Monthly Archives: October 2010

Beware the signs of mouth cancer

Author: Lisa Salmon

Most people think of a mouth ulcer as a minor irritation that will disappear in a few days. Normally they’re right. But if the ulcer doesn’t heal and lasts longer than three weeks, it could be a sign of something more sinister: mouth cancer.

Mouth, or oral, cancer, which can affect the lips, tongue, cheeks and throat, is one of the UK’s fastest-growing cancers. In the past decade, incidences have risen by 41% and, of the 5,000 people diagnosed with the disease every year, it kills around 2,000 of them. That’s one every five hours.

About 70% of mouth cancers are detected at a late stage, which dramatically reduces the chances of survival. Yet if the cancer is detected early, more than 90% of people survive.

For that reason, the British Dental Health Foundation (BDHF) has organised Mouth Cancer Action Month. In November, the organisation aims to raise awareness of the condition – which recently struck the film star Michael Douglas – so that people recognise the warning signs and are regularly checked for mouth cancer by their dentist.

Signs include ulcers which haven’t healed after three weeks and lumps, or red or white patches, in the mouth, all of which can be mistaken for something less serious.

In addition, swelling below the neck or chin, pain when chewing or swallowing, or a feeling that you have something in your throat that can’t be swallowed, can also indicate the disease.

If you have any of these symptoms, it’s probably wise to follow the Mouth Cancer Action Month slogan – if in doubt, get checked out.

Dr Nigel Carter, chief executive of the BDHF, explains: “The big problem with mouth cancer is late presentation. That happens in most cases – like Michael Douglas.”

At the point of diagnosis, Douglas’s cancer was a stage four – the most advanced. The actor has reportedly said that his throat had been bothering him for several months before the cancer was eventually diagnosed.

“His chances of survival are minimal, frankly, even though he can afford the best treatment,” warns Carter.

The 65-year-old actor has admitted that his illness was probably caused by a lifetime of drinking and smoking. Tobacco use and drinking alcohol are indeed the prime risk factors for mouth cancers and are connected to around 75% of cases. Even if you’re now an ex-smoker, it could take as long as 20 years after quitting before your risk diminishes.

The historical likelihood of more men using tobacco than women may explain why 50 years ago mouth cancer was five times more common in men than women. Today, it’s only twice as common.

Carter explains: “Social habits changed in the Sixties and Seventies, and we’ve now got more women around that have been smoking and drinking for longer, which is probably why the numbers are increasing.”

In addition, alcohol and tobacco work together to increase mouth cancer risk, so if a person uses both, they increase their chances of developing the condition by up to 30 times.

Overall, oral cancer rates may also be increasing because there’s a larger ethnic minority population in the UK, and some of them chew tobacco, another risk factor.

A poor diet is also a contributory factor, as is HPV (human papillomavirus), which has also been linked to cervical cancer.

The link to HPV may explain why an increasing number of young people are developing mouth cancer, says Carter – although the issue is by no means clear cut.

He asks: “With the whole of that young age group, is the mouth cancer because they smoke and drink – if they do – or is it down to HPV?”

About 25% of mouth cancers in the UK are diagnosed in the under-40 age group, and a quarter of those have no apparent risk factors.

“Research has shown a link between HPV and mouth cancer through oral sex, which helps to explain the increase in mouth cancer cases in young people, particularly among men.”

Experts say HPV could overtake tobacco and alcohol as a major risk factor for mouth cancer within the coming decade.

On a positive note, vaccination against HPV could help protect against mouth cancer, although the UK vaccination programme is currently only for girls and women.

However, dental check-ups, the best way of detecting mouth cancer, are available for everyone – although currently only 50% of people go to the dentist regularly.

BDHF research has found that a quarter of people have never heard of mouth cancer, and less than half can name the risk factors.

“Although there’s a death from mouth cancer every five hours, how do you get people to be self-aware when they don’t even realise they can get cancer in that area?” asks Carter.

“If in doubt, get checked out. In all probability there’s not going to be an issue – but if there is one, you stand a much better chance by catching it early.”

Individuals can make sure they have no signs of the condition by requesting a mouth cancer check-up from their dentist, although many dentists carry out the checks as a routine part of their examination.

One such dentist is Catherine Kershaw, who also offered free mouth cancer checks to non-patients during a previous Mouth Cancer Awareness Week. Her Leeds practice was swamped by demand.

One of Kershaw’s patients died from mouth cancer after not having a dental check-up for three years.

The woman, in her 50s, had noticed a mouth ulcer that wouldn’t heal.

Kershaw says: “It was very obviously mouth cancer – it wasn’t massive, it was just a small ulcer, but you can tell. She had surgery, but three months later she was dead.”

She stresses that if the problem is picked up before a patient complains of symptoms, there’s a 90% chance of them still being alive in five years.

“If they come with symptoms, that likelihood is less than 50%. That’s why it’s best to go to the dentist to get regularly screened, because the dentist, if they’re looking properly, should pick the problem up and your chances of survival are much better.”

“Don’t go to your dentist with a problem – go without one.”

