Does HPV vaccine reduce HIV-positive men oral cancer risks?

Source: www.precisionvaccinations.com
Author: Don Ward Hackett, Fact checked by Robert Carlson, MD & Danielle Reiter, RN

Does the HPV vaccine protect against oral infections?

That’s the question a new National Cancer Institutes (NCI) funded clinical trial of the Gardasil 9 vaccine hopes to answer.

This extensive study will determine whether the Gardasil 9 vaccine can prevent persistent oral HPV infections among men who are Human Immunodeficiency Virus (HIV) positive, said the NCI online on October 8, 2019.

Oral HPV infections and HPV-related oral cancers are common in men and among HIV-positive individuals.

Gardasil 9 is the most recent formulation of the Human Papolivirus (HPV) vaccine, which covers 5 additional cancer-causing HPV types. There are over 100 types of HPV.

“We are hoping that if we show the efficacy of the vaccine, that vaccinating both males and females will ultimately reverse” the rising incidence of HPV-related oropharyngeal cancers, said one of the trial’s lead investigators, Anna Giuliano, Ph.D., of Moffitt Cancer Center.

The trial is one of several within the US–Latin American–Caribbean Clinical Trials Network (ULACNet), an NCI-led effort to reduce the burden of HPV-related cancers in HIV-positive individuals.

This new study intends to build relevant insights upon a June 2017 study found that vaccination against HPV may sharply reduce oral HPV infections that are a major risk factor for oropharyngeal cancer, a type of head and neck cancer, says the NCI.

The 2017 study found that the prevalence of oral infection with 4 HPV types, including two high-risk, or cancer-causing, types, was 88 percent lower in those who reported receiving at least 1-dose of an HPV vaccine, than in those who said they were not vaccinated.

The ULACNet international collaborative research network brings together institutions in the United States and counterparts in low- and middle-income countries (LMICs) in the Latin American and the Caribbean (LAC) region.

Funded in Fall 2019 via a U54 Partnership Centers Cooperative Agreement mechanism, ULACNet comprises of 3 Partnership Centers, each collaboratively conducting a multidisciplinary Clinical Trials Program supported via an infrastructure of an Administrative and Coordinating Core, a Data Management and Statistical Core, and a Central Laboratory Core.

ULACNet investigators collaborate with the NCI to design and conduct clinical trials on three key scientific areas across the continuum of prevention interventions for HPV-related cancers in people living with HIV, including:

  • optimizing dosing and delivery and evaluating new indications for HPV prophylactic vaccines
  • evaluating new biomarkers and technologies for improving the accuracy of cervical and anogenital cancer screening and triage
  • evaluating novel non-excisional treatments for HPV-related precancerous lesions

Outcomes of ULACNet clinical trials are expected to influence the development of clinical practice guidelines to improve preventive clinical care and reduce the burden of highly preventable HPV-related cancers in people living with HIV.

The three ULACNet Partnership Centers include the following collaborations between institutions in the United States and partners in Mexico, Puerto Rico, Brazil, Peru, and the Dominican Republic:

  • University of California, San Francisco (UCSF) in San Francisco, CA (PI: Joel Palefsky, MD) in partnership with University of Puerto Rico in San Juan, Puerto Rico (PI: Anna Patricia Ortiz, PhD, MPH) and National Institute of Public Health (INSP) in Cuernavaca, Morelos, Mexico (PI: Jorge Salmeron, MD, DSc)
  • Weill Medical College of Cornell University in New York, NY (PI: Timothy Wilkin, MD, MS) in partnership with Moffitt Cancer Center, in Tampa, FL (PI: Anna Giuliano, PhD, MPH), University of Sao Paulo in Sao Paulo, Brazil (PI: Luisa Villa, PhD), National Institute of Public Health (INSP) in Cuernavaca, Morelos, Mexico (PI: Eduardo Lazcano-Ponce, MD, PhD), and the University of Puerto Rico in San Juan, Puerto Rico (PI: Jorge Santana-Bagur, MD)
  • Fred Hutchinson Cancer Research Center in Seattle, WA (PIs: Margaret Madeleine, PhD, MPH, and Ann Duerr, MD, PhD) in partnership with Asociacion Civil Via Libre in Lima, Peru (PI: Robinson Cabello, MD), National Institute of Infectious Diseases Evandro Chagas-Oswaldo Cruz Foundation (FIOCRUZ) in Rio de Janeiro, Brazil (PI: Beatriz Grinsztejn, MD, PhD), PATH in Seattle, WA (PI: Silvia de Sanjose, MD, PhD), and Instituto Dermatologico Dominicano y Cirugia de Piel (IDCP) in Santo Domingo, Dominican Republic (PI: Yeycy Donastorg, MD).

For more information about this important clinical trial, please contact the ULACNet Program Director is Vikrant Sahasrabuddhe, MBBS, DrPH in the NCI Division of Cancer Prevention.

References:
US-Latin American-Caribbean Clinical Trials Network (ULACNet) for Prevention of HPV-related Cancers in People Living with HIV
HPV Vaccine May Provide Men with “Herd Immunity” against Oral HPV Infections
HPV Vaccination Linked to Decreased Oral HPV Infections
HPV-Related Cancer Prevention and Control Programs at Community-Based HIV/AIDS Service Organizations: Implications for Future

Print Friendly, PDF & Email
October, 2019|Oral Cancer News|

Does your toothbrush have an app yet?

