throat cancer

Cancer-Preventing Vaccines Given To Less Than Half Of US Kids

Author: Carrie Feibel

U.S. regulators approved a vaccine to protect against the human papilloma virus (HPV) in 2006, but cancer experts say misconceptions and stigma continue to hamper acceptance by both doctors and parents.

Eighty percent of Americans are exposed to the human papilloma virus in their lifetimes. Some strains of HPV can cause genital warts, but most people experience no symptoms and clear the virus from their systems within a year or two. But for an unlucky minority, the virus causes damage that, years later, leads to cervical cancer, throat cancer, and other types.

Researchers at MD Anderson are frustrated that ten years after the first vaccine arrived on the market, only 42 percent of U.S. girls, and 28 percent of boys, are getting the three-shot series.

The series can be given to girls and boys between the ages of 9 and 26, but the immune response is strongest at younger ages, before sexual activity begins.

n 2007, then-Texas governor Rick Perry proposed making the HPV vaccine mandatory for all preteen girls.  At the time, the vaccine was only approved and marketed for girls.

Dr. Lois Ramondetta, a cervical cancer specialist at MD Anderson, remembers the outcry.

“A lot of people felt that was the right idea, but the wrong way to go about it. Nobody really likes being told what to do, especially in Texas,” Ramondetta said. “I think there was a lot of backlash.”

Eventually, the legislature rejected Perry’s plan, even though it included an opt-out provision. Ramondetta said too many politicians focused on the fact that HPV is sexually transmitted. That had the unfortunate effect of skewing the conversation away from health care and into debates about morality and sexuality. She said the best and most accurate way to discuss the vaccine is to describe it as something that can prevent illness and death.

“I try to remove the whole concept of sexuality,” Ramondetta said. “When you’re talking about an infection that infects 80 percent of people, you’re really talking about something that is part of the human condition. Kind of like, it’s important to wash your hands because staph and strep are on all of us.”

Today, only Virginia, Rhode Island and Washington, D.C. mandate HPV vaccines.

“Our vaccination rates are really terrible right now,” Ramondetta said.

In Texas, only 41 percent of girls get all three of the required shots, and only 24 percent of boys.


Kara Million of League City finds those numbers upsetting.  Million survived two rounds of treatment for cervical cancer.

“Even if you had a chance that your kid could have any kind of cancer, and you could have given them two shots or three shots for it? To me, it’s a no-brainer,” Million said.

Million always got regular Pap tests. But she missed one appointment during a busy time following the birth of her second child. When she went back, it had been only 15 months since her last Pap test. But the doctor found cervical cancer, and it had already progressed to stage 3.

“That was a huge surprise,” Million recalled.

Million had chemotherapy and radiation at MD Anderson. But a year later the cancer returned.

The next step was surgery, a radical procedure called a total pelvic exenteration.

Million and her husband looked it up online.

“When I was reading it, I was just, like, ‘this is so barbaric, there is no way they are still doing this in this day and age,’” Million said. “‘For certain, in 2010 we have better surgeries to do than this.’”

But there weren’t better surgeries. This was her only option.

“I had a total hysterectomy; they pulled all the reproductive system out,” she explained. “They take your bladder out, they take part of your rectum, they take part of your colon, they take your vagina, all of that in your pelvic area comes out.”

The surgery took 13 hours, and left her with a permanent colostomy bag and urostomy bag.

“At that point, with two kids at that age – I think they were one-and-a-half and three – there’s no option. I’m a mom, so I’m going to do whatever it takes so they can have their mom.”

Most women survive cervical cancer if it’s caught early enough. But Million’s cancer was diagnosed at a later stage, where only a third of women make it past five years. She has already made it past that five-year anniversary, and she’s not wasting any time.

She now volunteers as a peer counselor at MD Anderson to other cervical cancer patients, and she urges parents to vaccinate their kids.

“If most of cervical cancer is caused by HPV, and now we have something that can help prevent what I went through, and what my friends went through, and the friends that I lost?” Million says, “I don’t understand why people don’t line up at the door to get their kids vaccinated for it.”

But Dr. Ramondetta said parents can’t consent to the vaccination if pediatricians or family doctors don’t offer it. And they’re not offering it nearly enough, she said.

Some doctors don’t know how to broach the topic, fearing it will lead to a difficult conversation about sexual behavior. Some mistakenly think boys don’t need it, although they do – not only to protect their partners from HPV, but to protect themselves against oropharyngeal and anal cancers, which are also caused by HPV.  Ramondetta added that some doctors incorrectly assume that giving the vaccine will promote promiscuity.

Ramondetta says extensive research actually shows it doesn’t.

“There should be this understanding of an ethical responsibility. That this is part of cancer screening and prevention, just like recommending mammograms and colonoscopies.”

In Texas, only 41 percent of girls get all three of the required shots, and only 24 percent of boys.

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

September, 2016|Oral Cancer News|

California Raises Smoking Age To 21

Author: Huffington Post Staff

The law makes it the second state to raise the minimum age to 21, following Hawaii.


