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How Marijuana Accelerates Growth of HPV-related Head and Neck Cancer Identified

University of California San Diego School of Medicine researchers have identified the molecular mechanism activated by the presence of tetrahydrocannabinol (THC) — the ingredient that causes people to feel the euphoria or “high” associated with cannabis — in the bloodstream that accelerates cancer growth in patients with human papillomavirus (HPV)-positive head and neck squamous cell carcinoma.

“HPV-related head and neck cancer is one of the fastest growing cancers in the United States. While at the same time, exposure to marijuana is accelerating. This is a huge public health problem,” said Joseph A. Califano III, MD, senior author and professor and vice chief of the Division of Otolaryngology in the Department of Surgery at UC San Diego School of Medicine.

Head and neck squamous cell carcinoma is the sixth most common cancer worldwide. These cancers begin in the cells that line the mucous membranes inside the mouth, nose and throat. Approximately 30 percent of cases of this disease are related to HPV infection, and it is these cases, in particular that are on the rise. Califano suggested increased marijuana use may be a driving factor.

Previous studies have linked daily marijuana exposure to an increased prevalence of HPV-related throat cancer. However, a mechanism linking cannabis exposure to increased growth of the cancer was unknown.

Reporting in the January 13, 2020 online edition of Clinical Cancer Research, a journal of the American Association for Cancer Research, researchers outline how the presence of THC in the bloodstream activates the p38 MAPK pathway, which controls programed cell death called apoptosis. When activated, p38 MAPK prevents apoptosis from occurring, thus allowing cancer cells to grow uncontrollably.

Working with Chao Liu, MD, visiting scientist at UC San Diego and a physician at China’s Central South University, and other colleagues, Califano and team used animal and human cell lines to show that THC turns p38 MAPK on and were able to stop the growth of HPV-positive head and neck cancer by turning off the pathway.

The team then analyzed blood samples from patients with HPV-related throat cancer who had their genomes comprehensively mapped to define activated gene pathways. Similar to the cell lines, the blood samples showed p38 MAPK activation and loss of apoptosis in tumors from patients with THC in their blood.

The authors said studies and public opinion suggestions that THC and other cannabis products have cancer-fighting properties need additional, more critical evaluation. Past studies showing anticancer effects of THC and other cannabinoids often used levels of THC higher than those found with recreational use, but doses used recreationally clearly activate a cancer-causing pathway, said Califano.

“We now have convincing scientific evidence that daily marijuana use can drive tumor growth in HPV-related head and neck cancer,” said Califano. “Marijuana and other cannabis products are often considered benign, but it is important to note that all drugs that have benefits can also have drawbacks. This is a cautionary tale.”

According to the Centers for Disease Control and Prevention (CDC), HPV infections are responsible for approximately 35,000 new cancer diagnoses each year in the United States. Infection is so common that nearly all men and women will get at least one type of HPV at some point in their lives. Most clear up on their own, without the person ever knowing they’ve had it.

Several vaccines are available that can prevent the majority of HPV-related cancers. The vaccines work best when they are given before a person is exposed to the virus. The CDC recommends vaccinating boys and girls age 11 to 12 years old but it can be administered as early as age 9.

According to the National Institute on Drug Abuse, 15 percent of youth 12 to 17 years old and 47 percent of adults age 26 and older have used or tried marijuana.

Together, a low HPV vaccination rate and an increase in marijuana use among youth has the makings of a storm, said Califano, physician-in-chief and director of the Head and Neck Cancer Center at Moores Cancer Center at UC San Diego Health.

Moores Cancer Center is one of only 51 National Cancer Institute-designated Comprehensive Cancer Centers in the country and the only such center in San Diego County.

Treatment options for patients with early- or late-stage head and neck cancers include minimally invasive surgery, reconstruction and rehabilitation, proton therapy and other radiation therapy, innovative clinical trials and targeted therapy, including immunotherapy.

The Head and Neck Cancer Center provides comprehensive care that includes counseling, education and support groups, nutrition, dental rehabilitation, speech and language therapy and social workers to help patients through every step of the process beginning with diagnosis to support lifelong wellness.

Califano and team are now looking at whether cannabidiol, or CBD, has a similar effect to THC. CBD is another major chemical compound found in marijuana, but does not produce the “high” and is now commonly used in various over-the-counter products, such as lotions, ointments and edibles.

In addition, the team is investigating whether p38 MAPK can be targeted with drugs to stop HPV-related head and neck cancer from growing.

Co-authors include: Chao Liu, Sayed Sadat, Koji Ebisumoto, Akihiro Sakai, Bharat Panuganti, Shuling Ren, Yusuke Goto, Sunny Haft, Takahito Fukusumi, Mizuo Ando, Yuki Saito, Pablo Tamayo, Huwate Yeerna, William Kim, Jacqueline Hubbard, Andrew Sharabi and J. Silvio Gutkind from UC San Diego; and Theresa Guo from Johns Hopkins Medical Institutions.

Funding for this research came, in part, from the National Institute of Dental and Craniofacial Research and National Institute of Health (R01 DE023347, U01CA217885, R01HG009285, R01CA121941 and P30CA023100).

January, 2020|Oral Cancer News|

New cancer treatment delivers weeks of radiation therapy in a second

Source: New Atlas
Date: January 9th, 2020
Author: Michel Irving

Radiation therapy is currently our best shot at treating cancer, but it’s far from a perfect solution. It takes a course of weeks or even months, during which time healthy cells often become unfortunate collateral damage. But what if the whole course of treatment could be over in under a second? Researchers at the University of Pennsylvania have now shown just how this might be feasible.

With the right tools, cancer cells on their own aren’t all that difficult to kill. Radiation or drugs can be administered to kill them off relatively easily – the problem is tumors like to hide in crowds, and whatever weapons we fire at them also tend to hit healthy cells around them. Because radiation therapy takes weeks, there are more opportunities for those healthy cells to be affected, leading to all kinds of health problems even if the cancer is destroyed.

