tobacco

American Dental Association and The University of Texas MD Anderson Cancer Center announce collaboration

Source: www.prnewswire.com
Author: press release

The American Dental Association (ADA) and The University of Texas MD Anderson Cancer Center today announced a joint effort to improve patient outcomes through programs aimed at dental and medical professionals and the public to increase human papillomavirus (HPV) vaccinations and tobacco cessation for oral cancer prevention.

“ADA member dentists promise to put patients first, and as a profession we look for innovative ways to treat and prevent disease, and promote wellness,” said ADA President Gary Roberts, D.D.S. “Together with MD Anderson, one of the most respected cancer centers in the world, we are excited to pioneer new programs to help our patients live healthy and disease-free lives.”

Both organizations agree that increasing the percentage of children and young adults vaccinated for HPV is critical to improving their health and reducing risk of several related cancers, including those of the oropharynx (the part of the throat just behind the mouth which includes the back third of the tongue; the back part of the roof of the mouth, also known as the soft palate; the tonsils, and the side and back wall of the throat). In addition, programs aimed at preventing children and young adults from starting to smoke while encouraging current smokers to quit are another key component of the collaboration.

“MD Anderson is pleased to partner with the ADA to develop innovative educational programs that will increase awareness about the prevention and early detection of oral cancers,” said Marshall E. Hicks, M.D., president ad interim, MD Anderson. “Tobacco use and HPV infection remain the leading causes of oral cancers. Through this collaboration, we have a significant opportunity to inform care providers and the public about the associated risks, and we can make a difference in the fight to end cancer.”

According to the American Cancer Society, an estimated 50,000 cancers of the oral cavity and pharynx will be diagnosed this year in the U.S., and rates in men are more than twice as high as in women. These cancers are often not diagnosed until late stages, when treatment is less effective.

Tobacco use remains the leading preventable cause of cancers in the U.S., responsible for roughly one-third of all cases. HPV infections are responsible for approximately 70 percent of all oropharyngeal cancers, about 9,000 annually, as well as the majority of cervical, anal and genital cancers. HPV-related oropharyngeal cancers are four times more common in men than women, and the incidence rate of these cancers has risen significantly in recent years.

About the American Dental Association
The not-for-profit ADA is the nation’s largest dental association, representing more than 161,000 dentist members. The premier source of oral health information, the ADA has advocated for the public’s health and promoted the art and science of dentistry since 1859. The ADA’s state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA’s flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit ADA.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA’s consumer website MouthHealthy.org.

About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. The institution’s sole mission is to end cancer for patients and their families around the world. MD Anderson is one of only 47 comprehensive cancer centers designated by the National Cancer Institute (NCI). MD Anderson is ranked No.1 for cancer care in U.S. News & World Report’s “Best Hospitals” survey. It has ranked as one of the nation’s top two hospitals since the survey began in 1990, and has ranked first for nine of the past 10 years. MD Anderson receives a cancer center support grant from the NCI of the National Institutes of Health (P30 CA016672).

European Commission approves Bristol-Myers Squibb’s Opdivo (nivolumab) for squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy

Source: pipelinereview.com
Author: Bristol-Myers Squibb

Bristol-Myers Squibb Company today announced that the European Commission (EC) has approved Opdivo (nivolumab) as monotherapy for the treatment of squamous cell cancer of the head and neck (SCCHN) in adults progressing on or after platinum-based therapy. Opdivo is the first and only Immuno-Oncology (I-O) treatment that demonstrated in a Phase 3 trial a significant improvement in overall survival (OS) for these patients.

“Adult patients with squamous cell cancer of the head and neck that progresses on or after platinum-based therapy are fighting a debilitating and hard-to-treat disease that is associated with a very poor prognosis,” said Kevin Harrington, M.D., Ph.D., professor in Biological Cancer Therapies at The Institute of Cancer Research, London, and a consultant clinical oncologist at The Royal Marsden NHS Foundation Trust in London. “As an oncologist who helps patients deal with this terrible disease, I hope that nivolumab will now be made available as widely as possible, offering this group of patients a new treatment option that can potentially improve their overall survival.”

The approval was based on results from CheckMate -141, a global Phase 3, open-label, randomized trial, first published in The New England Journal of Medicine last October, which evaluated Opdivo versus investigator’s choice of therapy in patients aged 18 years and above with recurrent or metastatic, platinum-refractory SCCHN who had tumor progression during or within six months of receiving platinum-based therapy administered in the adjuvant, neo-adjuvant, primary or metastatic setting. Investigator’s choice of therapy included methotrexate, docetaxel, or cetuximab. The primary endpoint was OS. The trial’s secondary endpoints included progression-free survival (PFS) and objective response rate (ORR).

