Monthly Archives: July 2009

Oral sex cause of throat cancer rise

Author: Salynn Boyles

Changing sexual practices have led to a dramatic rise in throat cancer in the United States over the past two decades, and experts say they fear an epidemic of the disease.

The comments were made Wednesday at a news conference held by the American Association for Cancer Research to discuss research into the role of the sexually transmitted human papilloma virus ( HPV) in head and neck cancer.

Increasing rates of HPV infection, spread through oral sex, is largely driving the rapid rise in oropharyngeal cancers, which include tumors of the throat, tonsils, and base of the tongue, said Scott Lippman, MD, who chairs the thoracic department at the University of Texas M.D. Anderson Cancer Center.

Studies of oropharyngeal tumor tissue stored 20 years ago show that only around 20% are HPV positive, Lippman said. Today it is estimated that 60% of patients are infected with the virus.

“The percentage of oropharyngeal cancers that are HPV positive is much higher now than it was 20 years ago,” he said. “This is a real trend, and that is why there is concern of an epidemic given that fact that oropharyngeal cancer is increasing at an alarming rate.”

Changing Face of Throat Cancer
Smoking and alcohol abuse were once considered the only major risk factors for these cancers, but this is no longer the case.

American Cancer Society Chief Medical Officer Otis Brawley, MD, said as many as half of the oropharyngeal cancers diagnosed today appear to be caused by HPV infection.

“Changing sexual practices over the last 20 years, especially as they relate to oral sex, are increasing the rate of head and neck cancers and may be increasing the rates of other cancers as well,” he said.

He added that there is some evidence that oral HPV infection is also a risk factor for a type of cancer of the esophagus.

“The paradigm is changing,” Lippman said. “The types of patients we are seeing now with oropharyngeal cancers are not the patients we have classically seen who were older, smokers, and have lots of other problems. These are young people, executives, a whole different population.”

Oral Sex Not Safe Sex
The experts agreed that it is critical for the public to understand that oral sex doesn’t equal safe sex. The message was unofficially promoted in the early days of the HIV epidemic and it is still widely believed by many, especially teens.

Studies suggest that teens are often unaware of the risks associated with unprotected oral sex, including the transmission of HPV, chlamydia, and gonorrhea.

“There is a huge public health message here,” Brawley said.

Cancer pharmacoethnicity: ethnic differences in susceptibility to the effects of chemotherapy

Source: Clinical Cancer Research
Authors: Peter H. O’Donnell and M. Eileen Dolan

A long-term goal of pharmacogenomics research is the design of individualized therapy based on the genomic sequence of the patient, in order to maximize response and minimize adverse drug reactions. Pharmacoethnicity, or ethnic diversity in drug response or toxicity, is becoming increasingly recognized as an important factor accounting for interindividual variation in anticancer drug responsiveness. Although pharmacoethnicity is determined by genetic and nongenetic factors, there is rapidly accumulating clinical evidence about ethnic differences in the frequencies of polymorphisms within many of the important cancer drug-related genes. This article reviews the current clinical evidence for ethnic differences in anticancer drug dispositionand sensitivity while highlighting the challenges, and potential solutions, to acquiring such knowledge. The discovery of “ethnic-specific genetic signatures,” representing unique sets of drug susceptibility-governing polymorphisms, may be the outcome of such work. Ultimately, such understanding will further the lofty goal of individualization of chemotherapy based on a person’s unique genetic make-up to improve the tolerability and effectiveness of chemotherapy for all patients.

July, 2009|Oral Cancer News|

Throat cancer from HPV proves treatable

Author: Nathan Seppa

Cancer of the throat that stems from a human papillomavirus infection responds to treatment better than throat cancer that’s triggered by other causes, researchers report online July 29 in Cancer Prevention Research.

The scientists also find that blacks are less likely than whites to have throat cancer that’s attributable to HPV, which may explain why the cancer also proved more deadly in blacks in this study.

