7/12/2005 Bethesda, MD Daniel M. Cook et al. Health Affairs, Vol 24, Issue 4, 994-1004 A new medical diagnostic code for secondhand smoke exposure became available in 1994, but as of 2004 it remained an invalid entry on a common medical form. Soon after the code appeared, Philip Morris hired a Washington consultant to influence the governmental process for creating and using medical codes. Tobacco industry documents reveal that Philip Morris budgeted more than $2 million for this "ICD-9 Project." Tactics to prevent adoption of the new code included third-party lobbying, Paperwork Reduction Act challenges, and backing an alternative coding arrangement. Philip Morris’s reaction reveals the importance of policy decisions related to data collection and paperwork. Authors: Daniel M. Cook, Elisa K. Tong, Stanton A. Glantz and Lisa A. Bero

7/12/2005 Christoph Matthias, Ulrich Harreus, and Richard Strange Eur Arch Otorhinolaryngol, July 8, 2005 Alcohol consumption and cigarette smoking play a key role in the development and progression of head and neck cancer. Additionally, epidemiologic studies have given evidence that other environmental and genetic factors are relevant. We present a prospective study including 465 head and neck cancer patients. All patients were recruited between 1994 and 1998 during the initial tumor diagnosis. Three hundred twelve patients could be followed over 5 years after histologically proven curative surgical treatment. All clinical data were recorded (i.e., age, gender, TNM stage, histological grading, smoking and drinking habits) and genetic variations at loci encoding detoxifying enzymes (glutathione S-transferase and cytochrome P450); immune modulating cytokines (tumor necrosis factor) and cell cycle regulating proteins (cyclin D1) were determined. Parameters with an impact on recurrence-free survival were analyzed. A strong influence could be attributed to the tumor size at the time of presentation. Additionally, the grading of the tumor showed a strong influence (5 years recurrence free: G1: 87% and G1: 61%). Furthermore, it could be shown that the recurrence-free survival was significantly influenced by cyclin D1 genotypes ( CCND1GG: P =0.01; HR=3.72) and TNF microsatellite haplotypes ( TNFB1D5: P =0.043; HR=2.05). These findings are compatible with the view that genetic predisposition is important in determining recurrence-free survival after surgical treatment of head and neck cancer. Author's affiliation: Department of Otorhinolaryngology, Ludwig Maximilian University, Marchioninistr. 15, 83177, Munich, Germany

7/12/2005 Oak Brooks, IL Melanie B. Fukui, MD et al. RadioGraphics 2005;25:913-930 Part 2: Diagnostic Uses and Pitfalls of Oncologic Imaging Positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) is effective for monitoring head and neck cancer. However, lack of anatomic landmarks, variable physiologic FDG uptake, and asymmetric FDG distribution in the neck can confound image interpretation. This is particularly true in the treated neck, where distortion of normal tissue planes makes detection of early disease recurrence difficult with conventional computed tomography (CT) and magnetic resonance imaging. Combined PET-CT helps prevent the misinterpretation of FDG PET findings in patients with head and neck cancer. Superior localization of FDG uptake with this technique can improve diagnostic accuracy and help avoid interpretative pitfalls. In the future, development of tumor-specific ligands will enhance the usefulness of PET-CT in the detection of initial tumors and tumor recurrence, in the evaluation of tumors with low FDG avidity, and in treatment targeting. Furthermore, improved scanner resolution will help address the limitations of PET-CT with respect to small lesions and may make this modality more valuable in initial tumor staging. Authors: Melanie B. Fukui, MD, Todd M. Blodgett, MD, Carl H. Snyderman, MD, Jonas J. Johnson, MD, Eugene N. Myers, MD, Dave W. Townsend, PhD and Carolyn C. Meltzer, MD Authors' affiliation: From the Department of Radiology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212 (M.B.F.) and the Departments of Radiology (T.M.B., D.W.T., C.C.M.), Otolaryngology (C.H.S., J.J.J., E.N.M.), Psychiatry (C.C.M.), and Neurology (C.C.M.), University of [...]

