Monthly Archives: January 2009

Diagnostic aids in the screening of oral cancer

Author: Stefano Fedele

The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth.

There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa.

As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence.

The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking.

Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required.

Head &Neck Oncology 2009, 1:5

January, 2009|Oral Cancer News|

New laser for Chase Farm cancer patients

Author: Sarah Cosgrove

A new state-of the art laser will improve surgery for cancer patients, after being donated to Chase Farm Hospital by charities. The carbon dioxide laser allows surgeons to burn out cancers with the minimum of blood loss, sometimes allowing them to avoid cutting into patients completely.

Representatives from the Patricia Madden Cancer Trust and Barnet and District CancerLink joined patients, doctors and hospital chiefs to launch the C02 machine at the hospital on Tuesday.

Head and neck consultant, Wayne Halfpenny, explained that as well as lessening blood loss, cancers of the voicebox can be removed via the mouth by the machine, avoiding the need for radiotherapy or surgery through the neck.

He added: “The carbon dioxide laser is a fantastic piece of equipment in the surgical treatment of head and neck cancer.

“It cuts and seals tissue at the same time minimizing blood loss and allows some cancers to be treated without open neck surgery. It can also vaporize early cancers avoiding the need for surgical excision.”

Mr Halfpenny and Barnet and Chase Farm Hospitals NHS Trust chief executive Averil Dongworth thanked the charities for their “generous” support.

January, 2009|Oral Cancer News|

Smokeless tobacco ups oral cancer risk 80 pct – WHO


Author: staff

Chewing tobacco and snuff are less dangerous than cigarettes but the smokeless products still raise the risk of oral cancer by 80 percent, the World Health Organisation’s cancer agency said on Tuesday.

The review of 11 studies worldwide showed people who chewed tobacco and used snuff also had a 60 percent higher risk of oesophagus and pancreatic cancer.

The researchers sought to quantify the risk of smokeless tobacco after a number of studies differed on just how dangerous the products were, said Paolo Boffetta, an epidemiologist at the WHO’s International Agency for Research on Cancer.

“What we did was try to quantify the burden of smokeless cancer,” he said in a telephone interview. “This has never been attempted in such a systematic way before.”

The researchers, who published their findings in Lancet Oncology, did this by looking at population-wide studies and trials of both humans and animals.

They found frequency of use varies greatly both across and within countries, depending on sex, age, ethnic origin and economic background, and were highest in the United States, Sweden and India.

They also found that while snuff and chew were less dangerous than smoking because they were not linked to lung cancer, getting cigarette users to switch was not good public policy.

“If all smokers did this there would be a net benefit,” Boffetta said. “The point is we don’t know whether this would happen and there is no data to suggest these smokers would stop or switch.”

January, 2009|Oral Cancer News|

Study on the oral hygiene of patients with oral cavity cancer

Source: Stomatologiia (Mosk), January 1, 2008; 87(6): 21-23
Author: M St Bratoicheva and V K Kondeva

Many authors consider oral hygiene an important factor in the etiology and pathogenesis of oral cavity cancer. The aim of the present study was to establish the role of poor oral hygiene in the development of malignant lesions in the oral cavity. One hundred and three patients were interviewed. Questions, regarding oral hygiene were included in the interview.

Results showed that 53,80% of urban residents brush their teeth twice daily whereas 65,52% of rural residents brush their teeth irregularly – p<0,001 (chi(2)=23,67). 46,88% of women clean their teeth twice daily. 46,94% of men do not maintain adequate oral hygiene – p<0,05 (chi(2)= 9,21). Regarding the brush, it was found out that 56,00% of females use a hard bristle toothbrush, the same refers to 28,04% of men – p<0,05 (chi(2)= 4,15). Hard bristle toothbrush was used by 48,88% of urban residents and 9,09% of rural residents – p<0,05 (chi(2)= 5,78). People up to 30 years of age use hard bristle toothbrush most often -39,13% – p<0,01 (chi(2)=12,26).

The accumulated evidence provides further explanation why oral cavity cancer is more frequent in men, rural residents and in the elderly. Oral hygiene is a factor in the development of oral cavity cancer.

