The Oral Cancer Foundation

Suicide Rates Among Oral Cancer Patients on the Rise

Source: Dr.Bicuspid.com

May 23, 2012 — Suicide rates among patients with oral cavity and oropharyngeal (OC/OP) cancer have increased significantly over the past three decades, particularly among male patients during the first year after diagnosis.

As many as half of patients with head and neck cancer suffer from depression, among the highest of all oncology patients (Clinical Advances in Hematology & Oncology, June 2009 Vol. 7:6, pp. 397-403). However, despite documented high rates of depression and suicide among patients with head and neck cancer, studies examining suicide and other noncancer-related deaths in patients with OC/OP have not been published.

Brian Hill

Brian Hill, executive director of the Oral Cancer Foundation, survived stage 4 bilateral cervical lymph node metastases from oropharyngeal cancer.

This gap prompted researchers from the New York Eye and Ear Infirmary, New York Medical College, and Peking University to analyze 32,487 patients with OC/OP cancer using the Surveillance, Epidemiology, and End Results cancer registry data for 1980-1984, 1990-1994, 2000-2003, and 2004-2007 (Archives of Otolaryngology-Head & Neck Surgery, January 2012, Vol. 138:1, pp. 25-32).

They found that from 1980-1984 to 2004-2007, deaths from suicide increased by 406.2% (p = .01), while cardiovascular disease-related and pneumonia-related deaths decreased by 45.9% (p < .001) and 42.9% (p = .009), respectively. Risk factors for mortality included age (55-64), marital status, advanced tumor stage, and tumor location.

The researchers also calculated standardized mortality ratios (SMRs) for suicide, cardiovascular disease, and pneumonia and compared them with patient demographic and clinical characteristics.

The risk of death from suicide or heart disease was highest during the first year after the cancer diagnosis and subsequently decreased with time, the researchers found. Compared with the general population, the increased risk of suicide was SMR 7.8 during the first year, SMR 3.7 during the second year, and SMR 2.5 during the third year.

Male-specific trend

Interestingly, during the three years after OC/OP cancer diagnosis, the researchers found no suicides among female patients, while 32 male patients took their lives.

Prior studies of the suicide risk among all patients with cancer have found similar rates among males and females, the study authors noted (Public Health Reports, Sept-Oct 2010, Vol. 125:5, pp. 680-688). When compared with males with prostate cancer, however, risk of suicide in male patients with OC/OP cancer was approximately five times higher in the first year after cancer diagnosis, the researchers noted.

“To be the subject of people’s stares, it is devastating to have that happen to you.”
— Brian Hill, executive director, Oral Cancer Foundation

Brian Hill, executive director of the Oral Cancer Foundation, had stage 4 bilateral cervical lymph node metastases when his OP cancer was discovered. He was not surprised by the study’s finding that only men committed suicide.

“Women are tough,” he told DrBicuspid.com. “Men are driven very much by our male egos, and part of having a cancer which deforms you and limits you in many ways is that it really impacts your ego.”

OC/OP cancer affects speech, swallowing, and breathing, as well as appearance, and can lead to devastating effects on quality of life, the study noted. For Hill, having the right side of his neck and the musculature in his mouth removed during surgery deeply affected him.

“There’s this whole thing about my image and who I am,” he explained. “You take away part of my face, take away part of my neck, take away my ability to speak distinctly, take away the things which I identify as me, and it changed my self-perception. For some people they’d rather not be alive. To be the subject of people’s stares — it is devastating to have that happen to you.”

Emotional support critical

Marital status also played a role in the study findings, with unmarried, divorced, and separated patients demonstrating a significantly higher risk than their married counterparts, the authors noted. Most of the men were aged 55-64 who never married or were divorced, separated, or widowed; had advanced tumor stages; and did not receive treatment.

For Hill, having the support of his wife was crucial in helping him cope with the disease. “I would not have gotten through it without her,” he said.

Counseling to help OC/OP cancer patients cope with the impacts of the disease is also critical, Hill added.

“This is a psychological journey you have to go on,” he said. “You need good intervention and good support from your family or our 8,000-member support group to cheer you on, encouraging you to get back out and be part of our community, find purpose in life.”

Increased recognition of major depression among patients with OC/OP cancer may create opportunities for psychiatric and/or pharmacologic intervention, the researchers concluded, leading to improved quality of life and, potentially, a reduction in suicide mortality.

Hill says antidepressants definitely helped him deal with his cancer and that more doctors should be aware of the psychological impacts of the disease.

“You’d be surprised how many oncologists are only interested in getting rid of the disease and don’t treat the human being,” he observed. “I wanted to put my head in the oven too at some points, and if it hadn’t been electric I would have.”

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

Actor’s Diagnosis Puts Spotlight on Oral Cancer

Source: DrBicuspid.com

May 9, 2012 — Actor Michael Douglas’ recent revelation that he has stage IV oropharyngeal cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations.

The actor’s cancer includes a walnut-sized tumor at the base of his tongue, and he will require radiation therapy, chemotherapy, and surgery. Douglas says his doctors told him he has an 80% survival rate if it hasn’t spread to his lymph nodes.

While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to the human papillomavirus (HPV). There are approximately 130 versions of HPV but only nine cause cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation.

