approximately 3 to 5 percent of all cancers, but what’s changed in the past decade is the HPV-associated oropharyngeal cancer. It has reached epidemic proportions,” said Stenson.

The American Cancer Society estimates that 45,780 Americans will be diagnosed with cancer of the oral cavity and oropharynx in 2015. If this trend continues, the number of cases of HPV-positive oropharyngeal cancer will surpass the number of cervical cancer cases.

Early detection is key
The current vaccine has been shown to decrease the incidence of HPV-associated cervical infections and cancer. While the same result is anticipated for HPV-associated head and neck cancer, the impact of vaccines on incidence of persistent oral HPV infection and/or HPV associated oropharyngeal cancer has not yet been investigated. We will need about 10-30 more years to see the anticipated effect of the vaccine on HPV-related cancers that could affect people who are now teenagers. Still, head and neck surgeons, medical oncologists and other researchers strongly advocate vaccination of both girls and boys to help prevent all HPV-associated cancers.

“For all individuals, the key is in early detection, as with any cancer,” Stenson said.

In addition to being vaccinated, Stenson stresses the importance of regular visits to the dentist. “Dentists play a key role in detecting oral cancer. You might not see a primary care physician even once a year, but most people see their dentist twice a year. Having regular dental visits can help catch cancers early to help ensure the best outcome.”

The American Dental Association states that 60 percent of the U.S. population sees a dentist every year.

Oral cancer warning signs
The Oral Cancer Foundation presumes that cancer screenings of the existing patient population would yield tens of thousands of opportunities to catch oral cancer in its early stages.

“There is much that can be done for those who are diagnosed with head and neck cancer. Since early detection and treatment is critical, it’s important to see your dentist regularly and to promptly see a medical professional if there are any warnings signs,” Stenson advised. Strategies to improve public awareness and knowledge of signs, symptoms, and risk factors are critical topics for study and may decrease the disease burden of head and neck cancers.

Possible warning signs of oral cancer may include difficulty swallowing, pain when chewing, a white patch anywhere on the inside of your mouth, a lump or sore in the mouth or on the lip that does not heal.

If you notice any of these symptoms, ask your dentist or doctor about it.

Treatment includes surgery for early or low-volume late stage lesions and radiation or chemoradiation for more advanced cancers.

March, 2015|Oral Cancer News|

Cure Possible for Some HPV-Positive Oropharyngeal Cancers

Source: www.medscape.com
Author: Fran Lowry

In a subset of patients with human papillomavirus (HPV)-related oropharyngeal cancer, the goal of achieving a “cure” is a realistic one, even in patients who have limited distant metastases, a prospective study has shown.

Of the patients with HPV-positive oropharyngeal cancer and distant metastases, 10% survived more than 2 years after intensive treatment, which the researchers defined as a cure.

The study was presented at the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) in Nice, France.

The research was praised by Jean Bourhis, MD, head of the Department of Radiation Oncology at Centre Hospitalier Université Vaudois in Lucerne, Switzerland, and cochair of the ICHNO conference scientific committee.

“This important piece of research adds substantially to what we know about the role and the importance of the human papillomavirus in oropharyngeal cancers and gives real hope of improvement in both diagnosis and treatment to those who are affected by the condition,” he said in a statement.

This study, from a world-leading group of head and neck cancer experts, is very interesting, and related to relevant clinical and interdisciplinary questions,” said Daniel Zips, MD, professor of radiation oncology at the University of Tübingen in Germany.

“HPV status is also important for the management of metastatic disease,” he told Medscape Medical News.

He agrees that for some patients with HPV-positive oropharyngeal cancer, using the researchers’ definition, a cure is possible.

“I also agree that the results from this study might begin to change the view of this disease and provide some hope for patients and their families,” Dr Zips explained.

Distant Metastases Are Main Form of Failure
“The majority of patients with HPV-related oropharyngeal cancer can be cured, but distant metastasis can occur in about 15% of patients. In fact, distant metastasis has become the main form of failure for this patient population,” lead author Sophie Huang, a radiation therapist and assistant professor at the University of Toronto. Dr Huang was a physician in China but is an MRT(T) — a radiation therapist — in Canada.

