Study: HPV vaccination will reduce throat and mouth cancers, but overall impact will take 25-plus years to see

Source: www.newswise.com
Author: Johns Hopkins Bloomberg School of Public Health

Vaccinations against human papillomavirus (HPV), a major cause of throat and back of mouth cancers, are expected to yield significant reductions in the rates of these cancers in the U.S., but will not do so until after 2045, according to a new modeling study from researchers at the Johns Hopkins Bloomberg School of Public Health. HPV is the most common sexually transmitted infectious virus worldwide. HPV infections are often silent, and while most infections clear, some are chronic and can trigger cancers including mouth and throat (oropharyngeal), and cervical cancer because they disrupt DNA and inhibit tumor-suppressor proteins in the cells they infect. Although there is no cure for existing HPV infections, new infections are preventable with vaccines, the first of which entered use in the U.S. in 2006.

In the new study, the Bloomberg School researchers analyzed national databases on oropharyngeal cancer cases and HPV vaccinations, and projected the impact of HPV vaccination on the rates of these cancers in different age groups. They estimated that the oropharyngeal cancer rate would nearly halve between 2018 and 2045 among people ages 36–45. However, they also projected that the rate in the overall population would stay about the same from 2018-2045, due to still-rising rates of these cancers in older people, where most of these cancers occur.

The study appears online September 2 in JAMA Oncology.

“We estimate that most of the oropharyngeal cancers from 2018 to 2045 will occur among people who are 55 years and older and have not been vaccinated,” says study lead author Yuehan Zhang, a PhD candidate in the research group of Gypsyamber D’Souza, PhD, professor in the Department of Epidemiology at the Bloomberg School.

“HPV vaccination is going to work to prevent oropharyngeal cancers, but it will take time to see that impact, because these cancers mostly occur in middle age,” D’Souza says.

Oropharyngeal cancer is the most common HPV-related cancer, and according to the Oral Cancer Foundation there are more than 50,000 new cases of it in the U.S. each year. Alcohol and tobacco use also are risk factors, but are seen as increasingly less important than HPV.

Vaccination is a powerful medical weapon against this family of viruses, but has one major shortcoming: It can prevent, but not treat. In other words, it does not work against established HPV infections or against cells that have been transformed by HPV and are on their way to forming tumors. Thus it is recommended chiefly for the young who are not yet exposed to sexually transmitted HPV. (Most people who were already adults when HPV vaccination became available have never been vaccinated, and thus remain at risk for these cancers.)

For the study, the researchers estimated current and future HPV vaccination rates using data from surveys conducted by the U.S. Centers for Disease Control and Prevention, and projected oropharyngeal cancer rates based on past and current incidence data from the National Cancer Institute.

They estimated that the rates of vaccination by 2045, for different age groups—given the emphasis on vaccinating the young—will amount to about 72 percent of people ages 36–45, 37 percent of those ages 46–55, 9 percent of those ages 56–69, and 0 percent of people ages 70–83 being vaccinated.

These projections show continuing high oropharyngeal cancer rates in older, mostly unvaccinated groups, and almost no change in the overall U.S. rate of these cancers—14.3 per 100,000 assuming no vaccination; and 13.8 per 100,000, with vaccination, in 2045.

However, they foresaw the rates of new oropharyngeal cancers would fall substantially in the relatively well vaccinated 36–45 and 46–55 age groups during the 2018–2045 period: from 1.4 to 0.8 per 100,000; and from 8.7 to 7.2 per 100,000, respectively.

The results suggest, though, that by 2045 HPV vaccination will have begun to make a significant impact. “Our projections suggest that by around 2033, nearly 100 cases of oropharyngeal cancer will be prevented each year, but by 2045 that figure will have increased by about ten times,” Zhang says.

Notes:
“Projected Impact of HPV Vaccination on Oropharynx Cancer Incidence in the United States: 2020-2045” was co-authored by Yuehan Zhang, Carole Fakhry, and Gypsyamber D’Souza.

Funding was provided by the National Institute of Dental and Craniofacial Research (R35DE026631).

2021-09-03T12:26:37-07:00September, 2021|Oral Cancer News|

Study: Secondhand smoke exposure significantly increases risk of developing mouth cancer

Source: www.studyfinds.org
Author: Stephen Beech, SWNS writer

When most people think about the dangers of smoking, they probably consider the risks of cancer for the smoker. Although it’s common knowledge secondhand smoke is also dangerous, a new study is revealing just how devastating that exposure can be. Researchers say exposure to secondhand smoke can increase the risk of oral cancer by a staggering 51 percent.

Oral cancer, or cancers of the mouth, include those affecting the lip, oral cavity, and throat. These cancers account for almost 450,000 new disease cases and more than 228,000 deaths every year globally.

Scientists say that significant risk factors for these forms of cancer include tobacco smoking and use of smokeless tobacco products. Drinking alcohol can also increase the risk of oral cancer. Tobacco smoke represents the largest amount of human exposure to chemical carcinogens and causes a fifth of cancer-related deaths worldwide.