October, 2010|Oral Cancer News|

“Staggering” lack of awareness of mouth cancer revealed

Source: Dental Health Foundation

A NEW SURVEY undertaken by British Dental Health Foundation has revealed an alarming lack of awareness about the causes and symptoms of one of the UK’s fastest growing cancers – mouth cancer.

Despite the recent case of actor Michael Douglas, who is suffering from advanced throat cancer, the answers from over 1,000 members of the public who were questioned in the survey for Mouth Cancer Action Month supported by Denplan reveal that there is only limited knowledge and understanding of this potentially deadly disease.

One person in 10 claimed not even to have heard of mouth cancer.

Chief Executive of the Foundation, Dr Nigel Carter, said: “After recent high profile coverage of the Michael Douglas case it is staggering to see that some people still have no awareness at all of the condition.”

Dr Carter added: “It is vital that the public have a greater awareness because survival rates increase massively with early detection from just 50 percent to 90 percent. The public need to be aware of the risk factors and whether they are in a high risk group and how they can self–examine or who they can turn to if they’re concerned.”

The results of the survey reveal that it is the older members of the public who are most aware of mouth cancer, with more than 96 percent of those interviewed saying that they had heard of it.

Dr Carter added: “This sounds good as the majority of cases occur in the over 50s but now more young people are being diagnosed with mouth cancer it is important that everyone is aware of the problem. The survey also shows that women are more aware of the disease than men – yet men are twice as likely as women to suffer with mouth cancer.”

The results of the survey show that over a third of the public questioned dramatically underestimated the prevalence of the disease by answering that mouth cancer was responsible for one death every day in the UK. In fact, mouth cancer causes a death in the UK every five hours and is now responsible for more deaths than cervical and testicular cancer combined.

Dr Carter continued: “Rates of mouth cancer have increased by over 40 percent over the last decade and this year’s figures from Globecan show a worrying 10 percent increase over last year’s figures to very nearly 6,000 new cases a year. Despite this there is not always a great deal of publicity surrounding it, so people just do not realise how common and dangerous it is which is why we run Mouth Cancer Action Month every November in the UK.”

Statistically worldwide, an estimated 405,000 new cases are diagnosed each year and over two–thirds of cases in the UK are detected at a late stage. During the campaign the Foundation is encouraging people to self–examine for mouth cancer. Self–examination is important because there are early warning signs to look out for, such as a mouth ulcer that doesn’t heal for over three weeks, or red and white patches on the gums or tongue or any unusual swelling or lumps in the mouth. The campaign strap line is “If in doubt…get checked out” and the Foundation advises that anyone who thinks they have any of these symptoms to visit their dentist as early detection is vital. The dental team have a vital role to play in carrying out opportunistic screening at every recall visit and using this opportunity to educate their patients about mouth cancer, risk factors and self awareness and examination.

Tobacco remains the main risk factor for the disease and alongside excessive alcohol consumption is responsible for three in four cases. Poor diet is also a risk factor and advice for patients should be to have a balanced, healthy diet including five portions of fruit and vegetables every day.

The Human Papilloma Virus (HPV) spread via oral sex is an increasing concern to oral health experts and a recent study in the US connected over 20,000 cancer cases to HPV in the last five years. Experts now suggest it may rival tobacco as the main cause for mouth cancer in the next decade. Younger people and those with multiple sexual partners are most at risk.

October, 2010|Oral Cancer News|

Congressman wants chewing tobacco thrown out of World Series

Source: The Hill, The Washington Scene
By: Jordan Fabian

With the World Series set to begin Wednesday night, a New Jersey congressman wants the participating teams to give chewing tobacco the boot from their dugouts.

Rep. Frank Pallone Jr. (D) called on the Texas Rangers and San Francisco Giants to eschew their use of smokeless tobacco during the Fall Classic, saying it sets a bad example for kids.

“Asking @MLB World Series teams to ban chewing tobacco. It hurts more than players when so many young ppl watch & are influenced by players,” the congressman said on Twitter.

Pallone has long been an opponent of the use of chewing tobacco in the sport, citing its negative health effects and poor example for children.

The 11-term congressman held a hearing on the issue in April, at which House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) called on Major League Baseball to ban the use of smokeless tobacco.

A representative from the baseball players union opposed the move, drawing a contrast between cigarettes and chewing tobacco.

Scrutiny of players’ use of the tobacco products, however, re-emerged this month after Hall of Fame right fielder Tony Gwynn was diagnosed with a form of mouth cancer. Gwynn, who spent his entire 20-year career with the San Diego Padres, openly speculated that it resulted from his use of chewing tobacco.

October, 2010|Oral Cancer News|

Panitumumab Plus Platinum Chemo Misses Mark in Advanced Head and Neck Cancer

Source: Internal Medicine News Digital Network
By: Patrice Wendling

MILAN – Panitumumab plus chemotherapy with cisplatin and 5-fluorouracil proved clinically active, but failed to boost overall survival significantly in first-line recurrent or metastatic head and neck cancer in the global, phase III SPECTRUM trial.

