HPV vaccine might shield women against throat cancer

Source: healthfinder.gov
Author: staff

Young women who are vaccinated against the human papillomavirus (HPV) not only protect themselves from cervical cancer, but from throat cancer as well, a new study suggests. Many of the increasing number of throat cancers, seen mostly in developed countries, are caused by HPV infection and the HPV vaccine might prevent many of these cancers, the researchers say.

“We found the women who had the HPV vaccine had much less infection than the women who hadn’t,” said lead researcher Dr. Rolando Herrero, at the International Agency for Research on Cancer in Lyon, France.

“In fact, there was a 90 percent reduction in the prevalence of HPV infection in the women who received the vaccine compared to the women who had not,” he said.

HPV infection is strongly associated with cancer of the oral cavity, Herrero noted. “We think that it is possible that the prevention of the infection will also lead to the prevention of these cancers,” he explained.

The HPV vaccine has enormous benefit, said Herrero, “because of the cervical cancer prevention and the anal cancer prevention, and it can even prevent infections in their sexual partners.”

Herrero said boys, too, should be vaccinated to protect them from oral cancers. Oral cancer is much more prevalent among men than in women, he pointed out.

A 2011 study in the Journal of Clinical Oncology showed that in the United States, HPV-positive oral cancers increased from 16 percent of all oral cancers in the 1980s to 70 percent in the early 2000s. And according to the Oral Cancer Foundation, nearly 42,000 Americans will be diagnosed with oral and throat cancer in 2013, and more than 8,000 people will die from these conditions.

HPV-linked throat cancer recently came to the public’s attention when the British newspaper The Guardian reported that actor Michael Douglas’ recent bout with the disease might have been caused by oral sex.

For the new study, Herrero’s team randomly assigned more than 7,400 women aged 18 to 25 to either receive the HPV vaccine or a vaccine against hepatitis A, as a comparison.

Women in the HPV vaccine group were given Cervarix, one of two vaccines available for HPV prevention. (The other is Gardasil.)

Four years later, the researchers found the HPV vaccine was 93 percent effective in preventing throat cancer. Among women who received the HPV vaccine, only one patient showed an oral HPV infection, compared with 15 in the hepatitis A vaccine group, the researchers found.

The HPV vaccine costs $130 a dose and because three shots are required, the total cost is about $390, according to the U.S. Centers for Disease Control and Prevention. There are government programs that can help offset these costs for some patients, the agency noted.

Because HPV is a sexually transmitted infection, the vaccine is most effective when given before someone is sexually active. Eighty percent of people will test positive for HPV infection within five years of becoming sexually active, said Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center, in New York City.

That’s why the CDC recommends the vaccine for adolescent girls and boys starting at age 11.

The new report was published in the July issue of the online journal PLoS One.

“The study is really preliminary information,” said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital, in New York City. “It will provide a basis to begin to study how the vaccine will help to protect against throat cancer,” she noted.

“It’s going to take a while to study those who have been vaccinated to determine that they are protected against throat cancer. This is just the beginning,” she said.

Sources:
Rolando Herrero, M.D., Ph.D., prevention and implementation group, International Agency for Research on Cancer, Lyon, France;
Marc Siegel, M.D., associate professor of medicine, NYU Langone Medical Center, New York City;
Elizabeth Poynor, M.D., gynecologic oncologist and pelvic surgeon, Lenox Hill Hospital, New York City; July 2013,

HPV Vaccine Found to Help with Cancers of Throat

Source: NY Times

By: Donald G. McNeil Jr.

A vaccine that protects women against cervical cancer also appears to protect them against throat cancers caused by oral sex, and presumably would protect men as well, according to a study released Thursday.

Rates of this throat cancer have soared in the past 30 years, particularly among heterosexual middle-aged men. About 70 percent of oropharyngeal cancers are now caused by sexually transmitted viruses, up from 16 percent in the 1980s. The epidemic made headlines last month when the actor Michael Douglas told a British newspaper that his throat cancer had come from performing oral sex.

