Three shots that could stop cancer

Author: Meredith Wadman

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

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

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

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

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

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

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

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

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

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

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

August, 2014|Oral Cancer News|

President’s panel calls for more girls, boys to get HPV vaccine

Author: Government news release

Too few American girls and boys are getting vaccinated against the cancer-causing human papillomavirus (HPV), the President’s Cancer Panel reported Monday.

HPV is linked to cervical cancer as well as penis, rectal and oral cancers. One in four adults in the United States is infected with at least one type of HPV. Increasing HPV vaccination rates could prevent a large number of cancer cases and save many lives, the panel said.

“Today, there are two safe, effective, approved vaccines that prevent infection by the two most prevalent cancer-causing types, yet vaccination rates are far too low,” Barbara Rimer, chair of the President’s Cancer Panel, said in a panel news release.

“We are confident that if HPV vaccination for girls and boys is made a public health priority, hundreds of thousands will be protected from these HPV-associated diseases and cancers over their lifetimes,” she added.

Currently, the U.S. Centers for Disease Control and Prevention is recommending that girls aged 11 and 12 receive either the Cervarix or Gardasil vaccines, and Gardasil is recommended for boys of similar age.

In 2012, only a third of girls aged 13 to 17 got all three recommended doses of HPV vaccine, CDC data shows. That’s much lower than the federal government’s goal of having 80 percent of girls aged 13 to 15 fully vaccinated against HPV by 2020, the report said.

The picture is even more disappointing for boys. Less than 7 percent of males aged 13 to 17 completed the recommended HPV vaccination series in 2012. The vaccine was recommended for boys more recently.

Boosting HPV vaccination rates to 80 percent would prevent 53,000 future cervical cancer cases among girls who are currently aged 12 or younger, according to the CDC.

The agency also estimates that increased vaccination would prevent thousands of cases of other HPV-associated cancers in both females and males, the report added.

A number of things need to be done to increase HPV vaccination rates, the panel said. These include public education and other efforts to increase teens’ and parents’ acceptance of the vaccines; encouraging doctors and other health care providers to recommend and give vaccinations; and making sure that the vaccines are available where teens receive health care.

Source: President’s Cancer Panel, news release, Feb. 10, 2014

February, 2014|Oral Cancer News|

Concerned About HPV-Related Cancer Rise, Researchers Advocate Boosting HPV Vaccination Rates

By: Anna Azvolinsky
Source: JNCI Journal of the National Cancer Institute Advance Access
Published:  August 29, 2013


Deaths from the major cancers—lung, colorectal, breast, and prostate—continue to decline, a trend that started in the early 1990s. Cancer incidence is also declining, if slightly, for both sexes. That’s the good news from the annual Report to the Nation on the Status of Cancer, a joint research effort by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries (J Natl. Cancer Inst. 2013;105:175–201).

But the study also shows an uptick in rates of anal and oropharyngeal cancer, a type of head and neck cancer related to infection with the human papillomavirus (HPV), in the 10-year period ending in 2009. Cancer of the oropharynx increased among white men and women (3.9% and 1.7%, respectively). Anal cancer also increased in both sexes, with the greatest increase among black men (5.6%) and white women (3.7%). Rates of vulvar cancer, another HPV-related cancer, also increased among women despite continued lower rates of cervical cancer.

Researchers attribute this rise in HPV related cancers to more HPV infections. “We think that increases in oral–genital sexual practices and increasing number of sexual partners that occurred some 30 years ago as part of the sexual revolution may be implicated in part of the increase in cancer rates we are seeing today,” said Edgar P. Simard, Ph.D., M.P.H., senior epidemiologist of surveillance research. Although rates of HPV infection from three decades ago were not available in the joint report, a trend exists of men and women now in their 50s and 60s having the highest rates of both oropharyngeal and anal cancers.

To directly relate HPV infection with cancer development later in life, epidemiologists are attempting to understand how HPV, the most common sexually transmitted infection in the U.S., is spread and which populations are most at risk. HPV infection of the cervix increases with number of sexual partners and younger age of first sexual experience. Studies now show similar trends for oral HPV infection rates, which can lead to oropharyngeal cancer.

