Monthly Archives: August 2002

Oral Cancer Survival Rate Remains Unchanged Over the Last Thirty Years

  • 8/15/2002
  • Atlanta
  • Cancer Journal for Clinicians

An estimated 28,900 Americans will be diagnosed with oral or pharyngeal cancer and nearly 7,400 will succumb to the disease, according to a review published in the July/August issue of CA: A Cancer Journal for Clinicians, a peer-reviewed journal from the American Cancer Society.

This disease most commonly has been found in middle-aged and older individuals, and it has affected more men than women. However, authors Brad W. Neville, DDS, and Terry A. Day, MD, FACS, say that “a disturbing number of these malignancies is being documented in younger adults…[and the] disparity in the male:female ratio has become less pronounced over the past half century, probably because women have been more equally exposing themselves to known oral carcinogens such as tobacco and alcohol.”

Along with a review of the epidemiological and clinical features of oral and oropharyngeal squamous cell carcinoma, Neville and Day emphasize early detection as the best method of prevention.

“In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades,” say the authors.

August, 2002|Archive|

Pacemaker Could Improve Tongue Reconstruction

  • 8/14/2002
  • Berlin
  • Hannah Cleaver
  • Reuters Health

A “pacemaker for the tongue” could soon help victims of mouth cancer or accidents to control a reconstructed tongue built from transplanted muscle, animal studies in Germany suggest.

Currently, surgeons can fashion replacement tongues from neck muscles for people who lose their tongue to cancer or trauma. The muscles are grafted onto the base of the person’s original tongue.

But controlling the rebuilt organ, in order to eat and talk, is a major problem and reconstructed tongues need to be kept active to avoid shrinkage through disuse. “The reconstructed tongue initially makes passive movements, which are produced by contractions of the surrounding floor of the mouth as well as pharynx and chewing musculature,” said Professor Stephan Remmert, from Luebeck University Hospital, at last week’s German Ear, Nose and Throat Conference in Baden-Baden.

To give patients better control of the tongue, Remmert is using pacemaker technology to boost nerve signals to the reconstructed organ. He told Reuters Health that the main aim of the work was to filter the most important signals that the brain sends to the main tongue nerve, the hypoglossus. “Then we can amplify the signal and send it on to the new musculature,” Remmert said. “It has to be amplified enough to generate quite powerful movements.” In experiments on domestic pigs, the group is surrounding the severed end of the hypoglossus with electrodes to measure, reproduce and send its signals. Much of the other technology needed has already been developed, or is in development, much of it from the cardiac pacemaker field, he said.

Although the results of the animal experiments are promising, they will not be directly transferable to people. Still, Professor Remmert thinks clinical trials on people could be feasible within 2 or 3 years. As with heart pacemakers, he said the tongue pacemaker would eventually be implanted–under the collarbone and connected to the tongue by a wire.

August, 2002|Archive|

Sweet but Deadly Addiction is Seizing the Young in India

  • 8/13/2002
  • Bombay, India
  • Amy Waldman
  • Tata Memorial Hospital

Promoted by a slick and many-tentacled advertising campaign, gutka, an indigenous form of smokeless tobacco, has become a fixture in the mouths of millions of Indians over the last two decades. It has spread through the subcontinent, and even to South Asians in England.

But what has prompted particular concern here is the way that in the last 10 years, gutka – as portable as chewing gum and sometimes as sweet as candy – has found its way into the mouths of Indian children. Young people have become gutka consumers in large numbers, and they have become an alarming avant-garde in what doctors say is an oral cancer epidemic. That, among other factors, has prompted the state of Maharashtra, which includes Bombay, to take an unusual step. It enacted a five-year ban, the longest permitted by law, on the production, sale, transport and possession of gutka, a $30 million business in the state, effective Aug. 1. Several other states have undertaken similar bans, although some have been stayed by the courts.

It is easy, on the streets of Bombay, to find young men like Raga Vendra, now 19, a railway worker who began taking gutka at age 11. It is also easy to find gutka sellers, like Ahmed Maqsood, who say they have had customers as young as 6.

Dr. Surendra Shastri, the head of preventive oncology at Tata Memorial Hospital, noticed about five years ago that his patients were getting younger, by about eight to 10 years. “High school and college students were coming in with precancerous lesions,” he said. “Usage was starting much earlier.” India has 75,000 to 80,000 new cases of oral cancers a year – the world’s highest incidence, and about 2,000 deaths a day are tobacco related.

A 1998 survey of 1,800 boys ages 13 to 15 from a wide range of socioeconomic groups found that up to 20 percent were already using three to five packets of gutka daily. The price is low: sometimes less than two cents a packet. The contents, a mixture of ingredients including tobacco, are usually placed in the cheek lining, savored, then expelled.