Oncologists have assumed that the human papillomavirus vaccine, which is used to prevent cervical cancer, would also prevent this other type of cancer, but this was the first study to provide evidence.

“This is a very nice paper,” said Dr. Marshall R. Posner, medical director for head and neck cancer at Mount Sinai Medical Center in New York, who was not involved in the study. “We expected this — that’s why we want everyone to vaccinate both boys and girls. But there’s been no proof.”

The study, supported by the National Cancer Institute, found that Cervarix, made by GlaxoSmithKline, provided 93 percent protection against infection with the two types of human papillomavirus that cause most of the cancers.

“We were surprised at how big the effect was,” said Dr. Rolando Herrero, head of prevention for the World Health Organization’s International Agency for Research on Cancer, and the study’s lead author. “It’s a very powerful vaccine.”

The study was done with 5,840 women in Costa Rica who were ages 18 to 25 and sexually active when it began. Four years after being vaccinated, each gave a mouthwash gargle sample that picked up cells from deep in the throat. Only one woman who had received the vaccine was infected with the viruses HPV 16 or HPV 18, the cancer-causing types; 15 women who had gotten a placebo vaccine were infected.

Dr. Herrero explained some of the study’s limitations: when it began, it was concerned only with cervical cancer, so no men were enrolled. The women were initially tested to make sure they had no cervical infections, but were not tested for throat or anal infections. They gave oral samples only once, so it was not possible to say how many had persistent infections; most people clear HPV infections on their own, so only a tiny fraction lead to cancer. Four years is not long enough to know how many cancers would develop — but finding out for sure would require waiting 20 years or more, and ethical guidelines require that all women in the trial get regular examinations and that any suspicious lesions be destroyed before they turn cancerous. Also, only Cervarix, and not Merck’s similar Gardasil vaccine, was tested.

However, Dr. Herrero said, men would “probably” get the same protection as the women did, because the vaccine produces identical antibody levels in both sexes.

Dr. Posner said the large discrepancy in infection rates between those who got the vaccine and those who got placebo suggested that the data was “very reliable” even though the infections were detected far too early to produce cancers.

“What we don’t know,” he said, “is how long-term the protection is, or if re-vaccination is necessary.”

While cancers caused by smoking or drinking usually occur in the mouth, those caused by oral sex usually occur at the base of the tongue or deep in the folds of tonsillar tissue, and are hard to detect. They are more common among heterosexual men than among women or gay men; experts believe that is because vaginal fluid contains more virus than the surface of the penis.

Dr. Eric J. Moore, a Mayo Clinic surgeon specializing in these cancers, said the study was “very encouraging.”

“But remember,” he added. “It only works if you’re vaccinated prior to contracting the infection. Once you’re 40 and have had multiple sexual partners, it’s not going to help.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Vaccine is credited with steep fall of HPV in teenagers.

Source The New York Times
By SABRINA TAVERNISE
Published: June 19, 2013 342 Comments

 

The prevalence of dangerous strains of the human papillomavirus — the most common sexually transmitted infection in the United States and a principal cause of cervical cancer — has dropped by half among teenage girls in recent years, a striking measure of success for a vaccine against the virus that was introduced only in 2006, federal health officials said on Wednesday.

 
 
Dr. Judith L. Schaechter gives an HPV
vaccination to a 13-year-old girl in her
office at the University of Miami Leonard
M. Miller School of Medicine.

 

 

The sharp decline in the infection rate comes at a time of deepening worry among doctors and public health officials about the limited use of the HPV vaccine in the United States. Health departments across the country are scrambling for ways to increase vaccination rates, while nonprofit groups are using postcard reminders and social media campaigns and pediatricians are being encouraged to convince families of the vaccine’s benefits.

