Monthly Archives: February 2015

Tufts dental school to add oral medicine residency program

Author: DrBicuspid Staff

The Tufts University School of Dental Medicine will begin enrolling students in its new Advanced Education Program in Oral Medicine in July 2016, according to a Tufts Daily article.

The program is a two-year postgraduate certificate with the option for a three-year master’s degree track, according to the university. Teaching students how to treat oral symptoms of various diseases and conditions is the aim of the program.

The program teaches dentists to be responsible for the early detection and diagnosis of oral cancer and other malignancies that manifest in the oral cavity. Dentists will be trained to treat the oral manifestations of infectious diseases, including HIV; autoimmune and immune-related diseases such as lupus; and metabolic disorders such as diabetes.

Bhavik Desai, DMD, PhD, an assistant professor of oral medicine and temporomandibular joint disorder at the Virginia Commonwealth School of Dentistry, will begin as the program director on July 1.

Oral medicine is not yet recognized as a specialty by the ADA; the American Academy of Oral Medicine (AAOM) oversees the discipline and is responsible for certifying dentists in the field, according to Interim Program Director Arwa Farag. The program received accreditation from the Commission on Dental Accreditation (CODA) in August 2014.

The AAOM has encouraged the expansion of training programs, because there are only six other dental schools in the U.S. that offer training in oral medicine.

Only 3% of hospitals with cancer programs have oral medicine specialists, and patients are often directed to other departments that are not trained to handle medical issues such as head and neck cancers.

Residents in the program will work with other clinics such as the Cranofacial Pain Center, which sees 1,500 to 2,000 patients annually and allows residents to gain experience working with patients, according to the article.

Residents will also be required to do hospital rotations at the Tufts Medical Center in departments including internal medicine, hematology, dermatology, and rheumatology. They will also conduct visitations at the University of Massachusetts Memorial Medical Center and other Tufts facilities that serve patients with related needs.

If students choose to continue for a third year, they will do either clinical or laboratory research at the School of Dental Medicine, the Sackler School of Graduate Biomedical Sciences, or the Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging.

February, 2015|Oral Cancer News|

Researchers propose new staging model for HPV+ oropharyngeal cancer

Author: Donna Domino

Researchers are proposing a new tumor-staging model for predicting the outcomes and guiding treatments for patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC), according to a new study in the Journal of Clinical Oncology. Since HPV-related cancer differs significantly from smoking-related cancer, less intensive treatment strategies may be more appropriate, the study authors concluded.

Treatment regimens for oropharyngeal cancer have intensified over time and carry a toxicity burden, the Canadian researchers noted.

In the last few years, research has found that oropharyngeal cancer caused by HPV behaves differently than OPC caused by smoking and alcohol, yet both cancers use the same tumor classification model. Therefore, regardless of whether the OPC was caused by HPV or smoking, the treatment and perceived prognosis based on tumor staging has remained the same, even though patient outcomes vary considerably, the study authors noted (Journal of Clinical Oncology, February 10, 2015, Vol. 31:5, pp. 543-550).

A new tumor-staging model will help separate patients with promising prognoses from those with negative ones to design the most appropriate treatment strategies for each group, according to the researchers from Toronto’s Princess Margaret Cancer Centre.

The researchers analyzed 899 oropharyngeal cancer patients, including 505 (56%) patients with HPV who had been treated with radiotherapy or chemoradiotherapy from 2001 to 2009. The HPV-positive patients (382) had higher recurrence-free survival rates after about four years compared with HPV-negative patients (123). Disease recurrence was 16.7% (64) among HPV-positive patients; 38.2% among HPV-negative patients (47).

The tumor staging system classifies the disease into early, intermediate, or advanced stages of cancer. It helps determine treatment plans and can suggest likely outcomes.

For example, a stage IV patient with HPV-related cancer has an 80% survival rate, while a stage IV patient with smoking-related cancer has a 50% to 60% survival rate. But both are currently considered to have advanced-stage disease, which is recognized as a life-threatening prognosis.

