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Dental Professionals Should Remember the HPV Vaccine Too

Source: Dentistry Today
Date: April 13th, 2021
Author: Jo-Anne Jones

We live in a viral world as we patiently await the end of the COVID-19 pandemic. Many people already have chosen to be vaccinated to protect themselves from getting the virus, or, at the very least, minimize its severity.

The harsh nature of the pandemic has led to expediency in developing the vaccine, which has not been typical, historically speaking. While the COVID-19 vaccine took less than a year to develop, the mumps vaccine took four years. The polio vaccine took 13 years. The human papillomavirus (HPV), flu, and chicken pox vaccines took 17, 27, and 28 years, respectively.

Looking back in the annals of history, we have the remarkable work of Edward Jenner to thank for his development of the first vaccine. His work involved deliberately infecting a human being with a mild dose of smallpox. His rigorous trials were controlled, repeatable, and documented in his 1798 publication, “An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ.”

Jenner devoted the remainder of his life advocating for the safe and effective administration of the vaccine. In 1972, routine smallpox vaccination ended in the United States, followed by the World Health Organization declaring the disease’s elimination in 1980.

Another such vaccine victory is the polio vaccine, which was first available in the United States in 1955. Thanks to its widespread use, the United States has been polio-free since 1979.

And while the United States government has said that dentists can now administer the COVID-19 vaccine, there is another vaccine that we should bring to the attention of every adult who visits our practice: the HPV vaccine.

The Rise of Oropharyngeal Cancer

The fastest-growing segment of oropharyngeal cancers is attributed to HPV. Yet it can be prevented by the Gardasil HPV nine-valent vaccine (Gardasil 9 [9vHPV]). More than 270 million doses of the Gardasil HPV vaccine have been given worldwide, including 120 million doses in the United States.

Gardasil 9 is a non-infectious recombinant vaccine prepared from virus-like particles (VLPs) of the protein of HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

We accept vaccination due to perceived risk. Are your patients aware of the ubiquitous nature of this virus and the fact that merely being alive and sexually active may place them at inherent risk? Many of our patients who do not possess a history of tobacco or alcohol use do not perceive a risk of oral or oropharyngeal cancer.

But according to the Centers for Disease Control and Prevention, more than 70% of oropharyngeal cancers are related to HPV. HPV-related oropharyngeal cancer has now surpassed HPV-related cervical cancer as the leading HPV-associated cancer.

Cervical cancer used to be the leading cause of cancer death for women in the United States. But in the past 40 years, the number of cervical cancer cases and the number of cervical cancer deaths have decreased significantly. This decline is primarily the result of opportunistic screening practices and the HPV vaccine.

Most sexually active Americans will clear the virus without consequence. Many of them will not be aware of even having the virus. However, for persistent infection with a high-risk strain such as HPV-16, the risk for malignant transformation is real.

In 2020, the Food and Drug Administration approved an expanded indication for Gardasil 9 for the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58. The vaccine is also indicated to prevent cervical, vulvar, vaginal, anal, and penile cancer.

2021 is a year defined and impacted by an overstretched healthcare system. We have longer wait times and backlogs for cancer treatments than ever before. For a cancer that is essentially preventable by a vaccine, it is frustrating beyond words to know that many of our dental patients are unaware of its existence.

HPV is responsible for a small number of oral cancers, as the vast majority are caused by lifestyle behaviors including smoking and alcohol use—once again, preventable.

We are not powerless. Our patients do not have to fall victim to the collateral damage of COVID-19. We can encourage our patients to perform a self-examination of the oral cavity between professional visits. We can educate them about the subtle symptoms that may be associated with HPV-related oropharyngeal cancer.

A North American campaign entitled Check Your Mouth was developed to educate the public about the importance of oral self-examination. It is the result of collaboration between the Oral Cancer Foundation and Holland Healthcare, developer of the Throat Scope and TelScope.

The Throat Scope is the world’s first all-in-one illuminated tongue depressor. The TelScope is a seamless oral telehealth delivery system capable of capturing real-time high-resolution images and emailing them to an oral healthcare provider via encrypted email.

Empower your patients. Share the science that we are most fortunate to have and recognize that we can proactively fight back in a viral world.

Ms. Jones is an award-winning speaker who has given over a thousand presentations across the United States, Canada, England, Ireland, and Bermuda. She also joins the Dentistry Today’s Leaders in Continuing Education for the eleventh consecutive year. With her frank and open lecture style, focus on direct knowledge translation to practice, and educational and clinical resources, she has earned many loyal followers both nationally and internationally. She may be reached at jjones@jo-annejones.com.