More than 100 strains of the virus are passed through skin contact. Most cause benign warts on the genitals, hands, or face, but about 15 strains can cause cancer of the cervix, vagina, vulva, penis, anus, and oropharynx (tonsils, back of the throat, and base of the tongue). Most people with HPV clear the infection, but those with persistent infection for many years or decades are at risk for these cancers, depending on the site of viral infection.

Screening for Noncervical HPV-Related Cancers

The Pap smear screening test has drastically reduced both cervical cancer incidence rates and deaths. Screening methods for other HPV-related cancers are not so straightforward. “Right now, it is just cervical cancer screening and some anal cancer screening that is done for certain individuals who are high risk,” said Simard. HPV causes an estimated 90% of anal cancers. Anal cancer screenings are offered to HIV-positive men who have sex with men, but not enough research has yet occurred to adapt this type of screening for other cancer sites.

HPV infection causes approximately 60% of oropharyngeal cancers, but screening remains problematic. “We have a serious problem trying to screen for oropharyngeal cancer because we have not clearly identified a premalignant lesions that can be used for screening,” said Douglas R. Lowy, M.D., chief of the NCI Laboratory of Cellular Oncology, who works on HPV. This type of cancer has been studied for a relatively short time, and more research is needed to fully understand whether premalignant lesions caused by HPV could be identified early.

Oropharyngeal Cancer–HPV Link

Oropharyngeal cancers were seen predominantly in older men who had comorbidities and who tended to have a history of drinking or smoking. “What we see now is still more men than women, but these men are younger, in their 40s and 50s, and they don’t have the comorbidities from smoking and drinking and in general are more healthy,”said Everett E. Vokes, M.D., head and neck expert at the University of Chicago.

Researchers now distinguish two types of oropharyngeal cancers—those related to HPV infection, which generally have a better prognosis, and those related to tobacco and alcohol use. At the molecular level,  HPV-related cancers are not only positive for HPV DNA but also express the human p16 gene, induced by the virus’s oncoproteins. Most HPV-positive patients also have detectable antibodies against HPV.

HPV Vaccine Reaching Broader Population

Current HPV vaccination rates will at least partly influence the cancer statistics that will emerge in 20–30 years as a result of current HPV infection rates. Over time, “prevention is the key, and prevention is either abstinence or vaccination,” said Vokes.

The HPV vaccine can reduce the risk of HPV-related cancers that in 10–30 years could affect people who are now teenagers. The vaccine, a series of three shots, is recommended for girls aged 11 or 12 years (with catch-up until age 26 years) and boys aged 11 or 12 years (with catch-up until age 21 years), to protect against HPV infection and HPV related diseases, including cancer. Researchers initially developed the vaccine to protect against cervical cancer and genital warts, and the U.S. Food and Drug Administration has now approved it to protect against anal, vaginal, and vulvar cancers. In principle, the vaccine should also protect against HPV-positive oropharyngeal cancer because as many as 90% of cases are attributed to the two HPV strains that the vaccine targets.

“A critical aspect of the HPV vaccine is that it should reduce the risk of all cancers caused by the HPV types targeted by the vaccine, not just cervical cancer, for which we don’t have another public-health intervention,” said Lowy.

Yet uptake of the vaccine in the U.S. remains low: Only 35% of girls aged 13–17 years were fully vaccinated as of 2011, compared with 18% in 2008—considerably short of the 80% goal of the Healthy People 2020 program.

Studies indicate that physician recommendation is a main determinant of whether a teen will receive the vaccine. Susan T. Vadaparampil, Ph.D., associate member of the Health Outcomes and Behavior Program at the Moffitt Cancer Center in Tampa, Fla., who studies trends in HPV vaccination, said that pediatricians are more likely than family physicians to offer the vaccine (Cancer 2013;119:621–8). Her study also showed that physicians who care primarily for minority groups are more likely to administer the vaccine to these patients. Cost is not necessarily a deterrent because children from families who cannot pay can receive the vaccine free through Medicaid or the Vaccines for Children program.

These findings are consistent with results of a national survey that Vadaparampil conducted to compare rates of physicians’ HPV vaccine recommendations for girls aged 11–12 years from 2010 and 2011. Recommendation rates increased little, and another study focusing on low-income families showed that despite free programs and recommendations, vaccination rates for girls remained low.

