tongue cancer

Cancer Survivor Gears Up for 25 Mile Bike Ride at the Age of 77

Newark, Ohio — A 77-year-old woman and cancer survivor has biked 25 miles routinely in preparation for this month’s Pelotonia bicycle race.

Beverly Cote started out biking four miles a day and worked her way up to 25 miles, the distance of Pelotonia, 10TV’s Andrea Cambern reported Tuesday.

Her inspiration came from someone who made history on a bicycle.

“I have been bragging about my grandfather ever since I was a kid,” Cote said.

Her grandfather, John LaFrance, rode from New York to San Francisco in 22 days and made headlines, Cambern reported.

“My grandfather did not have a 10-speed back in 1896,” Cote said. “If he could do it, I could do it.”

He was not the only reason she will ride in the annual bike tour to fight cancer.  Cote is a survivor. Over a year ago, she was diagnosed with stage-four throat and tongue cancer.

She endured 35 radiation treatments and seven rounds of chemotherapy.

“On my last exam with Dr. Old at the James, he said, ‘Are you going to ride in Pelotonia, next year?’ I told Dr. Old that if he kept me well, for one year, I will ride in it,” Cote said.

Pelotonia is scheduled to begin on August 19.

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

August, 2011|Oral Cancer News|

Glowing Cornell Dots Target Cancer

SOURCE: Journal of Clinical Investigation, June 13, 2011

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

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

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

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

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

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

 

June, 2011|Oral Cancer News|

NHL icon Stan Mikita diagnosed with oral cancer

Source: Huliq.com

He is considered by Chicago Blackhawks hockey fans to be one of the greatest hockey players of all time, but he now faces his greatest challenge as it was announced Stan Mikita has cancer.

The statement was released by the Blackawks organization today. The statement was that Mikita was diagnosed with stage 1 oral cancer.

According to Chicago press reports, Mikita was diagnosed with the condition at Loyola Medical Center in downtown Chicago. The report from the team stated that the diagnosis was of early stage tongue cancer. The statement also said that, since the disease was found early, he stands a good chance of responding to treatment.

The release also asked that the press not ask the team for further information about Mikita’s condition. The statement was that it was a personal matter between Mikita and his family and his doctors. No further statements about his condition will be released by the team.

Stan Mikita was originally from Canada. He eventually came to the United States and played in the early days of the NHL. They played for the Chicago Blackhawks in the late 1950s and early 1960s. He was on the team when they beat the Detroit Redwings to win the Stanely Cup in 1961.

Mikita played professional hockey throughout the 1970s. He finally retired due to chronic back pain in 1980. He has been inducted into the Hockey Hall of Fame. During his time as a player he was the league MVP twice. He is also reportedly the first player to used the curved blade on his stick.

Even in retirement, Mikita has stayed close to Chicago and the Blackhawks. He made frequent appearances at games and around the city during the team’s Stanley Cup Championship in 2010. He is currently listed by the team as an official Blackhawks Ambassador.

 

 

Dental professionals join The Oral Cancer Foundation to raise awareness as HPV is now the primary cause of Oral Cancers in America

NEWPORT BEACH, Calif., April 4, 2011 /PRNewswire/ — A serious change in the cause of oral cancer is taking place nationally, and its implications are impacting the American public in a manner that a decade ago no one would have predicted.

For decades, oral cancer (also known as mouth cancer, tongue cancer, tonsil cancer, and throat cancer) has been a disease which most often occurred in older individuals, who during their lifetimes had been tobacco users.  Most cases were ultimately the result of lifestyle choices. Today that paradigm has changed. A common, sexually transferred virus has replaced tobacco as the number one cause of oral cancers, Human Papilloma Virus number 16 (HPV16). This is one of the same viruses that are responsible for the majority of cervical cancers in women.

This year alone, approximately 37,000 Americans will be newly diagnosed with oral cancer, and one person will die every hour of every day from this disease. HPV16, one of about 130 versions of the virus, is now the leading cause of oral cancer, and is found in about 60% of newly diagnosed patients. Dr. Maura Gillison from the James Cancer Center, a long time researcher of the relationship between HPV and oral cancers, recently reported these new findings at the American Academy for the Advancement of Science meeting.

This change in etiology, which has accelerated its influence over the last two decades as tobacco use in the US simultaneously was declining, has also changed the demographics of who is getting the disease. It is no longer the domain of those over 50 who have smoked a decade or more of their lives. The fastest growing segment of the oral cancer population, are people in the 25-50 age range, who are never smokers, and that group predominantly comes to the disease from HPV16.  Their oral cancers occur in locations anatomically unique, mostly localized to the posterior of the mouth; in the oropharynx, tonsils, and at the base of the tongue.  This viral etiology makes identifying the “high risk” individual much more difficult.

Tobacco use in any form by itself continues to be an important risk factor for the disease. However, in the developed world, oral cancers are becoming more common because of persistent HPV16 viral infections. Evidence indicates that the virus can be sexually transmitted between partners, and accounts for the increase in young victims of oral cancer who do not fall into the historic, tobacco risk factor group. Additional risk factors include high alcohol consumption, the use of conventional smokeless (chewing/spit) tobacco, as well as prolonged exposure to the sun (for lip cancers).