“The European Commission’s approval of Opdivo marks not only the first new treatment option in 10 years for patients with advanced cancers of the head and neck, but also the first Immuno-Oncology treatment for SCCHN,” said Murdo Gordon, executive vice president and chief commercial officer, Bristol-Myers Squibb. “Bristol-Myers Squibb remains committed to redefining survival for patients with cancer, and now that Opdivo is approved in Europe, we will work collaboratively with EU health authorities to ensure it is available for these patients as quickly as possible.”

In the interim analysis of the pivotal trial, Opdivo demonstrated statistically significant improvement in OS with a 30% reduction in the risk of death (HR=0.70 [95% CI: 0.53-0.92; p=0.0101]), and a median OS of 7.5 months (95% CI: 5.5-9.1) for Opdivo compared with 5.1 months (95% CI: 4.0-6.0) for the investigator’s choice arm. There were no statistically significant differences between the two arms for PFS (HR=0.89; 95% CI: 0.70, 1.13) or ORR (13.3% [95% CI: 9.3, 18.3] vs 5.8% [95% CI: 2.4, 11.6] for Opdivo and investigator’s choice, respectively. The EC approval was based on updated study results, which will be presented at the 53rd Annual Meeting of the American Society of Clinical Oncology (ASCO).

Patient reported outcomes (PROs) were evaluated using the following European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Assessment: EORTC QLQ-C30, EORTC QLQ-H&N35, and 3-level EQ-5D instruments. Patients treated with Opdivo exhibited stable PROs, while those assigned to investigator’s choice therapy exhibited significant declines in functioning (e.g., physical, role, social) and health status as well as increased symptomatology (e.g., fatigue, dyspnoea, appetite loss, pain and sensory problems).

The safety profile of Opdivo in CheckMate -141 was consistent with prior studies in patients with melanoma and non-small cell lung cancer. Serious adverse reactions occurred in 49% of patients receiving Opdivo. The most frequent serious adverse reactions reported in at least 2% of patients receiving Opdivo were pneumonia, dyspnea, aspiration pneumonia, respiratory failure, respiratory tract infection, and sepsis.

About Head & Neck Cancer
Cancers that are known as head and neck cancers usually begin in the squamous cells that line the moist mucosal surfaces inside the head and neck, such as inside the mouth, the nose and the throat. Head and neck cancer is the seventh most common cancer globally, with an estimated 400,000 to 600,000 new cases per year and 223,000 to 300,000 deaths per year. The five-year survival rate is reported as less than 4% for metastatic Stage IV disease. Squamous cell cancer of the head and neck (SCCHN) accounts for approximately 90% of all head and neck cancers with global incidence expected to increase by 17% between 2012 and 2022. Risk factors for SCCHN include tobacco and alcohol consumption. Human Papilloma Virus (HPV) infection is also a risk factor leading to rapid increase in oropharyngeal SCCHN in Europe and North America.

About Opdivo
Opdivo is a programmed death-1 (PD-1) immune checkpoint inhibitor that is designed to uniquely harness the body’s own immune system to help restore anti-tumor immune response. By harnessing the body’s own immune system to fight cancer, Opdivo has become an important treatment option across multiple cancers.

Opdivo’s leading global development program is based on Bristol-Myers Squibb’s scientific expertise in the field of Immuno-Oncology and includes a broad range of clinical trials across all phases, including Phase 3, in a variety of tumor types. To date, the Opdivo clinical development program has enrolled more than 25,000 patients. The Opdivo trials have contributed to gaining a deeper understanding of the potential role of biomarkers in patient care, particularly regarding how patients may benefit from Opdivo across the continuum of PD-L1 expression. In July 2014, Opdivo was the first PD-1 immune checkpoint inhibitor to receive regulatory approval anywhere in the world. Opdivo is currently approved in more than 60 countries, including the United States, the European Union and Japan. In October 2015, the company’s Opdivo and Yervoy combination regimen was the first Immuno-Oncology combination to receive regulatory approval for the treatment of metastatic melanoma and is currently approved in more than 50 countries, including the United States and the European Union.

U. S. FDA approved indications for Opdivo
Opdivo® (nivolumab) as a single agent is indicated for the treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma. This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Opdivo® (nivolumab) as a single agent is indicated for the treatment of patients with BRAF V600 wild-type unresectable or metastatic melanoma.

Opdivo® (nivolumab), in combination with YERVOY® (ipilimumab), is indicated for the treatment of patients with unresectable or metastatic melanoma. This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Opdivo® (nivolumab) is indicated for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO.

Opdivo® (nivolumab) is indicated for the treatment of patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy.