“Tobacco is no longer the only bad guy,” he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it continues on this trend line, it will replace tobacco as the primary cause of oral cancers.”

Dentists can play a key role in catching the disease in its early stages if they check for it during examinations, Hill pointed out. “But many dentists think it’s such a rare disease that they don’t bother to screen for it,” he said. “Most Americans have never even heard of oral cancer, but it’s not as rare or uncommon as people would like to think it is. This is why an opportunistic screening by the dental community is so important.”

Hill, a nonsmoker, got the same diagnosis as Douglas in 1998 and underwent radiation therapy, chemotherapy, and surgery. Since Hill’s oral cancer had metastasized to both sides of his neck by the time it was discovered, surgeons removed the right side of his neck to remove the lymph nodes there. He has been cancer-free for 10 years and said there are a lot of stage IV survivors out there.

“I’m on this side of the grass and that’s all that’s important,” he said, adding with a laugh, “I’m not pretty, but I’m still here.”

Changing demographics

Oral cancer screening tipsAccording to the Oral Cancer Foundation, an oral cancer screening includes a systematic visual examination of all the soft tissues of the mouth, including manual extension of the tongue to examine its base, a bimanual palpation of the floor of the mouth, and a digital examination of the borders of the tongue, and examination of the lymph nodes surrounding the oral cavity and in the neck.”Any sore, discoloration, induration, prominent tissue, irritation, or hoarseness that does not resolve within a two-week period on its own, with or without treatment, should be considered suspect and worthy of further examination or referral,” the foundation’s website states.The website also offers a more complete oral cancer screening protocol and a photo gallery showing various forms oral cancer can take.

In the last decade, the demographics of oral cancer have changed dramatically, according to Hill and other experts, pointing to the sexual revolution and accompanying increase in the prevalence of oral sex. Today almost half of those diagnosed with the disease are younger than 50 years old — with some as young as 20, according to Hill — and they are usually nonsmokers. According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer. The incidence in oral cancer patients younger than age 40 has increased nearly fivefold, with many patients with no known risk factors, according to the ADA.

“Social and sexual behaviors have changed,” Hill said. “Oral sex is more common. The virus is spreading, especially among young people because sexual contact is more common, and this virus is not only ubiquitous in our society, but the mechanism of transfer is very simple.”

Until 2000, scientists were unsure if HPV caused oral cancer, Hill said, but definitive research in 2000 revealed it as a distinct etiology for the disease, and more recent studies have supported this finding.

The disease is dangerous because often there are no symptoms in the early stages that a person might notice. “It’s a very insidious disease,” Hill explained. He recalled that it was not until a lymph node became swollen that Hill realized something was wrong. Even then, it was not painful, he said.

But an alert dentist will notice subtle signs and symptoms in a simple three to five minute visual and tactile exam, Hill noted. “There will be things he’ll pick up on, and that’s why we’re urging that the dental community to become more involved in oral cancer screening,” he said.

Approximately 36,000 new cases of oral cancer are diagnosed each year in the U.S., according to the ADA, and some 25% of those people will die of the disease. Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis, Hill said. Approximately 100 people in the U.S. will be diagnosed with oral cancer every day, he added, and one person will die every hour from it.

And when celebrities get oral cancer, it helps bring about much needed public awareness about the disease, said Hill, noting that, in addition to Michael Douglas, such luminaries as Sigmund Freud and Ulysses S. Grant have been among its victims.

“When somebody famous gets the disease, it finally gets the world’s attention,” he noted.

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

May, 2012|Oral Cancer News|

Study: Oral cancers take financial toll

Source: Dr.Biscuspid.com

April 26, 2012 — The cost of treating individuals with oral, orapharyngeal, and salivary gland cancers is significant, particularly for patients who undergo all three forms of treatment, according to a new study by Delta Dental of Michigan’s Research and Data Institute. And for many that is only the beginning of the financial impact of the disease.

The project, which involved Thomson Reuters, Delta Dental of Wisconsin, Vanderbilt University, and the University of Illinois at Chicago College of Dentistry, began in March 2010. It is the first retrospective data analysis of a large number of head and neck cancer patients in the U.S. analyzing direct and indirect costs and comparing those costs to a matched comparison group, according to the authors (Head Neck Onc, April 26, 2012).

Using data from the 2004-2008 Thomson Reuters MarketScan Databases: Commercial Claims and Encounters Database, Medicare Supplemental and Coordination of Benefits Database, Medicaid Multi-State Database, and the Health Productivity and Management Database, the researchers retrospectively analyzed claims data of 6,812 OC/OP/SG patients with employer-sponsored health insurance, Medicare, or Medicaid benefits.

They found that, on average, total annual healthcare spending during the year following diagnosis was $79,151, compared with $7,419 in a group comprising similar patients without these cancers. They also found that the average cost of care almost doubled when patients received all three types of treatment: surgery, radiation, and chemotherapy.

Healthcare costs were higher for oral cancer patients with commercial insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303), and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01), the study found. Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of care, from $96,520 in the Medicare population to $153,892 in the commercial population.

“The results of this research are significant in helping us to fully understand the cost burden of these three particular head and neck cancers on patients and health care providers,” stated Jed Jacobson, DDS, MS, MPH, chief science officer at Delta Dental and a lead contributor to the study, in a press release. “To our knowledge, this is the first study of its kind.”

