Monthly Archives: March 2011

DNA repair biomarker profiling of head and neck vancer: Ku80 rxpression predicts locoregional failure and death following radiotherapy

Source: American Association for Cancer Research


Purpose: Radiotherapy plays an integral role in the treatment of head and neck squamous cell carcinoma (HNSCC). Although proteins involved in DNA repair may predict HNSCC response to radiotherapy, none has been validated in this context. We examined whether differential expression of double-strand DNA break (DSB) repair proteins in HNSCC, the chief mediators of DNA repair following irradiation, predict for treatment outcomes.

Experimental Design: Archival HNSCC tumor specimens were assembled onto a tissue microarray and stained with antibodies raised against 38 biomarkers. The biomarker set was enriched for proteins involved in DSB repair, in addition to established mechanistic markers of radioresistance. Staining was correlated with treatment response and survival alongside established clinical and pathologic covariates. Results were validated in an independent intramural cohort.

Results: Ku80, a key mediator of DSB repair, correlated most closely with clinical outcomes. Ku80 was overexpressed in half of all tumors, and its expression was independent of all other covariates examined. Ku80 overexpression was an independent predictor for both locoregional failure and mortality following radiotherapy. The predictive power of Ku80 overexpression was confined largely to HPV-negative HNSCC, where it conferred a nine-fold greater risk of death at two years.

Conclusions: Ku80 overexpression is a common feature of HNSCC, and is a candidate DNA repair-related biomarker for radiation treatment failure and death, particularly in patients with high-risk HPV-negative disease. It is a promising, mechanistically rational biomarker to select individual HPV-negative HNSCC patients for strategies to intensify treatment. Clin Cancer Res; 17(7); 2035–43. ©2011 AACR.


  • Note: Supplementary data for this article are available at Clinical Cancer Research Online (

March, 2011|Oral Cancer News|

RoboDoc: deft mechanized hands aid Memphis surgeons in operating rooms

Author: Tom Charlier

The cancer in James Entrekin’s throat has curdled around the base of his tonsils, way too far down for a traditional surgeon to reach without doing a lot of cutting and bone-breaking. But there’s nothing traditional about the surgery going on in this Methodist University Hospital operating room. Employing nimble, cable-thin arms, a robot reaches into Entrekin’s mouth while wielding four instruments at once — removing tumors, cauterizing vessels, suctioning fluids and transmitting three-dimensional video images of the whole thing.

Dr. Sandeep Samant buries his head in the da Vinci Surgical System while performing a robotic throat surgery at Methodist University Hospital.

In a couple of hours, it’s over. And since there was no need to cut open his face and throat and break his jaw, as is done in conventional oral-cancer surgeries, Entrekin will enjoy a lower risk of complications and a much shorter recovery period, while avoiding extended difficulties swallowing and speaking.

“You avoid all that because that natural anatomy is not violated,” says Dr. Sandeep Samant, who guided the robot from a console in a corner of the operating room.

Although there are many types of surgeries where they can’t be used, robots such as the nearly $2 million device used in Entrekin’s case are carrying an ever-growing workload in the operating rooms of Memphis hospitals. Less than a decade after robotic surgery was introduced in Memphis, there now are five robots — one each in Methodist University, Methodist North and Methodist Germantown and two at Baptist Memorial Hospital-Memphis — performing roughly 1,000 operations annually.

They’re doing hysterectomies, removing prostates and kidneys, replacing heart valves, cutting out cancerous lung lobes and, beginning about year ago, conducting head and neck surgeries such as Entrekin’s. Comparative figures are difficult to come by, but in the Methodist Le Bonheur system alone the number of robotic surgeries increased 40 percent, to 491, last year as the third robot was added. At Baptist, robotic surgeries have become increasingly commonplace and now number 500-550 annually, said Dana Dye, chief nursing officer.

For all their current popularity, robots weren’t readily accepted by everyone in the medical community, said Dr. Todd Tillmanns, president of the Memphis Robotic Surgical Society. Not only did the robots represent a new technology, but they were somewhat difficult for doctors to master at first.