However, active smokers are not the only people who suffer from these chemicals. Researchers examining data from 192 countries find 33 percent of male non-smokers, 35 percent of female non-smokers, and 40 percent of children have experienced exposure to involuntary smoking through inhaling secondhand tobacco smoke.

Previous research also shows that inhaling secondhand smoke can cause several other diseases, including lung cancer. Although tobacco smoking can cause oral cancer, there is less evidence proving whether or not secondhand smoke also leads to the disease.

Long-term smoke exposure doubles cancer risks
A team from Britain, Portugal, Spain, and the United States evaluated the potential association between secondhand smoke exposure and the risk of oral cancer. Their review analyzed five existing studies involving more than 6,900 people. Among those participants — from Asia, Europe, North America, and Latin America — 3,452 had been exposed to secondhand smoke and 3,525 had not.

Their analysis, appearing in the journal Tobacco Control, reveals the more than 50-percent greater risk of mouth cancer due to secondhand smoke exposure. Additionally, exposure lasting more than 10 to 15 years increases the risk of oral cancers by more than twice the rate in comparison to people with no exposure to tobacco smoke.

“This systematic review and meta-analysis supports a causal association between secondhand smoke exposure and oral cancer,” researchers write in a media release. “Moreover, the analyses of exposure response, including by duration of exposure (more than 10 or 15 years) to secondhand smoke, further supports causal inference.”

“The identification of the harmful effects of secondhand smoke exposure provides guidance to public health professionals, researchers, and policymakers as they develop and deliver effective secondhand smoke exposure prevention programs and adopt appropriate measures to implement guidelines in Article 8 of the World Health Organization’s Framework Convention on Tobacco Control,” the team concludes.

Addressing unmet needs for head and neck cancer awareness month

Source: www.targetedonc.com
Author: Sara Karlovitch

Head and neck cancers, also known as squamous cell carcinomas of the head and neck, account for nearly 50,000 cases of cancer per year in the United States.

April is head and neck cancer month. According to the American Association for Cancer Research (AACR), alcohol and tobacco use are major risk factors for developing head and neck cancers. However, infection with the cancer-causing types of the human papillomavirus (HPV) also increases the risk for certain forms of the cancer, as well as eating preserved or salted foods, poor oral hygiene, occupational exposure to wood dust, asbestos, and synthetic fibers, radiation exposure, and Epstein-Barr virus infection in endemic regions, including southeast Asia.

Head and neck cancers are more common among men than women. Additionally, most patients who are diagnosed with this type of cancer are 50 years or older. Symptoms include a lump or sore on that does not go away or heal, difficulty swallowing, changes in voice, or a sore throat that does not resolve or heal.

Trials such as the KEYNOTE-048 study (NCT02358031), which investigated the use of pembrolizumab (Keytruda) as a first line treatment for recurrent or metastatic squamous cell cancer of the head and neck, have changed how head and neck cancers are treated. While many patients recover, many are still affected by life-long disabilities as the result of their disease and treatment.

Stuart J. Wong, MD, a medical oncologist, professor, and director of the Center for Disease Prevention Research at the Medical College of Wisconsin, discussed the KEYNOTE-048 trial, advances in head and neck cancers, and current unmet needs in this patient population in an interview with Targeted Oncology.

TARGETED ONCOLOGY: Can you discuss the evolution of treatments for patients with head and neck cancer?

WONG: Probably the biggest evolution is the integration of immune oncology into our treatment of head and neck cancer. We now have a first line indication for the use of an immune checkpoint inhibitor for patients with recurrent/metastatic head and neck cancer. This has been very successful in improving the overall survival for this patient population. Based upon the success of these agents in the recurrent and metastatic setting, there have been many new studies launched to test immune oncology agents into earlier stages of disease and to test novel immunotherapy combinations. The results of many of those studies are still anxiously being awaited.

TARGETED ONCOLOGY: What are your preferred first-line and later-line treatments in this setting?

WONG: My preferred first line is off of a clinical trial, pembrolizumab. The results of the KEYNOTE-048 study are very exciting and a huge help for patients, however we’re still not satisfied with that. My first choice, if at all possible, is to enroll patients in a clinical trial. Roughly about 20% of the patients with recurrent metastatic disease may have long-term survival with the use of pembrolizumab. Other patients receive benefits that may improve their survival, which is fantastic, but we’re not satisfied with those results and want to have higher response rates and more patients who would benefit from this therapy and more patients that have long-term survival. The only way we can do this is enroll patients in clinical trials and push the envelope even further and find strategies to improve the outcome of our patients.

TARGETED ONCOLOGY: What are some clinical trials of therapies in this setting right now, including for PD-L1 inhibitors and EGFR inhibitors?

WONG: The most exciting area of research are studies for patients who have progressed on an immune checkpoint inhibitor or have shown initial refractory disease. The most intriguing studies out there are for cellular therapies or other immune strategies. These novel therapies alone or in combination with an immune checkpoint inhibitor may overcome that initial resistance or subsequent resistance. There are many different strategies that are being explored. We are anxiously awaiting their results. As of yet, none of these strategies have proven to be successful compared with standard strategies. But I think in the next few years, we’re going to have some really dramatic results; something that will improve the outcome of this population of patients.