Authors’ affilation:
stomatologii Meditsinskogo universiteta, Plovdiv, Bolgariia

January, 2009|Oral Cancer News|

Screening for oral precancer with noninvasive genetic cytology

Source: Cancer Prevention Research, 10.1158/1940-6207
Authors: Jantine F. Bremmer et al.

Oral squamous cell carcinomas develop in precancerous fields consisting of genetically altered mucosal epithelial cells. These precancerous fields may appear as clinically visible lesions, in particular, oral leukoplakia, but the large majority remains clinically undetectable. The aim of this study was to assess the potential value of a noninvasive screening approach to detect precancerous fields.

As a first step, we developed a suitable assay and investigated 25 leukoplakia patients and 20 noncancer control subjects. Exfoliated cells were removed by a brush from multiple small areas of the oral mucosa, including the leukoplakia. Brushed samples were investigated for allelic imbalance (AI) at chromosomes 3p, 9p, 11q, and 17p using microsatellite markers known to show frequent alterations in oral precancer.

AI was absent in all (137) of the samples of the 20 control subjects, yielding a specificity of 100%. AI was detected in exfoliated cell samples of 40% (10 of 25) of the leukoplakia lesions studied. Genetic changes were also found outside the leukoplakia lesions. Most frequent was AI at 9p (9 of 10). The noninvasive assay was validated against the biopsy results of the leukoplakia lesions yielding an estimate of sensitivity of 78% (7 of 9) and a positive predictive value of 100% (7 of 7).

Altogether, these results show the feasibility of a noninvasive genetic screening approach for the detection and monitoring of oral precancer. This assay could therefore contribute to the secondary prevention of oral squamous cell carcinoma. The assay also shows promise for the detection of precancerous changes that are not macroscopically visible.

Jantine F. Bremmer1,4, A. Peggy Graveland2, Arjen Brink1,2, Boudewijn J.M. Braakhuis2, Dirk J. Kuik3, C. René Leemans2, Elisabeth Bloemena1,4, Isaäc van der Waal1,4 and Ruud H. Brakenhoff2

Authors’ affiliations:
Departments of 1 Oral and Maxillofacial Surgery and Oral Pathology, 2 Otolaryngology/Head-Neck Surgery, and 3 Clinical Epidemiology and Biostatistics, VU University Medical Center, and 4 ACTA, Amsterdam, the Netherlands

January, 2009|Oral Cancer News|

Tobacco road takes a turn to the smokeless

Author: Kevin Helliker

About 18 months ago, Russell Stevens gave up cigarettes and took up a new habit — placing between his lip and gum a tiny pouch of smokeless tobacco called Camel Snus. The 26-year-old Kentuckian says it satisfies his craving for nicotine while exposing him to far fewer risks than did smoking.

Like Mr. Stevens, more Americans are continuing to give up smoking, helping to push cigarette consumption down about 3% each year. To help kick the habit, many smokers turn to safer sources of nicotine — the addictive but non-carcinogenic ingredient in cigarettes — such as nicotine gum, patches or lozenges.

But one method that has been gaining ground as a safer alternative to cigarettes — smokeless tobacco — remains controversial. A decades-old federal law requires smokeless tobacco to carry a label warning that it is not a safe alternative to cigarettes. The perils include possibly increased risk for certain cancers and cardiovascular disease. And U.S. public-health officials note that no clinical trials have been conducted showing that smokeless tobacco is an effective quitting aid. Adding to the controversy: Some of the biggest cigarette makers are jumping into the non-combustible market.

“There is no evidence that smokers will switch to smokeless tobacco products and give up smoking,” Michael Thun, vice president of epidemiology for the American Cancer Society, said in a recent article in the journal CA.

Still, popular brands of smokeless tobacco generally contain far fewer carcinogens than do cigarettes, although some studies indicate the habit isn’t risk-free. One recent study showed that some newer brands, with names like Ariva, Camel Snus and Marlboro Snus, have sharply lower levels of a dangerous carcinogen than do older varieties of smokeless tobacco, such as Copenhagen and Skoal. Britain’s Royal College of Physicians, which sets health standards in the United Kingdom, has said smokeless tobacco is between one-tenth and one-one thousandth as hazardous as smoking, depending on the specific product. As with all nicotine-replacement products, smokeless tobacco can lead to addiction.