Source: www.nytimes.com
Author: Janet Morrissey

A classroom at the Touro College of Dental Medicine in Hawthorne, N.Y., displaying images of software that shows patients how they will look after treatment. CreditCreditKarsten Moran for The New York Times

When Theresa Gucciardo-Perry discovered a cracked crown in her mouth in April, she dreaded the idea of going to a dentist to get it replaced.

The Cortlandt Manor, N.Y., resident has undergone more than 18 root canal procedures; she also has five implants, with crowns on all but her front teeth. She hated the procedure in which trays of a gag-producing, putty-like substance were stuffed into her mouth to make impressions.

“The putty material is just absolutely gross — I want to throw up,” said Ms. Gucciardo-Perry, 55. “And the crown never fit right. I always had to go back.”

But this time, she sought care at the Touro Dental Health clinic, part of the Touro College of Dental Medicine in Hawthorne, N.Y., where students learn the latest state-of-the-art techniques. There, her teeth were digitally scanned with the wave of a wand — rather than a bulky goop-filled tray — and a crown was built digitally. It fit perfectly.

“I was amazed — totally amazed,” said Ms. Gucciardo-Perry.

Digital scanning is among a number of advances being adopted by the dental industry as the sector undergoes a technological metamorphosis.

Among the latest innovations: The use of digital scanners and 3-D printers to offer same-day crown replacements, smart toothbrushes that talk back to you via a phone app when you’ve missed an area while brushing, lasers that eliminate the need for an anesthetic, and digital tools that detect oral cancer.

Some of these advances had been around for a number of years but had not been widely adopted because of high equipment costs, lack of training or dentists who were more comfortable with older, traditional equipment.

Sensing this trend, the Touro College of Dental Medicine opened at New York Medical College in 2016 to train students in both established and cutting-edge technologies.

“We designed the school to address the practice world of 2030 — not the practice world of 1985,” said Edward Farkas, Touro’s vice dean and chairman of dentistry. And demand has been soaring.

“We have 3,600 applicants for 113 spaces this year,” he said. Larger schools, like New York University, Harvard and the University of Pennsylvania, offer similar state-of-the-art training but at a much higher tuition price. Touro charges $57,000 a year, compared to $78,854 at New York University and more at Ivy League schools.

Until recently, dentistry has largely lagged the medical field when it came to using artificial intelligence and other technology to diagnose or treat medical conditions. For researchers, dentistry didn’t attract the big headlines, fame and potentially lucrative windfalls that came with big medical advances, said Jeff Becker, senior analyst of health care strategy at Forrester Research.

But that changed as social media took off.

“These days, people want brighter, whiter, straighter teeth,” said Eric Payne, founder and chief executive of TEKagogo, a digital start up that connects dentists with technicians for same-day repairs. And dentists are jumping in, plastering before-and-after photos of their work all over the internet to attract new patients.

Around the same time that social media took off, cardiologists were starting to preach the connection between oral health and heart disease. Conditions like gingivitis and gum disease can raise red flags.

“The heart is pumping that bacteria from the oral cavity throughout your body,” said Mr. Payne. “If you don’t take care of your teeth, all that nastiness in your mouth is going to pump through your body.”

Suddenly, dentistry became trendy, and young researchers who saw opportunity started bringing tech advances to the dental world. At the University of Illinois at Urbana-Champaign, the top prize in the Cozad Competition for student start-ups went to dental-related technologies in both 2018 and 2019 — a first in the contest’s 20-year history, said Laura A. Frerichs, director of the University of Illinois Research Park, a technology hub for start-up companies.

So, which technologies are leading the dental industry’s transformation?

Digital scanners, computer-aided design and manufacturing (CAD/CAM) and 3-D printers are among the game changers.

A digital scanner is a wandlike device that captures three-dimensional images of the teeth, bite and surrounding tissue in real time. It’s fast and eliminates the need for clunky, goop-filled impression trays and messy plaster molds. The images can be sent electronically to a lab within minutes, which speeds up the wait time for patients needing crowns or bridges.

 

A CAD/CAM system allows dentists to make same-day crowns, veneers and bridges right in their offices. The system captures the digital images, designs the crown virtually and then sends the design to a milling machine or 3-D printer in the office.

Dr. Barbara Jurim, assistant director of digital dentistry at Touro, recalls recently treating a patient who was about to travel out of the country for three months and needed a new crown. She scanned the patient, designed the crown, manufactured it and cemented it in the office that day. “We’re talking about a treatment timeline that was two and a half hours as opposed to two visits over the course of two weeks,” she said.

Then there’s cone beam technology, which captures high-resolution, three-dimensional X-ray images through a machine that rotates around a patient’s head. The cone beam and scanner data allow a surgeon to create surgical guides, which are 3-D printed maps that pinpoint exactly how and where dental implants are placed during surgery, said Dr. Akshay Kumar, a periodontist in Hackensack, N.J., who uses scanners and cone beam technology in his practice.

“It’s changed the way we do dental implants” and cut the surgery time in half, said Dr. German Gallucci, associate professor and chairman of the department of restorative dentistry and biomaterials sciences at the Harvard School of Dental Medicine.

But finding dentists who use the technology is a challenge given the price: A digital scanner costs between $30,000 and $50,000, while a cone beam devices runs $80,000 to $100,000, Dr. Kumar said.

Fewer than 10 percent of dentists have milling machines or 3-D printers in their offices, and only 15 percent to 20 percent have digital scanners, estimates Dr. Ronnie Myers, dean and professor of dental medicine at Touro.

3-D milling machines can produce models of a patient’s teeth.CreditKarsten Moran for The New York Times

 

The machines can also produce surgical guides to aid in procedures.CreditKarsten Moran for The New York Times

As the price of digital scanners, milling machines and other technology comes down, more dentists will likely start adopting the technology, Dr. Kumar said.