That’s where FLASH radiotherapy comes in. This emerging form of treatment involves giving a patient in one second a similar amount of radiation as they would normally receive over weeks. Previous experiments have shown that the effect on the cancer itself is basically the same, but the collateral damage to healthy tissue is drastically reduced.

For the new study, researchers at Pennsylvania University found that by changing the type of fundamental particle used, they could make FLASH radiotherapy far more effective. Normally, electrons are the particles of choice for this method, but they don’t penetrate very deep into the body. That means they’re only really useful for shallower cancer types such as skin cancer.

In this case the researchers used protons, and showed that linear accelerators already in use in hospitals could be adapted to produce these particles. Since they can pass deeper into the body, they should be more useful against a wider range of tumor types.

The team tested it out on mice with pancreatic flank tumors, and found that the method did inhibit the growth of the cancers with roughly the same effectiveness as regular radiation therapy. Importantly though, the proton FLASH therapy reduced healthy cell loss and didn’t cause intestinal fibrosis, a common side effect of radiation therapy.

“This is the first time anyone has published findings that demonstrate the feasibility of using protons – rather than electrons – to generate FLASH doses, with an accelerator currently used for clinical treatments,” says James M. Metz, co-senior author of the study.

The researchers are currently working on how to translate the treatment to clinical trials. This includes designing a system that can deliver the proton radiation to humans.

January, 2020|Oral Cancer News|

Cervical pre-cancer rates down 88% in decade since HPV vaccinations began – first findings

Source: The Conversation
Date: April 19, 2019
Author: Kevin Polluck

Cervical cancer is the third most common cancer among women in the UK under the age of 35 after breast and skin cancer. In the majority of cases, the cancer only develops if the patient is infected with human papillomavirus (HPV) types 16 or 18. This virus is mainly transmitted between people having vaginal, anal or oral sex. At some point in their lives, four in five people will be infected by HPV strains – as many as 14 can cause cancer in total. According to recent studies, other cancers heavily linked to HPV infections include head-and-neck, vulvo-vaginal and anal.

In an effort to reduce rates of cervical cancer, a number of countries launched immunisation programmes in the late 2000s, starting with Australia in 2006. The UK and its devolved governments launched a school immunisation programme in 2008 to vaccinate all girls aged 12-13. To speed up the time lag associated with achieving the benefits of vaccination, they also kicked off a three-year catch-up programme for girls aged up to 18 years.

A decade on, we are finally able to publish the first results. The data relates to Scotland, since it was cervically screening women from the age of 20 until 2016 – before falling into line with the minimum age of 25 used in the rest of the UK. This meant that Scotland obtained screening data for the 2008-09 cohort before the change in screening age. Scotland also has very detailed information about take-up rates, which have been very high: running to approximately 90% in Scotland for the routinely vaccinated girls and 65% for the older girls vaccinated as part of the catch-up programme.

For the first time, we can now confirm that the vaccination programme has begun to profoundly alter the prevalence of HPV 16 and 18 among Scottish women – and presumably elsewhere as well.

The study

My team performed an eight-year study of the women eligible for the Scottish national vaccination and cervical screening programmes. We looked at their vaccination status, year of birth, indicators of deprivation and whether they lived in urban or rural areas. Using complex statistical modelling, we were able to calculate the effect of vaccination on cervical pre-cancer. Though not all pre-cancer becomes cancer, all cancer requires pre-cancer. Cervical pre-cancer occurs quicker than cancer and therefore this focus has allowed us to see the impact of the vaccine earlier.

Among women born in 1995-96 – the first group to go through the regular vaccination programme in 2008/09 – there has been an 88% reduction in rates of cervical pre-cancer. This is a fall in incidence from 1.44% to 0.17%.

Not only that, women born in these years who had not received the vaccine were also less likely to develop cervical pre-cancer. This was because the high vaccine uptake meant that HPV incidence was much lower in their age group, thanks to a phenomenon known as “herd protection”. This is particularly good news, since this group is also less likely to attend cervical screenings.

The findings clearly show that the routine HPV vaccination programme for girls aged 12 to 13 has been a resounding success. This is consistent with the fact that we have also seen a big fall in high-risk HPV infection in Scotland in recent years. The obvious conclusion is that we are going to see far fewer cases of cervical cancer in years to come.

From September, the UK is going to extend the vaccination programme to boys – becoming one of numerous countries to do so. This is in response to the fact that rates of head and neck cancer are rising in men: approximately 60% of head and neck cancer is associated with HPV16 infection, and should therefore be mostly preventable through vaccination. This programme should also mean that high-risk HPV infections among the population should be eliminated more quickly, which should have knock-on benefits for rates of HPV-driven cancers.

Meanwhile, in parts of Canada, HPV vaccinations are now being offered to uninfected women as part of the cervical screening process. This may protect older women from developing cervical cancer. This process may be adopted internationally, including the UK. When we look at the picture as a whole, eliminating the HPV virus, and making huge inroads into the various cancers that it helps develop, is now becoming a realistic possibility.

 

 

January, 2020|Oral Cancer News|

Immunotherapy study shows how to stop cancer hiding from immune cells

Source: New Atlas
Date: December 11th, 2019
Author: Michael Irving

The immune system is already our best defense against cancer, but sometimes it needs help. After all, cancer has a knack for deceiving it and hiding from immune cells, giving itself time to grow and spread. Now, researchers at QIMR Berghofer Medical Research Institute in Australia have identified one way it does so, and found a method to counter it in mouse tests.

T and NK cells act like the foot soldiers of the immune system, searching the body for invading pathogens and attacking them. But their activity can be regulated by other immune cells, such as mucosal-associated invariant T cells (MAIT cells), telling them when to attack and when to stand down.

