Monthly Archives: April 2009

Robot-assisted surgery feasible for head and neck cancer

Author: Roxanne Nelson

Robot-assisted surgery appears feasible for resection of select upper aerodigestive tract tumors, according to a study published in the April issue of Archives of Otolaryngology — Head & Neck Surgery. Researchers found that the surgical robot had several advantages over traditional endoscopic and open approaches, such as 3-dimensional visualization, tremor filtration, and greater freedom of instrument movement.

“Robotic surgery in head and neck patients is still considered investigational,” said senior author William Carroll, MD, associate professor of surgery and otolaryngology at the University of Alabama in Birmingham. “The procedure is under consideration by the [US Food and Drug Administration] for an approved indication.”

The key message from this study is that this technology could prove useful for the surgical management of select patients with head and neck cancers. “We hope to see similar or improved cure rates with fewer side effects and quicker return to function,” he told Medscape Oncology.

Since they were introduced a decade ago, robot-assisted surgeries have become widely accepted in the United States, especially for cardiac, gynecologic, and urologic procedures. The authors note that in 2007, about 60% of all radical prostatectomies were performed with robot assistance, and that robot-assisted cardiac and urological procedures can result in less blood loss and fewer complications than standard open approaches. In addition, the use of robots in cardiac surgery has had a favorable effect on operative time, length of stay in intensive care units, and length of overall inpatient care days, compared with open procedures.

For head and neck surgery, there are a number of theoretic advantages, explained Dr. Carroll. These include less morbidity than standard open surgery, shorter hospital stay, and the potential for less late toxicity from higher radiation doses.

“It also may allow targeted surgery and less radiation with better functional outcomes than existing chemoradiation protocols,” he said. “This hypothesis is just being evaluated in a multicenter study.”

For patients with upper aerodigestive tract tumors, surgery commonly requires a transcervical approach, including mandibulotomy and lip-splitting incision, and this can result in poor cosmesis and alterations in speech and the ability to swallow. Preclinical experimental studies, the authors write, have demonstrated the technical feasibility of transoral application of the robot, and subsequent clinical trials in patients have shown both the feasibility and the safety of robot-assisted resection of upper aerodigestive tract tumors.

Technically Feasible, Promising Results
In this study, Dr. Carroll and colleagues assessed the utility of using robot-assisted surgery for the excision of upper aerodigestive tract neoplasms and characterized patient and clinical predictors of successful robotic resection and functional outcome.

The prospective nonrandomized study involved 36 patients who presented with upper aerodigestive tract neoplasms from March 2007 to May 2008 at the University of Alabama. Within this cohort, 8 patients had undergone previous treatment for head and neck cancer.

Transoral resection using the robot was successfully performed in 29 patients (81%), and negative margins were obtained in all 29. Within this group, 11 patients (2 with oral-cavity lesions, 9 with oropharyngeal lesions) underwent simultaneous selective neck dissection, and 6 patients (5 with oropharyngeal lesions, 1 with laryngeal lesions) underwent selective neck dissection performed during a staged operation.

Patient blood loss ranged from 2 to 150 mL, and none of the patients required a transfusion. Nearly three quarters (n = 21, 72%) of the patients were able to be safely extubated before leaving the operating room. The mean hospital stay for patients who underwent robot-assisted resection was 2.9 days (range, 1 – 13 days); 1 patient who was hospitalized for 13 days had a second primary lesion that was detected intraoperatively, and opted to undergo a second surgery during this time period.

The researchers also noted that oral nutrition was tolerated by 16 of the 29 patients (55%) prior to discharge; in fact, oral nutrition was started on the day of surgery in 5 patients, on the first postoperative day in 10 patients, and on postoperative day 2 in 1 patient.

Postoperative complications that occurred within 30 days of the procedure included dehydration (n = 4), aspiration pneumonia (n = 1), delayed postoperative bleeding (n = 2), and airway edema requiring reintubation (n = 2). These complications, write the authors, were consistent with transoral excision by any method and not considered to be directly associated with the use of a surgical robot.

The researchers also observed that several factors were associated with successful robotic resection. These included lower T classification (P = .01) and edentulism (P = .07); factors associated with gastrostomy-tube dependence were advanced age (P = .02), tumor location in the larynx (P < .001), and higher T classification (P = .02). Comparisons Not Yet Available
“Compared with open surgical procedures, the hospitalization is shorter and the return to function quicker,” said Dr. Carroll. However, he emphasized that this comparison is based on historic information only.

