Monthly Archives: July 2006

Man’s loss proving gain for area students

  • 7/17/2006
  • Fort Worth, TX
  • Bob Ray Sanders

A 75-year-old Fort Worth man is the Billy Graham of the anti-smoking crusade.

When Jerry Berkowitz finishes talking to schoolchildren, they start coming down the aisles to testify — to ask questions and, in some cases, to give him something he gave up 25 years ago.

At his home the other day, he recalled his first speech. It was to more than 300 students at Aledo Middle School. The youngsters were seated on the gymnasium floor, and as Berkowitz prepared to address them, he remembered administrators’ warnings that the kids likely would be a little restless, partly because it was the last period of the day.

But as soon as he began to speak, sounding somewhat like a robot from a science fiction movie, the kids were mesmerized, he said.

At the end of his 25-minute presentation, “a little kid about this tall [just over waist high] handed me a pack of Marlboros and said, ‘Hey, mister, take this away from me. I’ll never smoke again, I promise.’ ”

Soon afterward at a similar event, a young girl approached him. He had noticed her on the front row, staring straight at him during the entire speech.

The girl was deaf, Berkowitz learned, and she had been reading his lips.

“She handed me a brand of cigarettes I had never seen before and said, ‘I’ve been trying to quit for years.’ And I burst out crying,” Berkowitz said as tears welled in his eyes at the memory.

Berkowitz, a native of the South Bronx in New York City, is a walking anti-smoking message. The hole in his throat where his larynx used to be is a constant remember of how damaging tobacco can be.

A successful entrepreneur who has done business in 22 countries, Berkowitz said, he started smoking unfiltered Camels when he was 13 and didn’t quit until he was 50 after a doctor friend told him that he would “die very shortly” if he didn’t do something about his lungs.

Although he had trouble breathing, he said, he started swimming daily.

When Berkowitz was 70, a dermatologist noticed a melanoma on his leg, and he went to M.D. Anderson hospital in Houston to have it removed. It was malignant, but the surgery took care of it, he said.

It was about that time that Berkowitz noticed he was hoarse and having trouble breathing.

“We need to operate immediately,” a doctor at M.D. Anderson told him upon discovering he had throat cancer.

“Give me a month,” Berkowitz told the doctor, explaining that he still had several businesses to run.

A month might be too late, the doctor said, and he told Berkowitz to report in a week for surgery. He would have to have a laryngectomy.

Afterward, he couldn’t speak, of course, and for a few days, he was very depressed, refusing to get out of bed, he said. He didn’t like the idea of having to write to communicate.

A woman who had gone through a similar experience came to his hospital room one day and asked, “Why are you in bed?”

She offered him an electronic device that he calls an artificial larynx. It looks like a small flashlight that he holds up to his throat; it creates a vibration that allows him to articulate speech.

These days, Berkowitz goes to Fort Worth-area hospitals whenever there’s a laryngectomy case. The first thing he says to the patient is what the woman said to him: “Why are you in bed?”

But he wants to spend more time with school-age children, telling his story about how he lost his voice box, and also his sense of smell and taste as well as a nerve that severely affected his golf swing.

Although he doesn’t play golf anymore, he still goes to the course for several hours a day to practice his swing — for exercise.

Among the first questions the school kids ask him is, “If you can’t taste or smell, do you like to eat?” He explains that he can still remember what certain foods tasted like.

And the students always want to see the hole in his neck. So, as they file out of the room after one of his speeches, he stands at the exit to give them a close-up view — one that should be an indelible reminder of why they should never smoke.

In the past year, Berkowitz has spoken to more than 4,000 students in secondary schools and colleges, and he hasn’t had enough. He recently sent packets of information about himself to several school districts, offering to speak.

“I think God has given me the opportunity to do this, and I’m definitely going to help these kids,” Berkowitz said. “I’ve never done anything more rewarding in my life than what I’m doing with these kids.”