“There has been very poor and slow uptake compared with the meningococcal and Tdap [combined tetanus–diphtheria– pertussis] vaccines given to teens,” said Robert M. Jacobson, M.D., a pediatrician at the Mayo Clinic. Jacobson recently found that the number of parents who opt out of vaccinating their teens against HPV is increasing nationally despite recommendations (Pediatrics 2013;131:645–51). “The most alarming finding, frankly more disturbing than the poor uptake, is the increasing concern of parents regarding safety issues and the decreasing number of parents who say they will vaccinate their daughters,” said Jacobson.

To better understand how to improve physician–parent communication, Jacobson and colleagues will, as part of a large national study, go directly to physicians’ offices to analyze the conversations physicians are having with parents and teens. “We need to find out what is being said and, perhaps more important, what is not being said.”

CDC and other organizations are leading campaigns to increase HPV vaccination rates. According to Simard, the campaigns underscore the vaccine’s anticancer function. As for the scientifically unfounded safety concerns, “we need to continue to communicate the scientific rationale for HPV vaccines to the public and underscore that all of the data support the conclusions that the vaccines are safe and efficacious,” said Simard. “We are confident in that, but we do need additional ways to combat people’s misperceptions about the HPV vaccine.”

© Oxford University Press 2013. DOI:10.1093/jnci/djt260

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

September, 2013|Oral Cancer News|

Vaccination Not Found To Increase Risk Of Guillain-Barre Syndrome

Source: Medical News Today
Article Date: 26 Jun 2013 – 0:00 PDT


Patients are not at increased risk of Guillain-Barre syndrome in the six-week period after vaccination with any vaccine, including influenza, according to a Kaiser Permanente study published in Clinical Infectious Diseases.

The retrospective study by researchers at the Kaiser Permanente Vaccine Study Center spanned 13 years and was controlled for seasonality.

“If there is a risk of Guillain-Barré syndrome following any vaccine, including influenza vaccines, it is extremely low,” said Roger Baxter, MD, co-director of the Kaiser Permanente Vaccine Study Center.

During the 13-year period (1994-2006), 415 confirmed cases of Guillain-Barré syndrome were observed. Within this group, the researchers found only 25 patients had received any vaccine in the six weeks prior to the onset of the disease. The study also found that 277 patients had a respiratory or gastrointestinal illness in the 90 days preceding the onset.

Guillain-Barré syndrome is an acute disease thought to be an autoimmune disorder resulting in destruction of a nerve’s myelin sheath and peripheral nerves. In many cases, the syndrome is temporally associated with an infectious disease; most published case series report that approximately two-thirds of all cases are preceded within three months by a gastrointestinal or respiratory infection. Guillain-Barré syndrome had been linked to the influenza vaccine in a 1976 study, but not clearly since. There have been reports of an association with other vaccines, which have not been confirmed.

Previous studies of Guillain-Barré syndrome as a possible adverse event related to vaccines have been subject to confounding by differences between vaccinated and unvaccinated individuals which may be unmeasured, said Dr. Baxter, who led the team that conducted this new research.

The Vaccine Study Center researchers further explained that variables that change over time – like infectious diseases or rates of vaccination – can lead to confusion in observational studies, which look at already collected data rather than randomizing people to treatment versus placebo. For this reason, they said, it is necessary to use special epidemiologic and statistical methods to overcome these variables.

The case-centered study design used to conduct this research focuses on the outcome, then looks back to determine vaccination status. This method can control for many of the variables that change over time and, consequently, lead to a more accurate assessment of Guillain-Barré syndrome risk or recurrence following vaccination.


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


July, 2013|Oral Cancer News|

Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008–2010

Source: Pediatrics
Authors: Paul M. Darden, MD, David M. Thompson, PhD, James R. Roberts, MD, MPH, Jessica J. Hale, MSa, Charlene Pope, PhD, MPH, RN, Monique Naifeh, MD, MPHa, and Robert M. Jacobson, MD
Published Online: March 18, 2013



OBJECTIVE: To determine the reasons adolescents are not vaccinated for specific vaccines and how these reasons have changed over time.

