Oral Cancer News

Acupuncture prevents radiation induced dry mouth

Source: www.healthcmi.com/
Author: staff

Acupuncture reduces the frequency and severity of xerostomia (dry mouth). University of Texas MD Anderson Cancer Center (Houston) and Fudan University Cancer Center (Shanghai) researchers conducted a randomized controlled clinical trial. The phase-three patient and assessor blinded investigation of acupuncture’s effects on head and neck cancer patients receiving radiation therapy demonstrated groundbreaking results. The researchers concluded that acupuncture “resulted in significantly fewer and less severe RIX [radiation-induced xerostomia] symptoms 1 year after treatment vs SCC [standard care control].” [1]

Salivary glands may be temporarily or permanently damaged by radiation therapy. There is a high-incidence of RIX, which may lead to complications including difficult or painful swallowing, impairment of the sense of taste (dysgeusia), and dental problems. Other RIX complications may include insomnia and difficulty speaking.

The study compared true acupuncture, sham acupuncture, and standard care control groups. True acupuncture produced significantly greater positive patient outcomes than the other groups. Outcome measures were based on a questionnaire, salivary flow, incidence of xerostomia, salivary contents, and quality of life scores. One year after completion of all acupuncture treatments, the true acupuncture group maintained significantly higher patient outcome rates over the standard care and sham groups.

All acupuncture treatments were provided by credentialed acupuncturists. The researchers note that their findings are consistent with several prior investigations. True acupuncture patients that received acupuncture three times per week during their six to seven week course of radiation therapy had significantly less dry mouth a year after completion of treatments than standard care control patients. No adverse effects occurred at University of Texas MD Anderson. One adverse effect was reported at the Fudan study location.

The researchers find that acupuncture is superior to standard care for the relief of radiation induced xerostomia. They comment that acupuncture is “minimally invasive” and “has a very low incidence of adverse effects.” [2] Based on the evidence, further research is warranted.

All participants in the study were at least 18 years of age, provided informed consent, had a diagnosis of head and neck carcinoma, and were scheduled for radiation therapy at a mean dose of 24 Gy to a minimum of one parotid gland. An extensive list of exclusion criteria was used to prevent variables created by comorbidity.

All acupuncturists providing treatment during the course of the study were licensed and were prepared and trained at the University of Texas MD Anderson Cancer Center. The acupuncture point prescription chosen for the study was the following:

  • CV24
  • LU7
  • KD6
  • Auricular: Shenmen, Point Zero, Salivary Gland 2 Prime, Larynx

Standard needle depths were used and the elicitation of deqi at the acupoints was at the discretion of treating acupuncturists. Notably, once deqi was elicited, needles were no longer manually stimulated (with the exception of displaced needles). Electroacupuncture was not used at any point.

Body-style acupuncture needles were of 0.25 mm diameter and 40 mm length. Auricular acupuncture needles were of 0.16 diameter and 15 mm length. Acupuncture treatments were provided a total of three times per week for the duration of the 6-7 week radiation treatment period.

The researchers chose to avoid the use of local points other than CV24 with the intent of preventing disturbance of tissues damaged by radiation. All patients were treated on the day of radiation therapy in a semisupine or supine position. Acupuncture was applied either before or after radiation therapy. Based on the data, the researchers note that acupuncture “should be considered for the prevention of radiation-induced xerostomia.” [3]

The investigators note that prior research indicates that acupuncture regulates blood flow at the parotid glands. In addition, a variety of other studies find acupuncture effective for the treatment of xerostomia. One of the studies cited in the investigation finds acupuncture effective for up to three years after treatment. Two pilot studies by the research group prior to this phase three clinical trial find acupuncture effective for the prevention of RIX if provided with radiation therapy.

The study employed strict controls and researchers monitored treatment facilities and licensed acupuncturists during the investigation. Further research will help to support standardization of acupuncture protocols for the prevention and treatment of RIX for inpatient and outpatient settings.