“When distant metastasis occurs, it is generally viewed as incurable disease. However, long-term survival after distant metastasis has been observed in nasopharyngeal cancer patients, which is another viral-related head and neck cancer, associated with the Epstein–Barr virus. Also, long-term survival in HPV-related OPC patients with distant metastasis has also been reported, but anecdotally,” Dr Huang told Medscape Medical News. “Are these just miracles? And would more miracles be found if we were able to understand how they happen?”

Dr Huang and her colleagues established a prospective database in which they collected data on enough patients to allow them to study how distant metastasis is manifested, how the cancer behaves after distant metastasis, and whether there are any factors that influence survival after distant metastasis.

“We felt that the answers to these questions would help us tailor surveillance strategies for the early detection of distant metastasis and explore optimal management algorithms to improve outcomes,” she explained.

Prospective Follow-up of Patients
The team evaluated 1238 consecutive oropharyngeal cancer patients treated at the Princess Margaret Cancer Centre in Toronto from 2000 to 2011. They identified 88 patients with HPV-related cancer and 54 with smoking-related cancer who were HPV-negative, all with distant metastases.

They assessed the pace of the manifestation of the distant metastases, characteristics, and patient survival, and identified factors that might predict longer survival.

The proportion of patients with distant metastases was similar in the two groups. However, metastases associated with HPV-positive oropharyngeal cancer had a later onset, different characteristics, and longer survival than those associated with HPV-negative oropharyngeal cancer.

Specifically, more than 94% of metastases occurred in the first 2 years after treatment in HPV-negative patients, whereas only a quarter occurred in HPV-positive cancers. In the HPV-positive group, some occurred after 5 years.

“This observation indicates that HPV-related OPC patients who are disease-free for 2 years are not out of the woods. A longer surveillance period for HPV-related OPC patients is needed to detect, and hopefully cure, distant metastases,” Dr Huang said.

Additionally, the researchers found two phenotypes of distant metastases in HPV-positive patients.

The disseminating phenotype is aggressive and spreads to multiple organs in a short period of time. This phenotype was found in 55% of the HPV-positive group but in 0% of the HPV-negative group.

The indolent phenotype is characterized by a few lesions growing at a slow pace, and manifesting as oligometastasis, with five or fewer lesions. In patients with metastases in a single organ, this phenotype was found in 24% of the HPV-positive group and in 26% of the HPV-negative group.

The lung was the most common site for distant metastasis in both groups.

“This indolent phenotype has longer survival and might be curable,” Dr Huang reported.

More HPV-positive than HPV-negative patients were specifically treated for distant metastasis (60% vs 31%)

table1

More HPV-positive patients with distant metastases than HPV-negative patients survived to 3 years (25% vs 15%; P = .01).

“The survival advantage in HPV-positive patients is due to a number of factors. The cancer is more sensitive to radiotherapy and chemotherapy, patients tend to be younger by about 10 years, and they have fewer other health problems, including those caused by smoking. This allows them to receive the more aggressive treatment necessary to eradicate metastatic disease,” Dr Huang explained.

table2

“This research shows that metastatic HPV-positive patients who receive active treatment can survive considerably longer. One of the reasons patients with metastatic disease fail to receive aggressive treatment is due to the physician and patient perception that this is an incurable state. We hope these results will motivate researchers to optimize management strategies for these patients,” Dr Huang said.

“The first distant metastasis site is mostly in the chest region,” she noted. In fact, most of the cured patients had lung metastasis. “Computed tomography of the thorax for the early detection of distant metastases” might enhance the cure rate for this disease, she added.

Future studies should look for ways to identify patients at initial presentation who are at high risk for distant metastasis, and which type of distant metastasis will develop.

“We know there is a degree of correlation between the initial stage and the risk of distant metastasis, but we did not find a strong relationship between this stage and the type of metastasis,” Dr Huang reported. “The intensity of cigarette smoking in the years prior to the time of diagnosis is a possible factor. Being able to identify such relationships could be a huge help in deciding appropriate treatment at an early stage.”