Throat cancer, formally known as oropharyngeal cancer, includes malignancies at the base of the tongue, on the tonsils, in the back of the mouth or on the walls of the throat. The cancer has been linked to smoking and alcohol use, but it can also arise from HPV infections acquired via oral sex (SN: 5/12/07, p. 291).

In the new study, researchers analyzed two sets of people with throat cancer.

One group included 196 whites and 28 blacks participating in an ongoing international medical trial. While 66 of the white patients had HPV-positive cancer, only one of the blacks did. All received chemotherapy and radiation.

Looking at survival among these patients over more than five years, the researchers found that HPV-negative throat cancer patients had a median survival of only 20 months. Race didn’t change this data significantly.

In contrast, patients with HPV-positive throat cancer lived substantially longer. Their median survival time could not be accurately discerned because many patients were still alive when the study data were analyzed, says study coauthor Kevin Cullen, a medical oncologist at the University of Maryland Medical Center in Baltimore. This bolsters previous studies showing HPV-positive throat cancer responds well to chemotherapy and radiation.

Cullen and his colleagues decided to examine survival rates among an additional group of patients treated for throat cancer in Baltimore. They identified 124 patients who had been monitored for more than five years, including 54 blacks and 70 whites. The two racial groups had comparable disease progression and received similar treatments. But median survival time for the whites was 69 months, compared with only 25 months for the blacks.

“The better outcome of white versus black oropharyngeal cancer patients in an equal-care setting can be explained by the larger proportion of white patients with better-prognosis HPV-positive tumors,” says oncologist Otis Brawley of the American Cancer Society in Atlanta, in a perspective article accompanying the report.

Differences in sexual practices are a very plausible explanation, he says. Brawley cites a survey showing that white males and females age 15 to 19 are more likely to engage in oral sex than are their black counterparts. Blacks that age are more likely than whites to have experienced genital-to-genital sex.

As the impact of HPV status on throat cancer becomes clearer, treatment for the malignancy will change, says Maura Gillison, a medical oncologist at Ohio State University in Columbus. Patients who test positive for HPV might get by with lighter doses of chemotherapy or radiation, she says.

But those with HPV-negative throat cancers — the kind brought on by smoking and alcohol — face a stiffer challenge because they benefit less from chemo and radiation.

“We’ve got to look at HPV-negative patients to see whether they have a good surgical option,” Cullen says.

Meanwhile, vaccines that prevent cervical cancer from HPV infection may have newfound value, Gillison says. “There is considerable optimism in the medical community that these vaccines will be effective in other sites,” including the throat, she says.

July, 2009|Oral Cancer News|

IsoRay announces first head and neck cancer treated with Cesium-131

Author: press release

IsoRay, Inc. announced today that on June 4, 2009, Dr. Karen Pitman of the Department of Otolaryngology and Communicative Sciences and Dr. Michael Baird of the Radiation Oncology Department of the University of Mississippi Medical Center performed the world’s first head and neck permanent seed Cesium-131 implant.

The implant was performed using Vicryl-embedded seeds in the tonsilar area in a patient who had locally failed IMRT external beam radiation and chemotherapy. Drs. Pitman and Baird chose Cesium-131 for this implant based on its high energy (30.4 kev) and short half-life (9.7 days). This combination allowed them to achieve a high dose of radiation to the recurrent disease, while limiting the dose to the previously heavily irradiated tissues of the neck. Cesium’s short half-life reduced the duration of side effects and the need for radiation protection.

Dr. Baird stated, “Although too early to determine the overall efficacy of treatment, the patient’s tolerance to the implant has been good. His acute reactions peaked at three weeks, and have resolved by six weeks. His clinical reaction in the implant volume corresponds well to the post implant dosimetry.”

Until now clinical experience with Cesium-131 has been focused on prostate cancer and ocular melanoma. However, Cesium-131 has been cleared by the FDA for use in the treatment of malignant disease (e.g., prostate, ocular melanoma, head and neck, lung, brain, breast, etc.) and may be used in surface, interstitial, and intracavitary applications for tumors with known radiosensitivity.