1. Garcia, M.K., Meng, Z., Rosenthal, D.I., Shen, Y., Chambers, M., Yang, P., Wei, Q., Hu, C., Wu, C., Bei, W. and Prinsloo, S., 2019. Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer: A Randomized Clinical Trial. JAMA Network Open, 2(12), pp.e1916910-e1916910.
2. Ibid.
3. Ibid.

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December, 2019|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.


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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.”

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December, 2019|Oral Cancer News|

Teams of microbes are at work in our bodies. Researchers have figured out what they’re up to

Source: phys.org
Author: staff, Drexel University

In the last decade, scientists have made tremendous progress in understanding that groups of bacteria and viruses that naturally coexist throughout the human body play an important role in some vital functions like digestion, metabolism and even fighting off diseases. But understanding just how they do it remains a question.

Researchers from Drexel University are hoping to help answer that question through a clever combination of high-throughput genetic sequencing and natural language processing computer algorithms. Their research, which was recently published in the journal PLOS ONE, reports a new method of analyzing the codes found in RNA that can delineate human microbial communities and reveal how they operate.

Much of the research on the human microbial environment—or microbiome—has focused on identifying all of the different microbe species. And the nascent development of treatments for microbiota-linked maladies operates under the idea that imbalances or deviations in the microbiome are the source of health problems, such as indigestion or Crohn’s disease.

But to properly correct these imbalances it’s important for scientists to have a broader understanding of microbial communities as they exist—both in the afflicted areas and throughout the entire body.

“We are really just beginning to scrape the surface of understanding the health effects of microbiota,” said Gail Rosen, Ph.D., an associate professor in Drexel’s College of Engineering, who was an author of the paper. “In many ways scientists have jumped into this work without having a full picture of what these microbial communities look like, how prevalent they are and how their internal configuration affects their immediate environment within the human body.”

Rosen heads Drexel’s Center for Biological Discovery from Big Data, a group of researchers that has been applying algorithms and machine learning to help decipher massive amounts of genetic sequencing information that has become available in the last handful of years. Their work and similar efforts around the world have moved microbiology and genetics research from the wet lab to the data center—creating a computational approach to studying organism interactions and evolution, called metagenomics.

In this type of research, a scan of a genetic material sample—DNA or RNA—can be interpreted to reveal the organisms that are likely present. The method presented by Rosen’s group takes that one step farther by analyzing the genetic code to spot recurring patterns, an indication that certain groups of organisms—microbes in this case—are found together so frequently that it’s not a coincidence.

“We call this method ‘themetagenomics,’ because we are looking for recurring themes in microbiomes that are indicators of co-occurring groups of microbes,” Rosen said. “There are thousands of species of microbes living in the body, so if you think about all the permutations of groupings that could exist you can imagine what a daunting task it is to determine which of them are living in community with each other. Our method puts a pattern-spotting algorithm to work on the task, which saves a tremendous amount of time and eliminates some guesswork.”

Current methods for studying microbiota, gut bacteria for example, take a sample from an area of the body and then look at the genetic material that’s present. This process inherently lacks important context, according to the authors.

“It’s impossible to really understand what microbe communities are doing if we don’t first understand the extent of the community and how frequently and where else they might be occurring in the body,” said Steve Woloszynek, Ph.D., and MD trainee in Drexel’s College of Medicine and co-author of the paper. “In other words, it’s hard to develop treatments to promote natural microbial coexistence if their ‘natural state’ is not yet known.”

Obtaining a full map of microbial communities, using themetagenomics, allows researchers to observe how they change over time—both in healthy people and those suffering from diseases. And observing the difference between the two provides clues to the function of the community, as well as illuminating the configuration of microbe species that enables it.

“Most metagenomics methods just tell you which microbes are abundant—therefore likely important—but they don’t really tell you much about how each species is supporting other community members,” Rosen said. “With our method you get a picture of the configuration of the community—for example, it may have E. coli and B. fragilis as the most abundant microbes and in pretty equal numbers—which may indicate that they’re cross-feeding. Another community may have B. fragilis as the most abundant microbe, with many other microbes in equal, but lower, numbers—which could indicate that they are feeding off whatever B. fragilis is making, without any cooperation.”