SAN FRANCISCO, CA - MAY 31:  Isaiah Atkinson smokes a cigarette in front of the San Francisco Centre on May 31, 2011 in San Francisco, California.  Since 1987, the World Health Organization has celebrated "World No Tobacco Day" to raise awareness to the health risks associated with smoking tobacco. Smoking is the second biggest cause of death globally and is responsible for the death of one in ten adults worldwide.  (Photo by Justin Sullivan/Getty Images)

SACRAMENTO, Calif. (Reuters) – California will raise the legal age for purchasing tobacco products to 21 from 18 under a bill signed on Wednesday by Democratic Governor Jerry Brown, part of a package of anti-smoking measures that also regulates electronic cigarettes.

Under five bills signed into law on Wednesday, California will ban the sale of vaping products or tobacco to anyone under the age of 21, imposing a fine of up to $5,000 against companies that violate the law.

“It is long past due for California to update our approach to tobacco,” said Steven Larson, president of the California Medical Association. “There has been an alarming rise in the use of e-cigarettes by teens, putting them at risk for lifelong addiction.”

Under the measures, electronic cigarettes will be regulated like traditional ones. That means that wherever cigarettes are banned, such as in restaurants, workplaces and public areas, use of e-cigarettes will also be prohibited.

The state will also expand its funding for anti-smoking programs under the bills.

Brown stopped short of allowing local counties to impose their own tobacco taxes, noting in his veto message that several proposed new taxes would be placed before voters on the November ballot.

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

May, 2016|Oral Cancer News|

Cancer-causing HPV plummeted in teens since vaccine, study finds

Author: Sarina Storres

(CNN)The human papillomavirus vaccine was first recommended for adolescent girls in the United States in 2006. Since that time, the prevalence of the cancer-causing virus has been dropping among young women, according to a new study.

Researchers at the Centers for Disease Control and Prevention compared the rates of HPV infection in women 14 to 34 years of age during the years before the vaccine was recommended, between 2003 and 2006, with the most recent years for which data are available, 2009 to 2012.

Among girls 14 to 19 years old, rates of infection with the four types of HPV included in the 4vHPV vaccine decreased from 11.5% to 4.3%. There was also a drop, although smaller, in women 20 to 24 years old, from 18.5% to 12.1%. Among the older groups, women ages 25 to 29 and 30 to 34, the prevalence of these HPV types did not change and was about 12% and 9%, respectively.

“These results are very encouraging and show the effectiveness of the vaccine,” said Dr. Lauri E. Markowitz, a medical epidemiologist at the CDC and lead author of the study, which was published Monday in the journal Pediatrics. “Eventually we expect to see decreases in HPV in older groups as women who were young (enough to get the vaccine) age,” Markowitz added.

Among the 14- to 24-year-old women in the study who were sexually active, rates of infection with the HPV types in the vaccine was only 2.1% among those who were vaccinated, compared with 16.9% among their unvaccinated counterparts.

The CDC Advisory Committee on Immunization Practices recommends the three-dose HPV vaccine for girls, and as of 2011 also boys, 11 to 12 years of age. The vaccine is recommended for women and men up to ages 26 and 21, respectively.

The researchers found that 51% of girls 14 to 19 years old reported having received at least one dose of the HPV vaccine. Rates were 33% and 15% among the women 20 to 24 and 25 to 29, respectively. Among the 30- to 34-year-olds, only 3% said they had gotten the vaccine because they were generally too old to receive it by the time it was first recommended.

There are signs that rates of HPV vaccination are on the rise. National surveys reported that the number of girls 13 to 17 years of age who received at least one dose of the HPV vaccine climbed from 44% in 2009 to 54% in 2012.

More vaccine coverage coming

In keeping with the trend toward greater vaccine coverage, an earlier study by Markowitz and her colleagues found that the prevalence of HPV types was 5.1% among 13- to 17-year-olds between 2007 and 2010, the first years after the vaccine was available, slightly higher than the 4.3% in the current study among 14- to 19-year-olds between 2009 and 2012. The waning prevalence of HPV among adolescent girls in more recent years is probably the result of more adolescent girls getting the HPV vaccine, Markowitz said.

However, among women in their 20s and 30s, there was no decrease in the prevalence of HPV between 2007 and 2010, compared with 2003 to 2006, because these women were already too old to receive the vaccine when it became available.

It may be possible for HPV to go the way of other largely eliminated infectious diseases in the United States such as measles, but only if vaccination rates improve, Markowitz said. The CDC is working with many groups, including large medical organizations such as the American Cancer Society, to increase knowledge among health care professionals and give them guidance for talking with families about the vaccine.

“Like all vaccines, having a strong recommendation by the clinician is one of greatest predictors of getting vaccinated,” Markowitz said.

It’s important for patients and parents to think of the HPV vaccine as another one of the vaccines that you get, like those for measles, mumps and rubella, said Dr. Sarah Feldman, co-director of ambulatory gynecologic oncology at Brigham and Women’s Hospital.

There have been some safety concerns, though unfounded, about the HPV vaccine, but the bigger issue is probably that parents shy away from vaccines for young children that protect against sexually transmitted diseases, Feldman said. But as people become more familiar with the vaccine, Feldman hopes there will be less focus on how HPV is transmitted. “We don’t talk about sexual activity as a way of transmitting hepatitis B, we just give the vaccine,” so when children get older and become sexually active, they are protected, she said.

“More and more, it’s becoming clear that this is a cancer prevention vaccine, and if we could get 100% of our boys and 100% of our girls vaccinated, we could probably eradicate the worst HPV types,” Feldman said.