“Learning it … takes an investment in time,” said Tillmanns, a gynecologic oncologist.

But as surgeons became proficient, they couldn’t help but be impressed by the advantages robotic surgery offer patients, he said.

“It’s a minimal-access surgery. You have smaller incisions, more delicate surgeries, less blood loss, less injury to localized tissue, and because of that, the patient recovers faster and has much less pain,” Tillmanns said.

In robotic gynecologic surgeries, he said, about 95 percent of patients leave the hospital less than a day afterwards — compared to a norm of three or four days for traditional operations. Within three days, 75 percent of the patients are not taking any pain medication, and they generally return to normal routines within three to seven days. As for cost, robotic surgery is less expensive than conventional “open” surgery but a little more costly than laparoscopic procedures, Tillmanns said.

The head and neck surgery now done at Methodist University represents the newest wave in the technology. The hospital is one of a small number across the nation where it is available, said Samant, who is professor and head of the division of head and neck surgery at the University of Tennessee Health Science Center. As with other robotic surgeries, the operations are directed by surgeons manipulating hand and foot controls at a nearby console.

Samant, with his head pressed against a console and his hands gripping a controller, looks as if he could be directing ninja cyborgs or repelling an alien invasion in a video game. Actually, he’s seeing a close-up, 3-D image of Entrekin’s throat.

“When you’re looking at it, you almost want to reach out and operate with your hands,” he said later.

The movements of Samant’s hands are transmitted to the robot’s arms, which have all the maneuverability of human wrists. In addition to having smaller limbs capable of reaching places human hands can’t, the robot can filter out tremors for smoother, less error-prone movements than human limbs are capable of.

The patient, Entrekin, is a 56-year-old Air Force retiree and laid-off truck driver who, after noticing a lump on his neck, was diagnosed with advanced cancer of the tonsils and base of tongue. He never smoked and previously had been hospitalized only once.

Entrekin, who has lived in Memphis for about 10 years, said he researched his options and was drawn to the benefits offered by robots. He said that if the only surgical option had been the traditional kind — requiring his jaw to be broken and lower face and throat cut open — he probably would have opted for just chemotherapy and radiation.

“That’s just so invasive, drastic,” Entrekin said.

Although he experienced some minor complications, Entrekin said he’s been pain-free since the operation and feels energetic and vital. He starts radiation in April and says he’s been given a good prognosis. Entrekin also said he wasn’t too nervous about the prospect of having a robot reach down his throat.

“I was less nervous (about that) than having my jaw cut open.”

March, 2011|Oral Cancer News|

Smokeless tobacco may be on its way out of Major League Baseball parks

Author: Karen Kaplan, Los Angeles Times

Major League Baseball begins the 2011 season in two days, and if public heath officials have their way it will be the last season during which players will be able to chew and spit smokeless tobacco on the field.

The leaders of 15 public health departments in cities with professional baseball teams sent a letter Monday to MLB Commissioner Bud Selig and Michael Weiner, executive director of the union representing major league players, urging them to forbid the use of smokeless tobacco products. Tobacco has been banned in baseball’s minor leagues since 1993.

“The use of smokeless tobacco endangers the health of Major League ballplayers and sets a terrible example for the millions of young people who watch baseball at the ballparks and on TV,” the health chiefs wrote. The letter continues:

Tobacco use is the number one cause of preventable death in the United States, killing more than400,000 people each year. As cigarette smoking has declined, the tobacco industry has increased its marketing of smokeless products and is spending record sums to promote them. But smokeless tobacco use is itself very dangerous, causing serious diseases of the mouth, including oral cancer. In addition, there is reason to worry that smokeless tobacco use by young persons may serve as a gateway to cigarette smoking, this nation’s leading preventable cause of premature death and disease.

As officials in Major League cities around the country, we know that baseball is important to civic life and that ballplayers are local heroes. They should provide positive role models and not associate themselves with a product that causes disease and death.