TARGETED ONCOLOGY: Can you talk about the role of low dose radiation for these patients?

WONG: This is an exciting area of research. The idea is that many of our patients with HPV-associated cancer have a favorable outcome and that you might be able to decrease the intensity of therapy and improve their outcome is a very promising strategy. A group from Memorial Sloan Kettering Cancer Center has led an interesting pilot study in which they decrease the intensity of the radiation using a significantly lower dose but kept cisplatin in the treatment regimen. Those results are very promising. The subsequent study of this paradigm and a larger multicenter trial would potentially warrant a sea of change in the way we manage patients. There are other strategies that are attempting to do the same thing. But this is an exciting area of research and something that patients seem to be very interested in exploring. We look forward to clinical trials that employ this technique.

TARGETED ONCOLOGY: Please go into detail on some of the unmet needs that are still relevant in the space.

WONG: The biggest one, I think, is that in clinical research, we still have a small minority of patients with head and neck cancer who enroll in clinical trials. There are many causes for this, but we cannot make progress in the treatment of these cancers unless we have more opportunities for patients to go on clinical trials and more clinical trials to offer to patients. It is frustrating that our progress is slow and that we cannot offer more advances to patients. There are some diseases where a much higher percentage of patients are treated on clinical trials initially and then when they recur, clinical trials are really part and parcel of the standard management of certain diseases. We don’t have that luxury in head and neck cancer, and this is something that we need to overcome. There is a desire for patients and for their physicians to make quicker progress. We cannot do that unless we have more resources at our fingertips to allow that to happen, and to make more progress on our patients.

I think the other big area that is in need of progress is supportive care oncology. Many of the treatment modalities that we utilize to cure or attempt to cure our patients have significant morbidity. The adverse effects linger with patients, sometimes for the rest of their life. While we’re happy that our patients are able to have their lives extended, or in some cases be cured, it makes us very frustrated that they do so at the expense of, sometimes, lifelong disabilities. We need more research into supportive care and survivorship issues. Many of us are very dedicated to this. But again, that runs into the issue that we have limited resources; there’s not as much funding for this kind of research. This is, I would say, a very big unmet need and frequently doesn’t rise to the top of discussion when we talk about cancer therapy and clinical trials.

TARGETED ONCOLOGY: Are there any specific upcoming trials or therapies that you think show promise in head and neck cancer?

WONG: If you would ask me in 2 months, I might have some really good ideas for you. I always look forward to our upcoming American Society of Clinical Oncology Annual Meeting. I’m sure this one promises to show some really exciting results. I guarantee in the next few years, we’re going to be making some exciting progress with respect to new technologies, especially cellular therapy strategies and immune oncology strategies. I can’t put bets on one line of research as being the most promising but there are many exciting lines of evidence that are being explored in ongoing clinical trials and clinical trials that are on the drawing board. I simply would say stay tuned and hopefully we’ll have some exciting news in the near future.

Reference:
Head and Neck Cancer Awareness Month. AACR. Accessed April 13, 2021. https://bit.ly/3sgeRHA

How much does drinking alcohol contribute to US cancer burden?

Source: www.medscape.com
Author: Kristin Jenkins

The first study to estimate the alcohol-related cancer burden on a state-by-state basis provides more evidence that the drinking habits of Americans account for a “considerable” proportion of cancer diagnoses and deaths, researchers say.

“In the United States, on average, alcohol consumption accounts for 4.8% of cancer cases and 3.2% of cancer deaths,” concludes Farhad Islami, MD, PhD, of the American Cancer Society (ACS) and colleagues.

However, the proportion was higher for specific cancer types, with alcohol consumption accounting for an estimated 12.1% of female breast cancers, 11.1% of colorectal, 10.5% of liver, and 7.7% of esophageal cancers, the study showed.

In addition, in 46 states, alcohol accounted for ≥ 45% of oral cavity/pharyngeal and ≥ 25% of laryngeal cancer diagnoses.

The study was published online January 19 in Cancer Epidemiology.

“Implementing state-level policies and cancer control efforts to reduce alcohol consumption could reduce this cancer burden,” the researchers comment.

They noted that restrictive policies on alcohol sales are associated with a reduction in cancer mortality rates and that a recent study showed increasing alcohol controls by 10% was associated with an 8.3% relative decrease in the oropharyngeal cancer mortality rate.

Separating Drinking From Smoking
The study is also one of a growing number to evaluate alcohol consumption and cancer risk in nonsmokers, said Mary Beth Terry, PhD, professor of epidemiology at Mailman School of Public Health, Columbia University, New York City, when approached for comment.

“This is important because the much larger effects of smoking and cancer risk have made it challenging in the past to evaluate the full impact of alcohol consumption,” she told Medscape Medical News. “In the past it was hard to calculate population-attributable fractions for alcohol because a large part of the population smoked and drank.”