During the new study, the QIMR researchers discovered that if MAIT cells were switched on, they would prevent T and NK cells from attacking tumors. The tumors seem to have figured this out too – the team found that cancer cells actively turn on MAIT cells by displaying molecules called MR1 on their surfaces.

“The cancer is effectively creating its own defence mechanism to evade immune attack and survive,” says Michele Teng, senior researcher on the study. “The display of MR1 activates the MAIT cells, which in turn switch off cancer-fighting T and NK cells. While other regulatory cells of the immune system are known to stop T and NK cells from killing tumor cells, this is the first time it’s been shown that these regulatory MAIT cells can do this job.”

Understanding this mechanism could lead to new immunotherapy treatments. The team tested the idea in mice, by giving the animals antibodies that block MR1. Sure enough that prevented MAIT cells from switching on, increased the attack power of T and NK cells and ultimately slowed the growth and spread of the cancer.

“This work demonstrates that antibodies that block MR1 could in future be an effective new immunotherapy,” says Teng. “It probably won’t work on every cancer, but it looks like it could be effective in treating cancers that can display the MR1 molecule. It also means this display of MR1 could be used to screen which patients would respond to this immunotherapy.”

The team says that the next step is to try to replicate the results in humans, starting by determining which human tumor types use MR1.

 

December, 2019|Oral Cancer News|

Whole Foods is selling dangerous anti-vaccine propaganda in its checkout aisles

Source: Insider
Date: December 10th, 2019
Author: Maddie Stone

 

More than any other major grocery store, Whole Foods has made healthy living central to its brand. Based on the Amazon-owned supermarket’s tremendous popularity, it’s a strategy that has worked.

If you look past the colorful organic produce displays and sustainably-sourced seafood counter, however, you’ll start to notice incongruities. There’s nothing particularly healthful, for instance, about the homeopathy aisle — a section of Whole Foods’ Whole Body Department that sells 19th century pseudoscience masquerading as cold and flu remedies — or the shelves filled with supplements and probiotics making claims that often don’t hold up to scientific scrutiny.

But all of this pales in comparison to the disinformation Whole Foods is selling in its check-out aisle: magazines with articles promoting vaccine skepticism.

Insider recently found several magazines that have run articles raising unfounded concerns about the safety or efficacy of vaccines. These messages are not only out of line with the mainstream medical consensus, they are actively dangerous, according to public health experts.

Scattered amongst the breezy magazines devoted to healthy cooking and pet care are titles like Well Being Journal, a bi-monthly publication sold at Whole Foods stores in New York City, Los Angeles, Chicago and Philadelphia, among other locations. It has published articles that tout medically unsupported homeopathic therapies as “non-toxic” alternatives to vaccination. Others promote the debunked link between the MMR vaccine and autism. One particularly egregious article in a 2017 issue, adapted from a defunct anti-vaccine website, is literally titled “MMR Vaccine Causes Autism.”

The magazine has a circulation of around 70,000 U.S. readers, according to its website. It’s also sold at Sprouts, Natural Grocers, and Barnes & Noble. But Whole Foods has more locations and cultural capital than the first two companies. And unlike Barnes & Noble, it bills itself as a one-stop shop for smart, healthy living.  (It’s also owned by one of the most powerful companies on the planet.)

One article, published late last year, is titled “Study Shows Gardasil Not Guarding.” It quotes an unnamed “former Merck representative” saying the HPV vaccine can cause “Guillain-Barré syndrome, paralysis of the lower limbs, vaccine-induced MS, and vaccine-induced encephalitis.” (The Centers for Disease Control attributes no serious side effects to the vaccine, and notes that it’s very effective.)

The same issue carried an excerpt from a book called “How to End the Autism Epidemicby JB Handley, founder of the nonprofit Generation Rescue, which advocates the scientifically unsupported idea that vaccines cause autism.

Well Being Journal has published similar content going back more than a decade.  

Another issue from 2018 features an excerpt from vaccine skeptic and family physician Richard Moskowitz’s book “Vaccines: A Reappraisal.” It includes a lengthy compilation of “clinical perspectives” on vaccines that hit many of the anti-vaccination movement’s favorite talking points. In the excerpt, prominent anti-vaccine doctor Sherri Tenpenny asserts that vaccines weren’t responsible for eradicating polio (they were), while homeopathic doctor Toni Bark compares mandatory vaccination policies to forced medical procedures performed in Nazi Germany.

The magazine commonly features articles written by alternative medicine gurus — naturopaths, acupuncturists, energy healers, intuitives, and some medical doctors — on topics like meditation, chronic illness, and toxins in consumer products. But these pieces promoting vaccine skepticism aren’t anomalies.

A keyword search for “vaccine” in Well Being Journal’s online archives revealed over two dozen articles going back more than a decade that cast doubt on the safety and efficacy of vaccines.

Several articles suggest that getting vaccinated for the flu may increase your risk of contracting the virus or infecting others with it, neither of which is true.

It isn’t the only title promoting vaccine skepticism, though experts Insider spoke with called its vaccine messaging unusually toxic.

Natural Solutions Magazine, which describes itself as a “top-selling health title in health food stores nationwide, including Whole Foods Market” and reported a distribution of 225,000 in 2019, contains on its website a number of articles expressing skepticism about the safety of vaccines or discussing the debunked link between vaccines and autism.

Natural Awakenings, a franchise of independently published magazines that claims to reach over 3 million readers a month, ran an article last fall suggesting Vitamin D supplements might be a “more effective and less costly” alternative to the flu shot. Another article from January 2018 warns about the impacts of thimerseral, a mercury-based preservative in vaccines that the CDC says is safe. It, too, lists Whole Foods as one of its distribution partners.

The articles are just one symbol of the growing anti-vaxxer movement.

Not long ago the anti-vaccination movement was at society’s fringes; in recent years, it has become well organized and has garnered powerful allies, including celebrities like Robert F. Kennedy Jr. and Congressional legislators. The rise of social media has helped powerful groups spread vaccine skepticism around the world — by buying ads on Facebook, for instance — and has enabled new concerns about vaccines to take root quickly via grassroots groups and forums.