Signatories include Dr. Jonathan Fielding, director of the Los Angeles County Department of Public Health; Dr. Thomas Farley, commissioner of the New York City Department of Health and Mental Hygiene; Dr. Bechara Choucair, commissioner of the Chicago Department of Public Health; Barbara Ferrer, executive director of the Boston Public Health Commission; Dr. Oxiris Barbot, commissioner of the Baltimore City Health Department; and 10 others representing cities from Seattle to the District of Columbia.

It’s certainly hard to argue that smokeless tobacco is good for public health. The products cause oral cancer and pancreatic cancer, and have been linked with other types of cancer. They also contribute to heart disease, gum disease and other problems.

The “Knock Tobacco Out of the Park” campaign was initiated by the American Academy of Pediatrics, the American Medical Assn., the American Cancer Society, the American Dental Assn., the American Heart Assn., the American Lung Assn., Oral Health America, Legacy, the Campaign for Tobacco-Free Kids and the Robert Wood Johnson Foundation. They are urging action now because Major League Baseball and the players union are negotiating a new contract that will take effect next year and is expected to remain in force for five seasons.

The prohibition would apply to managers, coaches and other baseball staff in addition to players.

The issue has received significant attention from members of Congress, with Democratic Senators Richard Durban of Illinois and Frank Lautenberg of New Jersey pressing the players union and the league to include a smokeless tobacco ban in their new contract. They were motivated in part by a Washington Post story in which Nationals pitching ace Stephen Strasburg explained why be began dipping tobacco and why he has resolved to quit:

“I was one of those kids that picked it up based on seeing ballplayers do it,” Strasburg said. “It’s not a good thing, and I don’t want to represent myself like that. That’s one of the big reasons. Another reason is, when I do have kids, I don’t want my kids to be like that, too.”

Among the role models Strasburg imitated was Hall of Famer Tony Gwynn, the former San Diego Padres star who coached Strasburg at San Diego State University. Last summer, Gwynn was diagnosed with cancer of the parotid gland, a salivary gland on the jawline. The tumor had wrapped itself around a crucial nerve that controlled movement on the right side of his face. Treatment was no picnic.

“Surgery to remove a tumor resulted in paralysis in the right side of his face, compromising his ability to smile or laugh,” according to this Los Angeles Times story. “He couldn’t blink his right eye. Radiation and chemotherapy left him so weak that he had to use a walker to get around. He estimated that he lost about 80 pounds from his 300-plus-pound frame.”

Gwynn has blamed his tumor on smokeless tobacco, which he has been addicted to since his rookie days with the minor league Walla Walla Padres in Washington State.

For more on the campaign against smokeless tobacco, you can visit the coalition’s website here.

March, 2011|Oral Cancer News|

Orofacial pain onset predicts transition to head and neck cancer


David K. Lam and Brian L. Schmidt

Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA

Bluestone Center for Clinical Research, New York University, New York, NY, USA

Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA


Contrary to a clinical aphorism that early head and neck cancer is painless, we show that patients who develop head and neck cancer experience significant pain at the time of initial diagnosis. We compared orofacial pain sensitivity in groups of patients with normal oral mucosa, oral precancer, and newly diagnosed oral cancer. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before being prescribed analgesics for pain and before any treatment. In contrast to those with biopsy-proven normal oral mucosa and oral precancer, only oral cancer patients reported significant levels of spontaneous pain and functional restriction from pain. Moreover, oral cancer patients experienced significantly higher function-related, rather than spontaneous, pain qualities. These findings suggest an important predictor for the transition from oral precancer to cancer may be the onset of orofacial pain that is exacerbated during function. Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer and may improve quality of life and survival for head and neck cancer patients.

March, 2011|Oral Cancer News|

Tea, coffee and oral cancer risk

Source: Based Dentistry

Question: Is there a relationship between coffee and tea intake and head and neck cancers?

