Monthly Archives: June 2004

Cancer survival up … by a little

  • 6/5/2004
  • The NCI, ACS, and CDC

More Americans are surviving cancer for five years or more and deaths from cancer overall are steadily declining, according to the latest annual report on cancer published Thursday in the journal Cancer. For the first time, fewer women are being diagnosed with lung cancer, the joint report from the American Cancer Society, Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries finds.

Not everyone is reaping the gains: Minorities still are more likely than whites to die from cancer, says the report. Cancer remains the second leading cause of death in the United States behind heart disease. This year 1.368 million Americans will learn they have cancer and 563,700 will die of it.

The “Annual Report to the Nation on the Status of Cancer, 1975-2001” finds that cancer rates dropped 0.5 percent per year from 1991 to 2001, while death rates from all cancers combined dropped 1.1 percent per year from 1993 to 2001.This is due to better prevention, screening that catches cancer early enough to treat it and better therapies.

Most striking in this latest tally is what’s happening with the No. 1 cancer killer: Rates of female lung cancer diagnoses have declined about 2 percent a year since 1998, years after men began a similar improvement. Smoking became common among men long before women, and the resulting lung cancer consequently struck men sooner. Lung cancer remains the nation’s top-killing malignancy for both sexes, and the second most common cancer. But it slowly declined among men starting in the early 1990s as older smokers died and fewer young men took up the habit — a pattern doctors expect to eventually see in women.

The report says female death rates from lung cancer have leveled off, remaining virtually unchanged since 1995, the report says. “The first-ever drop in lung cancer incidence rates in women is remarkable proof that we are making a difference in the number one cancer killer, and is powerful evidence that our successful efforts must continue,” said John Seffrin, chief executive officer of the American Cancer Society. Nonetheless about 174,000 Americans will be diagnosed with lung cancer this year and 160,000 will die of it. The report builds on one issued by the American Cancer Society alone in January, which also showed overall cancer diagnosis and death rates dropping across the United States.

The report’s other new finding: More people are living at least five years after a diagnosis of most types of cancer. Five-year survival is a major milestone for cancer patients, and the scientists found significant gains over the past two decades in how often that milestone was met. The joint report compares five-year survival rates of cancer patients diagnosed between 1975 and 1979 to those diagnosed between 1995 and 2000. For men, survival rates improved the most — more than 10 percent — for cancers of the prostate, colon and kidney, and for melanoma and leukemia.

What does that mean? Today, 99.3 percent of men diagnosed with prostate cancer will live five years, up from 70 percent in the 1970s. Five-year survival for breast cancer is 88 percent, up from 75 percent in the 1970s. But that survival is strongly connected to how early cancer is caught, stressed co-author Brenda Edwards of the NCI’s cancer-control division. The report found that patients with the most deadly forms such as lung, pancreatic or liver cancers were only a little more likely to survive.

When looking at all cancers combined, black men are 26 percent more likely to die of a malignancy than white men, and Hispanic men are 16 percent more likely than non-Hispanic whites, said the cancer society’s Jemal. Black women are 52 percent more likely to die of cancer than white women, and Hispanic women 20 percent more likely, he said.

Much of the disparity reflects minorities’ poorer access to cancer prevention and early detection services, Jemal said. But notable differences remain even when scientists examine people diagnosed at the same stage of cancer, said NCI’s Edwards. Black women were more likely to die of breast cancer, even though that disease is more common among whites.

June, 2004|Archive|

Pipe Smoking Confers Similar Risk to Cigar Smoking

  • 6/2/2004
  • Laurie Barclay, MD
  • Journal of the National Cancer Institute

Exclusive pipe smoking confers a risk of tobacco-associated disease similar to that of cigar smoking but less than that of cigarette smoking, according to the results of a prospective cohort trial published in the June 2 issue of the Journal of the National Cancer Institute.

Although many studies have examined the adverse health effects of pipe smoking combined with other forms of tobcco use, few have included large numbers of exclusive pipe smokers,” write S. Jane Henley, from the American Cancer Society in Atlanta, Georgia, and colleagues. “The prevalence of pipe smoking has declined since the 1960s, yet usage is still common regionally, especially among older populations.”
Previous studies of exclusive pipe smoking were small and could not exclude potential confounding factors, such as socioeconomic status and alcohol use. Pipe tobacco is the least commonly used tobacco product in the U.S., with overall use decreasing from 14% in 1965 to 2% in 1991. However, pipe smoking remains common among the American Indians and some other populations, and it has been increasing among American middle and high school students since 1999.