The primary end point of median overall survival showed a statistically insignificant increase from 9.0 months with chemotherapy alone to 11.1 months with the addition of panitumumab (Vectibix) (hazard ratio, 0.87; log-rank P = .14).

Subgroup analysis revealed, however, that the effect of panitumumab, an anti–epidermal growth factor receptor (EGFR) monoclonal antibody, was not the same for all patients in the international study, lead author Dr. Jan Vermorken said at the annual congress of the European Society for Medical Oncology.

Regional differences were observed, suggesting a greater benefit in patients from North/South America (HR, 0.69) and Western Europe (HR, 0.73) than in those in Eastern Europe (HR, 1.11). Asian Pacific patients fell somewhere in the middle (HR, 0.99).

About 45% of patients in each arm used some form of subsequent antitumor activity once off the study protocol, but differences cropped up here as well. The use of cytotoxic chemotherapy was imbalanced at 30% in the panitumumab arm vs. 25% in the chemotherapy arm, while twice as many patients in the chemotherapy arm (12% vs. 6%) received subsequent targeted systemic therapy driven largely by the use of anti-EGFR monoclonal antibodies, observed Dr. Vermorken of the Antwerp University Hospital in Edegem, Belgium.

“It’s clear this is the first analysis shown to you, and it’s also very clear that further analyses need to be done to identify subgroups that may have greater benefit than others with the combination of panitumumab with platinum-based chemotherapy,” he said.

SPECTRUM was conducted at 120 sites in 26 countries, and randomized 657 patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck to six 21-day cycles of cisplatin 100 mg/m2 on day 1 plus 5-FU 1,000 mg/m2 on days 1-4 with or without panitumumab 9 mg/kg on day 1.

Carboplatin was substituted for cisplatin because of severe neurotoxicity or a decrease in creatinine clearance in 21% of the 327 panitumumab patients and 26% of the 330 chemotherapy patients. Also, 33% of patients in the experimental arm opted to remain on panitumumab 9 mg/kg every 3 weeks, for a median of 11 weeks.

The median time to disease progression was significantly longer in patients receiving panitumumab at 5.8 months vs. 4.6 months with chemotherapy alone (log-rank P = .004, descriptive only; HR, 0.78), Dr. Vermorken said.

The objective response rate was 36% in the experimental arm vs. 25% in the control arm (P = .007, descriptive only). A complete response was achieved by 2% of patients in the experimental and control arms; partial responses in 35% and 24%, respectively; and stable disease in 46% and 47%.

The disease control rate also favored panitumumab at 82%, vs. 72% for chemotherapy alone (P = .004, descriptive only).

The safety profile of the experimental arm was in line with other trials of panitumumab and comparable with the use of other monoclonal antibodies in combination with chemotherapy, Dr. Vermorken said. Grade 3 and 4 events occurred in 31% and 15% of the panitumumab group, and in 18% and 8% of the chemotherapy group. Infusion reactions of any grade occurred in 3% of the panitumumab group and 2% of the chemotherapy group.

“The utility of this [triplet] appears significant,” said Dr. Marshall Posner, who was invited to discuss the late-breaking abstract. “The toxicity appears to be manageable, there are no infusion reactions, and the every three-week dosing makes this a somewhat easier agent to give than cetuximab.”

He suggested that the lack of survival advantage with panitumumab may be due to limited accessibility in some populations, notably the Eastern Europeans, to anti-EGFR antibodies, particularly cetuximab (Erbitux). In addition, cultural and regional differences in their cancer and the management of their care may have confounded survival.

What is not known is whether the oropharyngeal site, which has proved to do better in several other trials, did better in SPECTRUM and how well the triplet will work in second-line monotherapy, said Dr. Posner, medical director of the head and neck medical oncology program and cancer clinical trials office at Mount Sinai Medical Center in New York.

Amgen Inc. supported the trial. Dr. Vermorken reported participating in advisory boards for and receiving honoraria from Amgen, Merck-Serono, Lilly, Boehringer-Ingelheim, and Sanofi-Aventis. Two coinvestigators reported employee/stockholder relationships with Amgen. Dr. Posner disclosed consulting for several pharmaceutical companies.

October, 2010|Oral Cancer News|

GlaxoSmithKline Drops the Price of Cervarix

Source: PharmaLive

MISSISSAUGA, ON, Oct. 25 /CNW/ – Today, GlaxoSmithKline Inc. (Canada), announced its plan to reduce the cost of CERVARIX™ by 30%. The cost reduction is in response to recent research that demonstrates the relatively high price of cervical cancer vaccines, coupled with a low understanding of their protective benefits topped the list of reasons why the majority of young Canadian women have yet to be immunized.