“There was no direct group for comparison in this feasibility study,” he said. “We don’t want to overstate the functional benefits until we have better data. We are participating in a multicenter study comparing the outcomes of robotic resection [and] chemoradiation. Open surgery is so morbid that most patients are treated instead with chemoradiation currently.”

Thus far, clinical guidelines have not been established for robot-assisted resection of head and neck tumors, but the technology is widely available. This project only assessed the feasibility of robot-assisted surgery in this population, conclude the researchers, and the study does not confirm oncologic or functional superiority to any standard method of treatment. More research is needed to define the indications, advantages, limitations, and outcomes of robotic surgery for patients with head and neck cancer.

The researchers have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2009;135:397-401.

April, 2009|Oral Cancer News|

AACR show report: Dentists balk at cancer screenings


Author: Barbara Boughton

SAN DIEGO — Dentists don’t want to spend time screening patients for oral cancer because they’re not sure how to do it properly — or how to make money from it, researchers said at the American Association for Cancer Research annual meeting here.

The researchers, from Simon Fraser University and the British Columbia Oral Cancer Prevention Program in Canada, collected four months of data from pilot cancer screening projects at 10 dental offices in Vancouver, then queried dental staff in focus groups.

“The idea was to raise public awareness, and remind dentists and their staff about how easy an oral cancer exam can be,” said study author Denise Laronde, a dental hygienist and doctoral candidate at Simon Fraser University.

Earlier research has suggested that dentists could save lives with oral cancer screenings. In a British Columbia study, 70 percent of oral cancer patients who had regular dental office visits were diagnosed at an early stage (stage I or II), while only 40 percent of those who did not have regular dental visits were diagnosed at an early stage, the researchers said.

Oral cancer screening is a quick and painless procedure, yet fewer than 30 percent of people surveyed report being screened, the researchers added.

In the current study, dental personnel were taught to use a novel screening device that uses loss of autofluorescence to identify potential areas of concern in the oral mucosa. Dentists, dental hygienists, and dental assistants participated in a one-day workshop on the procedure with didactic sessions and hands-on assessments of patients with high grade dysplasia or squamous cell cancer lesions.

For the following four months, the dental offices screened all patients over age 21 for oral cancer, collected risk information, completed extraoral and intraoral exams, and performed autofluorescence visualization of the oral mucosa with a handheld device.

“With the autofluorescence device, the exams took less than two minutes,” said Laronde. “Although dentists are taught this skill, many of them had questions about the details of oral cancer screening, including how to talk to patients about screening and how to do biopsies.”

Some of the participants themselves suggested a way to communicate with patients: Information sheets for patients in different languages, and prep sheets for dental staff with simple responses to common questions, Laronde said. One dentist put together a one page script about oral cancer screening, including why screenings are important, and included statistics about oral cancer. “This raised patients’ awareness, and they started to ask questions about oral cancer that they hadn’t asked before,” the dentist said.

Some participants told the researchers that oral cancer just wasn’t at the top of their list. “You tend to forget oral cancer screening because you’re focusing on the crowns and bridges and fillings and implants,” one dentist said. “You kind of leave all that (screening) education behind.”

Others pointed out that they couldn’t make money from cancer screenings. “The dentists felt they needed extra time not only for the exam, but for explaining the screening process to patients,”Laronde said.

In general, patient responses were very positive to the screenings. However many were surprised because they hadn’t been screened before, dental personnel reported.

The dentists and other dental personnel called for mandatory continuing education for all dental personnel to maintain the skills needed for oral cancer screenings. They suggested that a certification course for new technology (including fluorescence visualization) be available at conferences and workshops. They also noted that there was a need for guidelines, protocols and referral pathways, regarding who should be screened, at what intervals, what cases to refer forward, and who to refer patients to for follow-up and possible treatment.

In an editorial in a special issue on oral cancer published by the Journal of the Canadian Dental Association in April 2008, the Canadian researchers noted that dentists can prioritize patients for screening. Dentists should especially screen patients over 40, smokers, and those who use alcohol regularly, since these patients are at higher risk, the researchers said. But they recommended that screenings should be performed at every dental visit. “It’s important for us to integrate these screenings into our daily practice,” Laronde said.

