Monthly Archives: January 2010

India ranks first in number of oral cancer cases: World Health Organization report

Author: staff

India has the highest number of oral cancer cases in the world out of which 90 per cent have been reported due to tobacco-related diseases, according to a World Health Organisation (WHO) survey report. The report said more than 2,200 Indians die each day from a tobacco-related cases and in 2010, an estimated ten lakh people will die due to the killer disease. Every day, 55,000 Indian youths start tobacco use, the report further said.

In view of the growing tobacco menace, a one-day Media Advocacy Workshop on Tobacco Control was jointly organised by Itanagar Press Club (IPC) and Voluntary Health Association of India (VHAI) here recently.

In the meeting both the print and electronic media unanimously observed that strict enforcement of section 4 of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003, should be ensured.

Highlighting different aspects of tobacco in terms of health hazards and socio-economic impact, epidemiologist Dr L Jampa informed that India is the second largest consumer and is placed third in respect of tobacco production.

He informed that in 17 out of 29 states of India, tobacco use is more than 69 per cent. The Northeastern region exhibits highest rates of tobacco use – in Mizoram more than 80 per cent of men use some form of tobacco, followed by Tripura (76 per cent) and Assam (72). Arunachal Pradesh is the second largest state whos people chew tobacco products after Mizoram.

Dr Jampa informed that Arunachal Pradesh has been taking steps to control tobacco being used in the state in various forms.

He said second hand smoking (SHS), also called passive smoking, was a major cause of disease, death and disability among non-smokers. SHS is a hazardous mixture which contains over 4,000 chemicals such as cadmium, lead, arsenic, benzene, carbon monoxide, out of which over 50 are carcinogenic for humans. Apart from this, some of the chemicals in SHS are irritants and systemic toxins whereas some are reproductive and developmental toxins, Dr Jampa explained.

Referring to the National Family Health Survey-3 report, conducted in 2005-06, the epidemiologist said, ”India has a very high prevalence of tobacco use with 57 per cent of males and 11 per cent of females using tobacco in some form. Tobacco use is more prevalent among the illiterate – 78 per cent uneducated men and 18 per cent of women use tobacco, whereas 38 per cent educated men and 1 per cent of educated women use tobacco, he informed.

According to the Global Youth Tobacco Survey 2006, a total of 36.9 per cent children in India initiate smoking before the age of 10 years, Dr Jampa said.

Calling upon the media to perform a pro-active rule to check and control use of tobacco products, Dr BB Rai, Executive Director, Sikkim VHA, said the use of tobacco products has been a part of socio-culture life of the people in Sikkim. But VHAS (Volutary Health Association of Sikkim) succeeded in spreading awareness among the people against use of tobacco to some extent, he informed.

IPC president and senior journalist Pradeep Kumar felt that active involvement of media and the state government would be able to implement different tobacco control measures.

January, 2010|Oral Cancer News|

Insurance tied to survival odds in head/neck cancers

Author: staff

People with cancers of the head or neck seem to have better survival odds if they have private health insurance, research hints. Head and neck cancers include cancers of the mouth, throat, nasal cavity, salivary glands and lymph nodes of the neck. Most cases are linked to smoking, with excessive drinking being the other major risk factor.

But while those habits may raise the odds of developing head and neck cancers, the new findings, reported in the journal Cancer, suggest that insurance coverage influences the odds of surviving.

Researchers found that among more than 1,200 patients treated at the Pittsburgh Medical Center between 1998 and 2007, those with private insurance had better survival rates than those with no insurance, as well as patients on Medicaid or Medicare disability.

Medicaid is the federal health insurance program for the poor; Medicare disability covers people younger than 65 who cannot work because of a serious disability or illness.

In this study, patients who were uninsured or on Medicaid were 50 percent more likely to die than privately insured patients. Those on Medicare disability had a 69 percent higher risk of dying — with factors such as age, race, income and smoking and drinking history taken into account.