In a National effort to raise awareness, The Oral Cancer Foundation has joined forces with dental offices throughout the US to screen individuals for the disease. Together, OCF and the dental community are urging the American public to take advantage of free oral cancer screenings during Oral Cancer Awareness Month in April.  Over 1250 free screening events are taking place in dental offices across America in this one month alone.  These simple visual and tactile screenings hold the hope for an early discovery, sometimes even as a pre cancer, when current treatments are the most effective and survival is the highest.  A list of the offices participating in this event can be located on the foundation’s web site at: http://www.oralcancer-screening.org/events/

Dr. Ross Kerr, an oral medicine specialist at NYU comments, “In a painless, three to five minute oral cancer screening, most of the signs and symptoms of oral cancer can be seen with the naked eye, felt with the fingers, or elucidated during the patient’s oral history interview. Suspect tissues can be easily biopsied for a definitive diagnosis. Unlike most other cancer detection exams, the screening for oral cancer does not require any special equipment, is not uncomfortable or expensive, nor require invasive procedures. Any dentist or primary care physician and many nurses and dental hygienists, who have been trained to do oral cancer examinations, are in a position to find the early signs and symptoms of this disease. The dental community, through this partnership with The Oral Cancer Foundation, is positioning itself as the first line of defense against oral cancer through the process of early discovery of suspect tissues.”

Oral cancer kills almost three times as many people as cervical cancer every year, and is responsible for more deaths than from other cancers we hear about more routinely. Yet it continues to remain off the radar to most of the American public. Only recently when actor Michael Douglas was diagnosed with a base of tongue oral cancer, did the disease gain significant visibility.

It is an insidious disease, as in its early development it does not always produce physical symptoms that a person may be aware of, and this makes routine, professional screening highly important. If oral cancer is detected early (in stages 1 or 2), the survival rate can be as high as 80%-90%; but when found as a late stage disease (stages 3 or 4), the chances of survival drop to 20%-30%. Unfortunately, in more than half the cases, oral cancer is found in its later stages, and late discovery and diagnosis are major factors in the high death rate.

The good news is that it does not have to be this way. Like other cancer screenings you engage in such as cervical, skin, prostate, colon and breast examinations, opportunistic oral cancer screenings are an effective means of finding cancer at its early, highly curable stages.

Brian Hill, an HPV+ stage four oral cancer survivor and OCF Founder said, “Reducing the high death rate associated with oral cancer is a tangible opportunity today. We have seen early detection positively impact the death rates of many other cancers. The most notable is our sister disease, cervical cancer. Like oral cancer, it is predominantly squamous cell carcinoma, and is caused almost exclusively by the same HPV virus group. In the 1950’s when American women began getting an opportunistic annual cervical screening, we saw the death rate associated with it drop dramatically. A reduction in oral cancer deaths is not waiting on a new scientific discovery, diagnostic device, intervention, or treatment to make it occur. We do need increased public awareness, coupled with an engaged professional dental and medical community doing opportunistic screenings, to make death reduction a reality. The American public needs to avoid known risk factors and make sure that they receive an oral cancer exam at least annually.”

The Oral Cancer Foundation is encouraging the public to take advantage of these free screenings during April’s Oral Cancer Awareness Month. There are hundreds of free screening events taking place throughout the country. To learn more about oral cancer, or to find a screening location near you, go to the foundation’s website, www.oralcancer.org.  Early detection saves lives.

The Oral Cancer Foundation is an IRS registered 501c3 non-profit public service charity, that provides information, patient support, sponsorship of research and advocacy related to this disease.

SOURCE The Oral Cancer Foundation

Rise of tongue cancer in young, white females

www.medscape.com

Roxanne Nelson – staff journalist for Medscape Oncology.

The incidence of oral tongue squamous cell carcinoma has been rising in young white American women, according to a new report. For the past 3 decades, the incidence has been increasing in white men and white women 18 to 44 years of age, but the trend is most pronounced in young white women.

In a report published online March 7 in the Journal of Clinical Oncology, the authors found that the incidence of oral cavity squamous cell carcinoma was declining for all age groups. The incidence of oral cavity and tongue cancer also was decreasing for nonwhite individuals. However, among people 18 to 44 years of age, the incidence of oral tongue cancer climbed 28% between 1975 and 2007. Among white people in this age group, the incidence increased 67%. The rising rates were most dramatic for white women, with a jump of 111%.

“Lately, we have been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals, but couldn’t find any information about gender-specific incidence rates, so we decided we should take a look at the SEER [Surveillance, Epidemiology, and End Results] data,” said lead author Bhisham Chera, MD, assistant professor in the Department of Radiation Oncology at the University of North Carolina School of Medicine, Chapel Hill. The authors note that historically, cancer of the oral cavity was considered to be associated with older men with histories of significant tobacco and alcohol use. But during the past 30 years, the incidence of oral cavity squamous cell carcinoma has been declining while the incidence of oropharyngeal squamous cell cancer has been increasing. These trends, note the authors, might be explained by the decreased use of tobacco and the association between the carcinogenic strains of human papillomavirus (HPV) and cancer of the oral cavity.

