Yearly Archives: 2003

Nonprofits Can’t Take the Place of Government

  • 12/13/2003
  • Los Angeles
  • Torie Osborn
  • Los Angeles Times

Every year at this time, news stories appear about needy nonprofits doing God’s work and modern-day good Samaritans-great men and women with names like Kroc, Gates and Annenberg-giving millions to worthy causes. We celebrate our generosity. We affirm that we are good people doing good things.

But if you look beyond the rim of your rose-colored glasses, you’ll see a bigger picture this year, one that is neither joyous nor heartwarming. Nonprofits are desperate. Need is up. Giving is down. Nationwide, charitable giving decreased last year, the first drop in 12 years. This year’s numbers aren’t expected to be any better.

But the disaster-in-the-making we face is bigger than this. Its magnitude came into focus after I read a story this year about the mayor of Somerville, Mass., going to that city’s nonprofits, pleading with churches, charities and nursing homes to make donations to the city to pay for the police and fire departments. A week later, I read another story about city officials in Pittsburgh doing the same thing. In Los Angeles, we’ve only just put our toe in the water. The city recently began charging nonprofits a $750 fee for park use (tables, clean-up, and utility hook-up not included). This time next year, nonprofits may be asked to adopt a cop. But all the nonprofits in Christendom can’t make up what government increasingly leaves unfunded.

Our crisis in public services is not simply a result of the economic downturn. The nation’s commitment to public infrastructure and the taxes that pay for them have been shrinking for some time. Expecting charity to “make up the difference” of what government fails to provide was never more than a pipe dream. When the economy heads south, the well-to-do reach for their wallet-and it’s not usually to open it. A recent Wealth + Values study found the wealthy feel they should give to charities more than they did three years ago, but because of the economy, they won’t.

Philanthropic institutions are searching for an appropriate response. A recent study of nonprofit funding conducted by Venture Philanthropy Partners in collaboration with McKinsey & Co. predicts tough times and recommends that more charitable dollars be directed to advocacy. Policy change, they conclude, is the only way to get beyond increasing demand for nonprofit services and a decreasing supply of money to provide them. In fact, philanthropic spending priorities are shifting as foundations begin to place greater emphasis on changing the policies that have brought us to this brink. Traditionally, philanthropy preferred to steer clear of advocacy and fund social services instead, but that reluctance is waning. The Ford Foundation has placed new emphasis on “Strategic philanthropy” focused on policy change. The Pew Charitable Trusts recently decided to change its legal status from a private foundation to a public charity in part because public charities are constrained by fewer rules regarding advocacy and lobbying.

Individual philanthropists-many of whom are middle-class people, not gajillionaires the media swoon over-might also respond to this crisis by reevaluating their traditional giving patterns and putting more emphasis on change, not just charity. Next year, incredibly, we face proposals for more federal tax cuts that will further shrink government’s ability to provide basic services. Nonprofits will stagger and fall under the weight. Where and how will this end? Your checks this year could make a difference.

OCF Note: OCF has been through several incarnations in its short existence. First I wished for it to become a content rich web site that contained all the information that I could not find elsewhere as I traveled the path of diagnosis, treatment, and recovery. We have made great strides in this area and continue to build upon the strong foundation that exists each month. As I moved into recovery, I realized the need for emotional support myself, and except for my wife who never skipped a beat or faltered, I could not find it anywhere… the genesis of the survivor/patient forum was the result, which today may provide more than face to face small support groups, due to the true generosity of the regulars who make it live and breathe with their insights and understanding which they share with newcomers each week. But over the last year my, and OCF’s efforts, have been singularly driven towards advocacy. We must change the system, one that continues to allow dentists, doctors, and the professional societies that they belong to live in the status quo with a disease that responds well to early detection… if only someone was taking the time to look for it. Unfortunately too few are. How many lives would be saved if all dentists and primary care physicians were up to speed on oral cancer and were finding it as highly curable stage ones and twos, instead of the stage threes and fours that make up almost 66% of all diagnosis (and which have correspondingly lower survival rates). This year OCF has spent efforts lobbying state licensing boards to make oral cancer screening protocols a mandatory continuing education requirement for re licensure of dentists in various states. I have been an outspoken critic at the Centers for Disease Control in Atlanta, an organization who could make opportunistic screening and early detection a priority but have not. We are beginning to work on a training CD for dentists to be followed by one for primary care physicians on recognizing these early lesions and pre cancerous tissues, and specifically what to do about them when they find them…. (which for anyone who has not been reading my editorials (click here) etc., means not treating them with what can only be called watchful neglect, and instead of sending them for referral or biopsy letting them bloom into late stage killers.) Hopefully we will find the funding to finish this project in 2004 and have a training CD in the hands of every dentist in the US soon there after. Next year I will be meeting with the heads of the NCI, NIH, and with the Surgeon General to try and garner support for our efforts, which relate to the underlying reasons this situation has gone largely unchanged for almost 5 decades. We are not waiting for a new cure or drug to be invented, we are not waiting for a new diagnostic procedure to be developed, we are not looking for a disease that is hard to find buried somewhere deep within your body, we are not asking for individuals to endure painful or expensive examinations… none of this is necessary to make a major dent in the death and morbidity that is associated with oral cancer, by finding the disease at the early stages, and saving lives in the process. As cancers go, it is right there in plain sight, available to be seen by the naked eye or felt with the fingers, out in the open right under your nose!! We are only asking that those who have the opportunistic ability to screen people they come into contact with each day, dentists and primary care physicians, do so with both regularity and with educated thoroughness, and when suspect tissues are found, to immediately refer the patient or biopsy the tissues so a definitive diagnosis can be immediately made.