One of the ultimate goals of analyzing human microbiota is to use the presence of certain microbe communities as indicators to identify diseases like Crohn’s or even specific types of cancer. To test their new method, the Drexel researchers put it up against similar topic modeling procedures that diagnose Crohn’s and mouth cancer by measuring the relative abundance of certain genetic sequences.

The themetagenomics method proved to be just as accurate predicting the diseases, but it does it much faster than the other topic modeling methods—minutes versus days—and it also teases out how each microbe species in the indicator community may contribute to the severity of the disease. With this level of granularity, researchers will be able to home in on particular genetic groupings when developing targeted treatments.

The group has made its themetagenomics analysis tools publicly available in hopes of speeding progress toward cures and treatments for these maladies.

“It’s very early right now, but the more that we understand about how the microbiome functions—even just knowing that groups may be acting together—then we can look into the metabolic pathways of these groups and intervene or control them, thus paving the way for drug development and therapy research,” Rosen said.

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December, 2019|Oral Cancer News|

Five things your teeth and gums are telling you about your overall health

Source: www.yahoo.com
Author: Deanna deBara

They say you can tell a lot about a person by their smile—and that’s especially true when it comes to understanding our health on a deeper level. “The health of your teeth and gums can give valuable insight into your overall health,” says Dr. Samuel B. Low, D.D.S., M.S., M.Ed. Chief Dental Officer of BIOLASE. “If you are doing everything correctly with your oral health, including frequent dental visits and proper oral hygiene, and are still having issues with your teeth and gums, this is an indication there is something else going on.”
Overall, there is a lot going on in the mouth that can affect the body and there is a lot going on in the body that can affect what is going on in the mouth. If any of [the following] symptoms are present, it is important to see an oral health professional who can determine if they are indicative of a larger issue,” continues Low. But how, exactly, are your teeth and gums connected to your system as a whole? Ahead, the symptoms to watch out for, including what those symptoms could actually mean beyond the context of your mouth.

Bleeding Gums
If you experience bleeding around the gum line when you brush or floss, consider it your mouth’s way of telling you to pay attention—and to take better care of your oral hygiene. “Bleeding gums can be a sign of gingivitis or periodontal disease,” says Dr. Jason Doublestein of 44 West Dental Professionals in Grandville, Michigan. “Periodontal has been shown to be connected to adverse health conditions such as heart disease, diabetes, and stroke.”

Receding Gums
Receding gums are another red flag that you’re dealing with periodontal disease. “If your gums begin pulling back from your teeth, you may notice that your teeth look elongated or you may notice increased tooth sensitivity,” says Dr. Emilia Taneva, DDS, MS, a Chicago-based orthodontist and founder of Bubbly Moments. “This is a symptom of periodontal disease and is often caused by a buildup of hardened plaque.”

White Tissue and Inflammation at the Gum Line
While signs of oral cancer are usually more prominent in other areas of the mouth, the disease can also be spotted along the gumline. “Unhealthy gums also are indicative of oral cancer. The ‘hot spots’ for oral cancer are on the underside of the tongue and floor of the mouth but can be present on any of the oral tissues—including the gums,” says Dr. Doublestein. “The most common appearance for oral cancer is white-ish tissue with a red inflamed ring around it.”

Tooth and Gum Sensitivity
Increased tooth and gum sensitivity can have a variety of causes, but if you’ve noticed increased sensitivity partnered with a lower quality of sleep, it’s time to pay attention. “One cause [of tooth and gum sensitivity] can be nighttime clenching and/or grinding,” says Dr. Doublestein. “Clenching and grinding can cause an array of issues such as tooth wear, sensitive teeth, and painful jaw muscles and joints.” The potential health risks go beyond just a painful jaw and sensitive teeth. “There is also a correlation between nighttime grinding and sleep apnea, which is a major health concern, having effects on a number of bodily systems as a result of lack of oxygen and poor sleep,” Dr. Doublestein adds.