July, 2006|Archive|

Putting the HEAT on cancer

  • 7/17/2006
  • Long Beach, CA
  • Phillip Zonkel
  • Long Beach

Sabrina Mansfield is receiving her final hyperthermia treatment a therapy designed to kill her aggressive and recurrent cancer.
She has seven catheters in her neck and head. Each one beams microwave energy to heat a precise location of her cancer-riddled tissue.

When this heating is combined with radiation or chemotherapy, it increases the success rate of these therapies for eradicating cancer cells, according to recent research.

“We needed to be extremely aggressive with Sabrina’s treatment,” says Dr. Behrooz Hakimian, Mansfield’s radiation oncologist at Cedars-Sinai Medical Center, who recommended the combination therapy. “She probably had one chance of treatment at this point. I wanted her to have the best treatment.”

Mansfield received her treatment from Dr. Nisar Syed, director of radiation oncology at Long Beach Memorial Medical Center, who is considered a leader in the field of hyperthermia. Syed has been administering the procedure for more than 22 years and has treated more than 3,000 patients. Of Syed’s patients, he says approximately 25 percent had recurrent cancer after treatment.

“Dr. Syed has the most experience in Southern California, if not on the West Coast, in using hyperthermia,” Hakimian says. “He’s magical with his hands.”

Hyperthermia works on selected cancers: head and neck, tongue, throat, cervix, prostate, melanoma, sarcoma and breast cancer on the chest wall. They can be locally advanced tumors that have not metastasized or recurrent cancers that have been treated with surgery, chemotherapy and/or radiation. Sixty-five percent of Syed’s patients had head and neck cancers, ones similar to Mansfield’s.

In 1992, one of Syed’s former patients had a large recurrent tumor on her right neck (similar to Mansfield’s) and tonsils removed. She received several hyperthermia-radiation treatments and has been cancer free for 14 years.

Syed is optimistic about Mansfield’s prognosis.

“Sabrina will respond very well,” he says. “She has hope.”

Before receiving hyperthermia, Mansfield says, the past 12 months were a long nightmare.

In June 2005, the 29-year-old Sherman Oaks resident had two malignant tumors removed (one from her tongue and one from her right neck) and then underwent two months of chemotherapy and a full dose of IMRT radiation.

The treatments were grueling. The chemotherapy made her nauseous. The radiation gave her severe mouth infections and an excruciating sore throat that prevented her from talking or eating for a month, causing severe malnutrition. The radiation also made her so weak she could barely stand.

It took Mansfield eight weeks to recover from the toxic side effects.

Then, in March, Mansfield found a large, ominous mass under her right jaw, the same location as her previous tumor.

“It felt like a tennis ball was pushing its way out,” she says.

The growth was removed and tested malignant Mansfield’s cancer had returned.

“I was pretty upset. I had to go through all that treatment and it wasn’t effective,” she says. “That was one of the most miserable experiences in my life.”

That was when she was sent to Dr. Syed for hyperthermia treatment, which has less painful side effects.

The procedure involves slowly raising the temperature of tumors and surrounding tissue to anywhere from 105 to 108 degrees Fahrenheit for 30 to 60 minutes. Patients often feel warm (comparable to a high fever), but the most significant side effect is a small (1 inch or less in area) burn on the skin.

The heat is administered in different ways, including beaming microwaves onto tumors near the skin’s surface or inserting catheters that emit microwaves into the tumor itself or the affected organ.

Hyperthermia, which can be given before or after the radiation, boosts the killing power of radiation and chemotherapy by up to 10 times. When the tumor reaches the desired temperature, it’s blasted with chemotherapy or radiation.

Hyperthermia increases blood and oxygen circulation within the tumor, making a smaller dose of radiation or chemotherapy more effective. That lower dosage is important to patients with recurrent cancer; their body can tolerate only so many rounds of radiation before it damages or even destroys healthy tissue or bone surrounding the cancer.

Radiation therapy works best on cells with high amounts of oxygen, while hyperthermia is most effective against oxygen-starved cells. This one-two punch is designed to kill all the cancer cells.