New HPV vaccine

The current study did not detect a difference in rates of infection with HPV types other than the types present in the 4vHPV vaccine, or another vaccine called 2vHPV. Both vaccines include the two HPV types responsible for 66% of cervical cancers in the United States. Markowitz suspects that it is still possible that some cross-protection is happening, if, for example, other HPV types look similar enough to the types in the vaccine that the immune system recognizes them.

However, this question is largely a moot point now that many people in the United States are receiving a new HPV vaccine called 9vHPV, approved in 2014, which protects against a total of nine HPV types, said Dr. Rebecca B. Perkins, associate professor of obstetrics and gynecology at Boston University School of Medicine and Boston Medical Center.

The Advisory Committee on Immunization Practices included 9vHPV as an option in this year’s immunization schedule, along with 4vHPV and 2vHPV. The 9vHPV vaccine protects against five additional cancer-causing HPV types, giving it the potential to prevent about 90% of HPV-associated cancers.

But even with the earlier forms of HPV vaccines, “the vaccine is doing exactly what it’s supposed to,” Perkins said. The current study is a “really strong call to get people vaccinated,” she added.

HPV vaccination could benefit more groups than in the current study, and in more ways. The CDC researchers are planning to look at the rates of HPV infection in males after the vaccine was recommended for boys in 2011. “You should expect to see similar effects in men because trials showed the vaccine worked as well in men as women,” Perkins said.

The CDC researchers are also going to look at rates of oral HPV infection since the HPV vaccine became available. A clinical trial suggested that the vaccine could effectively prevent throat cancers associated with HPV. These cancers are becoming increasingly common, and the trial predicted that in the next few decades, there will be more cases of oral cancers caused by HPV in the United States than cervical cancer.

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

February, 2016|Oral Cancer News|

ASTRO: Study maps distinct molecular signatures of HPV-positive throat cancer patients by smoking status

Author: ASTRO

Scottsdale, Ariz., February 18, 2016, ASTRO — Throat cancer patients exposed to both human papillomavirus (HPV) and tobacco smoke demonstrate a pattern of mutations along several key cancer genes, according to research presented today at the 2016 Multidisciplinary Head and Neck Cancer Symposium. These distinct molecular profiles of heavy and light smokers who develop HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) may inform decisions related to treatment intensity by establishing additional prognostic criteria for this subset of patients.

Researchers examined the molecular characteristics of OPSCC caused by HPV in an effort to determine which DNA mutations predict lower disease free and survival rates among HPV-positive throat cancer patients who smoke. Whereas most patients with OPSCC caused by HPV have an excellent prognosis for disease free survival, those who also smoke generally face more dire prognoses.

The 66 cases of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) in this study were split into heavy and light smoking behavior groups based on pack years. This metric of smoking frequency over long stretches of time is determined by multiplying the number of years a person has smoked by their average number of packs of cigarettes smoked per day. Forty of the 66 patients reported more than 10 pack years (e.g., more than one pack per day for 10 years or two packs per day for five years), and 26 patients reported fewer than 10 pack years.

“Throat cancer patients who smoked and had a history of fewer than 10 pack years had significantly better disease free and overall survival rates than the heavier smoking group,” said Jose P. Zevallos, MD, MPH, FACS, assistant professor and director of oncologic research in the division of head and neck surgical oncology at the University of North Carolina, Chapel Hill and member of the Lineberger Comprehensive Cancer Center. “Our analyses identified several key differences in molecular mutational profiles of the two groups that may shape these outcomes.”

Overall mutation rates were higher for HPV-positive OPSCC patients in the >10 pack year group than those in the <10 pack year group. HLA-A mutations occurred more often in the heavy smoking group, and mutations associated with tobacco exposure and poor survival occurred almost exclusively within the heavy smoker group, including those in TP53 (6 percent vs. 0 percent, p = 0.428), CDKN2A (2 percent vs. 0 percent, p = 0.758), FAT1 (14 percent vs. 6 percent, p = 0.688), CASP8 (8 percent vs. 0 percent, p = 0.565), NOTCH1 (18 percent vs. 0 percent, p = 0.092), FGFR3 (10 percent vs. 0 percent, p = 0.325), and KRAS (4 percent vs. 0 percent, p = 0.232) genes. Researchers on the study note that these are preliminary data and that they are currently recruiting additional participants to add to the small sample size and fully power the between-group tests.

“I think what is most striking is that these genes are mutated almost exclusively in smokers,” said Dr. Zevallos. “This molecular profile suggests that while HPV-positive OPSCC carcinogenesis initiates similarly, tumors in patients who smoke acquire novel mutations not traditionally associated with HPV-associated cancers.” Analyses indicated that the molecular profile of HPV-positive smokers bears similarities to the profile for HPV-negative head and neck cancer, although the profile does maintain several important molecular characteristics of HPV-positive cancer, including frequent PIK3CA and MLL-3 mutations.

Differences in immune-related and tobacco-related gene mutations by smoking status identified in this study may explain why HPV-positive cancer in smokers may be more aggressive. Findings could impact which treatment options are recommended to HPV-positive OPSCC patients by informing clinical trials to establish new molecular parameters to guide determinations of treatment intensity.

“Because HPV-positive throat cancers respond well to treatment, patients often are given the option of choosing less aggressive treatment with fewer side effects,” explained Dr. Zevallos. “Our study begins to set criteria-based changes in tumor DNA that can be used to predict more aggressive cases that should be given more intense treatment. We hope that this information will one day help to guide more personalized treatments for HPV-positive throat cancers.”