One of the big problems with oral cancer is that it is uncovered so late in the disease that the chances of survival are terrible, he added.

“So the key is early detection and diagnosis,” Dr. Jacobson said. “In the last decade, we have seen a flurry of activity in new science and technology with the promise of being able to find it earlier. The problem is, should I as a purchaser of healthcare buy this benefit? The answer is often return on investment: if I spend a dollar on this new technology, do I save anything relative to finding the cancer earlier? So we need to know what oral cancer costs.”

Social, psychological, economic impact

The project examined other factors also, including:

  • Indirect costs associated with these cancers from diagnosis, treatment, and recovery, such as absenteeism, worker productivity, and the disabling and disfiguring side effects of treatment
  • The cost burden of oral cancer on taxpayers who fund Medicaid and Medicare
  • The comparative value of preventive care for these oral cancers versus treatment

“Most oral cancers require costly and disfiguring medical intervention, and even then the five-year survival rate is approximately just 60%,” Dr. Jacobson said. “Yet when the cancer is detected early, the survival rate increases to 83%. This study allows us to get a better handle on the cost impact these diseases have and how we can combat them better.”

Head and neck cancers have always piqued the interest of health care providers, patients, and insurers because of the high-morbidity, high cost of care, and high-mortality rates associated with them. Yet, it has largely remained an unexplored area when it comes to research and backing up these conclusions.

“The actual study of the social, psychological, and economic impacts of these cancers has been understudied,” states Dr. Joel Epstein, former professor of oral medicine and diagnostic sciences at the University of Illinois in Chicago, now adjunct professor, director of oral medicine at City of Hope in Duarte, CA. “These are the reasons we decided to conduct this important research and be able to shed more light on the cost burden of treating head and neck cancer.”

By including screening as part of regular dental exams, dentists and hygienists have the opportunity to detect these cancers early, decreasing morbidity and mortality, the study authors noted. In addition, educational programs to raise awareness among health care providers and programs instructing individuals on self-examination may result in earlier detection and greatly reduce the high cost and mortality of oral and head and neck cancers.

“The information [in this study] will be a great asset in determining the cost-effectiveness of any new technologies and early detection systems that could potentially help decrease costs, and more importantly, lower the mortality rate of these cancers down the road,” Dr. Jacobson concluded.

However, while the findings of this study are important, it does not address the additional financial burden many oral cancer survivors face after treatment, noted Brian Hill, executive director of the Oral Cancer Foundation.

“If you look at the financial consequences in this economy, by not finding this disease early, the morbidity associated with treatments is significant,” he told DrBicuspid.com. “But also, treatment is just the beginning of the financial cascade of events. There are larger consequences to the economy. It isn’t just about survival, but other long-term consequences insurance wise, personally, and at the government level also due to long-term disability.”

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

Oral cancer on the rise in the US; Americans unaware of major risk factors

Source: Dental Tribune

NEWPORT BEACH, Calif., USA: New research conducted on behalf of the Oral Cancer Foundation has found that many Americans are unaware of the fact that the human papillomavirus (HPV), a sexually transmitted virus, is the fastest-growing risk factor for oral cancer. The data supports the current consensus that awareness of oral cancer and early discovery measures is low, and that most Americans do not recognize that the profile of the oral cancer patient has evolved from heavy smokers and drinkers to anyone who is sexually active.

According to the OCF, approximately 40,000 Americans will be newly diagnosed with oral cancer in 2012. This is the fifth consecutive year in which there has been an increase in the incidence rate of the dangerous disease. Oral cancer is often caught in the late stages, when the five-year survival rate is less than 50 percent. When diagnosed in the early stages of development, oral cancer patients have an 80 to 90 percent survival rate.

The results of the national survey, conducted by market research consultancy Kelton among a representative sample of 1,024 Americans aged 18 and over, indicated that more than four in five Americans know that smoking (83 percent) and chewing tobacco (83 percent) are risk factors. However, the survey also revealed that they remain in the dark about other potential causes of oral cancer, including alcohol consumption and HPV, the most common sexually transmitted infection.

The survey showed that women tend to be slightly more aware of the risk factors of oral cancer than men. Forty percent of women and 33 percent of men correctly recognize alcohol consumption as a risk factor for oral cancer, but less than 30 percent of both sexes realize that a sexually transmitted virus is a causative factor for the disease.

“Oral cancer takes the life of one person an hour and for those who do survive, it can be severely disfiguring and debilitating,” said Brian Hill, founder and executive director of the OCF and a stage-four oral cancer survivor. “It’s one of the few types of cancer that hasn’t experienced a significant decline in fatalities over the past several decades. To reverse this trend, we need to create awareness that virtually everyone over the age of 18 is potentially at risk and hence in need of an opportunistic annual oral cancer screening.”

According to Hill, because people are not aware of the risk factors, they do not take a proactive approach to screening and early detection of oral cancer, which has a high survival rate if diagnosed early.

