Monthly Archives: October 2019

Health department official on HPV vaccine: “What are we waiting for?”

Source: www.mynews13.com
Author: Rebecca Turco

Despite studies from the CDC showing the effectiveness of the HPV vaccine at preventing certain types of cancer, some parents are still hesitant to get their children vaccinated.

  • 92% of almost 35,000 cancers could be prevented by vaccine
  • Doctor: Some parents may think vaccine promotes sexual behavior
  • County Health Departments offer HPV vaccine for free

Dr. Raul Pino, the interim administrator of the Orange County Health Department, wants to change that.

Among the estimated 34,800 cancers probably caused by the human papilloma virus between 2012 and 2016, an estimated 92% could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.

“We have a vaccine that prevents some type of cancers, and now we’re questioning if we should take the vaccine,” he said. “It will not only prevent penile cancer or vaginal cancer or cervical cancer, but also oral, esophagus and tonsils.

“So what are we waiting for?”

Pino thinks some parents might be hesitant because of the widely spread, but disproven, belief that vaccines are linked to autism. Then, there are other parents who think giving their child the vaccine is promoting sexual behavior. HPV is the most common sexually transmitted infection.

“The reality is, I think what the parents have to present to themselves in this debate, is what is the paramount objective here?” Pino said. “Is the paramount objective to offer protection to the individual, or is the paramount objective to prevent the behavior?”

Officials recommended that children receive the multi-dose HPV vaccine years before becoming sexually active, anywhere from 9 to 12 years old. A little more than half of teens, 51 percent, received all recommended doses of the vaccine last year, according to the CDC.

The HPV vaccine is not a required immunization for students in Florida. County health departments offer the vaccine for free.

October, 2019|Oral Cancer News|

Does HPV vaccine reduce HIV-positive men oral cancer risks?

Source: www.precisionvaccinations.com
Author: Don Ward Hackett, Fact checked by Robert Carlson, MD & Danielle Reiter, RN

Does the HPV vaccine protect against oral infections?

That’s the question a new National Cancer Institutes (NCI) funded clinical trial of the Gardasil 9 vaccine hopes to answer.

This extensive study will determine whether the Gardasil 9 vaccine can prevent persistent oral HPV infections among men who are Human Immunodeficiency Virus (HIV) positive, said the NCI online on October 8, 2019.

Oral HPV infections and HPV-related oral cancers are common in men and among HIV-positive individuals.

Gardasil 9 is the most recent formulation of the Human Papolivirus (HPV) vaccine, which covers 5 additional cancer-causing HPV types. There are over 100 types of HPV.

“We are hoping that if we show the efficacy of the vaccine, that vaccinating both males and females will ultimately reverse” the rising incidence of HPV-related oropharyngeal cancers, said one of the trial’s lead investigators, Anna Giuliano, Ph.D., of Moffitt Cancer Center.

The trial is one of several within the US–Latin American–Caribbean Clinical Trials Network (ULACNet), an NCI-led effort to reduce the burden of HPV-related cancers in HIV-positive individuals.

This new study intends to build relevant insights upon a June 2017 study found that vaccination against HPV may sharply reduce oral HPV infections that are a major risk factor for oropharyngeal cancer, a type of head and neck cancer, says the NCI.

The 2017 study found that the prevalence of oral infection with 4 HPV types, including two high-risk, or cancer-causing, types, was 88 percent lower in those who reported receiving at least 1-dose of an HPV vaccine, than in those who said they were not vaccinated.

The ULACNet international collaborative research network brings together institutions in the United States and counterparts in low- and middle-income countries (LMICs) in the Latin American and the Caribbean (LAC) region.

Funded in Fall 2019 via a U54 Partnership Centers Cooperative Agreement mechanism, ULACNet comprises of 3 Partnership Centers, each collaboratively conducting a multidisciplinary Clinical Trials Program supported via an infrastructure of an Administrative and Coordinating Core, a Data Management and Statistical Core, and a Central Laboratory Core.

ULACNet investigators collaborate with the NCI to design and conduct clinical trials on three key scientific areas across the continuum of prevention interventions for HPV-related cancers in people living with HIV, including:

  • optimizing dosing and delivery and evaluating new indications for HPV prophylactic vaccines
  • evaluating new biomarkers and technologies for improving the accuracy of cervical and anogenital cancer screening and triage
  • evaluating novel non-excisional treatments for HPV-related precancerous lesions

Outcomes of ULACNet clinical trials are expected to influence the development of clinical practice guidelines to improve preventive clinical care and reduce the burden of highly preventable HPV-related cancers in people living with HIV.