Promoting unfounded or debunked concerns about the safety of vaccines is demonstrably dangerous to public health. Measles was eliminated in the United States as recently as 2000. Today, it’s seeing a resurgence around the country as increasing numbers of parents choose to opt their child out of the MMR vaccine — a trend driven by misconceptions about vaccine safety.

Well Being Journal’s articles on vaccines “hit a lot of the high points of the anti-vaccine movement,” Tara Smith, an infectious disease epidemiologist at Kent State University, told Insider after we shared a selection of recent issues with her. The way these articles are packaged — bylined by individuals with letters after their name, loaded with dense scientific jargon — creates an illusion of legitimacy, she added.

Nathan Boonstra, a pediatrician at Blank Children’s Hospital in Des Moines, said that alternative medicine outlets will typically “at least try to present the appearance of balance” when it comes to vaccination. But many of these articles seemed blatantly against it.

“This crosses the line into the ability to actively harm somebody,” he said.

When Insider reached out to Scott Miners, founder and executive editor of the Well Being Journal, he said in an email that the magazine is not “against vaccines” but rather seeks to foster “an informed discussion” and “find the truth for the good of all.”

Miners defended the book excerpt by JB Handley, noting that it does not precisely assert that vaccines cause autism. While that’s technically true, the excerpt does state that there is “clear and compelling scientific evidence that supports the connection between vaccines and autism,” which is false.

Insider reached out to multiple representatives at Whole Foods and Amazon by phone and email, but did not receive a response.

We provided them with questions about their relationship with the magazine, including how it got started, whether it was aware that the journal publishes articles promoting vaccine skepticism, and whether there any Whole Foods-wide guidelines concerning the sale of magazines containing vaccine misinformation. Neither company responded.

Well Being Journal is one of a number of magazines delivered to the grocery store through a third-party vendor called OneSource Distribution, which stocks the title at 430 out of the 479 Whole Foods stores in the U.S., according to Gregg Mason, who handles vendor relations for the company.

Mason, who called the Well Being Journal one of OneSource’s “top titles” in an email, told Insider the company has been distributing the magazine to stores since at least 2012. Every time a new issue comes in, it goes out to every store with a standing order. He confirmed that this includes last year’s November/December 2018 issue containing the book excerpt by Handley, as did a customer service representative at a New Jersey store when reached by phone. On average, Mason said, OneSource puts 15 copies per issue into each Whole Foods and 70 percent of them sell, “which is very good.”

Whole Foods’ parent company has also sold products that promote anti-vaccine messaging.

“This is an awful situation,” Peter Hotez, dean of the National School of Tropical Medicine at Baylor College, told Insider in an email. Hotez, who in the past has publicly criticized Amazon for selling anti-vaccine books, said that in his view Whole Foods “has violated the norms of corporate social responsibility” by providing a platform for this kind of disinformation.

Amazon has repeatedly come under fire for allowing anti-vaccine content to flourish. And while the company has recently removed several high-profile anti-vaccination titles from its online catalogs, including the documentaries “Vaxxed” and “Shoot ‘Em Up: The Truth About Vaccines,” following public pressure, a keyword search for “vaccines” on both Amazon Books and Amazon Audible Books still yields a results page filled with titles peddling misinformation.

To Hotez, the fact that Whole Foods, like its parent company, has apparently turned a blind eye to vaccine skepticism on its shelves isn’t surprising. Anecdotally, he said, the affluent, educated, liberal-leaning consumer base Whole Foods targets appears to be particularly susceptible to anti-vaccination messaging.

Hotez added, “Overall, I think Whole Foods and Amazon have exploited the demographic that’s exempting or opting their kids out of getting vaccinated, and they’re making money out of it.”

December, 2019|Oral Cancer News|

How the ADA Oral Cancer Policy Amendment Will Affect Your Practice

Source: Dentistry Today
Date: November 29th, 2019
Author: Jo-Anne Jones

The ADA recently announced an expansion to its policy on oral cancer detection recommending that dentists and dental hygienists perform routine examinations for oral cancer includingoropharyngeal cancer for all patients.

Passed by the ADA House of Delegates in September, this change was brought about to align with concerns from the Centers for Disease Control and Prevention (CDC) over the escalating numbers of diagnosed cases of oropharyngeal cancer linked to the human papillomavirus (HPV).

While HPV-related oropharyngeal cancer has risen by 225% over the past two decades, oral cancer linked to the historical etiologic pathways of tobacco and alcohol use has declined by 50%. The ADA’s policy also aligns with support for the HPV vaccine, as 70% of oropharyngeal cancers in the United States are related to HPV, according to the CDC.

Dentists and dental hygienists play a critical role in opportunistic screening on all adult patients despite whether they possess the historical risk factors of using tobacco products or alcohol. There is a distinct knowledge gap in today’s population to fully understand that a non-smoker and non-drinker may in fact be at risk for oral and oropharyngeal cancer due to HPV.

It is our responsibility to educate our dental patients about all of the risk factors that exist for both oral and oropharyngeal cancer. Now more than ever, it is critically important to extend our screening practices, both visual and tactile, to every adult in the practice on an annual basis.

Only about a third of adults in the United States report being screened for oral cancer, representing a strong disconnect in our ability to improve earlier discovery rates and improve treatment outcomes.

As dental professionals, it is critical that we elevate our understanding of the escalating profile of HPV-related oropharyngeal cancer. Researchers once predicted that cases of HPV-related oropharyngeal cancer would surpass the leading HPV-related cervical cancer by 2020. Yet recent data from national registries has now confirmed that HPV-related oropharyngeal cancer became the leading HPV-associated cancer in 2015.