Last week, research supported by The Society of Gynecologic Oncology of Canada (GOC), The Society of Obstetricians and Gynaecologists of Canada (SOGC), the Federation of Medical Women of Canada (FMWC), and the Society of Canadian Colposcopists (SCC) revealed that 9 out of 10 Canadian women aged 18 to 25 have not been vaccinated against cervical cancer. Half of young women polled (who do not have a private drug plan) cited cost as a barrier to obtaining the vaccine and 61% of mothers of young women agreed that cost was a deterring factor. In fact, 50% of non-vaccinated women aged 18 to 25 without vaccine coverage through their drug plan and 61% of mothers with daughters in this age group cited cost as a deciding factor. This is particularly relevant as 60% of Canadians do not have vaccine coverage through private insurance.1

As a patient-focused company, GlaxoSmithKline Inc. was concerned to learn that the cost of cervical cancer vaccines is deterring women from protecting themselves from a largely preventable disease that kills one Canadian woman every day.2

Effective today, October 25, 2010, the manufacturer’s list price of CERVARIX™ will be reduced from $134.95 a dose to $90.00 per dose, and three doses are recommended for optimal immunogenicity. This represents a 30% reduction in the cost of CERVARIX™.

“We’ve looked at the research and taken action to address the barrier where we were able to impact the most. We invite and encourage all those involved in this area of care: from those who educate women about immunization, to those who prescribe vaccines, to those who manufacture or dispense them, to consider how they too can help to ensure that all Canadian women have access to effective and affordable immunization against cervical cancer,” states Paul Lucas, President and CEO of GlaxoSmithKline Inc.

About Cervical Cancer in Canada:

* More than 1,000 Canadian women are told every day that their Pap test results are abnormal.3 * Among Canadian women aged 20 to 44, cervical cancer incidence ranks second only to breast cancer.4 * The lifetime probability of a woman developing cervical cancer in Canada is 1 in 150.5 * Annually, 1450 Canadian women will be diagnosed with cervical cancer, and 420 will die from it.5 * Clinical trials show that vaccination alongside regular Pap screening could reduce the chance of developing cervical cancer by 94%, compared to no intervention.6

About CERVARIX™ CERVARIX™ is a vaccine indicated in females from 10 to 25 years of age for the prevention of cervical cancer (squamous cell cancer and adenocarcinoma) by protecting against the following precancerous or dysplastic lesions caused by oncogenic Human Papillomavirus (HPV), types 16 and 18: cervical intraepithelial neoplasia (CIN) grade 2 and grade 3, cervical adenocarcinoma in situ (AIS), and cervical intraepithelial neoplasia (CIN) grade 1.

In an additional analysis, statistically significant vaccine efficacy in the prevention of CIN2/3 or AIS associated with HPV-31 and HPV-45 was demonstrated in the ATP and TVC cohorts, respectively.

CERVARIX™ has the longest duration of protection reported for any licensed cervical cancer vaccine. It is the only vaccine that has demonstrated that virtually all women tested (greater than 99%) still have protective antibodies against both HPV-16 and HPV-18 up to 6.4 years,

CERVARIX™ is generally well tolerated. The most commonly reported adverse events within 7 days of vaccination with Cervarix™/control [500 μg Al(OH)3] were: local [pain (91.8%/87.2%), redness (48.0%/24.4%) and swelling (44.1%/21.3%)]; and general [fatigue (55.0%/53.6%), headache (53.4%/61.4%)].7

October, 2010|Oral Cancer News|

Large Thyroid Nodules Linked to High Malignancy Risk

Elsevier Global Medical News
Author – MG Sullivan

PARIS (EGMN) – Patients with a non-decisive fine-needle aspiration for large non-diagnostic thyroid nodules or lesions of undetermined significance should be considered for surgery because more than half of these large nodules can be malignant.

In a review of 156 patients with non-decisive fine-needle aspirations (FNAs), nodule size was a major determinant in surgical referral, Dr. Susana Mascarell said at the International Thyroid Congress. “Nodules of this size were associated with a malignancy rate of up to 60%,” said Dr. Mascarell of the John H. Stroger Jr. Hospital of Cook County, Chicago.

FNA is considered the main diagnostic tool in deciding which patient to refer to surgery. “However,” Dr. Mascarell said, “the FNA results may not be helpful when the cytology specimen is non-diagnostic or qualifies as a follicular lesion of undetermined significance – both classifications that are part of the new six-level FNA classification system suggested by the National Cancer Institute.”

When an FNA comes back as non-decisive on such specimens, the clinician must choose between surgery and clinical follow-up as the next step. Unfortunately, said Dr. Mascarell, there are no hard-and-fast rules about which management path to choose.

Molecular markers are becoming more important in the decision, but can’t be relied upon in every patient, she said. “When these markers are present in high concentrations, they are up to 99% accurate in identifying malignant nodules and so are a very helpful tool. But only 40% of nodules are positive for these risk markers, so we still have an unmet need of what to do with many other patients.”

Dr. Mascarell and her colleagues reviewed all thyroid FNAs performed at the hospital from 2004 to 2007. Out of nearly 500 tests, 156 were non-decisive. Of these specimens, 90 (58%) were classified as follicular lesions of undetermined significance (FLUS) and 66 (42%) as non-diagnostic.

Overall, 104 patients had a thyroidectomy (77% of the FLUS group and 52% of the non-diagnostic group). The rest were followed clinically. The rate of malignancy was 41% in the FLUS patients and 32% in the non-diagnostic patients.