“When you tell a patient they have stage IV cancer, it’s an indication of advanced disease, and they don’t expect it to be curable,” Huang said in a statement. “We need a staging system that more accurately reflects a patient’s prognosis, which in a case caused by HPV is highly curable.”

The study also highlights the fact that many HPV-related OPC patients are overtreated because of the stage IV tumor classification. High-dose chemotherapy combined with high-dose radiation is often given to such patients when radiation therapy alone or other less-intensive strategies can probably cure many of them, the researchers said.


“Our study shows that the current model derived for smoking- and alcohol-related cancers is not suited for throat cancer caused by HPV, a burgeoning throat cancer population in the Western world, including Canada,” Huang concluded.

A new tumor staging model will help separate patients with promising prognoses from those with negative prognoses to design the most appropriate strategies for each group, the study authors concluded.

Clinical trials have now begun to address these questions, but their descriptions and designs are hindered by inadequacies of the current stage classification, they stated.

“Providing a relevant stage classification for a rapidly emerging disease is important, but the additional feature of the classification is that it provides the opportunity to include factors beyond just the traditional description of disease extent into the prognostic classification we are trying to develop to assist in treating patients,” he said.

The structure used for disease classification follows a template that was developed at the Union for International Cancer Control in Geneva and is relevant to all cancers, according to Dr. O’Sullivan.

“Important factors that are emerging throughout oncology are not currently included in the international classifications,” he concluded. “This needs to change to facilitate our goal of providing personalized approaches to patients with cancer.”

The Princess Margaret Hospital is collaborating with six major cancer centers worldwide to validate the findings.

February, 2015|Oral Cancer News|

Lawmaker proposes ‘smokeless tobacco’ ban at all baseball venues

Author: David E. Early, Bay Area News Group

For decades, Major League Baseball’s goofy love affair with chewing tobacco was so passionate that the gooey stuff was stocked by teams in clubhouses as surely as jocks and socks. Nearly all ball players had golf-ball-sized cheek bumps, and part of the show was spitting streams of saliva in dugouts from coast to coast.

But now the end may be near.

If a bill formally introduced in the state Capitol Tuesday becomes law, the use of “smokeless tobacco” will be banned in every baseball venue in the state — from San Jose sandlots to San Francisco’s AT&T Park. They would join minor league parks, which already outlaw it.

“This is all about helping young people. We want to stop youth from being exposed to cancer,” said freshman Assemblyman Tony Thurmond, D-Richmond, author of the bill. “Kids emulate ball players. If they see them use it, they will use it as well.”

The legislation was touted Tuesday at news conferences in Sacramento and San Francisco, where leaders of the Campaign for Tobacco-Free Kids took the podium. Their program, called “Knock Tobacco Out of the Park,” included commentary about oral cancer taking down beloved Hall of Famer Tony Gwynn, a retired San Diego Padre, in 2014 at age 54. And now retired Red Sox pitcher Curt Schilling is battling cancer that he openly blames on his longtime chewing habit.

Opio Dupree, Thurmond’s chief of staff, said Tuesday that the penalties for violating the proposed ban have not yet been determined.

As news about the bill flew like foul balls on Tuesday, baseball players at spring training in Arizona Tuesday had a range of reactions.

Avid dipper Andrew Susac, the San Francisco Giants’ backup catcher, said he wasn’t too pleased. “I’ll have to quit,” Susac said. But, he quickly added, “it would be a good thing for me.”

“My mom and my future wife, they’re hassling me all the time to quit,” added Susac, 24, who tries not to chew on the field or in public.

Oakland Athletics pitcher Dan Otero, who doesn’t dip, said: “I think it will be good to deter young players from maybe getting started.”

In a statement Tuesday, Major League Baseball said it is in favor of getting rid of smokeless tobacco. “We have sought a ban of its use on-field in discussions with the Major League Baseball Players Association,” the statement said.