Data sources

Pooled individual-level data from nine case–control studies of head and neck cancers, including 5,139 cases and 9,028 controls.

Study selection

Nine case-control studies were selected from the International Head and Neck Cancer Epidemiology (INHANCE) consortium pool of 33 studies, which included information on coffee (caffeinated and decaffeinated) and tea drinking and cancer of the oral cavity and pharynx. Seven studies also included information on laryngeal cancer.

Data extraction and synthesis

Data from individual studies were checked for inconsistencies and pooled in a standardised way into a common database, including a range of sociodemographic, behavioural, lifestyle and health information. Data on consumption across studies were then converted into cups of de/caffeinated tea or coffee per day. The association between head and neck cancers and caffeinated coffee, decaffeinated coffee or tea intake was assessed by estimating the odds ratios (OR) and the corresponding 95% confidence intervals (95% CI) using a two-stage random-effects logistic regression model with the maximum likelihood estimator. Pooled ORs were also estimated with a fixed-effects logistic regression model. In addition, a test for heterogeneity among studies was conducted.


Caffeinated coffee intake was inversely associated with the risk of cancer of the oral cavity and pharynx: the ORs were 0.96 (95% CI, 0.94–0.98) for an increment of one cup per day and 0.61 (95% CI, 0.47–0.80) in drinkers of >4 cups per day versus non-drinkers. This latter estimate was consistent for different anatomic sites (OR, 0.46; 95% CI, 0.30–0.71 for oral cavity; OR, 0.58; 95% CI, 0.41–0.82 for oropharynx/hypopharynx; and OR, 0.61; 95% CI, 0.37–1.01 for oral cavity/pharynx not otherwise specified) and across strata of selected covariates. No association of caffeinated coffee drinking was found with laryngeal cancer (OR, 0.96; 95% CI, 0.64–1.45 in drinkers of >4 cups per day versus non-drinkers). Data on decaffeinated coffee were too sparse for detailed analysis, but indicated no increased risk. Tea intake was not associated with head and neck cancer risk (OR, 0.99; 95% CI, 0.89–1.11 for drinkers versus non-drinkers).


This pooled analysis of case-control studies supports the hypothesis of an inverse association between caffeinated coffee drinking and risk of cancer of the oral cavity and pharynx.

March, 2011|Oral Cancer News|

Certain parts of the brain activated in people who heard tailored health messages and quit smoking

Staff writer, Healthy and Fit Magazine. com

People who demonstrated a stronger brain response to certain brain regions when receiving individually tailored smoking cessation messages were more likely to quit smoking four months later, a new study finds.

The new University of Michigan study underscores the importance of delivering individually tailored public health messages to curb unhealthy behaviors, said principal investigator Hannah Faye Chua, who led the study as a research assistant professor at the U-M School of Public Health.

It also begins to uncover the underlying neural reasons why these individually tailored messages are so much more effective than a one-size-fits-all approach, said Chua, who now works in the private sector. The study is scheduled for advance online publication Feb. 27 in the journal Nature Neuroscience

Researchers have known for 15 years that tailored public health messages that account for a person’s individuality work better at curbing unhealthy behaviors but until now, they haven’t known why.

Chua and the research team hypothesized that portions of the brain activated during self-related processing were also engaged when people received individually tailored health messages, and that this brain activity accounted for the increased effectiveness of tailored messages.

For the study, the research group assessed 91 people who wanted to stop smoking, and based on those answers they designed an individual smoking cessation program for each subject.

Next, researchers imaged subjects’ brains with MRI to see which portions responded to tailored and untailored messages about smoking cessation, and also to neutral messages. They then compared the brain response to the brain response during a self-appraisal task in which participants, still in MRI, made yes-no judgments to self-related statements such as “I am shy” or “I am athletic.”

Several brain regions activated during the self-related task also appeared to activate during the tailored messages in the same group of smokers. After the scan, participants completed the full smoking intervention program that was designed for each subject.