7/8/2005 Oxford, England Debbie M. Tromp et al Family Practice, doi:10.1093/fampra/cmi058 Background: Head and neck cancer patients are often diagnosed with advanced stage disease, while the location is easily accessible for examination or distinct symptoms are present. Professional delay in primary care affects tumour stage and survival. There has been little research on the role of the patient in delaying referral or diagnosis once the patient has visited a primary health care professional. Objectives: Our aim was to identify patient-related factors which are associated with delay in primary care and the referral to hospital. Methods: Case-series analysis using semi-structured interviews combined with questionnaires was conducted among 306 consecutive patients newly diagnosed in a tertiary referral centre for head and neck oncology patients in The Netherlands. The main outcome measure was delay in returning to the GP or dentist after the first consultation. Logistic regression analyses were performed to test which patient-related variables made delay more likely. Results: 155 patients (53%) were not referred or followed up after the first medical contact with the GP or dentist. Fifty per cent (n = 78) of them delayed returning to the health professional for more than three weeks. Patients were more likely to delay when they experienced voice change, were not familiar with head and neck cancer, were not suspicious of cancer or were generally not inclined to seek support. Conclusions: Delay in returning to the health professional is partly dependent on patient-related factors. Therefore, patients should be educated about the possible meaning [...]

7/7/2005 Baltimore, MD press release Johns Hopkins Kimmel Cancer Center JOHNS HOPKINS SCIENTISTS UNCOVER CLUES TO “DISAPPEARING” PRECANCERS May provide better targets for cervical cancer vaccine development New research sheds light on why cervical precancers disappear in some women and not in others. Scientists at the Johns Hopkins Kimmel Cancer Center report July 1 issue of Clinical Cancer Reseach that the reason many of these lesions persist is an unlikely mix of human papilloma virus (HPV) strain and a woman’s individual immune system. For decades, scientists have known that HPV causes nearly all cases of cancer in the neck of the womb. Most sexually active women – some reports say up to 80 percent – are exposed to HPV and more than half of these women are infected with strains of the virus that could likely turn a precancerous lesion to cancer. But only a small percentage of precancers progress to full-blown cancer, a process that takes years. To find out why, gynecologic oncologist Cornelia Trimble, M.D., closely monitored 100 women with high-grade, precancerous cervical lesions before standard surgery to remove the abnormal tissue. Some of the lesions – about 28 percent -- regressed by themselves before surgery within a time period considered within the bounds of care standards. But among patients whose pre-cancers lingered, Trimble discovered that women were three times less likely to resolve their lesions if they carried a certain immune system gene and did not have HPV16, the most common strain of the virus. Trimble was [...]

7/7/2005 Boston, MA press release The Forsyth Institute Scientists at the Forsyth Institute have found that three bacterial species are associated with the most common form of oral cancer - a discovery the researchers hope will lead to a simple diagnostic test for the often-fatal disease. The findings also open the question of whether bacteria might, in some way, play a causal role. The current discovery, reported in the July 7 Journal of Translational Medicine, suggests that elevated levels of three particular bacteria in saliva indicate the presence of oral squamous cell carcinoma (OSCC)˜one of the deadliest of cancers because it often goes undetected in its early stages. "Finding bacteria associated with OSCC encourages us to hope that we have discovered an early diagnostic marker for the disease," said Donna Mager, DDS, PhD., Assistant Member of the Staff in the Department of Periodontology and Molecular Genetics and the principal investigator. "If future studies bear this out, it may be possible to save lives by conducting large-scale screenings using saliva samples." The Forsyth scientists posit that oral cancer may change the oral ecology, thus allowing certain bacteria to colonize more rapidly than others. However, according to J. Max Goodson, DDS, PhD., Director of Clinical Research at Forsyth and a co-author of the study, "We cannot rule out the possibly that the bacteria themselves may be causally involved in the development of the disease." (Other bacteria, such as H. pylori, for example, have been implicated in augmenting the development of certain cancers). [...]

7/6/2005 Minneapolis, MN Jerret Raffety Minneapolis Daily (mndaily.com) Victims of disfiguring oral and facial injuries and medical conditions are finding some relief in Moos Tower, thanks to work being done in the University’s Maxillofacial Prosthodontics Clinic. Dr. Beth Brosky, a professor at the University’s School of Dentistry, said her work, maxillofacial prosthodontics, helps restore the quality of life for numerous victims of disfiguring conditions by reproducing damaged and missing parts of the interior and exterior of the mouth and face. Parts of the face commonly replaced by a maxillofacial prosthodontist can include eyes, ears, noses, teeth and parts of the jaw. Brosky said she sees approximately 50 to 70 patients every year. The most common causes of disfigurement are cleft palate, head and neck cancer, birth defects, and traumas such as self-inflicted injuries and automobile accidents, she said. Her patients typically come from all around Minnesota and the upper Midwest, but she said she has helped people from as far away as India. Brosky said victims of oral and facial disfigurement often become recluses, deteriorating their quality of life. “Sometimes family members won’t come to visit (patients) because they’re so grossly disfigured. Health-care workers have said they’re afraid to go into patients’ rooms,” Brosky said. “The prosthesis allows patients more interaction — they get people out of the house to get them to socialize more.” Dr. Patrick Lloyd, dean of the School of Dentistry, said maxillofacial prosthodontics are also used for creating devices that make swallowing, breathing and speaking easier [...]