Not HPV Associated

Unlike cancers of the tonsil and base of tongue subsites within the oropharynx, oral cavity and oral tongue squamous cell carcinomas are rarely associated with HPV infection, according to the authors. The demographics of HPV-related head and neck malignancies differ from those associated with HPV. Those with HPV-associated head and neck cancers generally tend to be white men who are nonsmokers. At Dr. Chera’s institution, the young patients with head and neck squamous cell carcinomas who are nonsmokers and nondrinkers are most likely to be white women with oral cavity squamous cell carcinoma.

“Our findings suggest that the epidemiology of this cancer in young white females may be unique and that the causative factors may be things other than tobacco and alcohol abuse,” Dr. Chera said. “Based on our observations and the published data, it appears that these cases may not be associated with the human papillomavirus. We are actively researching other causes of this cancer in this patient population.”

They have examined the HPV status of their young white female patients with oral tongue tumors and have not found an association. Other reports have shown similar findings — a higher number of oral tongue squamous cell carcinomas in women and an absence of detectable HPV DNA. It is possible that they are being caused by a different virus or another subtype of HPV, he told Medscape Medical News. “There are over 100 subtypes but only handful are associated with malignancy, and we only test for the high-risk types.”

“Could it be that another type is associated? . . . Basically, we don’t know yet,” Dr. Chera added. In their study, Dr. Chera and colleagues analyzed the incidence and survival data from the SEER Program from 1975 to 2007 for oral cavity squamous cell carcinoma and oral tongue squamous cell carcinomas. Specifically, they looked at 3 cohorts: patients of all ages, patients 18 to 44 years of age, and patients 44 years and older. The patients were also stratified by sex and/or race.

Possible Emerging Clinical Entity

During that time period, SEER data showed 32,776 cases of oral cavity squamous cell carcinoma, with 2223 of those occurring in young adults. The ratios for male/female and white/black or other races were 2.2:1.0 and 8.5:1.0, respectively. For all age groups, there were a total of 6,810 cases of oral tongue squamous cell carcinoma, with 814 in the 18 to 44 year age group. For all age groups, the male/female ratio was 1.6:1.0; stratified by race, 424 were white (82%), 50 (6%) were black, and 96 (12%) were other. Because it is not usually associated with HPV, the authors note that oral tongue squamous cell carcinoma in young white women “may be an emerging and distinct clinical entity, although future research is necessary before broad conclusions can be drawn.” Specifically, further investigation is needed to examine the sources of the observed variation, they write.

“Dentists and primary care physicians should be more cognizant of oral tongue squamous cell carcinoma in this group of patients,” said Dr. Chera. “At this point, the incidence is very small, and widespread screening may not be cost effective.”

“I would say that if a young white person has complaints of a persistent sore on their tongue, cancer should be moved up higher on the differential, based on our study,” he added. “Dentists should not only examine dental health but also examine the tongue. They are in a position to provide effective screening.”

The source for this article was – J Clin Oncol. Published online March 7, 2011. Abstract

March, 2011|Oral Cancer News|

Jury finds no negligence by orthodontist in Annadale woman’s tongue-cancer death

Source: Silive.com

tongue.jpg
Tragic teen: Stephanie Hare’s cancer was too far advanced, and aspiring teacher died in November 2004.

STATEN ISLAND, N.Y. — Annadale resident Stephanie Hare was only 19 years old when a cancerous lesion was detected on her tongue in April 2004. By that time, it was too late.

Despite undergoing surgery to remove most of her tongue and submitting to painful radiation and chemotherapy treatments, the vivacious young woman who aspired to be a teacher died seven months later at the age of 20.

Ms. Hare’s family contends her orthodontist, Dr. Michael J. Donato of Richmond, was responsible for her death by failing to detect the lesion during a December 2003 visit. However, a jury in state Supreme Court, St. George, disagreed.

The panel on Wednesday found Dr. Donato was not negligent and had followed standard dental practices and care when he examined Ms. Hare on Dec. 19, 2003.

“Stephanie’s death was not anybody’s fault,” Dr. Donato’s lawyer, Douglas J. Fitzmorris, told jurors in his summation. “Stephanie died of cancer. Dr. Donato’s not to blame. The whole specter of this lesion being missed by Dr. Donato is not what happened. There was no deviation from accepted practice.”

Jason C. Molesso, the lawyer for Ms. Hare’s family, had asked jurors to consider a $2.3 million award for her pain and suffering if they found Dr. Donato liable.

“This case is about choices,” Molesso told jurors in his closing argument as Ms. Hare’s family wept and hugged each other in the audience. “We have to live and die with the choices we make, but certain times we depend upon others to make the choices we live and die with.”

“When she was diagnosed with cancer, all the choices she had made about her life were going to be taken away from her. She died in a hospital bed of metastatic tongue cancer that was diagnosed when she was seeing a dentist once a month,” said Molesso. “You lost a productive person who cared a lot about other people.”

Molesso could not immediately be reached yesterday for comment.