“This was a very comprehensive analysis,” added Terry, who was not involved with the study. She pointed out that the authors used sales data in combination with self-reported alcohol consumption “to adjust for the fact that most alcohol consumption is severely underreported.”

For the study, researchers analyzed age-, sex-, and state-specific cancer incidence and mortality data (2013-2016) from the US Cancer Statistics database in adults 30 years of age and older. They also estimated state-level, self-reported age- and sex-stratified alcohol consumption using Behavioral Risk Factor Surveillance System surveys for 2003-2006 .

Large Variation Between States
The study also showed that state-specific estimates for incident cancer cases and cancer deaths varied widely, ranging from 2.1% to 5.0% in men, and from 1.4% to 4.4% in women.

The proportions of alcohol-attributable cancer tended to be higher in New England and the western states and lower in the midwestern and southern states, with two notable exceptions. Delaware had the highest number of alcohol-related cancer cases (6.7%) and deaths (4.5%) among men and women combined, and Utah had the lowest (2.9% and 1.9%, respectively).

The magnitude of the state-to-state variation in cancer burden left the researchers “a bit surprised,” Islami told Medscape Medical News.

“The proportion of cancer cases and deaths attributable to alcohol consumption among women was about three times higher in Delaware than in West Virginia,” he said.

He noted that in the last decade, alcohol consumption among women has increased. “This may make our results even more relevant,” Islami said.

Many adults have limited awareness of the cancer-related risks of alcohol consumption, Islami commented. Others may not take the association seriously but “many pay attention to their doctor’s health recommendations,” Islami said. “Clinicians could have an important role in increasing awareness of the cancer-related risks of alcohol consumption, which could result in a reduction in alcohol-related cancer burden.”

Overall, the proportion of alcohol-attributable cancer cases and deaths was not substantially different from that reported in their 2017 study of national-level estimates, the investigators said. That study was based on sales-adjusted 2013-2014 contemporary exposure data from the National Health Interview Survey. It showed that alcohol consumption accounted for an estimated 5.6% of incident cancer cases and 4.0% of cancer deaths.

“More research is needed to monitor alcohol consumption and the alcohol-related cancer burden to evaluate state-based policies and cancer control efforts,” said Islami. “Further research is also needed to fine-tune proven interventions to increase their efficacy and to identify other effective interventions.”

‘Best Not to Drink Alcohol’
In the meantime, a new, stronger directive on alcohol consumption was issued by the ACS last year (June 2020) in an update of its Guideline for Diet and Physical Activity for Cancer Prevention, the first since 2012.

That guideline recommends “it is best not to drink alcohol,” as previously reported by Medscape Medical News, although it also included the previous recommendation, that men should limit their daily intake to two drinks and women to one drink.

“Guidelines are based on the best available data, but risk does depend on many things, including underlying susceptibility,” Columbia’s Terry told Medscape Medical News. Emerging epidemiological data indicates that independent of daily alcohol consumption, binge drinking may be associated with increased risk of some common cancers, such as breast cancer.

“Alcohol metabolites are known carcinogens. It may be easier to convey a public health message focused on the harmful effects of binge drinking than in a specific daily amount,” Terry said.

Until then, evidence is growing for another disturbing trend: increased alcohol consumption to cope with the SARS-CoV-2 pandemic. Last spring, with many parts of the country in lockdown, 14% of Americans who participated in a national survey said they were drinking significantly more alcohol compared with the same time in 2019. As previously reported by Medscape Medical News, the results showed these increases were most evident in adults aged 30-59, women, and non-Hispanic Whites.

“Alcohol consumption can have significant negative health consequences, so this information suggests another way that the pandemic may be affecting the physical and mental health of Americans,” lead investigator Michael Pollard, PhD, sociologist at the RAND Corporation, said at the time.

More recently, a commentary for Medscape Medical News by F. Perry Wilson, MD, Yale School of Medicine in New Haven, Connecticut, also highlighted increased drinking. Published in the American Journal of Drug and Alcohol Abuse, a survey of 1928 affluent Americans who sheltered in place for an average of 4 weeks showed 60% who self-identified as binge drinkers reported significantly increasing their alcohol intake, as did about 30% of nonbinge drinkers. Depression was the only common factor statistically linked to increased drinking among binge drinkers.

“I think we need to consider that increased alcohol abuse is a potential harm of the social isolation that COVID-19 has forced upon us,” Wilson commented.

And what about physicians? Are they drinking more during the pandemic?

Apparently not. Nearly half of the 12,000 physicians surveyed for Medscape’s Physician Lifestyle & Happiness Report 2021 said they consume less than one drink of alcohol per week and 24% who said they never touch the stuff.

The study was funded by the ACS. Islami and colleagues were all employed by the ACS at the time of the study. The study authors and Terry have also reported no relevant financial relationships.

Cancer Epidemiol. Published online January 19, 2021. Abstract

Artificial intelligence being trained to predict risk of developing oral cancer

Source: thestreetjournal.org
Author: staff, NHS

The diagnosis of oral cancer could be ‘revolutionised’ by using artificial intelligence to predict whether someone is likely to develop the disease, experts have said.