The three ULACNet Partnership Centers include the following collaborations between institutions in the United States and partners in Mexico, Puerto Rico, Brazil, Peru, and the Dominican Republic:

  • University of California, San Francisco (UCSF) in San Francisco, CA (PI: Joel Palefsky, MD) in partnership with University of Puerto Rico in San Juan, Puerto Rico (PI: Anna Patricia Ortiz, PhD, MPH) and National Institute of Public Health (INSP) in Cuernavaca, Morelos, Mexico (PI: Jorge Salmeron, MD, DSc)
  • Weill Medical College of Cornell University in New York, NY (PI: Timothy Wilkin, MD, MS) in partnership with Moffitt Cancer Center, in Tampa, FL (PI: Anna Giuliano, PhD, MPH), University of Sao Paulo in Sao Paulo, Brazil (PI: Luisa Villa, PhD), National Institute of Public Health (INSP) in Cuernavaca, Morelos, Mexico (PI: Eduardo Lazcano-Ponce, MD, PhD), and the University of Puerto Rico in San Juan, Puerto Rico (PI: Jorge Santana-Bagur, MD)
  • Fred Hutchinson Cancer Research Center in Seattle, WA (PIs: Margaret Madeleine, PhD, MPH, and Ann Duerr, MD, PhD) in partnership with Asociacion Civil Via Libre in Lima, Peru (PI: Robinson Cabello, MD), National Institute of Infectious Diseases Evandro Chagas-Oswaldo Cruz Foundation (FIOCRUZ) in Rio de Janeiro, Brazil (PI: Beatriz Grinsztejn, MD, PhD), PATH in Seattle, WA (PI: Silvia de Sanjose, MD, PhD), and Instituto Dermatologico Dominicano y Cirugia de Piel (IDCP) in Santo Domingo, Dominican Republic (PI: Yeycy Donastorg, MD).

For more information about this important clinical trial, please contact the ULACNet Program Director is Vikrant Sahasrabuddhe, MBBS, DrPH in the NCI Division of Cancer Prevention.

References:
US-Latin American-Caribbean Clinical Trials Network (ULACNet) for Prevention of HPV-related Cancers in People Living with HIV
HPV Vaccine May Provide Men with “Herd Immunity” against Oral HPV Infections
HPV Vaccination Linked to Decreased Oral HPV Infections
HPV-Related Cancer Prevention and Control Programs at Community-Based HIV/AIDS Service Organizations: Implications for Future

October, 2019|Oral Cancer News|

Does your toothbrush have an app yet?

Source: www.nytimes.com
Author: Janet Morrissey

A classroom at the Touro College of Dental Medicine in Hawthorne, N.Y., displaying images of software that shows patients how they will look after treatment. CreditCreditKarsten Moran for The New York Times

When Theresa Gucciardo-Perry discovered a cracked crown in her mouth in April, she dreaded the idea of going to a dentist to get it replaced.

The Cortlandt Manor, N.Y., resident has undergone more than 18 root canal procedures; she also has five implants, with crowns on all but her front teeth. She hated the procedure in which trays of a gag-producing, putty-like substance were stuffed into her mouth to make impressions.

“The putty material is just absolutely gross — I want to throw up,” said Ms. Gucciardo-Perry, 55. “And the crown never fit right. I always had to go back.”

But this time, she sought care at the Touro Dental Health clinic, part of the Touro College of Dental Medicine in Hawthorne, N.Y., where students learn the latest state-of-the-art techniques. There, her teeth were digitally scanned with the wave of a wand — rather than a bulky goop-filled tray — and a crown was built digitally. It fit perfectly.

“I was amazed — totally amazed,” said Ms. Gucciardo-Perry.

Digital scanning is among a number of advances being adopted by the dental industry as the sector undergoes a technological metamorphosis.

Among the latest innovations: The use of digital scanners and 3-D printers to offer same-day crown replacements, smart toothbrushes that talk back to you via a phone app when you’ve missed an area while brushing, lasers that eliminate the need for an anesthetic, and digital tools that detect oral cancer.

Some of these advances had been around for a number of years but had not been widely adopted because of high equipment costs, lack of training or dentists who were more comfortable with older, traditional equipment.

Sensing this trend, the Touro College of Dental Medicine opened at New York Medical College in 2016 to train students in both established and cutting-edge technologies.