In the ‘90s, baseball announcer Joe Garagiola led the movement against chewing tobacco by teaming with retired major leaguer Bill Tuttle, who had mouth cancer. The pair traveled to ball parks to show the deformities — the loss of his teeth and gums, his jaw and his right cheekbone — Tuttle suffered from 40 years of chewing. He died in 1998.

While the players association had no response on Tuesday, Matthew Myers, president of the Campaign for Tobacco-Free kids, said the bill is the start of a national movement by nine national organizations.

“California seemed like the logical place to start this effort. It has the most teams in baseball. But it’s also important because of the death of Tony Gwynn,” Myers said. “He just meant so much to baseball and California, and he made it very clear before he died that he didn’t want another generation of young people to follow him in using smokeless tobacco. We hope California can be a catalyst.”

Thurmond, 46, elected last fall in a special election, said he has devoted his life to protecting youth.

“My mom died from cancer when I was 6 years old,” he said.

Meanwhile at spring training, Giants pitcher Tim Hudson, a non-chewer, predicted a number of players will not go down easily and will test the limits of the regulations.

“It all depends on what the fines and penalties are going to be,” Hudson said. “Guys have habits and are pretty stubborn, and they make a lot of money in here. They can pay a lot of whatever fines they want to give them. That’s going to be the biggest challenge — catching guys. Guys are sneaky.”

February, 2015|Oral Cancer News|

Great American Spit Out warns of new tobacco lures

Author: Kate Santich, Orlando Sentinel

As anti-tobacco advocates celebrate today’s Great American Spit Out — the “chew” equivalent of the Great American Smoke Out — health officials warn that new dissolvable and flavored varieties of smokeless-tobacco products are targeting teens in a mission to get them hooked.

Newly released data from state health researchers show that, while cigarette smoking among Florida youth has reached an all-time low, smokeless tobacco use has been virtually unchanged for the past decade: roughly 5.5 percent among high school students statewide.

And it’s nearly 9 percent in some counties, including Lake.

“The tobacco industry is targeting us,” said Magi Linscott, a Pensacola-area 18-year-old named National Youth Advocate for 2014 by the Campaign for Tobacco-Free Kids. “They’re trying to get a new generation of addicts.”

Recent product developments include colorfully packaged, kid-friendly flavors of tobacco-infused candy, mints, gum, breath strips and flavored toothpicks — all containing nicotine. Depending on the type, they are designed to be held in the mouth, chewed, or sucked until they dissolve and the juices swallowed.

Along with more traditional chew, snuff and a teabag-like pouch of finely ground tobacco called snus (“snoose”), smokeless products may lure users with a false sense of safety. Shannon Hughes, Tobacco Free Florida bureau chief, said young people — and their parents — may not realize the dangers of the products, which increase the risk of oral cancer by 80 percent.

“Adults think, ‘Well, at least they’re not smoking,'” Hughes said. “Yes, cigarettes do cause more systemic damage to the body. But smokeless tobacco dramatically increases the risk of oral cancer, which is horribly disfiguring, and a horrible way to die. The bottom line is: There’s no safe level of tobacco use.”

The Spit Out — aimed at raising awareness of the problem — is part of a national “Through with Chew Week.” But because no single agency sponsors the campaign, it lacks the name recognition of the Smoke Out, officials admit.

Still, Hughes and others said, the proliferation of smokeless products makes the message especially urgent.

Chew and snuff have long been popular among baseball players and in rural communities, where their use is sometimes a rite of passage. Among local high-school students surveyed last year, only 3.1 percent of those in Orange County said they currently used smokeless tobacco, while the rate was 4.2 in Osceola, 5.3 in Seminole and 8.9 percent in Lake.

Use is vastly more common for males than females and for whites than blacks or Hispanics.

“It’s part of the culture in certain areas,” Hughes said. “And it can be easier to conceal,” especially with the newer forms. It is also cheaper than cigarettes.