Instead, the poorer survival seemed to be partly explained by later diagnosis. People without private insurance generally had more-advanced cancer by the time they saw a doctor, according to the researchers, led by Joseph Kwok of the University of Pittsburgh Cancer Institute.

It’s possible, they write, that these patients are less likely to get screened for head and neck cancers, or may have to delay treatment after a diagnosis.

The findings are based on 1,231 patients who underwent treatment for some form of head and neck cancer. Of the 547 patients with private insurance, 145 died during the study period; of 128 patients who were on Medicaid or were uninsured, 50 died; of 81 on Medicare disability, 39 died.

Older adults covered by traditional Medicare had similar survival odds as patients on private insurance.

Later diagnosis appeared to be a major factor in the link between insurance and cancer survival, Kwok and his colleagues found.

Across cancer types, uninsured and Medicaid patients were at greater risk of having advanced cancer than their privately insured counterparts. For example, when it came to laryngeal cancer — cancer of the voice box — they were seven times more likely to be at an advanced stage at the time of diagnosis.

Even though Medicaid patients have insurance coverage, the researchers note, they — like the uninsured — may be less likely to have routine dental check-ups, which often catch signs of oral cancer early.

They also point to other barriers — like transportation problems or getting time off from work to visit the doctor — that may prevent some uninsured and Medicaid/Medicare disability patients from having any early cancer symptoms assessed, or from starting treatment after a diagnosis.

On a more positive note, Kwok’s team did find that insurance had no influence over the risk of a cancer recurrence. That, they say, suggests that once patients begin treatment, they receive comparable care regardless of insurance status.

Cancer, November 20, 2009.

January, 2010|Oral Cancer News|

Two doctors explain their support of the Gardasil vaccine

Author: Marcia G. Yerman

As parents contemplate whether or not they should have the Gardasil vaccine administered to their daughters, one of the first places that they turn is to their doctors. In this segment, I posed questions to two doctors supporting the vaccine.

Dr. Margaret Lewin, M.D., F.A.C.P., is the Medical Director of Cinergy Health, an insurance benefits provider. She advises the board on patient related issues and public health concerns. Lewin is board-certified in Internal Medicine, Hematology, and Medical Oncology. Lewin is affiliated with New York Presbyterian Hospital and the Hospital for Special Surgery.

Dr. Alan Gibstein, M.D., F.A.C.S., F.A.C.O.G., is a Clinical Assistant Professor of Obstetrics and Gynecology at NYU School of Medicine. He is board-certified in Obstetrics and Gynecology, and is affiliated with North Shore University Hospital. He was president of the LIJMC medical staff from 1982-9183. In addition to his work as an attending gynecologist, he has been actively involved in medical and residency teaching.

On why they supported the vaccine:
Dr. Lewin wrote:
“The evidence clearly shows that the quadrivalent HPV vaccine prevents cervical intraepithelial neoplasia caused by 70% of known HPV subtypes as well as preventing genital warts – both of which are highly contagious (even without sexual penetration), cause significant distress, substantial cost, and cannot reliably be permanently eliminated. There are published reports of oral cancer caused by the HPV virus. Oral cancers and their treatment are devastating, and the ability to avoid HPV-related oral cancers strongly increases my support from the vaccine.”

Dr. Gibstein wrote:
“Gardasil produces lasting immunity against the four most common types of HPV that we see in the vast majority of men and women. Types 6 and 11 are a benign virus that causes warts. Types 16 and 18 – most common associated types – causes pre-cancer or a cancerous cervix. Published results have shown that Gardasil blocks these four types of HPV, and therefore women will not get genital warts or dysplasia of cervix. If a series of injections are completed, this gives complete immunity against the four majority types and it can eradicate cervical cancer.

The most important aspect of the need for and value of the Gardasil vaccine is not just cervical cancer prevention, (which is extremely important), but the prevention of invasion by HPV in the first place. Only someone in a busy clinical practice could begin to describe and understand the enormous emotional impact that the first abnormal Pap smear has on any woman, but especially a young one. Women are well aware, by Internet, etc., about HPV and STDs.