Experts led from the Universities of Sheffield and Warwick have teamed up to investigate how machine learning could be applied to aid doctors in early detection.

Diagnoses of oral cancers — including those of the mouth, tongue and tonsils — have increased by almost 60 per cent over the last decade, team noted. The risk of such cancers is heightened by such factors as alcohol consumption, increasing age, insufficient fruit and vegetables, tobacco and viral infection.

Doctors evaluate the likelihood of pre-cancerous changes in the lining of the mouth — so-called oral epithelial dysplasia — developing into cancer using 15 criteria. As this approach is highly subjective, however, there is considerable variation in how patients are treated following biopsy — and a more objective system is needed.

The diagnosis of oral cancer could be ‘revolutionised’ by using artificial intelligence to predict whether someone is likely to develop the disease, experts have said.

‘The precise grading of oral epithelial dysplasia is a huge diagnostic challenge, even for experienced pathologists, as it is so subjective,’ said clinical dentist Ali Khurram of the University of Sheffield.

‘At the moment a biopsy may be graded differently by different pathologists, the same pathologist may even grade the same biopsy differently on a different day.’

‘Correct grading is vital in early oral cancer detection to inform treatment decisions, enabling a surgeon to determine whether a lesion should be monitored or surgically removed,’ he added.

‘Machine learning and artificial intelligence can aid tissue diagnostics by removing subjectivity, using automation and quantification to guide diagnosis and treatment.’

‘Until now this hasn’t been investigated, but artificial intelligence has the potential to revolutionise oral cancer diagnosis and management by ensuring accuracy, consistency and objectivity.’

The researchers plan to use samples of tissue — alongside at least five years of patient follow up data — to train an algorithm to consider the statistical correlation between classifiers and survival rates.

This will then guide doctors as to help them make an informed decision on what to recommend for the given patient’s treatment.

‘People often feel threatened by AI, however rather than replacing a doctor’s expertise, exceptionally high-level of training and experience, the technology can help to assist their decision-making and compliment their skills,’ added Dr Khurram.

‘This will help them to give a more accurate assessment and enable them to recommend the most beneficial treatment pathway for individual patients which will hope will help to improve survival rates.’

‘The pilot project will pave the way towards the development of a tool that can help identify pre-malignant changes in oral dysplasia, said computational pathologist Nasir Rajpoot of the University of Warwick.

This, he explained, is ‘crucial for the early detection of oral cancer.’

‘Successful completion of this project carries significant potential for saving lives and improving patient healthcare provision.’

What is Mouth Cancer?
Mouth cancer, also known as oral cancer, is where a tumour develops in the lining of the mouth. It may be on the surface of the tongue, the insides of the cheeks, the roof of the mouth (palate), or the lips or gums.

Tumours can also develop in the glands that produce saliva, the tonsils at the back of the mouth, and the part of the throat connecting your mouth to your windpipe (pharynx). However, these are less common.

Symptoms of mouth cancer include:

  • sore mouth ulcers that don’t heal within several weeks
  • unexplained, persistent lumps in the mouth that don’t go away
  • unexplained, persistent lumps in the neck that don’t go away
  • unexplained looseness of teeth, or sockets that don’t heal after extractions
  • unexplained, persistent numbness or an odd feeling on the lip or tongue
  • sometimes, white or red patches on the lining of the mouth or tongue – these can be early signs of cancer, so they should also be investigated
  • changes in speech, such as a lisp

See your GP or dentist if these symptoms don’t heal within three weeks, particularly if you drink or smoke heavily.

Source: NHS

2020-11-04T12:05:12-07:00November, 2020|Oral Cancer News|

Smell of a person’s breath may help identify early cancers

Source: www.theweek.in
Author: staff

Cancer researchers from Flinders University have reported significant progress in developing a method to test exhaled breath profiles which accurately differentiate head and neck cancer from non-cancer patients.

Previous studies elsewhere have indicated that the exhaled breath condensate can reveal gene mutations or DNA abnormalities in patients with lung cancer.

The global quest to use a person’s breath analysis for rapid, inexpensive and accurate early-stage testing for cancer and other diseases has taken a leap forward.

The Australian researchers collected breath samples from 181 patients suspected of having early-stage head and neck squamous cell carcinoma (HNSCC) before any treatment began.

“We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting head and neck cancer, which in time may result in a simple method to improve treatment outcomes and patient morbidity,” says lead researchers Dr Roger Yazbek and Associate Professor Eng Ooi.

Worldwide, head and neck cancer accounts for 6 percent of all cancers, killing more than 300,000 people per year globally. Tobacco, alcohol and poor oral hygiene are known major risk factors for this cancer.

A surge in human papilloma virus (HPV)-associated head and neck cancers is seeing these cancers affecting a much younger population, the researchers say.

Current therapies are effective at treating early-stage disease, however late-stage presentations are common, and often associated with poor prognosis and high treatment-related morbidity.