Pale Gums
Healthy gums should be a vibrant shade of pink. If they have more of a pale (or even white) appearance, it could be a sign that there’s something more serious going on elsewhere in the body. “If your gums seem to lose their pink color and appear pale, it may be a sign of anemia,” says Dr. Taneva. “This blood disorder occurs when your red blood cell count is low. You may also be experiencing fatigue and dizziness.”

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December, 2019|Oral Cancer News|

Tackling the complications from oral cancer and treatment

Source: www.medscape.com
Author: Tara Haelle

Complications from oral cancer and the toxic effects of treatment — including demineralization, caries, fibrosis, candidiasis, pain, sensitivity, and aesthetic concerns — can continue long after any evidence of cancer is apparent, experts reported at the World Dental Congress 2019.

One of the major toxic effects is changes in saliva, said Joel Epstein, DMD, director of cancer dentistry at the Cedars Sinai Health System in Los Angeles and director of dental oncology at the City of Hope Comprehensive Cancer Center in Duarte, California.

Another problem area — one that is often ignored — is taste, he told Medscape Medical News.

And toxic effects are common, he added, citing one study that showed that 16% of patients experienced dental toxicity in the year after undergoing radiotherapy. The rates increased to 36% after 3 years, 55% after 5 years, and 74% after 7 years.

For patients undergoing cancer therapy, dentists should look at overall oral hygiene, decay prevention, lip lubrication, dental emergencies, and oral mucosal infections, Epstein told the audience during his presentation on the management of patients with oral cancer, both during and after treatment.

Fortunately, there are a lot of things that dentists can help with, he pointed out. For example, fluoride can be used to promote mineralization and chlorhexidine rinse can be used to reduce cariogenic bacteria.

And photobiomodulation therapy, or low-level laser light therapy, can be used for the prevention of mucositis, which can be particularly painful, he added. Pain related to oral mucositis can be treated with transdermal fentanyl, 2% morphine mouth rinse, and 0.5% doxepin mouth rinse.

Dentists also need to emphasize prevention and monitor survivors for recurrence. “The highest-risk person for cancer,” said Epstein, “is the person who has already had cancer.”

Recognizing Worrisome Lesions
It can be difficult to determine which abnormalities in the mouth are cause for concern, said Mark Lingen, DDS, PhD, from the University of Chicago Pritzker School of Medicine. For example, candidiasis and squamous cell carcinoma can look similar, he pointed out.

Lingen opened the session on oral cancer prevention, early diagnosis, and patient management with an interactive exercise. He showed images of various oral lesions and it did not take long to winnow out the audience members who could correct identify all the worrisome lesions without false positives.

Some of the images were fairly textbook, said attendee Andrew Barnes, a dental hygienist from Santa Rosa, California, but others were a helpful refresher.

“Some of the more subtle stuff, you would look at it and think, ‘that’s nothing’,” Barnes told Medscape Medical News. “You need to be reminded that that might not be nothing.” In contrast, other images might appear concerning but probably aren’t cancerous.

The review of images was particularly helpful, said James Friedman, DDS, a dentist in private practice in Greenbrae, California. “I was one of the first people to sit down because I thought something wasn’t as serious as it turned out to be,” he said.

The use of cytology for the evaluation of suspicious lesions in patients who are resistant to biopsy or who live far from a provider who does biopsies, presented by Takashi Inoue, DDS, from the Tokyo Dental College, was also helpful, Friedman added.

The prevention guidelines, also presented by Lingen, were more familiar to Barnes and Friedman, and are part of conversations they have with their patients everyday about quitting smoking, reducing alcohol use, practicing good oral hygiene, and getting vaccinated against human papillomavirus (HPV), the most common cause of oral cancer.

Although the HPV vaccine has typically been regarded as the province of pediatricians, dental providers have taken an increasingly active role in preventing 70% of the 13,500 new cases of oropharyngeal cancer diagnosed each year in the United States.