OCF is currently organizing an extensive effort to promote Oral Cancer Awareness Month in April and to encourage dental and medical practices throughout the U.S. and Canada to offer free oral cancer screenings during the month. Several companies and organizations are co-sponsoring OCF’s efforts, including LED Dental, manufacturer of the VELscope Vx oral cancer screening system. The OCF survey was funded in part by the company.

A summary of the recently released survey, “Americans’ appreciation for their mouth overshadowed by their lack of awareness of oral cancer”, is available at www.oralcancer.org/study. The survey document includes detailed information about specific risk factors, as well as a summary of the survey results. The breakout report, which includes the survey questions and detailed answers, is also available on the same webpage.

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

April: Oral Cancer Awareness Month

Source: Aspen Dental

April is Oral Cancer Awareness Month. According to Brian Hill, founder and executive director of the Oral Cancer Foundation, as many as 40,000 people in the United States will be told they have oral or pharyngeal cancer in 2012. Some of them may be sitting in your dental chair today. With one person dying of oral cancer every hour of every day, and more than 50% of those diagnosed not living more than 5 years, this is a reminder to screen every patient yourself, and encourage your dental hygiene staff to do the same.

The Statistics

About 100 people are diagnosed with oral cancer every day in the United States. Few people are aware that the death rate for oral cancer is higher than for many other types of cancers, which is because oral cancer often is not discovered until it has reached later stages. This is particularly true for human papilloma virus number 16 (HPV16)-related oral cancer, which occurs most frequently in the posterior areas of the mouth—at the base of the tongue, around the tonsils, and in the oropharynx—where it’s harder to spot without a very thorough exam. To further complicate things, HPV16-related cancer does not always present the tell-tale physical characteristics, including lesions, that are easily distinguished from healthy oral tissues. This is not good news, because HPV16 has reached epidemic levels in the United States: of the 37,000 incidences of oral cancer, about 20,000 (up to 60%) can be linked to HPV, according to Hill.

Oral cancer accounts for 85% of the cancers grouped under “head and neck” cancers. If the number of larynx cancer cases (for which the historic risk factors; tobacco and alcohol are the same) is added to the oral cancer category, we’re now talking 50,000 people diagnosed yearly and 13,500 deaths per year in this country. More than 640,000 new cases occur worldwide annually. These stats do not include brain cancer, which is its own category.

“Late discovery and misdiagnosis are the biggest problems,” Hill says. “I’m a very typical example of this.” Hill was misdiagnosed with an infection by a physician when a painless lump appeared on the side of his neck. When it had not resolved after a course of antibiotics, Hill, who had a background in dentistry, insisted on having a needle aspiration biopsy. Testing resulted in a diagnosis of HPV16-related squamous cell carcinoma, a very deadly cancer. Fourteen years after extensive surgery, and both radiation and chemotherapy, he has since heard from literally thousands of people that they were misdiagnosed more than once, told not to worry about it, or were merely given antibiotics. “Why are so many people diagnosed late?” Hill asks. “Because, according to one study,probably under 20% of dentists are performing oral screenings.” 1 Another problem is that public awareness about oral cancer, its early signs and symptoms, and its changing etiology, is low. Additionally, oral cancer has historically been linked to long-term tobacco use and high alcohol consumption (or a combination of both), with associated lesions usually seen in the anterior areas of the oral cavity. With the prevalence of HPV16-related oral cancer increasing at an alarming rate, and tobacco-related cancers on the decline, it is critical that dental and medical professionals re-educate the public to understand the current risk factors and the need for an annual professional screening.

The Impact of HPV16

It was reported in 2009, before the advent of HPV-related cancers, that oral cancer incidence rates were more than twice as high in men as in women, and both were on the decline.2 That was before HPV-infected individuals became the fastest growing segment of the oral cancer population. HPV16 is a human papillomavirus related to more than 150 other HPV versions, over 40 of which can be easily sexually transmitted.3 Nine of these are known to be cancer causing. HPV’s were directly linked to cervical cancer, also squamous cell carcinoma, which was the number one killer of women in 1948. “Using the cervical cancer model, once ‘opportunistic’ screening and PAP testing became routine, the cervical cancer death rate dropped 71% in 10 years,” Hill notes. “We have no ‘viruscide’. But we do have an HPV vaccine that can be administered before young people become sexually active.” This is important information to share with patients, because 50%-80% of Americans will have HPV in their lifetime according to the Center for Disease Control and Prevention (CDC). About half of all men and more than 3 out of 4 women will be diagnosed with it at some point.4

Detection vs Diagnosis

Signs and symptoms or oral cancer, if there are any, range from a sore area or lesion that bleeds easily, a lump or thickening of tissues in the mouth or neck, ear pain, indurations or hard spots in the mucosa, or a red or white patch or ulceration that does not resolve within 2 weeks. If any of these are evident, the patient should return within 7-14 days to confirm either persistence or resolution. Later symptoms include difficulty chewing, swallowing, and/or moving the tongue or jaws.2

Early stage (1 and 2) lesions, which may not be readily evident during a routine exam, usually are asymptomatic and often mimic other conditions.5 It is important for dentists to acknowledge that malignant and benign lesions are virtually indistinguishable clinically, and their biological relevance cannot be assessed based on their appearance.5 Most resources advise referring any persistent abnormalities to a specialist. “We have a highly defined referral system in dentistry,” Hill points out. “You don’t have to learn anything new; you don’t have to be the expert. You just have to refer suspect tissues up the professional chain for proper evaluation/biopsy. There are many kinds of oral lesions. You may see only 3 cancer cases in 20 years of practicing dentistry, but every time you find something, especially in stage 1 or 2, you have the opportunity to save a life. Dentists are the first line of defense.”