“The bottom line is that people who are more likely to activate self-related regions of the brain during tailored message processing, particularly dorsomedial prefrontal cortex, are more likely to quit four months after,” Chua said.

The findings have broad public health implications. “The bigger picture of this is advertisers are increasing using functional MRI to test advertising,” said Vic Strecher, professor in the U-M SPH who worked on the project. “If you can imagine that people who create fast food or who sell cigarettes are doing this in an effort to convey a stronger message, we really need to better understand the ways our health messages can be more effective.”

Chua stressed that researchers don’t want to use functional MRI as a predictor for success of public health messages; it’s simply not economically feasible. They do, however, want to better understand and eventually map the portions of the brain responsible for making decisions that will improve their health.

Some people had a stronger brain response than others to the tailored messages, Chua said, but it’s not clear why. It may be that their brains are hardwired to process information differently, or that those people had a stronger desire or commitment to quitting.

“However, the desire is not just motivation, because there was no difference in motivation between quitters and non-quitters,” Chua said. More than 50 percent of people quit after the four month follow-up; most smoking cessation programs range from 15 to 30 percent success.

“Over 50 percent is really a successful measure,” Chua said.

The University of Michigan School of Public Health has been promoting health and preventing disease since 1941, and is ranked among the top public health schools in the nation. Whether making new discoveries in the lab or researching and educating in the field, our faculty, students, and alumni are deployed around the globe to promote and protect our health.

March, 2011|Oral Cancer News|

Pioglitazone Shows Promise for Oral Cancer Prevention

Laird Harrison

Medsscape staff writer

Pioglitazone (Actos, Takeda Pharmaceuticals) “works pretty well — better than anything we’ve seen before,” principal investigator Nelson Rhodus, DMD, MPH, professor of otolaryngology at the University of Minnesota, Minneapolis, toldMedscape Medical News.

Leukoplakia lesions, which are usually caused by irritation, appear on the tongue or sometimes on the insides of the cheek. About 17% of the lesions become invasive cancer, and no treatment has been shown to reliably prevent this, said Dr. Rhodus.

They researchers got interested in pioglitazone because it preserves cell differentiation, enhances apoptosis of tumor cells, and prevents tumor angiogenesis.

In a previous study, the researchers noticed a decrease in head, neck, and lung neoplasms in a population of diabetic men older than 40 years who took thiazolidinedione agents.

For this study, Dr. Rhodus and colleagues from the University of Minnesota, Minneapolis, and the National Cancer Institute in Bethesda, Maryland, recruited 44 patients with lesions characterized histopathologically as either moderate or severe epithelial dysplasia.

The researchers randomly divided these patients so that 22 patients received pioglitazone 45 mg daily for 12 weeks and 22 patients served as a comparison group. Dr. Rhodus’s team measured the leukoplakia lesions and took biopsies of the involved mucosa to evaluate histologic response in all participants.

They determined that 15 of the 22 patients in the pioglitazone group had a clinical and/or histologic response; they did not detect any change in the comparison group.

In the pioglitazone group, the lesions completely disappeared in 3 patients and partially disappeared in 12 patients, the epithelium completely returned to normal in 1 patient, and the dysplasia or hyperplasia reverted from advanced to early, or from early to normal, in 6 patients.

The only adverse reaction was edema, Dr. Rhodus said, and that affected 11% of the pioglitazone group.

“This is a novel finding that is distinctly better than the use of retinoids tried some time ago, which declined because of side effects,” Stephen J. Challacombe, BDS, PhD, a clinical professor of oral medicine and immunology at King’s College London, United Kingdom, told Medscape Medical News.

Because it is a diabetes drug, researchers checked the subjects’ glucose levels, but they found no change, apparently because pioglitazone only affects glucose in diabetics, said Dr. Rhodus.

He cautioned that the results of this phase 2 trial are only preliminary; it is too small to be definitive, and there was no placebo used.