April, 2009|Oral Cancer News|

New diagnostic advance seen for head, throat cancer

Author: staff

Pharmacy researchers at Oregon State University today announced the discovery of a genetic regulator that is expressed at higher levels in the most aggressive types of head and neck cancers, in work that may help to identify them earlier or even offer a new therapy at some point in the future.

This “transcriptional regulator” is called CTIP2, and in recent research has been demonstrated to be a master regulator that has important roles in many biological functions, ranging from the proper development of enamel on teeth to skin formation and the possible treatment of eczema or psoriasis.

In the newest study, published April 28 in PLoS One, scientists found for the first time that levels of CTIP2 were more than five times higher in the “poorly differentiated” tumor cells that caused the most deadly types of squamous cell carcinomas in the larynx, throat, tongue and other parts of the head. There was a high correlation between greater CTIP2 expression and the aggressive nature of the cancer.

Head and neck squamous cell cancers are the sixth most common cancers in the world, the researchers said in their study, and a significant cause of mortality. In 2008, cancers of the oral cavity and pharynx alone accounted for 35,310 new cases in the United States and 7,590 deaths. They have been linked to such things as tobacco use and alcohol consumption.

“Serious head and throat cancer is pretty common, and mortality rates from it haven’t improved much in 20 years, despite new types of treatments,” said Gitali Indra, an assistant professor in the OSU College of Pharmacy. “With these new findings, we believe it should be possible to create an early screening and diagnostic tool to spot these cancers earlier, tell physicians which ones need the most aggressive treatments and which are most apt to recur.”

It’s also possible the work may lead to new therapeutic approaches, researchers say.

“It’s not completely clear yet whether the higher levels of CTIP2 expression are a consequence of cancer, or part of the cause,” said Arup Indra, also an OSU assistant professor of pharmacy. “However, we strongly suspect that it’s causally related. If that’s true, then therapies that could block production of CTIP2 may provide a new therapeutic approach to this type of cancer.”

That this genetic regulator could be involved in both skin development and these types of cancer makes some sense, the scientists said – both originate from epithelial cells.

It’s also possible, the study found, that CTIP2 works to help regulate the growth of what is believed to be a cancer “stem” or “progenitor” cell, which has a greater potential to generate tumors through the stem cell processes of self-renewal and differentiation into multiple cell types. Therefore, targeting cancer stem cells holds promise for improvement of survival and quality of life of cancer patients.

This research was partly supported by a $1.5 million grant from the National Institutes of Health. The work was done in collaboration with researchers in the Cancer Institute in Strasbourg, France.

Journal reference:
1. Ganguli-Indra et al. CTIP2 Expression in Human Head and Neck Squamous Cell Carcinoma Is Linked to Poorly Differentiated Tumor Status. PLoS ONE, 2009; 4 (4): e5367 DOI: 10.1371/journal.pone.0005367

April, 2009|Oral Cancer News|

Experimental drug shows promise against head and neck cancer

Author: press release

A laboratory study by researchers at Albert Einstein College of Medicine of Yeshiva University suggests that an anti-cancer compound studied for treating blood cancers may also help in treating cancers of the head and neck. The work is reported in the April 28th online edition of the Journal of Pathology.

Head and neck cancer refers to tumors in the mouth, throat, or larynx (voice box). Each year about 40,000 men and women develop head and neck cancer in the U.S., making it the country’s sixth-most common type. Surgery, chemotherapy and/or radiation are the main treatment options but can cause serious side effects. Better treatments are needed, since only about half of patients with head and neck cancer survive for five or more years after diagnosis.

The Einstein study involved a new class of chemotherapy agents known as histone deacetylase (HDAC) inhibitors, which affect the availability of genes that are transcribed and translated into proteins. In many types of cancer, out-of-control cell growth results from certain genes that are either too active or not active enough in producing proteins. HDAC inhibitors appear to combat cancer by restoring the normal expression of key regulatory genes that control cell growth and survival.

The Einstein researchers focused on a particular HDAC inhibitor known as LBH589 that has already shown some success in clinical trials involving people with cancers of the blood. The researchers found that LBH589 succeeded in killing tumor cells that had been removed from head and neck cancer patients and grown in the laboratory.

“This report shows that an HDAC inhibitor is effective on head and neck cancer cell lines, and that is the first step toward use in humans,” said Richard Smith, M.D., the lead clinician involved in the study. Dr. Smith is associate professor of clinical otorhinolaryngology-head & neck surgery and associate professor of surgery at Einstein and is also vice-chair of otorhinolaryngology-head & neck surgery at Einstein and Montefiore.