Note:

1. Dr Bourhis, Dr Zips, Dr Huang, have disclosed no relevant financial relationships.
2. 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO): Abstract OC-044. Presented February 13, 2015.

March, 2015|Oral Cancer News|

Researchers propose new staging model for HPV+ oropharyngeal cancer

Source: www.drbicuspid.com
Author: Donna Domino

Researchers are proposing a new tumor-staging model for predicting the outcomes and guiding treatments for patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC), according to a new study in the Journal of Clinical Oncology. Since HPV-related cancer differs significantly from smoking-related cancer, less intensive treatment strategies may be more appropriate, the study authors concluded.

Treatment regimens for oropharyngeal cancer have intensified over time and carry a toxicity burden, the Canadian researchers noted.

In the last few years, research has found that oropharyngeal cancer caused by HPV behaves differently than OPC caused by smoking and alcohol, yet both cancers use the same tumor classification model. Therefore, regardless of whether the OPC was caused by HPV or smoking, the treatment and perceived prognosis based on tumor staging has remained the same, even though patient outcomes vary considerably, the study authors noted (Journal of Clinical Oncology, February 10, 2015, Vol. 31:5, pp. 543-550).

A new tumor-staging model will help separate patients with promising prognoses from those with negative ones to design the most appropriate treatment strategies for each group, according to the researchers from Toronto’s Princess Margaret Cancer Centre.

The researchers analyzed 899 oropharyngeal cancer patients, including 505 (56%) patients with HPV who had been treated with radiotherapy or chemoradiotherapy from 2001 to 2009. The HPV-positive patients (382) had higher recurrence-free survival rates after about four years compared with HPV-negative patients (123). Disease recurrence was 16.7% (64) among HPV-positive patients; 38.2% among HPV-negative patients (47).

The tumor staging system classifies the disease into early, intermediate, or advanced stages of cancer. It helps determine treatment plans and can suggest likely outcomes.

For example, a stage IV patient with HPV-related cancer has an 80% survival rate, while a stage IV patient with smoking-related cancer has a 50% to 60% survival rate. But both are currently considered to have advanced-stage disease, which is recognized as a life-threatening prognosis.

“When you tell a patient they have stage IV cancer, it’s an indication of advanced disease, and they don’t expect it to be curable,” Huang said in a statement. “We need a staging system that more accurately reflects a patient’s prognosis, which in a case caused by HPV is highly curable.”

The study also highlights the fact that many HPV-related OPC patients are overtreated because of the stage IV tumor classification. High-dose chemotherapy combined with high-dose radiation is often given to such patients when radiation therapy alone or other less-intensive strategies can probably cure many of them, the researchers said.

Conclusion

“Our study shows that the current model derived for smoking- and alcohol-related cancers is not suited for throat cancer caused by HPV, a burgeoning throat cancer population in the Western world, including Canada,” Huang concluded.

A new tumor staging model will help separate patients with promising prognoses from those with negative prognoses to design the most appropriate strategies for each group, the study authors concluded.

Clinical trials have now begun to address these questions, but their descriptions and designs are hindered by inadequacies of the current stage classification, they stated.

“Providing a relevant stage classification for a rapidly emerging disease is important, but the additional feature of the classification is that it provides the opportunity to include factors beyond just the traditional description of disease extent into the prognostic classification we are trying to develop to assist in treating patients,” he said.

The structure used for disease classification follows a template that was developed at the Union for International Cancer Control in Geneva and is relevant to all cancers, according to Dr. O’Sullivan.

“Important factors that are emerging throughout oncology are not currently included in the international classifications,” he concluded. “This needs to change to facilitate our goal of providing personalized approaches to patients with cancer.”

The Princess Margaret Hospital is collaborating with six major cancer centers worldwide to validate the findings.

February, 2015|Oral Cancer News|

Great American Spit Out warns of new tobacco lures

Source: www.orlandosentinel.com
Author: Kate Santich, Orlando Sentinel

As anti-tobacco advocates celebrate today’s Great American Spit Out — the “chew” equivalent of the Great American Smoke Out — health officials warn that new dissolvable and flavored varieties of smokeless-tobacco products are targeting teens in a mission to get them hooked.