“Dentists should be at least as involved as the medical community in advising vaccination for HPV,” said Epstein. “HPV cancers are preventable, but only by immunization, and it’s part of healthcare delivery that dentists should be more involved in.”

Although the prevention of oral cancer is a mainstay of daily dental practice, far fewer dentists feel confident about caring for patients who have oral cancer, said Epstein. In one study of Michigan dentists, for example, 55% of respondents said they did not feel adequately trained to care for patients with oral cancer, and 72% said they were interested in additional education.

The first part of this education is learning how to discuss bad news with patients. Epstein explained that he uses a version of the SPIKES protocol to talk to patients about a new oral cancer diagnosis.

Understanding a patient’s preferences can guide the provider’s approach, Epstein told the audience. “Some want a frank picture, the worst-case scenarios, while others want optimistic views” and a clear picture of all the treatment options from the start.

World Dental Congress (WDC) 2019.

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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.

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Late stage head and neck cancer in the U.S. sees increasing incidence

Source: www.cancernetwork.com
Author: Hannah Slater

A study released in Cancer indicates that there is an increasing incidence of late stage head and neck cancer (HNC) in the U.S., mostly due to an increasing incidence of oropharyngeal cancer, most likely due to HPV-related disease in patients diagnosed at stage IVC.1

Blacks, males, those who are underinsured or uninsured, and those who are unmarried tend to fare worse than others. The presented research highlights the need for continuous public health efforts toward the early detection of HNC.

In this cohort of 57,118 patients with stage IV HNC, the age-adjusted rates for stage IV HNC significantly increased by 26.1% (6.11 per 100,000 person-years in 2004 to 7.70 per 100,000 person-years in 2015). Despite a decreasing overall incidence of stage IV HNC in black patients (adjusted OR, 1.28; 95% CI, 1.22-1.34), they along with males (adjusted OR, 3.95; 95% CI, 3.80-4.11) had significantly increased risks of being diagnosed with late-stage HNC.

“In the absence of a mortality benefit for asymptomatic mass screenings, as per the U.S. Preventive Services Task Force oral cancer screening guideline, it is critical that there is sustained public awareness and education regarding the early detection of HNC, and prevention through cancer risk mitigation practices,” the researchers wrote.

Although black males had the highest risk of being diagnosed, the most significant change in annual incidence patterns was driven by white males (annual percent changes, 3.13; P < .01). A significant increase in incidence occurred in the population >50 years, with males tending to be younger at the time of diagnosis than females.

Of all primary tumor sites, the oropharynx was the most likely site for a late-stage diagnosis. The incidence of oropharyngeal cancer has increased dramatically in the U.S. within the last 40 years and is predominantly experienced by white males. Approximately 75% of cases of oropharyngeal cancer are associated with human papillomavirus (HPV), and these tumors often present with small primary tumors and larger cystic regional lymph node metastases as the first notable symptom.

Although patients with oropharyngeal cancer typically have a better prognosis, they also remain at risk of having positive lymph nodes and developing distant metastasis. Research indicated that the oropharynx, an HPV-related site, was the only site to experience a significant increase in the incidence of metastatic stage IV disease.

“If rates of true late-stage HNC continue to rise, it remains paramount to identify those patients who are at risk of potentially worse prognoses when HPV status is unknown,” the researchers wrote.

Stage IV was defined using the American Joint Committee on Cancer (AJCC) sixth edition stage classification as stages IVA, IVB, IVC, and IV not otherwise specified. With recent changes in AJCC staging, future studies are warranted to describe incidence trends based on new staging guidelines.

According to the CDC, HPV is so common that nearly all sexually active men and women get the virus at some point in their lives. Oropharyngeal cancers have traditionally been caused by tobacco and alcohol; however recent studies have suggested that about 70% of cancers of the oropharynx may be linked to HPV.2

1. Thompson-Harvey A, Yetukuri M, Hansen AR, et al. Rising Incidence of Late-Stage Head and Neck Cancer in the United States. Cancer. doi:10.1002/cncr.32583.
2. CDC. Human Papillomavirus (HPV) Statistics. CDC website. cdc.gov/std/hpv/stats.htm. Published January 4, 2017. Accessed November 21, 2019.