But I cannot do this alone. It will take funds, letter writing campaigns, public appearances from myself and others who desire to be heard, to make the difference in whether this disease continues it’s deadly drumbeat or is brought down from it undeserved high standing as a killer. It will take real advocacy. With over 12 million hits on our web site each month (certainly not one that is looked at much by those without some contact or direct interest in this disease), we have the numbers to make a difference. It is within our power if we are acting together. There must be a change, and each of us must be the change we wish to see in the world.

December, 2003|Archive|

Cancer-Virus Link Growing Quickly

  • 12/10/2003
  • New York, NY
  • By  Jennifer Warner,  Reviewed by Michael  Smith, MD
  • WebMD Medical News

Viral Infections Increasingly Implicated in Cancer Growth and Development

You can’t “catch” cancer like a cold, but new research now shows that infection with any of a number of different viruses may play an important role in the growth and development of cancer. More than a dozen different viruses have been linked to various forms of cancer. In most cases, the presence of a particular virus increases the risk of developing cancer or speeds its progression. For example, HIV and other viruses that affect the immune system make infected individuals prone to a variety of cancers by weakening the body’s natural defenses. But in other cases, there is now compelling evidence that certain viruses may also play a critical role in causing cancer. Proving that a particular virus causes cancer, however, is complicated.

“One of the things that is complicated about this is that there is a long time between exposure to the virus and development of the cancer,” says Bruce Johnson, MD, of the Dana-Farber Cancer Institute in Boston. “Number two is that it’s not a one-to-one thing. There are a lot more people who are exposed [to a virus] than have evidence of a tumor.” Johnson moderated a briefing today in New York City on the virus-cancer link sponsored by the American Society of Clinical Oncology.

Currently, Johnson says the scientific evidence is strongest for the link between cancer and the human papillomavirus (HPV) and the hepatitis B and C viruses, but many other viruses are also under investigation for their ties to cancer.

HPV Linked to More Than Cervical Cancer

HPV has long been associated with an increased risk of cervical cancer, but new research suggests that the virus may also cause head, neck, and anal cancers. HPV is the most common sexually transmitted virus, and about 5.5 million people in the U.S. become infected with HPV each year. In many people, HPV infection causes no symptoms and resolves on its own without causing illness. But about 18 of the 120 different types of HPV are closely associated with cancer and are known as high-risk types.

“Over the last three years there has been an explosion of data on HPV,” says Maura Gillison, MD, PhD, assistant professor of oncology at the Johns Hopkins School of Medicine in Baltimore, who also spoke at the briefing. Gillison says HPV has now been implicated in 99% of cervical cancer cases. But new studies show that the virus is also responsible for the majority of tonsillar and anal cancers, which helps explain a dramatic rise in these types of cancer in recent years. Gillison says up to 15% of the cancers reported each year worldwide are caused by HPV infection, and the virus accounts for one-third of all cancers attributable to infectious agents.

Hepatitis Infections Behind Rise in Liver Cancer

Researchers say viruses are also to blame for a dramatic 71% increase in the incidence of liver cancer from 1976-1995. Hepatitis B and C viruses are the major risk factors for developing liver cancer, and more than 80% of liver cancer cases worldwide are linked to hepatitis B infection in areas where the virus is prevalent, such as developing countries. But experts say hepatitis C may actually account for the rise in liver cancer in developed countries. Hepatitis C is transmitted primarily through intravenous (IV) drug use, blood transfusions with infected blood, and sexual contact.