But the American Cancer Society warns that because U.S. tobacco sellers are not required to list what’s in their products, it’s hard to know exactly how hazardous the smokeless varieties can be.

The World Health Organization has identified at least 28 carcinogens in smokeless tobacco, and along with the heightened risk of oral cancer, there’s a 60 percent increase in the risk of esophageal and pancreatic cancers compared to non-users. The products also raise the risk of heart disease and fatal strokes and may impact reproductive health, Hughes said.

“And because youth are often most concerned with the immediate impact,” she said, “we point out that smokeless tobacco use can cause tooth decay, permanent discoloration of teeth and gingivitis leading to tooth loss.”

Perhaps most disconcerting is the increased likelihood of stepping up to more lethal forms of tobacco. Researchers found smokeless-tobacco users tend to experiment with smoking and are more likely to become addicted. The younger the user, scientists say, the more sensitivity to nicotine.

February, 2015|Oral Cancer News|

Cancer patients rarely request unnecessary testing

Author: Anna Azvolinsky, PhD

A new study suggests that cancer patients tend not to request unnecessary and sometimes costly tests or treatments. Of the 5,050 interactions between a clinician and patient analyzed, only 1% resulted in a patient request for a clinically unnecessary or inappropriate test or therapy. Clinicians complied with only 7 of 50 requests (14%).

The study goes against a common assumption that the high cost of healthcare in the United States is partly due to extra or unnecessary treatments and analyses done as a result of patients’ requests.

The results of the study were published in JAMA Oncology.

Researcher Ezekiel J. Emanuel, MD, PhD, of the department of medical ethics and health policy at the Perelman School of Medicine of the University of Pennsylvania, and colleagues analyzed a total of 5,050 outpatient interactions among 60 clinicians and 3,624 patients that occurred between October 2013 and June 2014 at three Philadelphia-area hospitals. The 60 clinicians—34 oncologists, 11 oncology fellows, and 15 nurse practitioners and physician assistants—were interviewed by trained research assistants on each patient-clinician encounter.

“We decided to look specifically at cancer patients’ demands because oncology is a setting where there are life-and-death stakes for patients and the drugs and tests can get very expensive,” said Emanuel in a statement. “However, we found, contrary to expectations, that patient demands are low and cannot be a key driver of increasing healthcare costs.”

Most of the patients in the study were women (58.7%), and of the 5,050 encounters, 57.5% were between a clinician and a female patient. More than 50% of patients were between 55 and 74 years of age; 69.4% were white. More than half of the patients had private insurance (56.3%), while 40.6% had Medicare. The most common cancer types diagnosed among the patients were hematologic malignancies (25.9%). The next most common cancer type was gastrointestinal cancer.

Of the 5,050 encounters, 8.7% (440) included a request for treatment, test, or imaging by the patient. Clinicians complied with 83% (365) of these requests. Of the 440 requests, clinicians considered 11.4% of them to be inappropriate or unnecessary.

“At least in oncology, ‘demanding patients’ seem infrequent and may not account for a significant proportion of costs,” concluded the authors.

Of the 440 demands, 49.1% were requests for imaging, 15.5% were for palliative treatments, and 13.6% were for laboratory testing. A lung or head and neck cancer diagnosis, a fair- or poor-quality patient-clinician relationship, and active treatment by the patient were all factors associated with patient requests (all P < .01).

The United States spent $3 trillion on healthcare in 2014; at least one prior analysis of physicians’ sentiments showed that they believe that the availability of information on the Internet and patient-directed marketing stimulate patients to request novel and expensive tests and therapies. Still, there is a dearth of data on whether these physician claims are substantiated—both the frequency of such requests and whether or how often clinicians catered to them.

“We observed very few patient demands for inappropriate treatments, and it was even rarer that a physician complied with the demand,” said study author Keerthi Gogineni, MD, MSHP, of Winship Cancer Institute of Emory University in Atlanta, in a statement. “In this age of unregulated consumer medical information on the Internet, it’s encouraging to see that this hasn’t translated to cancer patients requesting inappropriate—and often costly—tests and treatments.”