Opdivo® (nivolumab) is indicated for the treatment of patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and post-transplantation brentuximab vedotin. This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

Opdivo® (nivolumab) is indicated for the treatment of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) with disease progression on or after platinum-based therapy.

Opdivo® (nivolumab) is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy. This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

April, 2017|Oral Cancer News|

Epigenetic modification discovered in adult throat cancers

Source: www.specialtypharmacytimes.com
Author: Lauren Santye, Assistant Editor

An epigenetic modification may be the cause of 15% of adult head and neck cancers that are linked to tobacco and alcohol use, according to a study published in Nature Genetics.

Although the body is made up of a large number of different types of cells––neurons, skins cells, fat cells, immune cells–– they all have the same DNA or genome. It was not until recently that scientists discovered their differences can be explained by epigenetics.

“This discovery was absolutely unexpected since it seemed highly improbable that the kind of alterations of the epigenome that we had previously found in other types of tumors in children and young adults could also target an epithelial tumor like throat cancer that occurs only in adults,” said Dr Nada Jabado.

There are already some promising drug molecules currently on the market for other diseases that could be tested for head and neck cancers, as well as other cancer types, according to the study. Additionally, the investigators hope that the findings could help in developing treatments for pediatric patients.

“Now that we’ve identified this cohort of patients, we can move quite quickly since the case of adults, as opposed to children, there are more patients and lots of clinical trials,” Dr Jabado said. “The medicines could then be tested on children afterward.”

Dr Jabado’s work focuses on epigenetics in pediatric cancers, particularly on the mutations of the histone H3 protein. In particular, the investigators were interested in a 2015 publication by the Tumor Cancer Genome Atlas Consortium on head and neck cancer that included 1 of the genes that regulates H3.

“We made use of the same data but took a completely different approach,” said principal study author Dr Jacek Majewski. “Instead of concentrating on genetic mutations, we looked at the effect of these mutations on histone H3 proteins. That’s when we discovered that the histone H3 protein was abnormal or incorrectly modified in about 15% of patients with head and neck cancer. The data were there, but this fact had gone unnoticed.”

An essential part of the study was collaboration between scientists and access to the vast genomic databases of patients around the globe, according to the investigators.

“It’s crucial to have access to public data, because it allows us to advance faster and go further in our analyses,” Dr Jabado said. “In our case, this discovery revealed a sub group of patients who might benefit from a therapy that targets the epigenome. This could improve the treatment of more than 1 in 5 patients suffering from devastating oropharyngeal cancer. We are currently collaborating with 2 big groups specializing in head and neck cancer with the goal of finding treatments.”

The investigators are hopeful that the results of the study will open a variety of treatment options in the future.

January, 2017|Oral Cancer News|

Genetic variants are associated with susceptibility to mouth and throat cancer

Source: www.eurekalert.org
Author: news release

A number of genetic variants associated with susceptibility to oral cavity and pharyngeal cancer have been described in an international study published in the journal Nature Genetics.

The most noteworthy finding was an association between cancer of the oropharynx and certain polymorphisms (alternative versions of a given DNA sequence) found in the human leukocyte antigen (HLA) genomic region. HLAs, proteins found on the surface of most cells in the body, play an important role in recognizing potential threats and triggering the immune response to foreign substances.

According to Eloiza Helena Tajara, a professor at the São José do Rio Preto Medical School (FAMERP) in São Paulo State, Brazil, and co-author of the article, a specific group of variants in this region, located on chromosome 6, is associated with enhanced protection against oropharyngeal cancer caused by human papilloma virus (HPV).

“Previous research showed that these same variants confer protection against cancer of the uterine cervix, which is known to be associated with HPV,” Tajara said. “Our findings suggest that the genes that control the immune system play a key role in predisposition to HPV-related tumors. This discovery points to the possibility of clarifying the mechanisms whereby such tumors develop and of designing methods for monitoring risk groups.”

The study was coordinated by the International Agency for Research on Cancer (IARC) and involved 40 research groups in Europe, the United States, and South America. The Brazilian participants are members of the Head & Neck Genome Project (GENCAPO), a consortium of scientists affiliated with several institutions.

In a recent study, GENCAPO evaluated more than 7 million genetic variants in samples from 6,034 patients with head and neck cancer. The cases comprised 2,990 oral cavity tumors, 2,641 oropharyngeal tumors, 305 tumors in the hypopharynx (the bottom part of the pharynx near the esophagus), and 168 tumors in other regions or more than one region concurrently. The study population also included samples from 6,585 people without cancer as controls.

The researchers detected eight loci (genomic sites) associated with susceptibility to these types of tumor. Seven had not previously been linked to mouth or throat cancer.