Although hepatitis C infection is less common than hepatitis B, affecting about 100 million vs. 300 million worldwide, researchers say hepatitis C is more dangerous. Many people with hepatitis B never develop symptoms and the virus resolves on its own. But more than 80% of those infected with hepatitis C develop a chronic infection that can lead to cirrhosis of the liver and liver cancer. But liver cancer does not develop overnight after hepatitis infection and often takes years to develop.

“If you can block infection or [successfully] treat chronic hepatitis infection, you don’t get sick,” says Andrew Zhu, MD, PhD, assistant physician at Massachusetts General Hospital in Boston, who also spoke at the briefing. In the U.S., the number of liver cancer cases and related deaths has doubled between 1975 and 1998. Although this increase has affected all ethnic groups, the largest increase has been among white men ages 45-54. Zhu says those trends are likely to continue over the next 10 to 20 years.

Future Directions

As researchers learn more about the role viruses play in cancer, they can develop better, more targeted treatments to reduce the risk or slow the progression of cancer in infected individuals. But experts say the greatest promise lies in the development of vaccines that protect people at risk from infection and prevent cancer from occurring. One example of such a vaccine already in development is an HPV-16 vaccine that targets a form of the HPV virus closely associated with cervical cancer. A clinical trial of the vaccine published last year in The New England Journal of Medicine showed that young women given three doses of the vaccine developed antibodies against HPV-16 and were protected against both persistent HPV infection and cervical cancer.

In areas where hepatitis B is prevalent, the primary mode of transmission is from mother to child during birth, but the virus may also be transmitted through sexual intercourse, IV drug use, or blood transfusions. A vaccine that protects against hepatitis B has been in use for many years. The American Academy of Pediatrics recommends the hepatitis B vaccine for all children 18 years and younger. In addition, adults at increased risk of hepatitis B, such as health-care workers, should also get the vaccine.

A nationwide vaccination program in Taiwan that started in 1984 has now been credited with reducing the incidence of liver cancer in children by 50%.

December, 2003|Archive|

Phase 3 Data Show Palifermin Improves Patient Reported Outcomes In Cancer Patients And Helps Reduce Hospitalizations And Healthcare Resources

  • 12/9/2003
  • San Diego
  • Amgen

Amgen (Nasdaq:AMGN), the world’s largest biotechnology company, today announced additional data from a Phase 3 study demonstrating that treatment with palifermin (recombinant human keratinocyte growth factor or rHuKGF), an investigational product, was associated with a statistically significant and clinically meaningful improvement in mouth and throat soreness as reported by patients with hematological malignancies undergoing high dose chemotherapy and radiotherapy with peripheral blood progenitor cell (PBPC) transplants. Mouth and throat soreness is caused by the severe mouth ulcerations characteristic of oral mucositis, a painful and debilitating side effect of some cancer treatments. The results were presented by the study’s lead investigator, Patrick Stiff, M.D., Director of the Cardinal Bernardin Cancer Center, Loyola University Health System and Professor of Hematology/Oncology, Loyola University Chicago Stritch School of Medicine, in an oral presentation at the 45th American Society of Hematology (ASH) Annual Meeting. [ASH Abstract # 676]

These findings are especially exciting because there are currently no approved therapies for the treatment or prevention of oral mucositis, Stiff said. In this trial, patients given palifermin experienced improvements in their ability to eat, drink, talk, swallow and sleep, as well as their overall functional well being. Patients enrolled in the study (n=212) reported daily how sore their mouths and throats were, as well as their limitation in carrying out daily activities. On average, patients receiving palifermin reported a reduction in soreness of 54 percent compared to the placebo arm of the study (p=0.0001). This reduction in soreness translated into, on average, a 40 percent improvement in palifermin-treated patients’ ability to eat, drink, swallow, sleep and talk (p<0.001).