The heat triggers a series of physiological events that are critical to the tumor’s demise. The blood vessels leak more than normal blood vessels, and heat opens them wider, enabling chemotherapy and radiation to penetrate more effectively and kill the cells.

Heat also increases a tumor’s level of oxygen, a critical element to the proper functioning of radiation and chemotherapy inside a cell.

Finally, heat amplifies the level of DNA damage that chemotherapy and radiation inflict upon the cancer cells. It prevents enzymes from repairing the damaged cancer cells.

Hyperthermia is not a new treatment. Writings from the ancient Egyptians maybe the world’s first oncologists claim they used an instrument called a “fire drill” to treat breast cancer. Hippocrates, the father of medicine, is credited with the saying, “What is not cured by the knife may be cured by fire.”

More than 100 years ago, American surgeon Dr. William B. Coley noticed some cancer patients, who also had high fevers from bacterial infections, had their tumors shrink. He began actively inducing fevers to cancer patients by infecting them with bacteria with similar results. But the treatment was controversial due to ethical concerns and toxic side effects.

Doctors have long thought that heat could boost the fighting power of some cancer therapies, but how much to heat the tumor and for how long and which cancers are susceptible has stymied the field and flawed past research.

Other practical barriers have slowed hyperthermia’s widespread use: such as when the tumor is hard to access, or the target is hard to hit and physicians cannot easily measure a tumor’s temperature.

But those obstacles have been challenged in recent years thanks to at least eight studies that have yielded promising results of combining hyperthermia with radiation or chemotherapy.

“There’s a lot of potential in hyperthermia for controlling tumors and for prolonging quality of life and survival,” says Rosemary Wong, radiation biologist and program director of radiation research at the National Cancer Institute. “Now we are getting the science to prove it.”

The May 2005 issue of the Journal of Oncology published a groundbreaking study by Duke University that used precise dosing, rigorous quality controls and full tumor exposure to ensure that the effects of hyperthermia are accurate and quantifiable.

In a sample of 109 female patients with cancers in the breast, chest wall, head and neck and melanoma who had previously undergone radiation, 23 percent had no evidence of active cancer with a second dose, compared to 68 percent who received heat and radiation.

“This is very significant,” says Dr. Ellen Jones, associate professor of radiation oncology and clinical director of the hyperthermia program at Duke University. “I’m very enthused, but we need to proceed in the framework of research protocol to be seen as credible.”

Hakimian is enthused by Mansfield’s treatment. “Her cancer is under control,” he says.

Mansfield says she hasn’t had any side effects from the hyperthermia and is optimistic about the future.

“My biggest fear was dying at such a young age. I had quite an aggressive beast,” Mansfield says. “I’m very pleased I went ahead with the hyperthermia and radiation. I’m very positive about my outcome.”

July, 2006|Archive|

Influence of Previous Radiotherapy on Free Tissue Transfer in the Head and Neck Region: Evaluation of 455 Cases

  • 7/15/2006
  • Viena, Austria
  • Clemens Klug et al.
  • Laryngoscope, July 1, 2006; 116(7): 1162-1167

The aim of this retrospective cohort study was to investigate the effect of prior radiotherapy (XRT) on the outcome of microvascular free tissue transfer in the head and neck region.

Four hundred fifty-five patients, subdivided into three groups, were analyzed. Groups I (no previous XRT, n = 110), II (previous radiochemotherapy with 50 Gy focus dosage in the primary treatment regime for oral cancer, n = 322), and III (secondary reconstruction after XRT-induced complications, n = 23) were compared regarding flap success rate, postoperative complications, postoperative mortality, duration of intensive care (DOIC), and hospitalization (DOH).

Flap success did not differ significantly across groups (I: 95.5%, II: 93.2%, III: 91.3%. Risk of postoperative complications was significantly lower for group I (12.7%) compared with groups II (23.9%) and III (39.1%). DOIC and DOH were significantly shorter for patients in group I than for those in groups II and III.

XRT before free tissue transfer does not significantly increase flap loss or postoperative mortality but does increase postoperative complications and length of hospitalization.

