Monthly Archives: May 2010

No need to fear!

Author: staff

Patients with dental phobias will now be able to relax in the dentist’s chair, as new brain calming technology can help de–stress those with even the worst fears.

New equipment developed by neuroscientists in America is being introduced in dental surgeries in the UK to help calm patients who suffer anxiety during treatments.

The new equipment, named NuCalm, induces a state of deep relaxation using systems know as Cranial Electrotherapy Stimulation (CES). A generator is connected to a headset worn by the patient and transmits relaxing electrical and sound frequencies to the brain.

After five minutes brain waves slow down to a state which is associated with meditation, sleep and deep relaxation.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter said of the new technology: “This is a great step forward. A recent survey we conducted for National Smile Month found that one in four people do not visit the dentist because of a phobia. If people know they will be ok when they’re in the chair, that they won’t be overcome by anxiety, it could be enough to encourage more people to go on a regular basis.”

Dr Carter added: “It is vital people go for regular dental check–ups. Dentists are at the forefront of oral health–care and are the best source for discovering serious problems such as mouth cancer and gum disease.

“Mouth cancer is the fastest growing cancer in the UK, with 5,000 new cases being diagnosed each year. If this illness is caught in the early stages it massively improves chances of survival. That’s why this development is so important. We need to get people into the dentist chair on a regular basis, and anything that does that can only be beneficial to oral health–care.”

During the treatment patients are asked to wear dark glasses and are given tablets of a brain chemical called GABA. The tablets, which are commonly available as a nutritional supplement, combined with the glasses help to deepen the sense of relaxation the patient experiences.

Trials have found that CES can be effective for people suffering with stress, chronic anxiety, insomnia and post–traumatic stress. CES encourages the release of brain chemicals, serotonin and dopamine, both of which are related to feelings of well–being and relaxation.

Smoking women at greater risk

Author: Poornima Nataraj

Surrendering to temptation of having a puff of nicotine to release tension, not only gives momentary pleasure but inflicts a long lasting damage on your biological system.

There has been no decrease in the number of deaths due to tobacco use, despite large-scale efforts to educate masses on the health hazards of tobacco consumption. And, what’s more concerning is the fact that not only men but a considerable percentage of women are also succumbing to the addiction at the risk of serious health complications.

The World Health Organisation’s theme for this year’s World No Tobacco Day focusses on “gender and tobacco, with emphasis on marketing to women.” It highlights the harmful effects of tobacco marketing and smoke on women and girls.
Dr Prathima Murthy, Professor of Psychiatry and Head of De-addiction Centre at National Institute of Mental Health and Neurological Sciences (NIMHANS), informs that any form of tobacco use harms every organ of one’s body.

“Chewing tobacco has a certain cultural acceptance in our country, leading to a high prevalence of oral cancer. However, smoking has much wider ill-effects, especially for women who are more prone as their biological system is more vulnerable to such toxic substances,” she says. Dr Murthy says women tend to take up smoking to relieve stress. There is also a rage to stay slim through smoking with the low nicotine content cigarettes. Irrespective of the percentage of nicotine content, there are other harmful substances which do not reduce the severity of damage to one’s health, she adds.

Cessation Centres
There are 18 Tobacco Cessation Centres in India where nearly 21,500 males and 1,820 females have registered themselves to give up tobacco use. “Although there are a variety of treatments to give up tobacco use, many patients, particularly, women do not come for a follow-up. There is also a social stigma attached in visiting these centres,” she adds.

In India, 57 per cent of men and 10 per cent of women use tobacco in some form or the other, which totalls to around 41 million tobacco users, according to Dr Murthy. And, majority of these are tobacco chewers than smokers, she adds.

Kidwai records
According to the records at the Kidwai Memorial Institute of Oncology, 95 per cent of patients have oral cancer due to tobacco chewing and nearly 1,000 new patients get added to the existing burden. Head and neck cancer and larynx cancer are indirectly associated to tobacco related cancer. The hospital receives nearly 100 patients per annum for lung cancers. In Kidwai alone, 200 patients die due to tobacco related cancer every year.