The researchers also identified a set of genes whose expression levels change in response to the HDAC inhibitors—a finding that may help doctors identify patients most likely to respond to the drug. Plans call for testing LBH589 on head and neck tumor cells from more patients so that the set of genes that respond to the drug can be more firmly established.

“We are performing studies in mice to confirm these laboratory results, which hopefully will progress to human clinical trials of LBH589 for the treatment of head and neck cancer,” said Michael Prystowsky, M.D., Ph.D., chair and professor of pathology at Einstein and corresponding author of the article.

Other Einstein researchers involved in the study were Alfred Adomako, Nicole Kawachi, Wendy McKimpson, Quan Chen, Nicolas Schlecht, Geoffrey Childs and Thomas Belbin. The title of the paper is “The histone deacetylase inhibitor LBH589 inhibits expression of mitotic genes causing G2/M arrest and cell death in head and neck squamous cell carcinoma cell lines.”

April, 2009|Oral Cancer News|

Spit tobacco is not a quit-smoking solution

What do you think?

Dr. Brad Rodu recommends spit tobacco use as a method to help with smoking cessation (“Smokers need the facts on alternatives,” Ideas, April 19).

This strategy, known as harm reduction, encourages spit tobacco as an alternative to cigarettes because of lower risks for severe health consequences.

Although smoking cessation is very important, spit tobacco is not a safe alternative. There are numerous diseases and illnesses that have been scientifically linked to spit tobacco, including gingivitis, tooth decay, cardiovascular disease and oral, esophageal, pharyngeal, laryngeal, stomach and pancreatic cancer.

The most dangerous of these health issues is oral cancer, which has a mortality rate of 54 percent within five years of diagnosis. The risk for developing oral cancer from spit tobacco has been found to be 14 times greater than the risk in nonusers.

Besides the health risks associated with the use of spit tobacco, there are other concerns with harm reduction. There could be an increase in use among adolescents who think “smokeless is harmless” when it comes to spit tobacco, an overall increase in the use of tobacco by nonusers, and an increase in sales of high-nicotine products that raise the risk for addiction.

In his research, Dr. Rodu has often discussed the effectiveness of harm-reduction programs in Sweden. While Swedish studies have indeed demonstrated decreased smoking levels through the use of spit tobacco, there are several differences between the two countries that make it difficult to compare the United States to Sweden.

First of all, the spit tobacco products are dramatically different. The levels of cancer-causing agents found in Swedish spit tobacco brands are dramatically lower (by as much as 98 percent). Sweden also has a rigorous system of controls over manufacturing and advertising of spit tobacco products. The United States has no regulatory control over spit tobacco and very few restrictions on advertising. The United States and Sweden are not similar when it comes to spit tobacco products and should not be compared for harm reduction purposes.

Dr. Rodu also states that the British Royal College of Physicians has endorsed spit tobacco use for smoking cessation. However, professor John Britton, chairman of the RCP tobacco advisory group, states, “The best thing that a smoker can do for his or her health is to quit all smoking and nicotine use completely. Nicotine products like the patch and gum deliver necessary amounts of the drug to overcome addiction withdrawal without any of the risks of tobacco use.” There are clinically proven options available that do not include any increased risk of cancer that should be utilized rather than other forms of tobacco.

Finally, the author neglected to mention his vested interest in the use of spit tobacco. Dr. Rodu is an endowed professor of tobacco harm reduction. Dr. Rodu’s position at the university and his line of research are directly sponsored by grants from the U.S. Smokeless Tobacco Co. (Skoal, Copenhagen) and Swedish Match — two of the largest spit tobacco manufacturers in the world. He has received millions of dollars in grant funding from spit tobacco companies and has acted as an expert witness for them in product liability lawsuits.

Given the uncertainties associated with Dr. Rodu’s strategy, the World Health Organization and other public health groups have determined that the overall risks associated with spit tobacco do not support the use of a harm reduction strategy.

Decreasing the smoking levels in North Carolina and the United States is very important from a health standpoint. But there are ways that this can be achieved without recommending spit tobacco. We need to decrease tobacco use, period, not replace one tobacco product with another.


Ted Eaves is an adjunct assistant professor at N.C. A&T State University whose research focuses on spit tobacco use and cessation.