According to Tajara, the IARC set out to focus on analyzing oral cavity and oropharynx tumors because there are no genome-wide association studies of these two tumor types. Although these cancers are predominantly caused by tobacco and alcohol use, the importance of HPV, particularly HPV16, as a cause of oropharyngeal cancer has become more evident in recent years.

“The throat is the most affected area among head and neck cancer subsites, likely because its tissue is more receptive to the virus,” Tajara said.

In the article, the researchers note that the proportion of HPV-related oropharyngeal cancer cases is estimated to be approximately 60% in the US and 30% in Europe but lower in South America.

“One finding that was expected to some extent was the absence of HLA associations with oropharyngeal cancer, which may be due to the fact that the frequency of HPV-positive oropharyngeal cancer is less than 10% in South America,” Tajara said. “The same factor appears to account for the weak association between the variants identified and HPV-positive oral cavity cancer, which is also far less frequent than HPV-negative oral cavity cancer.”

In her view, the strong rise in cases linked to HPV in the US could be partly due to a change in sexual habits, especially regarding the practice of oral sex. “It’s possible that Brazil is still in a transition stage and that the habits that favor infection are only starting to become more common. If so, the effects will appear in a few years’ time,” she said.

Previous studies have already shown that HPV-associated head and neck cancers affect younger people and develop rapidly. By contrast, cases associated with tobacco and alcohol use as well as poor oral hygiene are more prevalent in those over fifty years old and progress more slowly but are harder to treat.

In addition to DNA in tissue samples taken from participants of the study, data were also collected on environmental and clinical factors possibly associated with the development of this type of cancer, such as smoking, alcohol consumption, and age.

According to Tajara, thanks to the joint efforts of 40 research groups it was possible to obtain data on a significant number of patients, thus enhancing the impact and reliability of the results. The GENCAPO team contributed some 1,000 samples from tumors for analysis.

“Based on these results, we can try to understand from the molecular standpoint how the observed polymorphisms interfere with the response to HPV infection,” Tajara said. “This may give us clues as to how to protect people and how to reduce the incidence of this type of tumor.”

December, 2016|Oral Cancer News|

For this cancer, ‘stage 4’ isn’t as bad as it sounds

Source: www.omaha.com
Author: Steve Hendrix – The Washington Post

Hearing the word “cancer” in a doctor’s office is bad enough. Hearing “stage 4” invokes even more dread. When I learned I had stage 4 HPV-related oral cancer, I didn’t know exactly what it meant, but I knew there wasn’t a stage 5.

Doctors use the standardized staging system to describe the location, size and extent of a cancer and its spread throughout the body. Using data on the treatment and survivability of each particular kind of cancer, clinicians combine these factors to produce a number from stage 1 (a small tumor confined to one spot) to stage 4 (a cancer that has spread, either to a single adjacent lymph node or to distant organs).

My cancer was stage 4A, a small tumor at the base of my tongue that had spread to a single lymph node in my neck.

My doctor immediately tried to soften the blow. There were problems with the staging rules as they applied to this kind of cancer, he said. HPV oropharyngeal cancers, while potentially fatal, were far more treatable than other oral cancers, particularly the ones related to tobacco and alcohol use that were used to define the staging standards.

He was right. A study published in the Lancet early this year found that the current guidelines lead to needless panic for the newly diagnosed. “At the present time, most patients with HPV+ oropharyngeal cancer are told they have (stage 4) disease, but the reality is that their outlook is similar to that of patients with the most curable malignant diseases,” the study authors wrote.

This month, the American Joint Committee on Cancer is releasing new guidelines for HPV-positive oropharyngeal cancer staging that will ease patient fears and make it easier for doctors to offer less-invasive treatment options.

“It’s remarkable,” said my own physician, Arjun Joshi of George Washington University. “Under the new system, you would only be a stage 1.”

November, 2016|Oral Cancer News|

Tobacco is OUT! A third of all Major League Baseball stadiums to be free of tobacco

Source: www.dailyastorian.com
Author: American Heart Association News

With the end of this baseball season, so ended the long intertwined history of tobacco and baseball at more than one-third of all Major League stadiums.

The unhealthy coupling started unraveling when it became evident that chewing tobacco resulted in deadly consequences for some players, such as legendary San Diego Padre Tony Gwynn who died of mouth cancer in 2014.

Just months after Gwynn’s death, former Boston Red Sox pitcher Curt Schilling announced he was being treated for oral cancer.

Although Major League Baseball and the players’ union could not agree to take action, several cities have. Boston, Chicago, Los Angeles, New York and San Francisco all have passed laws prohibiting tobacco use of any kind at sports venues. A statewide law in California will take effect before the 2017 season begins.