Of 138,307 men enrolled in the Cancer Prevention Study II, 15,263 men were current or former pipe users, and 123,044 men had never used tobacco. During the 18-year follow-up, there were 23,589 deaths. Based on this mortality data, the investigators compared the risks of death from nine cancers (bladder, colon/rectum, esophagus, kidney, larynx, lung, oropharynx, pancreas, and stomach) and three other diseases (coronary heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease) in exclusive pipe smokers with mortality risks in nonsmokers.

Compared with never use of tobacco, current pipe smoking was associated with an increased risk of death from cancers of the lung (relative risk [RR], 5.00; 95% confidence interval [CI], 4.16 – 6.01), oropharynx (RR, 3.90; 95% CI, 2.15 – 7.08), esophagus (RR, 2.44; 95% CI, 1.51 – 3.95), colorectum (RR, 1.41; 95% CI, 1.15 – 1.73), pancreas (RR, 1.61; 95% CI, 1.24 – 2.09), and larynx (RR, 13.1; 95% CI, 5.2 – 33.1), and from coronary heart disease (RR, 1.30; 95% CI, 1.18 – 1.43), cerebrovascular disease (RR, 1.27; 95% CI, 1.09 – 1.48), and chronic obstructive pulmonary disease (RR, 2.98; 95% CI, 2.17 – 4.11).

Risks associated with pipe smoking were smaller than those associated with cigarette smoking but similar to those associated with cigar smoking.
Factors associated with increased relative risk of lung cancer were number of pipes smoked per day, years of smoking, and depth of inhalation, whereas increased number of years since quitting was associated with decreased risk.
A study limitation was that smoking habits were reported only at baseline.
“All tobacco products cause excessive morbidity and mortality,” the authors write. “Comprehensively documenting the deleterious health effects of pipe smoking is important in countering efforts by the tobacco industry to promote pipes as a desirable alternative to cigarettes or cigars.”

Source: J Natl Cancer Inst. 2004;96:853-861

June, 2004|Archive|

ADA to Establish New Reimbursement Code for Oral Cancer Screening; Applicable to Zila’s ViziLite and Potentially to OraTest

  • 6/2/2004
  • Phoenix, AZ

Zila, Inc. (Nasdaq:ZILA) announced today that the Code Revision Committee of the American Dental Association (ADA) has approved a new dental reimbursement code for oral cancer screening products. Zila’s ViziLite(R) product provided the pathway for the new code, and Zila anticipates that OraTest(R) will also satisfy the code requirements once its FDA clearance is obtained.

Zila said it recently received notice that the Committee approved a code for an “adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including pre-malignant and malignant lesions, not to include cytology or biopsy.”

Douglas D. Burkett, Ph.D., Chairman, CEO and President of Zila, Inc., said, “The ADA Committee’s action is further evidence that the dental profession recognizes the importance of early detection in the prevention and treatment of oral cancer.” Dr. Burkett continued, “There has never been such a reimbursement code available to dentists, because there has never been an FDA approved product for oral pre-cancer and early cancer identification — until ViziLite. ViziLite’s recent clinical efficacy data was cited as a factor in the Committee’s decision. We are unaware of any available products, other than ViziLite, that will be covered under this new code. We expect that the code will encourage the use of ViziLite, and we anticipate that this reimbursement code will be available for OraTest when its regulatory approval is achieved.”

Zila envisions ViziLite and OraTest to be synergistic products that provide a means for all adults to benefit from improved identification of oral pre-cancers and early cancers, and possibly prevent the disease through early intervention. ViziLite is currently being sold to dental offices nationally and OraTest is in phase III clinical trials as part of the FDA approval process.

The ADA-administered Code on Dental Procedures and Nomenclature supports accurate recording and reporting of dental treatments. The codes can be used to report dental procedures provided under public and private dental insurance benefit plans. Obtaining insurance reimbursement from specific carriers is a separate process. Zila is now engaged in this process for the ViziLite product.