Dwight Babcock, IsoRay’s CEO, stated “This is an important development in our strategy to significantly broaden our base beyond prostate cancer. Cesium-131 has unique characteristics for treating many additional cancers such as this new application that provided a minimally invasive treatment option for this patient.”

About IsoRay
IsoRay, Inc., through its subsidiary, IsoRay Medical, Inc., is the sole producer of the Proxcelan Cesium-131 brachytherapy seeds, used to treat prostate, ocular melanomas, and other cancers. Proxcelan seeds offer a significantly shorter half-life than the two other isotopes commonly used for brachytherapy, which results in a substantially faster delivery of therapeutic radiation, lower probability of cancer cell survival and reduction of the longevity of common brachytherapy side effects(a)(b). IsoRay is based in Richland, Washington. More information is available about IsoRay at

(a) Armpilia CI, Dale RG, Coles IP, et al. The Determination of Radiobiologically Optimized Half-lives for Radionuclides Used in Permanent Brachytherapy Implants. Int. J. Radiation Oncology Biol. Phys. 2003; 55 (2): 378-385.

(b) Prestidge B.R., Bice W.S., Jurkovic I., et al. Cesium-131 Permanent Prostate Brachytherapy: An Initial Report. Int. J. Radiation Oncology Biol. Phys. 2005; 63 (1): 5336-5337.

Low prevalence of HPV infection may be tied to poor prognosis for blacks with head and neck cancer

Author: public release

Groundbreaking study seeks to explain major disparity in survival between blacks and whites

Researchers at the University of Maryland Marlene and Stewart Greenebaum Cancer have found that head and neck cancer patients who test positive for the human papillomavirus (HPV) have much better survival rates than patients who don’t have the virus, according to a new study in the journal Cancer Prevention Research. The researchers also discovered that blacks in the study had a very low rate of HPV infection, and consequently worse survival, which may explain why African-American patients traditionally have had a poor prognosis for head and neck cancer.

“For the first time, we have evidence that the major difference in survival between black and white patients with head and neck cancer appears to be the rate of HPV infection. We found an astounding difference in prognosis between patients who are HPV-positive and those who are HPV-negative,” says the study’s senior author, Kevin J. Cullen, M.D., director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor of medicine at the University of Maryland School of Medicine.

Scott Lippman, M.D., chairman of the Department of Clinical Cancer Prevention at the University of Texas M.D. Anderson Cancer Center, called the study, “practice-changing.”

“Squamous cell carcinoma of the head and neck is one of the fastest growing cancers, and this study gives us a new way to assess prognosis for our patients,” says Dr. Lippman, who is editor-in-chief of Cancer Prevention Research, which is published by the American Association for Cancer Research.

Dr. Cullen adds, “We need to analyze HPV routinely in specific patients with head and neck cancer, which we’re currently not doing. HPV-positive cancer is biologically a very different disease than HPV-negative cancer, and we need to take that into account as we’re planning future therapies. Those with HPV-negative disease may not be as well served with our current treatments combining chemotherapy and radiation.”

The human papillomavirus is known to cause certain types of cancer and is a major risk factor for head and neck cancer, so researchers were surprised to find that patients with HPV infection had a better prognosis.

Only 4 percent of black patients with squamous cell carcinoma in the study were HPV-positive, compared with 34 percent of white patients. The median overall survival was more than three-fold higher for whites (70.6 months) than for blacks (20.9 months) who were treated with chemotherapy and radiation. Dr. Cullen says the survival rate at five years for HPV-positive patients was about 85 percent, compared to 35 percent for HPV-negative patients. Survival was similar for HPV-negative patients, regardless of race. The study’s findings confirm that HPV infection relates specifically to a type of head and neck cancer — cancer of the oropharynx, which include the tonsils, soft palate and base of the tongue.

Dr. Cullen says, “There is currently no consensus on why blacks fare worse with squamous cell carcinoma of the head and neck than whites, but our findings provide the first clue that a critical reason may be biologic rather than related to issues of access to care, lack of insurance or attitudes of health care providers.”