This week, the Washington, D.C. City Council gave final approval to a measure that would end the use of all tobacco products – including smokeless tobacco like chew, dip and snuff – at all organized sporting events within the city, including Nationals Park.

Councilmember Yvette Alexander said the move is needed to help protect children, who often look to sports professionals as role models, from taking up the habit. The measure will now be sent to Mayor Muriel Bowser to sign into law.

Additionally, on Oct. 20, St. Petersburg, Florida, City Council Vice Chair Darden Rice introduced a proposal to ban smokeless tobacco products from the city’s athletic venues. The proposal includes Tropicana Stadium, the home of the Tampa Bay Devil Rays. Rice said she hopes the proposal would clear before the start of the 2017 season.

Legislation is also currently under consideration in Toronto and the state of Minnesota.

“Our national pastime should be about promoting a healthy and active lifestyle, not a deadly and addictive product,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids.

November, 2016|Oral Cancer News|

Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium.

Source: www.pubmed.gov
Author: Wyss AB, Gillison ML, Olshan AF

Abstract

Previous studies on smokeless tobacco use and head and neck cancer (HNC) have found inconsistent and often imprecise estimates, with limited control for cigarette smoking. Using pooled data from 11 US case-control studies (1981-2006) of oral, pharyngeal, and laryngeal cancers (6,772 cases and 8,375 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, we applied hierarchical logistic regression to estimate odds ratios and 95% confidence intervals for ever use, frequency of use, and duration of use of snuff and chewing tobacco separately for never and ever cigarette smokers. Ever use (versus never use) of snuff was strongly associated with HNC among never cigarette smokers (odds ratio (OR) = 1.71, 95% confidence interval (CI): 1.08, 2.70), particularly for oral cavity cancers (OR = 3.01, 95% CI: 1.63, 5.55). Although ever (versus never) tobacco chewing was weakly associated with HNC among never cigarette smokers (OR = 1.20, 95% CI: 0.81, 1.77), analyses restricted to cancers of the oral cavity showed a stronger association (OR = 1.81, 95% CI: 1.04, 3.17). Few or no associations between each type of smokeless tobacco and HNC were observed among ever cigarette smokers, possibly reflecting residual confounding by smoking. Smokeless tobacco use appears to be associated with HNC, especially oral cancers, with snuff being more strongly associated than chewing tobacco.

© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.

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

October, 2016|Oral Cancer News|

Recognizing oral carcinoma

Source: nurse-practitioners-and-physician-assistants.advanceweb.com
Author: Amber Crossley, MSN, ARNP, FNP-BC

Oral carcinoma is identified as one of the top ten cancers worldwide, accounting for nearly 2% to 5% of all cancer cases.1, 2 In 2014, there were an estimated 42,440 new cases of oral and pharyngeal carcinoma.

Males have a greater risk of developing the disease compared to females.2 Black males in particular are amongst the highest at-risk group for developing oral carcinoma.2 Oral carcinoma typically develops after the age of 50, with the majority of cases occurring between the ages of 60 and 70.2 When initially diagnosed with oral carcinoma, more than 50% of people will have metastases.3

The most common causes of oral carcinoma are related to tobacco use and alcohol consumption.4 In fact, 75% of all cases of oral carcinoma may be caused by the combination of tobacco and alcohol use.4

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However, it has also been extrapolated that chronic trauma to the oral mucosa, such as in the case of ill-fitting dentures or the consumption of high-temperature foods, is a leading modifiable risk factor for oral carcinoma.1,5 Dietary deficiencies of vitamins A, C, E, selenium, and folates may also contribute to the development of malignant cancerous lesions in the oral cavity.6

While cases of oral carcinoma have decreased over the last few years in the United States, oropharyngeal cancer is increasing in incidence.4 The rise in cases of oropharyngeal cancer may be related to viral and infectious diseases; however, the mechanisms are largely unclear. Some of these infections and viruses include human papilloma virus (HPV), periodontitis, candida albicans, syphilis and herpes simplex virus.7 However, for the purposes of this case presentation, only oral cavity cancer will be discussed.

A Non-Healing Oral Lesion
MC is an 82-year-old white female who visited her primary care provider’s office complaining of a mouth sore. The sore was present for approximately six months, and grew increasingly painful.

She has worn dentures for more than 10 years, and was accustomed to the typical soreness with irritation sometimes associated with everyday denture use. With this particular occurrence, the soreness lingered in the same area and lasted longer than any previous experience.

MC attempted to alleviate the soreness with an existing prescription for hydrocodone. This treatment proved unsuccessful. MC scheduled an appointment with her primary care provider, as she assumed the pain was the result of ill-fitting dentures.