The case, which was tried over two weeks before Justice Joseph J. Maltese, hinged on several factors; namely, whether jurors believed the lesion was present on Dec. 19, 2003, whether Dr. Donato should have found it, and whether he followed standard dental practices during the exam and treatment of Ms. Hare.

According to court papers, Rosemary Hare, Ms. Hare’s mother, testified she first saw a “small bump” under her daughter’s tongue around Thanksgiving 2003. A month earlier, two different dentists had examined Stephanie and found no signs of lesions or cancer.

Citing multiple hospital records, Molesso, the Hares’ lawyer, contended Stephanie complained to Dr. Donato about soreness and bleeding in her mouth during a routine visit on Dec. 19, 2003. Dr. Donato had fitted Stephanie with braces about a year earlier.

However, there were no notations in Dr. Donato’s files for Dec. 19, 2003, regarding such a complaint.

Dr. Donato treated Ms. Hare again in January and March of 2004. There is no record of her complaining about mouth soreness on those visits although Dr. Donato smoothed an orthodontic band on her braces in January.

On April 5, 2004, Dr. Donato noted there was a cancerous-type lesion on Ms. Hare’s tongue. He removed a band near the lesion and prescribed a saline rinse. She returned two weeks later and Dr. Donato removed another band and referred her to an oral surgeon, who prescribed antibiotics.

A May 12, 2004, biopsy came back positive for squamous cell cancer and Ms. Hare subsequently underwent painful surgery and treatment. She couldn’t be saved.

Molesso said Ms. Hare’s cancer was in the advanced Stage 4 when it was diagnosed in May 2004. By that time, Ms. Hare’s chances of survival were less than 25 percent, he told jurors, maintaining it should have been detected earlier.

His oncology expert testified the cancer likely would have been in the less lethal Stage 1 in December 2003. Had it been detected then, Ms. Hare’s survival chances would have exceeded 80 percent, he said.

Fitzmorris, the defense lawyer, maintained the various histories provided by Ms. Hare and her family for some hospital records was “unreliable.”

He said other hospital records showed Ms. Hare had complained of a “vague discomfort” on the left side of her tongue in November 2003, attributed it to her braces and did not seek medical help.

Dr. Donato’s experts testified that he followed accepted procedures.

One, an orthodontist, said that if a patient complained of small bump in her mouth, he would monitor the situation but wouldn’t immediately prescribe further tests.

In addition, defense experts testified that tongue cancer was extremely rare in a patient of Ms. Hare’s age and physical condition, and would not have been among the first considerations in assessing her complaints.

In any case, Fitzmorris maintained the cancer spread so rapidly, there was little hope for Ms. Hare, even had it been detected in December 2003.

“Our sympathies continue to go out to the family for the tragic loss of such a sweet girl,” Fitzmorris said yesterday in a telephone interview. “Obviously, we were able to convince the jury, and, hopefully, the family, that Stephanie’s death was the direct result of the extraordinarily aggressive and rare nature of the cancer and not the result of the care rendered by Dr. Donato or any other medical or dental provider.”

March, 2011|Oral Cancer News|

Oral cancer screenings a must, say malpractice attorneys

Source: Dr.Bicuspid.com

By: Donna Domino

March 10, 2011 — The patient was insistent: All she wanted was to get her teeth whitened for an upcoming high school reunion. She came in for the $99 Internet special the dentist had run and mentioned a sore on her tongue, but she said it was recent, attributing it to a tongue-biting habit.

The dentist did the procedure but advised the patient that she needed a follow-up oral exam.

The patient eventually went to an oral surgeon who diagnosed the young mother with terminal tongue cancer. She sued the dentist who did the teeth whitening for malpractice, for missing her oral cancer.

That case, Tale of the Tainted Tongue, was dramatized at the recent Chicago Dental Society Midwinter Meeting in a session highlighting the growing number of malpractice suits over missed oral cancer screenings.

Anne Oldenburg, an attorney with Alholm, Monahan, Klauke, Hay & Oldenburg, which specializes in dental malpractice cases, participated in the mock trial. Ten years ago she didn’t have many such cases, she told DrBicuspid.com. But that scenario has changed dramatically in recent years, she said, noting that she is currently involved in three dental malpractice cases.

The mock trial was similar to a previous lawsuit she handled, in which a young man in his 40s died. “It was oral cancer that was clearly missed,” Oldenburg recalled. The family settled for $750,000 because the children didn’t want to go through the litigation process, but many death cases can reach $1 million policy limits, she noted.

Her colleague, Linda Hay, pointed to a tongue cancer case now garnering national headlines involving noted Chicago chef Grant Achatz, who wrote a book about his battle with tongue cancer. His surgeons wanted to surgically remove part of his tongue, but he wanted to preserve his ability to taste and opted instead to undergo radiation and chemotherapy in 2007. OCF Sadly, the treatment destroyed his ability to taste anyway, and Achatz sued his general dentist, alleging misdiagnosis. The case, which does not involve Oldenburg or Hay, will likely go to trial this year.

6-figure settlements

Publicity over actor Michael Douglas’s oropharyngeal cancer and movie critic Roger Ebert’s papillary thyroid cancer also has highlighted the growing incidence of oral cancer, especially among younger nonsmokers.