 

2021-04-13T12:57:09-07:00April, 2021|OCF In The News|

HPV vaccine leads to more than 80% drop in infections: What parents need to know

Source: Good Morning, America
Date: April 2nd, 2021
Author: Kathleen Kindalen

 

A new study has shown the effectiveness of the HPV vaccine, and found a dramatic decline in human papillomavirus infections in both vaccinated and unvaccinated teen girls and young women in the United States.

“This study shows that the vaccine works very well against a common virus, HPV,” Dr. Hannah Rosenblum, lead author of the study and medical epidemiologist at the Centers for Disease Control and Prevention (CDC), told “Good Morning America.”

“HPV can cause serious health problems later in life, including some cancers in both women and men,” she said. “HPV vaccination is cancer prevention — by vaccinating children at age 11 or 12, we can protect them from developing cancers later in life.”

HPV is the most common sexually transmitted infection in the United States and can cause health problems like genital warts in addition to cancer, which are most commonly cervical cancer in women and throat cancer in men, according to the CDC.

The HPV vaccine was first authorized in the U.S. for females in 2006, and for males in 2011. There has since been a more than 80% decline in HPV infections nationally, according to the CDC study.

The newly-released data from the CDC shows an 88% decrease in HPV infections among 14 to 19-year-old females and an 81% decrease among 20 to 24-year-old females.

There has also been a drop in unvaccinated females, according to Rosenblum, who warned that does not mean people should let their guard down.

“We also see an effect among unvaccinated females in these age groups due to less spread of the virus, however, unvaccinated persons are not immune and are still at risk of getting HPV,” she said. “They should talk to their doctor about getting vaccinated if they are 26-years-old or younger.”

HPV viruses are found in 80 million people in the United States, according to the CDC. There are hundreds of subtypes of HPV, and 1 in 4 people in the U.S. are infected with HPV at some point in their lives.

The CDC recommends two doses of the HPV vaccine, taken six to 12 months apart, for all girls and boys ages 11 to 12, but says the vaccine can be given to children as young as 9.

Teens and older who are not vaccinated are encouraged to do so by the age of 26. People ages 15 and older need three doses of the vaccine, according to the CDC.

The timing of the vaccine has to do with the state of children’s immune systems and also trying to vaccinate pre-teens before they are sexually active, Dr. Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and New York-Presbyterian in New York City, told “GMA.”

“Your immune system [at ages 11 and 12] is such that you have a robust response to this vaccine, and it lasts for a really long time,” she said. “But if you haven’t had it, still continue talking to your doctor about getting it up to age 26.”

Riley said she hopes the CDC’s new data — which stands out for being a 10-year study — combined with the safety of the HPV vaccine eases any remaining concerns parents may have about getting their children vaccinated against HPV.

“When [the HPV vaccine] first rolled out, the message wasn’t quite clear, so instead of people recognizing that you were going to prevent your kid from getting cancer, people were focused on the fact that HPV is a sexually transmitted disease,” she said. “The education has to continue so that parents can understand the real benefit of this vaccine.”

“The real benefit is to prevent your child from getting cervical cancer,” Riley said. “The fact that you can prevent [cervical cancer] with a vaccine that has been used for years and has shown to be safe, why wouldn’t you do it?”

Long-lasting infection with certain types of HPV is the main cause of cervical cancer, which has the best survival rates if detected early according to the CDC. Doctors routinely screen for cervical cancer with the Pap test and HPV DNA testing depending on age and risk factors.

“We need to make sure that the teenagers and pre-teens are getting the benefit of the HPV vaccine, because it really is an anti-cancer vaccine,” said Riley. “[Cervical cancer] is a really devastating disease.”

Globally, a woman loses her life to cervical cancer every two minutes, according to a 2019 article published in the medical journal The Lancet.

In the U.S., doctors on the frontlines like Riley said more must continue to be done to educate parents about the HPV vaccine and make sure that all children across the country have access to the vaccine. As of 2018, nearly 40% of adults ages 18 to 26 reported receiving one or more doses of the HPV vaccine, according to the CDC.

“We need to make sure that we work on access to this vaccine and make sure that all girls of all races and ethnicities have the access,” said Riley. “And we need to be sure that the message is clear so that everyone gets the two doses of the vaccine, because that’s what is associated with the best protection.”