Among those with FLUS who had surgery, 50% had no other clinical indication for surgery except the non-decisive FNA, Dr. Mascarell said. “The most common documented indication was a nodule size of 3 cm or larger in 29%.” Other indications – each of which accounted for less than 5% – were male gender, a family history of thyroid cancer, exposure to radiation, and a suspicious ultrasound exam.

“In the non-diagnostic group, all of those who went for surgery had other indications [besides the FNA result]. The most common one was a cold thyroid scan in 31%. Other indications were nodule size (20%), microcalcifications on ultrasound (16%), and a history of radiation exposure (15%).” Indications that Dr. Mascarell did not specify accounted for the remaining 18%.

Half of all patients for whom nodule size was the documented surgical indication had clinically significant thyroid cancer. “When we compared the surgical and clinical follow-up groups, we found that 60% of the surgical group had a lesion 3 cm or larger, compared with 29% of the follow-up group, so clearly, when clinicians found a large lesion, most of them referred to surgery,” Dr. Mascarell said.

Dr. Mascarell said she had no potential conflicts of interest.

October, 2010|Oral Cancer News|

Poll reveals patients are not mouth cancer-savvy

Author: Staff

The public are oblivious to signs of mouth cancer.

A poll, commissioned to coincide with November’s Mouth Cancer Action Month, reveals that one person in 10 claimed not to have even heard of the condition.

Despite the much-publicised news of the battle actor Michael Douglas is currently having with advanced throat cancer, the survey, conducted by the British Dental Health Foundation and Denplan. oll reveals an alarming lack of awareness about the causes and symptoms of one of the UK’s fastest growing cancers.

The poll of more than 1,000 people suggests that there is only limited knowledge and understanding of this potentially deadly disease.

Chief executive of the Foundation, Dr Nigel Carter, says: “After recent high profile coverage of the Michael Douglas case it is staggering to see that some people still have no awareness at all of the condition.

‘The public need to be aware of the risk factors and whether they are in a high risk group and how they can self-examine or who they can turn to if they’re concerned.’

The results of the survey reveal that it is the older members of the public who are most aware of mouth cancer, with more than 96% of those interviewed saying that they had heard of it.

Dr Carter adds: ‘This sounds good as the majority of cases occur in the over 50s but now more young people are being diagnosed with mouth cancer it is important that everyone is aware of the problem. The survey also shows that women are more aware of the disease than men – yet men are twice as likely as women to suffer with mouth cancer.’

The results of the survey show that more than a third of the public questioned dramatically underestimated the prevalence of the disease by answering that mouth cancer was responsible for one death every day in the UK.

In fact, mouth cancer causes a death in the UK every five hours and is now responsible for more deaths than cervical and testicular cancer combined.

Dr Carter says: ‘Rates of mouth cancer have increased by over 40% over the last decade and this year’s figures from Globecan show a worrying 10% increase over last year’s figures to very nearly 6,000 new cases a year.

‘Despite this, there is not always a great deal of publicity surrounding it, so people just do not realise how common and dangerous it is which is why we run Mouth Cancer Action Month every November in the UK.’

October, 2010|Oral Cancer News|

The Most Deadly HPVs in the World

Source: WebMD News
Author: Daniel DeNoon

Cervical Cancer-Causing Viruses ID’d in Worldwide Study

Oct. 19, 2010 – Two human papillomavirus types included in HPV vaccines cause 71% of cervical cancers — but there are six other cervical cancer-causing HPVs, an international study finds.

Led by Spanish researcher Silvia de Sanjose, MD, the effort analyzed 22,661 tissue samples from 14,249 women from 38 countries in six continents. Researchers looked for any of the 118 known types of HPV.

The samples included 10,575 cases of invasive cervical cancer — for women, the second most common cancer in the world. HPV is believed to cause nearly all cervical cancers. Although the study detected HPV in only 85% of cervical cancers, de Sanjose and colleagues suggest that various problems (such as DNA degradation in samples) led researchers to miss HPV in the remaining 15% of cases.

There are currently two HPV vaccines: Cervarix from GlaxoSmithKline and Gardasil from Merck. Both protect against HPV types 16 and 18; Gardasil also protects against the genital wart-causing HPV strains 6 and 11.

The new study strongly supports use of these vaccines, as HPV 16 and HPV 18 account for 71% of invasive cervical cancers. HPV 16, HPV 18, and HPV 45 are found in 94% of cervical adenocarcinomas.

HPV types 18 and 45 are found in much younger women with invasive cervical cancer, suggesting that these viruses are particularly deadly. HPV 16 is also linked to cancer in younger women.

In addition to HPV 16, 18, and 45, there are six other HPV types that cause cervical cancer: types 31, 33, 35, 52, and 58.
“This international effort … reinforces the rationale for prevention of cervical cancer through the use of existing vaccines,” de Sanjose and colleagues conclude. Their report appears in the Oct. 18 online issue of The Lancet.