In fact, many plaintiffs who are suing their dentist for missed oral cancer diagnoses don’t fit the traditional profile, according to Hay. “It’s not the old drinker-smokers,” she noted. “We’re seeing more young people who don’t have the usual risk factors.”

Recent studies have attributed the steady increase of oral cancer to the human papillomavirus (HPV). Today, almost half of those diagnosed with the disease are younger than 50 years old — with some as young as 20, according to the Oral Cancer Foundation.

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

Oldenburg attributes the growing incidence of missed diagnoses to casual patients who come in mainly for cosmetic procedures such as teeth whitening and aren’t planning on staying with the dentist.

“They’re swooping in and getting cosmetic procedures, and they’re done,” she explained. “The dentists are missing an opportunity to do detailed follow-up and comprehensive exams. Had the patient [in the mock trial] come back, the dentist would have seen it [the lesion] was still there, and he would have the opportunity to take steps.”

Most cases settle out of court, with amounts averaging six figures, Hay said. Settlements also depend on the patient’s age, their occupation, and whether they have children. The number of malpractice cases involving oral cancer has risen dramatically in the past few years, the attorneys said.

Million-dollar settlements usually occur only when the patient dies, they added.

Hay recounted a malpractice case involving a man who developed an infection that spread to his brain following an extraction. The patient, who claimed he had permanently lost a lot of brain function, sued his general dentist, the oral surgeon who did the extraction, the family doctor, and the hospital where he had been taken. The oral surgeon’s insurance company paid the approximately $500,000 settlement.

Some policies have settlement clauses that limit a dentist’s ability to litigate such cases, according to James Carney, who specializes in dental malpractice claims for Southpoint Insurance Agency and humorously portrayed a bored judge in the mock trial. For example, if an insurance company wants to settle a case for $250,000 but the dentist insists on going to trial, he would have to pay the difference if he loses in court.

“With the downturn in the economy, there’s more pressure to earn a profit, and some companies are re-evaluating how to defend such cases and how they settle claims,” Carney told DrBicuspid.com.

He, too, has noticed a marked increase in dental malpractice cases. “I’m seeing more and more of them — two to three claims a year, where before we didn’t see any,” Carney said. The standard policy limit is $1 million, but some carriers provide $5 million to $7 million coverage, he added.

Carney agreed with the attorneys that patients often bear some responsibility in such cases, although other factors can be relevant as well.

“You can have a patient who is complacent in following the dentist’s treatment plan,” he said. “Technology comes into play if the dentist doesn’t have the appropriate technology to detect or diagnose some of these issues.” And patients are sometimes untruthful with the dentist about symptoms, he said.

When it comes to the dollar amount of a settlement, life expectancy is a significant consideration, Carney noted.

“If the patient is a successful businessperson with three young children, you can just fill in the number you want,” he said.

Dentists can avoid malpractice suits by doing simple things, such as documentation, taking the time with a patient, and doing a thorough oral exam — “things they teach in dental school,” Carney said.

Oldenburg agreed.

“Document, document, document,” she said. “And do your oral cancer screen even if they’re only coming in for a $99 special.”

Martin Duffy, 70; Marathon fixture went extra mile

Source: Boston.com

By: Bryan Marquard


The morning he died, during what turned out to be his last hour or so of life, Martin Duffy got up and ran through his daily regimen of stretching, push-ups, and sit-ups. Several months before, cancer had kept him from adding to his extraordinary streak of 40 consecutive Boston Marathons, but he was used to forging ahead when his body said stop.

Take one particular Marathon, probably his 26th. Afterward, he learned he had competed with a broken foot. Realizing at the 2-mile mark that something was amiss, “I divided that race into sections of 6 miles, with each segment a challenge to get through,’’ he told the Globe in 2000. “And somehow I did.’’

In 2009, Mr. Duffy’s string of consecutive completed Boston Marathons was recorded as the third-longest in history when he ran his 40th and final race a few months after being diagnosed with tongue cancer induced by the human papilloma virus. He was 70 when he died Nov. 29 in his Belmont home.

Runners often sought advice from Mr. Duffy, given his experience, and he didn’t stop at simply offering tips on how and where to train. An economist who advised businesses and helped them develop strategies, he was still in touch with friends and clients in his final days.

“He went in to work the week before he passed away,’’ said his wife, Rusty Stieff. And that was after treatment had left Mr. Duffy no longer able to speak. Instead, he carried an index card with bold lettering that said:

Please Excuse Me For Not Speaking. I have throat Cancer And have lost my Voice. Rejoice in your own!

Mr. Duffy never stopped rejoicing in life and in helping others, bidden or unbidden.

“His nickname was Father Martin, and believe me, he wasn’t a priest, but Martin sincerely believed that he could help you with all your problems,’’ said his longtime friend Jim Johnston of the Chestnut Hill neighborhood of Philadelphia, adding with a laugh: “Sometimes he defined problems you didn’t think you had. He stubbornly had answers, and frequently he was right.’’

Martin E. Duffy was born at home in Fall River, where he was the youngest of five siblings and liked to say that he started running as a child, to and from stores when he was sent on errands. He was captain of the track team at Durfee High School and set aside running at Tufts University, which he attended on an academic scholarship. He graduated in 1963 with a bachelor of arts in history and a bachelor of science in electrical engineering.

