11/13/2004 E.J. Mundell USA Today A generation or two ago, dentures were common among the elderly, even the middle-aged. Fortunately, public health initiatives over the past 50 years have changed attitudes and hygiene practices, and a majority of today's Baby Boomers are growing older with the teeth they had as teenagers. But will the nation's dentists be able to care for them as they continue to age? "By about 2030, an enormous amount of people — 20% of the population —will be 65 years of age or older. Those numbers are going to be overwhelming, and I don't think dentists right now are very well-equipped to deal with them," said Dr. Ira Lamster, dean of the Columbia University School of Dental and Oral Surgery, in New York City. In an article published earlier this year in the American Journal of Public Health, Lamster warned of a "looming crisis" in geriatric dentistry. "The country's been successful, and rightly so, in convincing people that teeth can last a lifetime," he said. On the other hand, aging teeth and gums have special health-care needs. "What are teeth? They are biomechanical devices for crushing and grinding food," explained dentist and American Dental Association spokesman Dr. Richard Price. "But any machine is going to wear or break. As you get older, gums recede. In some populations, tooth decay among senior citizens is twice that of teenagers." Some of the contributing factors to poor oral health in old age include: A lifetime of tooth repair using [...]

11/13/2004 Washington, D.C. David McAlary Voice of America (voanews.com) Researchers in the North America and Brazil have successfully tested a vaccine to prevent cervical cancer, the second most common cancer in women around the world, after breast cancer. Such a vaccine might eventually prevent hundreds of thousands of deaths each year. The human papillomavirus is a common infection that invades more than 75 percent of women at some time in their lives. Most of the time, it lasts only a short time and produces no symptoms. But in nearly 500,000 women worldwide each year, it persists long enough to cause cancer of the cervix, the opening to the uterus. Nearly 250,000 die from it each year, most of them in developing countries. An experimental GlaxoSmithKline vaccine offers hope against this disease. Researchers tested it for two-and-a-half years in more than 1100 U.S., Brazilian, and Canadian women aged 15 to 25. According to the journal Lancet, three doses of the vaccine prevented human papillomavirus infections in 92 percent of the women. Even better, it completely prevented the long-lasting infections that can lead to cancer. "It is outstanding, phenomenal news that it is 100 percent! We are so excited with that outcome," said study leader, Dartmouth University Medical School researcher Diane Harper. She added that the vaccine proved safe with few side effects. "This really moves women's health care forward in a very positive direction and allows us to make changes in the way we care for women at a personal level," [...]

11/13/2004 Sue S Yom and David I Rosenthal Nature Clinical Practice Oncology (2004) 1, 14-15 Background: Patients with advanced high-risk squamous-cell carcinoma of the head and neck frequently have a recurrence in the original tumor bed. Following tumor resection, radiotherapy can be effective in improving cancer control. This study assessed whether the addition of cisplatin to postoperative radiotherapy could improve local and regional control rates in head and neck cancer patients. Design: This phase III, multicenter, randomized, stratified study enrolled men and women with squamous-cell carcinoma, who were at high risk of disease, had undergone tumor resection, and who could tolerate chemotherapy. Patients were included if they were aged 18 years or more with a minimum Karnofsky Performance Status score of 60, and on the basis of particular clinical laboratory results. Intervention: Radiotherapy began not later than 8 weeks after surgery; patients were stratified according to age (>70 years vs <70 years), surgical margin, and tumor status. Patients were randomly assigned to receive 60 Gy radiosurgery in 30 fractions over 6 weeks, with or without 6 Gy boosts in 3 fractions over a 3-day period. Patients in the combined therapy group also received intravenous cisplatin at 100 mg/m2 of body-surface area on days 1, 22, and 43. Patients were examined weekly during treatment, and post-treatment evaluations were carried out after 9 weeks, then every 3 months for the first year, twice in the second and third years, and annually thereafter. Outcome Measures: Local and regional tumor control was the primary [...]