The field of orthodontics has seen some of the biggest advances. Technology that uses augmented reality, scanners and 3-D printers can show patients how they would look with new crowns or straightened teeth. And clear aligners can do the job of traditional braces.

“Instead of going to the orthodontist and getting your braces adjusted, a new set of 3-D printed aligners are made and mailed to your home, and they progressively shift the teeth into alignment for you,” Mr. Becker said.

Technology by Mechanodontics, a start-up, straightens teeth from behind.

Another start-up called Mechanodontics has developed a technology that straightens without the use of braces and aligners. Instead, tiny springs and brackets are placed behind a patient’s teeth, with no regular adjustments required. The technology can cut treatment time in half, the company says.

Then there’s the smart toothbrush, which uses 3-D motion sensors and artificial intelligence to track the time, frequency, duration and location of brushing, and alerts the user to areas that have been missed through a Bluetooth-connected phone app.

Thomas Serval, a co-founder of Kolibree, which makes the artificial intelligence toothbrush, came up with the idea in 2014 when trying to find ways to motivate his daughter, Heloise, to brush her teeth. He added mobile games to the phone app, giving virtual awards for good brushing.

In 2018, Mr. Serval licensed the technology to Colgate, which sells it as the Colgate Smart Electric toothbrush. A new version aimed at children, called Magik, is also being rolled out in the United States.

Colgate’s Smart Electric toothbrush sends data to the Colgate Connect app.

Ms. Gucciardo-Perry, said that after her experience being treated with new technology at the Touro clinic, she’s never going back to old-school treatments.

“I’ll absolutely be going back to Touro,” she said. “And my children will be going there too.”

Print Friendly, PDF & Email
October, 2019|Oral Cancer News|

Prevalence of Oral HPV Infection Declines in Unvaccinated Individuals

Source: Infectious Disease Advisor
Date: September 30th, 2019
Author: Zahra Masoud

Oral human papillomavirus (HPV) prevalence has decreased in unvaccinated men, possibly as a result of herd protection, but the incidence of such infection has remained unchanged in unvaccinated women from 2009 to 2016 in the United States, according to a study published in the Journal of the American Medical Association.

Since 2011 for women and 2006 for men, prophylactic HPV vaccination for prevention of anogenital HPV infection has been recommended for routine use in the United States. Previous studies have demonstrated that this vaccine has high efficacy in reducing the prevalence of oral HPV infection. However, the vaccine is not indicated to prevent oral HPV infection or oropharyngeal cancers because there are few results from randomized trials. Further, there has been a lack of surveillance studies reporting on herd protection against oral HPV infection, which is defined as a form of indirect protection from infectious diseases that occurs when a large percentage of the population has become immune/vaccinated, thereby providing protection for individuals who are not immune/not vaccinated. Therefore, this study investigated evidence for herd protection against oral HPV infection in unvaccinated men and women in the United States using temporal comparisons of oral HPV prevalence for 4 vaccine types and 33 non-vaccine types.

This study was conducted across 4 cycles (from 2009 to 2016) of the National Health and Nutrition Examination Survey (NHANES), using a cross-sectional, stratified, multistage probability sample of the civilian population in the United States. For the examination component, response rates were 68.5% in the 2009 to 2010 period, 69.5% in the 2011 to 2012 period, 68.5% in 2013 to 2014, and 58.7% in 2015 to 2016. In total, 13,676 participants were included, which represented 174,333,042 individuals in the US population aged 18 to 59 years. The 4 vaccine-type oral HPV were HPV-16, -18, -6, and -11. DNA was collected from oral rinses and was evaluated using PGMY09/11 polymerase chain reaction and linear array genotyping for 37 types of HPV presence. In unvaccinated individuals, sex-stratified analyses were performed along with multivariable logistic regression analyses adjusted for other variables.

From 2009 to 2016, HPV vaccination rates increased from 0% to 5.8% in men and from 7.3% to 15.1% in women. From 2009 to 2010 to 2015 to 2016, vaccine-type oral HPV prevalence declined from 2.7% to 1.6% (P =.009) in unvaccinated men; however, this decline was not heterogenous by age (P =.41 for interaction). During this period, non-vaccine-type oral HPV prevalence remained unchanged (P =.66) among unvaccinated men. From 2009 to 2010 to 2015 to 2016 in unvaccinated women, both vaccine-type and non-vaccine-type oral HPV prevalence remained unchanged (P =.79 and P =.58, respectively).

The 37% decline in vaccine-type oral HPV among unvaccinated men from 2009 to 2016 suggests herd protection against oral HPV infections. This herd protection may arise from the increased rate of HPV vaccination among women and is consistent with herd protection studies against genital HPV infections in unvaccinated women in the United States. The unchanged prevalence of oral HPV among unvaccinated women from 2009 to 2016 does not suggest herd protection; this may reflect low statistical power because of a low prevalence in women.

Overall, the study authors concluded that, “The estimated herd protection should be incorporated into evaluations of cost-effectiveness of HPV vaccination of men older than 26 years. Vaccine trials of oral HPV incidence and persistence in men should inflate sample sizes to account for herd protection.”

Reference

Chaturvedi AK, Graubard BI, Broutian T, Xiao W, Pickard RK, Kahle L, Gillison ML. Prevalence of oral HPV infection in unvaccinated men and women in the United States, 2009-2016. JAMA. 2019;322(10):977-979.