Tobacco consumption among youngsters a concern

Author: Tausif Alam

The rise of tobacco consumption among children and young adults between 10 to 17 years has become a major cause of concern in the city. In the wake of it, cases of oral cancer among children are also on rise, say experts.

According to the data released by the World Health Organisation (WHO), prevalence of smoking among children in India, between the age group of 13-15 years, is 5.8 per cent and 2.4 per cent in male and female respectively. The consumption of tobacco in different forms by children varies between 16.2 per cent and 7.2 per cent in male and female respectively.

“Children between the age group of 10-17 years have been consuming tobacco mostly in the form mawa, pan masala and gutkha. The major cause of addiction among children is cheap availability of tobacco products. Though our law restricts selling of tobacco products to minors, the rule is not observed stringently, and minors have easy access to these products,” said Kalyan Gangwal, founder member of the Sarva Jeev Mangal Pratishthan. He added that prevalence of tobacco consumption is mostly seen among slum children.

The uses of mawa, pan masala and gutkha can cause oral submucous fibrosis, a pre-cancerous lesion which can lead to cancer. The symptoms are the difficulty in opening mouth and inability to tolerate hot, spicy food. Now, a large number of cases of oral submucous fibrosis have been found among youngsters who consume tobacco, said Gangwal.

“The children mostly inherit the habit from their parents. Among slum dwellers, consumption of tobacco by children is not usually considered a bad habit as the adults themselves are unaware of concomitant effects of tobacco,” said Prasad Oak, counselor at the Anandvan Bahuddeshiya Sanstha.

He added that children from affluent and middle class families are also exposed to tobacco, but mostly in the form of cigarettes, which causes respiratory disease as well as lung and heart diseases. According to WHO, over 40 per cent children have at least one parent who smokes.

Scientists find genes associated with throat cancer

Author: staff

Scientists from Singapore, China and USA have identified three new susceptibility genes in a genome-wide association study of nasopharyngeal carcinoma (NPC). The study, led by the Genome Institute of Singapore (GIS), a biomedical research institute of the Agency for Science, Technology and Research (A*STAR), and the Sun Yat-Sen University Cancer Centre, identified genetic risk factors of NPC that advance the understanding of the important role played by host genetic variation in influencing the susceptibility to this cancer.

NPC is a type of cancer that forms in the epithelial lining of the nasopharynx, the area of the upper throat that lies behind the nose. It is particularly prevalent in southern China, such as Guangdong, with an occurrence rate of about 25 times higher than that in most regions of the world. NPC is therefore referred to as the Cantonese Cancer (Cantonese is a Chinese dialect spoken in and around the city of Guangzhou in Southern China). Led by Dr Liu Jianjun, Associate Director and Senior Group Leader of Human Genetics at the GIS, and Professor Yi-Xin Zeng, President of the Sun Yat-sen University Cancer Center, the findings were published in Nature Genetics on May 30, 2010.

To search for the genetic risk factors for NPC, the scientists carried out a comprehensive genetic analysis of the human genome in a large clinical sample of southern Chinese descent – approximately 5,000 patients and 5,000 controls. The researchers found that the genetic variation within the human leukocyte antigen (HLA) and the three genes known as TNFRSF19, MDSIEVI1 and CDKN2A/2B can significantly influence a person’s risk of developing NPC. The researchers also noticed that these three susceptibility genes for NPC have been reported to be involved in the development of leukemia, suggesting there might be some shared biological mechanism between the developments of these two diseases. This finding provides an important opportunity for biologists to understand the molecular mechanism underlying the development of this cancer, and its unusual pattern of high prevalence in southern China.