Newly released data from state health researchers show that, while cigarette smoking among Florida youth has reached an all-time low, smokeless tobacco use has been virtually unchanged for the past decade: roughly 5.5 percent among high school students statewide.

And it’s nearly 9 percent in some counties, including Lake.

“The tobacco industry is targeting us,” said Magi Linscott, a Pensacola-area 18-year-old named National Youth Advocate for 2014 by the Campaign for Tobacco-Free Kids. “They’re trying to get a new generation of addicts.”

Recent product developments include colorfully packaged, kid-friendly flavors of tobacco-infused candy, mints, gum, breath strips and flavored toothpicks — all containing nicotine. Depending on the type, they are designed to be held in the mouth, chewed, or sucked until they dissolve and the juices swallowed.

Along with more traditional chew, snuff and a teabag-like pouch of finely ground tobacco called snus (“snoose”), smokeless products may lure users with a false sense of safety. Shannon Hughes, Tobacco Free Florida bureau chief, said young people — and their parents — may not realize the dangers of the products, which increase the risk of oral cancer by 80 percent.

“Adults think, ‘Well, at least they’re not smoking,'” Hughes said. “Yes, cigarettes do cause more systemic damage to the body. But smokeless tobacco dramatically increases the risk of oral cancer, which is horribly disfiguring, and a horrible way to die. The bottom line is: There’s no safe level of tobacco use.”

The Spit Out — aimed at raising awareness of the problem — is part of a national “Through with Chew Week.” But because no single agency sponsors the campaign, it lacks the name recognition of the Smoke Out, officials admit.

Still, Hughes and others said, the proliferation of smokeless products makes the message especially urgent.

Chew and snuff have long been popular among baseball players and in rural communities, where their use is sometimes a rite of passage. Among local high-school students surveyed last year, only 3.1 percent of those in Orange County said they currently used smokeless tobacco, while the rate was 4.2 in Osceola, 5.3 in Seminole and 8.9 percent in Lake.

Use is vastly more common for males than females and for whites than blacks or Hispanics.

“It’s part of the culture in certain areas,” Hughes said. “And it can be easier to conceal,” especially with the newer forms. It is also cheaper than cigarettes.

But the American Cancer Society warns that because U.S. tobacco sellers are not required to list what’s in their products, it’s hard to know exactly how hazardous the smokeless varieties can be.

The World Health Organization has identified at least 28 carcinogens in smokeless tobacco, and along with the heightened risk of oral cancer, there’s a 60 percent increase in the risk of esophageal and pancreatic cancers compared to non-users. The products also raise the risk of heart disease and fatal strokes and may impact reproductive health, Hughes said.

“And because youth are often most concerned with the immediate impact,” she said, “we point out that smokeless tobacco use can cause tooth decay, permanent discoloration of teeth and gingivitis leading to tooth loss.”

Perhaps most disconcerting is the increased likelihood of stepping up to more lethal forms of tobacco. Researchers found smokeless-tobacco users tend to experiment with smoking and are more likely to become addicted. The younger the user, scientists say, the more sensitivity to nicotine.

February, 2015|Oral Cancer News|

A Study Finds Smoking’s Toll On Your Body and Health Worse Than Previously Thought

Source: nytimes.com
Author: Denise Grady
 

However bad you thought smoking was, it’s even worse.

A new study adds at least five diseases and 60,000 deaths a year to the toll taken by tobacco in the United States. Before the study, smoking was already blamed for nearly half a million deaths a year in this country from 21 diseases, including 12 types of cancer.

The new findings are based on health data from nearly a million people who were followed for 10 years. In addition to the well-known hazards of lung cancer, artery disease, heart attacks, chronic lung disease and stroke, the researchers found that smoking was linked to significantly increased risks of infection, kidney disease, intestinal disease caused by inadequate blood flow, and heart and lung ailments not previously attributed to tobacco.

Even though people are already barraged with messages about the dangers of smoking, researchers say it is important to let the public know that there is yet more bad news.