There are some signs that resistance to the vaccine may be growing. A study published in the journal Pediatrics in March found that 44 percent of parents in 2010 said they did not intend to vaccinate their daughters, up from 40 percent in 2008. Because it prevents a sexually transmitted infection, the vaccine comes with a stigma. Some parents worry it promotes promiscuity. And it has been controversial. During the Republican primary in 2011, Representative Michele Bachmann, Republican of Minnesota, said the vaccine could have “dangerous side effects,” a concern that health officials say is unfounded.

The magnitude of the decline in HPV infections surprised public health experts because only about a third of teenage girls in the United States have been vaccinated with the full course of three doses. By comparison, vaccination rates in countries like Denmark and Britain are above 80 percent. Even Rwanda, in East Africa, has reached 80 percent.

Yet even with relatively low vaccination rates in the United States, infection with the viral strains that cause cancer dropped to 3.6 percent among girls ages 14 to 19 in 2010, from 7.2 percent in 2006, the officials said.

“These are striking results,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. “They should be a wake-up call that we need to increase vaccination rates. The bottom line is this: It is possible to protect the next generation from cancer, and we need to do it.”

The findings, published online Wednesday in The Journal of Infectious Diseases, covered the years 2003 to 2010 and were based on a national survey that is conducted every two years and is considered the gold standard on health indicators. Government health workers interviewed more than 8,000 girls and women ages 14 to 59 and collected vaginal swabs that were evaluated by the C.D.C.

The infection rate for girls fell even further when the two strains of the virus that cause genital warts were included, with a 56 percent drop over the period of the study. The rate was flat in the years before the vaccine was introduced, giving researchers even more assurance that the vaccine was driving the decline. Health officials began monitoring HPV prevalence in boys only this year. The first data will be available in 2015.

There are about 12,000 cases of cervical cancer and 4,000 deaths a year in the United States. At current vaccination rates, the vaccine would prevent 45,000 cases of cervical cancer and 14,000 deaths among girls now age 13 and younger over the course of their lifetimes, according to C.D.C. estimates. Increasing the rate to 80 percent could prevent an additional 53,000 cancers and nearly 17,000 deaths.

Federal officials on Wednesday sought to dispel fears about the vaccine, and emphasized its role in preventing cervical cancer.

“This is an anticancer vaccine,” Dr. Frieden said.

About 79 million Americans, most in their late teens and early 20s, are infected with HPV, or about a quarter of the American population. Each year, about 14 million people become infected. The virus causes about 19,000 cancers in women every year, and 8,000 in men, according to the C.D.C. Cervical cancer is the most common among women; among men, throat cancer is most common.

Health officials offered several possible explanations for why the drop was so sharp even though most girls in the United States are still not fully vaccinated.

One possible reason is a phenomenon known as herd immunity, in which people who are vaccinated reduce the overall prevalence of the virus in society, decreasing the chances that unvaccinated people would be exposed to someone who is infected. Another is the unexpected effectiveness of a partial dosage of the HPV vaccine, said Dr. Lauri E. Markowitz, a medical epidemiologist at the C.D.C. and the lead author of the study. About half of teenage girls in the United States have received at least one dose of the vaccine.

Because girls and women who got vaccinated tended to be more sexually active, compared with those who were not vaccinated, researchers suggest that those who had been contributing most to the prevalence of the infection were no longer infecting others.

There are two HPV vaccines, one made by Merck for boys and girls, and one by GlaxoSmithKline, for girls. Experts recommended in 2007 that all girls get vaccinated, and extended that guidance to boys in 2011.

Earlier data from the C.D.C. showed that Hispanic girls were more likely to be vaccinated than white girls, even though they were less likely to come from families with health insurance or to get regular medical care. That is partly because a federal program that covers vaccines for the poor and underserved gave the H.P.V. vaccine to clinics, while many patients with private insurance had high co-pays or had to pay the full price, generally up to $500 for a complete cycle of the vaccine.

But cost will be less of an issue after the full implementation of President Obama’s health care law, which Dr. Frieden said requires providers to cover the vaccine at no cost to patients.