The results merit a larger clinical trial, said John S. Greenspan, BDS, PhD, from the University of California, San Francisco. “I thought it was a fascinating study, an excellent pilot/initial exploration of the safety and efficacy of pioglitazone in the management of oral leukoplakia. If confirmed in larger-scale multicenter trials, this could add an important approach to the control of that lesion.”

In fact, the researchers are now undertaking a phase 3 clinical trial, Dr. Rhodus reported.

If the drug is eventually approved for leukoplakia, it is unlikely that general dentists will prescribe it, he added, but they can identify the types of lesions they should refer to oral surgeons, oral pathologists, or otolaryngologists for treatment, he said.

This study was funded by the National Cancer Institute. Dr. Rhodus and Dr. Greenspan have disclosed no relevant financial relationships.

International Association of Dental Research (IADR) 89th General Session and Exhibition: Abstract 945. Presented March 17, 2011.

March, 2011|Oral Cancer News|

Rise of tongue cancer in young, white females

Roxanne Nelson – staff journalist for Medscape Oncology.

The incidence of oral tongue squamous cell carcinoma has been rising in young white American women, according to a new report. For the past 3 decades, the incidence has been increasing in white men and white women 18 to 44 years of age, but the trend is most pronounced in young white women.

In a report published online March 7 in the Journal of Clinical Oncology, the authors found that the incidence of oral cavity squamous cell carcinoma was declining for all age groups. The incidence of oral cavity and tongue cancer also was decreasing for nonwhite individuals. However, among people 18 to 44 years of age, the incidence of oral tongue cancer climbed 28% between 1975 and 2007. Among white people in this age group, the incidence increased 67%. The rising rates were most dramatic for white women, with a jump of 111%.

“Lately, we have been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals, but couldn’t find any information about gender-specific incidence rates, so we decided we should take a look at the SEER [Surveillance, Epidemiology, and End Results] data,” said lead author Bhisham Chera, MD, assistant professor in the Department of Radiation Oncology at the University of North Carolina School of Medicine, Chapel Hill. The authors note that historically, cancer of the oral cavity was considered to be associated with older men with histories of significant tobacco and alcohol use. But during the past 30 years, the incidence of oral cavity squamous cell carcinoma has been declining while the incidence of oropharyngeal squamous cell cancer has been increasing. These trends, note the authors, might be explained by the decreased use of tobacco and the association between the carcinogenic strains of human papillomavirus (HPV) and cancer of the oral cavity.

Not HPV Associated

Unlike cancers of the tonsil and base of tongue subsites within the oropharynx, oral cavity and oral tongue squamous cell carcinomas are rarely associated with HPV infection, according to the authors. The demographics of HPV-related head and neck malignancies differ from those associated with HPV. Those with HPV-associated head and neck cancers generally tend to be white men who are nonsmokers. At Dr. Chera’s institution, the young patients with head and neck squamous cell carcinomas who are nonsmokers and nondrinkers are most likely to be white women with oral cavity squamous cell carcinoma.

“Our findings suggest that the epidemiology of this cancer in young white females may be unique and that the causative factors may be things other than tobacco and alcohol abuse,” Dr. Chera said. “Based on our observations and the published data, it appears that these cases may not be associated with the human papillomavirus. We are actively researching other causes of this cancer in this patient population.”

They have examined the HPV status of their young white female patients with oral tongue tumors and have not found an association. Other reports have shown similar findings — a higher number of oral tongue squamous cell carcinomas in women and an absence of detectable HPV DNA. It is possible that they are being caused by a different virus or another subtype of HPV, he told Medscape Medical News. “There are over 100 subtypes but only handful are associated with malignancy, and we only test for the high-risk types.”

“Could it be that another type is associated? . . . Basically, we don’t know yet,” Dr. Chera added. In their study, Dr. Chera and colleagues analyzed the incidence and survival data from the SEER Program from 1975 to 2007 for oral cavity squamous cell carcinoma and oral tongue squamous cell carcinomas. Specifically, they looked at 3 cohorts: patients of all ages, patients 18 to 44 years of age, and patients 44 years and older. The patients were also stratified by sex and/or race.