The Code Revision Committee is balanced to include representatives from the dental profession and third-party payers. It receives regular requests for code revisions, reflecting the dynamic changes in dentistry. Each request receives structured and rigorous evaluation before it can become part of the code, which is the national standard for reporting dental procedures electronically under the Health Insurance Portability and Accountability Act of 1996. The new code will be published in the next version of the Code on Dental Procedures and Nomenclature (the Code) and will be effective on January 1, 2005.

June, 2004|Archive|

Study: Virus May Predict Cancer’s Spread

  • 6/11/2004
  • The Associated Press

High concentrations of the virus that causes mononucleosis can help doctors predict the spread of a type of cancer that develops behind the nose, a study found.

Epstein-Barr virus levels in the blood may also help predict the course of Hodgkin’s disease and some other cancers of the immune system, said lead researcher Jin-Ching Lin of Taiwan. Researchers do not know exactly how the virus is connected to those cancers, but a link has been found in the past.

The study is too small to draw any final conclusions, said Dr. Ralph Vance, national volunteer president of the American Cancer Society. “It will be interesting to see if it can be duplicated by others,” said Vance, a professor in the University of Mississippi School of Medicine’s department of oncology.

Epstein-Barr is one of the most common human viruses – as many as 95 percent of U.S. residents have been infected by age 40. Most have no symptoms, though up to half of those infected as adolescents and young adults develop mono, according to the National Institutes of Health. After infection, the virus can lurk in a few cells, occasionally becoming active again.

Lin, of the department of radiation oncology at Taichung Veterans General Hospital, studied a cancer that is rare in the United States but common in southeastern China – cancer of the nasopharynx, an area above the soft palate. All 99 patients in the study in Thursday’s New England Journal of Medicine got chemotherapy followed by radiation. Researchers looked for fragments of DNA from the Epstein-Barr virus in patients’ blood, before and after treatment. The 18 who had relapses within two years all started with more than 1,500 fragments per milliliter. The 81 others all started with fewer. After treatment, the virus could be found in only 10 patients’ blood; within two years, the cancer had spread in seven of them.

Epstein-Barr has also been associated with Burkitts lymphoma and T-cell lymphomas, as well as breast and stomach cancer.

June, 2004|Archive|

Marijuana and oral cancers – two different perspectives

  • 6/1/2004
  • Newport Beach, CA
  • The Oral Cancer Foundation

It would seem that the debate on this issue is yet to be resolved. Two studies published at the same time in respected peer reviewed journals come to different conclusions. The studies appear below.

Marijuana Use and Risk of Oral Squamous Cell Carcinoma.

Rosenblatt KA, Daling JR, Chen C, Sherman KJ, Schwartz SM.

Department of Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois.

Previous laboratory investigations, case reports, and a hospital-based case-control study have suggested that marijuana use may be a risk factor for squamous cell head and neck cancer. We conducted a population-based case-control study to determine whether marijuana use is associated with the development of oral squamous cell carcinoma (OSCC). Case subjects (n = 407) were 18-65-year-old residents of three counties in western Washington State who were newly diagnosed with OSCC from 1985 through 1995. Control subjects (n = 615), who were similar to the cases with respect to age and sex, were selected from the general population using random-digit telephone dialing. Lifetime histories of marijuana use and exposure to known OSCC risk factors were ascertained using a structured questionnaire. Information on genetic polymorphisms in glutathione S-transferase enzymes was obtained from assays on participant DNA. Odds ratios for associations with features of marijuana use were adjusted for sex, education, birth year, alcohol consumption, and cigarette smoking. A similar proportion of case subjects (25.6%) and control subjects (24.4%) reported ever use of marijuana (adjusted odds ratio, 0.9; 95% confidence interval, 0.6-1.3). There were no trends in risk observed with increasing duration or average frequency of use or time since first or last use. No subgroup defined by known or suspected OSCC risk factors (age, cigarette smoking, alcohol consumption, and genetic polymorphisms) showed an increased risk. Marijuana use was not associated with OSCC risk in this large, population-based study.

Marijuana use and increased risk of squamous cell carcinoma of the head and neck.