METHODS: We analyzed the 2008–2010 National Immunization Survey of Teens examining reasons parents do not have their teens immunized. Parents whose teens were not up to date (Not-UTD) for Tdap/Td and MCV4 were asked the main reason they were not vaccinated. Parents of female teens Not-UTD for human papillomavirus vaccine (HPV) were asked their intent to give HPV, and those unlikely to get HPV were asked the main reason why not.

RESULTS: The most frequent reasons for not vaccinating were the same for Tdap/Td and MCV4, including “Not recommended” and “Not needed or not necessary.” For HPV, the most frequent reasons included those for the other vaccines as well as 4 others, including “Not sexually active” and “Safety concerns/Side effects.” “Safety concerns/Side effects” increased from 4.5% in 2008 to 7.7% in 2009 to 16.4% in 2010 and, in 2010, approaching the most common reason “Not Needed or Not Necessary” at 17.4% (95% CI: 15.7–19.1). Although parents report that health care professionals increasingly recommend all vaccines, including HPV, the intent to not vaccinate for HPV increased from 39.8% in 2008 to 43.9% in 2010 (OR for trend 1.08, 95% CI: 1.04–1.13).

CONCLUSIONS: Despite doctors increasingly recommending adolescent vaccines, parents increasingly intend not to vaccinate female teens with HPV. The concern about safety of HPV grew with each year. Addressing specific and growing parental concerns about HPV will require different considerations than those for the other vaccines.


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


June, 2013|Oral Cancer News|

Throat Cancer and HPV – the researcher

6 February, 2013 12:26PM AEDT
By Carol Duncan (ABC Local)


Assoc Prof Karen Canfell is a researcher with the Lowy Cancer Research Centre at the University of NSW. HPV is her area of expertise. What does she want us to know about HPV and the vaccination program?

CAROL DUNCAN: Karen, your area of expertise is human papilloma virus and I understand there’s not just one but 100 or more?

ASSOC PROF KAREN CANFELL: That’s right, there’s a large number of types HPV that have been implicated in cancer but it’s really two of those types that are responsible for the vast majority of cancers, HPV 16 & 18 and those types are the ones that are included in the vaccine that is now available to us.

CAROL DUNCAN: I guess this is the point of this series this week is that we now have another cancer which is, in essence, preventable.

ASSOC PROF KAREN CANFELL: Yes, I think what we’re seeing with HPV is an incredible success story in cancer prevention. This started with the vaccination of girls and women in Australia. Because HPV has a very important role in cervical cancer and, in fact HPV is responsible for virtually all cervical cancers, the types we just mentioned (types 16 & 18) are responsible for about 70% of those cancers.

Five years ago, in 2007, we had the implementation of the National HPV Vaccination Program in girls and women in Australia and that’s really had incredible effects already. For example we’ve already seen a drop in the number of young girls infected with HPV, we’ve also seen a reduction in the numbers of high-grade abnormalities of the cervix which are the precursor to cervical cancer, and we’ve seen a reduction in anogenital warts which are also caused by different types of HPV which are also included in the vaccine.

So in terms of what’s happened in females, it’s just a remarkable story and we’ve really seen it play out in Australia before anywhere else in the world because Australia was one of the first countries to adopt the vaccine.

CAROL DUNCAN: And now it takes another step as of this year (2013) with the extension of the cervical cancer vaccine to boys.

ASSOC PROF KAREN CANFELL: That’s right. Again, Australia is one of the first countries to make this decision.

Last year, the Pharmaceutical Benefits Advisory Committee recommended that young boys are included in the National HPV Vaccination Program and that will roll out from this year. What that means is that it is going to provide incremental benefits to both girls and boys and I think what we have to remember here is that HPV is transmitted between males and females so vaccination of females was already going to have some beneficial effects for males ultimately because it would cut off the circulation of the virus in the population, but by including young boys in the program we have even greater coverage and we also have protection of the gay community, so I think this really does provide and important incremental step to protecting males even further against HPV infection and the cancers that can be caused by it.

CAROL DUNCAN: The cancers that HPV can cause in men are equally as horrific as cervical cancer.

ASSOC PROF KAREN CANFELL: That’s right, there is a whole range of cancers that HPV can cause in men and also in women in sites other than the cervix.