Clemens Klug, Dominik Berzaczy, Heidrun Reinbacher, Martin Voracek, Thomas Rath, Werner Millesi, and Rolf Ewers

Authors’ affiliations:
From the Hospital of Cranio-Maxillofacial and Oral Surgery (c.k., d.b., h.r., r.e.), Medical University of Vienna, Vienna, Austria; the School of Psychology (m.v.), University of Vienna, Vienna, Austria; the Department of Plastic and Reconstructive Surgery (t.r.), Medical University of Vienna, Vienna, Austria; and the Department for Oral and Maxillofacial Surgery and Dentistry and Ludwig Boltzmann Institute for Gerostomatology Hospital (w.m.), Lainz, Vienna

July, 2006|Archive|

Use of hydrogen peroxide-based tooth whitening products and its relationship to oral cancer

  • 7/15/2006
  • Mississauga, Ontario, Canada
  • IC Munro et al.
  • J Esthet Restor Dent, January 1, 2006; 18(3): 119-25

Tooth whitening products containing hydrogen peroxide or carbamide peroxide were evaluated in this review for potential oral cancer risk from their use. Hydrogen peroxide is genotoxic in vitro, but not in vivo. Hydrogen peroxide was not considered to pose a genotoxic risk to humans.

The animal toxicology data relevant to the assessment of the carcinogenicity of hydrogen peroxide do not indicate that it has significant carcinogenic activity at any site, including the oral cavity. Hydrogen peroxide was found to enhance the carcinogenic effects of potent DNA reactive carcinogens in experimental animals. However, these experimental conditions are artificial as they are related to high exposures and are of no relevance to potential human exposures to low quantities of hydrogen peroxide from the use of tooth whitening products.

Clinical data on hydrogen peroxide-containing tooth whitening products show no evidence for the development of preneoplastic or neoplastic oral lesions. Exposures to hydrogen peroxide received by the oral cavity are exceedingly low, of short duration (30-60 minutes), and could not plausibly enhance any carcinogenic risk associated with exposure of the oral cavity to chemicals in cigarette smoke or to alcohol, both known risk factors for the development of oral cancer.

Based on a comprehensive review of the available literature and research, the use of tooth whitening products containing hydrogen peroxide or carbamide peroxide does not appear to pose an increased risk of oral cancer in the general population, including those persons who are alcohol abusers and/or heavy cigarette smokers.

IC Munro, GM Williams, HO Heymann, and R Kroes

Authors’ affilations:
Cantox Health Sciences International, Suite 308, 2233 Argentia Road Mississauga, Ontario, Canada

July, 2006|Archive|

“Trojan peptide” vaccine turns body against cancer

  • 7/15/2006
  • Baltimore, MD
  • Karl B. Hille

A possible cure for some types of mouth, larynx and throat cancer is being tested at the University of Maryland Medical Center.

University researchers have begun testing “Trojan peptide” vaccines to treat squamous cell carcinoma, a common type of head and neck cancer. The vaccine targets specific proteins made by tumors, and in theory can stimulate the body’s immune system to destroy the cancer.

“It’s really founded on very strong science,” said Dr. Scott Strome, who developed the vaccine and stands to benefit if it becomes an approved treatment.

Currently, researchers are accepting patients for Phase I trials, which test the safety of a new therapy. If it proves safe, further trials will test the effectiveness of the vaccine.

Strome said the vaccine is experimental and it is not known yet if it will reduce or eliminate patients’ tumors. Researchers hope the vaccine therapy will improve the survival rate and quality of life for patients. Cancers of the head and neck — including those of the throat, mouth, voice box, sinuses, salivary glands and skin — are often difficult to treat and have a high risk of recurrence, according to information provided by the University of Maryland. Treatments include surgery, chemotherapy and radiation therapy.

Much larger than traditional vaccine molecules, these peptides contain approximately 40 to 50 amino acids, Strome said.

Researchers believe these larger peptides may trigger a stronger, two-pronged response by the body’s immune system. The vaccines prepare white blood cells to go after the cells that form them.

