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Médicos discutem a importância de novos exames de câncer de boca

Source: g1.globo.com Author: Laurie Tarkan Do 'New York Times' Apesar de relativamente raro, esse é um dos tipos de câncer mais fáceis de observar e diagnosticar. E, se tratado a tempo, é geralmente curável. Então, por que especialistas acham o câncer de boca tão problemático? Embora tenham ocorrido vários avanços na luta contra o câncer nas últimas décadas, as estatísticas sobre esse tipo da doença permanecem desalentadoras. Mais de 60% dos casos são diagnosticados nos estágios mais avançados, e a sobrevivência em cinco anos é de decepcionantes 59%. Além disso, o câncer de boca está aumentando em pessoas tradicionalmente de baixo risco, um fenômeno atribuído em parte ao aumento do papilomavírus humano, HPV, causador de câncer, que pode ser transmitido através do sexo oral. Agora, alguns dentistas – cujos exames visuais há tempos têm sido uma primeira linha de defesa contra o câncer de boca – estão usando aparelhos de imagem capazes, segundo eles, de ajudar a identificar cânceres e lesões pré-malignas. Porém, esses novos exames despertaram um debate sobre o custo-benefício. Especialistas estão divididos entre a possibilidade desses tais exames reduzirem a mortalidade por câncer de boca ou simplesmente levarem a uma onda de biópsias dispendiosas e desnecessárias. Números da doença Aproximadamente 35.300 americanos souberam ter câncer de boca no ano passado, e cerca de 7.600 morreram em decorrência da doença. Para os sobreviventes, o câncer de boca pode ser doloroso e desfigurador, e pode destruir a capacidade de saborear e apreciar alimentos. Considera-se que fumantes e pessoas que [...]

2009-02-05T15:07:48-07:00February, 2009|OCF In The News, Oral Cancer News|
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Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium

Source: Cancer Epidemiology Biomarkers & Prevention, 10.1158/1055-9965.EPI-08-0347 Authors: Mia Hashibe et al. Background: The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden. Methods: We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter ({psi}) and population attributable risks (PAR). Results: A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk ({psi} = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases <45 years, 73% for cases >60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America). Conclusions: Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco [...]

2009-02-04T08:54:19-07:00February, 2009|Oral Cancer News|
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New oral cancer tests: crucial or wasteful?

Source: nytimes.com Author: Laurie Tarkan Though relatively rare, it is one of the easiest cancers to spot and diagnose. And if treated early, it is usually curable. So why do experts find oral cancer so vexing? Despite the many advances against cancer in recent decades, the statistics on this form of it remain discouraging: more than 60 percent of cases are diagnosed in the late stages, and the five-year survival rate is a disappointing 59 percent. Moreover, oral cancer is increasing in people traditionally at low risk, a phenomenon partly attributed to the rise of the cancer-causing human papillomavirus, or HPV, which can be transmitted through oral sex. Now some dentists — whose visual examinations have long been a first line of defense against oral cancer — are using screening devices that they say may help identify cancers and premalignant lesions. But these new tests have set off a debate over cost and effectiveness. Experts are divided on whether they will reduce mortality from oral cancer or simply lead to a wave of expensive and unnecessary biopsies. An estimated 35,300 Americans learned they had oral cancer last year, and about 7,600 died from the disease. For survivors, oral cancer can be painful and disfiguring, and can destroy the ability to taste and enjoy food. Smokers and heavy drinkers are considered at highest risk for the disease, but 25 percent of those who receive a diagnosis are neither. Still, the lifetime risk of oral cancer — about 1 in 99 — [...]

2009-02-03T20:50:30-07:00February, 2009|OCF In The News, Oral Cancer News|
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What is the adequate margin of surgical resection in oral cancer?