Zhang ZF, Morgenstern H, Spitz MR, Tashkin DP, Yu GP, Marshall JR, Hsu TC, Schantz SP.

Department of Epidemiology, University of California at Los Angeles School of Public Health, and Jonsson Comprehensive Cancer Center

Marijuana is the most commonly used illegal drug in the United States. In some subcultures, it is widely perceived to be harmless. Although the carcinogenic properties of marijuana smoke are similar to those of tobacco, no epidemiological studies of the relationship between marijuana use and head and neck cancer have been published. The relationship between marijuana use and head and neck cancer was investigated by a case-control study of 173 previously untreated cases with pathologically confirmed diagnoses of squamous cell carcinoma of the head and neck and 176 cancer-free controls at Memorial Sloan-Kettering Cancer Center between 1992 and 1994. Epidemiological data was collected by using a structured questionnaire, which included history of tobacco smoking, alcohol use, and marijuana use. The associations between marijuana use and head and neck cancer were analyzed by Mantel-Haenszel methods and logistic regression models. Controlling for age, sex, race, education, alcohol consumption, pack-years of cigarette smoking, and passive smoking, the risk of squamous cell carcinoma of the head and neck was increased with marijuana use [odds ratio (OR) comparing ever with never users, 2.6; 95% confidence interval (CI), 1.1-6.6]. Dose-response relationships were observed for frequency of marijuana use/day (P for trend <0.05) and years of marijuana use (P for trend <0.05). These associations were stronger for subjects who were 55 years of age and younger (OR, 3.1; 95% CI, 1.0-9.7). Possible interaction effects of marijuana use were observed with cigarette smoking, mutagen sensitivity, and to a lesser extent, alcohol use. Our results suggest that marijuana use may increase the risk of head and neck cancer with a strong dose-response pattern. Our analysis indicated that marijuana use may interact with mutagen sensitivity and other risk factors to increase the risk of head and neck cancer. The results need to be interpreted with some caution in drawing causal inferences because of certain methodological limitations, especially with regard to interactions.

June, 2004|Archive|

Cigarette smoke transforms healthy saliva into a deadly cocktail that can accelerate mouth cancer

  • 6/1/2004
  • London, UK
  • Medical News Today

Cigarette smoke transforms healthy saliva into a deadly cocktail that can accelerate mouth cancer, according to new research in the British Journal of Cancer. Normally, saliva provides a protective buffer between toxins and the lining of the mouth because it contains important enzymes that fight and neutralize harmful substances. But the new research shows that the chemicals in tobacco smoke combine with saliva with devastating effect. They destroy the protective components of saliva – leaving a corrosive mix that damages cells in the mouth and can eventually turn them cancerous.

The researchers in this study wanted to examine saliva’s role in the development of mouth cancer. The study recreated the effects of cigarette smoke on cancerous cells of the mouth. Half of the cell samples were exposed to cigarette smoke and the other half to the saliva and cigarette smoke mixture. Cancerous cells were used in order to quickly assess whether the saliva and smoke mixture would speed the cancer’s development.

The study revealed that the longer the mouth cells were exposed to the contaminated saliva, the more the cells were damaged. Dr Rafi Nagler, based at the Technion-Israel Institute of Technology, who co-led the study, says: “Most people will find it very shocking that the mixture of saliva and smoke is actually more lethal to cells in the mouth than cigarette smoke alone. “Our study shows that once exposed to cigarette smoke, our normally healthy saliva not only loses its beneficial qualities but it turns traitor and actually aids in destroying the cells of the mouth and oral cavity. Cigarette smoke is not only damaging on its own, it can turn the body against itself.”

Saliva contains anti-oxidants. These are molecules that can help protect the body against cancer. The researchers found that the cigarette smoke destroyed them and turned saliva into a dangerous cocktail of chemicals that could accelerate the development of mouth cancer. Jean King, Director of Tobacco Control for Cancer Research UK, which owns the British Journal of Cancer, says: “It is World No Tobacco Day this week and once more we see the dreadful impact smoking can have on health. This insight into how mouth cancer can develop offers more reasons for smokers to try and quit. People know of the link with lung cancer, and this research adds compelling evidence about the damage smoking can do to the mouth.”

June, 2004|Archive|