Whether the results can be generalized to inpatient interactions, other US geographies, and other practices outside of oncology is not clear. Most of the patients had private insurance; therefore, other studies should analyze whether the results are applicable to a larger Medicare and less affluent population.

In an accompanying editorial, Anthony L. Back, MD, of the Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center at the University of Washington in Seattle, acknowledged what he called the “myth of the demanding patient.”

“The real point of the study, however, is this: we have to stop blaming patients for being demanding. In reality, it is hardly happening. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories. And when we have calmed down enough to look up, we see that what is really happening between patients and physicians these days is something quite different,” wrote Back. “It is possible that what the study by Gogineni et al documents is a point in the evolution of the patient-physician relationship when both sides recognize that the complexity of cancer care belies a simple fix. Perhaps this ‘negative’ study is pointing to an important truth: that we need to redirect our attention from the myths that are distracting us.”

February, 2015|Oral Cancer News|

Novel endoscope gives clearer view of cancers

Author: Tim Hayes

An endoscope under development by a team from the University at Buffalo combines imaging ability with light delivery, as a means to improve both cancer detection and the efficient treatment of tumors once they have been discovered.

The platform employs spatial frequency domain imaging (SFDI) as a means to improve the low-contrast image quality that some endoscopic systems are prone to. But it can also deliver a pulse of light of the necessary strength and intensity to burst nanoballoons of lipid-encapsulated drugs at the tumor site.

SFDI is a relatively new technique that allows quantitative, depth-resolved measurements of tissue absorption and scattering parameters, as well as imaging of exogenously administrated fluorescence contrast agents, according to Ulas Sunar of Buffalo’s Biomedical Engineering department.

“The technique directs sinusoidal patterns of light at a tissue surface at multiple spatial frequencies, and measures a frequency-dependent tissue response that, once processed, yields information about the optical absorption and scattering parameters. This information can be much like a fingerprint,” Sunar commented. “Quantifying absorption and scattering parameters is very important, since it allows an accurate determination of light propagation and attenuation in living tissue.”

SFDI can also quantify absolute fluorescence concentrations of exogenous agents, such as drugs that have been allowed to accumulate in cancerous tissues – an approach usually hindered by deterioration of the raw fluorescence signal thanks to strong tissue absorption and scatter. Knowledge of these concentrations is very useful, since drug distribution can allow better localization of the disease, and accordingly assist with delivery of an accurate light dose for improved therapeutic outcomes.

A further appeal is that SFDI instrumentation can be based around simple, cheap and widely available components, such as CCD cameras, projectors and LEDs. As a non-contact, wide-field imaging method, it could potentially allow clinicians to rapidly screen relatively large areas of tissue, making it suitable for use in the operating theater to map optical contrasts for disease characterization.

Diffuse optics and deep tissues
SFDI has its origins in wide-field imaging research carried out at the Beckman Laser Institute, and is essentially a diffuse optical extension of established structured-light microscopy principles. But while structured light-based microscopy mainly focuses on high-resolution imaging at depths measured in microns, SFDI is designed to image deeper tissues, millimeters below the surface.

“The diffuse optics community mainly focuses on wide-field large tissue imaging of breast, brain, and muscle, so there has not been any specific need to develop it for internal organs,” said Sunar. “After working on photodynamic therapy of head and neck cancer for the last five years, and implementing diffuse optical spectroscopy in clinical settings to monitor PDT patients, I realized the need for deep-tissue imaging of internal organs such as the oral cavity, lung, peritoneal cavity and gastrointestinal tract.”

Sunar’s current project, funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), has focused on applying the technique to ovarian cancer.