The American Cancer Society estimated in 2009 that almost 90% of oral cancers are squamous cell carcinomas, and more than 97% of these cancers occur in adults 35 years and older.5 People ranging in age from 25-50 who never smoked are the fastest growing group being diagnosed with HPV16-related oral cancer.6

Standard treatment usually involves radiation therapy and surgery, and often chemotherapy.2 Relative survival rates vary by stage at the time of diagnosis—in 2009, about 83% survived 1 year after diagnosis, 60% 5 years after diagnosis, and 49% after 10 years.2 However, today, the 5-year survival rate is only about 57% when you include all stages of the disease at time of discovery. This high death rate is directly tied to late discovery, when treatments are less effective.7 Studies reveal that oral and pharyngeal cancer are diagnosed at a localized stage in only one-third of patients in the United States.5 It’s time to make a difference.

The Oral Cancer Foundation

The Oral Cancer Foundation (OCF) is a national public service, non-profit organization dedicated to oral cancer prevention, education, research, advocacy, and patient support activities. Its website, www.oralcancerfoundation.org, provides vetted information about rates of occurrence, risk factors, signs and symptoms, treatments, current research, complications, nutrition, clinical trials, related news, links to other sources, and treatment institutions. A free, anonymous, 8700-member patient/survivor discussion forum is open to the public, providing insights and inspiration. OCF also has a free RSS oral cancer news feed you may subscribe to which is updated several times a week. OCF is a valuable resource for patients, students, and practicing medical and dental professionals.

Visit oralcancerfoundation.org to learn of its Oral Cancer Awareness Month initiatives (such as hosting a free screening event in April), and find information to share with your patients.

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

Studies underscore genetic complexity of head and neck squamous cell cancers

Source: Dentistry IQ

By Maria Perno Goldie, RDH, MS

While we should be screening patients for oral and pharyngeal cancer daily, April has been designated as the month when we highlight this disease, and increase awareness about its prevention and treatment.

Powerful new technologies that pinpoint the connections between human genes and diseases have clarified the background of cancer, singling out changes in tumor DNA that force the development of certain types of malignancies. Several major biomedical centers have collaborated to study head and neck squamous cell cancer. Their large-scale analysis has revealed a surprising new set of mutations involved in this disease.

The studies underscored the genetic complexity of head and neck squamous cell cancers. Two independent, multi-institution research teams identified a large number of genetic defects associated with head and neck squamous cell carcinoma (HNSCC), the most common form of head and neck cancer. The researchers sequenced the entire protein-coding regions, or exomes, of the DNA in dozens of patient tissue samples.(1,2)

Tobacco use, excessive alcohol consumption, and human papillomavirus (HPV) infection are known risk factors for HNSCC, including cancers occuring in the mouth and throat. The 5-year survival rate for many types of HNSCC has improved little over the past 40 years.

According to the authors, the degree of differentiation, or tumor cell grade, has never consistently been shown to be a clinical prognostic factor in HNSCC. They said it was surprising to find mutations in a series of genes that appear to contribute to differentiation.

Both studies found far fewer mutated genes in HPV-positive tumors than in HPV-negative tumors, supporting the idea that HPV-positive HNSCC, which has a better prognosis, is a distinct disease and thus merits different treatment.

Head and neck cancer has complex biology with many forms, and is not one disease. It’s many diseases, despite appearing identical under the microscope.

Human Papillomavirus (HPV)

The prevalence of HPV infections in the oral cavity is significantly higher among men than women in the United States, according to a study from researchers at Ohio State University and NCI’s Division of Cancer Epidemiology and Genetics (DCEG). Oral HPV infections have been associated with oropharyngeal cancer, subset of head and neck cancers that arise in the back of the tongue, throat, and tonsils, rates of which have risen dramatically over the last several decades. The study is the first to comprehensively document the prevalence of oral HPV infections in men and women in the United States. Overall, approximately 7 percent of people between the ages of 14 and 69 have an oral HPV infection. The prevalence of oral infections is much lower than that of infections in the genital tract. About 1 percent of the population has an oral infection with HPV 16, a type that is linked to cancer.(3)

HPV Virus

Using data from the National Health and Nutrition Examination Survey (NHANES), the researchers studied nearly 5,600 men and women ages 14 to 69, who provided an oral rinse and mouthwash gargle samples.(4) The most common subtype of HPV in the oral cells of study participants was HPV 16, the HPV type that is responsible for more than half of all oropharyngeal cancer cases.(3)

Oral HPV infections were three times more common in men than in women (10.1 percent versus 3.6 percent), with older men having the highest rates. Oral infections with HPV 16 were seen in 1.6 percent of men and 0.3 percent of women. The prevalence of HPV infections was highest among people who smoke at least a pack a day and those with more than 20 lifetime sexual partners.(3) HPV-related head and neck cancers are much more common among men than women. The higher oral HPV infection rates in men, in particular the over fivefold higher prevalence of HPV 16 among men compared to women, likely explains the discrepancy, according to the study authors.(3).