They also contain a peptide sequence that helps to transport the proteins into cancerous cells that “present” them to the body’s immune system.

The University of Maryland School of Medicine is seeking to patent the vaccines.

More than 40,000 people in the United States are diagnosed each year with head and neck cancer, and about half will die of the disease. Smoking has been linked to some cancers, but physicians are seeing an increase in this type of cancer in people who do not smoke.

Strome expects to enroll up to 90 patients over the next two to three years in the clinical trial, which is funded by the National Institutes of Health.

July, 2006|Archive|

Pain complaint as the first symptom of oral cancer: a descriptive study

  • 7/15/2006
  • Sao Paolo, Brazil
  • L. Cuffari et al.
  • Oral Surg Oral Med Oral Pathol Oral Radiol Endod, July 1, 2006; 102(1): 56-61

To identify pain as the initial symptom of oral cancer patients. STUDY DESIGN: Hospital charts of 1412 patients (1977 to 1998) with oral cancer were reviewed (238 female and 1174 male).

Pain was the initial complaint in 19.2% of the sample. Oral cancer (ratio 4:1) and initial pain (ratio 9:1; P= .001) was prevalent in men. There were 12 different complaints of pain: sore throat (37.6%), tongue pain (14.0%), mouth pain (12.9%); pain when swallowing (11.1%), dental pain (5.9%); earache (5.9%); pain in the palate (4.1%); burning mouth (3.3%); gingival pain (2.2%); pain when chewing (1.1%); neck pain (1.1%), and facial pain (0.7%). Pain was associated with advanced TNM staging and location of tumor in the tongue (P= .004) and the tongue/mouth floor (P< .006).

There were 12 different descriptions of pain; pain was related to TNM staging in the tongue and the tongue/mouth floor. The data presented reinforce the suggestion that patients with orofacial pain need systematized evaluation and sometimes require an interdisciplinary approach.

L Cuffari, JT Tesseroli de Siqueira, K Nemr, and A Rapaport

Authors’ affilation:
Oral Surgery, Dental School of Universidade Bandeirante (UNIBAN), São Paulo, Brazil

July, 2006|Archive|

Guidelines Address Larynx Preservation

  • 7/15/2006
  • Iowa City, IA
  • staff

The American Society of Clinical Oncology recently published guidelines about larynx preservation in patients with laryngeal cancer. The guidelines note the importance of balancing successful cancer treatment with patient function and quality of life.

Head and neck cancers originate in the throat, larynx (voice box), pharynx, salivary glands, or oral cavity (lip, mouth, tongue). Most head and neck cancers involve squamous cells, which are cells that line the mouth, throat, or other structures.

For patients facing the treatment of laryngeal cancer, an important consideration is whether the larynx can be preserved. Because the larynx is involved in speech and communication, complete removal of the larynx can have a dramatic and adverse effect on a patient’s life.

Treatment approaches that preserve the larynx include radiation therapy alone, chemotherapy plus radiation therapy, and surgery that preserves the function of the larynx. Certain patients, however, may not be candidates for these approaches, and may require more extensive treatment.

To guide the use of larynx-preservation approaches, the American Society of Clinical Oncology summarized the available evidence and released recommendations. Final decisions about treatment, however, will still require consideration of each patient’s individual circumstances.

– For patients with limited laryngeal cancer (T1 or T2), the recommendations note that patients should initially be treated with the intent to preserve the larynx. In these patients, radiation therapy alone or larynx-preservation surgery each appear to produce similar survival outcomes. The recommendations include the qualification that “Limited-stage laryngeal cancer constitutes a wide spectrum of disease. The clinician must exercise judgment when recommending treatment in this category.”

– For patients with advanced stage (T3 or T4) laryngeal cancer, patients should be evaluated for their suitability for larynx preservation. If the cancer has not spread through the cartilage into soft tissue, larynx preservation (commonly involving treatment with chemotherapy plus radiation therapy) is often an appropriate treatment approach.

Patients who are going to undergo treatment for laryngeal cancer may wish to talk with their doctor about whether they are candidates for larynx preservation, and about the risks and benefits of different approaches to larynx preservation.