Patients in the study were randomized to receive either palifermin (106 patients) 60 mcg/kg/day or placebo (106 patients) for three days prior to high-dose chemotherapy and total body irradiation (TBI). Then all patients received PBPC transplantation, followed by an additional three days of either palifermin or placebo.
Patients undergoing PBPC transplants rate severe mucositis as one of the most debilitating side effects of this treatment. Everyday activities like eating, swallowing and talking can become difficult or impossible leading to malnutrition and dehydration that often requires hospitalization. In addition, the pain from severe ulcerations often requires morphine-based analgesics, which can lead to hallucinations and patients feeling loss of control. Patients with the most severe form of oral mucositis are unable to swallow anything at all and may need total parenteral nutrition (TPN) administered intravenously until the pain from the mucositis recedes, and the patient is able to swallow again. In addition to a lower incidence of severe oral mucositis, patients receiving palifermin had almost one week less severe mucositis compared to those receiving placebo (10.4 days vs. 3.7 days). In particular, palifermin helped protect patients from the most severe form of oral mucositis (grade 4) with three times fewer palifermin-treated patients getting this painful and debilitating side effect, compared to placebo-treated patients (62 vs. 20 percent). [ASCO 2003 Abstract #3642]

Further Analysis Shows Palifermin May Help Reduce Health Utilization Costs

Additional data from the same trial was presented in a second oral session by Christos Emmanouilides, M.D., University of California, Los Angeles Medical Center, and demonstrated that by reducing the severity and duration of oral mucositis in this patient population, palifermin also reduced health resource utilization in terms of number of days of hospitalization, analgesic use and parenteral nutrition. Patients receiving palifermin spent fewer days in the hospital than those on placebo (15.3 vs. 17.3 days), required less narcotic analgesics and were significantly less likely to need parenteral nutrition (11 vs. 43 percent of patients). [ASH Abstract # 883] Adverse events included mild/moderate skin and oral erythema with/without edema. Transient, asymptomatic increases in serum amylase and lipase were also observed and occurred more frequently in palifermin recipients than in placebo recipients, although the difference was not statistically significant.

About Palifermin

Natural keratinocyte growth factor has been shown in preclinical studies to stimulate the growth and development of epithelial cells, which include those that line the mouth and gastrointestinal tract. Amgen is studying palifermin (rHuKGF) for protection and healing of epithelial cells injured by anti-tumor treatments such as radiation and chemotherapy.

December, 2003|Archive|

Farmers of Ethiopia turn to khat as world coffee prices tumble. Less coffee, more mouth cancer.

  • 12/8/2003
  • Nairobi
  • William Wallis
  • Financial Times

Farmers in Ethiopia, where the drinking of coffee originated 3,000 years ago, have begun cutting down coffee bushes and replacing them with the drug khat, according to research by Oxfam, the British aid group, which says the slump in world coffee prices is boosting the global drugs trade.

The research – published on Tuesday to coincide with a crisis meeting of coffee farmers, industry officials and international institutions in Geneva – says production has dropped by 17 per cent since 1998 in the Ethiopian province of Harar, an area reputed by tasters to produce some of the world’s finest Arabica beans. According to Meles Zenawi, Ethiopia’s prime minister, the trend is spreading, although industry officials say favourable climactic conditions have kept the overall crop steady this year. In the past five years coffee’s contribution to Ethiopia’s foreign exchange earnings has fallen from 70 to below 40 per cent, while earnings from khat doubled to $58m (£35m, ?48m).

A similar phenomenon is occurring in Peru, where “coffee sells at around 65 US cents per pound, while coca, which is processed into cocaine, is around $3 a pound”, says the report, which blames the coffee industry for its “half-hearted” efforts to address the world price slump. When chewed for hours, khat produces an amphetamine-like high. It is popular with African truck drivers and is used by 50 per cent of militiamen in Somalia, according to a recent United Nations survey.
Long-term use of khat can cause depression, mouth cancer, and loss of libido.

Oxfam argues that khat will overtake coffee as Ethiopia’s primary export commodity within a decade if world coffee prices do not rebound. Global overproduction and soaring harvests in Brazil and Vietnam have brought about record lows. Oxfam says its investigations found the “big four” coffee companies – Sara Lee, Kraft, Nestle and Procter & Gamble – were failing to compensate by adopting fair trade guidelines to ensure farmers a basic standard of living.

“People are moving from coffee, which is safe, to drugs like khat, because the market is not working for them,” Mr Zenawi told the BBC yesterday.Coffee is central to Ethiopia’s economy, which is among the world’s poorest, providing work for some 700,000 farmers. At today’s prices, farmers earn around 86 cents per kilo, equivalent to 0.57 per cent of the value from a cup of coffee retailed at $1.50. Khat fetches $9 a bushel.