Morgan Stanley estimates that U.S. consumers spent $4.77 billion on smokeless tobacco in 2007 versus $78 billion on cigarettes. Smokeless-tobacco sales have been increasing about 5% or more a year.

Some switchers say the benefits of smokeless tobacco can be immediate and dramatic. After 30 years of smoking more than a pack a day, Deborah Barr required several respiratory medications just to breathe. An analysis of her lung capacity shocked her physician. “He said, ‘I’ve never seen anybody this bad,’ ” recalls Mrs. Barr, 53, of Richmond, Va. So she switched to Ariva, a tobacco pellet that dissolves in the mouth. “Within three days I could breathe without medication,” says Mrs. Barr, who smoked her last cigarette four years ago and still uses Ariva.

No Spitting
For many people, smokeless tobacco conjures up an image of a wad of chewing tobacco bulging from the cheeks of users who spit brown juice. Instead, recent products consist of dissolvable pellets or tiny pouches of tobacco that reside invisibly in the mouth and induce no spitting. The model for these new brands comes from Sweden, where use of spit-free smokeless tobacco, called snus, is more common among men than smoking.

Studies of Swedish snus users have found no elevated incidence of mouth cancer compared with the general population. Other studies, however, have linked snus consumption to cardiovascular disease, albeit at rates far below the risks of smoking, and some research has found a minor link with pancreatic cancer. Many of the studies were performed by the Swedish government, which discourages the use of snus and cigarettes.

Big U.S. cigarette makers have been staking out the smokeless tobacco field. Altria Group Inc., the nation’s largest cigarette maker, this month completed its $10.3 billion purchase of UST Inc., the biggest smokeless-tobacco maker and owner of the Copenhagen and Skoal brands. Reynolds American Inc., which owns Conwood Co., a discount smokeless purveyor, this month announced that the Camel Snus brand has performed well enough in test markets to warrant national distribution. Marlboro Snus is available in a few test markets.

“There are probably in excess of 400,000 adults switching to smokeless each year,” says Seth Moskowitz, a spokesman for Reynolds American. But the company doesn’t know whether switchers succeeded in permanently giving up their previous form of tobacco.

Tommy Payne, Reynolds American’s executive vice president of public affairs, says that he himself is a Camel Snus user. When asked, he says the product helped him successfully quit smoking, a habit he says he had practiced for “too long.”

Cutting Nitrosamines
A federally funded study by the University of Minnesota’s Masonic Cancer Center found that Camel Snus, made by Reynolds American unit R.J. Reynolds, and Marlboro Snus, made by Altria’s Philip Morris unit, bear substantially lower levels of nitrosamines, the class of carcinogen that most concerns public-health officials, than do traditional brands. The study, published in the December issue of Nicotine & Tobacco Research, a leading journal of researchers battling tobacco-caused disease, was similar to one done in 2006 measuring the carcinogen in Ariva and Stonewall, two smokeless-tobacco products made by tiny Star Scientific Inc.

“The reduction in carcinogenic…content in the new smokeless tobacco is encouraging,” concluded the authors, none of whom had financial ties to industry.

The December study also found that Marlboro Snus contained a very low level of nicotine. By contrast, Camel Snus offers a jolt of nicotine that “has the potential to satisfy those smokers who are looking for a substitute to smoking, and to keep them addicted to this product,” the authors said.

An Altria spokesman says the nicotine level of Marlboro Snus has been increased. “Our interest is offering Marlboro Snus to adult smokers who are interested in a smokeless alternative to cigarettes,” the spokesman says.

Purveyors of smokeless tobacco aren’t marketing it as a smoking-cessation aid, because doing so could force it off the shelves as an unapproved medical treatment. Makers of the products are beginning to push back against such limitations, although they haven’t yet altered their marketing pitches.

Star Scientific this month announced that a study it conducted of smokers in withdrawal found that its Stonewall smokeless tobacco and a nicotine lozenge, used separately, proved to be “much more effective” than placebos at satisfying cravings. And Reynolds American is calling for public-health officials to talk openly about the lower risks of non-combustible tobacco products. “I believe that governments, public-health associations, tobacco manufacturers and others should provide consumers with accurate information, based on sound science, on the different levels of risks posed by different types of tobacco products,” Susan Ivey, chairman of Reynolds American, said in a speech last year at the University of Arkansas.