Cases were drawn from a North Carolina population-based epidemiologic study conducted from 2001 to 2006 and were examined for mutations across more than 800 genes. Mutations were measured against the Catalogue of Somatic Mutations in Cancer (COSMIC), an online database of information on mutations in an expert-curated selection of key cancer genes that is maintained by the Sanger Institute as part of its Cancer Genome Project. Somatic mutations, which do not occur in reproductive cells and therefore are not passed on to children, were compared for both frequency and copy number variations, as well as their association with survival outcomes.

The abstract, “Molecular Profile of HPV-positive Oropharyngeal Squamous Cell Carcinoma Stratified by Smoking Status,” will be presented in detail during the K. Kian Ang Commemorative Plenary Session on Thursday, February 18, 2016, at 10:30 a.m. Mountain time at the 2016 Multidisciplinary Head and Neck Cancer Symposium in Scottsdale, Arizona. To speak with Dr. Zevallos, contact the ASTRO media relations team at 480-905-7935 (February 18-19 only), 703-286-1600 or

The 2016 Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO) and the American Head & Neck Society (AHNS). The two-and-a-half day meeting includes interactive educational sessions focused on topics such as novel multidisciplinary therapies, directed therapy, treatment guidelines, prevention, surveillance and supportive care, as well as 13 oral abstract presentations of the current science of relevance to the head and neck cancer community. A total of 262 abstracts will be presented, including 249 posters. Keynote speakers include Tanguy Seiwert, MD, of the University of Chicago, to present “Immunotherapy for Head and Neck Cancer;” Robert I. Haddad, MD, of Brigham and Women’s Hospital, to present “Personalized Treatment for Head and Neck Cancer — The Time is Now;” Quynh-Thu Le, MD, FASTRO, of the Stanford School of Medicine, to present “Precision Therapy in Head and Neck Cancer — From Technology to Biomarker-based Risk Stratification;” and Neil Hayes, MD, MPH, of the UNC School of Medicine, to present “Genome Atlas and Sequencing Data: How We Use This Going Forward.”

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


February, 2016|Oral Cancer News|

Possible marker for recurring HPV-linked oropharyngeal cancers

Author: John Hopkins Media Contact: Vanessa Wasta

A look-back analysis of HPV infection antibodies in patients treated for oropharyngeal (mouth and throat) cancers linked to HPV infection suggests at least one of the antibodies could be useful in identifying those at risk for a recurrence of the cancer, say scientists at The Johns Hopkins University. A report on the study is published in the February issue of Cancer Prevention Research.

HPV infections, which are virtually all sexually transmitted, are responsible for the recent rise in the incidence of oropharyngeal cancers in the United States, according to the National Cancer Institute, and now account for about 80 percent of these cancers.

People with HPV-positive tumors of the throat, base of the tongue and tonsils have higher overall survival rates compared to people with similar tumors not caused by HPV, but studies show that more than 25 percent of HPV-positive cancers recur–usually within the first two years after treatment.

“There are currently no reliable tests available to detect early recurrence, so we hope to find a biological marker that could help identify those most at risk,” says Carole Fakhry, M.D., M.P.H., associate professor of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine and member of the Johns Hopkins Kimmel Cancer Center.

For the new study, Fakhry and her colleagues focused their attention on the antibodies, or immune system protein the body produces to fight HPV-related cancer proteins. One such antibody, called E6, is strongly linked to the diagnosis of HPV-positive oropharyngeal cancer.

Levels of the E6 antibody should fall when a patient is treated and cured of their cancer, Fakhry and her colleagues reasoned, so an increase in a patient’s E6 levels after treatment might indicate a higher risk of the cancer returning.

To find out, the researchers looked back at the health records and blood serum samples of 60 patients with HPV-positive oropharyngeal cancer and a median age of 56, mostly Caucasian men, who were treated at The Johns Hopkins Hospital. Some 43 of the patients had samples taken before their treatment, 34 had samples taken up to six months after therapy, and 52 had samples taken six months or later after therapy. Among the 60 patients, Fakhry and colleagues identified six cases of recurring cancer within an average of 4.4 years of follow-up after treatment.

The scientists looked at a variety of HPV cancer cell antibodies in these patients and discovered that the average level of most of these antibodies was lower after treatment. Patients who had high levels of E6 antibody before their treatment were seven times more likely than those with lower levels to have their cancer return, they also found.

Fakhry says the study is a promising start toward finding a way to identify patients most at risk for a cancer recurrence through the use of a blood test, but much more data are needed to confirm E6’s usefulness as a biomarker. One of the best ways to proceed, she says, would be to conduct a study of the antibody on a large group of patients at the start of their treatment, drawing blood at a series of predetermined points during their therapy to examine E6 levels.

At the moment, these HPV antibodies are not measured routinely in patients, so it is difficult to estimate the costs and time needed to conduct such a “gold-standard” trial, she notes.

More research is also needed to know whether such tests would be useful in determining the path of a patient’s follow-up care, such as whether and how often a patient might need imaging or clinical exams to watch for a cancer’s possible return.