“He was such a renaissance man,’’ his wife said. “I mean, who majors in engineering and history?’’

Mr. Duffy served in the US Navy as a lieutenant with a Seabee battalion with the Civil Engineer Corps, then went to the Wharton School of the University of Pennsylvania in Philadelphia, graduating in 1967 with a master’s in business administration.

He continued his graduate studies at the university in applied and general economics, finishing everything but his dissertation while serving as an assistant dean and as associate director of the Fels Institute of Government. In recent years, Mr. Duffy was on the adjunct faculty at Emmanuel College and Suffolk University, teaching management and economics.

Returning to the Boston area in 1973, Mr. Duffy was director of financial analysis at Harvard University and assistant to the financial vice president, jumping two years later to McGraw-Hill, where he was a vice president and chief consumer economist. In 1986, he founded the Perseus Group, an economic research and consulting firm for which he specialized in forensic analysis.

His first marriage, to Irene Maxx Duffy of Monrovia, Calif., ended in divorce.

Katie Daley Duffy of Winchester, Mr. Duffy’s daughter from his first marriage, wrote about her father’s running for the Globe in 1997, just before his 28th Boston Marathon.

“For the last few years, my father has claimed at the end of the race that this is his last Boston,’’ she wrote, “but at 56, he still hits his feet to pavement and finds that place within himself where the running literally becomes the rhythm of balance in his life.’’

In 1988, Mr. Duffy married Stieff, whom he had helped train to qualify for the first women’s Olympic marathon trials in 1984. Their daughter, Brianna of Belmont, is also a runner.

For many years, Mr. Duffy coached girls’ soccer and was known for inspirational e-mail that he sent to players and their parents. He also was for many years a Town Meeting member in Belmont.

“He really was an exceptional guy,’’ Johnston said. “In many ways, he was better than the rest of us.’’

A service has been held for Mr. Duffy, who in addition to his wife, two daughters, and former wife, leaves two sisters, Janice Kirkman of Swansea and Anne Kenney of Hancock, N.H.; two brothers, Arthur of Stonington, Conn., and Tom of Rocky Point, N.Y.; and two grandchildren.

“He wasn’t afraid of death, but he loved life so much,’’ Stieff said. “He embraced it and exalted in it. Even as his cancer grew, he found new ways of engaging in life.’’

The uphills and downhills that the decades bring, Mr. Duffy said, are reflected in the 26.2 miles runners travel from Hopkinton to Copley Square.

“Life is a little like the Boston Marathon,’’ he told M. Nicole Nazzaro for Runner’s World magazine. “It is an allegory from bucolic Hopkinton through Natick, Wellesley, and Newton to the City on the Hill, Boston. And in the beginning, you get lulled by its ease. From Hopkinton Green, the course opens downhill. It starts easy — maybe way too easy. And so you overdo and thrill in the fast miles. The hills and the challenges are down the road and way in the future [‘and I’ll even feel better then!’].’’

As with life’s twists and turns, he added, the Marathon course can at times be misleading.

“After that last long downhill in Wellesley, the course starts uphill at Mile 16, crossing over Route 128. You thought you paced yourself conservatively, but now you find out. And then even as the crest of Heartbreak falls behind you at Mile 21, you discover another test, the downhills past Boston College that tear up your quads. You look at the CITGO sign on Boylston Street, but it just seems to stay in the same place until finally the last mile opens up to you.’’

January, 2011|Oral Cancer News|

Smokeless tobacco picking up steam — Products growing in popularity as smokers turn to cheaper and less obtrusive alternatives

Source: Los Angeles Times

By: Julie Wernau

Ron Carroll prefers to smoke cigars and pipes. But when he can’t do that he says he manages to unobtrusively get his nicotine fix by slipping a packet of tobacco, about the size of a teabag, under his upper lip.

“I use it all the time — movies, planes,” said the Chicagoan, who adds that he likes the fact he can remove the packet as easily as a piece of gum. There’s no chewing, spitting or mess, he says.

“It’s discreet, and you don’t look like an addict, he said. “Smoking’s definitely more about the flavor; the whole experience,” Carroll said. “With this, it’s just taking the edge off.”

Cigarette sales by volume have plummeted 17 percent from 2005, partly the result of health warnings and bans on smoking in public places as well as taxation by local and federal governments. And the heat on cigarette smokers is expected to intensify as the federal Food and Drug Administration requires images of corpses and diseased lungs to be featured on cigarette packs in two years.

Smokeless tobacco products — which come in shapes ranging from toothpicks to orbs and in flavors from cherry to peach — so far have not met with the same intense scrutiny, although there have been some changes. In June, the FDA increased the size of warning labels on smokeless products. “This product is addictive” and “This product is not a safe alternative to cigarettes,” say the warnings.

Scientists say that overall, smokeless tobacco products are less harmful than cigarettes, in large part because of a reduced risk of lung cancer. But medical experts agree that quitting tobacco altogether is the best alternative.