Print Friendly, PDF & Email
October, 2019|OCF In The News|

Anti-malarial drug can make cancer chemotherapy more effective

Source: medicalxpress.com
Author: Emma McKinney, University of Birmingham

Scientists at the University of Birmingham have found an anti-malarial drug was effective in treating head and neck cancer in mice.

The drug quinacrine was used extensively to prevent and treat malaria in soldiers fighting in mosquito-ridden areas during World War Two. It is similar to the quinine that makes tonic water glow, has minimal side-effects, and is now used for treating parasite infections and other conditions.

Each year around 11,900 people are diagnosed with head and neck cancer in the UK. Current treatment relies heavily on debilitating surgery and toxic chemotherapy, but despite this, it has a poor outcome with three to seven in 10 people surviving their disease for five years or more.

The drug, quinacrine, was tested through a number of methods, including on cell cultures, in tumour biopsies from patients with head and neck cancer, and in mice.

The research results, published in Oncotarget, show that in mice quinacrine can make standard chemotherapy more effective—suggesting a lower dose may be used, reducing toxic side effects.

The results also showed the drug to be effective at reducing the growth of cancer cells grown in the lab, and in tumors.

Significantly, the research in mice showed a combination therapy of quinacrine and chemotherapy, and so allowed for the chemotherapy dose to be halved while still maintaining the same impairment of tumor growth.

Lead author Dr. Jennifer Bryant, of the University of Birmingham’s Institute of Head and Neck Studies and Education, said: “This is important research in the laboratory and demonstrates the real potential in repurposing drugs.

“The team is now looking to translate these research findings into a clinical trial for head and neck cancer patients.”

Corresponding author Professor Hisham Mehanna, Director of the Institute of Head and Neck Studies and Education at the University of Birmingham and Consultant Head, Neck and Thyroid Surgeon at University Hospitals Birmingham NHS Foundation Trust, said drug repurposing is particularly exciting due to known safety in humans and low cost, which mean they can be rapidly translated from the lab to the clinic.

He added: “Head and neck cancer patients have limited treatment options, often associated with severe, potentially life-threatening, side effects, it is important, therefore, that we find different treatments.

“My team has developed a drug repurposing platform called “AcceleraTED’ which assesses drugs that treat other non-cancerous conditions and have been approved by the Food and Drug Administration and the European Medicines Agency to see if they have the potential to be effective anti-cancer agents against head and neck cancer.

“This research is an example of the success we are having in the laboratory through this platform in identifying promising drugs that can be candidates to be used in patients in clinic.”

Print Friendly, PDF & Email
October, 2019|Oral Cancer News|

Radiation for head and neck cancer may cause problems years later

Source: www.usnews.com
Author: Steven Reinberg

Ten years after radiation treatment for head and neck cancer, some patients may develop problems speaking and swallowing, a new study finds.

These problems are related to radiation damage to the cranial nerves, the researchers explained. The condition is called radiation-induced cranial neuropathy.

“We had always thought that radiation did not damage cranial nerves because they get treated in every patient with head and neck cancer, and we do not see cranial neuropathy that commonly,” said Dr. Thomas Galloway, of the department of radiation oncology at the Fox Chase Cancer Center in Philadelphia.

“What our data is suggesting is that a small percentage of people do get cranial nerve damage from treatment, but it occurs after a long latency period,” Galloway said.

For the study, the researchers collected data on 1,100 patients who had radiation for head and neck cancer between 1990 and 2005. Among these patients, 112 were followed for at least 10 years.

Of the 112 patients, 14% developed at least one cranial neuropathy. The median time until the condition was seen was more than seven years. It took some patients more than 10 years to develop the problem, the findings showed.

Curing the initial cancer is the most important concern, Galloway said. But these patients need to be followed for the rest of their lives, if possible, he added.

The report was published recently in the journal Oral Oncology.

Print Friendly, PDF & Email
October, 2019|Oral Cancer News|

New blood test capable of detecting multiple types of cancer

Source: www.sciencedaily.com
Author: Materials provided by Dana-Farber Cancer Institute.

A new blood test in development has shown ability to screen for numerous types of cancer with a high degree of accuracy, a trial of the test shows. Dana-Farber Cancer Institute investigators will present the results of the multi-center trial during a session today at the European Society for Medical Oncology (ESMO) 2019 Congress.

The test, developed by GRAIL, Inc., uses next-generation sequencing technology to probe DNA for tiny chemical tags (methylation) that influence whether genes are active or inactive. When applied to nearly 3,600 blood samples — some from patients with cancer, some from people who had not been diagnosed with cancer at the time of the blood draw — the test successfully picked up a cancer signal from the cancer patient samples, and correctly identified the tissue from where the cancer began (the tissue of origin). The test’s specificity — its ability to return a positive result only when cancer is actually present — was high, as was its ability to pinpoint the organ or tissue of origin, researchers found.

The new test looks for DNA, which cancer cells shed into the bloodstream when they die. In contrast to “liquid biopsies,” which detect genetic mutations or other cancer-related alterations in DNA, the technology focuses on modifications to DNA known as methyl groups. Methyl groups are chemical units that can be attached to DNA, in a process called methylation, to control which genes are “on” and which are “off.” Abnormal patterns of methylation turn out to be, in many cases, more indicative of cancer — and cancer type — than mutations are. The new test zeroes in on portions of the genome where abnormal methylation patterns are found in cancer cells.

“Our previous work indicated that methylation-based assays outperform traditional DNA-sequencing approaches to detecting multiple forms of cancer in blood samples,” said the study’s lead author, Geoffrey Oxnard, MD, of Dana-Farber. “The results of the new study demonstrate that such assays are a feasible way of screening people for cancer.”