Source: Oral Surg Oral Med Oral Pathol Oral Radiol Endod, January 23, 2009 Authors: Richard W Nason et al. Objective: The "adequate surgical margin" has always remained an enigma in the minds of head and neck surgeons. This study systematically analyses the impact of the width of the clear surgical margin on survival in oral cancer. Study Design: A historical cohort of 277 surgically treated patients with oral cancer were followed for a median period of 36 months. Cox proportional hazard models were used to determine the independent effect of the clear surgical margin, in millimeters, on 5-year survival. Results: Patients with margins of 5 mm or more had a 5-year survival rate of 73% when compared to those with margins of 3 to 4 mm (69%) , 2 mm or less (62%), and involved margins (39%, P = .000). After controlling for confounding variables (age, gender, stage) each 1-mm increase in clear surgical margin decreased the risk of death at 5 years by 8% (HR 0.92; 95% CI 0.86, 0.99; P = .021). Based on this model, patients with positive surgical margins had a 2.5-fold increase in risk of death at 5 years and those with close (

2009-02-01T22:30:19-07:00February, 2009|Oral Cancer News|
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Variations in gene DNA boost drinkers’ cancer risk

Source: www.washingtonpost.com Author: staff Variations in the DNA of certain genes can increase the risk of cancer in people who drink alcohol, according to researchers who reviewed studies on alcohol consumption, genetic polymorphisms and cancer. Their analysis suggests that such variations, called gene polymorphisms, in two enzymes -- alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) -- involved in metabolizing alcohol significantly increase alcohol drinkers' risk of cancers of the head and neck and the esophagus. The researchers looked at the effect of gene variations in other enzymes involved in alcohol and folate metabolism but found there wasn't enough data to fully assess the effect of those gene variants on cancer risk. They said that currently available data does not allow for a quantitative evaluation by meta-analysis of the link between gene variations and cancer risk in people who drink alcohol. "We have highlighted the need for large, multicenter studies and for approaches to the study of multiple polymorphisms," wrote Dr. Nathalie Druesne-Pecollo and colleagues at the French National Institute of Agronomical Research. The review was published in the February issue of the The Lancet Oncology. Previous research has shown a clear link between alcohol consumption and health risk, according to background information in the review. Recent figures show that drinking alcohol was a major contributing factor in the development of almost 400,000 cancers worldwide in 2002. In that same year, 323,900 cancer deaths (3.6 percent of all cancer deaths) were alcohol-related. Source: The Lancet Oncology, news release, Jan. 30, 2009

2009-02-01T07:18:31-07:00February, 2009|Oral Cancer News|
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Diagnostic aids in the screening of oral cancer

Source: 7thspace.com Author: Stefano Fedele The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth. There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa. As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence. The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking. Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required. Source: Head &Neck Oncology 2009, 1:5

2009-01-30T13:29:53-07:00January, 2009|Oral Cancer News|
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New laser for Chase Farm cancer patients

Source: www.enfieldindependent.co.uk Author: Sarah Cosgrove A new state-of the art laser will improve surgery for cancer patients, after being donated to Chase Farm Hospital by charities. The carbon dioxide laser allows surgeons to burn out cancers with the minimum of blood loss, sometimes allowing them to avoid cutting into patients completely. Representatives from the Patricia Madden Cancer Trust and Barnet and District CancerLink joined patients, doctors and hospital chiefs to launch the C02 machine at the hospital on Tuesday. Head and neck consultant, Wayne Halfpenny, explained that as well as lessening blood loss, cancers of the voicebox can be removed via the mouth by the machine, avoiding the need for radiotherapy or surgery through the neck. He added: "The carbon dioxide laser is a fantastic piece of equipment in the surgical treatment of head and neck cancer. "It cuts and seals tissue at the same time minimizing blood loss and allows some cancers to be treated without open neck surgery. It can also vaporize early cancers avoiding the need for surgical excision." Mr Halfpenny and Barnet and Chase Farm Hospitals NHS Trust chief executive Averil Dongworth thanked the charities for their "generous" support.