Co-lead author Dr Liu Jianjun said, “Although many groups have attempted to identify the genetic risk factors of NPC, the findings of previous studies were limited by the small number of genes and clinical samples used. Because of this large-scale study of approximately 10,000 subjects in total, we are able to break through with more robust evidence compared to previous studies.”

Co-lead author Prof Zeng added, “This finding confirmed the strong genetic effect of HLA locus in the risk of NPC. By using the high density of genetic markers, our finding helps to narrow down the chromosome region to search for the causative gene variant(s) associated with HLA loci. The identification of susceptibility genes involved in the risk of NPC will help to develop a model for risk prediction and then screen for high risk populations, which in turn will be helpful for early diagnosis of NPC.”

Dr Malcolm Simons, Chief Scientific Officer of Simons Haplomics Limited who first discovered the association of HLA genes with NPC in Singapore in 1974, said, “This confirmatory study finalises the evidence produced over the past three decades from case-control and linkage studies of single NPC cases and of multiple case families that the HLA gene system is principally involved in risk for NPC development in Chinese. There is no longer a need to perform any more studies for evidence of the HLA association. The challenge is now to identify the location within or outside the HLA complex that underlies this genetic association or associations, and to determine whether the genetic change is required to be present on both of the pair of chromosomes (known as recessive homozygosity). The indication of three new genes contributing risk, albeit at a much lower level of significance than that of HLA, provides a focus for molecular biological analysis of these candidate risk genes”.

Source: “A genome-wide association study of nasopharyngeal carcinoma identifies three new susceptibility loci”, Nature Genetics, Advance Online Publication, 30 May 2010.

Garagiola, who quit, warns about chewing tobacco

Author: George Vescey

Joe Garagiola has been to too many funerals. Some of them were for friends who chewed tobacco, the way Garagiola used to do.

Now Garagiola has been given the gift of time. He intends to use it to speak out against the habit of chewing tobacco.

“I tell these guys, ‘You may not like what I say, but with lung cancer you die of lung cancer,’ ” Garagiola said the other day, with the zeal of a convert. “With oral cancer, you die one piece at a time. They operate on your neck, they operate on your jaw, they operate on your throat.”

Garagiola is one of America’s gifted talkers — starting in bullpens and dugouts, moving on to broadcasting games, then doing game shows, the “Today” show.

He is still talking. Last month he traveled to a Congressional hearing to speak against smokeless tobacco. The trip itself was a gesture of courage, because he was recovering from brain surgery for what he calls a nonmalignant ailment, which he said was not linked to the tobacco habit he beat 50 years ago.

Last Friday, Garagiola received great news. After a CAT scan six months after surgery, doctors told him he was clear. He took a deep breath and celebrated by doing what he does best.

Speaking about the lobbyists for new smokeless products, he said: “They tell you it’s a safe alternative, but my answer is, Hey, don’t jump out the 50th floor, jump out the 25th floor. You got 25 floors on your side. The results are going to be the same.”

At 84, he still sounds like the exuberant kid catcher who batted .316 in the 1946 World Series. He doesn’t like to admit he could play — it’s bad for his bench-warmer image.

While Garagiola was with the Cardinals in the late ’40s, he picked up the habit of chewing from teammates, many of them rural and Southern. (Young white males are the highest users today — 15 percent.)

Garagiola remembers the day he stopped chewing, in the late ’50s, after his baseball career ended. His youngest child, Gina, came home from grade school and asked if he was going to die from cancer because of tobacco.

“I said, ‘That’s it,’ and I put it aside,” he said. “It was difficult, but I quit.”

He became an activist, going around to training camps with Bill Tuttle, a former outfielder whose jaw was being chipped away by operations for cancer. Tuttle, who had learned to chew from older players, died in 1998 at age 69.

There were successes. When Curt Schilling was with the Phillies, Garagiola walked him to the free clubhouse exam by telling endless Yogi Berra stories. Garagiola describes the stricken look on Schilling, who soon had a precancerous lesion removed and has given credit to Garagiola for helping to save his life.