“The smoking epidemic is still ongoing, and there is a need to evaluate how smoking is hurting us as a society, to support clinicians and policy making in public health,” said Brian D. Carter, an epidemiologist at the American Cancer Society and the first author of an article about the study, which appears in The New England Journal of Medicine. “It’s not a done story.”

In an editorial accompanying the article, Dr. Graham A. Colditz, from Washington University School of Medicine in St. Louis, said the new findings showed that officials in the United States had substantially underestimated the effect smoking has on public health. He said smokers, particularly those who depend on Medicaid, had not been receiving enough help to quit.

About 42 million Americans smoke — 15 percent of women and 21 percent of men — according to the Centers for Disease Control and Prevention. Research has shown that their death rates are two to three times higher than those of people who have never smoked, and that on average, they die more than a decade before nonsmokers. Smokers are more than 20 times as likely as nonsmokers to die of lung cancer. Poor people and those with less formal education are the most likely to smoke.

Mr. Carter said he had been inspired to dig deeper into the causes of death in smokers after taking an initial look at data from five large health surveys being conducted by other researchers. The participants were 421,378 men and 532,651 women 55 and older, including nearly 89,000 current smokers.

As expected, death rates were higher among the smokers. But diseases known to be caused by tobacco accounted for only 83 percent of the excess deaths in people who smoked.

“I thought, ‘Wow, that’s really low,’ ” Mr. Carter said. “We have this huge cohort. Let’s get into the weeds, cast a wide net and see what is killing smokers that we don’t already know.”

The research was paid for by the American Cancer Society, and Mr. Carter worked with scientists from four universities and the National Cancer Institute.

The study was observational, meaning that it looked at people’s habits, like smoking, and noted statistical correlations between their behavior and their health. Correlation does not prove a cause-and-effect relationship, so this kind of research is not considered as strong as experiments in which participants are assigned at random to treatments or placebos and then compared. But people cannot ethically be instructed to smoke for a study, so a lot of the data on smoking’s effects on people comes from observational studies.

Analyzing deaths among the participants from 2000 to 2011, the researchers found that, compared with people who had never smoked, smokers were about twice as likely to die from infections, kidney disease, respiratory ailments not previously linked to tobacco, and hypertensive heart disease, in which high blood pressure leads to heart failure. Smokers were also six times more likely to die from a rare illness caused by insufficient blood flow to the intestines.

Mr. Carter said he had confidence in the findings because, biologically, it made sense that those conditions were related to tobacco. Smoking can weaken the immune system, increasing the risk of infection, he said. It is also known to cause diabetes, high blood pressure and artery disease, all of which can lead to kidney problems. Artery disease can also choke off the blood supply to the intestines. Lung damage from smoke, combined with increased vulnerability to infection, can lead to multiple respiratory illnesses.

Two other observations supported the findings, he said. One was that the more heavily a person smoked, the greater the added risks. The second was that among former smokers, the risks diminished over time. In general, such effects, known as a dose response, suggest that an observed correlation is more than a coincidence.

The study also found small increases in the risks of breast and prostate cancer among smokers. Mr. Carter said those findings were not as strong as the others, adding that additional research could help determine whether there were biological mechanisms that would support a connection.

A 2014 report by the surgeon general’s office said the evidence for a causal connection between smoking and breast cancer was “suggestive but not sufficient.” The same report found no evidence that smoking caused prostate cancer, but it noted that in men who did have prostate cancer, smoking seemed to worsen the outcome.

The diseases that had previously been established by the surgeon general as caused by smoking were cancers of the esophagus, stomach, colon, liver, pancreas, larynx, lung, bladder, kidney, cervix, lip and oral cavity; acute myeloid leukemia; diabetes; heart disease; stroke; atherosclerosis; aortic aneurysm; other artery diseases; chronic lung disease; pneumonia; influenza; and tuberculosis.

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

New model proposed for predicting outcomes more accurately in HPV-related throat cancer patients

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

Researchers at the Princess Margaret Cancer Centre are proposing a new model to enable doctors to predict outcomes more accurately for patients with throat cancers specifically caused by Human Papillomavirus (HPV).