The FDA won’t report to the Secretary of Health and Human Services until 2012 on whether such products pose a threat to adolescents and children.

In a letter to tobacco-maker R.J. Reynolds in February, Lawrence Dayton, director for the FDA’s Center for Tobacco Products, expressed concern that the Camel dissolvables line — which includes tobacco strips that dissolve in the mouth, sticks that resemble toothpicks and orbs that look like hard candy — could be appealing to children and adolescents.

“Absolutely none of us, no one, wants kids to smoke or to use tobacco products,” said Todd Holbrook, senior director of marketing for Camel Snus, at Reynolds.

Sherry Emery, senior scientist at the Institute for Health Research and Policy at the University of Illinois at Chicago, has conducted focus groups on smoking products and said smoking tends to appeal to young people because it is visible, not because it is invisible. “Smoking is still very much a social behavior,” she said. “Smokeless tobacco is not social; the idea is to conceal it.”

While smokeless products represented just 6 percent of all tobacco sales in 2009, the market is growing at a rate of about 7 percent a year. Sales of smokeless tobacco products in 2010 are expected to total about $4.8 billion, according to Chicago-based Morningstar, which calculated that figure based on a year-over-year growth rate of 7 percent.

One of the reasons for the uptick is that “now you can consume products without anybody else being aware of it,” said Phil Gorham, a Morningstar analyst who follows the tobacco industry. He also said economic factors are driving people to quit or to switch to smokeless products. “We’ve had a big tax increase both on the federal and state level on cigarettes, and it’s becoming more expensive to smoke in some states,” he said.

At one retailer in Chicago, a pack of Marlboro was $10, with state, county and city excise taxes included, whereas a can of premium Swedish snus was $5.27 after taxes.

Gorham also said the growing array of smokeless tobacco products also has helped grow the market. “Going back a few years, smokeless products — all there really was the moist tobacco products that baseball players used, where you had to spit out the juice,” he said.

For the first time, viable alternatives exist, said Jason Healy, who founded an electronic cigarette company called Blu Cigs in 2009 in response to what he said has been a movement to treat smokers like “lepers.”

“Everyone’s been looking for the Holy Grail that allows you to smoke without everything that everyone’s concerned about,” Healy said.

Big Tobacco has taken notice. Between 2006 and 2009, the country’s two largest tobacco companies by market share — Altria Group and Reynolds American Inc. — acquired smokeless tobacco companies that together give them about 90 percent of the U.S. market share in that category.

The tobacco companies have begun branding smokeless products with traditional cigarette brand names such as Marlboro and Camel to lure disenfranchised smokers.

“Use of a well-defined brand name is more likely to make a smoker consider trying a category they’ve never tried before,” said Maura Payne, spokeswoman for Reynolds American, which began testing in certain markets Camel brand tobacco products that dissolve like hard candy.

In 2009, Altria Group’s Marlboro Snus and Reynolds’ Camel Snus made the national scene. Snus comes in small tea-bag like sachets that are placed in the mouth but don’t need to be chewed for the user to absorb the nicotine. Snus is pasteurized and refrigerated instead of fermented, a process that significantly lowers the levels of carcinogens that lead to mouth cancers.

The Snus market saw 28 percent year-over-year growth by volume in 2009, according to Euromonitor.

Chuck Levy, owner of Iwan Ries & Co., a fifth-generation family-owned tobacco purveyor at Wabash and Madison that’s home to one of the city’s only surviving legal smoking lounges, said he used to carry Marlboro and Camel Snus. But he said they didn’t sell as well as General Snus, a popular Swedish brand.

“We sell it to young people, old people. They come in suits as well as jeans,” he said.

With smoking bans in place, Levy said, many are looking for a replacement that can also give them the oral sensation they get from smoking.

Smokeless products also help adhere to smoking policies. Douglas Luke, director of the Center for Tobacco Policy Research at Washington University in St. Louis, said, “The smoke-free policies tend to be around protecting people from exposure to secondhand smoke. So, since smokeless products don’t have that, the gold standards are silent on that.”

Dr. Frank Leone, director of the University of Pennsylvania Medical Center’s Comprehensive Smoking Treatment Program, said smoke-free alternatives to cigarettes are a way for cigarette smokers to prolong their addiction to nicotine. It’s what he calls the “compromise position” — not as healthy as quitting, but not as unhealthy as smoking.

“It’s much more likely that people will find and seek out that compromise position than stop altogether,” he said.

While Leone said smokeless tobacco products are less harmful than cigarettes, that advantage may be done-in by the frequency of use. That’s because some smokers who have cut back because of smoking bans, may be consuming smokeless tobacco all day long, between cigarettes.

Traditional chewing tobacco has been shown to cause mouth, tongue, lip, jaw and even bladder cancers, said Leone. And like cigarettes, smokeless tobacco use can lead to a host of cardiovascular diseases although to a lesser extent, he said. While several studies show a decreased risk of cancer for those who use Snus over traditional fermented tobacco, little is known about its cardiovascular effects, he said.

Adam Johnson said he could smoke 50 hours a week if he wasn’t careful. Usually a pipe smoker, Johnson uses Snus packets throughout the day, he says, to stop himself from smoking too much.