“Many researchers at the University of Maryland School of Medicine are conducting important studies relating to racial disparities in diagnosis and treatment. This groundbreaking study will have a significant impact on how doctors care for patients with head and neck cancer,” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.

Cancer experts believe that head and neck cancer, particularly oropharyngeal cancer, is on the rise because of an increase in HPV infection in the oral cavity. Overall, about 25 percent of head and neck cancers are tied to HPV infection, Dr. Cullen says. In comparison, HPV causes virtually 100 percent of cervical cancers, and a vaccine has been developed to help prevent this type of cancer by preventing HPV infection.

Researchers don’t yet understand why blacks have a lower rate of HPV infection in head and neck cancers than whites, Dr. Cullen says. There is some evidence that HPV transmission associated with oral cancer may be related to sexual practices, but he says there are probably a number of other factors involved, including possible differences in immunity and how the virus can become integrated into the cell’s DNA “that now we just don’t understand.”

In the study, researchers analyzed data from about 200 patients who had been treated at the Greenebaum Cancer Center and then evaluated another group of 230 patients treated as part of a multi-center clinical trial.

The study was funded in part by the Maryland Cigarette Restitution Fund Program, which uses money from a legal settlement with big tobacco companies for cancer research and cancer screening, education and prevention programs in Maryland. “This is really a wonderful example of how CRF-supported research can benefit Marylanders and all people who are battling cancer,” Dr. Cullen says. “We are very committed to helping the Cigarette Restitution Fund fulfill its mission of erasing racial disparities in diagnosis and care.”

1. The research was also funded by grants from sanofi-aventis U.S. and the Orokawa Foundation.

2. The University of Maryland Marlene and Stewart Greenebaum Cancer Center is a National Cancer Institute-designated cancer center. It offers a full range of treatments for all types of cancer and has a very active cancer research program. To learn more, go to

Study suggests VELscope System helps reduce recurrence of oral cancer

Author: press release

LED Dental Inc. announced today that a recent study suggests that its VELscope screening system can help surgeons reduce the recurrence rate for oral cancer following surgery.

The article, “Tracing the ‘At-Risk’ Oral Mucosa Field with Autofluorescence: Steps Toward Clinical Impact,” was just published in the journal Cancer Prevention Research. It was authored by Catherine F. Poh, Calum E. MacAulay and Miriam Rosin of the BC Cancer Agency and Lewei Zhang of the University of British Columbia. The study was prompted by numerous previous studies showing that oral cancer recurs in a significant percentage of patients following oral cancer surgery.

The study examined the experience of 60 oral cancer surgery patients between 2004 and 2008. Their cancerous lesions were treated with surgical excision alone, with a minimum follow-up time of 12 months. For 38 of the 60 patients, the surgeon used a surgical margin that was 10 mm beyond the tumor edge defined by the VELscope exam. Because the VELscope system utilizes fluorescence visualization, or FV, technology, these patients are described in the article as having had FV-guided surgery. The remaining 22 patients–the control group–did not have FV-guided surgery; instead, the surgeon used a surgical margin that was 10 mm beyond the tumor edge defined by the standard white-light exam. White light exams rely on visual inspection with the naked eye, whereas the VELscope system allows clinicians to discover cancerous and precancerous tissue that might not be apparent to the naked eye.

Four years into the study, severe dysplasia or more serious tumors have recurred in 7, or 32%, of the 22 control group patients. In contrast, none of the 38 FV-guided group patients has suffered a recurrence of severe dysplasia or more serious tumors, including cancer.

“The VELscope system is the first adjunctive device cleared by both the FDA and Health Canada to help surgeons determine the appropriate surgical margin,” said Ralph Green, D.D.S., M.B.A., president and CEO of LED Dental’s parent, LED Medical Diagnostics. “While the findings of this study are not surprising, it is nonetheless gratifying to have these respected researchers report that absolutely zero of the 38 oral cancer patients whose surgical margins were determined using the VELscope system has experienced a recurrence of this deadly and disfiguring disease.” Dr. Green added, “Numerous other studies, as well as extensive feedback from our users, have documented the ability of the VELscope system to help dental practitioners discover cancerous and precancerous lesions that otherwise would have been missed. This new study suggests that in addition to enhancing the detection of oral cancer, the VELscope system can help ensure that all targeted diseased tissue is removed when surgical excision is indicated.”