7/6/2005 Taiwan Shu-Hang Ng, MD et al. Journal of Nuclear Medicine Vol. 46 No. 7 1136-1143 Accurate evaluation of primary tumors and cervical lymph node status of squamous cell carcinoma (SCC) of the oral cavity is important to treatment planning and prognosis prediction. In this prospective study, we evaluated the use of 18F-FDG PET, CT/MRI, and their visual correlation for the identification of primary tumors and cervical nodal metastases of SCC of the oral cavity with histologic correlation. Methods: One hundred twenty-four patients with pathologically proven diagnoses of oral cavity SCC underwent 18F-FDG PET and CT/MRI within 2 wk before surgery. We interpreted 18F-FDG PET, CT/MRI, and visually correlated 18F-FDG PET and CT/MRI separately to assess the primary tumors and their regional lymph node status. We recorded lymph node metastases according to the neck level system of imaging-based nodal classification. Histopathologic analysis was used as the gold standard for assessment of the primary tumors and lymph node involvement. We analyzed differences in sensitivity and specificity among the imaging modalities using the McNemar test. The receiver-operating-characteristic (ROC) curve and calculation of the area under the curve were used to evaluate their discriminative power. Results: The accuracy of 18F-FDG PET, CT/MRI, and their visual correlation for the identification of primary tumors was 98.4%, 87.1%, and 99.2%, respectively. The sensitivity of 18F-FDG PET for the identification of nodal metastases on a level-by-level basis was 22.1% higher than that of CT/MRI (74.7% vs. 52.6%, P < 0.001), whereas the specificity of 18F-FDG PET was [...]

7/4/2005 Rochester, NY Medical News Editor Medical News Today (www.medicalnewstoday.com) The European Patent Office has awarded the patent for a technology that is proving to be key to efforts to protect women against cervical cancer to a team of scientists at the University of Rochester Medical Center. The office has awarded a patent to the University for the work performed by a trio of virologists - Robert Rose, Ph.D., William Bonnez, M.D., and Richard Reichman, M.D. - for creating a way to protect the body against human papillomaviruses (HPV), which cause cervical cancer in women. The University's technology is a key element of two vaccines that are now in the final stages of testing in people. Earlier this year the two companies developing vaccines, Merck and Co. and GlaxoSmithKline (GSK), along with the University and several other parties agreed on a settlement involving patents and royalties related to the vaccines, clearing the way for continued development of their products. Both vaccines, which are given as a series of three shots, are being studied in tens of thousands of women. While there are more than 100 types of HPV, and more than three dozen cause sexually transmitted diseases, a handful can lead to cervical cancer, which kills more than 250,000 women around the globe every year. More than a decade ago the Rochester team created virus-like particles (VLPs) that are harmless but which mimic real HPV viruses, triggering an immune response in people that wards off infection by HPV. The team [...]

7/2/2005 Israel Barry Knishkowy, MD, MPH and Yona Amitai, MD, MPH PEDIATRICS Vol. 116 No. 1 July 2005, pp. e113-e119 Narghile, or water-pipe smoking (WPS), has been practiced extensively for 400 years. It is common in the Arabian Peninsula, Turkey, India, Pakistan, and other countries. In recent years, there has been a revival of WPS, notably among youth. Most US health professionals are unfamiliar with the practice and health consequences of WPS. Therefore, this trend presents a new challenge for adolescent health care providers. The composition of the tobacco used in WPS is variable and not well standardized. Studies that have examined narghile smokers and the aerosol of narghile smoke have reported high concentrations of carbon monoxide, nicotine, "tar," and heavy metals. These concentrations were as high or higher than those among cigarette smokers. The few scientific data regarding the adverse health consequences of WPS point to dangers that are similar to those associated with cigarette smoking: malignancy, impaired pulmonary function, low birth weight, and others. Additional dangers not encountered with cigarette smoking are infectious diseases resulting from pipe sharing and the frequent addition of alcohol or psychoactive drugs to the tobacco. Public health strategies for controlling the emerging epidemic of WPS include carrying out epidemiologic and toxicologic research; implementation of laws to limit acquisition and use; and health education, targeting adolescents in particular.