In the Australian study, a selected ion flow-tube mass spectrometer was used to analyse breath for volatile organic compounds. Using statistical modelling, the Flinders researchers were able to develop a breath test that could differentiate cancer and control (benign disease) patients, with an average sensitivity and specificity of 85 percent.

Diagnosis was confirmed by analysis of tissue biopsies.

“With these strong results, we hope to trial the method in primary care settings, such as GP clinics, to further develop its use in early-stage screening for HNSCC in the community,” says co-lead author Dr Nuwan Dharmawardana.

The study has been published in the British Journal of Cancer.

Should we be drinking less?

Source: www.nytimes.com
Author: Anahad O’Connor

Can a daily drink or two lead to better health?

For many years, the federal government’s influential dietary guidelines implied as much, saying there was evidence that moderate drinking could lower the risk of heart disease and reduce mortality.

But now a committee of scientists that is helping to update the latest edition of the Dietary Guidelines for Americans is taking a harder stance on alcohol. The committee said in a recent conference call that it plans to recommend that men and women who drink limit themselves to a single serving of wine, beer or liquor per day. Do not drink because you think it will make you healthier, the committee says: It won’t. And it maintains that drinking less is generally better for health than drinking more.

That message is a departure from previous guidelines, which since 1980 have defined “moderate” drinking as up to two drinks a day for men and one for women. Government agencies have also long defined a standard drink as 12 ounces of regular beer, five ounces of wine, or one and a half ounces of distilled spirits (40 percent alcohol), amounts often exceeded in Americans’ typical “drink.”

Between 1990 and 2010, many editions of the guidelines, which are updated every five years, discouraged heavy drinking and warned pregnant women and people with certain medical conditions not to drink. But they also noted that moderate drinking was linked to fewer heart attacks and lower mortality. The 2010 guidelines mentioned that moderate drinking may even “help to keep cognitive function intact with age.”

The new recommendation would be a victory for experts who have long questioned the health halo around moderate drinking. They say that studies showing it can protect health are deeply flawed, and that any potential cardiovascular benefits would be outweighed by the fact that alcohol is a leading preventable cause of cancer. According to the National Cancer Institute, even one drink a day increases the risk of breast, esophageal and oral cancer.

“This is significant because the committee has finally gotten away from this idea that a small amount of alcohol is good for you,” said Thomas Gremillion, the director of food policy at the Consumer Federation of America, a public interest group that has pushed for cancer warnings on alcohol. “They’re really taking a stand and saying drinking less is always better. That’s the right message and I think they deserve credit for making that change.”

The new advice is not yet final. The advisory panel is expected to include it in a report that it will release publicly in mid-July and submit to the Department of Agriculture and the Department of Health and Human Services. Those two agencies are scheduled to publish the official dietary guidelines later this year.

If accepted, the new recommendation would make the United States the latest country to issue stricter guidelines on alcohol consumption. In recent years, Britain, Australia, France and other countries have issued new guidelines lowering their recommended limits on daily and weekly alcohol intake. Health authorities in those countries have said that recent evidence suggests consuming less alcohol is safer and that even one drink a day increases cancer risk.

The scientific debate over moderate drinking dates at least back to the 1970s, when researchers in California noticed that teetotalers seemed to have more heart attacks than people who drank moderately. In the decades that followed, many observational studies looking at large populations documented what is known as a J-shaped curve between alcohol and mortality from all causes, especially heart disease: Mortality rates dipped for moderate drinkers compared to nondrinkers and then climbed higher among people whose intake exceeded one or two drinks daily.

But observational studies can show only correlations, not causation. And they have other limitations. One major confounding factor is that socioeconomic status is a strong predictor of health and life span — and it tracks closely with drinking levels. Studies show that compared to heavy drinkers and abstainers, people who drink moderately tend to be wealthier and have higher levels of education. They tend to have better health care, exercise more, eat healthier diets, and have less obesity.

One study that compared nondrinkers to moderate drinkers — defined as having two drinks daily for men and one for women — found that 27 out of 30 well established risk factors for heart disease were “significantly more prevalent” among nondrinkers. Rather than causing better health, in other words, moderate drinking may be a marker for higher socioeconomic status and other lifestyle factors that promote a longer life.

Another problem with observational studies is selection bias. In some large studies, people categorized as “nondrinkers” may actually be former heavy drinkers, or they may have health issues that cause them not to imbibe. Studies have found that nondrinkers have higher rates of physical disabilities, psychiatric problems and pre-existing illnesses. When rigorous studies take these factors into account, they find that the protective effect of moderate drinking disappears.

“The appearance of protection vanishes like the mist on an autumn day as the sun comes up,” said Timothy Stockwell, an alcohol researcher and director of the Canadian Institute for Substance Use Research at the University of Victoria. “All of these thousands of studies, when you do a forensic examination of them, most of them have these horrendous flaws and are open to these systematic biases.”