“Potentially, a low-risk patient may need less stringent surveillance while a high-risk patient may require more intense imaging,” Fakhry explains. “But this is far away from clinical practice, as we would really need to understand whether this hypothetical approach [with E6] would improve lead time to diagnosis of recurrence and survival outcomes.”


Other Johns Hopkins scientists who contributed to the research include Jesse Qualliotine, Zhe Zhang, Nishant Agrawal, Daria Gaykalova, Justin Bishop, Rathan M. Subramaniam, Wayne Koch, Christine Chung, David W. Eisele, Joseph Califano and Raphael P. Viscidi.

Funding for the study was provided by the Oral Cancer Foundation and the National Institute of Dental and Craniofacial Research (P50DE019032-13).

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

Depressed Head and Neck Cancer Patients Have Lower Survival and Higher Recurrence Risk

Author: Kathy Boltz, PhD

Depression is a significant predictor of 5-year survival and recurrence in patients with head and neck cancer, according to a new study published in Pyschosomatic Medicine (doi: 10.1097/PSY.0000000000000256). These findings represent one of the largest studies to report on the impact of depression on cancer survival.

Although depression can have obvious detrimental effects on a person’s quality of life, its impact on cancer patients is more apparent, explained lead author Eileen Shinn, PhD, assistant professor of Behavioral Science at The University of Texas MD Anderson Cancer Center, in Houston. Increasing evidence shows modest associations between elevated symptoms of depression and greater risk for mortality among patients with lung, breast, ovarian, and kidney cancers.

The research team sought to clarify the influence of depression on survival, focusing their analysis on a single cancer type. By limiting the sample set and adjusting for factors known to affect outcome, such as age, tumor size, and previous chemotherapy, they were able to uncover a more profound impact of depression.

The researchers followed 130 patients at MD Anderson with newly diagnosed oropharyngeal squamous cell carcinoma (OSCC), a type of cancer in which the tumor originates at the back of the throat and base of the tongue.

At the beginning of their radiation therapy, Patients completed a validated questionnaire at the beginning of their radiation therapy to identify symptoms of clinical depression. Researchers monitored the participants, all of whom completed treatment, until their last clinic visit or death, a median period of 5 years.

“The results of this study were quite intriguing, showing depression was a significant factor predicting survival at 5 years, even after controlling for commonly accepted prognostic factors,” said senior author Adam Garden, MD, professor, Radiation Oncology. Furthermore, depression was the only factor shown to have a significant impact on survival.

Patients who scored as depressed on the questionnaire were 3.5 times less likely to have survived to the 5-year interval compared with those who did not score as depressed. The degree of depression was also found to be significant, as every unit increase on this scale indicated a 10% higher risk for reduced survival.

The results were replicated with a different psychological health survey and were not influenced by how soon following diagnosis the depression assessment was done.

OSCC is diagnosed in 10 000 to 15 000 Americans each year. Major risk factors known to be associated with OSCC include smoking and tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Incidence of OSCC has doubled in the last 20 years due to increasing HPV infection rates, noted Shinn.

Neither alcohol nor tobacco use, also surveyed in this group, had a significant impact on survival. HPV infection status, when available, also did not appear correlated.

Despite a high cure rate, normally 60% to 80%, recurrence rate of disease is unusually high in these patients (approximately 30%). The researchers also investigated a potential link between depression and disease recurrence.

“When we controlled for all variables, depression was linked with a nearly 4 times higher risk of recurrence,” said Shinn. In addition, never smokers had a 73% lower chance of recurrence, compared with current smokers. Those were the only two factors associated with cancer recurrence.

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

December, 2015|Oral Cancer News|

Baseball and tobacco are a deadly mix

Authors: Dr. Howard Koh & Dr. Alan C. Woodward
ortiz copyUnhealthy as it looks: David Ortiz spat out his “chew” after flying out against Tampa Bay in Game 3 of the 2008 ALCS at Fenway Park.


Search the web for the phrase “tobacco and baseball” and you’ll find an association that dates back almost to the beginning of the sport. In the late 1800s, tobacco companies debuted baseball cards in cigarette packs. By the early 1900s, Bull Durham was advertising its chewing tobacco product on outfield fences.

Today, cigarette smoking is prohibited or restricted in all Major League parks. Still, players, coaches, and others use smokeless tobacco, often referred to as “chew” or “dip,” in virtually every stadium across the country. But tobacco that is “smokeless” is not “harmless.” It contains at least 28 carcinogens and causes oral, pancreatic, and esophageal cancer, along with serious health problems such as heart disease, gum disease, tooth decay, and mouth lesions.

The longstanding link between tobacco and baseball has led to tragic outcomes, for players and young fans alike. Baseball legend Babe Ruth died at age 53 of throat cancer after decades of dipping and chewing. Last summer, former Red Sox pitching great Curt Schilling announced that he had been treated for oral cancer, which he attributed to three decades of chewing tobacco. Sadly, his news came shortly after the death of Hall of Famer Tony Gwynn, at age 54, after a lengthy fight with salivary gland cancer. Gwynn, too, attributed his cancer to longtime smokeless tobacco use.

As physicians who have spent decades providing patient care and promoting public health, we believe it is time to make baseball tobacco free. Today, we are proud to join Mayor Marty Walsh as he announces a historic and lifesaving city ordinance to eliminate the use of smokeless and all other tobacco products at baseball venues and athletic fields. This includes Fenway Park.