Oral cancer claims the life of one North American every hour of every day. Despite the reduction in the use of tobacco products, it is one of the few types of cancer that has not experienced a significant reduction in the number of victims over the past several decades. Recent studies suggest that the reason is a link between oral cancer and the sexually-transmitted human papilloma virus, or HPV. As a result, many health experts recommend that all adults receive oral cancer examinations on at least an annual basis.

Introduced to the dental market approximately three years ago, the VELscope system is already used for more oral cancer examinations than any other adjunctive technology in the world. Since its introduction, over 4,500 systems have been sold worldwide, and over 4.5 million VELscope examinations have been conducted. LED Dental estimates that over 3 million examinations, which are completely non-invasive and take only 2-to-3 minutes, will be conducted in 2009 alone.

The tissue fluorescence visualization technology platform on which the VELscope system is based is the culmination of over $50 million in research funded by the National Institutes of Health and other respected institutions and conducted by such leading organizations as the BC Cancer Agency and the University of Texas’s M.D. Anderson Cancer Center. The VELscope system also helps clinicians discover non-cancerous types of oral mucosal abnormalities

Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study

Author: Juhua Luo, MSc et al.

Although classified as carcinogenic, snuff is used increasingly in several populations. Scandinavian moist snuff (snus) has been proposed as a less harmful alternative to smoking, but precise data on the independent associations of snus use with site-specific cancers are sparse. We aimed to assess the risks for cancer of the oral cavity, lung, and pancreas.

Detailed information about tobacco smoking and snus use was obtained from 279 897 male Swedish construction workers in 1978—92. Complete follow-up until end of 2004 was accomplished through links with population and health registers. To distinguish possible effects of snus from those of smoking, we focused on 125 576 workers who were reported to be never-smokers at entry. Adjusted relative risks were derived from Cox proportional hazards regression models.

60 cases of oral, 154 of lung, and 83 of pancreatic cancer were recorded in never-smokers. Snus use was independently associated with increased risk of pancreatic cancer (relative risk for ever-users of snus 2·0; 95% CI 1·2—3·3, compared with never-users of any tobacco), but was unrelated to incidence of oral (0·8, 95% CI 0·4—1·7) and lung cancer (0·8, 0·5—1·3).

Use of Swedish snus should be added to the list of tentative risk factors for pancreatic cancer. We were unable to confirm any excess of oral or lung cancer in snus users.

Juhua Luo MSc a, Weimin Ye MD a, Kazem Zendehdel MD a c, Johanna Adami MD a b, Prof Hans-Olov Adami MD a d, Prof Paolo Boffetta MD a e, Prof Olof Nyrén MD

The Lancet, Volume 369, Issue 9578, Pages 2015 – 2020, 16 June 2007

Give Gardasil to boys too, experts say

Author: Dina Rosendorff

Recent evidence shows the human papilloma virus (HPV), which causes cervical cancer in women, is poised to become one of the leading causes of oral cancer in men because of changing sexual behaviours.

The findings have reignited the debate over whether boys should be given the cervical cancer vaccine, Gardasil.

A visiting British virologist, Professor Margaret Stanley, says governments around the world need to examine the long-term economic and health benefits of immunising boys and young men.

The head of Microbiology and Infectious Diseases at Melbourne’s Royal Women’s Hospital, Professor Suzanne Garland, says Australia is leading the way in the rollout of the cervical cancer vaccine Gardasil, which immunises against HPV.

“We are in our third year of rolling out the vaccine and we are in the order in the school-based group, in the high 70s, whereas in many other countries, they have only got 30 per cent who have been vaccinated,” she said.

But now the vaccination debate has switched genders.

There are growing calls from the medical community for boys and young men to also be vaccinated against HPV.