One way to get around these limitations is through genetic studies. Some people carry a genetic variant that disrupts their ability to metabolize alcohol, causing them to develop skin flushing, irritation and other unpleasant symptoms when they drink alcohol. As a result, they tend to abstain or drink very little. If alcohol was good for heart health, these people should in theory have more heart disease compared to others. Instead, as one large analysis published in BMJ in 2014 found, they have “a more favorable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant.”

The study concluded: “This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.”

Not everyone agrees that the health benefits of moderate drinking are illusory. Alcohol has blood-thinning properties, and red wine in particular contains polyphenols that have beneficial effects on the microbiome, said Dr. Erik Skovenborg, a family doctor and member of the International Alcohol Forum, an international group of scientists who study alcohol and health. Alcohol also raises HDL cholesterol, often referred to as the “good” kind, though recent studies have cast doubt on it being cardioprotective.

Dr. Skovenborg said the observational data makes it clear that moderate drinking is more than a marker for a healthy lifestyle.

“In these studies you have many participants that have all the healthy lifestyle factors,” he said, “and if you add moderate alcohol consumption on top of that, it increases the benefits regarding longer life and fewer health problems.”

Dr. Skovenborg said his general advice to patients who drink is to follow the Mediterranean tradition: Have a little wine with your meals, drink slowly, enjoy it, and don’t drink to get drunk. Exercise regularly, avoid smoking, eat nutritious foods, and maintain a normal weight. “It’s a pattern of things you should be doing, not just one thing,” he added.

Showing definitively that moderate drinking protects heart health requires doing a lengthy clinical trial, one that randomly assigns some people to have a drink daily and others to abstain. In 2014, the National Institutes of Health launched a clinical trial designed to do just that. But it was shut down in 2018 after a New York Times investigation revealed that N.I.H. officials had lobbied beer and liquor companies for funding and suggested that the results of the trial would support moderate drinking. As it turns out, experts have long raised concerns about industry influence on alcohol studies.

Members of the advisory committee declined to comment on their recommendations until their report is released. Dr. Stockwell said he agreed with the one-drink-a-day recommendation but he would word it slightly differently. “I’d probably say seven drinks a week for men and women and no more than two drinks on one day,” he said. “I would have a little flexibility.”

Study: Regular drinkers can curb chance of getting alcohol related diseases with exercise

Source: www.express.co.uk
Author: Richard Percival

The scientists revealed that heavier drinkers needed to produce greater physical output to offset other deadly diseases associated with drink. Meanwhile, people who recently gave up alcohol could also reduce their chances of getting sick if they exercised more too.

Researchers from the University of Sydney used data from participants aged 30 years and over in ten British population-based health surveys. They then compared this with death rates of alcohol-related cancers which included oral cavity, throat, larynx, oesophagus, liver, colorectal, stomach and additionally pancreas and lung

Using models, they discovered a strong direct association between alcohol consumption and mortality risk of alcohol-related cancers, with a significantly higher risk among ex-drinkers.

They discovered people who drank excessive amounts of alcohol every week (more than 14 units for women and 21 for men) but who did at least seven hours of exercise were less likely to die from these cancers.

The study published in the International Study of Cancer last week added: “Engaging in a recommended level of physical activity attenuated the negative effects of alcohol consumption on alcohol-related cancer mortality.

“This provides valuable evidence of the potential of promoting physical activity as an adjunct risk minimisation measure for alcohol-related cancer prevention.”

It is the first time analysts have looked at the link between exercise and surviving cancers linked with alcohol. Anne McTiernan, a cancer prevention expert at the Fred Hutchinson Cancer Research Centre, said that the evidence between exercise and alcohol “was clear”.

Healthy diet may avert nutritional problems in head, neck cancer patients

Source: medicalxpress.com
Author: University of Illinois at Urbana-Champaign

At least 90 percent of head and neck cancer patients develop symptoms that affect their ability or desire to eat, because of either the tumor itself or the surgery or radiation used to treat it. These problems, called nutrition impact symptoms, have wide-ranging negative effects on patients’ physical and mental health and quality of life.

However, patients who eat foods high in antioxidants and other micronutrients prior to diagnosis may reduce their risks of developing chronic nutrition impact symptoms up to one year after being diagnosed with head or neck cancer, according to a recent study led by researchers at the University of Illinois.

The scientists analyzed the dietary patterns of 336 adults with newly diagnosed head and neck cancers and these patients’ problems with eating, swallowing and inflammation of the digestive tract. This painful inflammatory condition, called mucositis, is a common side effect of radiation treatment and chemotherapy.

The mitigating effects of a healthy diet were particularly significant in people who had never smoked and in patients who were underweight or normal weight at diagnosis, who often experience the greatest eating and digestive problems during treatment, said Sylvia L. Crowder, the paper’s first author.

Crowder is a research fellow in the Cancer Scholars for Translational and Applied Research program, a collaborative initiative of the U. of I. and Carle Foundation Hospital in Urbana, Illinois.

“While previous work has established that the presence of nutrition impact symptoms is associated with decreased food intake and weight loss, no studies have examined how pre-treatment dietary intake may influence the presence of these symptoms later in the course of the disease,” Crowder said.