“We designed the school to address the practice world of 2030 — not the practice world of 1985,” said Edward Farkas, Touro’s vice dean and chairman of dentistry. And demand has been soaring.

“We have 3,600 applicants for 113 spaces this year,” he said. Larger schools, like New York University, Harvard and the University of Pennsylvania, offer similar state-of-the-art training but at a much higher tuition price. Touro charges $57,000 a year, compared to $78,854 at New York University and more at Ivy League schools.

Until recently, dentistry has largely lagged the medical field when it came to using artificial intelligence and other technology to diagnose or treat medical conditions. For researchers, dentistry didn’t attract the big headlines, fame and potentially lucrative windfalls that came with big medical advances, said Jeff Becker, senior analyst of health care strategy at Forrester Research.

But that changed as social media took off.

“These days, people want brighter, whiter, straighter teeth,” said Eric Payne, founder and chief executive of TEKagogo, a digital start up that connects dentists with technicians for same-day repairs. And dentists are jumping in, plastering before-and-after photos of their work all over the internet to attract new patients.

Around the same time that social media took off, cardiologists were starting to preach the connection between oral health and heart disease. Conditions like gingivitis and gum disease can raise red flags.

“The heart is pumping that bacteria from the oral cavity throughout your body,” said Mr. Payne. “If you don’t take care of your teeth, all that nastiness in your mouth is going to pump through your body.”

Suddenly, dentistry became trendy, and young researchers who saw opportunity started bringing tech advances to the dental world. At the University of Illinois at Urbana-Champaign, the top prize in the Cozad Competition for student start-ups went to dental-related technologies in both 2018 and 2019 — a first in the contest’s 20-year history, said Laura A. Frerichs, director of the University of Illinois Research Park, a technology hub for start-up companies.

So, which technologies are leading the dental industry’s transformation?

Digital scanners, computer-aided design and manufacturing (CAD/CAM) and 3-D printers are among the game changers.

A digital scanner is a wandlike device that captures three-dimensional images of the teeth, bite and surrounding tissue in real time. It’s fast and eliminates the need for clunky, goop-filled impression trays and messy plaster molds. The images can be sent electronically to a lab within minutes, which speeds up the wait time for patients needing crowns or bridges.

 

A CAD/CAM system allows dentists to make same-day crowns, veneers and bridges right in their offices. The system captures the digital images, designs the crown virtually and then sends the design to a milling machine or 3-D printer in the office.

Dr. Barbara Jurim, assistant director of digital dentistry at Touro, recalls recently treating a patient who was about to travel out of the country for three months and needed a new crown. She scanned the patient, designed the crown, manufactured it and cemented it in the office that day. “We’re talking about a treatment timeline that was two and a half hours as opposed to two visits over the course of two weeks,” she said.

Then there’s cone beam technology, which captures high-resolution, three-dimensional X-ray images through a machine that rotates around a patient’s head. The cone beam and scanner data allow a surgeon to create surgical guides, which are 3-D printed maps that pinpoint exactly how and where dental implants are placed during surgery, said Dr. Akshay Kumar, a periodontist in Hackensack, N.J., who uses scanners and cone beam technology in his practice.

“It’s changed the way we do dental implants” and cut the surgery time in half, said Dr. German Gallucci, associate professor and chairman of the department of restorative dentistry and biomaterials sciences at the Harvard School of Dental Medicine.

But finding dentists who use the technology is a challenge given the price: A digital scanner costs between $30,000 and $50,000, while a cone beam devices runs $80,000 to $100,000, Dr. Kumar said.

Fewer than 10 percent of dentists have milling machines or 3-D printers in their offices, and only 15 percent to 20 percent have digital scanners, estimates Dr. Ronnie Myers, dean and professor of dental medicine at Touro.

3-D milling machines can produce models of a patient’s teeth.CreditKarsten Moran for The New York Times

 

The machines can also produce surgical guides to aid in procedures.CreditKarsten Moran for The New York Times

As the price of digital scanners, milling machines and other technology comes down, more dentists will likely start adopting the technology, Dr. Kumar said.

The field of orthodontics has seen some of the biggest advances. Technology that uses augmented reality, scanners and 3-D printers can show patients how they would look with new crowns or straightened teeth. And clear aligners can do the job of traditional braces.

“Instead of going to the orthodontist and getting your braces adjusted, a new set of 3-D printed aligners are made and mailed to your home, and they progressively shift the teeth into alignment for you,” Mr. Becker said.