At MC’s initial appointment, the provider noticed a 7mm erythematous lesion on the lower interior aspect of her right molar, and suggested it could be the result of her ill-fitting dentures. Because MC had exhausted her hydrocodone, the provider prescribed tramadol and a viscous lidocaine suspension for pain. She was told to follow-up with her dentist once the sore completely healed in order to be fitted with new dentures. She was instructed to refrain from denture use until the sore had resolved. There were no further follow-up instructions given.

One week after the initial visit, MC returned to the primary care provider’s office because of increasing pain and discomfort. During this visit, the provider noted the sore had ulcerated edges that were friable and showed little improvement. She was referred immediately to an otolaryngologist for the suspicion of carcinoma of the oral cavity.

Patient History
MC is an 82-year-old widow. She is a Medicare recipient living in government-subsidized housing for the elderly. MC smoked tobacco between the ages of 17 and 52 at a rate of 1.5 packs per day, or 53 pack years. During the same 35 year time frame, she drank 1 to 2 alcoholic beverages daily.

Over the past 10 years, she lost a total of 40 pounds without any lifestyle modifications to justify the weight loss. At the time of MC’s initial primary care visit, she weighed 91 pounds. Additional patient history included hypothyroidism, mitral stenosis, gastroesophageal reflux disease, coronary artery disease, arthritis and hypertension.

Clinical Features
Oral carcinoma is defined as cancer involving the floor of the mouth, hard palate, buccal mucosa, interior tongue, retromolar trigone, or alveolar ridge.8 Premalignant oral carcinoma may present as a painless white patch known as leukoplakia, or a painful reddened patch identified as erythroplakia.9 In addition to the aforementioned signs, the cervical lymph nodes may be enlarged.10 Any erythroplakia or leukoplakia lesions that appear to be non-healing in an older individual should be deemed suspicious.10

Differential Diagnosis

Refer to the table below to help you rule out other conditions.

table

Diagnosis
Early identification of oral carcinoma offers patients the greatest chance for successful treatment and survival following diagnosis.5

An initial patient history that includes tobacco use, alcohol consumption, sexual practices, denture use, oral trauma, infections of the oral cavity and a history of present illness should be obtained.8 It is important to understand that patients complaining of ill-fitting dentures are four times more likely to develop an oral lesion that is cancerous.5

Oral lesions caused by trauma increase the likelihood of carcinogen absorption from tobacco and alcohol in the oral mucosa. This absorption may disrupt the deoxyribonucleic acid of the mucosal cells.1

Following a thorough history, the provider can perform a complete head and neck examination. During oral cavity inspection, a mirror and fiberoptic exam should also be performed.8 A combination of inspection and palpation for lumps or abnormalities within the tissue of the oral mucosa is the definitive mechanism used to screen for oral cancer as identified by the U.S. Preventive Services Task Force.4 In the presence of a potentially cancerous oral lesion, a surgical biopsy should be completed to confirm a diagnosis of oral carcinoma.9

Imaging studies can be used to detect and identify metastases of oral carcinoma. Computed tomography is the preferred imaging study performed at the site of the primary tumor.11 This study can identify the extent of the tumor, as well as lymph node involvement.10,12 Additionally, a chest x-ray is recommended in order to determine whether or not the oral carcinoma originated in the lungs or metastasized to the lungs. The lungs are the primary site for metastases of oral carcinoma.12 More than 90% of oral cavity cancers are considered to be squamous cell carcinoma.11

Laboratory studies should also be considered in addition to imaging studies. Serum ferritin, alpha anti-trypsin, and alpha-antiglycoprotein levels can be elevated in patients with advanced cancer of the head or neck region.12 Laboratory studies alone cannot determine the presence of oral carcinoma. However, they can aide in identifying the extent and progression of the cancer.12

Case Outcome
A surgical biopsy was performed in order to identify the causative organism. MC was diagnosed with stage IV malignant squamous cell carcinoma of the right retromolar trigone, as well as squamous cell carcinoma of the right middle and lower lobe of the lung. The patient had no lymph node involvement.

Because of her increased age and nutritional status, MC did not qualify for multimodal treatment. Instead, she is being treated with aggressive radiation therapy over a period of 12 weeks.

Understanding key factors related to MC’s case — increased age, history of tobacco and alcohol use, and ill-fitting dentures — is paramount when identifying the painful, non-healing, 7 mm lesion in her oral cavity as a potential diagnosis of oral carcinoma.