In the study, investigators analyzed cell-free DNA (DNA that had once been confined to cells but had entered the bloodstream upon the cells’ death) in 3,583 blood samples, including 1,530 from patients diagnosed with cancer and 2,053 from people without cancer. The patient samples comprised more than 20 types of cancer, including hormone receptor-negative breast, colorectal, esophageal, gallbladder, gastric, head and neck, lung, lymphoid leukemia, multiple myeloma, ovarian, and pancreatic cancer.

The overall specificity was 99.4%, meaning only 0.6% of the results incorrectly indicated that cancer was present. The sensitivity of the assay for detecting a pre-specified high mortality cancers (the percent of blood samples from these patients that tested positive for cancer) was 76%. Within this group, the sensitivity was 32% for patients with stage I cancer; 76% for those with stage II; 85% for stage III; and 93% for stage IV. Sensitivity across all cancer types was 55%, with similar increases in detection by stage. For the 97% of samples that returned a tissue of origin result, the test correctly identified the organ or tissue of origin in 89% of cases.

Detecting even a modest percent of common cancers early could translate into many patients who may be able to receive more effective treatment if the test were in wide use, Oxnard remarked.

Note:
Materials provided by Dana-Farber Cancer Institute. Content may be edited for style and length.

Print Friendly, PDF & Email
September, 2019|Oral Cancer News|

How Anti-Vaccine Sentiment Took Hold in the United States

Source: The New York Times
Date: September 23, 2019
Author: Jan Hoffman

As families face back-to-school medical requirements this month, the country feels the impact of a vaccine resistance movement decades in the making.

 

The question is often whispered, the questioners sheepish. But increasingly, parents at the Central Park playground where Dr. Elizabeth A. Comen takes her young children have been asking her: “Do you vaccinate your kids?”

Dr. Comen, an oncologist who has treated patients for cancers related to the human papillomavirus that a vaccine can now prevent, replies emphatically: Absolutely.

She never imagined she would be getting such queries. Yet these playground exchanges are reflective of the national conversation at the end of the second decade of the 21st century — a time of stunning scientific and medical advances but also a time when the United States may, next month, lose its World Health Organization designation as a country that has eliminated measles, because of outbreaks this year. The W.H.O. has listed vaccine hesitancy as one of the top threats to global health.

As millions of families face back-to-school medical requirements and forms this month, the contentiousness surrounding vaccines is heating up again, with possibly even more fervor.

Though the situation may seem improbable to some, anti-vaccine sentiment has been building for decades, a byproduct of an internet humming with rumor and misinformation; the backlash against Big Pharma; an infatuation with celebrities that gives special credence to the anti-immunization statements from actors like Jenny McCarthy, Jim Carrey and Alicia Silverstone, the rapper Kevin Gates and Robert F. Kennedy Jr. And now, the Trump administration’s anti-science rhetoric.

“Science has become just another voice in the room,” said Dr. Paul A. Offit, an infectious disease expert at Children’s Hospital of Philadelphia. “It has lost its platform. Now, you simply declare your own truth.”

The constituents who make up the so-called vaccine resistant come from disparate groups, and include anti-government libertarians, apostles of the all-natural and parents who believe that doctors should not dictate medical decisions about children. Labeling resisters with one dismissive stereotype would be wrongheaded.

“To just say that these parents are ignorant or selfish is an easy trope,” said Jennifer Reich, a sociologist at the University of Colorado Denver, who studies vaccine-resistant families.

It remains true that the overwhelming majority of American parents have their children vaccinated. Parent-driven groups like Voices for Vaccines, formed to counter anti-vaccination sentiment, have proliferated. Five states have eliminated exemptions for religious and philosophical reasons, permitting only medical opt-outs.

But there are ominous trends. For highly contagious diseases like measles, the vaccine rate to achieve herd immunity — the term that describes the optimum rate for protecting an entire population — is typically thought to be 95 percent. The Centers for Disease Control and Prevention found that the vaccination rate for the measles, mumps and rubella (M.M.R.) injection in kindergartners in the 2017-2018 school year had slipped nationally to 94.3 percent, the third year in a row it dropped.

Seven states reported rates for the M.M.R. vaccine that were far lower for kindergartners, including Kansas at 89.1 percent; New Hampshire, 92.4 percent; the District of Columbia, 81.3 percent. (The highest is West Virginia at 98.4 percent.)

Almost all states have at least one anti-vaccine group. At least four have registered political action committees, supporting candidates who favor less restrictive vaccine exemption policies.

Public health experts say that patients and many doctors may not appreciate the severity of diseases that immunizations have thwarted, like polio, which can affect the spinal cord and brain — because they probably have not seen cases.

“Vaccines are a victim of their own success,” said Dr. Offit, a co-inventor of a vaccine for rotavirus, which can cause severe diarrhea in young children. “We have largely eliminated the memory of many diseases.”

The growth of vaccine doubt in America coincides with several competing forces and attitudes.

Since the early 2000s, as the number of required childhood vaccines was increasing, a generation of parents was becoming hypervigilant about their children and, through social media, patting each other on the backs for doing so. In their view, parents who permitted vaccination were gullible toadies of status quo medicine.

In 2011, Dana Fuqua, of Aurora, Colo., pregnant with her first child, felt that irresistible pull of groupthink parenting.

She had just moved to the area, so she reached out to mothers’ groups on Facebook. Colorado, with a kindergarten vaccination compliance rate of 88.7 percent, has a rambunctious vaccine-resistant movement. Ms. Fuqua’s new friends urged her to have a drug-free birth, use cloth diapers and never to let a drop of formula pass her baby’s lips. Vaccines, it followed, were anathema.