Some smokers on their own have long viewed smokeless tobacco as a way out of their habit. During medical school in the early 1970s, Michael Moore was trying without luck to kick cigarettes when a fellow nicotine addict recommended that he switch to smokeless tobacco. The Minneapolis resident stopped smoking and used smokeless tobacco for decades, quitting two years ago at the urging of his loved ones. “I never saw anything in the scientific literature that convinced me it was very dangerous,” says Dr. Moore. As a psychiatrist, however, he concedes that rationalization is a symptom of addiction. Dr. Moore says he has no connection to anti-tobacco causes, although his father, a scientist, years ago contributed to research linking cigarettes to disease.

January, 2009|Oral Cancer News|

Refeeding syndrome – awareness, prevention and management

Source: Head &Neck Oncology 2009, 1:4
Authors: Hisham M Mehanna, Paul C Nankivell, Jamil Moledina and Jane Travis

Refeeding syndrome is an important, yet commonly overlooked condition affecting patients. It occurs when feeding is commenced after a period of starvation. Head and neck cancer patients are at particular risk owing to prolonged periods of poor nutritional intake. This may be from general effects such as cancer anorexia or from more specific problems of dysphagia associated with this group of patients. Awareness of the condition is crucial in identifying patients at risk and taking measures to prevent its occurrence.

The aims of this review are to:
1) Highlight the condition and stress the importance of its consideration when admitting head and neck cancer patients.
2) Discuss the pathophysiology behind refeeding syndrome.
3) Review the literature for the best available evidence and guidelines.
4) Highlight the need for further high quality research.

Refeeding syndrome is potentially fatal, yet is preventable. Awareness and identification of at-risk patients is crucial to improving management. Refeeding syndrome is caused by rapid refeeding after a period of under-nutrition, characterised by hypophosphataemia, electrolyte shifts and has metabolic and clinical complications. High risk patients include the chronically under-nourished and those with little intake for greater than 10 days.

Patients with dysphagia are at particular risk. Refeeding should commence at 10kcal/kg per day in patients at risk, and increased slowly. Thiamine, vitamin B complex and multi-vitamin supplements should be started with refeeding. New NICE guidelines state that pre-feeding correction of electrolyte and fluid deficits is unnecessary, but should be done concurrently with re-feeding. More research in this field is needed as the evidence base is lacking.

Author: Hisham M Mehanna, Paul C Nankivell, Jamil Moledina and Jane Travis
Credits/Source: Head &Neck Oncology 2009, 1:4

January, 2009|Oral Cancer News|

Perceptronix sponsors UBC dentistry research day

Author: press release

Perceptronix is proud to be a silver sponsor for the 2009 UBC Dentistry Research Day on January 27 with its focus on early detection of oral cancer. This event closely parallels the company’s agenda in promoting early cancer diagnosis for better patient outcomes. Perceptronix will be showcasing and demonstrating the use of OralAdvance(TM), a new quantitative cytology test for the early detection of oral cancer.

With recent advances in visualization techniques for the oral cavity, dentists are encountering more suspicious lesions. OralAdvance(TM), with its soft cyto-brush sample collection kit, provides dentists with an informative new option for assessing these lesions when biopsy is not warranted or possible. It provides an objective measure of gross DNA abnormality that can give important information about the pre-malignant or malignant nature of a lesion.

About Perceptronix Medical Inc.

Perceptronix Medical Inc. (Vancouver, Canada) is a private laboratory and cancer diagnostics company specializing in the provision of innovative early cancer detection tests based on quantitative cytology. The Company’s DNA image cytometry technology was developed in partnership with the British Columbia Cancer Agency (Vancouver, Canada). Quantitative cytology provides physicians with an innovative cytopathology assessment based on an objective measure of large-scale DNA abnormality that can indicate precancerous or cancerous changes. The company has developed proprietary tests for the early detection of lung cancer and oral cancer using its DNA cytometry technology and offers quantitative cytology analysis of various tissues.

January, 2009|Oral Cancer News|

Nicorette launches 25g nicotine patch to help people stop smoking

Source: Nursing Times

Nicorette has launched a new nicotine replacement therapy programme that includes a 25mg nicotine patch to help people trying to stop smoking

Nicorette recommends that smokers begin a stop smoking attempt using a 25mg nicotine patch for eight weeks, then step down to a 15mg patch for two weeks, followed by 10mg patch for a further two weeks.