City offers Oral Cancer Screenings; Health Officials aim to reduce cancer rates, save lives

Source: El Paso Herald Post
Date: April 1st, 2021
Author: Staff Reporter

Thursday morning, city officials announced that they will be offering referral services and health screenings to decrease the rate of oral cancer diagnoses and save lives, in recognition of April’s National Oral Cancer Awareness Month.

“Improving oral and oropharyngeal cancer awareness in our community is imperative,” said Angela Mora, Department of Public Health Director.

“Oral cancer has an incidence rate of about 7.2 per 100,000 residents in El Paso County and affects males twice as much as females in the U.S., but we as a community can work to reduce the incidence rate by participating in Oral Cancer Awareness month.”

Mora said residents can take part in Oral Cancer Awareness month by:

  • Reducing the use of tobacco products

Tobacco use and vaping significantly increases the risk of infection by the human papillomavirus (HPV) which causes oral or oropharyngeal cancer.

  • Getting Screened

Oral and oropharyngeal cancers occur most often in the tongue, soft and hard palate, tonsils, gums and back of the throat which is why regular oral and dental examinations by a health professional is important.

  • Getting the Human Papilloma Virus (HPV) Vaccine

According to the CDC, HPV is known to cause approximately 70 percent of oral and oropharyngeal cancer cases, and the HPV vaccine was developed to prevent infection by the high-risk types of HPV that cause cancers such as oral and oropharyngeal cancer.

For more information on the services and health screenings provided by the Department of Public Health visit EPHealth.com under the Services Tab Education and Promotion or call 2-1-1.

 

UB awarded $1.5 million to reprogram white blood cells in fight against oral cancer

Source: Science Magazine
Date: March 25th, 2021

BUFFALO, N.Y. – The University at Buffalo has received a $1.5 million grant from the United States Department of Defense to develop new therapies that help reduce chronic inflammation and immunosuppression in oral cancers.

Through the three-year grant, the research will center on a type of white blood cell called a macrophage that – after migrating to oral tumors – triggers uncontrolled inflammation, which suppresses the body’s immune response and lowers the effectiveness of anticancer therapies.

The researchers aim to reprogram the macrophages by targeting genes that regulate inflammation. By lowering inflammation, oral cancers will become more sensitive to new and traditional chemotherapies.

If successful, the findings could help increase survivorship of oral cancers, which claim the life of roughly half of all oral cancer patients within five years, according to Keith Kirkwood, DDS, PhD, principal investigator, Centennial Endowed Chair and professor of oral biology in the UB School of Dental Medicine.

“A change in behavior in the white blood cells within the tumor itself removes the ‘brakes’ in the system, causing more oral cancer growth,” says Kirkwood, also associate dean for innovation and technology transfer in the UB School of Dental Medicine. “We propose to reprogram the white blood cells to regain control of the brakes.”

Additional investigators from Roswell Park Comprehensive Cancer Center include Wesley Hicks Jr., MD, DDS, chair of the Department of Head and Neck/Plastic and Reconstructive Surgery; William Magner, PhD, scientist in the Department of Immunology; and Scott Abrams, PhD, professor in the Department of Immunology.

The research will focus on oral squamous cell carcinoma, the most common type of oral cancer. Found in the lips, mouth or throat, oral cancers can affect the ability to eat and speak, and may cause permanent disfigurement of the face.

Veterans are two times more likely to develop head and neck cancers than non-veterans, says Kirkwood. The increased risk may be attributed to higher rates of alcohol and tobacco use among veterans, he says. Nearly 75% of oral cancers are caused by either alcohol or tobacco use, according to outside research.

Sunstar Americas, Inc. Issues Voluntary Nationwide Recall of GUM® Hydral Dry Mouth Relief Oral Spray Due to Possible Microbial Contamination

Source: Yahoo! Finance
Date: February 18th, 2021

CHICAGO, Feb. 18, 2021 /PRNewswire/ — Sunstar Americas, Inc. (SAI) is voluntarily recalling GUM® Hydral Dry Mouth Relief Oral Spray products bearing an expiration date from 2021-11 through 2022-05 (see specific lots below) to the consumer level. This product may be contaminated with the bacteria Burkholderia cepacia.

Use of the defective product in the immunocompetent host may result in oral and, potentially, systemic infections requiring antibacterial therapy. In the most at-risk populations, the use of the defective product may result in life-threatening infections, such as pneumonia and bacteremia. To date, no adverse events have been reported to SAI related to this recall.