December, 2003|Archive|

PET/CT shows promise as first-line tool for oncologic staging, topping MRI in one head-to-head comparison

  • 12/3/2003
  • Chicago
  • Jonathan S. Batchelor

Accurate tumor staging is critical for patient management in
clinical oncology. Research conducted by a team from Essen, Germany,
suggests stage-adapted therapy (tumor staging (T), lymph node metastasis
staging (N), and distant metastasis staging (M) ), may benefit by the use of
a mix of modalities.

Dr. Gerald Antoch, from the department of radiology at the University
Hospital of Essen, presented the results of a study performed to compare the diagnostic accuracy of whole-body dual-modality PET/CT with whole-body MRI for the staging of cancer at the RSNA 2003 on Tuesday. The researchers conducted imaging studies with PET/CT and MRI on patients with different malignant diseases to assess tumor staging. The studies all covered an axial field of view from the head to the upper thighs, said Antoch

The team imaged 60 patients using a dual-modality PET/CT (Biograph, Siemens Medical Solutions). PET imaging was performed one hour after the administration of 18-FDG and both intravenous and oral contrast agents were used in the diagnostic CT portion of the scan, he said. MRI imaging was conducted on a 1.5 T scanner (Sonata, Siemens Medical Solutions). Unenhanced T1- and T2-weighted studies of the liver and thorax as well as contrast-enhanced whole-body T1 coverage was conducted by the team. PET/CT and MRI data sets were evaluated by different reader teams who were blinded to the results of the other imaging procedure, reported Antoch.

The researchers used histological results and clinical follow-up (mean, 199
days, +/-68) as their standards of reference. We limited our whole-body modality-to-modality comparison of accurate T-staging with PET/CT and MRI to 47 patients whose tumor stage was histologically verified, noted Antoch. The group found that the T-stage was accurately determined in 41 of 47 patients (87%) with PET/CT and in 28 of 47 patients with MRI (60%).

PET/CT accurately staged lymph node status in 92 of 99 patients (93%) while
MRI had a correct N-status in 82 of 99 patients (83%), according to the researchers. The M-stage was correctly determined in 91 of 99 patients (92%) with PET/CT and in 90 of 99 patients (91%) with MRI, said Antoch.

However, when the researchers looked at specific sites of carcinoma, both MR and PET/CT showed staging strengths and weaknesses. Antoch reported that
PET/CT was superior in the staging of pulmonary metastases with sensitivity and specificity both at 96%, compared with MRI‚s 89% and 81%.

Although PET/CT showed strong numbers for staging liver metastases, a sensitivity and specificity of 90% and 98%, MRI was more accurate with a sensitivity of 100% and a specificity of 97%. Bone metastases were also better staged with MRI, with PET/CT demonstrating a sensitivity of 75% and a specificity of 97%, while MRI showed an 83% sensitivity and a 96% specificity, he said. When it comes to whole-body imaging for the purposes of determining the T and N stage of tumors, PET/CT demonstrates better sensitivity and specificity than MRI. However, for certain metastases, such as those in the liver and bone, MRI is the superior imaging tool. On the basis of our results, we believe that PET/CT is ready to be used as a first-line tool for oncologic staging said Antoch.

December, 2003|Archive|

Cancer survivor retraces tobacco choices that almost killed him

  • 12/3/2003
  • Illinois
  • Bluefield Daily Telegraph

“People look at me like I’m a freak. I’m not a monster. If you give me a chance, you’ll find I’m pretty likable.”Those were the words of Gruen Von Behrens, a 26-year-old from Stewardson, Ill. A victim of oral cancer, he now travels the country, speaking to high school students and athletes about the dangers of smokeless tobacco. He was at PikeView High School on Tuesday, after making trips to Montcalm High School and Bluefield Intermediate School.

With half of a tongue and a deformed face, it is sometimes difficult to understand Von Behrens when he speaks. “I know I’m hard to understand. That’s why you have to listen closely,” he told the gathered ninth- and 10th graders.

“I went camping with some of my buddies when I was 13, and one of my friends asked me if I wanted a dip,” Von Behrens said. “I was 13. I didn’t have a care in the world, so I took a dip, and I liked the taste.” Von Behrens said he started dipping nearly a can a day until he was 17 years old. That’s approximately 1,827 cans. “We would play games to see who could get the biggest chew in their mouth or see who would get sick first. It was fun,” the cancer victim said.

Then, when he was nearing his 17th birthday, Von Behrens said he noticed a white spot on the side of his tongue, sort of like a fever blister. “It didn’t go away like a fever blister though. Pretty soon it split my tongue,” he said. Von Behrens, who grew up with only his sister and his mother, could not confide the news that he might have cancer to his family. “I was scared to death. I could talk to my mom about anything. She was my best friend. But I couldn’t tell her that I had cancer. “She was asking me why I was talking funny, why I drooled a lot and why food kept falling out of my mouth when I ate. I told her that my wisdom teeth were coming in.”