On October 25, 2011, U.S. vaccine advisers voted to recommend that boys be routinely vaccinated with Merck & Co.’s Gardasil vaccine to protect them from human papillomavirus or HPV infections, which cause genital warts and oral, penile, and anal cancers in males and cervical cancers in women.(5) The Advisory Committee on Immunization Practices, which advises the U.S. Centers for Disease Control and Prevention, voted unanimously to recommend routine use of Gardasil in 11- and 12-year-old boys to fight the sexually transmitted virus, with 13 yes votes and one abstention. (6)

Previously, the CDC has said doctors are free to use the vaccine in boys but it has did not go as far as recommending routine vaccination. The CDC also recommends HPV vaccinations made by Merck and GlaxoSmithKline for girls and women between the ages of 11 and 26.(5)

The CDC said in a statement the HPV vaccine will afford protection against certain HPV-related conditions and cancers in males, and vaccination of males with HPV also may provide indirect protection of women by reducing transmission of HPV. The CDC experts advised the panel there is no evidence the vaccine can cause “mental retardation,” a concern raised in a Republican presidential candidate debate. The vaccine costs $360 for a course of three shots.

Some experts acknowledge there may be concerns about the use of this vaccine in children. However, they say that if there is concern about vaccinating children against a potential sexually transmitted disease in the future, consider that we regularly vaccinate children against diseases that primarily occur in adults. Most people eventually get HPV infection, albeit it may not be a cancer-causing strain. However, once you get the infection, the vaccine does not help.(6) For more information on HPV and oral cancer, visit The Oral Cancer Foundation website.(7)

New Throat Cancer Gene Uncovered

Researchers at King’s College London and Hiroshima University, Japan, have identified a specific gene linked to throat cancer following a small genetic study of a family with 10 members who have developed the condition.(8) The researchers discovered a mutation in the ATR (ataxia telangiectasia and Rad3 related) gene, demonstrating the first evidence of a link between abnormality in this gene and an inherited form of cancer. The researchers say this finding raises new ideas about genetic factors linked to throat cancer and provides a platform for exploring the role of ATR more generally in cancer biology. They conducted a genome-wide linkage study in a U.S. family with an unusual hereditary condition affecting 24 members of the family over five generations.

Characteristics include developmental abnormalities of hair, teeth and nails as well as dilated skin blood vessels. Remarkably, nearly every person with the condition involved in the study had developed throat cancer (oropharyngeal squamous cell carcinoma) in their 20s or 30s. After analyzing blood samples, the scientists found that a single mutation in ATR was present in all the people with the condition, but none of the unaffected people had the mutation. Ten of the 13 people with the condition had developed throat cancer.(8) They plan to investigate the cancer pathways in more detail to try to find new treatments.

Squamous cell carcinoma

In summary, screen all patients for oral cancer!

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

Discussing the Horrors of Oral Cancer with Two Survivors

Source: Dentistry IQ

Mar 14, 2012

By Kevin Henry

Managing Editor, Dental Economics

Editor’s Note: I recently had the chance to talk with Christine Brader, a former smoker and three-time oral cancer survivor who lives in Allentown, Pa. She is a volunteer senior patient advocate and a board administrator for the Oral Cancer Foundation. For nearly five years, Brader has been active with the Oral Cancer Foundation’s online public forum. She devotes several hours a day to compassionately helping oral cancer patients with information and support. I discussed her battle against oral cancer as well as her current push to get more dental offices involved in the war against the disease.

Brader and Eric Statler (interviewed later in this article) will be featured on the April cover of Dental Economics.

Kevin Henry: You survived oral cancer three times. How were you able to overcome?

Christine Brader: There aren’t very many three-time cancer survivors out there, especially when we are talking about oral cancer. I believe God saved me for my children. I wasn’t going to do any kind of surgery because I really didn’t think I was going to survive the third round of oral cancer within three years. I knew the surgery would be bad; I was Stage IV and needed my jaw removed. I knew I would probably end up disfigured. It’s hard to do something when you know your looks are going to be gone overnight and you’re not guaranteed that you will survive, but I knew I had my children depending on me. I had to at least try for them.

Henry: Talk about your recovery.

Brader: I was in a medically induced coma for three weeks and in the hospital for two months. My body rejected the titanium jaw and the surgery had to be redone. Every day when I woke up, I cried. Even with medication, the pain was almost unbearable. I was really messed up; even my mind didn’t work quite right. A husband of one of my friends had gone through this same surgery. I asked her why she hadn’t warned me that the surgery and recovery were going to be as bad as they were. She told me she didn’t because she knew I wouldn’t go through with it if she had. I was in agony and all pieced together. It was important for me to survive for my kids. I was the only parent they had. It took me a full year to recover from my surgery.

Henry: You’re involved with the Oral Cancer Foundation and local fund-raising efforts in the battle against oral cancer. What are you doing to educate dentists on what you’ve been through?

Brader: My goal is to get to every one of the 200 local dental offices and set up free oral cancer screenings in many of them. I’m very persistent and very passionate about this, so I don’t mind asking dental offices to be part of this. Before my surgery, I was shy and quiet. Now I’m a chatterbox.