October, 2010|Oral Cancer News|

Health Risks of Oral Sex- linked to Oral Cancer

Source: Women’s Health Magazine
Author: Alyssa Giacobbe

Long known to cause cervical cancer, the pervasive but often silent human papillomavirus (HPV) has been finding its way into women’s mouths

Mische Eddins, 37, awoke with a head cold. Or what seemed like one anyway. Postnasal drip. Sore throat. Swollen lymph nodes. No biggie—it was the fall of 2007, and a seasonal bug was winding its way through Seattle. “I had just been bragging to my friends about how I’d managed to avoid getting sick,” she says. “But I was healthy, so it all passed quickly.” Everything, that is, except a swollen node on the left side of her neck, which, months later, hadn’t gone away.

Christmastime came, and the little bump was still there. Sans appointment, Mische walked into her doctor’s office and left with a script for antibiotics. No improvement. She then bounced from M.D. to M.D., and finally, six months after that seemingly innocuous head cold, she had a PET/CT scan. The results were a total shock: Mische had stage III oral cancer, and the disease had spread from her tonsil to her lymph nodes.

Within hours, her docs had scheduled a tonsillectomy and were talking about chemo and radiation. Someone suggested she prepare a will. “I was floored,” she says. “A will?” A professional singer, Mische exercised almost every day, ate a mostly organic diet, didn’t booze heavily, and never smoked as an adult. Even her doctors were stymied.

Searching for answers, one physician tested Mische’s cancer cells for human papillomavirus (HPV), the sexually transmitted infection notoriously linked to cervical cancer. Mische was taken aback; she’d spent the past 16 years in two monogamous relationships and was fastidious about getting annual Pap smears, which had never been abnormal. Why were they now testing her mouth? Her doctors explained the worrisome new link between oral cancer and HPV, which can be transmitted to the mouth through oral sex. And indeed, she tested positive. Her oral cancer was HPV-related.

Ten years ago, oral cancer among women was practically unheard of. Patients were nearly always male and over 50, heavy smokers or drinkers, or both. (When actor Michael Douglas, 66, was diagnosed with the illness this past summer, the media pointed to his longtime half-a-pack-a-day habit.) But according to the Journal of Clinical Oncology, there has been a major upswing in HPV-related oropharyngeal cancer, a deadly disease often found in the base of the tongue and the tonsils. In fact, roughly a quarter of all oral cancers are now HPV-related, according to the American Cancer Society, and approximately 25 percent of cases occur in women—some as young as 19, says Gregory Masters, M.D., an oncologist at the Helen F. Graham Cancer Center in Newark, Delaware.

But how could HPV, a “down there” disease, be causing so many mouth problems? It’s something the best doctors and public-health experts out there have long feared, thanks to the rampant spread of the virus. You’ve likely heard the daunting stats: Approximately 20 million Americans currently have HPV, with 6 million new infections discovered each year through Pap or cervical swab tests, according to the Centers for Disease Control and Prevention. What’s more, the virus—which can have zero symptoms or bloom into a series of visible warts—will affect up to 80 percent of sexually active women at some point in their lives.

In the vast majority of cases, the body’s immune system will clear HPV on its own within two years (there is some debate over whether the same HPV infection can ever return to cause cervical lesions later, but research is still in early stages). However, a small percentage of infected women—around 11,000 per year—will not clear HPV and may develop cervical cancer. This has prompted the federal government to recommend, somewhat controversially, that all girls be vaccinated for HPV by age 12.

To date, safe-sex campaigns have typically blamed the spread of HPV on unprotected vaginal intercourse. But it’s now clear that the disease can be contracted orally too. And that’s where things got dangerous for Mische Eddins and thousands of other women. Their mouths were infected with HPV-16, the particular type that most doctors believe is responsible for the majority of cases of HPV-related oral cancer.

Just how long HPV-16 lingers in the mouth before turning into cancer is uncertain. But what is evident is that more than 14 percent of cases aren’t caught until very late stages, possibly because some physicians are slow to consider the cancer in young female patients. “Since HPV-related oral cancers don’t affect the traditional group of those at risk for mouth cancer, a lot of these cases are missed or diagnosed late,” affirms Eric J. Moore, M.D., an otolaryngologist at the Mayo Clinic in Rochester, Minnesota. “Usually, the patient is healthy, exercises regularly, and eats right. She doesn’t fit the profile.”

Lydia Miner definitely didn’t fit the profile. She, too, ate well, worked out, and didn’t smoke or drink much. But she had a strange sensation in the back of her throat that felt like a half-swallowed pill, stuck midway. Or maybe, she thought, it was a patch of skin irritated by one of the many times she’d hurriedly choked down lunch during her hectic job as an environmental consultant in Anchorage, Alaska. “For a while I thought I was just imagining it,” says Lydia, now in her forties. But after two months, she knew better.

Like Mische, she got a scan, which showed something alarming. “The doctor stared at the results, then turned to me and said, ‘I’ve got to tell you, I think you have oral cancer,’ ” she recalls. Her small malignant tumor, which was later surgically removed, tested positive for HPV. Lydia was incredulous. She hadn’t thought about the virus in more than a decade.