Approval of the rule would allow Boston to join San Francisco as the first two US cities to protect the future health of players, coaches, and fans in this way. It could also inspire other jurisdictions to consider similar action.

Implementing this measure would also add to our city and state’s history of leadership in fighting tobacco. Massachusetts can boast one of the first tobacco prevention and cessation programs in the country (1993), a comprehensive smoke-free law (2004), and a series of tobacco tax increases to protect kids and fund public health. Although adequate funding for state tobacco control remains an ongoing challenge, these and other measures have dropped the Massachusetts youth smoking rate (10.7 percent in 2013) to nearly a third below the national average.

Despite this progress, the national rate of smokeless tobacco use in high school has stayed disturbingly steady. In the US, nearly 15 percent of high school boys currently use smokeless tobacco. More than half a million youth try smokeless tobacco for the first time. Smokeless tobacco companies annually spend $435 million on marketing. A key message of such advertising is that boys can’t be real men unless they chew. Also, scores of Major League Baseball players who chew or dip in front of fans provide invaluable free advertising for the industry. Impressionable kids stand ready to imitate their every move.

For too long, the tobacco industry has normalized and glamorized products that cause drug dependence, disability, and death. Leveraging the prestige and appeal of baseball has been an essential part of that strategy. It’s time for baseball to start a new chapter that reclaims tobacco-free parks as the new norm — and for Boston, home to so many sports achievements, to lead the way.

Dr. Howard K. Koh is the former US Assistant Secretary for Health and former Massachusetts Commissioner of Public Heath. Dr. Alan C. Woodward, a former president of the Massachusetts Medical Society, is chair of Tobacco Free Mass.

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

August, 2015|Oral Cancer News|

Professor Harald zur Hausen: Nobel scientist calls for HPV vaccination for boys

Author: Charlie Cooper & Gloria Nakajubi

The UK should vaccinate all boys against the cancer-causing human papilloma virus (HPV), the Nobel Prize-winning scientist who discovered the link between HPV and cancer has said.

Professor Harald zur Hausen, the German virologist whose theory that HPV could be a cause of cervical cancers led to global efforts to vaccinate girls against the virus, said that boys should also be protected.

There is now a wealth of evidence that HPV also causes cancers in men, including anal, penile and throat cancer. Professor zur Hausen added that there was now a chance to “eradicate” HPV viruses altogether if the world developed global vaccination programmes for all children.

Since 2008 the UK has offered free vaccinations against HPV to girls aged 12 to 13 – a programme that had an almost 87 per cent uptake from 2013 to 2014 and has led to falls in the number of pre-cancerous abnormalities of the cervix, according to research carried out among vaccinated girls in Scotland.


Vaccine authorities in the UK, traditionally an international leader in the field of immunisation, are yet to make a judgement on a publicly funded vaccination programme for boys, which would follow in the wake of those already in place in Australia, Austria, Israel and parts of Canada.

HPV is the name for a common group of viruses that can affect the moist membranes of the cervix, anus, mouth and throat. It is usually spread through sexual contact.

Most sexually active people will contract it in their lifetime but usually it causes no ill-effects. However, in some cases it causes changes to cells, which can become cancerous. It is the cause of almost all cases of cervical cancer, a discovery made by Professor zur Hausen in the 1970s, for which he won the Nobel Prize in physiology or medicine in 2008.

Speaking to HPV Action, in an interview to be published by the campaign group this week, Professor zur Hausen said that vaccinating boys was of “the utmost importance”, not only because boys can also contract HPV-related cancers of the throat, anus and penis, but because protecting boys is key to ending transmission of the virus altogether.

“The vaccination programme for girls [in the UK] is marvellous – it reaches a very high proportion,” he said. “In my opinion, the vaccination of boys is also of the utmost importance because virus transmission is due to male partners and men are affected by oropharyngeal [cancers of the throat], anal and penile cancers as well as genital warts.”

Last year the UK’s vaccination authority, the Joint Committee on Vaccination and Immunisation (JCVI), recommended that the UK introduce a vaccination programme for gay men, to be delivered via sexual health clinics. The rationale behind the recommendation is that heterosexual men will be protected from HPV infection because most women will have been immunised, but that men who have sex with men will miss out on “herd immunity”.

However, campaigners and some experts say this reasoning is flawed, as many gay men will have been sexually active before their first visit to a sexual health clinic, and would most likely have already contracted or transmitted the virus.

The JCVI is due to consider the cost-effectiveness of vaccination for boys but campaigners do not anticipate any decision until 2017.

However, the NHS in London is currently planning what would be the first pilot of routine HPV vaccination for boys, with a likely start date of February 2016. The “field test” will work across four sites to establish whether school-age young males would “embrace the uptake of HPV vaccination as part of a community programme”, NHS England’s London office said.

Rolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer.

Scientists say changes in sexual behaviour – with more couples having oral and anal sex – may be the cause of increased cases of anal and throat cancers in both men and women in recent decades.

Margaret Stanley, emeritus professor at the University of Cambridge and a leading expert on HPV, said that cases could continue to rise. “It’s very much under-thirties [having more anal and oral sex] so you can predict there will be a rise in both those cancers. It’s a time bomb,” she said. “Wider exposure to different sexual practices – in other words porn on the internet – is also changing sexual behaviour in teenagers.”