“The main challenge was accurate quantification of the optical parameters and the drug fluorescence concentration,” he noted. “Currently we are working on improving the signal-to-noise ratio along with fast data acquisition and analysis, since projecting the patterns rapidly and acquiring with sufficient SNR is a vital component of the approach. Selection of optical components for a particular application is also very important. Research is all about continuous iterations, and this project is not an exception.”

Bursting the nanoballoon
Imaging is only one part of the probe’s capabilities. Another project at Buffalo, led by Jonathan Lovell, has investigated ways to encapsulate drugs within modified liposomes, forming “nanoballoons” that will open when hit by a suitably intense pulse of near-infrared light. Arranging for the nanoballoons to reach the tumor and then opening them with a pulse of laser light could be a way to maximize the effective placement of the therapeutic chemical, while also reducing unwelcome side effects.

The two technologies make an excellent fit, with Sunar working on ways to control the profile of the endoscopic light beam and allow it to deliver the balloon-popping pulses.

“This requires control of both the beam shape and intensity,” he explained. “We want to control the shape in order to only illuminate those targeted areas where we intend to release the drug, so as to eliminate or reduce the side effects of chemo-drugs.”

Controlling the intensity is equally important, given that a threshold beam strength is needed to allow the release process to occur. There may also be scenarios in which the encapsulated drug is localized deeper within the tissue, requiring a different intensity of light in order to reach it and trigger drug release.

Development of the endoscope itself should be completed during 2015, after which the technique will begin its progress out of the lab – a process Sunar believes should go relatively smoothly.

“Clinical translation is very feasible and we are hoping to start within two years,” said Sunar. “The main challenge, I expect, will be the clinical acceptance of the drug construct, which generally takes longer due to the necessary side-effect tests. However, in this case the drug construct is based on porphyrin and doxorubicin, both of which are already in clinical use. So we are expecting that the clinical translation will be quicker than usual.”

February, 2015|Oral Cancer News|

Possibility of cure For HPV positive throat cancer patients—new research

Author: Samantha Richardson

A new research conducted by Dr. Sophie Huang, assistant professor in the Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada revealed that throat cancer caused by the Human Papilloma virus (HPV+) can possibly be cured. The research is of utmost importance as it is the first to provide substantial evidence to prove that patients suffering from oropharynx cancer can be healed.

The disease also spreads to other parts of the body. The press release disclosed that the tumours remain passive and go undetected for over two years in most case, which makes it incurable. The research was presented at the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) on Friday. She states that cure is possible among patients suffering from oropharyngeal cancer is possible for the first time.

“Our research, the largest study to date to explore survival predictors for metastatic HPV+ and HPV- oropharyngeal cancer patients,” says Dr. Huang.

For the research, 934 patients suffering from HPV+ OPC were studied. All subjects were patients treated at the Princess Margaret Cancer Centre between 2000 and 2011. The researchers found two types of distinct metastases or tumours in other parts of the body away from the source in HPV+ patients: “explosive” and “indolent” metastases. The former grows and spreads quicker while the latter is slower and manifests itself as oligometastasis. However, they found the lung as the most common metastatic site in both HPV+ and HPV- patients. According to Dr. Huang, more aggressive treatments solely aimed at disease control resulted in a long term disease-free period, suggesting that some may be cured.

“In the HPV+ group with oligometases 25% were still alive after three years, whereas the percentage in the HPV- group was 15%,” the press release stated. The reason for higher survival rates among HPV+ patients is the younger age of the patients. In addition, the cancer is more sensitive to radiotherapy and chemotherapy. Those who receive treatment are at an advantage and can survive longer than those who do not undergo the process. Early detection of metastases and aggressive treatment can cure the patient.

Dr. Huang explained that they were aware of the correlation between the initial stages and the risk of a tumour on another site of the body. However, the degree by which they are related remains unknown. She highlights that identifying such relationships could help find an appropriate treatment at an early stage.

Professor Jean Bourhis, co-chair of the conference scientific committee, says that this is a very important research with respect to finding the cure of oropharynx cancer. He states that it provides hope in both the treatment and diagnosis of the patients.