The women intimidated her. They had advanced degrees; she had only a bachelor of science and a nursing background.

“I didn’t argue with them,” Ms. Fuqua said. “I was so desperate for their support that I compromised by delaying the vaccine schedule, so I wouldn’t get kicked out of the group.”

But when her second child was born prematurely, susceptible to illness, the group’s approval was not as important as her baby’s safety. Her position, she said, shifted from, “‘I can’t hang out with you if you had a vaccine because you could be shedding a virus’” — a common, false belief among the vaccine resistant — to, “ ‘If you haven’t had a vaccine, I will not associate with you.’”

She had both children fully vaccinated.

There have been anti-vaccination movements at least since 1796, when Edward Jenner invented the smallpox vaccine. But many experts say that the current one can be traced to 1982, when NBC aired a documentary, “DPT: Vaccine Roulette,” that took up a controversy percolating in England: a purported tie between the vaccine for pertussis — a potentially fatal disease that can cause lung problems — and seizures in young children.

Doctors sharply criticized the show as dangerously inaccurate. But fear spread. Anti-vaccination groups formed. Many companies stopped making vaccines, which were considered loss-leaders and not worth the corporate headache.

Then, in 1998, Andrew Wakefield, a British gastroenterologist, published a Lancet study (since discredited and withdrawn), associating the M.M.R. vaccine with autism.

Faced with risking autism or measles, some parents thought the answer was obvious. Most had never seen measles, mumps or rubella because vaccines had nearly eliminated them. But they believed they knew autism.

And most people are notoriously poor at assessing risk, say experts in medical decision-making.

Many stumble on omission bias: “We would rather not do something and have something bad happen, than do something and have something bad happen,” explained Alison M. Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania School of Nursing.

People are flummoxed by numerical risk. “We pay more attention to numerators, such as ‘16 adverse events,’ than we do to denominators, such as ‘per million vaccine doses,’ ” Dr. Buttenheim said.

A concept called “ambiguity aversion” is also involved, she added. “Parents would like to be told that vaccines are 100 percent safe,” she said. “But that’s not a standard we hold any medical treatment to.”

Relatively few people are absolutists about refusing all vaccines. “But if you’re uncertain about a decision, you’ll find those who confirm your bias and cement what you think,” said Rupali J. Limaye, a social scientist who studies vaccine behaviors at the Johns Hopkins Bloomberg School of Public Health.

Nowhere is that reinforcement more clamorous than on social media, Dr. Limaye added. “You may only see your pediatrician a few times a year but you can spend all day on the internet,” she said.

People tend to believe an individual’s anecdotal narrative over abstract numbers. By 2007, when Ms. McCarthy, the actress, insisted that vaccines caused her son’s autism, thousands found her to be more persuasive than data showing otherwise. A nascent movement took hold.

At the same time that these powerful attacks on vaccine confidence were underway, a constellation of trends was emerging.

The definition of a good parent was becoming fraught with the responsibility for overseeing every aspect of a child’s life.

“As we adopted a culture of individualistic parenting, public health became a hard sell,” Dr. Reich said.

The primary reason for healthy people to get the flu shot is to protect those with compromised immune systems, like infants and older adults, from getting sick. But altruism isn’t a great motivator for parents, Dr. Buttenheim said. “They are much more concerned about protecting their own child at all costs,” she said.

Contrast that attitude with the collective good will of the 1950s, say medical sociologists, when American parents who had seen President Franklin Delano Roosevelt’s wheelchair as a debilitating symbol of polio patriotically sought to vaccinate their children to help eradicate the disease worldwide.

By 2014, studies showed that parental confidence in authorities like the C.D.C. and in pediatricians was dropping, especially around vaccines. Mistrust of Big Pharma was even more pronounced.

By then, Donald Trump was offering support on Twitter for the discredited link between autism and vaccination. As president-elect, he met with leaders of the anti-vaccination movement, although as measles cases surged, he endorsed vaccination.

As parenting became rife with orthodoxy, the Marcus Welby model of the paternalistic doctor retreated. Patients asserted autonomy, brandishing internet printouts at doctors. Shared decision-making became the model of doctor-patient engagement.

Pediatricians offered to stagger vaccine schedules. Some were even flexible about vaccinations altogether.

In 2011, shortly after Emma Wagner had given birth in Savannah, Ga., a pediatrician on the ward examined the baby. “He asked me if I was interested in the hepatitis B vaccine,” she said of an inoculation typically done at birth.

She was apprehensive.

He replied, “‘That’s fine, because your 2-day-old daughter isn’t a prostitute and isn’t using I.V. drugs, so hep B isn’t at the top of my worries.’”

Ms. Wagner said she “swallowed the anti-vax Kool-Aid. I was motivated by fear. I thought, ‘Until I know for certain that these are safe, I won’t do it.’ The pediatrician said, ‘I will support your decision and in a few years we’ll talk about exemptions for school.’”

She has since become a staunch supporter of immunization.

Libertarianism also courses through vaccine hesitation, with parents who assert that government should not be able to tell them what to put in their bodies — a position often marketed as “the right to choose.”

“Having the government order them to do something reinforces conspiracy theories,” said Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins. “And people perceive their risk to be higher when it’s not voluntary.”

In reality, he said, one’s risk of harm is greater while driving to an airport than it is being on the airplane itself. But driving is voluntary and gives the illusion of control. People fear flying because they cannot control the plane. By extension, many childhood vaccines are not voluntary, which rattles those who prefer to believe they can control their health.

