Monthly Archives: January 2015

Coupling head and neck cancer screening and lung cancer scans could improve early detection, survival

Author: staff

Adding head and neck cancer screenings to recommended lung cancer screenings would likely improve early detection and survival, according to a multidisciplinary team led by scientists affiliated with the University of Pittsburgh Cancer Institute (UPCI), a partner with UPMC CancerCenter.

In an analysis published in the journal Cancer and funded by the National Institutes of Health (NIH), the team provides a rationale for a national clinical trial to assess the effectiveness of adding examination of the head and neck to lung cancer screening programs. People most at risk for lung cancer are also those most at risk for head and neck cancer.

“When caught early, the five-year survival rate for head and neck cancer is over 83 percent,” said senior author Brenda Diergaarde, Ph.D., assistant professor of epidemiology at Pitt’s Graduate School of Public Health and member of the UPCI. “However, the majority of cases are diagnosed later when survival rates generally shrink below 50 percent. There is a strong need to develop strategies that will result in identification of the cancer when it can still be successfully treated.”

Screening patients for head and neck cancer and lung cancer could improve early detection and survival.

Screening patients for head and neck cancer and lung cancer could improve early detection and survival.

Head and neck cancer is the world’s sixth-most common type of cancer. Worldwide every year, 600,000 people are diagnosed with it and about 350,000 die. Tobacco use and alcohol consumption are the major risk factors for developing the cancer.

The early symptoms are typically a lump or sore in the mouth or throat, trouble swallowing or a voice change, which are often brushed off as a cold or something that will heal. Treatment, particularly in later stages, can be disfiguring and can change the way a person talks or eats.

Dr. Diergaarde and her team analyzed the records of 3,587 people enrolled in the Pittsburgh Lung Screening Study (PLuSS), which consists of current and ex-smokers aged 50 and older, to see if they had a higher chance of developing head and neck cancer.

In the general U.S. population, fewer than 43 per 100,000 people would be expected to develop head and neck cancer annually among those 50 and older. Among the PLuSS participants, the rate was 71.4 cases annually per 100,000 people.

Recently, the U.S. Preventive Services Task Force*, as well as the American Cancer Society and several other organizations, recommended annual screening for lung cancer with low-dose computed tomography in people 55 to 74 years old with a smoking history averaging at least a pack a day for a total of 30 years. The recommendation came after a national clinical trial showed that such screening reduces lung cancer mortality.

“Head and neck cancer is relatively rare, and screening the general population would be impractical,” said co-author David O. Wilson, M.D., M.P.H., associate director of UPMC’s Lung Cancer Center. “However, the patients at risk for lung cancer whom we would refer for the newly recommended annual screening are the same patients that our study shows also likely would benefit from regular head and neck cancer screenings. If such screening reduces mortality in these at-risk patients, that would be a convenient way to increase early detection and save lives.”

Dr. Diergaarde’s team is collaborating with otolaryngologists to design a national trial that would determine if regular head and neck cancer screenings for people referred for lung cancer screenings would indeed reduce mortality.

January, 2015|Oral Cancer News|

Experience counts with radiation for head and neck cancer

Author: Kathy Boltz, PhD

When it comes to specialized cancer surgery, the more experienced the surgeon, the better the outcome is generally true. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study.

Published in the Journal of Clinical Oncology(1) with an accompanying editorial(2), the study compared survival and other outcomes in 470 patients treated with radiation therapy at 101 treatment centers through a clinical trial held from 2002 to 2005. The trial was sponsored by the National Cancer Institute and organized by the Radiation Therapy Oncology Group (RTOG). It was conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital in Columbus.

The findings indicated that patients treated at the less-experienced centers were more likely to have cancer recurrence compared with highly experienced centers (62% vs 42%, respectively, at 5 years) and had poorer overall survival compared with those at the highly experienced centers (51% vs 69% 5-year survival, respectively).

“Our findings suggest that institutional experience strongly influences outcomes in patients treated with radiation therapy for head and neck cancer,” said first author Evan Wuthrick, MD. “They indicate that patients do better when treated at centers where more of these procedures are performed versus centers that do fewer.”

Radiation therapy for head and neck cancer requires complex treatment planning that can vary considerably between institutions and physicians. In addition, significant short-term and long-term side effects can occur that require management by a carefully coordinated multidisciplinary care team.

National Comprehensive Cancer Network (NCCN) guidelines recommend that head and neck cancer patients receive treatment at experienced centers, but whether provider experience affects outcomes was previously unknown.