The oral spray, available through retail, is indicated for use for lubricating, moisturizing, soothing, and refreshing properties to help relieve and manage the symptoms of dry mouth:

  • 1800R/1800RA GUM® Hydral Dry Mouth Relief Oral Spray is distributed in 2.0 fluid ounce Polyethylene Terephthalate (PET) bottles with white polypropylene caps and a separate spray nozzle.

GUM® Hydral Dry Mouth Relief Oral Spray was distributed Nationwide to Grocery and Drug Wholesalers, Grocery and Drug chains, Web distribution and sales, and direct to consumers.

SAI is notifying its direct distributors and customers by USPS Priority mail and is arranging for return of all recalled products. Patients, pharmacies, and healthcare facilities in possession of these products should stop using and dispensing immediately.

Consumers with questions regarding this recall can contact SAI by phone at 1-800-528-8537 or email us.pcr@us.sunstar.com on Monday-Friday from 8am-5pm CST. Consumers should contact their physician or healthcare provider if they have experienced any problems that may be related to using this drug product.

Affected products and lot numbers follow below:

AFFECTED LOTS

SKU# Lot Exp
1800R 493538 2021/11
1800R 493539 2021/11
1800R 493540 2021/11
1800R 493541 2021/12
1800R 498339 2021/12
1800R 498340 2021/12
1800R 498341 2021/12
1800R 498342 2021/12
1800R 511571 2022/01
1800R 516383 2022/02
1800R 516384 2022/02
1800RA C140DD 2022-05

 

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

Sunstar is committed to delivering safe, fully compliant products of the highest quality and is taking necessary steps to prevent future occurrence of this issue.

This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.

About Sunstar Americas, Inc.

Sunstar Americas, Inc., a member of the Sunstar Group of companies, is a global organization headquartered in Switzerland that is a leader in the oral care industry and the manufacturer and distributor of the GUM and Butler Brands.

2021-02-22T11:19:16-07:00February, 2021|Oral Cancer News|

How enlisting dentists can speed up Covid-19 vaccinations

Source: Knowable Magazine
Date: February 3rd, 2021
Author: Mary E. Northridge

OPINION: Dental care providers have the skills, the facilities and the trust of patients who might otherwise miss out

 

Even as the Biden administration has upped its Covid-19 vaccine goal to 1.5 million per day, early reports say vaccination rates are lagging in hard-hit Black and Latino communities. On both fronts, America’s dentists can help.

Dental professionals — dentists, dental hygienists and dental assistants — have been responding to the pandemic from the outset, even as many practices were shut down by the emergency. At the health center where I work in Brooklyn, dental providers first donated their personal protective equipment (PPE) to the affiliated hospital. Then many of them were redeployed to perform arterial blood gas measurements and even transport deceased patients to makeshift morgues.

Today, the urgent need is to get millions of shots in arms. States should immediately authorize dental providers to administer Covid-19 vaccines. That would not only expand the trained immunization workforce, it would open up additional sites to dispense the vaccine and bolster vaccine acceptance among patients who do not routinely go to the doctor.

This is not without precedent. In 2019, Oregon became the first state to allow dentists to offer any vaccine to patients. Other states, including Illinois and Minnesota, allow dentists to administer influenza vaccines. Since late 2020, Arkansas, Massachusetts and California have permitted dentists to administer Covid-19 vaccines.

During this devastating public health emergency, this idea needs to be extended to all states.

There are more than 110,000 dentists – excluding specialists — and over 200,000 hygienists in the United States, and they already have the skills needed. Dentists routinely administer intra- and extra-oral injections to provide anesthesia, so any additional training would be minimal. In California, for instance, dentists will do four hours of online training before joining the vaccination effort.

California currently plans to utilize dentists just as extra manpower at vaccine clinics. But dental offices, too, will be valuable in vaccinating hard-to-reach populations.

Dental offices and clinics are a safe location. Despite early concerns that they might be particularly vulnerable to aerosol-borne transmission of the novel coronavirus, evidence is mounting that transmission at dental sites is rare. As in medical settings, precautions such as using PPE and increasing ventilation are effective. Nearly all dental practices and clinics have reopened to provide care. And that has been essential during the pandemic: Treating damaged teeth, tooth decay, gum disease and oral sores before they become acute prevents patients from going to emergency departments because of dental pain.

Interrupting community spread, however, is the chief imperative to prevent Covid-19 cases from overwhelming hospitals today. And that means adding vaccines to dental services.