April, 2009|Oral Cancer News|

Too Hot for Teacher?

Calendar raises money and eyebrows

Source: Fox 35 News

Author: Holly Bristow

COCOA BEACH, Fla. (WOFL FOX 35) – On campus, he teaches math at Cocoa Beach Junior/Senior High. Off campus, he’s known in some circles as “Mr. August.” 

Patrick Kile is the driving force behind a calendar which features fellow teachers – some scantily-clad – all for a charity project.

Money raised from calendar sales goes to cancer research. It’s a fundraiser for his “Relay for Life” team and all profits are going to the the American Cancer Society, but do students really need to see skin from their teachers?

While it’s getting some good reviews, shots like Mr. June (pictured) are making some waves, as six of the teachers are shirtless.

“Coach Mortar coaches wrestling and works with weightlifting,” said Kile. “He also teaches history.”

“They’re teachers! You’ve got young impressionable teenage girls,” said one parent “They don’t need that. They need role models, not sexy muscles.”

Kile, 33, teaches Geometry and helps coach Girl’s Soccer.

“We just wanted something ‘outside the box,’ unique and fun and different, that would help open some eyeballs and raise some money,” said Kile, who is a cancer survivor himself. 

“Back in 2005, I was diagnosed with tongue cancer that spread to my neck.”

Now that he’s in remission, Kile is trying to help other cancer victims. 

“It’s for a good cause. I went to the school board and spoke with the ethics director of human resources and he thought it was a great idea!” 

Kile hopes others see it that way too. If not, he says, “Just don’t buy the calendar.”

So far, he has sold 100 calendars. Each is priced at $20. His goal is to sell 1,000 calendars to raise about $10,000.

To buy the calendar, contact Patrick Kile at 

April, 2009|Oral Cancer News|

The oral cancer battle

Author: Beth Dunham

As people look for ways to cut corners and save money in this time of economic uncertainty, healthcare sometimes takes a back seat to other expenses — putting lives at risk. A visit to the dentist is crucial and could mean the difference between life and death; someone in the United States dies of oral cancer nearly every hour, according to the Oral Cancer Foundation.

Early detection is crucial in the fight against oral cancer, an aggressive, deadly disease that hasn’t seen the same improvements in survival rates as other cancers, said Parish Sedghizadeh of the USC School of Dentistry.

“Oral cancer has one of the highest mortality rates among cancers,” said Sedghizadeh, assistant professor of clinical dentistry at USC. “It’s usually not noticed until the later stages, when a recovery is less likely. People have heard of oral cancer, but they don’t know what it looks like.”

The disease rarely causes pain or other noticeable symptoms until it reaches a very advanced stage, he said. And while many people stay vigilant for the symptoms of more common cancers, dental care access challenges and a lack of oral cancer education means that most patients don’t know the early signs of oral cancer.

“Oral cancer will often start as a small red or white plaque or sore that doesn’t go away with time, unlike other normal mouth, tongue, or lip sores that usually heal within a week or so,” Sedghizadeh said.

Even if the disease is spotted and treated, fighting it can be especially traumatic, even compared to battling cancer in other regions of the body.

“Oral cancer, given its location, can seriously affect a patient’s quality of life,” Sedghizadeh said. “The disease, as well as the methods used to treat it, can impact a person’s ability to breathe, speak and eat and can permanently disfigure the face.”

Oral cancer is unique in that its diagnoses usually come from dentists instead of physicians. A visual screening for oral cancer involves examining every surface in the mouth, from the lips to underneath the tongue, but physicians may only give the back of the throat a brief examination during a checkup and do no further oral investigation if any at all, Sedghizadeh said.

“Most physicians aren’t looking for problems in the mouth,” he said. “It’s the oral health care professionals that should be performing the oral cancer screenings and diagnosing cases.”

The majority of oral cancers are seen in older patients with several years of exposure to risk factors, including the use of alcohol, tobacco and other drugs. But new findings recently published in the New England Journal of Medicine highlight a possible connection between human papilloma virus (HPV) infection in young adults and higher rates of oral cancer, including a type of cancer previously found only in older smokers.

While the study needs to be replicated and the findings need to be further supported, it’s clear that people of all ages and backgrounds need to maintain good oral health practices, stay vigilant for the signs of oral cancer and make sure that they receive a regular oral health checkup from a dentist or other oral health professional, Sedghizadeh said.