Gutka was the product of a packaging revolution that made an Indian tradition portable and cheap. Many Indians have long chewed paan, a betel leaf wrapped around a mixture of lime paste, spices, areca nut and often tobacco. But obtaining paan required a visit to a paanwallah – it was too messy to be transported. All of that changed with gutka, a dried version of the concoction, but without the betel leaf, preserved and perfumed with chemicals and sealed in a plastic or foil pack.
Gutka could be used at will, at work or at home or at school, and it was used, in very large quantities. Sales of gutka and its tobaccoless counterpart, paan masala, are now more than $1 billion a year, having quintupled during the
1990’s. “What caused this boom of oral cancers was this packaging of tobacco,” said Dr. A. K. D’Cruz, the lead head-and-neck surgeon at Tata Memorial Hospital. “Convenience got them hooked.”

Many consumers say they welcome the ban, because they see no other way to curb their addiction. Even some vendors like Mr. Maqsood have embraced it, saying they felt they were trading in toxins. “The chemicals used in gutka were poisonous,” he said. “I have seen some customers who can’t open their mouth.”

The ban’s critics, gutka manufacturers among them, argue that countless other tobacco products remain on the market. While vendors, fearing large fines, are largely observing the ban for now, gutka can easily be bought just a state away. Gutka manufacturers contend that the ban stemmed less from concern about children than from a desire to protect cigarette makers, who are fighting for market share. The gutka makers have begun running an ad that argues that if gutka is banned, cigarettes should be as well. “No government in the world has been able to stop cigarettes,” Dr. Shastri countered. The gutka ban, he noted, is possible only because of a law allowing the state to ban harmful foodstuffs.

“The gutka makers say the ban will have spurious effects,” he continued. “I don’t care – 70 to 80 percent of children won’t have access to the black market, or to smugglers. We will prevent children from taking it up.”

Gutka is seen by doctors as particularly insidious because it contains many unhealthful additives, like magnesium carbonate, and is cheap. For children and teenagers, smoking cigarettes remains taboo. Gutka has no social stigma among peers, and it is easy to hide from parents.

Padmini Samini, who started an antitobacco advocacy group after her father got oral cancer, said she had found cases in which gutka makers had given free samples to children after school. Some of it was sweetened so much to mask the harsh tobacco taste, she said, that children considered it candy. Gutka manufacturers managed to erase whatever stigma was tied to using tobacco with paan by marketing campaigns that made gutka use glamorous and socially acceptable.

For about a decade India’s version of the Oscars has been sponsored by Manikchand, one of the top-selling brands. Gutka manufacturers have sponsored religious festivals, distributing free samples. In television commercials, gutka
gives actors the power to perform superhuman feats. That may be why Abinash Parab, an ordinary laborer, thought he needed gutka to do his heavy lifting job. Until two weeks ago he was using 20 to 25 packets of Manikchand a day. “There was a sense of intoxication” from gutka, he said. What stopped him was not the ban; it was the wards he passed through at Tata Memorial Hospital when he went to get ulcers in his mouth checked out. Tumors bulge from cheeks and jaws. There are holes where larynxes used to be.

About 30 percent of the cancers in India are in the head and neck, compared with 4.5 percent in the West. Furthermore, Dr. D’Cruz added, “most of our cancers come a decade earlier than the West.” They come in the cheek and jaw, often preceded by submucosal fibrosis, a hardening of the palate that can make it almost impossible to open the mouth.

Rasiklal Manikchand Dhariwal, the founder of Manikchand and the country’s king of gutka, says he has no such health problems, despite being a user himself. The fruits of gutka’s popularity are visible at his 14,000-square-foot home in Pune, where he lives behind guarded gates in immodest opulence. He exports gutka to 22 countries, and calls his product a health promoter and job producer, noting that hundreds of thousands of Indians farm tobacco for their livelihood.

Manikchand, he said, is made with the highest level of quality control. He compared its scent to a “French perfume.” As long as the brand is of high quality, he said, it is fine for children, although his product is now marked “not for minors.” He disparaged his competitors for making shoddy, possibly injurious products. He also blamed consumers for overdoing it. “If you take anything in excess it will also harm, no?” he said. “Even milk.”

August, 2002|Archive|

Screenwriter Eszterhas Has Cancer

  • 8/9/2002
  • New York
  • AP

“Basic Instinct” screenwriter Joe Eszterhas has throat cancer after a lifetime of smoking, and is urging Hollywood to stop glamorizing cigarette use the way he says he did.

Eszterhas writes in an op-ed piece in Friday’s New York Times that he was diagnosed with the disease 18 months ago. Much of his larynx is gone, he says, and he has difficulty speaking and being understood. “Smoking was an integral part of many of my screenplays because I was a militant smoker. It was part of a bad boy image I’d cultivated for a long time — smoking, drinking, partying, rock ‘n’ roll,” the 57-year-old writes. “Smoking, I once believed, was every person’s right. … I don’t think smoking is every person’s right anymore. I think smoking should be as illegal as heroin.”