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November, 2019|Oral Cancer News|

How to encourage vaccination against HPV cancers? Drexel study suggests taking a cue from anti-vaxxers

Source: www.inquirer.com
Author: Marie McCullough

To persuade more people to get the cancer-preventing HPV vaccination, public health groups should emulate a tactic of the anti-vaccine movement, concludes a Drexel University study of Instagram posts.

The researchers aren’t suggesting that vaccine proponents spread misinformation on social media, as vaccine foes do. But the study found that emotional, personal accounts with photos of youngsters — a staple of anti-vaccine content — get way more “likes” than the dispassionate, factual messages typical of pro-vaccine posts.

“By studying what makes these messages so effective, we can improve fact-based, pro-vaccination messaging,” said senior author Philip M. Massey, a community health researcher at Drexel.

The study, which analyzed 360 Instagram posts from April to August of last year, was conducted before Facebook — the owner of Instagram — announced this spring that it would curb anti-vaccine messages. But such content still abounds, because Facebook’s crackdown is limited to recommendations and ads.

Before the crackdown, a majority of Facebook ads spreading vaccine misinformation were funded by just two groups, one led by Robert F. Kennedy Jr.’s World Mercury Project, according to a study published this month in the journal Vaccine.

Another study, in JAMA Pediatrics in September, found that 13 years after Merck’s Gardasil vaccine was hailed as a revolution in cancer prevention, most Americans still don’t know that HPV (human papillomavirus) is a family of sexually transmitted germs that can cause oral and genital cancers, and most doctors still aren’t promoting the shots.

The immunization is recommended for boys and girls at age 11 or 12, before they become sexually active, and as “catch-up” shots to age 26. But only about half of U.S. teens have been fully vaccinated, federal data show. (Adults ages 27 to 45 can opt for the immunization, although they are less likely to benefit.)

Despite low uptake, many studies show vaccination has reduced genital warts and precancerous lesions that can progress to cancer. (It will take more time to see the impact on cancer rates.)

But studies also show that while cervical cancer rates have declined over the last 20 years because of routine Pap screening, rates of mouth and throat cancers in men have risen more than 200%, and anal cancers in women have risen 150%.

Scientific groups and global health authorities who continue to monitor the vaccine assert that it is safe and does not cause chronic pain, heart arrhythmias, autoimmune diseases, life-threatening allergic reactions, stroke, neurological disorders, premature ovarian failure, miscarriages, or other health problems.

But that does not prevent vaccine foes from saying it does.

“So many sad stories on here,” a woman posted recently on the Facebook page Gardasil Class Action Australia. “Here’s mine. I had Gardasil in 2007, had a miscarriage in early 2008, and now have chronic fatigue and fibromyalgia. It’s so hard to be a good mum and give the kids what they need and the house clean when you’re sooo tired and your body aches.”

The Drexel study found that 46% of anti-vaccine posts on Instagram featured personal narratives, compared with 28% of pro-vaccine posts. Each anti-vaccine message got an average of 86 likes, compared with 24 likes per pro-vaccine post.

The paper, published in the journal Health Education and Behavior, has only a few examples of actual pro and con posts, including these:

“Your child can get protection for HPV cancers during the same visit they are protected against other serious diseases,” says the U.S Centers for Disease Control and Prevention.

“Jamie is not doing well after her first Gardasil vaccine for HPV prevention. She keeps turning yellow, wants to throw up and pass out,” says a post that shows a teenage girl folded over her knees in a chair.

Although the study does not propose potential pro-vaccine narratives, Massey said in an interview that developing and testing such messages on parents of preadolescents is the next step in his research.

He pointed to a recent Merck TV commercial as an example of a pro-vaccine message that “pulls at the heartstrings.” It portrays a young woman or young man with HPV-related cancer, voicing over a retrospective of photos and videos going back to age 11 or 12. The man speculates that his parents didn’t know about HPV or the vaccine, then his tween self asks, “Right, Mom? Dad?”