They cite evidence from a European multi-centre trialinvolving 3,575 smokers to support the introduction of a higher strength 25mg patch.

This study found that one in two smokers who used the 25mg patch and abstained from smoking during the first week of a quit attempt remained smoke free at 12 weeks.

Read full study here

January, 2009|Oral Cancer News|

Developing smokeless tobacco products for smokers: an examination of tobacco industry documents : February 2009 (Volume 18, Number 1)

Source: Clove Cigarettes News Blog 

Objective: To investigate whether development of smokeless tobacco products (SLT) is intended to target current smokers. . . .

Conclusions: Heavy marketing of new SLT products may encourage dual use and result in unknown public health effects. SLT products have been designed to augment cigarette use and offset regulatory strategies such as clean indoor air laws. In the United States, the SLT strategy may provide cigarette companies with a diversified range of products under the prospect of federal regulation. These products may pose significant challenges to efforts by federal agencies to reduce harm caused by tobacco use.

Internal documents show that tobacco manufacturers, including cigarette and SLT companies, have developed and targeted new SLT products to exploit cigarette smokers. Cigarette manufacturers recognised the importance of entering the SLT market especially in light of health, social and legislative changes influencing the cigarette market and shifting demographics of traditional SLT users. Cigarette manufacturers were initially focused on developing alternative smokeless products for smokers who would otherwise quit because of the changes in the cigarette market. Over time, the cigarette companies appear to have focused their efforts on products designed to augment cigarette use when smoking is not possible, thus offsetting regulatory strategies such as clean indoor air laws.

Major cigarette companies’ marketing of new SLT products under established brand names may be aimed at increasing the appeal of SLT to smokers, who are not necessarily interested in quitting smoking. At the same time, SLT companies have aimed to exploit smokers by promoting SLT as a cigarette alternative in the face of smoking restrictions. UST and SM have developed and marketed new, spitless SLT to appeal to smokers.

The introduction of new SLT products raises important questions with regard to the health risks associated with these products, particularly in light of the possibility that cigarette manufacturers are promoting combined cigarette and SLT use. Heavy marketing of SLT products to smokers by both industries may encourage dual use, and, thus, result in unknown and potentially harmful public health effects. Camel Snus marketing materials, for example, describe the product as “A tasty new tobacco pleasure for wherever” stating “You Can Snus virtually anywhere, from work to bars to trains to your fussy friend’s party”. Test markets for Camel Snus have included college communities. This corresponds with internal documents showing that college males were considered an important growth market for moist snuff. Further, college students are subject to campus and worksite smoking bans and may be enticed by the attractive marketing campaign.

The increased availability and use of SLT as a harm reduction method remains a controversial issue within the public health community.52 Although new SLT products contain lower levels of total carcinogens, these products still contain potentially harmful levels of toxicants including tobacco specific nitrosamines (TSNAs) and, thus, could result in adverse health consequences when used alone or as a smoking substitute.52 53 Assessment of internal SLT research may lead health researchers to an improved understanding of the possible role of SLT in maintaining tobacco dependence.

Nevertheless, the findings of this study should be considered in relation to the limitations associated with document-based research methodology. Internal documents disclose statements and conclusions from various authors representing various tobacco manufacturers that do not represent a complete set of documents. Additionally, the documents span a wide time period and do not represent a complete set of documents. In this study, documents were retrieved through 2006, which may not account for more recent developments in the tobacco market. Despite these limitations, document-based studies have contributed a wealth of important evidence to the published literature regarding internal industry research and practice.

What this paper adds

* Our study results show that tobacco manufacturers, including cigarette and SLT companies, have developed and targeted new SLT products to exploit cigarette smokers. These products have been designed to augment cigarette use when smoking is not possible, thus offsetting regulatory strategies such as clean indoor air laws.

* Heavy marketing of SLT products to smokers by both industries may encourage dual use and, thus, result in unknown and potentially harmful public health effects.

* Assessment of internal SLT research may lead health researchers to an improved understanding of the possible role of SLT in maintaining tobacco dependence.

Future studies should examine entry of tobacco manufacturers into the international SLT market, particularly in developing countries with limited tobacco control measures.

January, 2009|Oral Cancer News|