How common is HPV-related oropharyngeal cancer? About 53,000 Americans will be diagnosed with oral and oropharyngeal cancer this year. Close to 20,000 of those cases will occur in the oropharyngeal area, with 70% related to HPV.

The CDC also reports that HPV is so common that almost all sexually active adults will have an infection in their lifetimes, with most of the population clearing the infection with no repercussions. In contrast, a persistent infection with a high-risk strain such as HPV-16 can transform into oral or oropharyngeal cancer.

This transformation may take anywhere between 15 and 30 years. It seems to be targeting a much younger profile of white, non-smoking males age 35 to 55 with a four-to-one incidence of gender predisposition of males over females.

HPV has an affinity for lymphoid tissues and occurs most commonly in the tonsillar areas and the base of the tongue, with a smaller percentage occurring anteriorly in the oral cavity. Due to limited visual acuity, it is important to know and recognize the subtle symptoms that may accompany a posteriorly positioned tumor of HPV origin.

The following symptoms may be among the first distinguishable signs of the presence of oropharyngeal cancer:

  • Bleeding in the mouth or throat
  • Hoarseness or a change in the voice
  • A lump in the throat or the feeling that something is stuck in the throat
  • Continual lymphadenopathy or persistent neck masses despite antibiotic therapy
  • Slurred speech or difficulty articulating certain sounds
  • A tongue that tracks to one side when stuck out
  • Asymmetry in the tonsillar area
  • A persistent or recurring throat infection that doesn’t fully resolve with antibiotics
  • Unilateral earache
  • A persistent cough

Oral cancer can be very subtle, so it is extremely important to use magnification such as loupes and a dedicated light source or headlight to be able to discern early visible changes. The paradox that exists is that abnormal cellular differentiation typically starts at the basement membrane. By the time it becomes visible, it has progressed to a later stage of development.

Tactile palpation is paramount in uncovering any areas of hardness or induration possibly suggesting a mass or a tumor that is not yet clinically visible.

Enhanced oral cancer screening with a device such as the VELscope Vx from Apteryx Imaging may reveal what is not visible to the naked eye. It employs direct fluorescence visualization, which has been used successfully in the cervix, lungs, and colon. Using a proprietary wavelength, it gives clinicians the opportunity to visually penetrate the tissue surface to reveal the basement membrane.

The VELscope Vx is an assessment tool, however, and it does not convey a diagnosis. The golden rule always applies. Any oral abnormality that exists beyond 14 days is suspect and requires referral for further evaluation.

The Oral Cancer Foundation offers comprehensive information to help healthcare professionals and the general public to learn more about HPV’s connection with oral and oropharyngeal cancer. In April of 2019, the group launched the “Check Your Mouth” campaign to educate the public about the importance of self-examination of the oral cavity between dental appointments.

The impetus behind this project was to improve earlier discovery rates by having the public self-refer should they find anything new or abnormal that persists beyond 14 days. Cards may be ordered free of charge from the Oral Cancer Foundation store for distribution to dental patients.

Lastly, sharing information regarding the HPV vaccine is one of the strongest prevention methods we have today to make positive inroads in minimizing this type of cancer. The Food and Drug Administration has approved the HPV vaccine for both boys and girls and expanded the use of Gardasil 9 to include individuals age 27 through 45.

Together, we can have an impact on the earlier discovery of oral and oropharyngeal cancer.

Disclosure: Jo-Anne Jones is a KOL and consultant with Apteryx Imaging.

Ms. Jones is the president of RDH Connection, an educational and clinical training company dedicated to quality education and team training. In the midst of preparing to present her extensive research on HPV-related oropharyngeal cancer to her national association, a loved one was diagnosed with late stage HPV-positive tonsillar cancer and lost her life 16 months later. Jo-Anne proudly partners with the Oral Cancer Foundation in conveying the urgent need for changing the way in which we screen for oral cancer to meet the needs of today’s population. She can be reached at jjones@jo-annejones.com.

Doctors try CRISPR gene editing for cancer, a 1st in the US

Source: AP News
Date: 11/6/19
Author: Marilynn Marchione

The first attempt in the United States to use a gene editing tool called CRISPR against cancer seems safe in the three patients who have had it so far, but it’s too soon to know if it will improve survival, doctors reported Wednesday.

The doctors were able to take immune system cells from the patients’ blood and alter them genetically to help them recognize and fight cancer, with minimal and manageable side effects.

The treatment deletes three genes that might have been hindering these cells’ ability to attack the disease, and adds a new, fourth feature to help them do the job.

“It’s the most complicated genetic, cellular engineering that’s been attempted so far,” said the study leader, Dr. Edward Stadtmauer of the University of Pennsylvania in Philadelphia. “This is proof that we can safely do gene editing of these cells.”

After two to three months, one patient’s cancer continued to worsen and another was stable. The third patient was treated too recently to know how she’ll fare. The plan is to treat 15 more patients and assess safety and how well it works.

“It’s very early, but I’m incredibly encouraged by this,” said one independent expert, Dr. Aaron Gerds, a Cleveland Clinic cancer specialist.

Other cell therapies for some blood cancers “have been a huge hit, taking diseases that are uncurable and curing them,” and the gene editing may give a way to improve on those, he said.

Gene editing is a way to permanently change DNA to attack the root causes of a disease. CRISPR is a tool to cut DNA at a specific spot. It’s long been used in the lab and is being tried for other diseases.

This study is not aimed at changing DNA within a person’s body. Instead it seeks to remove, alter and give back to the patient cells that are super-powered to fight their cancer — a form of immunotherapy.

Chinese scientists reportedly have tried this for cancer patients, but this is the first such study outside that country. It’s so novel that it took more than two years to get approval from U.S. government regulators to try it.

The early results were released by the American Society of Hematology; details will be given at its annual conference in December.

The study is sponsored by the University of Pennsylvania, the Parker Institute for Cancer Immunotherapy in San Francisco, and a biotech company, Tmunity Therapeutics. Several study leaders and the university have a financial stake in the company and may benefit from patents and licenses on the technology.