“The bottom line,” Massey said, “is that there’s a great opportunity to incorporate storytelling into our pro-vaccine messages.”

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November, 2019|Oral Cancer News|

Reducing RT toxicity in head and neck cancer: recent research context

Source: www.medpagetoday.com
Author: Kristin Jenkins, contributing writer, MedPage Today

In patients with head and neck malignancies, studies show that the significant acute and long-term toxicities and poor quality of life (QOL) associated with postoperative radiation therapy (PORT) can be improved by selectively reducing larger radiotherapy volumes. This includes treating just one side of the neck.

In patients with locally advanced head and neck squamous cell carcinoma (HNSCC), however, locoregional failure rates with the omission of PORT to the pathologically uninvolved neck (PN0) have been less clear. As a result, PORT has historically been delivered to the PN0 neck, with several studies showing high rates of regional control ranging from 95% to 100%. Notably, consensus clinical practice guidelines continue to recommend the use of bilateral irradiation of node-negative necks.

However, results from a prospective phase II study in 72 patients with primary HNSCC and high-risk pathology features now suggest that PORT to the PNo neck can be eliminated without sacrificing excellent disease control or QOL. At a median follow-up of 53 months, absolute regional control in the unirradiated neck was 97%, even though 67 patients (93%) had stage III/IV disease and 71% of tumors involved or crossed midline.

No patient received contralateral neck PORT, and 17 patients (24%) were treated for the primary neck tumor only, said Wade Thorstad, MD, of Washington University in St. Louis, and colleagues. The 5-year rates of local control, regional control, progression-free survival, and overall survival (OS) were 84%, 93%, 60%, and 64%, respectively, they reported in their study in the Journal of Clinical Oncology.

The study also showed that QOL measures were not significantly different from baseline at 1 year and 2 years post-completion of PORT (P>0.05).

“Our study demonstrated that this approach is safe and results in excellent control in a high-volume center where physicians are sub-site specialists,” Thorstad told the Reading Room. “All patients had complete preoperative staging and were discussed in a multidisciplinary setting. In this context, we feel this approach is reasonable, although confirmatory studies are needed.”

Has Been Ongoing Challenge
Achieving optimal disease control using the smallest volumes of QOL-destroying radiotherapy remains an ongoing clinical challenge for clinicians managing various subgroups of patients with HNSCC. What’s more, uncertainty about how to find the right balance between survival and QOL may have been seeded almost 50 years ago.

In October 1971, results from a seminal review of metastasis in previously untreated patients with HNSCC were presented at the annual meeting of ASTRO, then called the American Society of Therapeutic Radiologists and now the American Society for Radiation Oncology. In that presentation, Robert Lindberg, MD, of the University of Texas MD Anderson Cancer Center in Houston, included detailed maps of the seven common regions of metastasis seen on admission in 2,044 previously untreated patients.

Meanwhile, evidence for the impact of larger radiotherapy volumes on patients’ QOL has continued to accumulate. In 2009, a review of dysphagia related to treatment for HNSCC confirmed that the severity of radiation-associated effects on the tongue, larynx, and pharyngeal muscles is directly related to dosimetry.

The review authors noted that in addition to dysphagia and aspiration — recognized as potentially devastating complications of irradiation of the head and neck — the acute side effects of radiotherapy in HNSCC include xerostomia, hoarseness, erythema, and desquamation of the skin. Potential late sequelae include osteonecrosis, dental decay, trismus, hypogeusia, subcutaneous fibrosis, thyroid dysfunction, esophageal stenosis, hoarseness, and damage to the middle or inner ear.

Although radiation-induced xerostomia is also the most commonly reported late side effect, swallowing problems and the risk of aspiration remain the dose-limiting toxicity.

In the last 2 decades, advances in treatment technology have made significant strides towards improved survival that does not forfeit QOL. The widespread adoption of three-dimensional intensity-modulated radiation therapy (IMRT) in locally advanced HNSCC has made it possible to selectively restrict treatment volumes, sparing normal tissue.