These include anogenital cancers but also cancers of the head and neck. These are an important set of cancers. I think the complication is that not all of these cancers are caused by HPV but still a significant fraction are and probably that fraction is increasing in the case of head and neck cancers.

CAROL DUNCAN: Dr Jonathan Clark mentioned that, and that so far researchers don’t know why the rate is increasing.

ASSOC PROF KAREN CANFELL: We can’t say definitively but it certainly seems that in Australia and the US that that is happening. A US study has recently shown that cancers of the head and neck maybe now about 70% of them could be attibutable to HPV, so that is a high proportion of those cases.

The other message we need to say here is that vaccination is a really wonderful thing and it’s going to have important long-term effects for men and women in Australia and in most countries which have implemented vaccination programs.

But for women in particular, it’s really important not to forget about cervical screening because that’s what is also protecting older, unvaccinated women against cervical cancer and really the two preventative mechanisms need to work together for the forseeable future.

The main message here is that the vaccination program in females has been incredibly effective. It’s about 73% coverage in young girls in Australia, so there still is one in four girls in Australia not being vaccinated so I think for parents of both young boys and young girls at school it’s really important to see this as a long-term wonderful gift that you can give to your children in terms of cancer prevention.

CAROL DUNCAN: I have watched six hours of throat cancer surgery, I can assure you you don’t want your children to go through that.



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


February, 2013|Oral Cancer News|

HPV-related cancers on the rise

Author: Drbicuspid staff

The rising incidence of cancers associated with human papillomavirus (HPV) shows a need to increase HPV vaccination coverage levels, according to a report in the Journal of the National Cancer Institute (January 7, 2013).

Despite the decline in cancer death rates in the U.S., the rate of HPV-associated cancers has increased, the report noted.

The American Cancer Society (ACS), the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries annually provide updates on trends in cancer incidence and death rates in the U.S. This year’s report highlighted trends in incidence rates for HPV-associated cancers and HPV vaccination coverage levels.

Two HPV vaccines (bivalent and quadrivalent) have been shown to protect against most cervical cancers in women and one vaccine (quadrivalent) also protects against genital warts and cancers of the anus, vagina, and vulva. However, the report had no data available on the vaccine’s efficacy for preventing HPV-associated cancers of the oropharynx.

To assess trends in HPV-associated cancer incidence rates and HPV vaccination coverage levels, ACS researchers looked at trends in age-standardized incidence and death rates for all cancers combined and for the leading cancers among men and women. They also analyzed HPV vaccination coverage levels during 2008 and 2010.

Nationally, 32% of females ages 13 to 17 years received three doses of the HPV vaccine in 2010, showing the necessity for increased efforts to increase HPV vaccination coverage, the report said.

HPV vaccination efforts should be focused on females because it’s been predicted to be the most effective way to ensure population-level vaccine effectiveness, the researchers concluded.

January, 2013|Oral Cancer News|

1 of 6 cancer deaths worldwide caused by preventable infections

Source: Los Angeles Times


One in every six cancer deaths worldwide is caused by preventable infections, a total of 1.5 million deaths yearly that could be halted by widespread vaccination programs, researchers reported Wednesday. Since 1990, that number has grown by about half a million, suggesting that vaccination programs are losing ground in the battle rather than gaining it.  The vast majority of the cases are caused by three viruses and a bacterium, which are the leading causes of gastric, liver and cervical cancers. Cervical cancers account for about half of the infection-related cancers in women, while liver and gastric cancers account for about 80% of those in men.

The causes of many cancers are largely unknown, but genetics and poor luck play big roles. The World Health Organization estimated in 2004 that nine lifestyle and environmental factors — smoking being a particularly large one — account for as many as 35% of the 12.7 million cancers that occur each year, about twice the proportion now linked to infections.

Cervical cancers are caused primarily by the human papilloma virus (HPV), as are anal and penile tumors. Stomach cancers are caused by the bacterium Helicobacter pylori. The hepatitis B and hepatitis C viruses cause liver cancer.  All such infections are readily preventable by vaccination. Other less common agents include the Epstein-Barr virus, which causes nasopharynx tumors and Hodgkin’s lymphoma; human herpes virus type 8, which causes Kaposi’s sarcoma, usually in conjunction with HIV; and the parasite Schistosoma haematobium, which causes bladder cancer.