Unfortunately not all practioners, or even gynecologists, are aware of the natural pathogenesis of most HPV infections to “cure” themselves. This ignorance or greed leads to the beginning of a cycle of repeat examinations, repeat biopsies, colposcopies, conizations, LEEPs, etc. In other words, fear, anxiety, social upheaval and accusations, time, enormous expense and risk of real damage. This can be prevented with Gardasil in the vast majority.

Gardasil will also protect against HPV infections of the vulva, vagina and cervix, as well as tongue, throat and floor of the mouth where cancers also occur linked to HPV. In my practice, I examined every male consort of my patients with HPV and found evidence of warts in virtually 100% of them. Since abstinence is a proven failed social condition, and because HPV literally coats the earth, eventually the majority of sexually active adolescents and young adults will be exposed. The amount of expense, time, and emotion expended to treat HPV amounts to scores of millions of dollars per year, nearly all of which would be prevented by vaccination.”

On the reports of young girls who have suffered adverse side effects to the vaccine:
Dr. Lewin wrote:
“The adverse effects of the vaccine are grossly overstated in the lay media. The post licensure safety surveillance for this vaccine (via VAERS: the Vaccine Adverse Event Reporting System) has reported 12,424 adverse events (53.9 per 100,000 doses distributed). 772 of these have been serious. The rates of most of the serious adverse events are not greater than the background rates for other vaccines, except for the following:

• Syncope (passing out) – in 0.2 per 100,000 doses, leading to the recommendation that the recipient receive the vaccine while lying down and be observed in the physician’s office for 15 minutes after it has been administered

• Venous thromboembolism (abnormal blood clots). 90% of those who had blood clots had a known risk factor for such clots, such as the use of oral contraceptives – a pre-condition well-known to cause such clotting. The possibility of a causative relation to the vaccine is being closely investigated.

• 32 reported deaths, of which 12 could not be verified by review of the medical records. There was no common pattern to the remaining deaths that would suggest they were caused by the vaccine, and the cause of the deaths can be explained by factors other than the vaccine. For example, 2 were from vaccine-unrelated diabetic ketoacidosis, 6 were cardiac related, and 1 was associated with prescription drug abuse.”

Dr Gibstein wrote:
“Critics seem to forget the uproar in the past to reactions to the polio vaccine, the varicella vaccine (including neurologic reactions) and the triple vaccines. Gardasil can and does cause local reaction, pain and redness in many, some syncope in a small number, and perhaps can trigger serious neurologic disorders such as Guillane-Barre or ALS in a few. Gardasil is composed of DNA (protein) gotten from the envelope (capsule) of the human papilloma virus. As such, it is not a live virus and cannot directly cause infection or disease. But it contains several metals and minerals, and is made in yeast. Therefore it can, like many other vaccines, trigger hypersensitivity reactions in susceptible individuals. Except for people known to be allergic to yeast, most of these reactions would not be predictable.” Gibstein acknowledged that the vaccine has a fair amount of local reaction with soreness/redness 48-72 hours, and that a small percentage of recipients have a bit of mild flu reaction.”

Gibstein referenced Dr. Martin M. Fisher, Director of Adolescent Medicine at Schneider’s Children’s Hospital at North Shore/Long Island Jewish Hospital, who is advising that Gardasil be recommended to all women from age 12 to 26. Both Dr. Gibstein and Dr. Fisher agree that adverse reactions are 97% local and transient, and the severe reactions as reported by the CDC are occurring at no greater frequency than occur spontaneously in the general population of the same age.

Dr. Lewin maintained that a 5-year clinical trial was ample time to do the necessary follow-up, with the “understanding that close post licensure studies continued.” Responding to my query on the point of giving the vaccine as early as 9 years old if the vaccine does not last fifteen years she wrote:

“It is not yet clear how long the vaccine lasts and it might be necessary to give a booster after ten years or so as is the case with mumps and polio, for example. Since it takes several months for the vaccine to be fully effective, starting at a young age is necessary to protect young girls from this highly contagious virus, which can be transmitted by any skin-to-skin contact. In addition to the unfortunate early beginning of consensual sexual activity (whether oral, vaginal or simply intimate ‘petting’), it cannot be ignored that many young girls are victims of non-consensual contact.”