Eszterhas says he has trouble forgiving himself for the rampant cigarette use in his films. “I have been an accomplice to the murders of untold numbers of human beings. I am admitting this only because I have made a deal with God. Spare me, I said, and I will try to stop others from committing the same crimes I did.” The writer of other guilty-pleasure movies, including “Flashdance,” “Sliver” and “Showgirls,” says there are “1,000 better and more original ways to reveal a character’s personality” than with cigarettes.

In 1992’s “Basic Instinct,” Eszterhas explains, smoking is part of the sexual subtext. ” Sharon Stone’s character smokes; Michael Douglas’ is trying to quit. She seduces him with literal and figurative smoke that she blows in his face,” he says. “In the movie’s most famous and controversial scene, she even has a cigarette in her hand.”

Eszterhas says he has stopped smoking and drinking since his cancer was diagnosed, and now walks five miles a day and attends church on Sunday. “My hands are bloody; so are Hollywood’s. My cancer has caused me to attempt to cleanse mine,” he writes. “I don’t wish my fate upon anyone in Hollywood, but I beg that Hollywood stop imposing it upon millions of others.”

August, 2002|Archive|

Oral Cancer Test Detects Over 2500 Mouth Cancers of Precancers in Last 16 Months; New Data Confirms Dentists Should Expect to See Testable Lesions Each Week

  • 8/8/2002
  • Melville, NY
  • Business Wire

Sullivan-Schein Dental, the U.S. Dental Business of Henry Schein, Inc. (Nasdaq:HSIC), announced today that OralCDx, a painless, early oral cancer detection test exclusively distributed by the company in the U.S., is credited with identifying more than 2,500 precancerous or cancerous lesions during the past 16 months, according to CDx Laboratories, developers of the OralCDx biopsy brush.

Many of these cancers presented as benign-appearing spots or sores in the mouth have been traditionally overlooked or “watched” before this test became available. New evidence recently published in the Journal of the American Dental Association (Christian DC. J Am Dent Assoc 2002; 133: 357-62) confirms that, upon careful examination, dentists should expect to see at least two benign-appearing lesions that should be tested each week even in low-risk patients.

Oral cancer results in more deaths nationwide than either melanoma (skin cancer) or cervical cancer, according to the U.S. Centers for Disease Control and Prevention. Approximately one-half of all patients diagnosed with oral cancer survive more than five years following the diagnosis. However, when detected early, the disease is often curable.

“I tested a white, very small lesion in one of my patients, a 20-year non-smoker, who came in for a cleaning,” said Craig Steichen, DDS, of Albuquerque, N.M. “It turned out to be an early stage squamous cell carcinoma. This was one of those lesions that, without this test, would have gone undiagnosed until the cancer was more advanced. The OralCDx test I performed probably saved this patient’s life.”

OralCDx is a computer-assisted brush biopsy test that can determine if oral lesions contain potentially dangerous precancerous or cancerous cells. The general dentist or dental specialist performs the brush biopsy in minutes during a routine office visit. The procedure, meant for testing the benign-appearing spots or sores that are commonly seen in the mouth, is virtually painless, and patients require no anesthesia. If a brush biopsy specimen proves to be suspicious, a traditional incisional biopsy is then performed to give a definitive diagnosis.

Oral cancer affects some 30,000 Americans each year, including more than 20,000 men, according to the American Cancer Society. Although tobacco users are at higher risk for developing oral cancer, more than 25 percent of oral cancer victims do not smoke and have no other risk factors. In its earliest, most treatable stages, oral cancer generally causes no pain or discomfort and may be difficult to diagnose visually. Precancerous and cancerous spots or sores are virtually indistinguishable from benign spots or sores that can form in the mouth.

“Unlike other cancers, the mortality rate for oral cancer hasn’t changed in more than 40 years,” said Drore Eisen, MD, DDS, Medical Director of CDx Laboratories, providers of the OralCDx test. “Routine use of the OralCDx test, even in low-risk patients, will allow dental professionals to find the disease early and make progress in decreasing the mortality rate. Early detection will also help many people avoid the devastating effects of extensive surgery, which often is needed for oral cancers detected in late stages.”

“At Sullivan-Schein Dental, we see Oral CDx as an opportunity to do well by doing good,” said Jim Breslawski, President of Sullivan-Schein Dental. “We have supported the product to help ensure that our customers can perform the highest quality dentistry and be of the greatest aid to their patients. The fact that it has been instrumental in detecting 2,500 precancerous or cancerous lesions during the past 16 months is extremely gratifying.”

August, 2002|Archive|