A team headed by Dr. Catherine de Martel and Dr. Martyn Plummer of the International Agency for Cancer Research in Lyon, France, used data compiled by the agency’s GLOBOCAN program to estimate the cancer incidence in various regions of the world, then used actual data of various cancers as well as estimates to predict the total attributable to infectious agents. They reported in the journal Lancet that the worldwide average of cancers caused by infectious agents was 16.5%, with about three times more (22.9%) occurring in developing countries than in developed countries (7.4%). Rates varied widely between regions, ranging from a low of 3.3% in Australia and New Zealand to a high of 32.7% in sub-Saharan Africa. About 4% of cancers were caused by infectious agents in North America and 7% in Europe.

In an editorial accompanying the report, Dr. Goodarz Danaei of the Harvard School of Public Health in Boston noted that vaccines for HPV and hepatitis B are available at a “relatively low cost” and “increasing coverage [with them] should be a priority for health systems in high-burden countries.”

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

May, 2012|Oral Cancer News|

Vaccination rates higher in states requiring them in middle school

Source: LA Times

Teen vaccination.

States that require vaccination for pertussis, meningitis and tetanus for admission to middle school have a higher vaccination rate than states that do not, but the rate is not nearly as high as one might expect from such a requirement, researchers reported Monday. States that required only that educational materials be sent home for those vaccines and the human papilloma virus (HPV) vaccine showed no improvement in vaccination rates.

Vaccines for tetanus and pertussis are typically given during childhood, but the effects can diminish over time and a booster shot is recommended in early adolescence. The meningitis and HPV vaccines typically are given in adolescence. Concern has been spreading about low vaccination rates because of recent outbreaks of pertussis, commonly called whooping cough, in California and Washington.  Some parents refuse to have their children vaccinated because of groundless fears about vaccine side effects — particularly the now-refuted link to autism — but others simply find that it is easier to express “philosophical opposition” to the vaccines rather than take their children for the shots. But these unvaccinated children serve as a natural reservoir for the diseases, enhancing their spread, particularly to those who are too old or immune-impaired to receive the vaccines themselves.

Thirty-two states required middle school vaccination with either the tetanus/diptheria (Td) vaccine or the tetanus/diptheria/acellular pertussis (TdaP) vaccine when the survey was performed in 2008-09. Fourteen of those specifically required the TdaP vaccine. None required that educational materials about those vaccines be sent home. Three states required the meningitis vaccine and 10 required education. Only Virginia and the District of Columbia required HPV vaccination, which is controversial because the virus is transmitted primarily by sexual contact. It is also expensive for the three-dose series required.

Dr. Christina Dorrell and her colleagues at the Centers for Disease Control and Prevention used data from the 2008-09 National Immunization Survey-Teen, in which telephone numbers are randomly called to provide a cross-section of households with teenagers. Parents were questioned about vaccinations, then asked for permission to contact vaccine providers.

The team reported in the journal Pediatrics that 71% of teens in states with vaccination requirements had indeed been immunized against meningitis, compared to 53% in states with no requirements. For Td and TdaP, the corresponding numbers were 80% and 70%. Educational requirements did not raise immunization rates for any of the vaccines. Since the data was collected for the study, 21 states have enacted new or updated vaccination requirements for TdaP and six have made new requirements for the meningitis vaccine.

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

May, 2012|Oral Cancer News|

Viruses recruited as killers of tumors

Author: Rachel Nuwer

In 1951, a 4-year-old boy with leukemia contracted chickenpox. His liver and spleen, swollen by the cancer, soon returned to normal, and his elevated blood cell count fell to that of a healthy child.

His doctors at the Laboratory of Experimental Oncology in San Francisco were thrilled by his sudden remission, but the blessing was short-lived. After one month, his leukemia returned and progressed rapidly until the child’s death.

In the early 1900s, not much could be done for cancer patients. Unless surgeons could excise a tumor, the disease typically spelled a swift and inevitable end. But in dozens of published cases over the years, doctors noticed a peculiar trend: Struggling cancer patients sometimes enjoyed a brief reprieve from their malignancies when they caught a viral infection.