Possible Emerging Clinical Entity

During that time period, SEER data showed 32,776 cases of oral cavity squamous cell carcinoma, with 2223 of those occurring in young adults. The ratios for male/female and white/black or other races were 2.2:1.0 and 8.5:1.0, respectively. For all age groups, there were a total of 6,810 cases of oral tongue squamous cell carcinoma, with 814 in the 18 to 44 year age group. For all age groups, the male/female ratio was 1.6:1.0; stratified by race, 424 were white (82%), 50 (6%) were black, and 96 (12%) were other. Because it is not usually associated with HPV, the authors note that oral tongue squamous cell carcinoma in young white women “may be an emerging and distinct clinical entity, although future research is necessary before broad conclusions can be drawn.” Specifically, further investigation is needed to examine the sources of the observed variation, they write.

“Dentists and primary care physicians should be more cognizant of oral tongue squamous cell carcinoma in this group of patients,” said Dr. Chera. “At this point, the incidence is very small, and widespread screening may not be cost effective.”

“I would say that if a young white person has complaints of a persistent sore on their tongue, cancer should be moved up higher on the differential, based on our study,” he added. “Dentists should not only examine dental health but also examine the tongue. They are in a position to provide effective screening.”

The source for this article was – J Clin Oncol. Published online March 7, 2011. Abstract

March, 2011|Oral Cancer News|

Oral cancer screenings: dental professionals can save lives

Author: Michelle Kratt

I am sure that you have heard of HPV (human papillomavirus)? Did you know that some types of HPV can cause oral cancer? Recent studies in the United States indicate that HPV is now the leading cause of head and neck cancers at 64%, even rising above smoking, tobacco chewing, and drinking alcohol.

Oral cancer accounts for 2% to 4% of all cancers diagnosed annually in the United States. The number of oral cancer cases is steadily rising, and today it is showing up in younger patients. More than 37,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause more than 8,000 deaths, killing roughly one person per hour, 24 hours per day. Of those 37,000 newly diagnosed individuals, only slightly more than half will be alive in five years. The death rate for these types of cancer is so high not because it is hard to discover or diagnose, but because it is caught too late in its development, with 70% found in Stage III or IV.

Aside from the usual risk factors — tobacco and alcohol, ultraviolet light, poor nutrition, immune system suppression, lichen planus, and history of cancer — the addition of HPV as a risk factor for oral cancer has made it extremely difficult to easily define high-risk individuals (25% of mouth cancers and 35% of throat cancers are caused by HPV). Another risk factor, although controversial, is ill-fitting dentures. It has been suggested that long-term irritation of the lining of the mouth caused by poorly fitting dentures is a risk factor, since poorly fitting dentures can tend to trap agents that have been proven to cause oral cancer, such as alcohol and tobacco particles.

The dental community is the first line of defense against oral cancer. According to the ADA, 60% of the U.S. population sees a dentist every year. Unfortunately, published studies show that currently less than 15% of those who visit the dentist regularly report having had an oral cancer screening. Screening everyone is the only way to find oral cancer at the very early stages and decreasing the death rate.

It is important that everyone from the dental community to the public population realize that a visit to the dentist is not just to have your teeth cleaned or have a crown done. It is actually a matter of life and death. Dental examinations, including an oral cancer screening when done properly, will save lives.

Where should you begin?

  • Instill a call to action for patients to come back to your practice and be screened annually, just as they do with their physician for other diseases.
  • Screen EVERYONE regardless of their age or traditional risk factors. You cannot tell who has HPV; often patients who have this virus won’t have any sores or other visible signs.
  • Educate your patients and your community about oral cancer and its risk factors.
  • Educate yourself and your team. It is always best to update your screening skills and maybe invest in some of the diagnostic technology out there (ViziLite, Microlux D/L, VELscope, and Orascoptic DK).