Another obstacle to higher vaccination rates are doctors, who Dr. Frieden said are “not consistently giving strong recommendations for the vaccines, particularly for younger teens.”

Dr. Amanda F. Dempsey, an associate professor of pediatrics at the University of Colorado Denver, says most providers believe in the vaccine, but have met considerable resistance from parents, and feel that the brief time during visits may be better used on topics to which parents are more receptive.

“You want to make the biggest impact,” said Dr. Dempsey, who recommends the vaccine to patients, but still gets a lot of refusals. Many parents do not believe their child is at risk because they are not sexually active, but she said that she explains that vaccination should happen long before exposure.

She added, “For a lot of people there’s still a vague sense that there’s some controversy about the vaccine.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

It’s True. You Can Get Throat Cancer From Oral Sex

By: Alexandra Sifferlin
June 03, 2013
Source: TIME

 

On Sunday, in an interview with the Guardian, actor Michael Douglas revealed that his throat cancer was not caused by tobacco and alcohol, but by HPV, which was transmitted through oral sex. He has since called the statement a misunderstanding, but it’s still true: you can get throat cancer from HPV.

In an eye-poppingly candid interview with the Guardian’s Xan Brooks, Douglas, who is married to actress Catherine Zeta-Jones, allegedly told the reporter his cancer was caused by the STD:

The throat cancer, I assume, was first seeded during those wild middle years, when he drank like a fish and smoked like the devil. Looking back, knowing what he knows now, does he feel he overloaded his system?

“No,” he says. “No. Because, without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”

From what? For a moment I think that I may have misheard.

“From cunnilingus. I mean, I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer.” He shrugs. “And if you have it, cunnilingus is also the best cure for it.”

Right, I say. OK. So what he is suggesting is that it all evens out? “That’s right,” says Douglas. “It giveth and it taketh.”

Human papillomavirus (HPV) is a sexually transmitted disease that can cause genital warts or present itself without symptoms. If left untreated, it can also cause cancers of the cervix, anus, penis, vulva, vagina — and head and neck cancers. “HPV being a cause of head and neck cancer was really only accepted about five years ago,” says Dr. Maura Gillison, a professor at the Ohio State University who studies HPV infections in the head, throat and neck. “Before then, no one really cared about oral HPV infections.”

According to the U.S. Centers for Disease Control and Prevention, about 60% of oropharyngeal cancers — cancers of the throat, tonsils and the base of tongue — are related to HPV. It is estimated that every year in the U.S., more than 2,370 new cases of HPV-related oropharyngeal cancers are diagnosed in women and about 9,356 are diagnosed in men; they are most common in white men.

“It is a known phenomenon,” says Gillison. “In the U.S., there is an active shift going on. Fortunately thanks to tobacco policy and public-health awareness, the incidence rate for the classical head and neck cancer caused by smoking is declining. But unfortunately, the rate of oropharynx cancer is still going up and it’s because of the HPV component.”

In 2011, Gillison and her colleagues conducted a study looking at the proportion of oropharynx cancers associated with HPV over time in the U.S. The proportion increased from 16% to 72% from the late 1980s to the early 2000s. “The incidence is rising pretty rapidly in the U.S.,” says Gillison. “Approximately 10% per year, particularly among Caucasian middle-age men.”

HPV-related throat cancer presents similarly to tobacco- and alcohol-related throat cancer, but they are considered two separate diseases, says Gillison. There are about 15 different HPV types that are established causes of cancer. The most common are HPV 16 and 18, accounting for about 70% of cervical cancers. “For oral infection, we find the same types of HPV in the oral cavity as we do in the cervix or genital region for men, but the infection is considerably less common,” says Gillison.

Oral HPV doesn’t benefit from the comprehensive testing and preventative procedures established for HPV of the cervix. Women who get regular Pap smears are quickly tested for cancerous changes that may be caused by HPV of the cervix.