With so many different but deeply held convictions, public health experts struggle to design vaccine-positive campaigns.

In 2017, researchers applied the six values of “the moral foundations theory” to vaccine attitudes, surveying 1,007 American parents.

The results were intriguing. Those most resistant to vaccines scored highest in two values: purity (“my body is a temple”) and liberty (“I want to make my child’s health care decisions”).

A third, said Saad B. Omer, director of Yale’s Global Health Institute and an author of the study, was also telling: deference to authority — a score indicating whether one was likely to adhere to the advice of experts like a pediatrician or the C.D.C.

Dr. Salmon’s team at Johns Hopkins is working on an app to capture parents’ vaccine attitudes and to tailor information to persuade them to vaccinate their children.

Pediatricians are front-line persuaders, he said, and they should be compensated for the time it takes to educate parents.

Most experts note that physicians themselves, never mind parents, have no idea about the federal vaccine monitoring systems, which have been in place for more than 20 years.

“We ask parents in the first two years of their child’s life to protect them against 14 diseases, that most people don’t see, using fluids they don’t understand,” Dr. Offit said. “It’s time for us to stand back and explain ourselves better.”

Print Friendly, PDF & Email
September, 2019|Oral Cancer News|

AI can predict the chances of surviving oral cancer

Source: medicalxpress.com
Author: University of Warwick

Whole slide images are multi-gigapixel images and cannot be used directly for image analysis tasks particularly training a deep learning based classifier. Therefore, we divide the WSIs into small regions (patches) for processing. A deep learning based classifier is applied on the patches to identify whether the patch contains tumour, lymphocytes or other histological primitives. However, the regions where the lymphocytes are infiltrating the tumour may not be confined within a patch. Besides, there is considerable variation in the size of TIL regions, making the quantification of TILs a non-trivial task. We address this issue by adopting the widely accepted definition of TILs, i.e., lymphocytes that lie in the neighbourhood of tumour areas. The patch labels predicted as lymphocytes or tumour are then used to compute a statistical measure of co-localization, which is further incorporated into the computation of the TILAb score of lymphocytic infiltration. Credit: University of Warwick

 

The chances of surviving oral cancers can be predicted by state of the art AI algorithms—developed by scientists at the Department of Computer Science at the University of Warwick—that precisely calculate the abundance of immune cells in the midst of tumour cells to help better understand the spread of and resistance to cancer.
In 2014 there were more than 11,000 cases of head and neck cancers in the UK and more than 2,300 deaths resulting from the most common of them; oral cavity cancer.

Oral cancer is most prevalent in South Asia, particularly India, Pakistan and Sri Lanka, mainly due to tobacco chewing, betel quid consumption and viral infections such as HPV (Human papillomavirus).

The chances of surviving such cancers can be predicted thanks to research in a pilot study from the University of Warwick’s Department of Computer Science in the paper “A Novel Digital Score for Abundance of Tumour Infiltrating Lymphocytes Predicts Disease Free Survival in Oral Squamous Cell Carcinoma,” published today, Monday 16 September, in the journal Nature Scientific Reports.

Researchers managed to develop a digital score that could measure Tumour Infiltrating Lymphocytes (TILs). The more TILs present the higher the chance of survival and longer disease free survival of oral cancer.

The images were produced by scans from patients at Shaukat Khanum Memorial Cancer Hospital Research Centre in Pakistan, who had all already been treated by radiation and a head and neck surgery. The cancer tissue samples were then sent to University Hospital Coventry and Warwickshire in the UK, where using a state of the art imaging machine researchers were able to digitally produce high-resolution images of the samples at a microscopic scale.

The presence of lymphocytes in the vicinity of the tumor cells doesn’t only help determine the stage of the cancer, it can be used to predict the progression of it accurately.

The more TILs present in the scans indicates the patient’s immunity to the cancer and the response to treatment, and the density and spatial arrangement of TILs correlates with the chances of overall survival and disease free survival.

Professor Nasir Rajpoot from the Department of Computer Science at the University of Warwick, who led the study, comments:

“We are only beginning to unravel the remarkable potential of wealth of information present in pathology image data. This pilot study shows that with the help of modern cancer image analytics algorithms, we can precisely calculate the score of abundance of TILs in oral cancers in an objective manner and then use that score for risk stratification in terms of disease free survival.”

Prof Hisham Mehanna, Professor of Head & Neck Oncology at the University of Birmingham, comments:

“This is a very exciting development. Not only is this one of the first artificial intelligence based scores to be validated in oral cancer, this score also seems to have a strong prognostic power, which could eventually lead to stratifying patients for different treatment modalities.”

Dr. Asif Loya, Medical Director at the Shaukat Khanum Memorial Cancer Hospital & Research Centre in Pakistan where the patient samples were sourced from, comments:

“With almost 13,000 new cases every year, oral cancers have the highest incidence rates among cancers in Pakistan, second highest mortality rate, and a very low five-year survival. However, there is little known about the histological signatures corresponding to patient subgroups with differing outcomes in this part of the world. Histologic risk assessment is strongly predictive of local disease-free and overall survival in oral squamous cell carcinoma thus there is need for a validated scoring system to be used as an aid in treatment decision making in these cancers in our patients . Strong pilot data from this collaborative research using the objective assessment method of digital analysis may play a role in establishing such prognostication models so that treatment decisions related to elective neck dissection (END) and adjuvant radiotherapy can be made more appropriately.”