“Even though treatment has improved, we need to be catching oral cancer much earlier,” he said. “And the people best prepared to detect it are dentists.”

Article courtesy of the USC School of Dentistry.

Diet, nutrition, and cancer — don’t trust any single study

Source: American Association for Cancer Research (AACR) 100th Annual Meeting
Author: Zosia Chustecka

Numerous studies on diet and cancer were presented here at the American Association for Cancer Research (AACR) 100th Annual Meeting, but several of the findings that were highlighted in AACR press releases — and thus are likely to be picked up by the lay media — run counter to the accumulated body of evidence, and some of the comments based on these studies are untrue or premature. So said Walter Willet, MD, DrPH, from the department of nutrition at Harvard School of Public Health, in Boston, Massachusetts, in an exclusive interview with Medscape Oncology.

“No conclusions should be made on the basis of a single study,” he said.

Dr. Willett presented an overview entitled “Diet, Nutrition, and Cancer: The Search for Truth,” in which he reviewed many of the associations that have been suggested by epidemiologic studies. These include consumption of red meat, meat cooked at a high temperature, a high-fat diet, and alcohol all increasing the risk, and fruit and vegetables decreasing the risk. However, much of the evidence for these links is rather weak, he said; the most robust evidence supports a link between obesity and an increased risk for cancer.

“The estimate that diet contributes to around 30% to 35% of cancers is still reasonable,” Dr. Willet said, “but much of this is related to being overweight and inactive.”

“At this point in time, being overweight is second only to smoking as a clear and avoidable cause of cancer,” he said. “People should stay as lean as they can, recognizing that it is more difficult for some than for others.”

Beyond this clear message about obesity, there are only hints from the rest of the data. One of the main limitations of all of the studies so far is that they have looked at a specific time of life — for example, women after menopause — and they have had fairly short follow-ups, often less than 10 years. “So what we are looking at are little slices of life,” Dr. Willet said, whereas the effect of diet is lifelong, and might be particularly important in the years before adulthood (e.g., during adolescence).

Barbequing and Other High-Temperature Cooking
One suspect that has been extensively studied as potentially increasing the risk for cancer is the high-temperature cooking of meat, such as barbequing, grilling, frying, and roasting, during which the meat is charred and can form carcinogens.

If there was a strong association, we would have seen it by now.
“But after more than 30 years of study, this link has not been refuted or confirmed in any clear way,” Dr. Willet commented. “If there was a strong association we would have seen it by now, but we cannot exclude a mild or moderate effect.”

One of the studies highlighted in an ACCR press release suggests that charred meat increases the risk for pancreatic cancer. The finding comes from a prospective analysis of 62,581 participants of the Prostate, Lung, Colorectal, and Ovarian multicenter screening trial, and was presented by Kristin Anderson, PhD, associate professor at the University of Minnesota School of Public Health, in Minneapolis. Her team looked at 208 cases of pancreatic cancer, and found that individuals who preferred very well done steak were almost 60% more likely to develop pancreatic cancer than those who ate their steak less well done or who did not eat steak at all. When the researchers considered overall consumption and doneness preferences, this rose to a 70% higher risk for pancreatic cancer.

“We cannot say with absolute certainty that the risk is increased due to carcinogens formed in burned meat,” Dr. Andersen said in the AACR press release. “However, those who enjoy either fried or barbequed meat should consider turning down the heat or cutting off the burned portions when it’s finished.”

Dr. Anderson also advised “cooking meat sufficiently to kill bacteria without charring,” and microwaving meat for a few minutes and pouring off the juices before cooking it on the grill to reduce the precursors of cancer-causing compounds.

But Dr. Willet said that these are very specific recommendations, and “I just don’t think that this is appropriate on the basis of a single study.”

Alcohol — Even 1 Glass Might Increase Risk
For alcohol, there have now been dozens of studies showing an increase in the risk for breast cancer, even with very low levels of consumption, “so this is now an established relationship,” Dr. Willet said in his talk.

It’s been known for a long time that alcohol increases the risk for cancers of the upper aerodigestive organs, but this is at high levels of consumption (around 3 or 4 glasses a day), he told Medscape Oncology. “What’s unique about breast cancer is that the risk is increased at very modest levels of consumption,” he said.

“There is strong evidence that even 1 glass a day can cause a small but significant increase in the risk of breast cancer,” he said. A recent study from the United Kingdom suggests that the risk for many different cancers is increased with even 1 drink a day, and that the risk increases in a dose-dependent fashion, as reported by Medscape Oncology.