Implications for Practice
Due to the increase in oral health disparities, the Institute of Medicine released a report revealing a new demand for non-dental health care providers to perform screenings for oral diseases as well as offering prevention advice and referral to preventative services.13

Increasing interprofessional collaboration amongst dentists, nurse practitioners, physician assistants, physicians and medical students has shown to be effective in implementing the head, ears, eyes, nose, oral cavity, and throat (HEENOT) assessment into practice.14 While this is similar to the head, ears, eyes, nose and throat assessment, it allows for the integration of the oral cavity into the evaluation of the head and neck exam.

One study, conducted between 2008 and 2014 at New York University, revealed that the result of HEENOT implementation led to 500 patient referrals to dental clinics for suspicious oral lesions.14 Preventative measures at the primary care level should focus on the greatest risk factors (tobacco use, alcohol consumption and ill-fitting dentures).

Research has shown that due to the sometimes vague and misleading symptoms of early-onset oral carcinoma, a diagnosis may be prolonged by up to 6 months.12 Although screening for oral cancer in healthy individuals without risk factors may not be beneficial, evidence supports oral screenings by primary care providers for high-risk patients.3, 4, 15

Given the fact that only 30% of patients ages 65 years and older have dental insurance coverage, the primary care provider must screen patients who present with many risk factors for oral carcinoma.14,16 Because there are a greater number of primary care providers in comparison to dentists, they have the potential to increase awareness and detection of oral carcinoma.16

While the leading cause for oral carcinoma is tobacco use, it is recommended that the primary care provider encourage patients who use tobacco to employ smoking cessation products.4 Second, the primary care provider should educate patients on the harmful effects of daily alcohol use.12 Third, providers should stress to patients the importance of regular dental check-ups and denture fittings as an essential tool for maintaining good oral health.5

Note:
Amber Crossley practices as an advanced registered nurse practitioner in Jacksonville, Florida.

References
1. Piemonte ED, et al. Relationship between chronic trauma or the oral mucosa, oral potentially malignant disorders and oral cancer. J Oral Pathol Med. 2010;39(7):513-517.

2. National Cancer Institute. Stat fact sheets: oral cavity and pharynx cancer. http://seer.cancer.gov/statfacts/html/oralcav.html.

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October, 2016|Oral Cancer News|

Rodeo Competitors Fight Smokeless Tobacco Use at Laramie Jubilee Days

Source: www.y95country.com
Author: Nick Learned

Cody Kiser and Carly Twisselman

Two professional rodeo contestants will ride exclusively for the Oral Cancer Foundation this weekend as part of Laramie Jubilee Days with a goal of preventing young fans from using smokeless tobacco.

Cody Kiser and Carly Twisselman each aim to show rodeo fans, particularly the younger ones, chewing or using other forms of smokeless tobacco isn’t what makes them who they are. They promote the Foundation’s campaign which uses the slogan “Be Smart. Don’t Start.”

Their approach is anything but confrontational or aggressive. Rather than encouraging people to quit, they hope to encourage young fans to never pick up the habit in the first place. And where some rely on statistics to make the point, Kiser and Twisselman take a different approach. Simply giving attention to young rodeo fans is a big part of getting their message across.

“Its not the facts that they’re going to take home,” Kiser says. “Everybody knows that tobacco’s bad; you can get cancer and you can die. But the biggest impact that I see is just acknowledging those kids or acknowledging those people in the audience that want to know more, and you can show them what you can do without tobacco.”

“I’m not out there to tell anybody how to live their life or preach to them about needing to quit,” Kiser says.

“It’s not our place to do that,” Twisselman says. “People most of the time aren’t going to listen when you tell them something like that anyway.”

The pair will be wearing Oral Cancer Foundation gear and handing out buttons, wristbands and bandanas bearing campaign messaging.

As they travel the rodeo circuit, Kiser and Twisselman each say they often see other riders use various types of smokeless tobacco such as chew and snuff.

“It’s very common,” says Kiser. “You see it everywhere.”

“One of my traveling partners, he started when he was in high school. He was just around it all the time,” says Kiser. “It was just the ‘cowboy’ thing to do, I guess.”

“A lot of people are very respectful about it,” Twisselman says. “They’ll see me in my shirt and be like ‘oh yeah, you represent the Oral Cancer Foundation’ and they’ll spit their chew out. I think that in itself is a positive side effect of it.”

“I think a large part of a lot of these cowboys is, it’s the cowboy thing to do, so they start doing it,” Kiser says. “And that’s where I want to step in and show the younger generation that you don’t have to chew to be a cowboy. You can be a cowboy athlete and not chew and treat your body as best you can, because what we do is very difficult and it’s hard on the body.”

“A lot of folks started when they young,” Kiser says. “And I’ve talked to guys who started chewing later in life and they can’t quit, or it’s hard for them. It’s a vicious thing.”