Advocates include one of Britain’s top cervical cancer specialists, Professor Margaret Stanley from Cambridge University, who says a cervical cancer jab in the arms of boys would not just be for the sake of girls.

“These HPVs don’t just cause cancer in women. They cause it in men as well. Cancer in the mouth, cancer in the anus and those cancers are very hard to treat,” she said.

“As an anti-cancer prevention strategy, I would have thought immunising boys was a sensible way to go.”

Professor Stanley is visiting Melbourne as the guest speaker at a cervical cancer conference at the Royal Women’s Hospital.

She says the rate of oral cancers linked to HPV is rising, and it is strongly associated with an increase in the practice of oral sex.

“There are some caused by alcohol and tobacco use and they are declining, but there is no doubt that the cancer caused by HPV are on an upward trajectory,” she said.

Professor Suzanne Garland says there would be other benefits to vaccinating men against HPV.

“I think it would also help destigmatise this just being a female disease,” she said.

The benefits exist, but critics say they do not outweigh the cost of a government-funded vaccination program for boys and young men. However Professor Stanley rejects that categorically.

“The cost-effective modelling that is being done at the minute has actually not taken into account these other cancers,” she said.

“It has really only looked at ‘if we immunise boys, what effect will we have on cervix cancer’ and I think they need to go back to their models and say ‘if we immunise boys, what effect will have on these other cancers and what value for money will that be’.”

Radiological balloon dilatation of post-treatment benign pharyngeal strictures

Source: J Laryngol Otol, July 16, 2009; 1-4
Author: L R Williams et al.

To assess the technical success, clinical outcomes and complications of radiologically guided balloon dilatation of benign strictures developing after treatment for head and neck cancer.

Materials and methods:
Forty-six balloon dilatations were performed in 20 patients. All dilatations were performed over a guidewire.

Technical success was 100 per cent. Fifteen of the 20 patients demonstrated clinical improvement in dysphagia scores. Improvement in dysphagia was temporary in all patients (median 102 days), with multiple dilatations usually required (total dilatations ranged from one to seven). Immediate complications were encountered in six of the 46 (13 per cent) dilatations and were all minor. Late complications occurred after two procedures (4 per cent): localised perforation (later complicated by secondary infection) and recurrence of a previous, small, pharyngo-cutaneous fistula.

Radiologically guided balloon dilatation is straightforward to perform and is well tolerated, but there is a small risk of perforation. Relief of symptoms is likely to be temporary, requiring multiple subsequent dilatations. A minority of patients will obtain no symptomatic relief.

FDA approves fentanyl buccal film for breakthrough cancer pain

Author: Yael Waknine

The US Food and Drug Administration (FDA) has approved a fentanyl buccal film (Onsolis, Aveva Drug Delivery Systems under license from BioDelivery Sciences International, Inc) for the management of breakthrough pain in patients with cancer aged 18 years and older who receive around-the-clock opioid therapy and are able to safely use high doses of additional opioid agents.

Because fentanyl is subject to abuse and misuse, the product was approved with a risk evaluation and mitigation strategy that includes a restricted distribution program requiring registration of prescribers, pharmacies, and patients. The program emphasizes the need for clinician and pharmacist education and patient counseling regarding the attendant risks of fentanyl therapy.

“Onsolis can provide strong pain relief to patients who are opioid tolerant. But for patients who are not opioid tolerant, it can lead to overdose, sudden serious breathing difficulties and death,” said Bob Rappaport, MD, director, Division of Anesthesia, Analgesia and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research, in an agency news release. “For this reason, Onsolis should be prescribed only under the safeguards provided by the FDA-required [risk evaluation and mitigation strategy] and by health care professionals knowledgeable about Onsolis and the use of potent opioid medications.”

A boxed warning in the prescribing monograph for fentanyl buccal film advises that the product should not be used for the management of migraines, dental pain, or postoperative pain or in patients who use opioids intermittently on an as-needed basis. The fentanyl buccal film is not interchangeable with other fentanyl products.