Remember, it’s not your job to diagnose. Your job is discovery of suspect tissue and conditions. Perform a thorough exam and know what to look for. Many benign conditions in the mouth mimic oral cancer. When you find an abnormality, it is important to find out if it has persisted for more than two weeks. Conditions that do not resolve within two weeks deserve a definitive diagnosis through the appropriate referral process. It’s important to reassure the patient that most things like this are not serious, but it is better to be safe and know for sure. By doing so, you’ll find out that what you saw was nothing at all or that you’ve saved the patient’s life.

When it comes to oral cancer and saving lives, the primary responsibilities of the dental community are creating awareness, discovery, diagnosis, and referral. The most important step in reducing the death rate from oral cancer is early discovery. There is no one who has a better opportunity to make an impact better than dental professionals.

April is Oral Cancer Awareness month. If you are not already screening your patients with one of the many products that are now available, this is the perfect time to start. The Oral Cancer Foundation has great marketing products, such as awareness buttons, for your team and patients.

For more information on implementing an oral cancer screening program in your practice, visit or

About the author:
Michelle Kratt brings more than 20 years of dental office experience to her new role in administration and practice-management consulting with Amy Smith Consulting, LLC. Michelle’s history and experience in dentistry is impressive. She is a fellow of the American Association of Dental Office Managers (AADOM) and the Association of Dental Implant Auxiliaries. She is also the founder and president of NEDAT Study Club for dental administrative team members, and was recently recognized by AADOM for her efforts in this capacity. She can be reached at or


Evaluation of human papillomavirus testing for squamous cell carcinoma of the tonsil in clinical practice

Authors: Selvam Thavaraj et al.

Oncogenic human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) is a subtype of head-and-neck cancer with a distinct clinical and prognostic profile. While there are calls to undertake HPV testing for oropharyngeal SCCs within the diagnostic setting and for clinical trials, there are currently no internationally accepted standards.

142 tonsil SCCs were tested using p16 immunohistochemistry (IHC), high-risk HPV DNA in situ hybridisation (ISH) and HPV DNA polymerase chain reaction (PCR; GP5+/6+ primers).

There were high levels of agreement between pathologists for p16 IHC and HPV ISH scoring; however, around 10% of HPV ISH cases showed some interobserver discrepancy that was resolved by slide review. The combination of p16 IHC and HPV ISH classified 53% of the samples as HPV-positive, whereas the combination of p16 IHC and HPV PCR classified 61% of the samples as HPV-positive. By employing a three-tiered, staged algorithm (p16 IHC/HPV ISH/HPV PCR), the authors were able to classify 98% of the cases as either HPV-positive (p16 IHC+/HPV DNA+; 62%) or HPV-negative (p16 IHC−/HPV DNA−; 35%).

The current study suggests that using a combination of p16 IHC/HPV ISH/HPV PCR, in a three-tiered, staged algorithm, in conjunction with consensus reporting of HPV ISH, leads to less equivocal molecular classification. In order to ensure consistent reporting of this emerging disease, it is increasingly important for the head-and-neck oncology community to define the minimum requirements for assigning a diagnosis of ‘HPV-related’ oropharyngeal SCC in order to inform prognosis and for stratification in clinical trials.

1. Selvam Thavaraj1,
2. Angela Stokes1,
3. Eliete Guerra2,
4. Jon Bible3,
5. Eugene Halligan3,
6. Anna Long4,
7. Atuora Okpokam4,
8. Philip Sloan4,5,
9. Edward Odell1,
10. Max Robinson5

Authors’ affiliations:

1. Oral Pathology, Department of Clinical and Diagnostic Sciences, King’s College London Dental Institute, London, UK
2. Oral Pathology, Department of Dentistry, Faculty of Health Science, University of Brasilia, Brasilia, Brazil
3. GSTS Pathology, Department of Infection, Virology Section, St Thomas’ Hospital, London, UK
4. Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
5. Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK

Source: J Clin Pathol 2011;64:308-312 Published Online First: 23 February 2011 doi:10.1136/jcp.2010.088450

March, 2011|Oral Cancer News|