In the early 2000s, researchers hypothesized that consuming antioxidant supplements might protect patients’ normal cells from damage during radiotherapy, enabling them to better tolerate treatment and higher dosages.

Accordingly, prior research by Anna E. Arthur, a professor of food science and human nutrition at the U. of I. and the current study’s corresponding author, indicated that eating a diet of whole foods abundant in antioxidants and phytochemicals improved recurrence and survival rates in head and neck cancer patients.

Like Arthur’s prior research, the new study was conducted with patients of the University of Michigan Head and Neck Specialized Program of Excellence.

Data on patients’ tumor sites, stages and treatment were obtained from their medical records. More than half of these patients had stage 4 tumors at diagnosis.

Prior to starting cancer treatment and again one year post-diagnosis, the patients completed a questionnaire on their diet, tobacco and alcohol use, and quality of life. Patients reported whether they experienced any of seven nutrition impact symptoms—such as pain or difficulty chewing, tasting or swallowing foods and liquids—and rated on a five-point scale how bothersome each symptom was.

In analyzing the patients’ eating habits, the scientists found that they followed either of two major dietary patterns—the Western pattern, which included high amounts of red and processed meats, fried foods and sugar; or the prudent pattern, which included healthier fare such as fruits and vegetables, fish and whole grains.

Patients who ate healthier at diagnosis reported fewer problems with chewing, swallowing and mucositis one year after treatment, the scientists found.

“While the origin and development of nutrition impact symptoms are complex and varied, they generally share one common mechanism—cell damage due to inflammation,” said Arthur, who is also an oncology dietitian with the Carle Cancer Center. “The prudent dietary pattern has the potential to reduce inflammation and affect the biological processes involved in the pathogenesis of these symptoms.”

The scientists hypothesized that some patients may begin eating healthier after being diagnosed with cancer, potentially counteracting the pro-inflammatory effects of their previous dietary habits.

Reverse causation was possible too, they hypothesized—patients’ lack of symptoms may have enabled them to consume a broader range of foods, including healthier whole foods, before their cancer was discovered.

Alcohol use high among cancer survivors

Source: www.medwirenews.com
Author: Shreeya Nanda

Over half of cancer survivors report being current drinkers, including about a fifth who appear to engage in excessive drinking behaviors, finds a US study.

“Given that alcohol intake has implications for cancer prevention and is a potentially modifiable risk factor for cancer-specific outcomes, the high prevalence of alcohol use among cancer survivors highlights the need for public health strategies aimed at the reduction of alcohol consumption,” write the study authors in JNCCN—Journal of the National Comprehensive Cancer Network.

They used data from 34,080 participants of the US National Health Interview Survey interviewed between 2000 and 2017 who reported a history of cancer.

In all, 56.5% of the total cohort reported being current drinkers, including 34.9% who exceeded moderate drinking limits – defined as a daily intake of more than one drink for women and more than two drinks for men – and 21.0% who engaged in binge drinking, which was defined as at least five drinks per day on at least one occasion in the past year.

Researcher Nina Sanford (University of Texas Southwestern Medical Center, Dallas, USA) and colleagues caution that for the blood alcohol concentration to reach the threshold for binge drinking, drinks generally need to be consumed within 2 hours, but the survey did not collect information on the duration of alcohol intake and therefore participants who reported binge drinking may not have reached the biologic threshold.

They also investigated factors linked to alcohol use, finding that younger age (18–34 years vs other age groups), current or former smoking status, and later survey period (2010–2014 and 2015–2017 vs 2000–2004) were significantly associated with a greater likelihood of current drinking, exceeding moderate drinking limits, and binge drinking.

For other factors, such as sex and ethnicity, associations were observed for some of the levels of current drinking but not all – for instance, female sex was significantly associated with exceeding moderate limits, but male sex was a significant predictor of reporting current drinking and binge drinking.

The prevalence rates and predictive factors were similar in sensitivity analyses that included just the 20,828 participants who had been diagnosed at least 5 years prior to survey administration.

“By reporting the demographic and socioeconomic variables associated with alcohol intake, our work begins to identify subgroups toward whom alcohol-based interventions could be targeted, and could serve as a benchmark for assessing changes in drinking behavior in the population of patients with cancer,” say Sanford et al.

Individuals with a history of cervical or testicular cancer were significantly more likely to report current drinking, exceeding moderate limits, and binge drinking compared with participants reporting other tumor types. Additionally, those with a history of head and neck cancer or melanoma were also significantly more likely to report binge drinking.

This finding is “likely a reflection of the predominant demographic characteristics—particularly younger age—associated with these cancer diagnoses, rather than an intrinsic association between cancer type and alcohol use,” comment the researchers.

Sanford and colleagues highlight the need for further research, “including large-scale systems-based research on alcohol use in cancer survivors.”

And they conclude: “For the time being, because oncologists have a responsibility to promote the overall health and well-being of their patients, efforts should be undertaken to accurately assess alcohol intake among cancer survivors and to inform these individuals of the potential harms associated with continued drinking.”

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