February, 2015|Oral Cancer News|

Hookahs don’t filter out tobacco toxins

Author: Robert Preidt, HealthDay Reporter

Contrary to what many people think, hookah water pipes do not filter out most of the heavy metals in tobacco, a new study warns.

Tobacco plants can absorb and accumulate heavy metals, such as copper, iron, chromium, lead and uranium. Long-term exposure to these heavy metals can increase smokers’ risk of head and neck cancers, as well as other diseases, the study authors said.

It’s widely believed that hookahs filter out these heavy metals and are therefore safer than cigarettes, the authors pointed out in a news release from BioMed Central.

But researchers from the German Jordanian University and the Royal Scientific Society Amman-Jordan tested four of the most popular tobacco brands in Jordan. The investigators found that hookahs remove only about 3 percent of heavy metals in tobacco, which is not enough to protect smokers against exposure to these toxic substances.

The findings were released online Feb. 19 in the journal BMC Public Health.

“Since the trend of smoking water pipe has increased markedly among the young in the last decade, not only in the Middle East but worldwide, our research adds to the evidence about its potential health hazards,” lead researcher Akeel Al-Kazwini said in the news release.

The water mainly cools the smoke, rather than filtering it as people may believe, according to Al-Kazwini.

More needs to be done to make people aware of the dangers of smoking hookahs, the researchers said.

“At present, the water pipe tobacco industry operates without regulation and the impact of health warning labels on water pipe use has not been extensively investigated. It is therefore essential that regulators and policymakers prioritize the correct labeling of water pipe tobacco products in order to ensure users are informed of the dangers,” Al-Kazwini said.

February, 2015|Oral Cancer News|

Clinician support critical to HPV vaccination

Author: Charles Bankhead, Staff Writer, MedPage Today

Immunization against human papillomavirus (HPV) infection continues to lag behind rates for other vaccine-preventable diseases, primarily because of lost opportunities in the clinic, according to participants in a national conference.

Primary care providers have yet to get onboard with HPV immunization with their critical recommendation to patients or parents. Enthusiasm for HPV vaccination also has taken a hit because of its portrayal as a means to prevent a sexually transmitted disease (STD) instead of a vaccine to prevent cancer, speakers said during an HPV vaccination “summit” at Moffitt Cancer Center in Tampa, Fla.

“The most important problem is that many healthcare providers are not making a strong recommendation for the vaccine in the same way that they recommend other recommended vaccines,” said Melinda Wharton, MD, of the Centers for Disease Control and Prevention (CDC) in Atlanta. “That’s fundamentally what we think the biggest problem is.”

“We’re hurting ourselves by approaching it differently and talking about it differently than we’re talking about the other vaccines,” said Ailis Clyne, MD, of the Rhode Island Department of Health, which has mounted one of the more successful HPV immunization campaigns in the U.S.

Not only have the primary “pitch men” not been getting the message out about HPV, too often the sales pitch has focused on the wrong disease, said Otis Brawley, MD, chief medical officer for the American Cancer Society (ACS).

“We need to start talking about [the vaccine] as a cancer vaccine, instead of a vaccine for sexually transmitted disease,” said Brawley.

The focus on HPV vaccination as protection against an STD helped create and perpetuate a stigma associated with the vaccine. Moreover, focusing on the STD angle obscures the bottom-line benefit of preventing cervical and other cancers, Brawley and other speakers at the conference emphasized.

The conference brought together dozens of representatives of cancer and public health organizations to compare notes on how to improve HPV vaccination rates. In addition to the CDC and ACS, conference participants included the National Cancer Institute, National Partners for Comprehensive Cancer Control, and representatives of the nation’s comprehensive cancer centers.