A 2014 analysis of 50 consecutive survivors of locally advanced HNSCC at the University of California-Davis Comprehensive Cancer Center provided evidence for improved long-term QOL with IMRT. Five years after bilateral neck IMRT, the vast majority of patients reported being satisfied with their QOL. Using the University of Washington Quality of Life (UW-QOL) questionnaire, 41 of 50 patients (82%) rated their overall QOL as “outstanding” or “very good.”

At 5 years, the lowest domain score on the UW-QOL questionnaire was salivary function. Nevertheless, 42 patients (84%) reported saliva “of normal consistency” or “less saliva than normal but enough.” Although eight patients (16%) said they had “too little saliva,” none reported having “no saliva.”

In a 2017 study, Thorstad and colleagues reported that unilateral IMRT delivered oncologic outcomes similar to those of bilateral IMRT in 154 patients with surgically treated squamous cell carcinoma of the palatine tonsil. There were no contralateral neck recurrences in the unilateral IMRT group. In addition, patient self-reports indicated that those treated unilaterally had less acute toxicity, less need for use of gastrostomy tubes, and better QOL than patients treated bilaterally.

“Significant controversy remains regarding the use of unilateral RT in some subgroups of patients with palatine tonsillar cancer, particularly in those with N2b neck disease,” the study authors noted. “[Although] the 2011 American College of Radiology (ACR) appropriateness criteria recommended bilateral RT for this subgroup of patients, some authors challenged this recommendation.”

As far back as 1999 — the year that IMRT was introduced — the Brazilian Head and Neck Cancer Study Group reported that radiotherapy volumes could be safely reduced using unilateral rather than bilateral neck treatment in patients with PN0 necks. The findings showed that the rates of 5-year OS, neck recurrence, and complications were similar in both groups. When PORT was omitted in 83 patients with PN0 necks, there were only three treatment failures.

In Australia, experience at the Peter MacCallum Cancer Center at the University of Melbourne also appears to support the potential use of unilateral radiation therapy for lateralized tonsil primaries, even with advanced ipsilateral nodal disease. Results from a 2013 retrospective review of all 167 tonsillar cancer patients treated with curative intent (1990-2002) showed that the 5-year rates for local, nodal, locoregional, and distant failures were 14%, 4%, 18%, and 8%, respectively. The majority (58%) of patients had stage IV disease, and 86% were current or ex‐smokers. There were no contralateral nodal failures in 58 patients treated unilaterally, even though 33% had N2a, N2b, or N3 nodal disease.

Evidence for improved morbidity with IMRT restricted to the ipsilateral neck is also growing. In 2011, the phase III randomized controlled PARSPORT study demonstrated significant functional and overall QOL benefits in pharyngeal squamous cell carcinoma (T1-4, N0-3, M0) with the use of parotid-sparing IMRT compared with conventional radiotherapy.

In 94 patients treated at six radiotherapy centers in the U.K., significant recovery of saliva secretion was seen at 12 and 24 months with IMRT compared with conventional radiotherapy. Clinically significant improvements in dry mouth-related and global QOL scores were also reported. At 2 years, there were no significant differences in non-xerostomia late toxicities, locoregional control, or OS between the groups.

In 2007, results from a Danish study in patients with cancer of the oropharynx showed that ipsilateral radiotherapy of curative intent did not negatively influence locoregional control or survival compared with bilateral radiotherapy. In fact, the researchers found that the only factors that differed between the two treatment groups were primary tumor extension outside the tonsillar fossa and T stage.

However, the significant difference in adverse effects seen in patients who received ipsilateral treatment were compelling. These patients experienced a 50% reduction in moderate to severe treatment side effects compared with those treated with bilateral radiotherapy. This included all radiotherapy-induced morbidity — xerostomia, dysphagia, hoarseness, atrophy, and edema — with the exception of fibrosis.

Thorstad reported a financial relationship with Elekta; several co-authors also disclosed financial relationships with industry.

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November, 2019|Oral Cancer News|