2009-01-29T10:10:01-07:00January, 2009|Oral Cancer News|
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Study on the oral hygiene of patients with oral cavity cancer

Source: Stomatologiia (Mosk), January 1, 2008; 87(6): 21-23 Author: M St Bratoicheva and V K Kondeva Many authors consider oral hygiene an important factor in the etiology and pathogenesis of oral cavity cancer. The aim of the present study was to establish the role of poor oral hygiene in the development of malignant lesions in the oral cavity. One hundred and three patients were interviewed. Questions, regarding oral hygiene were included in the interview. Results showed that 53,80% of urban residents brush their teeth twice daily whereas 65,52% of rural residents brush their teeth irregularly - p<0,001 (chi(2)=23,67). 46,88% of women clean their teeth twice daily. 46,94% of men do not maintain adequate oral hygiene - p<0,05 (chi(2)= 9,21). Regarding the brush, it was found out that 56,00% of females use a hard bristle toothbrush, the same refers to 28,04% of men - p<0,05 (chi(2)= 4,15). Hard bristle toothbrush was used by 48,88% of urban residents and 9,09% of rural residents - p<0,05 (chi(2)= 5,78). People up to 30 years of age use hard bristle toothbrush most often -39,13% - p<0,01 (chi(2)=12,26). The accumulated evidence provides further explanation why oral cavity cancer is more frequent in men, rural residents and in the elderly. Oral hygiene is a factor in the development of oral cavity cancer. Authors' affilation: stomatologii Meditsinskogo universiteta, Plovdiv, Bolgariia

2009-01-28T09:30:56-07:00January, 2009|Oral Cancer News|
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Screening for oral precancer with noninvasive genetic cytology

Source: Cancer Prevention Research, 10.1158/1940-6207 Authors: Jantine F. Bremmer et al. Oral squamous cell carcinomas develop in precancerous fields consisting of genetically altered mucosal epithelial cells. These precancerous fields may appear as clinically visible lesions, in particular, oral leukoplakia, but the large majority remains clinically undetectable. The aim of this study was to assess the potential value of a noninvasive screening approach to detect precancerous fields. As a first step, we developed a suitable assay and investigated 25 leukoplakia patients and 20 noncancer control subjects. Exfoliated cells were removed by a brush from multiple small areas of the oral mucosa, including the leukoplakia. Brushed samples were investigated for allelic imbalance (AI) at chromosomes 3p, 9p, 11q, and 17p using microsatellite markers known to show frequent alterations in oral precancer. AI was absent in all (137) of the samples of the 20 control subjects, yielding a specificity of 100%. AI was detected in exfoliated cell samples of 40% (10 of 25) of the leukoplakia lesions studied. Genetic changes were also found outside the leukoplakia lesions. Most frequent was AI at 9p (9 of 10). The noninvasive assay was validated against the biopsy results of the leukoplakia lesions yielding an estimate of sensitivity of 78% (7 of 9) and a positive predictive value of 100% (7 of 7). Altogether, these results show the feasibility of a noninvasive genetic screening approach for the detection and monitoring of oral precancer. This assay could therefore contribute to the secondary prevention of oral squamous cell carcinoma. [...]

2009-01-28T09:00:06-07:00January, 2009|Oral Cancer News|
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Tobacco road takes a turn to the smokeless

Source: online.wsj.com Author: Kevin Helliker About 18 months ago, Russell Stevens gave up cigarettes and took up a new habit -- placing between his lip and gum a tiny pouch of smokeless tobacco called Camel Snus. The 26-year-old Kentuckian says it satisfies his craving for nicotine while exposing him to far fewer risks than did smoking. Like Mr. Stevens, more Americans are continuing to give up smoking, helping to push cigarette consumption down about 3% each year. To help kick the habit, many smokers turn to safer sources of nicotine -- the addictive but non-carcinogenic ingredient in cigarettes -- such as nicotine gum, patches or lozenges. But one method that has been gaining ground as a safer alternative to cigarettes -- smokeless tobacco -- remains controversial. A decades-old federal law requires smokeless tobacco to carry a label warning that it is not a safe alternative to cigarettes. The perils include possibly increased risk for certain cancers and cardiovascular disease. And U.S. public-health officials note that no clinical trials have been conducted showing that smokeless tobacco is an effective quitting aid. Adding to the controversy: Some of the biggest cigarette makers are jumping into the non-combustible market. "There is no evidence that smokers will switch to smokeless tobacco products and give up smoking," Michael Thun, vice president of epidemiology for the American Cancer Society, said in a recent article in the journal CA. Still, popular brands of smokeless tobacco generally contain far fewer carcinogens than do cigarettes, although some studies indicate [...]

2009-01-27T15:06:01-07:00January, 2009|Oral Cancer News|
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