In her twenties, she’d had a series of abnormal Pap smears; however, by her thirties, her Paps continuously came back normal, and she’d forgotten all about any irregularities. But HPV is nothing if not sneaky; it can lie dormant and undetectable in the body for years, making it incredibly difficult to know if you’re infected and unknowingly passing it along to others. This can also make it nearly impossible to pinpoint the partner responsible for giving it to you. (Meaning, that one-night stand you had in your teens or even the guy you dated seriously in college can come back to haunt you well into your thirties and beyond.) Though between 40 and 60 percent of guys have HPV at any given time, less than 1 percent will have visible symptoms, and there are currently no FDA-approved HPV tests for men. What all this means is that oral sex—once considered a safer alternative to vaginal sex—might not be so harmless after all.

The most obvious HPV-related oral-cancer risk factors, as you might imagine, have to do with the kind of sex you have, how often you have it, and the number of partners you’ve tangled sheets with. According to a study in the New England Journal of Medicine, people who have had six or more sex partners are more than twice as likely to develop oral cancer. But those who’ve had six or more oral sex partners increase their chances by a whopping 340 percent. As such, says Masters, HPV-related oropharyngeal cancer should be considered a sexually communicable disease. “From cases I see, I get the sense that many younger people don’t think oral sex counts as sex,” he says. “But oral sex has risks too.”

As is the case with most STDs, the best way to protect yourself from HPV-related oral cancer is abstinence, which isn’t realistic for most people. Complete honesty about your sexual history and frequent HPV testing can help, and the HPV vaccine might work too, says Francis Worden, M.D., a clinical associate professor of medicine at the University of Michigan and a leading researcher of HPV-related oral cancers. (Though, Worden notes, the vaccine’s efficacy is an assumption at this point: “There’s no data just yet.”) Using condoms for any sexual contact—yes, including oral sex and even with a committed partner—can also help thwart the genital-to-mouth spread of HPV, though Moore concedes it’s naive to think couples will commit to a lifetime of wrapped-up oral sex. (For their part, men can get oral HPV by performing oral sex on a woman with vaginal HPV, with or without using a dental dam, says Worden. Michael Douglas reportedly tested positive for HPV, and while there’s no concrete link between his particular cancer and the STD, cases of HPV-related oral cancer are also rising among men.)

If this advice sounds thin, that’s because it is. The fact is, a lot of HPV research still needs to be done—if it can be done at all. For one thing, determining how sexually transmitted diseases spread depends in large part on the truthfulness of patients and test subjects. “It’s particularly tough to get figures on sexual habits, because you’re relying on people’s memories and forthrightness,” says Masters.

The good news you’ve been waiting for: If detected early, this type of cancer is highly treatable. Compared with other forms of mouth malignancies, HPV-related oropharyngeal cancers have significantly higher survival rates, especially among nonsmokers. “For reasons we’re not entirely sure of, HPV-related cancers respond better to chemotherapy and radiation,” says Masters. “The majority of patients are cured not only because they are generally younger and more tolerant of treatment but also because the cancer actually behaves differently.” The key, of course, is to catch it early—in most cases, this means spotting a lesion or a change in mouth tissue color or texture. It also means seeing your dentist regularly.

Tests using rinses, dyes, and different types of light are being developed to allow dentists to administer comprehensive oral-cancer screenings, but many dentists are already actively peering into patients’ mouths, on red alert for cancerous signs. (While all dentists are educated in cancer screenings, not all perform them, so it’s crucial to ask.) John Comisi, D.D.S., a dentist in Ithaca, New York, says he has caught dozens of lesions on female patients, many in their thirties. “Some don’t turn out to be much of anything,” he says. “Others turn out to be abnormal cells that over time would surely become cancerous.”

“Women are really good about going for their annual Pap smears, but I don’t know one gynecologist who will look in your mouth,” adds Gigi Meinecke, D.M.D., a dentist in Potomac, Maryland, who performs a thorough oral exam on all of her patients. “The only place you’re going to get that is at your dental office.”

A good oral-cancer screening, says Meinecke, includes a comprehensive head, neck, and lower-jaw examination, as well as superficial checks of the lymph nodes, the front of the ears (where tumors can also develop), and the back of the neck. And your tongue should be thoroughly examined from every angle. “Basically, what we’re looking for are subtle changes in coloration,” she says.

Dental screenings aren’t 100 percent fail-safe. “The biggest problem with these types of cancers is that people typically don’t have a lot of symptoms, and if you can’t see it or feel it, your dentist might not either,” says Moore. But enlisting an extra set of trained eyes is still a worthwhile protective measure. “In my opinion, any oral abnormality should be investigated,” says Comisi. “You just can’t be too sure.”

Contraction Reaction

Nearly all cases of HPV-related oral cancer have been linked to one particular type of the virus: HPV-16. Although there’s still research to be done, scientists have determined its general path:

1. A guy gets HPV-16 through vaginal sex with an infected partner.
Condoms are the best way to prevent the spread of HPV, but because the virus can be transmitted both via bodily fluids (like ejaculate and saliva) and skin-to-skin contact (including contact between the vagina and the scrotum), they’re not 100 percent effective.