Pfister DG, Laurie SA, Weinstein GS et al. American Society of Clinical Oncology Clinical Practice Guideline for the Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer. Journal of Clinical Oncology. Early Online Publication July 10, 2006.

July, 2006|Archive|

Head and neck cancer: past, present and future

  • 7/15/2006
  • Queensland, Australia
  • D Chin et al.
  • Expert Rev Anticancer Ther, July 1, 2006; 6(7): 1111-8

Head and neck cancer consists of a diverse group of cancers that ranges from cutaneous, lip, salivary glands, sinuses, oral cavity, pharynx and larynx. Each group dictates different management.

In this review, the primary focus is on head and neck squamous cell carcinoma (HNSCC) arising from the mucosal lining of the oral cavity and pharynx, excluding nasopharyngeal cancer. Presently, HNSCC is the sixth most prevalent neoplasm in the world, with approximately 900,000 cases diagnosed worldwide. Prognosis has improved little in the past 30 years.

In those who have survived, pain, disfigurement and physical disability from treatment have had an enormous psychosocial impact on their lives. Management of these patients remains a challenge, especially in developing countries where this disease is most common.

Of all human cancers, HNSCC is the most distressing since the head and neck is the site of the most complex functional anatomy in the human body. Its areas of responsibility include breathing, the CNS, vision, hearing, balance, olfaction, taste, swallowing, voice, endocrine and cosmesis. Cancers that occur in this area impact on these important human functions.

Consequently, in treating cancers of the head and neck, the effects of the treatment on the functional outcome of the patient need the most serious consideration. In assessing the success of HNSCC treatment, consideration of both the survival and functional deficits that the patient may suffer as a consequence of their treatment are of paramount importance. For this reason, the modern-day management of head and neck patients should be carried out in a multidisciplinary head and neck clinic.

D Chin, GM Boyle, S Porceddu, DR Theile, PG Parsons, and WB Coman

Authors’ affiliation:
Department of Plastic Surgery and Head & Neck Unit, Princess Alexandra Hospital, Brisbane 4102, Queensland, Australia

July, 2006|Archive|

U Of Minnesota Researchers Discover Compounds To Shrink Tumors

  • 7/11/2006
  • Rochester, MN
  • staff

Researchers at the University of Minnesota have developed novel anti-cancer drugs to treat solid tumors. These “small molecules” belong to a class of pharmaceutical agents called anti-angiogenics. The new compounds are a refined form of drugs that effectively reduce blood flow to the tumor, thereby inhibiting tumor growth. The results of the study appear in the July 5 issue of the Journal of the National Cancer Institute.

“This is a novel class of drugs that increases the potential for good, effective treatment for cancer patients with tumors,” said Kevin Mayo, Ph.D., principle investigator and professor of biochemistry, molecular biology and biophysics at the University of Minnesota Medical School.

There is currently a protein anti-angiogenic agent approved by the FDA for clinical use. These new tumor-targeting compounds were designed to mimic the functional part of an anti-angiogenic protein. But, because the compounds are not proteins themselves, they have the advantage of possibly being taken in pill form and being less costly to produce.

In animal studies with mice, the compounds inhibited tumor growth by up to 80 percent, and in combination with chemotherapy tumors essentially disappeared. Although the compounds proved effective against solid tumors, researchers believe they have potential to treat liquid tumors as well, such as the type found in leukemia and other blood cancers.

“Our next step is to treat people with the drug in FDA-approved clinical trials,” said Mayo.

July, 2006|Archive|

Chewing tobacco losing its bite in baseball dugouts

  • 7/9/2006
  • Pittsburgh, PA
  • Lee Bowman
  • ScrippsNews (

The Pittsburgh Pirates’ dugout at PNC Park, site of Tuesday’s All-Star game, is less likely to be tobacco-stained than was their lair in old Three Rivers Stadium when the Midsummer Classic was last played there 12 years ago.