Two of the patients have multiple myeloma, a blood cancer, and the third has a sarcoma, cancer that forms in connective or soft tissue. All had failed multiple standard treatments and were out of good options.

Their blood was filtered to remove immune system soldiers called T cells, which were modified in the lab and then returned to the patients through an IV. It’s intended as a one-time treatment. The cells should multiply into an army within the body and act as a living drug.

So far, the cells have survived and have been multiplying as intended, Stadtmauer said.

“This is a brand new therapy” so not it’s not clear how soon any anti-cancer effects will be seen. Following these patients longer, and testing more of them, will tell, he said.

November, 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|

How Anti-Vaccine Sentiment Took Hold in the United States

Source: The New York Times
Date: September 23, 2019
Author: Jan Hoffman

As families face back-to-school medical requirements this month, the country feels the impact of a vaccine resistance movement decades in the making.

 

The question is often whispered, the questioners sheepish. But increasingly, parents at the Central Park playground where Dr. Elizabeth A. Comen takes her young children have been asking her: “Do you vaccinate your kids?”

Dr. Comen, an oncologist who has treated patients for cancers related to the human papillomavirus that a vaccine can now prevent, replies emphatically: Absolutely.

She never imagined she would be getting such queries. Yet these playground exchanges are reflective of the national conversation at the end of the second decade of the 21st century — a time of stunning scientific and medical advances but also a time when the United States may, next month, lose its World Health Organization designation as a country that has eliminated measles, because of outbreaks this year. The W.H.O. has listed vaccine hesitancy as one of the top threats to global health.

As millions of families face back-to-school medical requirements and forms this month, the contentiousness surrounding vaccines is heating up again, with possibly even more fervor.

Though the situation may seem improbable to some, anti-vaccine sentiment has been building for decades, a byproduct of an internet humming with rumor and misinformation; the backlash against Big Pharma; an infatuation with celebrities that gives special credence to the anti-immunization statements from actors like Jenny McCarthy, Jim Carrey and Alicia Silverstone, the rapper Kevin Gates and Robert F. Kennedy Jr. And now, the Trump administration’s anti-science rhetoric.

“Science has become just another voice in the room,” said Dr. Paul A. Offit, an infectious disease expert at Children’s Hospital of Philadelphia. “It has lost its platform. Now, you simply declare your own truth.”

The constituents who make up the so-called vaccine resistant come from disparate groups, and include anti-government libertarians, apostles of the all-natural and parents who believe that doctors should not dictate medical decisions about children. Labeling resisters with one dismissive stereotype would be wrongheaded.

“To just say that these parents are ignorant or selfish is an easy trope,” said Jennifer Reich, a sociologist at the University of Colorado Denver, who studies vaccine-resistant families.

It remains true that the overwhelming majority of American parents have their children vaccinated. Parent-driven groups like Voices for Vaccines, formed to counter anti-vaccination sentiment, have proliferated. Five states have eliminated exemptions for religious and philosophical reasons, permitting only medical opt-outs.

But there are ominous trends. For highly contagious diseases like measles, the vaccine rate to achieve herd immunity — the term that describes the optimum rate for protecting an entire population — is typically thought to be 95 percent. The Centers for Disease Control and Prevention found that the vaccination rate for the measles, mumps and rubella (M.M.R.) injection in kindergartners in the 2017-2018 school year had slipped nationally to 94.3 percent, the third year in a row it dropped.

Seven states reported rates for the M.M.R. vaccine that were far lower for kindergartners, including Kansas at 89.1 percent; New Hampshire, 92.4 percent; the District of Columbia, 81.3 percent. (The highest is West Virginia at 98.4 percent.)

Almost all states have at least one anti-vaccine group. At least four have registered political action committees, supporting candidates who favor less restrictive vaccine exemption policies.

Public health experts say that patients and many doctors may not appreciate the severity of diseases that immunizations have thwarted, like polio, which can affect the spinal cord and brain — because they probably have not seen cases.

“Vaccines are a victim of their own success,” said Dr. Offit, a co-inventor of a vaccine for rotavirus, which can cause severe diarrhea in young children. “We have largely eliminated the memory of many diseases.”

The growth of vaccine doubt in America coincides with several competing forces and attitudes.

Since the early 2000s, as the number of required childhood vaccines was increasing, a generation of parents was becoming hypervigilant about their children and, through social media, patting each other on the backs for doing so. In their view, parents who permitted vaccination were gullible toadies of status quo medicine.

In 2011, Dana Fuqua, of Aurora, Colo., pregnant with her first child, felt that irresistible pull of groupthink parenting.

She had just moved to the area, so she reached out to mothers’ groups on Facebook. Colorado, with a kindergarten vaccination compliance rate of 88.7 percent, has a rambunctious vaccine-resistant movement. Ms. Fuqua’s new friends urged her to have a drug-free birth, use cloth diapers and never to let a drop of formula pass her baby’s lips. Vaccines, it followed, were anathema.

The women intimidated her. They had advanced degrees; she had only a bachelor of science and a nursing background.

“I didn’t argue with them,” Ms. Fuqua said. “I was so desperate for their support that I compromised by delaying the vaccine schedule, so I wouldn’t get kicked out of the group.”

But when her second child was born prematurely, susceptible to illness, the group’s approval was not as important as her baby’s safety. Her position, she said, shifted from, “‘I can’t hang out with you if you had a vaccine because you could be shedding a virus’” — a common, false belief among the vaccine resistant — to, “ ‘If you haven’t had a vaccine, I will not associate with you.’”

She had both children fully vaccinated.

There have been anti-vaccination movements at least since 1796, when Edward Jenner invented the smallpox vaccine. But many experts say that the current one can be traced to 1982, when NBC aired a documentary, “DPT: Vaccine Roulette,” that took up a controversy percolating in England: a purported tie between the vaccine for pertussis — a potentially fatal disease that can cause lung problems — and seizures in young children.