When I go into a dental office, I tell them I am a three-time oral cancer survivor and I am a representative of the Oral Cancer Foundation. I tell them how important it is to do the oral cancer screenings on every single patient. If people ask me about my face while I am out in public, I am happy to have the opportunity to tell them about oral cancer and the importance of getting regular oral cancer screenings. When people see with their own eyes what oral cancer can do, then they can truly understand how horrible it is. This is why it’s so important for me to go out and speak with dental professionals face to face. Along with asking for free oral cancer screenings, I also ask for donations to the Oral Cancer Foundation.

Henry: What’s your main message when you talk to a dentist or dental team member?

Brader: I want to tell all of them that oral cancer is a fast-moving and deadly disease. Dental offices really are the front line in this battle. It takes just a minute to do a screening. It’s so important to catch the cancer early when it’s easier to treat. Only about 50% of the people who are diagnosed with oral cancer will still be alive in five years. I believe oral cancer screenings should be a part of the regular checkup, and dental offices should be educating their patients. We don’t want to scare patients, but they also need to know that sometimes a canker sore may not be just a canker sore. If it isn’t caught early, that little “canker sore” might kill you. Lately, there are many younger people being diagnosed with oral cancer who don’t fit the usual criteria; some are HPV+ and others have no known cause. I know what caused my oral cancer; I was stupid and smoked. Now I have to eat with a feeding tube. I know how lucky I am to still be alive, which is the most important thing.

Henry: But you’re also finding that many dental practices still aren’t doing any kind of oral cancer screening, correct?

Brader: I’ve asked so many people I have randomly met if their dentist has ever checked them for oral cancer, and no one has ever said yes. People are still very unaware of oral cancer, and I think that includes dentists as well. How can they not know about it? I do think dentists know, but it’s far back in their minds when they are talking to patients. It’s time that it becomes a part of every checkup in every practice.

Editor’s Note: I also had the chance to talk to Eric Statler, a Stage IV oral cancer survivor who now serves as the Director of Strategic Partnerships for The Oral Cancer Foundation. I discussed his battle against oral cancer and the message he is trying to spread about the link between HPV and oral cancer.

Henry: What would you say to dental professionals about the importance of screening for oral cancer in their practice?

Eric Statler: Honestly, I wouldn’t have to say much. My face really says it all. When I went through my oral cancer surgery, I lost everything. I can’t kiss my wife. My diet is 99 percent liquid. I still remember how good food tastes, but I can’t enjoy it because I don’t want to take a chance on choking. It’s been four years, and I’m just now starting to get my life back together.

People can read about oral cancer in a book and see the pictures and it may not make much of an impact. But when you meet a survivor, that’s when oral cancer becomes real. People just don’t seem to understand that half of those diagnosed with oral cancer die, and many survivors are left severely disfigured. It doesn’t have to be that way.”

Henry: Talk about your thoughts when you first heard you had oral cancer.

Statler: My first thought was my family. I had a 4- and 7-year-old at the time, and I was worried about them and my wife. I was really in disbelief. I didn’t smoke or use tobacco. I rarely drank. My oral cancer came from HPV (Human papillomavirus) and I was diagnosed on January 23. It could’ve been diagnosed much earlier when I went to the dentist with what I thought was pain from wisdom teeth in August.

Henry: Your oral cancer came from HPV, which is contracted through unprotected sex and oral sex. That’s a tough discussion for many dental professionals to have because it’s uncomfortable to talk about the link between oral sex and oral cancer. What’s your thought on that?

Statler: What’s more comfortable for you? Talking to a patient about the link and/or handing them a brochure or telling a patient he or she has oral cancer? The latest statistic I’ve seen is that 80 percent of women by the age of 60 will have a strain of HPV. Dentists are medical professionals. Why wouldn’t you talk to your patients about it? It’s your responsibility.

Henry: Talk about your work with the Oral Cancer Foundation.

Statler: I found OCF 11 months after my diagnosis. I was going through my treatment and surgery and was able to plug in and talk to other people who had been through oral cancer. Now I want to help others and raise awareness about how horrible oral cancer is. I want to inspire people to focus what they should already be focusing on, and that’s finding oral cancer early.

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

The Oral Cancer Foundation Helps Sponsor HPV/Oral Cancer Study

Source: Jada.org

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

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

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

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

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

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

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

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

Michael Douglas Continues to Put Oral Cancer in the Spotlight

Source: Dr.Biscupid.com

Actor Michael Douglas’ recent revelation that he had stage IV oropharyngeal cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations.

The actor’s cancer included a walnut-sized tumor at the base of his tongue,  requiring radiation therapy, chemotherapy, and surgery. Douglas says his doctors told him he had an 80% survival rate if it hadn’t spread to his lymph nodes.

While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to the human papillomavirus (HPV16). There are approximately 130 versions of HPV but only nine cause cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation.

“Tobacco is no longer the only bad guy,” he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it continues on this trend line, it will replace tobacco as the primary cause of oral cancers.”

Dentists can play a key role in catching the disease in its early stages if they check for it during examinations, Hill pointed out. “But many dentists think it’s such a rare disease that they don’t bother to screen for it,” he said. “Most Americans have never even heard of oral cancer, but it’s not as rare or uncommon as people would like to think it is. This is why an opportunistic screening by the dental community is so important.”