Inoculating patients who are already in chairs for dental visits could improve vaccine acceptance. At the health center where I work, a simple workflow change for preventive tooth sealant placement nearly doubled the number of eligible children treated, from 37 percent to nearly 78 percent. Rather than schedule a separate appointment, sealants were applied during the kids’ initial or recall visits. Fewer visits meant greater acceptance of the treatment and higher rates of completion. The same could be true for vaccines.

Community dental clinics also serve hard-to-reach patients — minorities, immigrants, impoverished people — those who may be hesitant to seek out the vaccine because of historical injustices, fear of deportation or lack of health insurance. But dental providers have often earned trust through longstanding service in these communities. Ongoing quality improvement studies at our health center, for instance, document no racial/ethnic bias in treatment by dental providers. When patients are treated with respect regardless of their ability to pay for services, they may be more willing to accept a vaccine that will protect them, their families and their communities.

Many states have suspended regulations and expanded the scope of dental practices to combat the pandemic. To help ensure health equity and successfully immunize the whole US population, all states ought to enlist dental providers to administer Covid-19 vaccines as well.

This article is part of “Reset: The Science of Crisis & Recovery,” an ongoing Knowable Magazine series exploring how the world is navigating the coronavirus pandemic, its consequences and the way forward. “Reset” is supported by a grant from the Alfred P. Sloan Foundation. 

 

2021-02-08T12:25:34-07:00February, 2021|Oral Cancer News|

Deadly Spread of Some Cancers May Be Driven by a Common Mouth Microbe

Source: Scientific American
Author: Claudia Wallis
Image courtesy of Fatinha Ramos

When people hear that they might have cancer, perhaps the only thing more frightening than the C word is the M word. Metastatic disease—in which the malignancy has traveled beyond its primary site to other spots in the body—is responsible for nine out of every 10 cancer deaths.

Recently an unexpected player in this process has emerged: a common bacterium. Fusobacterium nucleatum, which normally lives harmlessly in the gums, appears to have a role in the spread of some cancers of the colon, esophagus, pancreas and—possibly—breast. Laboratory studies and evidence in patients indicate that the microbe can travel through the blood and infect tumor cells by attaching to a sugar molecule on their surface. There it provokes a range of signals and immune responses known to cause tumor cells to migrate. If further confirmed, the work with F. nucleatum could add to a growing understanding of how the microbiome influences cancer progression and may even point the way to fresh approaches to treatment.
In a healthy human mouth, F. nucleatum is a law-abiding member of the microbial community. With poor dental hygiene, uncontrolled diabetes and other conditions, however, it can go rogue and cause periodontitis, tonsillitis, appendicitis and even preterm labor. A connection to colorectal cancer was first hinted at about nine years ago, when two research groups discovered that the bacterium’s DNA was overrepresented in colon tumor tissue compared with normal tissue. Dozens of studies have since found that the infection in tumor cells is a sign of trouble: it is linked to a poorer prognosis in patients with pancreatic, esophageal or colorectal cancer; resistance to chemotherapy in the latter two groups; and metastasis in colorectal cancer, which is the world’s third most common and second most deadly malignancy.

Still, the question remained: Is this bug merely a warning sign, or is it an active participant in cancer progression? This year at least three studies of colon cancer, by separate teams, pointed to an active role. “We reached the same conclusion through different pathways,” says biochemist Daniel Slade of Virginia Tech. Slade and his colleagues found that when cultured human colon tumor cells were invaded by the bacterium, they produced two inflammatory proteins called cytokines—specifically, interleukin-8 and CXCL1—that have been shown to promote the migration of malignant cells, a step in metastasis. A second paper reported that the bacterium induces changes in gene regulation that boost metastasis to the lungs in mice. A third study determined that the abundance of F. nucleatum in human colon cancer tissue correlates with the amount of metastases and, in mice, identified additional signals by which the microbe may “orchestrate” metastasis. Slade and others have also demonstrated that the bacterium incites a kind of cytokine storm that is aimed at controlling the infection but that ultimately exacerbates the cancer. “It’s like throwing gas on an already lit fire,” Slade says.

Something similar may be going on in some breast tumors. In June a team led by microbiologist Gilad Bachrach of Hebrew University reported finding F. nucleatum DNA in 30 percent of the human breast cancer tissue examined; the bacterium was most common in cancer cells that expressed a lot of the surface sugar molecule Gal/GalNAc. Researchers also showed that the infection promotes growth of both primary tumors and metastases in mouse models of breast cancer. “The data imply that fusobacterium is not a cause of cancer, but it can accelerate progression,” Bachrach says.