It was not a coincidence. Common viruses sometimes attack tumor cells, researchers discovered. For decades, they tried to harness this phenomenon, to transform it into a cancer treatment. Now, after a long string of failures, they are nearing success with viruses engineered to kill cancer.

“It’s a very exciting time,” said Dr. Robert Martuza, chief neurosurgeon at the Massachusetts General Hospital and professor of neuroscience at Harvard Medical School. “I think it will work out in some tumor, with some virus.” Candidates are already in advanced trials, he noted.

Cancer cells are able to replicate wildly, but there’s a trade-off: They cannot ward off infection as effectively as healthy cells. So scientists have been looking for ways to create viruses that are too weak to damage healthy cells yet strong enough to invade and destroy tumor cells. It has been a long, difficult challenge.

Researchers started down this road in 1904, when they discovered that women with cervical cancer temporarily recovered when given a rabies vaccination. By midcentury, physicians were administering live viruses to cancer patients. They tried infecting terminally ill children with polio and adenovirus. They injected patients with concoctions from the feces of normal children, from sick chickens, and from “feline spleen suspension” of rural kittens infected with “cat plague.”

These experiments proved ill fated. The cancer returned, or — in the worst cases — the injections themselves caused “the development of lethal infection in the host,” according to a 1964 American Journal of Pathology report.

The field was abandoned for a time. But in 1991, Dr. Martuza seized upon the idea of using the herpes simplex virus (HSV-1) as a cancer-fighter.

The genome of HSV-1 is comparatively large and can accommodate a number of mutations and deletions. Dr. Martuza weakened the virus by removing some of its genes. The modified virus was injected into mice with brain cancer, and it did bring about remission. But most of the mice died of encephalitis.

In 1990, Bernard Roizman, a virologist at the University of Chicago, found a “master gene” in the herpes virus. When this gene is removed, the virus no longer has the strength to overcome healthy cells’ defenses. As it turned out, the modified virus was so crippled that it could only slow tumor growth.

Then, in 1996, Dr. Ian Mohr, a virologist at New York University, stumbled on a way of further altering Dr. Roizman’s crippled virus. He exposed it repeatedly to cancer cells until a new viral mutant evolved with the ability to replicate in those cells.

Dr. Mohr and a doctoral student, Matt Mulvey, then engineered a way for their virus to evade the immune system, making it an even more potent cancer-killing agent.

Unlike chemotherapy, which can diminish in effectiveness over time, oncolytic viruses multiply in the body and gain strength as the infection becomes established. In addition to attacking cancer cells directly, some also produce an immune response that targets tumors.

Today, several potential cancer-fighting viruses are in trials, including two in Phase 3 trials.

An engineered form of vaccinia — the viral agent that helped eradicate smallpox — is being tested against advanced liver cancer, the third leading cause of cancer deaths globally. In a recent trial, survival for patients treated with high doses of the virus, called JX-594, doubled to 14 months from 7, compared with that of patients treated with low doses.

“To see that kind of response in a randomized trial is simply unheard of,” said Tony Reid, the director of clinical investigation at the Moores Cancer Center of the University of California, San Diego, who has no financial ties to the virus’s manufacturer.

A herpes virus based on Dr. Mohr’s original discovery is in advanced trials against melanoma; initial data showed a 26 percent response rate in patient regression and survival. A reovirus is being tested against head and neck cancers, often difficult to treat.

According to the researchers, the side effects of treatment with these viruses are minimal, and include nausea, fatigue and aches. “In comparison to what happens with standard chemotherapy, flulike symptoms are very manageable,” said Dr. Reid, who has treated hundreds of patients with oncolytic viruses.

Oncolytic viruses are likely to find a place in medicine, especially paired with other therapies targeting difficult and aggressive tumors, said Gary Hayward, a virologist at the Johns Hopkins Herpesvirus Research Program. But the “biology is complex,” Dr. Hayward warned, and progress is likely to be incremental.

Dr. Mulvey now heads a firm in Baltimore testing viruses to fight melanoma and bladder cancer. The biggest challenge now, he said, is simply convincing others that the new treatment is “not science fiction.”

“Thankfully, that hurdle is diminishing,” he said.

March, 2012|Oral Cancer News|