Technology by Mechanodontics, a start-up, straightens teeth from behind.

Another start-up called Mechanodontics has developed a technology that straightens without the use of braces and aligners. Instead, tiny springs and brackets are placed behind a patient’s teeth, with no regular adjustments required. The technology can cut treatment time in half, the company says.

Then there’s the smart toothbrush, which uses 3-D motion sensors and artificial intelligence to track the time, frequency, duration and location of brushing, and alerts the user to areas that have been missed through a Bluetooth-connected phone app.

Thomas Serval, a co-founder of Kolibree, which makes the artificial intelligence toothbrush, came up with the idea in 2014 when trying to find ways to motivate his daughter, Heloise, to brush her teeth. He added mobile games to the phone app, giving virtual awards for good brushing.

In 2018, Mr. Serval licensed the technology to Colgate, which sells it as the Colgate Smart Electric toothbrush. A new version aimed at children, called Magik, is also being rolled out in the United States.

Colgate’s Smart Electric toothbrush sends data to the Colgate Connect app.

Ms. Gucciardo-Perry, said that after her experience being treated with new technology at the Touro clinic, she’s never going back to old-school treatments.

“I’ll absolutely be going back to Touro,” she said. “And my children will be going there too.”

October, 2019|Oral Cancer News|

Prevalence of Oral HPV Infection Declines in Unvaccinated Individuals

Source: Infectious Disease Advisor
Date: September 30th, 2019
Author: Zahra Masoud

Oral human papillomavirus (HPV) prevalence has decreased in unvaccinated men, possibly as a result of herd protection, but the incidence of such infection has remained unchanged in unvaccinated women from 2009 to 2016 in the United States, according to a study published in the Journal of the American Medical Association.

Since 2011 for women and 2006 for men, prophylactic HPV vaccination for prevention of anogenital HPV infection has been recommended for routine use in the United States. Previous studies have demonstrated that this vaccine has high efficacy in reducing the prevalence of oral HPV infection. However, the vaccine is not indicated to prevent oral HPV infection or oropharyngeal cancers because there are few results from randomized trials. Further, there has been a lack of surveillance studies reporting on herd protection against oral HPV infection, which is defined as a form of indirect protection from infectious diseases that occurs when a large percentage of the population has become immune/vaccinated, thereby providing protection for individuals who are not immune/not vaccinated. Therefore, this study investigated evidence for herd protection against oral HPV infection in unvaccinated men and women in the United States using temporal comparisons of oral HPV prevalence for 4 vaccine types and 33 non-vaccine types.

This study was conducted across 4 cycles (from 2009 to 2016) of the National Health and Nutrition Examination Survey (NHANES), using a cross-sectional, stratified, multistage probability sample of the civilian population in the United States. For the examination component, response rates were 68.5% in the 2009 to 2010 period, 69.5% in the 2011 to 2012 period, 68.5% in 2013 to 2014, and 58.7% in 2015 to 2016. In total, 13,676 participants were included, which represented 174,333,042 individuals in the US population aged 18 to 59 years. The 4 vaccine-type oral HPV were HPV-16, -18, -6, and -11. DNA was collected from oral rinses and was evaluated using PGMY09/11 polymerase chain reaction and linear array genotyping for 37 types of HPV presence. In unvaccinated individuals, sex-stratified analyses were performed along with multivariable logistic regression analyses adjusted for other variables.

From 2009 to 2016, HPV vaccination rates increased from 0% to 5.8% in men and from 7.3% to 15.1% in women. From 2009 to 2010 to 2015 to 2016, vaccine-type oral HPV prevalence declined from 2.7% to 1.6% (P =.009) in unvaccinated men; however, this decline was not heterogenous by age (P =.41 for interaction). During this period, non-vaccine-type oral HPV prevalence remained unchanged (P =.66) among unvaccinated men. From 2009 to 2010 to 2015 to 2016 in unvaccinated women, both vaccine-type and non-vaccine-type oral HPV prevalence remained unchanged (P =.79 and P =.58, respectively).

The 37% decline in vaccine-type oral HPV among unvaccinated men from 2009 to 2016 suggests herd protection against oral HPV infections. This herd protection may arise from the increased rate of HPV vaccination among women and is consistent with herd protection studies against genital HPV infections in unvaccinated women in the United States. The unchanged prevalence of oral HPV among unvaccinated women from 2009 to 2016 does not suggest herd protection; this may reflect low statistical power because of a low prevalence in women.