How much this is happening in humans is, of course, a critical question. “The findings are intriguing, and it makes sense,” says Joan Massagué of Memorial Sloan Kettering Cancer Center, who is a leading investigator of metastasis. Inflammation is invariably part of the metastatic process, he says, so an infection that incites a dramatic inflammatory reaction in a tumor will have a consequence: “it helps cancer cells engage in mobile, invasive behavior.”

The discoveries about fusobacterium are part of a fast-moving field that is illuminating the way the microbiome both promotes and battles cancer. Many modern immunotherapy drugs, for instance, work best in the presence of beneficent microbes—as do some older chemotherapies. Some scientists envision that fusobacterium eventually could be turned into a cancer fighter. Given the microbe’s attraction to a sugar on tumor cells, they suggest, perhaps it could be deployed as a Trojan horse, bound to cancer drugs and carrying them straight to a malignant target.

2020-09-24T11:24:02-07:00September, 2020|Oral Cancer News|

Fighting cancer in the pandemic means fighting cancer alone

Source: The Washington Post
Date: August 12, 2020
Author: Laura B. Kadetsky

 

A doctor pointed out to me at a recent appointment that my latest bout with oral cancer tracked the first spikes of the coronavirus pandemic. On that beautiful, cancer-free day in late May, workers chatted over lunch outside the hospital entrance, and I gawked at their carefree togetherness while I hurried by wearing my mask and gloves. It was a world apart from March, when I hastily scheduled a biopsy in case the hospital canceled ENT procedures entirely, and April, when I had the surgery in an abnormally quiet hospital, where coronavirus precautions were expanding daily.

In March, horror stories were flooding in, and the threat of the virus hung over everything. Waiting for the biopsy results only heightened that pandemic-induced anxiety: How do you deal with cancer when no one knows what’s safe anymore? Although it felt like the pandemic put most of life on hold, serious health issues don’t wait for a worldwide crisis to end. After I had spent 10 years fighting oral cancer on and off, the cancer was back, and I had to deal with it.

At the hospital, which already had covid-19 patients, the danger of infection seemed everywhere. I focused on ways to try to control my risk — maybe because having cancer makes everything else feel squarely out of control. I parked on the street to avoid having a stranger park my car in the hospital garage and contaminate it. I wore my homemade dish-towel mask, because masks hadn’t yet become widely available. I covered the driver’s seat with a sheet in case my clothes picked up the virus and transferred it to the car, as this was before we learned more about surface transmission. Those things won’t stop cancer, I reasoned, but maybe they’d block the virus.

Walking the halls, I kept my eyes down to avoid sending — or receiving — accusatory looks: Did you cough near me? Why are you in the hospital? Do you have the virus? I tallied door handles: three to get in and out of the building, each one a potential germ site. It felt bizarre to be this hyper-alert and yet entirely reasonable.

I needed a coronavirus test before the surgery, well before drive-through testing sites popped up. As much as I feared getting the virus, the medical workers rightly worried that they might get it from me. In ENT surgeries especially, working in or near the respiratory system risks the virus spreading throughout the operating room. I understood, but I obsessed about it. It sounded barbaric, adding insult to injury: I already have cancer, and now you have to jam a cotton swab up my nose, too?

In good-for-coronavirus news, the test was negative, and surgery was on — and at the start of Oral, Head and Neck Cancer Awareness Week, no less (a reminder: I don’t smoke, and I rarely drink alcohol, so everyone thinking this happens to “someone else” should have their oral cancer screening as soon as they can get to the dentist). Having been through this before, my husband and I thought we knew how to get ready. But preparing for surgery in a pandemic comes with new complications. With quarantines and the dangers of infection for our elderly parents, no family members could come to help. Physical distancing norms left us worried about asking friends for anything. I’d been having groceries delivered for years, but suddenly, I couldn’t get a slot. I found myself staying awake for hours refreshing the overwhelmed delivery website in the middle of the night, funneling my stress into obsession about how to feed my family safely and find food I could eat after surgery.

We agonized about how to tell our 5-year-old son. The anxiety of the pandemic had ratcheted up my distraction, and I’d been mixing up words for weeks. I tried to explain bandages to him and compared them to zombies. “No, Mommy,” he corrected me, giggling, “you’ll be a mummy, not a zombie.” Of course, he was right. He decided I needed one of his stuffed animals to take with me. In the face of his generosity, I hesitated, wondering how we could clean germs off a stuffed giraffe.