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

Rodeo outreach program fights oral cancer

Source: www.olivesoftware.com
Author: Stewart M. Green

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Carly Twisselman, a spokesperson with the Oral Cancer Foundation’s rodeo outreach program, and her horse Chanel travel the Western rodeo circuit and talk with kids about the dangers of using spit tobacco. Photo by Stewart M. Green

Carly Twisselman brushed her horse Chanel outside a stall at the Norris-Penrose Event Center, home of the Pikes Peak or Bust Rodeo, which will roll into town July 13-16. “I’ve been rodeoing my whole life,” she said. “Now I do it at the professional level. This is my rookie year so I’m going really hard. I want to win the rookie title.”

Summer is the busiest time of the year for cowgirls and cowboys. “We call it Cowboy Christmas, the 4th of July run,” she said. Twisselman and her travel partner have recently competed in Utah, Nevada, Arizona, New Mexico, and just drove up from Pecos, Texas, to Colorado Springs for qualifiers. “It’s a crazy time,” she said. “Lots of traveling, but lots of money to be won.”

Twisselman, a 30-year-old barrel racer, grew up on a ranch near San Luis Obispo on the central California coast. “My family’s been ranching there for seven generations,” she said. “I was on the back of a horse all the time. I was riding before I could walk.”

While growing up in the Western ranching and rodeo culture, Twisselman was aware of the widespread use of spit tobacco by cowboys. “I’ve been around it my whole life and seen a lot of things that were negative and I was affected by it.”

Rodeo and tobacco have a long history together. Starting in 1986, the U.S. Smokeless Tobacco Company sponsored the Professional Rodeo Cowboys Association until the association ended its partnership with tobacco advertisers in 2009. Tobacco use, however, still thrives with cowboys and spectators at rodeos.

In 2014, the Oral Cancer Foundation, a nonprofit organization that supports prevention, education and research of oral cancer, reached out to pro rodeo athletes to spread the word about the dangers of tobacco use, with Cody Kiser, a bareback bronc rider, as their first rodeo spokesperson. This past year they added Carly Twisselman to continue creating awareness in the rodeo community.

“Honestly, it was God that they came to me,” said Twisselman. “Their goal was to reach rodeo people, people in the Western culture and people that were horse lovers because tobacco is a huge problem in rodeo.” The foundation asked Twisselman to be a spokesperson and she gladly accepted. “It’s an amazing thing to represent such a great organization. I can take this rodeo platform where I’m in front of thousands of people and use it for good.” While the Oral Cancer Foundation wants to help adults with tobacco problems, its rodeo focus is on children. According to The Centers for Disease Control and Prevention, 9.9 percent of high school-age boys use spit tobacco nationwide, while 10.5 percent of men ages 18-25 use it. Usage is higher in rural states like Wyoming, Montana and West Virginia. A can of spit tobacco packs as much nicotine as 40 cigarettes, and a 30-minute chew is like smoking three cigarettes, making addiction to spit tobacco one of the hardest to break. Spit tobacco, including smokeless tobacco, dip, snuff, chew and chewing tobacco, can cause gum disease, tooth decay and oral cancer. Almost 50,000 people will be diagnosed with oral cancer in 2016.

“We aren’t telling people they should stop,” Twisselman said, “but we show people why it’s not good to use tobacco. If someone is chewing, I’m not going to go lecture them.”

Twisselman and Kiser focus on helping kids make positive choices about tobacco use. “Kids look up to us as idols and if they see us doing good and not chewing tobacco then maybe they won’t either,” Twisselman said. “Our message is: ‘Be Smart, Don’t Start.’”

Twisselman also attends junior rodeos where she hands out wristbands, bandanas, pins, and buttons. “Kids love the freebies,” she said. She also wears Oral Cancer Foundation logos on her competition shirts.

Surprisingly, some rodeo women chew tobacco. “It’s not the problem it is with the men,” Twisselman said, “but I do see it. I find it really repulsive. Sometimes women who chew will see me and say, “Oh, you work with oral cancer” and they’ll take their chew out and throw it away because they don’t want to be disrespectful to me.”

Twisselman said she and Kiser are making a difference, noting people are becoming more educated about the dangers of throat cancer from chewing tobacco and learning that it’s not a healthy habit. “We’ve only been doing this for a year now and we’re still getting our feet wet,” she said. “It’s hard to know if fewer kids are chewing now but I’m getting the word out and interacting with them. Because we take the time to talk with kids and give them the little gifts, it has a huge impact on them.”

To learn more about oral cancer and its prevention, medical research, education and for patient support, then visit oralcancer.org.

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