Never-Smokers Have Survival Advantage

  • 4/18/2003
  • Maury Breecher
  • Cancer Epidemiology, Biomarkers & Prevention (Vol. 10: 823-829)

Lower Second Tumor Occurrence in Head and Neck Cancer Patients who have never smoked

Patients with head and neck cancer are known to have a significant risk of developing a second primary cancer (SPT), especially in the head and neck area. The good news, however, is that former smokers and those who have never smoked develop fewer of these second primary tumors than active smokers, according to a report in Cancer Epidemiology, Biomarkers & Prevention (Vol. 10: 823-829).

This is first large-scale randomized study to evaluate the impact of smoking history on the development of SPTs and recurrence in patients with head and neck cancers.

Smoking Increases Second Cancer Risk

“Controversy has existed about the role of continued smoking in the development of SPTs, but our study provides the first objective evidence proving that continued smoking increases the risks of SPTs,” Edward Kim, MD, an author of the study, tells ACS News Today. Recurring tumors are the return of an original tumor. SPTs are new tumors with a different histology (different cell types) which occur at locations anywhere in the body greater than two centimeters away from the site of the first tumor, says Kim.

Active Smokers Have Highest Risk

“Significantly different smoking-related SPT development rates were observed in current, former, and never-smokers,” Kim says. “The results showed significantly higher SPT rates in active smokers versus patients who had never smoked and showed former smokers had a survival advantage over active smokers.” “This is important information because it reinforces the idea that individuals who develop cancer — in this case head and neck cancer — are at increased risk of developing second primary tumors if they are active smokers,” says Michael Thun, MD, vice president of epidemiology and surveillance research for the American Cancer Society. Those tumors pose substantial risks to life.” Thun points out that surgery and radiation therapies are usually effective therapies in early-stage head and neck cancer. “However, secondary tumors cause much of the mortality that occurs in this type of cancer,” Thun says. “That’s why the development of SPTs is something that we want to prevent. The study shows that even in long-term smokers who had already developed one cancer, quitting is beneficial in reducing the risk of occurrence of SPTs. Thus quitting smoking provides a survival advantage to head and neck cancer patients.”

The researchers studied 1,191 cancer patients who had been treated for an initial cancer in the head and neck area, and who, at the time of their entry into the study, were disease free. The patients were randomly assigned to receive either a medication or a placebo — a medication with no active ingredient—to determine if the medication under study decreased the recurrence of head and neck cancers after primary treatment, or the later development of SPTs. SPTs developed in 172 patients at various sites throughout their bodies. Of those patients, 121 (70.3%) were determined to have smoking-related tumors located in the head and neck, esophagus, lungs, or bladder. Of the active smokers, 4.2% developed second primary tumors compared to 3.2% of former smokers and 1.9% of the never smokers. The remaining 51 cases included cancers determined not to be tobacco-related.

The study is continuing, with patients receiving either the placebo or the experimental medication, a retinoid called 13cRA (taken from the A vitamin). Researchers hope the medication will have a significant impact on preventing the development of SPTs. “The final results of this trial will help tremendously in establishing the optimal, post therapeutic intervention in this population,” says Kim. “Should the results be positive, a new, unequivocal standard of care will be set for prevention therapy.”

2009-03-22T20:09:34-07:00April, 2003|Archive|

FDA Approves New Cervical Cancer Screening Test Test For HPV Now Combined With Pap Smear

  • 4/17/2003
  • The American Cancer Society

The Food and Drug Administration has approved a new screening test for cervical cancer that could help distinguish women at increased risk from those at very low risk of developing the disease.

Women over age 30 can now receive a test for human papilloma virus, or HPV, at the same time they receive a Pap test. The HPV test, manufactured by Digene Corp. of Gaithersburg, Maryland, is already approved to detect HPV in women with abnormal Pap smears, but until now, it was not approved for screening purposes, before results of the Pap test were known.

Since March, 2000, the test has been used for women whose Pap tests show mild abnormalities that can’t be readily explained, a condition referred to as Atypical Squamous Cells of Unknown Origin, or ASC-US. Until then, such women had to undergo repeated Pap smears every few months in hopes of determining the nature of the abnormal cells – whether they might develop into precancerous lesions or clear up on their own. In some cases, a colposcopy – an examination of the cervix with magnifying binoculars – was used to select areas of the cervix to biopsy, to determine whether the cells were dangerous.

Women with ASC-US Pap results who have negative HPV test results could be reassured that their short term risk of developing cervical cancer was very low, and that they could safely return to the usual screening schedule.

HPV is a family of more than 100 extremely common viruses, of which about 30 are sexually transmitted. Of these, about a dozen “high-risk” varieties are linked to nearly all cervical cancers, and to some cases of vaginal, vulvar, anal, oral, and penile cancers. Other, “low-risk” varieties cause genital warts. In most cases, however, HPV infection causes no symptoms at all, so a person who has HPV might not even know it. In other cases, symptoms of HPV do not appear until years after infection.

According to the Centers for Disease Control and Prevention, 50%-75% of sexually active adults will harbor the virus at some point in their life. In most cases, the immune system defeats the virus with no permanent effects. Sometimes, though, HPV that lingers in the body causes changes in the cervix that are detected with a Pap smear. In rare cases, these changes lead to cancer.

The risk of HPV progressing – causing changes that could lead to cancer – is greater for women over age 30 than for younger women, said Debbie Saslow, PhD, director of breast and gynecologic cancer programs for ACS, which is why the new screening test isn’t recommended for younger women. HPV infections in younger women tend to go away by themselves.

“In a woman over 30,” Saslow said, “if [an HPV infection] hasn’t cleared in a year, you want to do additional testing. It doesn’t mean she’s going to get cancer, but you want to follow her and watch her more carefully” to see if any treatment is needed.

The FDA said women who have an abnormal Pap test and an HPV infection have a 6% to 7% greater risk of developing cervical cancer if they aren’t treated.
Still, cervical cancer is rare even among women who do have an HPV infection. The American Cancer Society estimates about 12,200 new cases of cervical cancer will be diagnosed this year. Screening can help prevent the disease by catching abnormalities in the cervix before they become cancerous.

The Society recommends Pap tests beginning either at age 21 or three years after a woman first has sexual intercourse. Until age 30, screening should be done every year with the regular Pap test or every two years using the newer liquid-based Pap test. After age 30, women who have had three normal Pap tests in a row can wait two or three years for their next Pap.The FDA said the new use of the HPV test is in addition to Pap tests. The HPV test is not a substitute for regular Pap tests.

OCF Note: We have put this news article up because of the strong relationship between non-smokers who develop oral cancers and HPV. There is additional information regarding HPV within the main body of the OCF web site.

2009-03-22T20:08:13-07:00April, 2003|Archive|
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