So the finding from another study highlighted by the AACR, that “drinking wine may increase survival among non-Hodgkin’s lymphoma patients,” is somewhat surprising. “This conclusion is controversial,” admits first author Xuesong Han, a doctoral candidate at the Yale School of Public Health, in New Haven, Connecticut. “However, we are continually seeing a link between wine and positive outcomes in many cancers,” she noted in the AACR press release.

“This is not true,” said Dr. Willet. There have been benefits shown consistently for cardiovascular disease, but not for cancer, he told Medscape Oncology.

The study conducted by Han and colleagues involved 546 women with non-Hodgkin’s lymphoma. Those who drank wine had a 5-year survival rate of 76%, and those who did not had a 5-year survival rate of 65%. In a subanalysis, the researchers found that the strongest link was seen in patients with diffuse large B-cell lymphoma. These patients had a 40% to 50% reduced risk for death, relapse, or secondary cancer.

The researchers also asked the patients about their wine-drinking habits in the 25 years before their diagnosis. In the overall group, patients who had been drinking wine at least this long had a 25% to 35% reduced risk for death, relapse, or cancer, whereas in the subgroup of patients with large B-cell lymphoma, this reduction was 60%.

“We cannot look at this 1 study is isolation,” said Dr. Willet.

Specific Foods and Anticancer Effects
So far, there have been no specific foodstuffs that have been identified as having proven anticancer effects, Dr. Willet told Medscape Oncology.

Even the case for eating more fruit and vegetables, a message widely promulgated by many authorities, including the World Cancer Research Fund, is fairly weak when it comes to cancer. There have been studies showing a decrease in the risk for colon and breast cancer, but other studies have shown insignificant or no appreciable effects, Dr. Willet told the meeting. A 2004 meta-analysis by Hsin-Chia Hung and colleagues concluded that eating more fruits and vegetables decreases the risk for cardiovascular disease, but not the risk for cancer (J Natl Cancer Inst. 2004;96:1577-1584).

“So the message to eat fruits and vegetables is still a good message, but there appears to be more benefit for cardiovascular disease than for cancer,” he said.

In that context, the claim made in another AACR press release, that “walnuts may prevent breast cancer” is premature, especially because it is based on an animal study, Dr. Willet said. The study was conducted in a mouse model of breast cancer, and mice fed a diet estimated to contain the human equivalent of 2 ounces of walnuts per day showed a significant decrease in the incidence of tumors, a significant decrease in tumor size, and a delay in the development of these tumors by about 3 weeks..

Lead researcher Elaine Hardman, PhD, associate professor of medicine at Marshall University School of Medicine, in Huntington, West Virginia, said: “It is clear that walnuts contribute to a healthy diet that can reduce breast cancer.”

“That’s a premature leap, that’s for sure,” said Dr. Willet.

Maybe the only foodstuff that does have some evidence suggesting a preventive anticancer effect is soy products. Its antiestrogen properties might protect against prostate cancer in men and against breast cancer in women, especially in premenstrual women, Dr. Willet noted. “But this is not yet in the category of convincing — it’s possible,” he said.

Dr. Willet has disclosed no relevant financial relationships.

American Association for Cancer Research (AACR) 100th Annual Meeting: Abstracts LB-224, LB-243, and LB-247. Presented April 21, 2009.

April, 2009|Oral Cancer News|

House bill curbs advertising, increases taxes on smokeless tobacco

Source: The Clackamas Review
Author: News Team

(news photo)

A vending display for Snus, a smokeless, spitless tobacco Camel first marketed in Portland and Austin, Texas. A new house bill would limit advertising for such products while increasing taxes on them.


The bill also bans the practice of handing out samples

The Oregon House today passed a bill that would require all smokeless tobacco products to adhere to federally mandated marketing restrictions placed on older existing brands in an effort to curb youth advertising campaigns. The legislation would also increase the tax on such products.

The bill, co-sponsored by House Speaker Dave Hunt, D-Gladstone, came about partially as a response to the proliferation of smokeless tobacco products critics said targeted young customers. In 2006, Camel used the Portland region and Austin, Texas as test markets for its Snus smokeless tobacco. Smoking cessation advocates cried foul, saying the colorful ads with their rhyming slogans were designed to attract young people.