The findings are published online today in the Journal of Clinical Oncology. Study investigators, Dr. Brian O’Sullivan, Lead, Head and Neck Cancer Site Group and Shao-Hui Huang, Research and Clinical Radiation Therapist at Princess Margaret Cancer Centre, have determined that a new model for classifying the most frequently seen throat cancers in our geographic location is needed. This classification incorporates individual patient factors including age and their smoking status with the traditional classification of the extent of disease, to offer a more personalized approach to predict outcomes and guide treatment.

“Our study shows that the current model derived for smoking and alcohol related cancers is not suited for throat cancer caused by HPV, a burgeoning throat cancer population in the Western World, including Canada,” says Huang.

“This is the future of tumour staging. We need to consider the patient as a whole. Both individual factors, how extensive the disease is in the patient, and tumour biology should play a role in determining the best course of treatment.”

The purpose of a tumour staging system is to classify the disease into early, intermediate or advanced stage cancer. This classification helps determine treatment plans and can suggest what is likely to be the outcome. In recent years, it’s been discovered that throat cancer caused by HPV behaves differently than throat cancer caused by smoking and alcohol, yet both cancers use the same tumour classification model. Therefore, regardless of whether the cancer was caused by HPV or smoking, the treatment and perceived prognosis based on tumour staging has remained the same – even though patient outcomes, as this study demonstrates, vary considerably.

For example, a stage IV patient with HPV-related cancer has an 80 per cent survival rate while a stage IV smoking-related cancer patient has a 50-60 percent survival rate, but both are presently considered advanced stage – which is recognized as a life-threatening prognosis.

“When you tell a patient they have stage IV cancer, it’s an indication of advanced disease and they don’t expect it to be curable,” says Huang. “We need a staging system that more accurately reflects a patient’s prognosis – which in a case caused by HPV, is highly curable.”

The study also highlights the fact that many HPV-related throat cancer patients are over-treated due to the stage IV tumour classification. High dose chemotherapy combined with high dose radiation is often given to this patient population when radiation therapy alone or other less intensive strategies can probably cure many of them.

Clinical trials have now begun to address these questions but their descriptions and design are hindered by inadequacies of the current stage classification. A new tumour staging model will help to separate patients with promising prognoses from those with negative prognoses to design the most appropriate treatment strategies for each group.

“This work has several interesting characteristics, and not just relating to the management of head and neck cancer. Providing a relevant stage classification for a rapidly emerging disease is important, but the additional feature of the classification is that it provides the opportunity to include factors beyond just the traditional description of disease extent into the prognostic classification we are trying to develop to assist in treating patients,” says Dr. O’Sullivan.

“The structure used for the classification follows a template we developed at the Union for International Cancer Control (UICC) and is relevant to all cancers. Important factors that are emerging throughout oncology are not currently included in the international classifications. This needs to change to facilitate our goal of providing personalized approaches to patients with cancer.”

The Princess Margaret is collaborating with six major cancer centres across the world to validate these findings, which will provide solid evidence for a new tumour staging system that offers a personalized approach to medicine.

Source:
Princess Margaret Cancer Centre, University Health Network

February, 2015|Oral Cancer News|

Inherited factors linked to head and neck cancers in young adults

Source: www.news-medical.net
Author: Oxford University Press

An article published online today in the International Journal of Epidemiology pools data from 25 case-control studies and conducts separate analyses to show that head and neck cancers (HNC) in young adults are more likely to be as a result of inherited factors, rather than lifestyle factors such as smoking or drinking alcohol.

Approximately 550,000 new cases of HNC are diagnosed worldwide annually, with an increased incidence in young adults (YA) also being reported. In particular, reports indicate an increase in tumours affecting the tongue and oropharynx among young adults in Europe, the United States, India, and China.

Dr Tatiana Natasha Toporcov and colleagues pooled data from 25 studies from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare the role of major risk factors and family history in HNC for YA (45 years of age or younger) and older adults (over 45 years of age). Participants were surveyed about their history of cigarette smoking, alcohol drinking, and diet, as well as family history of cancer. In total, there were 2,010 cases and 4,042 controls in YA, and 17,700 cases and 22,704 controls in older adults.