In mid-April, the House Energy and Commerce Committee held a hearing, led by its chairman, Rep. Henry A. Waxman, Democrat of California.

Terry Pechacek of the Centers for Disease Control and Prevention said smokeless tobacco could cause oral cancer and pancreatic cancer and had been linked to fatal heart attacks. He also said the product was highly addictive.

Baseball officials agree that smokeless tobacco is dangerous, but they cannot address the issue until collective bargaining for the next contract, after the 2011 season. Some players assert they have the right to chew.

“We’d like to discourage players from using smokeless tobacco,” Michael Weiner, the new head of the union, said in a recent interview, adding he had “no doubt of the effects to habitual users.”

Rob Manfred, an executive vice president of Major League Baseball, noted that baseball provides oral exams and literature about the danger of smokeless tobacco.

Baseball does not permit smokeless tobacco in the minor leagues, but Garagiola, who has been around clubhouses since he was 15, knows all the tricks.

“Kids, they’re smart, they put sunflower seeds in front, dip in the back or whatever, and they’ll spit so the tobacco cop doesn’t get you,” he said. “And when they come to the big leagues, the first thing they do is put a dip in their mouth.”

Garagiola talked about a star pitcher he saw on television recently, coming out of a game: “They’re praising him for being a gamer and he sits on the bench and what’s the first thing he does? He takes out some tobacco.”

At least baseball could stop players from sticking that familiar circular tin in their hip pocket, Garagiola said. He said he told a baseball official: “Arnold Palmer always walked on the green and flipped a cigarette. Why wouldn’t you let a guy walk up to home plate and flip a cigarette when he got to the batter’s box? You don’t allow that.”

Garagiola told about the funeral in 1998 for a high school coach, Bob Leslie, who died of oral cancer at 31. As he delivered the eulogy, Garagiola noticed his friend’s widow “holding this baby and I’m thinking, He’s not going to see her go to school, he’s not going to see her get married.”

His voice quavered, momentarily. Then he resumed. Joe Garagiola still has something to say.

FDA tobacco regulator promises firm approach, open mind

Source: The Wall St. Journal
Author: David Kesmodel

WILLIAMSBURG, Va.—The top tobacco regulator at the Food and Drug Administration signaled to industry executives Monday that he would take a firm approach to overseeing the industry, but pledged to keep an open mind about new products and ideas to reduce tobacco-related illnesses.

Dr. Lawrence Deyton, director of the agency’s Center for Tobacco Products, said in a speech at an annual tobacco-industry conference here that his job “is to address this enormous toll of confusion, suffering and death caused by the current state of tobacco use in this country.”

In one of his first speeches to a large group of tobacco executives, Mr. Deyton told members of the Tobacco Merchants Association that he would place strong emphasis on reducing the number of minors who become tobacco users. He said 4,000 kids begin smoking each day, on average, and 1,000 become regular users.

He reiterated his concern that new, dissolvable forms of smokeless tobacco produced by companies such as Reynolds American Inc. are candy-like in their appearance. Reynolds is complying with a review of such products by the FDA and has said its dissolvable products, which are being test-marketed in three cities, are made and marketed for adults.

Mr. Deyton, a longtime public-health expert, began his job in September, a few months after the agency was given broad powers to regulate the industry under a landmark law signed by President Obama.

The agency is still in the early stages of solidifying the framework under which it will oversee such industry categories as menthol cigarettes and smokeless tobacco. Mr. Deyton said the tobacco center now has about 90 employees.

Mr. Deyton said he’s a fan of competition in industries and that he would be open-minded about new products that might reduce illness and death associated with tobacco use. He did not specify smokeless tobacco, but some tobacco companies have argued that the agency should permit them to market the products as being less dangerous than cigarettes.

The tobacco law, however, creates a high bar for a company to be able to market a product as posing less harm to consumers than conventional tobacco products.