Between the placement of the tumor, and the multiple prior surgeries, I faced an uncertain outcome. Only after surgery started would we find out how intense it would be. No matter what, though, I would be staying in the hospital, where covid-19 numbers were increasing daily. All the controls I’d put in place to stay safe were gone. Although I was tested, the medical staff was not all tested before touching me — let alone operating on me. I couldn’t wash my hands while sedated or wear a mask during the surgery. No one wants to stay in the hospital, but now I was bucking all the directives; not only would people not be six feet away, they would actually have their hands in my mouth and all over my face. Everything I had been told not to do was turned on its head.

And no matter what, I would be alone. Because of the coronavirus, my family was barred from visiting me in the hospital. The doctors suggested that my husband not stay in the surgical waiting room, or anywhere on the hospital campus, to find out what happened, in case anyone there carried it (although in the end, he refused to leave until the procedure was done). When they wheeled me out of pre-op, we didn’t know when we would see each other again or in what condition I would be. I couldn’t comprehend how I would manage on my own. He couldn’t comprehend not being there for me.

When we are sick, those closest to us provide a vital source of healing. Yet the pandemic makes that physically impossible. When I was hospitalized, the distance between my family and friends and me was not just six feet, but absolute. My family couldn’t act on a basic human need to provide comfort through their presence. Instead, my son made colorful, glittery drawings, and my husband covered them with cheering messages, such as, “Sending you healing powers from your #1 fans.” But notes and video calls can’t replace someone at your bedside. It is a terrible loss when those of us at our most vulnerable cannot be fully present with those who love us most; the pandemic exacerbates patients’ suffering by making that impossible.

In one version of this story, I was lucky. My surgery was one of the serious cases still allowed to proceed when many hospitals had been turned into covid wards (shortly after waking up, I overheard someone tell another patient, “Congratulations, you have a new kidney!”). The surgeons and medical staff worked magic, and I made it through the surgery with the best possible outcome. I had access to a hospital system that saw what happened in New York and prepared before cases rose, so the medical staff caring for both me and the covid patients there knew how to stay protected.

But in the other version, being a patient right now is a nightmare. It means having to ask things such as, “Will a ventilator be available if I need it?” “Will the hospital allow my care to proceed?” “How will my husband take me to the hospital when our son is at home with no child care?” “How will I get through this alone?” Or, “When I can’t speak post-surgery and am alone in the hospital, when I can’t advocate for myself, who will advocate for me?”

People are desperate to be done with restrictions; I get it. They’re tired of being stuck at home. They want to hang out with their friends without worrying about killing them. But the virus is still out there. And the longer we let it linger, the more people will have to go through what I went through.

2020-08-18T10:18:49-07:00August, 2020|Oral Cancer News|

Doctors diagnose advanced cancer—in a dinosaur

Source: Science Mag
Date: August 3rd, 2020
Author: Gretchen Vogel

 

This deformed bone is the first clear example of a malignant tumor diagnosed in a dinosaur. The partial fibula—a bone from the lower leg—belonged to a horned, plant-eating Centrosaurus that lived roughly 76 million years ago in what is now Dinosaur Park in southern Alberta in Canada.

Paleontologists initially thought the bone’s strange shape was due to a fracture that hadn’t healed cleanly. But a new study, published today in The Lancet Oncology, compares the internal structure of the fossil (above) with a bone tumor from a human patient to seek a diagnosis. The conclusion: The dinosaur suffered from osteosarcoma, a cancer that, in humans, primarily attacks teens and young adults. The disease causes tumors of immature bone tissue, frequently in the long bones of the leg.

This isn’t the first time cancer has been found in fossil remains. Scientists have identified benign tumors in Tyrannosaurus rex fossils and arthritis in duck-billed hadrosaurs, as well as an osteosarcoma in a 240-million-year-old turtle. But the researchers say their study is the first to confirm a dinosaur cancer diagnosis at the cellular level.

Scientists, including paleontologists, pathologists, a surgeon, and a radiologist, examined the full fossil with high-resolution computerized tomography scans and examined thin sections under the microscope to evaluate the structure of the cells. They found that the tumor was advanced enough that it had probably plagued the animal for some time. A similar case in a human, left untreated, would likely be fatal, they write. However, because the fossil was found in a bone bed with lots of other Centrosaurus specimens, the dinosaur likely died in a flood with the rest of its herd and not from the cancer.

The researchers say their diagnosis shows a more careful look at unusual fossil malformations using modern imaging and diagnostic techniques can pay off, leading to new insights about the evolutionary origins of diseases.