11/13/2004 Windsor PM, Nicol KF, Potter J. Nature Clinical Practice Oncology (2004) 1, 10-11 Cancer patients experiencing treatment- and disease-related fatigue are commonly advised to rest and relax, although inactivity may actually be detrimental. To address the lack of randomized, controlled trials of exercise interventions, Windsor et al. have studied the effects of aerobic exercise in patients undergoing radiotherapy for localized prostate carcinoma. Consecutive patients were randomized to an exercise group (n = 33) or a control group (n = 33) before receiving radical external beam radiation therapy. During the 4-week treatment period, patients in the exercise group were advised to carry out home-based, moderate-intensity, continuous walking for 30 minutes at least three times per week. Men in the control group were given 'normal' advice, i.e. to carry out activities as usual and to rest if fatigued. Outcome measures were fatigue (assessed using the Brief Fatigue Inventory [BFI]) and physical functioning (assessed by measuring the distance walked in a modified shuttle test). Fatigue scores increased significantly in the control group after therapy (P = 0.013), whereas men in the exercise group showed no significant changes in fatigue over time. The shuttle test distance was reduced by 2.4% in the control group after therapy, but this was not statistically significant. Physical functioning was significantly improved, however, in the exercise group, whose mean shuttle test distance had increased by 13.2.% at the end of treatment (P = 0.0003). The authors conclude that home-based, moderate-intensity walking improved physical functioning and that this may [...]

11/11/2004 GINA KOLATA New York Times People who take high doses of vitamin E to improve their health may not be getting any benefits and may, in fact, be slightly increasing their risks of dying earlier, researchers reported yesterday. The adverse effect was tiny, however, and some experts with no connections to the vitamin industry say they are not convinced it was demonstrated. It emerged only when the researchers pooled the results from 19 clinical trials involving 135,967 participants. That led them to conclude that there were 39 additional deaths per 10,000 people who were taking vitamin E doses exceeding 400 international units a day. The recommended daily amount of vitamin E is about 20 international units a day, and the dose in a multivitamin pill is about 30 units. People take much higher doses because they believe that at high doses the vitamin acts like a drug, protecting them from disease. The new study, by Dr. Edgar R. Miller III, an associate professor of medicine and epidemiology at Johns Hopkins University, will be published on Jan. 4 in The Annals of Internal Medicine. Dr. Miller presented the data at the American Heart Association meeting yesterday in New Orleans, and the journal is making the paper available free on its Web site, www.annals.org. The results, some nutrition experts said, were disconcerting because vitamin E is widely used by people who hope it will act as an antioxidant and prevent heart disease, cancer, Alzheimer's disease, and even the common cold. In [...]

11/11/2004 Washington, D.C. DONNA DE LA CRUZ newsday.com About 30,000 Americans each year contract oral cancer, and 8,000 of them will die, but people remain ignorant of a disease that can be cured if caught in the early stages, a University of Medicine & Dentistry of New Jersey official said Wednesday. "This is not a disease that strikes just old men anymore," said Arnold Rosenheck, assistant dean at UMDNJ's dental school, before he was to speak to health care professionals about oral cancer at the American Public Health Association's annual meeting here. Oral cancer can strike anyone, even people who don't smoke or drink, which are two of the risk factors, Rosenheck said, adding that his goal is to educate Americans and health care professionals on how to prevent the disease. Oral cancer once struck mainly men in their 60s, but the largest increase in cases now is seen in people under 40 years of age, and in women. The survival rate remains unchanged from 50 years ago - about 50 percent for someone diagnosed with the disease in its later stages. Women began developing oral cancer when smoking became chic, said Rosenheck, referring to the well-known Virginia Slims ad campaign, "You've Come a Long Way, Baby," that ran from 1968 to 1986. "As a result, women have taken their place alongside their male counterparts in developing the diseases that are prevalent to tobacco use," Rosenheck said. "And I think women are drinking more openly now, going out with the [...]

11/9/2004 Elizabeth Querna USNews.com Straight, white teeth signify not only good physical health but also high social class. A nice set of choppers makes you look more employable, giving new meaning to the phrase putting your money where your mouth is. But for those segments of population without access to healthcare, bad teeth have economic and physical consequences. A policy report from the Joint Center for Political and Economic Studies' Health Policy Institute in Washington, D.C. shows how the disparity in dental care hurts one group, African-American males. What the researchers wanted to know: How good is the dental health of African-American males, and what can be done to improve it? What they did: The authors pulled from numerous research studies showing differences in the dental care received by people of different races. Using studies published in the past decade, the authors examined dental care coverage, disease and tooth loss rates, percentage of black dentists, and dental visitations by African-American men. What they found: Fifty percent of black men have untreated dental decay as compared with 28 percent of white men; black men also have the highest rate of oral cancer of any demographic group, and the lowest survival rate. In Harlem, N.Y., 46 percent of African-American seniors were missing teeth, compared with 22 percent of Latinos. More than 9.5 billion African-American men, about 75 percent of the population, are without dental coverage, and are not usually eligible for Medicaid. Fewer than 25 percent of black men have visited a [...]