HPV is also the cause of genital warts, the second-most common sexually transmitted infection in the UK. There are nearly 90,000 cases annually, costing the NHS around £55m. Campaigners hope that figure will be taken into account when the JCVI weighs up the cost-effectiveness of a vaccination programme.

Despite safety concerns being raised about the vaccine’s alleged side effects in some parts of the world, including Japan, no causal links have been established between the vaccine and reported long-term health problems. It is approved by the World Health Organisation, as well as European and UK vaccine-safety authorities. Professor zur Hausen added that it was “one of the safest vaccines we have”.

8-Injection-GetRolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer (Getty)


A Department of Health spokesperson said: “The HPV-prevention programme is key in helping us prevent cervical cancer. We have successfully given more than a million doses in the UK since 2008.

“Our independent vaccination experts are assessing whether it should be extended to prevent cancers in adolescent boys, men who have sex with men, or both.”

Time for an update?

Parents are currently advised and asked for consent for their daughters to have the HPV vaccination through a form and information leaflet sent out via schools.

The vaccine’s preventative effects against cervical cancer and the protection it offers against genital warts are explained. The protection against other cancers is not mentioned.

Parents and children are told that the vaccine, which is now given in just two doses instead of three, protects against 70 per cent of cervical cancers and that girls will still require cervical screening tests when they are older. Newer versions of the vaccine may protect against more cases in the future.

Parents are told that the vaccine may cause “soreness, swelling and redness in the arm” that will wear off in a couple of days. The leaflet states that “more serious side effects are extremely rare” and reassures parents that it meets European and UK safety standards. However, parents have the option to deny permission for their daughters to have the jab – and are told it would be “helpful” if they gave reasons for refusal.

The leaflet is directly targeted at girls and their parents and focuses on cervical cancer. If the Government were to extend the HPV-vaccination programme to boys, they would have to reconsider how the vaccine was presented to parents and children. The current programme has had impressive uptake, possibly in part because the key reason for taking the vaccine – to prevent cervical cancer – is straightforward and well understood. It may be that in a new HPV vaccination programme, the jab could be presented more broadly as protection against “a range of cancers”.

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

The Cancer Cure Parents Aren’t Using

Author: Meredith Wadman


Not so long ago, when my sons still had smooth cheeks and children’s voices, I had them vaccinated against human papillomavirus, the most common sexually transmitted disease. It was late 2011, and the Centers for Disease Control and Prevention had just recommended that boys join girls in being vaccinated at age 11 or 12. I was certainly receptive: HPV, as it’s commonly called, causes cervical cancer, cancer of the tonsils, cancer of the back of the tongue and, less often, cancers of the vulva, vagina, anus and penis. It seemed important to ensure that my kids were protected.

Yet numbers released last month by the CDC show that my sons, now 14 and 15, are among a small minority of adolescent males who have been vaccinated. In 2013, just 14 percent of American boys ages 13 to 17 had received all three recommended doses of the HPV vaccine. (The CDC also recommends “catch-up” vaccination for males up to age 21.)

Not that parents are rushing to have their girls vaccinated either, even though the CDC first recommended the vaccine for prepubescent girls in 2007 and virtually all insurers pay for it. In 2013, fewer than 38 percent of American girls between 13 and 17 had received the full three-dose course.

It is heartbreaking to watch a safe, effective vaccine go unused. Consider this: The CDC estimates that increasing the vaccination rate of American girls to 80 percent would prevent 53,000 cervical cancers during the lifetimes of girls who are now 12 and younger.

When I had my sons vaccinated, it was partly with girls in mind. After all, if fewer young men are infected, fewer young women will be exposed to the virus that causes cervical cancer — currently the most common cancer prevented by the vaccine. But now I am realizing that HPV poses a growing risk to boys.

A new breed of cancer of the back of the tongue and tonsils, caused by HPV, is rising in incidence — likely caused, researchers suspect, by increases in premarital sex and oral sex over the past several decades. These cancers afflict men far more often than women, and at relatively younger ages than do other head and neck cancers, which typically appear in men older than 60. Middle-aged men who don’t die from their HPV-linked cancer often must live for years with the side effects of intensive chemotherapy and radiation delivered to the back of the throat. These can include the permanent inability to swallow and the appearance later ofnew, aggressive, radiation-induced cancers.

If this trend continues, we are going to see more cancer of the back of the tongue and the tonsils caused by HPV. One recent analysis of 30 studies, conducted by University of Wisconsin researchers, found that the proportion of such cancers caused by HPV rose from 21 percent before 1990 to 65 percent after 2000. Anil Chaturvedi of the National Cancer Institute and his colleagues have estimated, based on recent trends, that by 2020 there will be more new cases of these HPV-induced throat cancers in the United States each year than new cervical cancer cases.

So the actor Michael Douglas did us all a service when he was so frank with Britain’s Guardian newspaper last year. When asked if his throat cancer had been caused by heavy drinking and smoking, which are also risk factors for the disease, the actor replied: “No. I mean, without getting too specific, this particular cancer in tests is caused by something called HPV, which actually comes about from cunnilingus.”

Many parents don’t like to think of their 11- and 12-year-olds as sexual creatures. Ironically, the CDC recommendation assumes not that kids are sexually active at this tender age but rather that they are not: The point of vaccination is to close the door before the horse is out of the barn.