Overall, the study authors concluded that, “The estimated herd protection should be incorporated into evaluations of cost-effectiveness of HPV vaccination of men older than 26 years. Vaccine trials of oral HPV incidence and persistence in men should inflate sample sizes to account for herd protection.”

Reference

Chaturvedi AK, Graubard BI, Broutian T, Xiao W, Pickard RK, Kahle L, Gillison ML. Prevalence of oral HPV infection in unvaccinated men and women in the United States, 2009-2016. JAMA. 2019;322(10):977-979.

October, 2019|OCF In The News|

Anti-malarial drug can make cancer chemotherapy more effective

Source: medicalxpress.com
Author: Emma McKinney, University of Birmingham

Scientists at the University of Birmingham have found an anti-malarial drug was effective in treating head and neck cancer in mice.

The drug quinacrine was used extensively to prevent and treat malaria in soldiers fighting in mosquito-ridden areas during World War Two. It is similar to the quinine that makes tonic water glow, has minimal side-effects, and is now used for treating parasite infections and other conditions.

Each year around 11,900 people are diagnosed with head and neck cancer in the UK. Current treatment relies heavily on debilitating surgery and toxic chemotherapy, but despite this, it has a poor outcome with three to seven in 10 people surviving their disease for five years or more.

The drug, quinacrine, was tested through a number of methods, including on cell cultures, in tumour biopsies from patients with head and neck cancer, and in mice.

The research results, published in Oncotarget, show that in mice quinacrine can make standard chemotherapy more effective—suggesting a lower dose may be used, reducing toxic side effects.

The results also showed the drug to be effective at reducing the growth of cancer cells grown in the lab, and in tumors.

Significantly, the research in mice showed a combination therapy of quinacrine and chemotherapy, and so allowed for the chemotherapy dose to be halved while still maintaining the same impairment of tumor growth.

Lead author Dr. Jennifer Bryant, of the University of Birmingham’s Institute of Head and Neck Studies and Education, said: “This is important research in the laboratory and demonstrates the real potential in repurposing drugs.

“The team is now looking to translate these research findings into a clinical trial for head and neck cancer patients.”

Corresponding author Professor Hisham Mehanna, Director of the Institute of Head and Neck Studies and Education at the University of Birmingham and Consultant Head, Neck and Thyroid Surgeon at University Hospitals Birmingham NHS Foundation Trust, said drug repurposing is particularly exciting due to known safety in humans and low cost, which mean they can be rapidly translated from the lab to the clinic.

He added: “Head and neck cancer patients have limited treatment options, often associated with severe, potentially life-threatening, side effects, it is important, therefore, that we find different treatments.

“My team has developed a drug repurposing platform called “AcceleraTED’ which assesses drugs that treat other non-cancerous conditions and have been approved by the Food and Drug Administration and the European Medicines Agency to see if they have the potential to be effective anti-cancer agents against head and neck cancer.

“This research is an example of the success we are having in the laboratory through this platform in identifying promising drugs that can be candidates to be used in patients in clinic.”

October, 2019|Oral Cancer News|

Radiation for head and neck cancer may cause problems years later

Source: www.usnews.com
Author: Steven Reinberg

Ten years after radiation treatment for head and neck cancer, some patients may develop problems speaking and swallowing, a new study finds.

These problems are related to radiation damage to the cranial nerves, the researchers explained. The condition is called radiation-induced cranial neuropathy.

“We had always thought that radiation did not damage cranial nerves because they get treated in every patient with head and neck cancer, and we do not see cranial neuropathy that commonly,” said Dr. Thomas Galloway, of the department of radiation oncology at the Fox Chase Cancer Center in Philadelphia.

“What our data is suggesting is that a small percentage of people do get cranial nerve damage from treatment, but it occurs after a long latency period,” Galloway said.

For the study, the researchers collected data on 1,100 patients who had radiation for head and neck cancer between 1990 and 2005. Among these patients, 112 were followed for at least 10 years.

Of the 112 patients, 14% developed at least one cranial neuropathy. The median time until the condition was seen was more than seven years. It took some patients more than 10 years to develop the problem, the findings showed.

Curing the initial cancer is the most important concern, Galloway said. But these patients need to be followed for the rest of their lives, if possible, he added.

The report was published recently in the journal Oral Oncology.

October, 2019|Oral Cancer News|