11/9/2004 Lidia Arcavi, MD; Neal L. Benowitz, MD Archives of Internal Medicine, Vol. 164 No. 20, November 8, 2004 Background: Infectious diseases may rival cancer, heart disease, and chronic lung disease as sources of morbidity and mortality from smoking. We reviewed mechanisms by which smoking increases the risk of infection and the epidemiology of smoking-related infection, and delineated implications of this increased risk of infection among cigarette smokers. Methods: The MEDLINE database was searched for articles on the mechanisms and epidemiology of smoking-related infectious diseases. English-language articles and selected cross-references were included. Results: Mechanisms by which smoking increases the risk of infections include structural changes in the respiratory tract and a decrease in immune response. Cigarette smoking is a substantial risk factor for important bacterial and viral infections. For example, smokers incur a 2- to 4-fold increased risk of invasive pneumococcal disease. Influenza risk is severalfold higher and is much more severe in smokers than nonsmokers. Perhaps the greatest public health impact of smoking on infection is the increased risk of tuberculosis, a particular problem in underdeveloped countries where smoking rates are increasing rapidly. Conclusions: The clinical implications of our findings include emphasizing the importance of smoking cessation as part of the therapeutic plan for people with serious infectious diseases or periodontitis, and individuals who have positive results of tuberculin skin tests. Controlling exposure to secondhand cigarette smoke in children is important to reduce the risks of meningococcal disease and otitis media, and in adults to reduce the risk of [...]

11/9/2004 Pia Huguenin, Karl T. Beer et al. Journal of Clinical Oncology, 10.1200/JCO.2004.12.193 Purpose: To determine whether the application of two courses of cisplatin simultaneously with hyperfractionated radiotherapy improves the outcome in locally advanced and/or node-positive nonmetastatic carcinomas of the head and neck, compared with hyperfractionated radiotherapy alone. Patients and Methods: From July 1994 to July 2000, 224 patients with squamous cell carcinomas of the head and neck (excluding nasopharynx and paranasal sinus) were randomly assigned to hyperfractionated radiotherapy (median dose, 74.4 Gy; 1.2 Gy twice daily) or the same radiotherapy combined with two cycles of concomitant cisplatin (20 mg/m2 on 5 days of weeks 1 and 5). The primary end point was time to any treatment failure; secondary end points were locoregional failure, metastatic relapse, overall survival, and late toxicity. Results: There was no difference in radiotherapy between both treatment arms (74.4 Gy in 44 days). The full cisplatin dose was applied in 93% and 71% of patients during the first and second treatment cycles, respectively. Acute toxicity was similar in both arms. Median time to any treatment failure was not significantly different between treatment arms (19 months for combined treatment and 16 months for radiotherapy only, respectively) and the failure-free rate at 2.5 years was 45% and 33%, respectively. Locoregional control and distant disease-free survival were significantly improved with cisplatin (log-rank test, P = .039 and .011, respectively). The difference in overall survival did not reach significance (log-rank test, P = .147). Late toxicity was comparable in both [...]

11/9/2004 Liz Szabo USA Today Supreme Court Chief Justice William Rehnquist's diagnosis of thyroid cancer, announced late last month, comes at an time when research in the malignancy — which experts say was stalled for many years — is suddenly taking off. In the past year or so, scientists have initiated at least 10 new studies of thyroid cancer, and a dozen more will soon be up and running, says Steven Sherman, an associate professor at M.D. Anderson Cancer Center in Houston. "There's been an explosion," Sherman says. "Before that, there was almost nothing." Thyroid cancer research has suffered partly because its most common variety is usually curable, making the disease seem less threatening. Yet the most aggressive form of thyroid cancer, anaplastic carcinoma, is one of the most lethal of all tumors. Anaplastic cancers afflict so few people — just a few hundred a year — that experts long doubted that it was possible to even start clinical trials, says Manisha Shah, a thyroid cancer specialist at Ohio State University Comprehensive Cancer Center. Recent research has been sparked by the discovery of genetic mutations involved in thyroid tumors, as well as progress in the growing field of "targeted" cancer therapies that affect the tumors but not the surrounding, healthy tissue. Last year, a team of scientists at Johns Hopkins University School of Medicine discovered a genetic mutation that is present in most papillary thyroid cancers, the most common sort. Earlier this year, the same team showed that the mutation [...]