It’s no use telling yourself that your child isn’t “that kind” of kid. The fact is, HPV is so common that almost all sexually active adults are infected at some point. Last year, the CDC estimated that about 79 million Americans were infected, most of them in their late teens and early 20s.

Most people who get HPV have a transient infection that their immune system clears with no lasting damage. But in some people, the virus takes up residence and goes on to cause cancer. I am grateful that, thanks to the HPV vaccine, I will never have to find out if my sons fell into that second, unlucky group.

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

CDC finds coverage for HPV vaccination among teens is still low

Author: staff

Although there has been a slight increase in human papillomavirus vaccination coverage among adolescents since 2012, a new report from the Centers for Disease Control and Prevention states that vaccine coverage in this population remains “unacceptably low”.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US. There are more than 150 types of HPV, 40 of which can be contracted through skin-to-skin contact during vaginal, anal or oral sex.

Low-risk HPV types, such as HPV-6 and HPV-11, can cause warts around the genitals or anus. But high-risk types, including HPV-16 and HPV-18, account for approximately 5% of all cancers worldwide.

Specifically, HPV-16 and HPV-18 account for around 70% of all cervical cancers and almost 50% of all vaginal, vulvar and penile cancers. HPV-16 is also accountable for more than 50% of throat cancers.

There are currently two vaccines available for HPV, which are administered in three shots over 6 months. Cervarix and Gardasil are used for the prevention of cervical cancer, while Gardasil can also protect against anal, vulvar andvaginal cancers and genital warts.

The Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. The vaccination is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.

HPV vaccination coverage increased in 2012-13, but remains too low

But despite these recommendations, a new report from the Centers for Disease Control and Prevention (CDC) – published in this week’s Morbidity and Mortality Weekly Report – estimates that in 2013, only 57% of girls and 35% of boys ages 13-17 years received one or more doses of the HPV vaccine.

The figures came from results of the CDC’s National Immunization Survey-Teen (NIS-Teen), which includes vaccine information via telephone surveys for adolescents aged 13-17 years from across the US.

The CDC investigators did, however, find that HPV vaccination coverage increased slightly among girls between 2012-13, from 53.8% to 57.3%, although only a third received the complete three doses. Teenage boys saw a greater increase in vaccination coverage, from 20.8% to 34.6%.

But still, the CDC say HPV vaccination coverage among adolescents is too low, particularly when compared with coverage to other vaccination types. For example, another report from the CDC found that almost 86% of adolescents received one dose of the Tdap vaccine last year, which protects against tetanus, diphtheria and whooping cough.

A 10-year national objective in the US – set in 2010 by Healthy People 2020 – is to reach 80% HPV vaccination coverage among adolescents. These latest statistics suggest there is a lot of work to be done. But lead author of the report, Shannon Stokley, assistant director for science at the CDC’s Immunization Services Division, says they also show the 80% vaccination coverage target is realistic:

“The data on missed vaccination opportunities tells us that it is possible. When we look at the most recent cohort of girls that turned 13, 91% of them had a health care encounter where they could have started the HPV vaccine series before their 13th birthday.

Also, 86% of 13-17 year-olds have received the Tdap vaccine. What these numbers tell us is that preteens and teens are getting to the doctor and they are getting vaccinated, but they aren’t always receiving the HPV vaccine.” 

Why is HPV vaccination coverage still low?

From NIS-Teen, the CDC investigators were also able to establish some reasons as to why HPV vaccination coverage remains low among adolescents.

They found that clinicians’ recommendations significantly influenced a parent’s decision of whether to have their children vaccinated against HPV.

Of parents whose daughters were vaccinated, 74% said they received a recommendation from their doctor, while 52% of parents who did not have their daughters vaccinated received a doctor’s recommendation. Among parents whose sons were vaccinated, 72% received a recommendation, while only 26% of parents whose sons were not vaccinated received a recommendation.

Based on these findings, Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases, believes health care professionals are key in boosting HPV vaccination coverage among adolescents in the US.

“Pediatricians and family physicians are uniquely situated to prevent missed opportunities by giving HPV vaccine during the same visit they give Tdap and meningococcal vaccines,” she adds.

Parents also revealed that concerns over the safety of the HPV vaccine deterred them from vaccinating their children. However, the CDC stress that – after analyzing national postlicensure vaccine safety data – no serious safety concerns have been linked to the HPV vaccine in the 8 years it has been available.

The investigators point out that the most commonly reported side effects of the vaccine include dizziness, fainting, nausea and headache, and injection-site reactions – including pain, redness and swelling.

When we asked Stokely what needs to be done to alleviate parents’ concerns about vaccinating their children against HPV, she replied:

“Parents need to see information in mainstream media that HPV vaccination is very effective at preventing infection with the types of HPV that cause the most cancers. Parents also need to hear that the HPV vaccine is safe and that it is recommended to be given when their children are 11 or 12 years old, before their risk of acquiring an HPV infection increases.”

In conclusion to the report, the CDC say they will continue efforts to team up with state and local immunization programs, cancer organizations, professional organizations and other stakeholders in an attempt to educate parents and health care professionals about the importance of the HPV vaccine, adding:

“Collaborative efforts remain critical to promoting HPV vaccination so that the nation’s adolescents are protected against vaccine-preventable, HPV-associated cancers.”

Earlier this year, Medical News Today reported on a study claiming that two thirds of healthy American adults areinfected with one or more of 109 strains of HPV.

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