The attributable fraction (an estimate of the proportion of cases which could be avoided if the exposures were eliminated) for smoking on the risk of HNC was 20% in young women, 49% in older women, 46% in young men, and 64% in older men. The attributable fraction for drinking alcohol on the risk of HNC was 5% in young women, 20% in older women, 22% in young men, and 50% in older men. Eating a diet rich in fruits and vegetables was shown to be inversely associated with the risk of HNC in both age groups.

Dr Toporcov says: “To our knowledge, this is the largest study to evaluate the role of the major risk factors for HNC in young adults as well as to compare risks in younger and older patients. The large sample size allowed us to elucidate any differences in the role of risk factors in HNC in YA according to age group, sex and cancer sub sites.

“Although they were less likely to be drinkers and/or smokers, alcohol consumption was a risk factor for HNC in YA. However, a stronger association with heavy drinking was observed for the older group. Our results also indicate that the inverse association with fruit and vegetable intake is similar among young and older populations. YA were more likely to have been diagnosed with oral and oropharynx cancer than older adults. Also, early onset cancer in the family was associated with HNC risk only among YA.

“Our results support public health efforts to decrease exposure to major risk factors for HNC in the population regardless of age. However, investigations of the role of other risk factors, such as human papilloma virus and inherited characteristics, on HNC in the younger age group are warranted.”

January, 2015|Oral Cancer News|

Ring in the New Year by encouraging patients to quit tobacco use

Source: www.dentistryiq.com
Author: Maria Perno Goldie

The New Year always brings a sense of hope and conviction to improve our lives. New Year’s resolutions abound. With the New Year come new beginnings, fresh starts, and promises for a brighter future. We try to move on from the losses and trials of 2014, but we never forget. The people we’ve lost will be in our hearts forever, and the trials can be viewed as life lessons and opportunities.

As World Oral Health Day (WOHD) 2015 approaches, FDI World Dental Federation wants people to make a healthy New Year’s resolution and reduce their use of tobacco – or give it up completely – as part of the 2015 World Oral Health Day Smile for Life campaign.(1) Tobacco use can significantly increase the risk of many serious oral health problems, including oral cancer, periodontal disease, early tooth loss, tooth discoloration, oral malodor, and a reduced ability to taste and smell.

Dental and dental hygiene office visits can create an opportunities to help patients quit smoking and using tobacco, yet dental settings are often not used for treatment of tobacco dependence. The purpose of one study was to evaluate issues that may influence patterns of tobacco-use-related practice among a national sample of dental providers.(2) Researchers surveyed a representative sample of general dentists practicing in the U.S. More than 90% of dental providers reported that they regularly ask patients about tobacco use, 76% counsel patients, and 45% routinely offer cessation assistance. This was defined as referring patients for cessation counseling, providing a cessation prescription, or both. Results showed that cessation assistance was associated with having a practice with one or more dental hygienists, having a chart system that includes a tobacco use question, having received training on treating tobacco dependence, and having positive attitudes toward treating tobacco use.

Providers who did not offer assistance but reported they would change their practice patterns if they were sufficiently reimbursed were likely to be in a group practice, treat patients insured through Medicaid, and have positive attitudes toward treating tobacco dependence. The results indicated the benefit of increasing training opportunities and promoting changes to increase the involvement of dental providers in conducting tobacco use treatment. Reimbursement models should be tested to assess the effect on dental provider practice patterns.

The ADA issued a letter on “modified risk” tobacco products.(3) In a letter signed by the president and executive director, the ADA expressed to the FDA that “it is ‘virtually impossible’ to justify claims that smokeless tobacco and such newer generation products as electronic cigarettes and hookah tobacco ‘are somehow less harmful to the oral cavity than combustible tobacco products or without other adverse effects.’” The ADA strongly supports developing the published research on the latest generation of tobacco products and the short- and long-term effects of these products on oral health.

Last, but not last, there is a new report on smokeless tobacco. (4) Smokeless tobacco (ST) products present a multifaceted and extensive challenge to public health that has not been adequately addressed by researchers and policymakers. International tobacco control efforts have largely focused on cigarettes, and dedicated only limited attention to other types of products, including smokeless tobacco. This report addresses these issues.