The research team used participation in previous RTOG head and neck cancer clinical trials as a surrogate for experience. They identified 88 low-accruing centers that enrolled an average of four patients yearly to the trials, and 13 high-accruing centers that enrolled an average of 65 patients annually. Next, the researchers compared outcomes based on whether patients were treated at the high-accruing (more experienced) or low-accruing (less experienced) centers.

They found that 5-year local recurrence rates were higher among patients treated at less experienced centers versus more experienced centers (36% vs 21%). The radiation therapy plan was more likely to deviate from protocol at less experienced centers (18% vs 6%).

Treatment at low-accruing centers was associated with a 91% increased risk of death and an 89% increase in progression or death when compared with high-accruing centers.

Institutional elements not assessed by the study that can also influence outcomes included use of a tumor board, the number of colleagues and their years of practice, and ancillary services such as speech and swallowing therapy, diet and nutrition support, and specialized nursing.

1. (2014; doi:10.1200/JCO.2014.56.5218)
2. (doi:10.1200/JCO.2014.58.2239)

January, 2015|Oral Cancer News|

Majority of public unaware of alcohol’s link with cancer

Author: staff

More than half of the British public are unaware of the link between alcohol consumption and cancer, according to a survey from the Alcohol Health Alliance UK (AHA) (link is external).


The UK- wide poll found that just 47 per cent of people were aware of any connection between alcohol and the disease. But an overwhelming majority (83 per cent) would back further nutritional and health information on alcohol labelling.

Sarah Williams, Cancer Research UK’s senior health information officer, said: “Alcohol has long been a scientifically established cause of cancer, but there is surprisingly low awareness among the public of this link.

“And it isn’t just a risk for heavy drinkers; regularly drinking alcohol puts you at greater risk of seven different types of cancer, including breast and mouth cancer”

Alcohol is currently exempt from the EU legislation that makes it mandatory for food products and soft drinks to carry nutritional value information, despite alcohol being classed as a group 1 carcinogen by the World Health Organisation (link is external).

The AHA’s chair, Sir Ian Gilmore, says the lack of health information on many alcoholic products is “indefensible”.

“It’s not right that labelling is mandatory for a box of corn flakes but not for alcoholic products which can seriously harm health,” he said.

Gilmore urges the Government to start listening to public opinion on this issue rather than the demands of big businesses.

The results from the survey of 3077 people showed that nine in 10 (91 per cent) think that clarifying the health impacts of alcohol is important. But when challenged over their current knowledge, just under one in three (31 per cent) of people successfully acknowledged the links between alcohol and breast cancer.

This stretched to half of people being aware of the links in relation to mouth or throat cancer.

The AHA is calling for health labelling to be made a legal requirement for alcohol products. Its campaign is pushing for every alcohol product to clearly describe its nutritional, calorie and alcohol content as well as make it clear through labelling that the safest option for pregnant women is to avoid alcohol consumption entirely. Cancer Research UK supports the campaign for clearer labelling so everyone can make better choices about their drinking, said Williams.

“Cutting back on alcohol can help cut the risk, so you could try having more alcohol free days or making every other drink something soft,” she added.

January, 2015|Oral Cancer News|

Time to treatment increasing with head, neck cancer

Author: staff

Time to treatment initiation (TTI) is rising for patients with head and neck squamous cell carcinoma, according to a study published online Dec. 9 in Cancer
Colin T. Murphy, M.D., from the Fox Chase Cancer Center in Philadelphia, and colleagues analyzed data from the National Cancer Database to identify head and neck cancer sites (oral tongue, oropharynx, larynx, and hypopharynx) and to determine TTI (the number of days from diagnosis to the initiation of definitive treatment).

The researchers found that based on 274,630 patients from 1998 to 2011, the median TTI for all patients was 26 days, and increased from 19 to 30 days (P < 0.0001). Increased TTI was associated with treatment with chemoradiation (CRT; P < 0.0001), treatment at an academic facility (P < 0.0001), and stage IV disease (P < 0.0001). For each disease stage (P < 0.0001), treatment modality (P < 0.0001), and facility type (P < 0.0001), TTI significantly increased over time. Longer TTI was predicted in multivariate analysis by treatment at an academic facility (33 days), transitioning care (37 days), and receipt of CRT (39 days). "Those who have advanced-stage disease, receive treatment with CRT, are treated at academic facilities, and who have a transition in care realized the greatest increases in TTI," the authors write. Note: Several authors disclosed financial ties to the pharmaceutical industry.

January, 2015|Oral Cancer News|