Doctors sharply criticized the show as dangerously inaccurate. But fear spread. Anti-vaccination groups formed. Many companies stopped making vaccines, which were considered loss-leaders and not worth the corporate headache.

Then, in 1998, Andrew Wakefield, a British gastroenterologist, published a Lancet study (since discredited and withdrawn), associating the M.M.R. vaccine with autism.

Faced with risking autism or measles, some parents thought the answer was obvious. Most had never seen measles, mumps or rubella because vaccines had nearly eliminated them. But they believed they knew autism.

And most people are notoriously poor at assessing risk, say experts in medical decision-making.

Many stumble on omission bias: “We would rather not do something and have something bad happen, than do something and have something bad happen,” explained Alison M. Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania School of Nursing.

People are flummoxed by numerical risk. “We pay more attention to numerators, such as ‘16 adverse events,’ than we do to denominators, such as ‘per million vaccine doses,’ ” Dr. Buttenheim said.

A concept called “ambiguity aversion” is also involved, she added. “Parents would like to be told that vaccines are 100 percent safe,” she said. “But that’s not a standard we hold any medical treatment to.”

Relatively few people are absolutists about refusing all vaccines. “But if you’re uncertain about a decision, you’ll find those who confirm your bias and cement what you think,” said Rupali J. Limaye, a social scientist who studies vaccine behaviors at the Johns Hopkins Bloomberg School of Public Health.

Nowhere is that reinforcement more clamorous than on social media, Dr. Limaye added. “You may only see your pediatrician a few times a year but you can spend all day on the internet,” she said.

People tend to believe an individual’s anecdotal narrative over abstract numbers. By 2007, when Ms. McCarthy, the actress, insisted that vaccines caused her son’s autism, thousands found her to be more persuasive than data showing otherwise. A nascent movement took hold.

At the same time that these powerful attacks on vaccine confidence were underway, a constellation of trends was emerging.

The definition of a good parent was becoming fraught with the responsibility for overseeing every aspect of a child’s life.

“As we adopted a culture of individualistic parenting, public health became a hard sell,” Dr. Reich said.

The primary reason for healthy people to get the flu shot is to protect those with compromised immune systems, like infants and older adults, from getting sick. But altruism isn’t a great motivator for parents, Dr. Buttenheim said. “They are much more concerned about protecting their own child at all costs,” she said.

Contrast that attitude with the collective good will of the 1950s, say medical sociologists, when American parents who had seen President Franklin Delano Roosevelt’s wheelchair as a debilitating symbol of polio patriotically sought to vaccinate their children to help eradicate the disease worldwide.

By 2014, studies showed that parental confidence in authorities like the C.D.C. and in pediatricians was dropping, especially around vaccines. Mistrust of Big Pharma was even more pronounced.

By then, Donald Trump was offering support on Twitter for the discredited link between autism and vaccination. As president-elect, he met with leaders of the anti-vaccination movement, although as measles cases surged, he endorsed vaccination.

As parenting became rife with orthodoxy, the Marcus Welby model of the paternalistic doctor retreated. Patients asserted autonomy, brandishing internet printouts at doctors. Shared decision-making became the model of doctor-patient engagement.

Pediatricians offered to stagger vaccine schedules. Some were even flexible about vaccinations altogether.

In 2011, shortly after Emma Wagner had given birth in Savannah, Ga., a pediatrician on the ward examined the baby. “He asked me if I was interested in the hepatitis B vaccine,” she said of an inoculation typically done at birth.

She was apprehensive.

He replied, “‘That’s fine, because your 2-day-old daughter isn’t a prostitute and isn’t using I.V. drugs, so hep B isn’t at the top of my worries.’”

Ms. Wagner said she “swallowed the anti-vax Kool-Aid. I was motivated by fear. I thought, ‘Until I know for certain that these are safe, I won’t do it.’ The pediatrician said, ‘I will support your decision and in a few years we’ll talk about exemptions for school.’”

She has since become a staunch supporter of immunization.

Libertarianism also courses through vaccine hesitation, with parents who assert that government should not be able to tell them what to put in their bodies — a position often marketed as “the right to choose.”

“Having the government order them to do something reinforces conspiracy theories,” said Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins. “And people perceive their risk to be higher when it’s not voluntary.”

In reality, he said, one’s risk of harm is greater while driving to an airport than it is being on the airplane itself. But driving is voluntary and gives the illusion of control. People fear flying because they cannot control the plane. By extension, many childhood vaccines are not voluntary, which rattles those who prefer to believe they can control their health.

With so many different but deeply held convictions, public health experts struggle to design vaccine-positive campaigns.

In 2017, researchers applied the six values of “the moral foundations theory” to vaccine attitudes, surveying 1,007 American parents.

The results were intriguing. Those most resistant to vaccines scored highest in two values: purity (“my body is a temple”) and liberty (“I want to make my child’s health care decisions”).

A third, said Saad B. Omer, director of Yale’s Global Health Institute and an author of the study, was also telling: deference to authority — a score indicating whether one was likely to adhere to the advice of experts like a pediatrician or the C.D.C.

Dr. Salmon’s team at Johns Hopkins is working on an app to capture parents’ vaccine attitudes and to tailor information to persuade them to vaccinate their children.

Pediatricians are front-line persuaders, he said, and they should be compensated for the time it takes to educate parents.

Most experts note that physicians themselves, never mind parents, have no idea about the federal vaccine monitoring systems, which have been in place for more than 20 years.

“We ask parents in the first two years of their child’s life to protect them against 14 diseases, that most people don’t see, using fluids they don’t understand,” Dr. Offit said. “It’s time for us to stand back and explain ourselves better.”