Then, one Friday afternoon, his mother got him into the car under the pretense of going shopping. She actually took him to a dentist’s office, he said, to pull his wisdom teeth. “Right before the doctor was going to put that mask over my face to knock me out. I said, ‘Wait. That isn’t why I’m here. I’ve got cancer.’ The doctor took one glance in my mouth and nodded to my mother that it was true. I don’t think I ever saw her cry that hard.”

The next week, Von Behrens was three hours away from home, undergoing a 13-hour surgery in which doctors removed half of his tongue. “The doctor said I had a 75 percent chance that I wouldn’t survive the surgery,” he said. After the surgery, Von Behrens spent a month and a half in the hospital and then had to undergo painful radiation treatments every day for eight weeks. “It was hell. I knew that it was going to hurt every day for eight weeks. It was the God-awfulest thing in my life. It would burn my face, and I went from 190 pounds to 113 pounds in eight weeks. “But I beat the cancer.”

His fight was far from over. The tumor decayed much of the lower half of Von Behrens face. By the time he was 19, he had to have all of his teeth removed. “Those were the best years of my life, right? No. People didn’t talk to me anymore.” For four years, he fought to save his mandible, the lower jawbone, but eventually, had to undergo surgery to have three inches of it removed. “I almost died from the infection,” he said.

In January of this year, he lost his entire mandible, but doctors removed a bone from his left leg to replace it with. They also grafted some skin from his right leg to help with his facial features. “I want to be pretty again, but I just had to have that dip,” Von Behrens said. Von Behrens, who was homecoming king at his high school and a star baseball player, said it’s difficult to go out in public when people are constantly pointing at him. “God made us all different for a reason. So what if that girl likes pink hair, or that guy wears green shoes. Who are you to tell them to stop?”

He said, “I made this mistake, and it taught me a valuable lesson. I know now to make the right choices. I wish I would have back then.” Von Behrens said he still has no feeling from the top of his mouth down. He underwent five surgeries this past year and has had more than 30 surgeries since he was diagnosed with oral cancer.

Although he hasn’t finished college, he spends his time traveling around the U.S. talking to professional athletes and schoolchildren. He has also appeared on MTV to share his story. “I think one of the proudest moments of my life was when a baseball player with the Arizona Diamondbacks quit dipping because of me,” he said.

He started dipping because he thought it would make him seem cooler to his friends, but pointing to himself on stage at PikeView on Tuesday, he said, “How cool does this look?”

December, 2003|Archive|

268,000 new oral cancer cases yearly

  • 11/27/2003
  • Malaysia

Oral cancer accounts for the 11th commonest form of cancer, with oral leukoplakia, as an instance, showing a prevalence (from epidemiological studies) ranging from 0.96 to 16.9 per cent for Malaysia and 0.2 to 11.7 per cent for other countries.

Annually, 268,000 new cases are diagnosed, and 128,000 deaths reported. The overall survival rate for oral cancer is less than 50 per cent over a five-year period. It has not improved in the last 30 years. The reason for this is that the disease is diagnosed only in its late stages and for the regional metastasis.

For the benefit of dental surgeons practicing in Sabah, a symposium on “Oral Cancer, What the GP can do”, organized by the Malaysian Dental Association (MDA) with the cooperation of the Dental Division of the Sabah Health Services Department, will be held on Dec 15.

“Dental surgeons, especially those in the private sector, should therefore participate in this rare opportunity,” said Dr Zaiton Hj Tahir, who is the State Coordinator for the Implementation of the National Program for Primary Prevention and Early Detection of Oral Pre-cancer and Cancer.

There will also be a hands-on course, “An Innovative Procedure in Fixing Loose Lower Complete Dentures and Long Term Mini Implants”, she added.

According to her, the MDA would be presenting three guest speakers, Dr Rosnah Zain, Dr M. Thomas Abraham and Dr Philip CS Ting.

Dr Rosnah, currently a professor and head at the Department of Oral Medicine and Periodontology, University Malaya, is also the president-elect of the Malaysian Section of the International Association of Dental Research – Southeast Asian Division. Her works involving major research in oral cancer and potentially malignant lesions – aspects on prognostic indicators and training of dentists for oral cancer screening, have been widely published in local and international journals.