Gibstein suggested that time would tell if the protection is durable, and if complications can be directly attributable to the vaccine.

Both doctors had strong words about the marketing tactics of all pharmaceutical companies. They had read the JAMA article, “Marketing HPV Vaccine.” Dr. Lewin responded, “I am outraged by all Pharma advertising to the lay public.” Dr. Gibstein stated, “Drug companies like Merck and others often behave both unethically and disgracefully in both their limited reporting of adverse reactions and their abhorrent advertising on TV, radio, etc. The advertising for Gardasil is, in my opinion, inexcusable. The high cost of the vaccine is another example of price gouging by Pharma, but is worth it to offset the cost of treating HPV infections.”

In reaching out for this piece, a sidebar of interest arose. Adina Nack, Ph.D., author of Damaged Goods? Women Living with Incurable STDs and professor of medical sociology and sexuality studies at California Lutheran University, contacted me to emphasize her concern for the advocacy of “comprehensive HPV education, and for allocating resources to improve the development and provision of testing and treatment options for those who contract the variety of HPV infections and HPV-related cancers.” Her work has focused on these concerns, in addition to her support of the development of Gardasil.

January, 2010|Oral Cancer News|

1,000: the magic number in genomic research

Aurhor: Sharon Schmickle

The number 1,000 is emerging as a standard benchmark on the frontiers of genomic research.

In the 1000 Genomes Project — launched two years ago — American, British, Chinese and German scientists are sequencing the genomes of some 1,000 individuals from around the world in order to aid medical research as it relates to human genetic variation.

Then there’s the goal of the $1,000 genome. Reduce the cost of accurately spelling an individual’s DNA to that level and we could see practical results from decades of genomic discovery — even at the clinical level. A research team from Complete Genomics Inc. in Mountain View, California, reported progress in that regard this week in the journal Science.

Now comes a new report from the “1,000 tumor” project at the University of Chicago’s Institute for Genomics and Systems Biology.

The Chicago scientists are working toward the goal of collecting and analyzing the genetic sequences and variations of every gene expressed by 1,000 tumors. One year into the three-year project, they have completed data for genes expressed by 100 tumors — primarily breast cancer, head and neck cancer, and leukemia. In the process, they have streamlined techniques for analyzing the remaining 900 tumors.

Meanwhile, by correlating genetic data with patient outcomes, the Chicago team has begun to identify genetic patterns within tumors that may help them predict how a cancer will behave. Eventually, the research should help identify which patients would benefit from which treatments.

We must have at least 1,000 genome projects around the world at this point in the research. Has anyone bothered to count?

The Mayo Clinic reported in November that its cancer research team in Arizona has completed its first whole human genome sequencing on a patient with multiple myeloma, a cancer of the bone marrow. Among other information, they captured an entire snapshot of the patient’s cancer cells through various stages of the disease.

Mayo teams in Rochester, Minn., are working on other genomic studies as are scientists at the University of Minnesota.

This will be a great field to watch in this new decade.

January, 2010|Oral Cancer News|

Liverpool scientists working on vaccine for mouth cancer

Author: Liza Williams

ONE central project the scientists and doctors are working on is a vaccine for mouth cancer. Liverpool researchers have found some cases are caused by the HPV virus – the same bug which causes cervical cancer. They have discovered that two-thirds of tonsil cancer tumour samples showed evidence of the HPV-16 gene.

The work is particularly important because the researchers are also seeing the rates of tonsil cancer doubling in non-smokers and non-drinkers – two of the main causes of the disease.

They have found a DNA test helps to predict whether a patient has HPV. This could be used to decide which treatment is best for the patient, because both chemo and radiotherapy are more successful in patients with the virus.

They are now developing a clinical trial for a HPV vaccine for head and neck cancer, like the jab given to teenage girls to prevent cervical cancer.

January, 2010|Oral Cancer News|