2. The infected guy receives oral sex (protected or not) from a woman; she picks up oral HPV-16. Or The infected guy has protected or unprotected vaginal sex with a woman, who gets cervical HPV-16.* She then has vaginal sex with a new partner, who later passes HPV- 16 back to her through oral sex.

Note: Doctors do not believe that HPV can travel up through your body from cervix to mouth. That is, you cannot develop oral HPV simply because you have cervical HPV.

3. HPV-16-infected cells live and multiply in the mouth. How long the virus can linger there— i.e., its latency period— is undetermined, but it could be up to several decades.

4. HPV-16-infected cells may develop into precancerous, then cancerous, lesions that can form tumors on the back of the tongue, or on the upper throat, and swell the lymph nodes.

Roughly a quarter of cancerous oral lesions are HPV-related.

October, 2010|Oral Cancer News|

Experts say oral cancer on the rise in younger people

Author: staff

It was the winter of 2002 when then-34-year-old Kelley Fish of Grosse Pointe Park, Mich., first spotted the lump that would change her life. “I was looking in the mirror, and I thought ‘what the heck is that?’ It was certainly visible,” said Fish.

Fish went to the doctor, who thought it was an infection and prescribed antibiotics. But two months later, the lump was still there. “Then they went forward and sent me to an ear, nose and throat specialist and finally had the lump removed,” said Fish. Fish said the tumor was the size of a large grape, and it was malignant. Fish was diagnosed with stage 4 oral cancer.

“I was horrified,” said Fish. “They say you should never get on the Internet. The statistics were not in my favor at that point.”

Experts said oral cancer includes cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses and throat. Stage four is the most advanced stage.

Fish had surgery, 32 radiation treatments and three cycles of chemotherapy. The treatments left her fatigued and suffering multiple side effects. “It was hell, excuse my expression,” said Fish. “I was unable to swallow after a period of time. I had burns, second- or third-degree burns, on my neck. It was the scariest moment or time in my life to say the least.” Like most people, Fish had assumed oral cancer was something older men got, not 34-year-old women.

“When I was in dental school, it was considered an ‘old man’s’ disease,” said Dr. Jed Jacobson, the chief science officer for Delta Dental of Michigan. But Jacobson said oral cancer trends are changing.

“Two groups in which oral cancer is increasing is women and our younger Americans,” said Jacobson.

Experts said smoking, chewing tobacco and drinking too much alcohol are the major risk factors for oral cancer, but about 25 percent of people being diagnosed, especially younger people, don’t smoke or drink. Experts believe the human papillomavirus, or HPV, may be to blame.

“They have located and found HPV, human papillomavirus 16 and 18, in those tissues, and so there is a strong association in that 25 percent that doesn’t have the traditional factors,” said Jacobson.

A study in the New England Journal of Medicine found people infected with HPV were 32 times more likely to develop cancer of the tonsils or tongue than those who did not have the virus. That’s a concern because HPV is incredibly common. According to the Centers for Disease Control and Prevention, at least 50 percent of sexually active men and women will be infected at some point in their lives. Some estimates put that number as high as 80 percent in women.

There is a vaccine that protects against the most common strains of HPV. It’s currently recommended for girls and women age 9 to 26. It’s also been approved for use in boys and men age 9 to 26.

“There’s a level of embarrassment, if you will, to talk about a virus that’s passed through sexual activity, but that’s the reality, and regardless of how uncomfortable the conversation may be, we have to educate the public to the risks,” said Jacobson.

Experts said every patient should be screened for oral cancer at least once a year during their regular dental checkup.

“The hygienist or dentist will grasp the tongue with a piece of gauze and very carefully pull the tongue out and thoroughly examine the top of the tongue and the sides of the tongue, as well as laying a tongue blade or mouth mirror on the tongue and have the patient phonate the word ‘ahh,’ so that the dentist and hygienist can visualize back to the throat,” said Jacobson.

Doctors said the symptoms of oral cancer include red or white spots in the mouth or on the lips or tongue that don’t heal, any swelling, lumps, bumps or sores that don’t go away in two weeks, a lump in the neck, unexplained bleeding, numbness, or tenderness in the mouth, difficulty chewing or swallowing, and hoarseness, chronic sore throat, ear pain or weight loss.

Fish was a smoker when she was diagnosed with oral cancer. She tested negative for HPV, but she wants to warn people to take oral cancer seriously. She hopes sharing her experience with the disease will help save someone else.

“More and more younger people are being diagnosed with this atrocious, hideous disease, and I think that it is important that people are aware of the risk factors, and not just drinking and smoking,” said Fish.

After beating the odds, Fish now has a 5-year-old son and another baby on the way. She said still worries the cancer will come back.

“I do have a lot of anxiety, and I think that the first several years, a sore throat, or just your average annual flu or cold that comes around or came around, I ran right to my doctor,” said Fish.

But she said she tries to focus on enjoying her second chance at life.

“I am just so happy that I’ve been able to experience being a mother, and I get up everyday and thank the dear God that I’m here,” said Fish.

October, 2010|Oral Cancer News|