References:
1. http://www.worldoralhealthday.com/fdi-calls-for-a-tobacco-free-new-year-and-a-long-lasting-smile-for-life/.
2. Jannat-Khah DP, McNeely J, Pereyra MR, et al. Dentists’ Self-Perceived Role in Offering Tobacco Cessation Services: Results From a Nationally Representative Survey, United States, 2010–2011. Prev Chronic Dis 2014; 11:140186. http://www.cdc.gov/pcd/issues/2014/14_0186.htm.
3. ADA News. December 5, 2014. http://www.ada.org/en/publications/ada-news/2014-archive/december/ada-comments-on-modified-risk-tobacco-products.
4. National Cancer Institute and Centers for Disease Control and Prevention. Smokeless Tobacco and Public Health: A Global Perspective. Bethesda, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute. NIH Publication No. 14-7983; 2014.http://tobaksfakta.se/wp-content/uploads/2014/12/SmokelessTobaccoAndPublicHealth_AGlobalPerspective.pdf.

December, 2014|Oral Cancer News|

Oral cancer on rise in young people

Source: www.wwltv.com
Author: Jaclyn Kelley

Alex Dupuy is like most 15-year-old boys, except for one very special talent. Last year he stole the headlines during a bowling tournament for bowling a perfect 300. But that high wouldn’t last long.

“My son came to us one day and said I have an ulcer, and we thought, OK, let’s gargle with some salt water and we kept checking on it and it never went away,” said Nancy Dupuy, Alex’s mother.

When the sore on Alex’s tongue never cleared up, but instead started growing, his mother became concerned and took him to see the doctor.

“It has grown so rapidly that I would really like to have the tumor or whatever it was removed,” she said.

Alex was taken to Children’s Hospital for surgery, and doctors removed the sore and 30 percent of his tongue. Three days later test results came back confirming the Dupuy’s worst fears: It was cancer.

“The word aggressive stuck out to me,” Nancy Dupuy said. “The type of cancer that my son presented with was an adult cancer. It’s not usually diagnosed in young children.”

The doctors said Alex had a rapid form of squamous cell carcinoma of the tongue. Four days later he and his parents were on a plane to MD Anderson Cancer Center in Houston.

Through it all, Alex managed to stay positive.

“I felt nervous, I felt scared and I told myself, I’ll be alright,” Alex said.

In Houston Alex would have yet another surgery before starting six weeks of intense radiation.

“We would wrap his neck because the neck would be burned. The skin, the tissue was burned when it would start to break down,” Nancy Dupuy said.

Dr. Paul Friedlander, the chairman for Tulane’s ear, nose and throat department, said the number of young people with oral cancer is on the rise.

“Most of the cancers we saw were smoking, alcohol related,” Friedlander said. “Right now we’ve seen an increase in a number of people who have not been exposed to cigarettes and alcohol that have these cancers.”

And he said that’s because of the human papaloma virus, or HPV. It’s an orally transmitted virus that he says is easy to get.

“These can be transmitted through oral sexual contact or something as innocuous as an open-mouth kiss,” Friedlander said.

Friedlander said early detection is key.

“If one does have a sore on their mouth, difficulty with swallowing, hoarseness or a neck mass that persists after two or three weeks, it’s a good idea to see your local doctor,” he said.

He recommends parents consider getting their teens the HPV vaccination, which doctors say can help prevent oral cancer.

It’s something Nancy Dupuy did with Alex and his brothers after his diagnosis.

“In our case it wasn’t HPV, but just the thought of oral cancer and that there is maybe something that could have prevented it is just really worth it in the end,” she said.

Several weeks of radiation would take its toll on Alex, but his family says it’s bowling that got him through it.

“On the good days, Alex would bowl and Alex would be in a world that was just perfect, and to me that was the most important thing that helped him get through six weeks of radiation,” Nancy Dupuy said.

Thank to early detection, Alex is now in remission.

“I always thank God I am cancer free.”

December, 2014|Oral Cancer News|