“There’s no monopoly on great ideas, so we at FDA will keep an ear open for great ideas as we move ahead,” Mr. Deyton said.

He said, however, that the industry “has a long history of resistance to government action” and warned that the agency would not hesitate to issue civil penalties and take other actions to enforce regulations.

Mr. Deyton said the FDA had just begun a fact-finding effort to decide whether to add cigars to the list of tobacco products that it will closely regulate.

“We are examining the public health impact of other products” besides cigarettes and smokeless tobacco, he said, “but on no particular deadline.”

One of the first priorities of the agency’s tobacco center is evaluate the public-health effects of menthol in cigarettes and to decide what actions, if any, to take about the products, including a possible ban. Most flavorings already were barred from being used in tobacco as part of the law, but not menthol.

Mr. Deyton didn’t specifically address menthol in his speech. Several industry analysts speaking at the conference Monday, however, said they didn’t think the FDA would ultimately prohibit menthol cigarettes, a category led by Lorillard Inc.’s Newport brand.

Banning menthol cigarettes, which account for about a third of the U.S. cigarette market, could result in the rise of a large, illegal sector in which the government garners no tax revenue from sales, said Nik Modi, an analyst with UBS.

Write to David Kesmodel at

May, 2010|Oral Cancer News|

Advanced type of cancer radiation reduces side effects, but impact on controlling cancer is unclear

Author: press release

An advanced type of cancer radiation is more successful than traditional radiation in avoiding “dry mouth” when treating head and neck cancers, but it is unknown whether the treatment is better or worse at reducing the size of tumors, according to a new comparative effectiveness review funded by HHS’ Agency for Healthcare Research and Quality.

The report finds that intensity-modulated radiation therapy (IMRT) leads to fewer cases of xerostomia, commonly known as dry mouth, than other types of radiation. Xerostomia, a potential side effect to radiation when salivary glands are damaged, can affect basic functions like chewing, swallowing and breathing; senses such as taste, smell and hearing; and can significantly alter a patient’s appearance and voice.

However, the report did not find evidence that IMRT is more successful than any other kind of radiation therapy in reducing tumors. Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissues, but more research is needed, the report said. The comparative effectiveness review, Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, was authored by the Blue Cross and Blue Shield (BC/BS) Association, Technology Evaluation Center in Chicago.

“The development of new technologies to treat cancer has been one of the true success stories of American medical research,” said AHRQ Director Carolyn M. Clancy, M.D. “This report provides patients and their doctors with more information about these advances, which they can use to make more informed choices about their own treatment.”

The report examines treatment for cancers to the head and neck, including the mouth, larynx and sinuses. (Tumors in the brain are considered a separate type of cancer and are not discussed in this report.) Non-brain head and neck cancers account for up to 5 percent of cancers that are diagnosed in the United States, with an estimated 47,560 new cases and 11,260 deaths in 2008.

As with other cancers, head and neck cancer often is treated by radiation, which can damage both cancerous and non-cancerous cells. To limit damage to non-cancerous cells, scientists have sought ways to target high doses of radiation to cancerous cells while sparing healthy ones. This is particularly important with head and neck cancers, because tumors can reside close to vital organs.

Standard radiation therapy has evolved over the past 20 years and now provides doctors with two- or three-dimensional images that simulate a patient’s treatment area on a computer screen. IMRT, which has been implemented over the past 10 years, also employs three-dimensional imaging and further technological and treatment enhancements that tightly control and target the amount of radiation delivered to the target area.

Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

Authors: Su Jung Shim et al.

The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T1-2N0-1 oral tongue squamous cell carcinoma (OSCC) and to evaluate survival and prognostic factors.

Retrospective analysis of 86 patients with T1-2N0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3%) received postoperative radiotherapy (PORT). Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed.

The median follow-up was 45 months. The five-year overall survival (OS) and disease-free survival (DFS) rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth [greater than or equal to] 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth). In the risk group, there was no local failure in patients with postoperative radiotherapy.