Hill, a nonsmoker, got the same diagnosis as Douglas in 1998 and underwent radiation therapy, chemotherapy, and surgery. Since Hill’s oral cancer had metastasized to both sides of his neck by the time it was discovered, surgeons removed the right side of his neck to remove the lymph nodes there. He has been cancer-free for 10 years and said there are a lot of stage IV survivors out there.

“I’m on this side of the grass and that’s all that’s important,” he said, adding with a laugh, “I’m not pretty, but I’m still here.”

Changing demographics

In the last decade, the demographics of oral cancer have changed dramatically, according to Hill and other experts, pointing to the sexual revolution and accompanying increase in the prevalence of oral sex. Today almost half of those diagnosed with the disease are younger than 50 years old — with some as young as 20, according to Hill — and they are usually nonsmokers. According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer. The incidence in oral cancer patients younger than age 40 has increased nearly fivefold, with many patients with no known risk factors, according to the ADA.

“Social and sexual behaviors have changed,” Hill said. “Oral sex is more common. The virus is spreading, especially among young people because sexual contact is more common, and this virus is not only ubiquitous in our society, but the mechanism of transfer is very simple.”

Until 2000, scientists were unsure if HPV caused oral cancer, Hill said, but definitive research in 2000 revealed it as a distinct etiology for the disease, and more recent studies have supported this finding.

The disease is dangerous because often there are no symptoms in the early stages that a person might notice. “It’s a very insidious disease,” Hill explained. He recalled that it was not until a lymph node became swollen that Hill realized something was wrong. Even then, it was not painful, he said.

But an alert dentist will notice subtle signs and symptoms in a simple three to five minute visual and tactile exam, Hill noted. “There will be things he’ll pick up on, and that’s why we’re urging that the dental community to become more involved in oral cancer screening,” he said.

Approximately 37,000 new cases of oral cancer are diagnosed each year in the U.S., according to OCF, and some 43% of those people will die of the disease. Only 57% of all diagnosed oral cancer patients (considering all stages at time of discovery) will be alive five years after their diagnosis, Hill said. Approximately 100 people in the U.S. will be diagnosed with oral cancer every day, he added, and one person will die every hour from it.

And when celebrities get oral cancer, it helps bring about much needed public awareness about the disease, said Hill, noting that, in addition to Michael Douglas, such luminaries as Sigmund Freud, Babe Ruth, Beatle George Harrison, and Ulysses S. Grant have been among its victims.

“When somebody famous gets the disease, it finally gets the world’s attention,” he noted.

Oral cancer screening tips

According to the Oral Cancer Foundation, an oral cancer screening includes a systematic visual examination of all the soft tissues of the mouth, including manual extension of the tongue to examine its base, a bimanual palpation of the floor of the mouth, and a digital examination of the borders of the tongue, and a tactile examination of the lymph nodes surrounding the oral cavity and in the neck.

“Any sore, discoloration, induration, prominent tissue, irritation, or hoarseness that does not resolve within a two-week period on its own, with or without treatment, should be considered suspect and worthy of further examination or referral,” the foundation’s website states.

The website also offers a more complete oral cancer screening protocol and a photo gallery showing various forms oral cancer can take. It can be accessed at www.oralcancer.org

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

Glowing Cornell Dots Target Cancer

SOURCE: Journal of Clinical Investigation, June 13, 2011

(Ivanhoe Newswire)– New medical technology is showing that Cornell dots may be a potential cancer diagnostic tool. The U.S Food and Drug Administration (FDA) has recently approved the first clinical trial in humans using Cornell Dots- brightly glowing nanoparticles that can light up cancer cells in PET-optical imaging.

Cornell Dots are silica spheres less than eight nanometers in diameter that enclose several dye molecules. To make the dots stick to tumor cells, organic molecules that bind to tumor surfaces, or even specific locations within the tumors, can be attached to a polyethylene glycol shell. This shell, also referred to as PEG, prevents the body from recognizing the dots as foreign substances. When exposed to near-infrared light, the dots fluoresce much brighter than dye to serve as a beacon identifying the target cells. Researchers say this technology enables visualization during surgical treatment.

Cornell Dots were first developed in 2005 by Hooisweng Ow, a coauthor of the paper on this study and once a graduate student working with Ulrich Wiesner, Cornell Professor of Materials Science and Engineering. Ow and other researchers of this technology are currently in the process of forming a new commercial entity in New York City that will help transition this research into commercial products that will benefit cancer patients.

Michelle S. Bradbury, M.D, of the Memorial Sloan-Kettering Cancer Center and an assistant professor of radiology at Weill Cornell Medical College, was quoted as saying, “This is the first FDA IND approved inorganic particle platform of its class and properties that can be used for multiple clinical indications as well as cancer disease staging and tumor burden assessment via lymph node mapping.”

Scientists are able to perform real-time imaging of lymphatic drainage patterns and particle clearance rates as well as sensitivity, to detect nodal metastases. Nodal mapping is also being pursued which is expected to lead to another clinical trial in humans.

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

 

June, 2011|Oral Cancer News|