A newly published study_ based on 10 years of surveys and looking into the mouths of professional baseball players at Pirates spring training camps _ finds that smokeless-tobacco use among members of the club’s major and minor league teams declined by more than a third between 1990 and 2000.

Dipping and chewing goes way back with baseball. Many think the urge to chew and spit is a way to expend nervous energy between the next at-bat or the next play in the field, whether the chew is sunflower seeds, bubble gum or wads of tobacco.

“A lot of players say they only use tobacco during the season or cut way down in the off-season. It’s very much part of the cultural aspect of baseball,” said Dr. Keith Sinusas, lead author of the study published in the July issue of Medicine and Science in Sports and Exercise.

The difference, says Sinusas, is that tobacco users are much more likely to have one or more lesions or patches in or around the mouth that can progress to oral cancer.

Since 1986, the U.S. Surgeon General has warned of a clear association between smokeless tobacco use and oral cancers.

Sinusas and former Pirates team physician Dr. Joseph Coroso started surveying players and managers at spring training in Bradenton, Fla., in 1991.

“It was all voluntary, but we got about 90 percent compliance with taking the survey and letting us do oral exams every year. They all have to take a physical anyway, so they’re sitting around and we gave them the forms. It gave them something to do,” said Sinusas, who practices at the Middlesex Hospital Family Medicine Residency in Middletown, Conn.

Typically, about 200 to 250 men from the Pirates farm system teams and the major league club show up at spring camps. The doctors got 190 to 259, including some coaches, to participate each year.

In their first survey, they found that 41 percent of players at all levels were using snuff or chew. They found the lesions, called oral leukoplakia, in 22.6 percent of all players in 1991 and in 9.3 percent of players examined in 2000. Throughout the decade, about a third of those who reported smokeless tobacco use were found to have the lesions.

By the time of the last survey in 2000, only 25 percent of the players at all levels said they were using smokeless tobacco. The prevalence of lesions among all players was 9.4 percent.

That’s still far above the national level of smokeless tobacco use _ about 3.4 percent _ as measured by a government survey on drug abuse done in 2000.

While several other studies have used surveys and oral exams to get snapshots of chew tobacco use among professional baseball players, and found similar levels of use, Sinusas and Coroso are the only ones to have looked at so many players _ nearly 2,700 total exams _ and over a full decade.

Of course, the study didn’t track the same players the whole time. The turnover in participants in each camp was 20 to 25 percent _ because of trades, retirements and players being released. And because they kept the surveys anonymous, the doctors had no way to track the habits of the few veterans and coachers who may have reported to camp the entire decade.

“Still, we think we captured the trend for this team and, actually because of all the turnover, for baseball in general,” Sinusas said.

While player education about the risks of smokeless tobacco clearly played a role, the biggest impact on the change appears to have come from Major League Baseball’s 1993 decision to ban the stuff from all minor league clubs.

“The ban’s only in effect at the minor level, but there was a decline in use among both majors and minors,” Sinusas said.

Use among minor players was 40 percent in the first year of the survey and just 20 percent by 2000. Among players in the majors, use fell from 55 percent to 32 percent over the decade.

“We gave a talk about the risks each year to the minor leaguers, and I want to believe that had some influence,” the researcher said. “Anyone who we found lesions in, we counseled them at the time about the hazards and quitting.”

The National Spit Tobacco Education Program, with former catcher and broadcaster Joe Garagiola as leading spokesman, also has been instrumental in getting the message about the dangers of chew and snuff to athletes at all levels, and there have been some high-profile quitters, including pitcher Curt Schilling and centerfielder Brett Butler, both of whom had cancer scares.

Still, spit tobacco is well entrenched in baseball. “We did notice that the coaches, as a group, had much less a decline in using tobacco than the players, probably because they’re older and their habits are more ingrained,” Sinusas said.

“On the plus side, the percentage of players who said they wanted to quit almost doubled, from 29 percent in 1991 to 52 percent in 2000,” Sinusas said. “As guys in the minors move up and older players retire, it’s logical that we’ll see fewer and fewer major leaguers with the habit.”

July, 2006|Archive|