The bill also prevents companies from handing out free samples of smokeless tobacco, something Rep. Carloyn Tomei, D-Milwaukie, said was happening everywhere from the streets of Portland to rodeos and fairs in eastern Oregon, particularly since Washington already has a ban. She introduced a similar bill earlier this year.

“Oregon has become the place where they have campaigns for smokeless tobacco,” she said. “They’re handing out free Snus samples, and to whom did they hand it out? Not people my age; it’s the young ones.”

The bill would tax smokeless tobacco by the can and the weight instead of as a percentage of the price. The tax will be a flat $2.14 on all cans of smokeless tobacco that weigh 1.2 ounces.

The bill puts Oregon on track to become the first state to include all smokeless tobacco companies in the restrictions on youth marketing in the federal smokeless tobacco master settlement agreement. Previously, only items in existence at the time of the master settlement in 1998 were covered. According to Geoff Sugerman, Hunt’s spokesperson, that meant only a handful of products were covered. In the past decade, dozens of new smokeless items have popped up as tobacco companies have searched for a way to sell products while dealing with increased taxes and restrictions on cigarettes.

The bill passed the House 40-18.

“They may look like gum. They may look like breath mints. They may taste like candy. But make no mistake – these products will kill our children. This is tobacco with training wheels,” said State Rep. Sara Gelser, D-Corvallis, who co-sponsored the current bill along with Hunt. “This bill will stop kids from taking up another dangerous habit that today falls outside the tobacco master settlement agreement regulating advertising aimed at teens.”

The bill now moves on to the Oregon Senate.

April, 2009|Oral Cancer News|

Cancer risk of nicotine gum and lozenges higher than thought

Author: Mark Henderson

Nicotine chewing gum, lozenges and inhalers designed to help people to give up smoking may have the potential to cause cancer, research has suggested.

Scientists have discovered a link between mouth cancer and exposure to nicotine, which may indicate that using oral nicotine replacement therapies for long periods could contribute to a raised risk of the disease. A study funded by the Medical Research Council, led by Muy-Teck Teh, of Queen Mary, University of London, has found that the effects of a genetic mutation that is common in mouth cancer can be worsened by nicotine in the levels that are typically found in smoking cessation products.

The results raise the prospect that nicotine, the addictive chemical in tobacco, may be more carcinogenic than had previously been appreciated. “Although we acknowledge the importance of encouraging people to quit smoking, our research suggests nicotine found in lozenges and chewing gums may increase the risk of mouth cancer,” Dr Teh said. “Smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their general practitioners if they are concerned. The important message is not to overuse it, and to follow advice on the packet.”

Most nicotine replacement products have labels advising people to cut down after three months of use and to stop completely after six months.

Mouth cancer affects nearly 5,000 people each year in Britain and is usually linked to smoking, chewing tobacco or drinking alcohol. It is often diagnosed at a late stage, and consequently has a poor prognosis.

Although nicotine is acknowledged as the addictive element in cigarettes its role in cancer has long been disputed. It is not as potent a carcinogen as other chemicals found in tobacco smoke, such as tar, but some previous research has suggested that it may also contribute to the formation of tumours.

Nonetheless, it is much less dangerous than cigarettes and is therefore used in a wide variety of smoking cessation products that allow addicts to satisfy a craving for the chemical without smoking.

In the new research, published in the journal Public Library of Science One, Dr Teh’s team has investigated the role of a gene called FOXM1 in mouth cancer.

A mutation that raises the activity of this gene is commonly found in many tumours, and is also present in pre-cancerous cells in the mouth, the scientists found. This raised expression can then be worsened by exposure to nicotine, according to Dr Teh.

“If you already have a mouth lesion that is expressing high levels of FOXM1 and you expose it to nicotine, it may add to the risk of converting it into cancer,” he said. “Neither the raised FOXM1 nor nicotine is alone sufficient to trigger cancer, but together they may have an effect.

“The concern is that with smokers, you are looking at people who are already at risk of oral cancer. I’m worried that some may already have lesions they don’t know about in the mouth, and if they keep on taking nicotine replacement when they stop smoking products they will not be doing themselves any good.”

The findings could also lead to new ways of diagnosing mouth cancer while it is still in its early stages and easier to treat.

Dr Teh emphasised that smokers should not stop their attempts to give up. “There is no doubt about the harmful effects of smoking, so smokers should make every effort to quit.”

April, 2009|Oral Cancer News|