Her talk would centre on “Diagnosis and Management of Leukoplakia and Lichen Planus in the Oral Cavity”. Besides oral leukoplakia, epidemiological studies have also shown a prevalence of oral lichen planus (OLP), ranging from 0.38 to 5.4 per cent for Malaysia and 0.1 to 2.3 per cent for other countries.

Management of these two lesions differs and the importance of differentiating between OLP, especially the plaque type from leukoplakia, will be highlighted in relation to the management strategies for these patients.

“The final objective of this presentation is to get general dental practitioners to know how to clinically diagnose and treat these lesions while also recognizing which type and/or at what stage a referral of such patients to specialists will be required,” said Dr Zaiton.

Dr M. Thomas, attached to Tengku Ampuan Rahimah Hospital, Klang, worked in India and United Kingdom from 1991 – 2000 before returning to Malaysia and joining the Ministry of Health at Selayang Hospital. He is currently Publications Secretary for the Malaysian Dental Journal and is also Commission Chairman, Oral Disease Asia Pacific Dental Federation.

OCF Note: Besides this news article offering an estimate of the oral cancer cases yearly worldwide (which is a low estimate by some other publications), we have included it here to show that whether in the US or Malaysia, the task to bring the death rate down from oral cancer is still the same. Public and professional awareness, and the help of the dental community to find those early lesions by doing opportunistic screening of the mouths that are in their offices every day.

November, 2003|Archive|

From oil prospecting to cancer detection

  • 11/6/2003
  • Scotland
  • Control & Instrumentation

Finding oil and gas reservoirs has just become a matter of following your nose – or rather a super-sensitive electronic nose developed by researchers in Scotland. The device, which measures tiny quantities of the gas ethane, can also be used as a breathalyzer to sniff out lung cancer in its early stages.
Prospecting for oil and gas is usually an expensive and laborious process, involving bouncing sound waves through rock layers to see if they might be capable of trapping hydrocarbons. Results can take 6-12 months to interpret, and even then there is no guarantee that the rocks do contain oil – just that they have the potential to do so. Drilling new sites is therefore an expensive gamble for oil companies.

But oil and gas reservoirs naturally leak tiny traces of hydrocarbons such as ethane into the atmosphere. Dr. Bill Hirst and colleagues at Shell Global Solutions realized that detecting and tracking down the sources of these faint whiffs of underground gas could help improve the success rate of prospectors. To improve their first ‘Light Touch’ prototype sensor Shell contacted Professor Miles Padgett and his colleagues in the Optics Group at the University of Glasgow. The Glasgow team developed a sensor system that fits into a Landcruiser and can sniff out ethane in the air at less than one part per billion. The ethane sensor continuously sucks air into a chamber where the gas is measured using an infrared laser. By measuring the amount of laser light absorbed at a certain wavelength, the instrument can measure how much ethane is in the chamber. To prospect for oil and gas, measurements of ethane and wind direction are combined to locate the likely sources of the gas detected using software also developed by the Glasgow group.

The new survey technique is much quicker and cheaper to use than traditional techniques and reveals whether oil and gas are actually present. The system can be used to screen an area before deciding whether to use other survey techniques, or to rank previously surveyed areas to predict which are most likely to contain oil and gas. Drilling is now underway in Oman at the first of several sites pinpointed by the technique and other locations will be drilled later this year.

But it is not only oil fields that breathe tiny quantities of ethane into the air – people can do so too as an indirect result of cancer. Part of the body’s response to cancerous cells produces elevated levels of free radicals – highly reactive chemicals that break down cell membranes into hydrocarbons including ethane. Dr. Chris Longbottom of the University of Dundee recognized that the Glasgow technology was well placed to detect these gases in a patient’s breath where medical research has shown that they can provide clues as to what is going on inside the body. The ethane sensor is now being put to the test to detect early stages of disease including lung cancer in clinical trials at Ninewells Hospital in Dundee. Lung cancer often spreads before significant symptoms appear and there are no alternative techniques for early detection of the disease.

November, 2003|Archive|

Vocal support for cancer patients

  • 11/5/2003
  • UK and the Netherlands
  • University of Wales College of Medicine

A prosthesis that will dramatically improve the quality of life for throat cancer patients, making it easier for them to speak after undergoing radical surgery, has been developed by researchers in the UK and the Netherlands.
The Newvoice valve – created by researchers at the University of Wales College of Medicine, UK medical polymer specialists Principality Medical and the University of Groningen in the Netherlands – consists of a sound-producing cylinder integrated into a one-way valve made from bacteria-resistant silicone rubber.