In T1-2N0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm.

Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features.

Authors: Su Jung Shim, Jihye Cha, Woong Sub Koom, Gwi Eon Kim, Chang Geol Lee, Eun Chang Choi, Ki Chang Keum

Source: Radiation Oncology 2010, 5:43

Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer

Source: Stanford University
Author: Staff

Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d’Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Radiation Oncology, Genolier Swiss Medical Network, Geneva, Switzerland; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Quality Assurance Review Center, Providence, RI.

PURPOSE To report the impact of radiotherapy quality on outcome in a large international phase III trial evaluating radiotherapy with concurrent cisplatin plus tirapazamine for advanced head and neck cancer. PATIENTS AND METHODS The protocol required interventional review of radiotherapy plans by the Quality Assurance Review Center (QARC). All plans and radiotherapy documentation underwent post-treatment review by the Trial Management Committee (TMC) for protocol compliance. Secondary review of noncompliant plans for predicted impact on tumor control was performed. Factors associated with poor protocol compliance were studied, and outcome data were analyzed in relation to protocol compliance and radiotherapy quality. Results At TMC review, 25.4% of the patients had noncompliant plans but none in which QARC-recommended changes had been made. At secondary review, 47% of noncompliant plans (12% overall) had deficiencies with a predicted major adverse impact on tumor control. Major deficiencies were unrelated to tumor subsite or to T or N stage (if N+), but were highly correlated with number of patients enrolled at the treatment center (< five patients, 29.8%; >/= 20 patients, 5.4%; P < .001). In patients who received at least 60 Gy, those with major deficiencies in their treatment plans (n = 87) had a markedly inferior outcome compared with those whose treatment was initially protocol compliant (n = 502): -2 years overall survival, 50% v 70%; hazard ratio (HR), 1.99; P < .001; and 2 years freedom from locoregional failure, 54% v 78%; HR, 2.37; P < .001, respectively. CONCLUSION These results demonstrate the critical importance of radiotherapy quality on outcome of chemoradiotherapy in head and neck cancer. Centers treating only a few patients are the major source of quality problems.

May, 2010|Oral Cancer News|

Swedish Match snuff separates from snus pack

Source: Tobacco News
Author: Staff

Swedish Match North America, maker of moist snuff, cigars and chewing tobacco, is taking a different approach to marketing its Swedish-style snus tobacco product when compared to two other U.S. tobacco companies offering the product, according to a report by the Richmond Times-Dispatch. Swedish Match marketers began a sampling effort in Vail, Colo., and now are handing out silvery sample packs of General Snus on Wall Street — a sign that the product will be positioned as a high-end item, the report stated.”We are emphasizing the Swedish cachet,” Richard Flaherty, president of Swedish Match North America, told the paper when asked about the sampling push. In addition, Swedish Match’s General brand is more expensive than either the Marlboro brand by Altria Group’s Philip Morris unit, or Reynolds American’s Camel brand.

The premium positioning is not the only difference in its marketing strategy.”We’re not marketing snus as something for when you can’t smoke. We’re marketing it as an alternative to cigarettes,” Flaherty said in the report.

The company is looking for smokers who don’t want to smoke at all, rather than using the product as a fill-in to cigarettes, the report stated. For this reason, the company identified a key target group in parents who worry about secondhand smoke at home, Flaherty said. In addition, the focus on niche consumer groups rather than the general tobacco market is a reason why General isn’t appearing in convenience stores. Instead of fighting for shelf space with two of the toughest competitors in c-stores, Swedish Match has focused on tobacco outlets, Flaherty said.

Last year, the company expanded General’s retail availability from 100 stores to more than 600. That expansion is continuing this year, with entrances into specialty cigarette and cigar stores, Flaherty said in the report.”We’re being very deliberate,” Flaherty said. “But we’re definitely expanding.”

May, 2010|Oral Cancer News|