Print Friendly, PDF & Email
September, 2019|Oral Cancer News|

Researchers: Favorable survival, fewer side effects after reduced therapy for HPV-linked head and neck cancer

Source: medicalxpress.com
Author: University of North Carolina at Chapel Hill School of Medicine

University of North Carolina Lineberger Comprehensive Cancer Center researchers reported that reducing the intensity of radiation treatment for patients with human papillomavirus-associated head and neck cancer produced a promising two-year progression-free survival rate and resulted in fewer side effects.

The findings, published in the Journal of Clinical Oncology, were drawn from a phase II clinical trial that included 114 patients with HPV-linked head and neck cancer and a limited smoking history. The researchers reported that they saw a similar progression free survival rate, and that patients experienced fewer long-term side effects in the study compared with patients who received standard intensity treatment in previous studies.

“A simple de-intensification strategy of reducing radiation and chemotherapy appears to be as effective at cancer control as the standard seven-week regimen,” said UNC Lineberger’s Bhishamjit S. Chera, MD, associate professor in the UNC School of Medicine Department of Radiation Oncology. “Furthermore, there were fewer toxicities.”

For the trial, patients received six weeks of treatment, including a reduced intensity of radiation therapy of 60 Gray with weekly low-dose chemotherapy of cisplatin. The standard of care regimen is seven weeks of treatment 70 Gray and high-dose chemotherapy.

The main outcome that the researchers were studying was two-year progression-free survival. On the reduced regimen, researchers found that the two-year progression free survival was 86 percent, compared to a two-year progression free survival reported from other studies using standard treatment doses of 87 percent.

Chera said the major long-term side effects of radiation treatment are related to swallowing and dry mouth. Previous studies have shown the majority of patients treated with standard intensity chemoradiotherapy require a temporary feeding tube and some have significant long-term swallowing dysfunction.

Notably, in this study, patients reported that their swallowing returned to baseline after de-intensified treatment, and only 34 percent required a temporary feeding tube.

The results need to be validated in larger, randomized clinical trials, Chera said, and studies are ongoing to investigate this.

He added that while this study included patients with a limited smoking history, other current studies include patients with more extensive smoking histories.

Chera said that researchers want to continue to improve two-year progression free response rates while achieving better side effect results. They want to do that by identifying additional biomarkers to drive precision medicine strategies.

Although traditional clinical risk help clinicians predict outcomes and select patients for clinical trials of de-intensified treatments, Chera said that these risk factors are imprecise. He and his colleagues are currently evaluating additional novel biomarkers that they believe could be used to better predict a patient’s prognosis and outline a course of treatment.

Specifically, they have shown in a previous study how levels of circulating HPV DNA in the blood, and how quickly patients clear this from the blood, were linked to outcomes.

Print Friendly, PDF & Email
September, 2019|Oral Cancer News|

Which feeding tubes do head and neck cancer clinicians prefer to use in patients undergoing radiotherapy?

Source: www.oncologynurseadvisor.com
Author: Susan Moench, PhD, PA-C

A study of the perceptions of health care professionals involved in the care of patients with head and neck cancer undergoing radiation therapy regarding optimal feeding tube practices showed no consensus; however, feeding tube placement was considered important for some patients. This study was published in JPEN Journal of Parenteral Enteral Nutrition.

Patients with head and neck cancer frequently undergo intensive treatment that may include a long course of radiation therapy in addition to surgery and chemotherapy. Treatment-related toxicity can involve severe dysphagia and mucositis, as well as reduced food intake and unintentional weight loss; these clinical sequelae can also lead to treatment delays and an increased risk of hospitalization.

Clinical practice guidelines include recommendations for early enteral feeding in patients with stage IV disease or hypopharyngeal tumors who are receiving chemoradiotherapy, as well as other patients with head and neck cancer, “depending on factors including their treatment, nutrition status, dysphagia, social support, and food intake.” However, there is no conclusive evidence as to which of the most commonly used feeding tubes — a nasogastric tube (NGT) placed when additional nutritional support is needed or a prophylactic gastrostomy tube (PGT) placed before radiation therapy — is preferable.

In this qualitative study, in-depth interviews were conducted with interdisciplinary health care professionals from 4 radiation therapy departments (2 in the United States and 2 in Australia) to evaluate their perspectives and experiences regarding feeding tube practices in patients with head and neck cancer.

Of the 46 health care professionals participating in the study, 26% were nurses, 37% were radiation oncologists, 24% dieticians, and 13% were speech pathologists.

One of the interesting findings from this study was the lack of a feeding tube protocol in place at all 4 radiation oncology departments, with decisions regarding feeding tube placement typically made by staff specialists on a case-by-case basis.

When use of a feeding tube was deemed appropriate, healthcare professionals at 3 of the radiation oncology departments favored the use of PGT, whereas NGT was preferred at the remaining department.

Patient-related factors considered to be important in decision making regarding feeding tube placement included planned treatment, tumor characteristics, nutrition and swallow status, risk of tube dependence, psychosocial status, and patient preferences. Other factors cited as potentially bearing on decisions related to feeding tubes were access to a dietician and a speech pathologist, as well as interdisciplinary collaboration, and the infrastructure to support timely feeding tube placements and intravenous fluids.

“Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered feeding tube practices,” the investigators concluded.

Reference
Hazzard E, Walton K, McMahon AT, et al. Healthcare professionals’ perceptions of feeding tube practices for patients with head and neck cancer across 4 international radiation oncology departments [published online September 2, 2019]. JPEN J Parenter Enteral Nutr. doi: 10.1002/jpen.1699

Print Friendly, PDF & Email
September, 2019|Oral Cancer News|