“With (smoking) tobacco, I say I’m doing it for the flavor. This is — you can get a dose of nicotine while you’re helping a customer who doesn’t smoke, and they won’t even know it,” said Johnson.

Reynolds’ Holbrook said consumers are moving to smokeless because it offers freedom and choice that cigarettes can no longer offer.

“They’re looking for options where they can continue to enjoy tobacco on their terms, and they have control of the situation. They want tobacco that can be enjoyed at a bar or a nightclub,” he said.

December, 2010|Oral Cancer News|

HPV Causing “Slow Epidemic” of Oral Cancers

Source: Medscape Today
By: Janis C. Kelly

October 21, 2010 — Human papillomavirus (HPV) is a risk factor for oropharyngeal squamous cell carcinoma (OSCC), and might account for the steady increase in OSCC incidence, even in subjects who do not smoke or consume alcohol, according to Swedish researchers.

A review of recent studies, conducted by Trobjorn Ramqvist, MD, and Tina Dalianis, MD, PhD, and published online October 13 in Emerging Infectious Diseases, suggests that changes in sexual practices are behind the surge in OSCC cases linked to sexually transmitted HPV. The key factors appear to be multiple sex partners, starting sexual activity at a younger age, and increased oral sex.

The data are startling. For example, from 1970 to 2002, tonsillar cancer (which is the most common OSCC) increased in Stockholm, Sweden, by 2.8-fold, and by 2006/07, 93% of all tonsillar cancers in that city were HPV-positive.

Dr. Dalianis, who is professor of tumor virology and the head of the Department of Oncology–Pathology at Karolinska Institutet in Stockholm, told Medscape Medical News that “we realized that there was an increase in HPV-induced tonsillar cancer, but we did not realize it was so eminent until we separated the 2 groups (HPV-negative and -positive tonsillar cancer cases) the way we did.”

The most common OSCC is tonsillar cancer, followed by base of tongue cancer. Overall 5-year survival for OSCC is about 25%, and HPV-positive OSCC generally has better clinical outcomes than HPV-negative disease.

Dr. Dalianis said that HPV (most commonly type 16) was found in 45% to 100% of OSCCs in various studies.

“It was also observed that patients with HPV-positive OSCC were younger and lacked the traditional risk factors of smoking and alcohol consumption,” the authors write. “We suggest the increased incidence of OSCC depends on HPV infection and results in an increased proportion of HPV-positive OSCCs.”

Dutch Expert Questions Proportions of HPV Positivity

Using data from the Swedish Cancer Registry, the researchers found that the incidence of HPV-positive tonsillar tumors almost doubled over each decade from 1970 to 2007, for a cumulative 7-fold increase over that period.

Similarly, HPV-positive base of tongue cancers increased from 54% in 1998/99 to 84% in 2006/07.

However, another expert, asked to comment on the study by Medscape Medical News, raised questions about the high proportion of HPV-positive tumors found in the Stockholm registry data.

Boudewijn J.M. Braakhuis, PhD, is from the section of tumor biology in the Department of Otolaryngology/Head and Neck Surgery at VU University Medical Center in Amsterdam, the Netherlands. Dr. Braakhuis, whose work focuses on oral and oropharyngeal cancers, said that the proportion of HPV-positive OSCCs in the Amsterdam area is about 20%.

Dr. Braakhuis said that the Swedish analysis is hampered by the lack of a standardized method for measuring HPV involvement. Dr. Braakhuis’s group proposes doing p16 staining followed by general primer polymerase chain reaction with typing, which might reduce the risk for false positives.

The Case for HPV Vaccination

Dr. Dalianis said that there is a significant association of HPV-positive tonsillar cancer with early initial sex, and with the number of oral or vaginal sex partners. She also noted that one study reported “that not only oral sex, but also open-mouthed kissing, was associated with the development of oral HPV infection.”

Noting that this could mean that oral-to-oral contact might play a role in oral HPV transmission, Dr. Dalianis said that this has implications for the timing of vaccinating children to prevent HPV.

Dr. Dalianis is “a strong supporter of giving the HPV vaccine to both girls and boys,” and writes that “it is crucial to monitor the effects of the present HPV vaccination, not only on the incidence of cervical cancer but also on the incidence of OSCC.”

Dr. Braakhuis agreed: “One may expect that vaccination will decrease the number of HPV-positive oropharyngeal cancers” after decades.

Another important point uncovered in the review is that the incidence of head and neck squamous cell carcinoma is decreasing and OSCC is increasing, which might presage a risk for overtreatment if the intensified regimens used for head and neck squamous cell carcinoma are applied to HPV-positive OSCC, which has a better prognosis than HPV-negative disease.

“It is possible that increasing numbers of OSCC patients with a better prognosis are being treated with intensified therapy. As a result, many patients have substantial chronic unnecessary side effects. It is therefore necessary to identify which patients need and which do not need intensified treatment,” the study authors write. The suggestion is that OSCC patients with HPV-positive tumors who have never smoked might be candidates for less intensive treatment.

Dr. Dalianis and Dr. Braakhuis have disclosed no relevant financial relationships.

October, 2010|Oral Cancer News|