2020-08-12T16:39:58-07:00August, 2020|Oral Cancer News|

Immunotherapy-resistant cancers eliminated in mouse study

Source: Science Magazine
Date: August 11th, 2020
Author/Credit: William Vermi/Martina Molgora

Immunotherapy has revolutionized cancer treatment by stimulating the patient’s own immune system to attack cancer cells, yielding remarkably quick and complete remission in some cases. But such drugs work for less than a quarter of patients because tumors are notoriously adept at evading immune assault.

A new study in mice by researchers at Washington University School of Medicine in St. Louis has shown that the effects of a standard immunotherapy drug can be enhanced by blocking the protein TREM2, resulting in complete elimination of tumors. The findings, which are published Aug. 11 in the journal Cell, point to a potential new way to unlock the power of immunotherapy for more cancer patients.

“Essentially, we have found a new tool to enhance tumor immunotherapy,” said senior author Marco Colonna, MD, the Robert Rock Belliveau, MD, Professor of Pathology. “An antibody against TREM2 alone reduces the growth of certain tumors, and when we combine it with an immunotherapy drug, we see total rejection of the tumor. The nice thing is that some anti-TREM2 antibodies are already in clinical trials for another disease. We have to do more work in animal models to verify these results, but if those work, we’d be able to move into clinical trials fairly easily because there are already a number of antibodies available.”

T cells, a kind of immune cell, have the ability to detect and destroy tumor cells. To survive, tumors create a suppressive immune environment in and around themselves that keeps T cells subdued. A type of immunotherapy known as checkpoint inhibition wakes T cells from their quiescence so they can begin attacking the tumor. But if the tumor environment is still immunosuppressive, checkpoint inhibition alone may not be enough to eliminate the tumor.

An expert on the immune system, Colonna has long studied a protein called TREM2 in the context of Alzheimer’s disease, where it is associated with underperforming immune cells in the brain. Colonna and first author Martina Molgora, PhD, a postdoctoral researcher, realized that the same kind of immune cells, known as macrophages, also were found in tumors, where they produce TREM2 and promote an environment that suppresses the activity of T cells.

“When we looked at where TREM2 is found in the body, we found that it is expressed at high levels inside the tumor and not outside of the tumor,” Colonna said. “So it’s actually an ideal target, because if you engage TREM2, you’ll have little effect on peripheral tissue.”

Colonna and Molgora — along with colleagues Robert D. Schreiber, PhD, the Andrew M. and Jane M. Bursky Distinguished Professor; and William Vermi, MD, an immunologist at the University of Brescia — set out to determine whether inhibiting TREM2 could reduce immunosuppression and boost the tumor-killing powers of T cells.

As part of this study, the researchers injected cancerous cells into mice to induce the development of a sarcoma. The mice were divided into four groups. In one group, the mice received an antibody that blocked TREM2; in another group, a checkpoint inhibitor; in the third group, both; and the fourth group, placebo. In the mice that received only placebo, the sarcomas grew steadily. In the mice that received the TREM2 antibody or the checkpoint inhibitor alone, the tumors grew more slowly and plateaued or, in a few cases, disappeared. But all of the mice that received both antibodies rejected the tumors completely. The researchers repeated the experiment using a colorectal cancer cell line with similarly impressive results.

With the help of graduate student Ekaterina Esaulova, who works in the lab of Maxim Artyomov, PhD, an associate professor of pathology and immunology, the researchers analyzed immune cells in the tumors of the mice treated with the TREM2 antibody alone. They found that suppressive macrophages were largely missing and that T cells were plentiful and active, indicating that blocking TREM2 is an effective means of boosting anti-tumor T cell activity.

Further experiments revealed that macrophages with TREM2 are found in many kinds of cancers. To assess the relationship between TREM2 expression and clinical outcomes, the researchers turned to The Cancer Genome Atlas, a publicly available database of cancer genetics jointly maintained by the National Cancer Institute and the National Human Genome Research Institute. They found that higher levels of TREM2 correlated with shorter survival in both colorectal cancer and breast cancer.

The researchers are now expanding their study of TREM2 to other kinds of cancers to see whether TREM2 inhibition is a promising strategy for a range of cancers.

“We saw that TREM2 is expressed on over 200 cases of human cancers and different subtypes, but we have only tested models of the colon, sarcoma and breast, so there are other models to test,” Molgora said. “And then we also have a mouse model with a human version of TREM2.”

Added Colonna: “The next step is to do the animal model using the human antibody. And then if that works, we’d be ready, I think, to go into a clinical trial.”

 

2020-08-12T16:46:59-07:00August, 2020|Oral Cancer News|
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