Worldwide around 30,000 throat cancer patients each year must undergo a laryngectomy to save their lives. The procedure involves removing the larynx, vocal cords and epiglottis, then connecting the windpipe to the outside of the neck where it is sewn into the skin to leave a hole through which patients breathe. The voice is restored using a one-way valve that prevents food and drink entering the trachea. To speak, patients must close the hole in their throat with a finger, forcing air through the valve and into the esophagus where the tissues vibrate to produce sound.
Over a relatively short time these valves tend to malfunction due to a build-up of bacterial and fungal contamination from food and drink. The device may need replacing as often as every four months, requiring another operation each time. As the silicone rubber used to make the Newvoice valve is already resistant to bacteria and fungus it does not need to be coated, reducing manufacturing costs.

The valve can produce sound without the need for the throat to be covered with the hand and patients will also benefit from a more lifelike voice, as the system uses artificial rubber vocal chords to produce natural inflections and improved tonal variation. ‘This prosthesis should last years rather than months,’ said Dr. Mark Waters of the University of Wales College of Medicine’s Dental School, where the novel material was designed.

November, 2003|Archive|

MIT to develop non-invasive cancer detection tools

  • 11/4/2003
  • Boston

The George R. Harrison Spectroscopy Laboratory in the School of Science at MIT has been awarded a Bioengineering Research Partnership grant to develop and implement spectroscopic techniques for imaging and diagnosing dysplasia -the precursor to cancer – in the uterine cervix and the oral cavity.
Cervical and oral cancer account for approximately 11,000 deaths in the United States each year. Detection of the precancerous state of human tissue is crucial for ease of treatment and greatly improved survival, but it is often invisible and difficult to diagnose. The new techniques are said to provide a method for visualization and accurate diagnosis based on spectroscopic detection and imaging.

Clinical screening for cervical and oral precancer are multibillion-dollar industries which currently rely on visual detection of suspicious areas followed by invasive biopsy and microscopic examination. Given that visually identified suspicious areas do not always correspond to clinically significant lesions; spectroscopic imaging and diagnosis could prevent unnecessary invasive biopsies and potential delays in diagnosis.
Michael S. Feld, professor of physics and director of the Spectroscopy Lab, says the laboratory has developed a portable instrument that delivers weak pulses of laser light and ordinary white light from a thin optical fiber probe onto the patient’s tissue through an endoscope. This device analyses tissue over a region around 1 millimeter in diameter and has shown promising results in clinical studies. It accurately identified invisible precancerous changes in the colon, bladder and esophagus, as well as the cervix and oral cavity. The second device, which has not yet been tested on patients, can image precancerous features over areas of tissue up to a few centimeters in diameter.

Feld predicted that in a couple of years, these devices will lead to a new class of endoscopes and other diagnostic instruments that will allow physicians to obtain high-resolution images. These easy-to-read images will map out normal, precancerous and cancerous tissue the way a contour map highlights elevations in different colors. The optical fiber probe instrument employs a method called trimodal spectroscopy, in which three diagnostic techniques – light-scattering spectroscopy (LSS), diffuse reflectance spectroscopy (DRS) and intrinsic fluorescence spectroscopy (IFS) – are combined.
IFS provides chemical information about the tissue, LSS provides information about the cell nuclei near the tissue surface and DRS provides structural information about the underlying tissue. The information provided by the three techniques is complementary and leads to a combined diagnosis, though the imaging technique is based on LSS alone.
The LSS optical technique has long been used to study the size and shape of small spheres such as water droplets. For cancer detection, the method is applied to the cell’s spheroid nucleus. Physics theory predicts that scattered light undergoes small but significant color variations when bouncing back from spheres of a certain size and refractive index.
Light is delivered through the probe onto the patient’s tissue. The probe collects the light that bounces back and analyses its colors. The color content is then used to extract diagnostic information.
‘By analyzing the intensity variations in this back-scattered component from color to color, the nuclear size and density can be mapped,’ Feld said. Closely packed cells with larger-than-normal nuclei packed tightly with genetic material are markers of precancerous change.

‘The images created with this new technique are different from ordinary microscopic images in that they provide hard and fast information about cellular features,’ he said. ‘We believe this is an important step that will lead to new optical tools for both [making] early cancer diagnoses and developing a better understanding of how changes in the genetic material inside the cell’s nucleus make the tissue more vulnerable to cancer.

November, 2003|Archive|