September, 2019|Oral Cancer News|

Cases of Vaping-Related Lung Illness Surge, Health Officials Say

Source: New York Times
Date: 09/06/19
Author: Matt Ritchel & Denise Grady

Indiana announced a third death linked to the illness on Friday, and Minnesota a fourth. State and federal health officials are working urgently to understand the causes.

Medical experts and federal health officials on Friday warned the public about the dangers of vaping and discouraged using the devices as the number of people with a severe lung illness linked to vaping has more than doubled to 450 possible cases in 33 states. The number of deaths linked to vaping rose to four from two on Friday.

The Indiana Department of Health announced the third death, saying only that the victim was older than 18. Hours later, officials in Minnesota confirmed that a fourth person had died. The patient, who was 65, had a history of lung disease, but state officials said his acute lung injury was linked to “vaping illicit T.H.C. products.”

The Los Angeles County Department of Public Health was investigating a possible fifth death, saying on Friday afternoon that the fatality was “associated with the use of e-cigarettes, also known as vaping.”

“There is clearly an epidemic that begs for an urgent response,” Dr. David C. Christiani of the Harvard T.H. Chan School of Public Health wrote in an editorial published on Friday in The New England Journal of Medicine.

The editorial called on doctors to discourage their patients from using e-cigarettes and for a broader effort to increase public awareness about “the harmful effects of vaping.”

Officials from the Centers for Disease Control and Prevention echoed that call in a briefing.

“While this investigation is ongoing, people should consider not using e-cigarette products,” said Dr. Dana Meaney-Delman, who is leading the C.D.C.’s investigation into the illness.

C.D.C. officials said they believe that some “chemical” is involved as the cause but they have not identified a single responsible “device, product or substance,” Dr. Meaney-Delman said.

Dr. Christiani wrote in The New England Journal editorial that it was not yet clear which substances were causing the damage. E-cigarette fluids alone contain “at least six groups of potentially toxic compounds,” he wrote, but he noted that many of the patients had also vaped substances extracted from marijuana or hemp. The mixed-up stew of chemicals might even create new toxins, Dr. Christiani suggested. The journal also published a study of two clusters of 53 cases in Wisconsin and Illinois.

What looked like scattered cases earlier this summer has become a full-fledged and widespread public health scare, leaving otherwise healthy teenagers and young adults severely ill.

The first case of the mysterious lung illness, in Illinois, came in April, indicating that the syndrome emerged earlier than the mid-June date that federal officials have often cited as the time the afflictions began.

The patients studied in Illinois and Wisconsin were typically “healthy, young, with a median age of 19 years and a majority have been men,” said Dr. Jennifer Layden, chief medical officer and state epidemiologist for the Illinois Department of Public Health. A third were younger than 18.

The journal article about the Illinois and Wisconsin patients said that 98 percent were hospitalized, half required admission to the intensive care unit, and a third had so much trouble breathing that they needed to be placed on ventilators.

Eighty-four percent had vaped a product including T.H.C., the high-inducing chemical in marijuana. Dr. Layden said a majority had also used a “nicotine-based product,” noting that there were “a range of products and devices.”

The journal article about those cases mentions that the heating coils in vaping devices might release metal particles that could be inhaled.

“The focus of our investigation is narrowing but is still faced with complex questions,” said Ileana Arias, the C.D.C.’s acting deputy director for noninfectious diseases. She added, “We are working tirelessly and relentlessly.”

Mitch Zeller, the director of the Center for Tobacco Products at the Food and Drug Administration, said particular concern is developing around products that are jury-rigged by vaping retailers, or tampered with or mixed by consumers themselves. “Think twice,” he said, urging consumers to avoid vaping products purchased on the street or that they have made themselves.

Public health officials have underscored one fundamental point: that the surge in illnesses is a new phenomenon and not merely a recognition of a syndrome that may have been developing for years.

Indiana on Friday confirmed a third death from a severe lung illness linked to vaping shortly before officials in Minnesota confirmed a fourth. Two other people — one in Illinois, the other in Oregon, both of whom were adults — have died from what appears to be the same type of illness, health officials in those states have said.

Patients afflicted with the illness typically have showed up in emergency rooms with shortness of breath after several days of flulike symptoms, including high fever.

In an especially severe case in Utah, a 21-year-old man had such serious lung damage that even a ventilator could not provide enough breathing help. Doctors had to connect him to a machine that pumped oxygen directly into his bloodstream to keep him alive.

Fluid from his lungs contained white blood cells full of fat, not from the substances he had vaped, but more likely a sort of debris from the breakdown of his lung tissue.

“We were flying in the dark with this kid,” said Dr. Sean J. Callahan, a pulmonologist and critical care specialist at the University of Utah, and an author of a letter about six vaping patients in Utah that was published Friday in The New England Journal of Medicine.

“I thought he was going to die,” Dr. Callahan said. “I kept thinking, his parents were there, if this were me and my wife, how crushed we would be for something that is completely avoidable. I worry that these products are really geared toward young people and kids, and we need a call to ban these things. That’s my call to action as a father and a doctor.”

The patient survived, and went home after two weeks in the hospital.

It is too soon to tell whether people with vaping injuries will recover fully, or sustain lasting lung damage, Dr. Callahan said.

He added that doctors need to take better histories of young patients who come in with pneumonialike symptoms to try to find the real cause. Some patients and their families are forthcoming about vaping, but others are not. In one case, he said, medical residents were puzzled by what could have caused the illness. He asked the patient’s mother to leave the room and then, instead of asking if the patient vaped, he simply asked, “What do you vape?” The answer was T.H.C.

The state of New York, where 34 people have become ill, said on Thursday that vaping samples from eight of its cases showed high levels of a compound called vitamin E acetate. Investigators there are focusing on the possibility that the oily substance might be playing a key role in the illness.

However, some of the more than 100 vaping samples being examined by the federal government did not test positive for vitamin E acetate, so that compound remains only one of many possible causes of the heavy lung inflammation.

September, 2019|Oral Cancer News|