Since 2006, the CDC Advisory Committee on Immunization Practices (ACIP) has recommended HPV immunization as a part of routine care for all girls ages 11 to 12, extending the recommendation to 11- and 12-year-old boys in 2011. According to the latest estimates from the CDC, 57% of adolescent girls and 34% of boys have received at least one of the recommended three doses of HPV vaccine. If every girl born in 2000 had received at least one dose of vaccine, coverage would have exceeded 91% by now.

Presentations and discussion at the HPV conference highlighted a number of obstacles to HPV vaccine uptake. Currently, a majority of states (29) have no formal policies regarding HPV immunization. Conference participants appeared divided about the effectiveness of vaccine mandates, as some speakers said mandated HPV immunization (along with other childhood immunizations) is the only way to ensure uptake, whereas others said experience to date suggests mandates have had limited success in improving the vaccination rate for HPV.

Clyne provided a few insights into potential pathways to improved vaccine uptake. The state health department had the autonomy to mandate HPV vaccination without seeking approval of the state legislature. Additionally, Rhode Island directly purchases all state-mandated vaccines and distributes them to healthcare providers free of charge.

Clyne’s bosses at the Rhode Island Department of Health refused MedPage Today’s request to interview her about the state’s HPV immunization program.

Discussants repeatedly returned to the issue of providing support and encouragement to clinicians, whose recommendations have proven critical to a wide range of healthcare actions.

“One of the things we can do at the community level is to help physicians make that strong recommendation,” said Anna Giuliano, PhD, of Moffitt Cancer Center. “When they have families in their offices with age-eligible boys and girls, they should take that opportunity to make the recommendation for HPV vaccination.”

Public education also will play a major role in improving vaccine uptake, Giuliano added. Parents need clear, accurate, and concise information to make an informed decision about HPV vaccination.

Education for the public and healthcare professionals should emphasize the wide range of cancers that can be prevented by HPV immunization, said Jennifer Smith, PhD, of the University of North Carolina School of Public Health at Chapel Hill. Although cervical cancer has received the most attention, HPV also causes anal, penile, and vulvar cancer, as well as oral cancer.

“Increasing the uptake of the vaccine will be followed by reductions in all of the HPV-associated cancers,” said Smith.

The conference ended with agreement to prepare a written summary of the conference proceedings, develop an agenda for action, and revisit the issues, obstacles, and progress related to HPV immunization at a future date. Additionally, several working groups have taken shape to address specific issues in greater detail.

“The top priorities are really about that provider recommendation, making sure that it is strong and it is consistent,” Susan Vadaparampil, MD, of Moffitt Cancer Center, told MedPage Today. “Another important priority is to emphasize that we need to vaccinate not only our adolescent girls but also our adolescent boys. Finally, the message about the benefits of this vaccine are around cancer prevention.”

February, 2015|Oral Cancer News|

Band Announces Iron Maiden Singer is Battling Tongue Cancer

Author: Maria Puente


Iron Maiden singer Bruce Dickinson is being treated for cancer of the tongue, the heavy metal band announced on its website Thursday. But it was caught early, seven weeks of chemotherapy and radiation have just been completed, and a full recovery is expected, the announcement said. “Bruce is doing very well considering the circumstances and the whole team are very positive,” it concluded.

The announcement said that before Christmas, Dickinson visited his doctor for a routine check-up. This led to tests and biopsies, which revealed a small cancerous tumor at the back of his tongue.

“As the tumor was caught in the early stages, the prognosis thankfully is extremely good,” the announcement said. “Bruce’s medical team fully expect him to make a complete recovery with the all-clear envisaged by late May.

“It will then take a further few months for Bruce to get back to full fitness. In the meantime we would ask for your patience, understanding and respect for Bruce and his family’s privacy until we update everyone by the end of May.”

Dickinson, 56, joined the British megastar band in the early 1980s, and is also a commercial airline pilot. Iron Maiden’s hits include Run to the Hills and The Number of the Beast.

Last year, the band announced that Clive Burr, former drummer with Iron Maiden, had died in his London home in March. He was 56 and had multiple sclerosis.


*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
February, 2015|Oral Cancer News|