“When HPV was recognized to be the cause of cervical cancer, the entire algorithm for doing Pap smears and referring a patient to a gynecologist was already established,” says Gillison. “The researchers were able to just piggyback all of their analysis and testing for HPV on the cervix onto something that was already established in the field. For oral, there is no established screening algorithm so there is no piggybacking onto routine clinical care.”

There is currently no method to routinely test for oral HPV, nor is there a way to test men for genital HPV. Researchers are working on developing clinical tests for the virus, which is among the most common STDs: researchers say most sexually active people will likely have an HPV infection at some point, but many never know. The infection doesn’t always present symptoms, and typically clears the body in one to two years.

According to the Johns Hopkins School of Medicine, it is estimated that 20 million people in the U.S. currently have HPV infection, and 1 in 49 people will contract a new HPV infection each year.

Physicians recommend the HPV vaccine for both young boys and girls to prevent infection from the disease.

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Cancer jabs for girls

Katharine Child & Denise Williams
16 May, 2013 01:15
Source: Times Live
Image by: Gallo Images/Thinkstock

 

Fresh from his battle to reduce HIV infections and make antiretrovirals freely available to almost two million South Africans infected with the virus that causes Aids, Health Minister Aaron Motsoaledi is now taking on cervical cancer.

 

In parliament yesterday, Motsoaledi announced that girls as young as nine at poorer primary schools would be given free vaccinations against human papilloma virus (HPV) from February.

As many as 520000 girls aged between nine and 10 will be vaccinated against HPV, which causes cervical cancer.

It is important that girls be vaccinated before they are sexually active if they are to be protected against HPV.

More South African women are killed by cervical cancer than by any other type of cancer. Black women and HIV-positive women are particularly vulnerable to the disease.

The drive to vaccinate schoolgirls was prompted by the severity and prevalence of the disease in young women, said Motsoaledi.

He said it was not known what the vaccination roll-out would cost but he was negotiating with pharmaceutical companies on the pricing of the vaccine.

“It’s not about the money; it’s about the human suffering … we are obliged at all times to put money aside for treatment but we are not obliged at all times to put money aside for prevention,” said Motsoaledi.

He said about 6000 women were treated each year for cervical cancer in public hospitals at a cost of R100000 a patient. Of these patients, 3500 died each year. In total, the cost to the state of cervical cancer treatment was about R600-million a year.

Cervical cancer, caused by two strains of the HPV, is less prevalent than breast cancer but kills more people. In South Africa, about 80% of cervical cancer fatalities are black women.

The virus is sexually transmitted.

The vaccine costs between R500 and R750 a dose and three doses must be administered over a six-month period forit to be effective.

University of Stellenbosch gynaecologist Haynes van der Merwe said Motsoaledi’s announcement was ”indeed good news” acrobat xi download.

In the US, a similar vaccination programme has been largely ineffective because too few girls were given all three injections over six months. But Australia has effectively rolled out the HPV campaign to schoolgirls aged 12 to 13.

Advocacy group Equal Education welcomed the move. Its deputy general secretary, Doron Isaacs, urged a roll-out of condoms at schools as well.

Motsoaledi’s spokesman, Joe Maila, said the vaccine was not being made available to boys because HPV caused cancer in girls but genital warts in boys.

“Because of this [severe effect on] girls, we have targeted them as a starting point.”

But the Centres for Disease Control in the US, and the SA Dental Association, have called for boys to be vaccinated before they are sexually active.

This is because young men worldwide are contracting deadly oral and throat cancers caused by the HPV.

The increase in throat and oral cancer among people under the age of 45 was “massive”, said University of Pretoria dental professor Andre van Zyl. He said throat cancers were previously most commonly diseases of old people and heavy smokers.

“Oral sex is perceived to be a safer sexual behaviour in an Aids-dominated world,” said Van Zyl.

“However, though it is true that the spread of HIV infection is lowered by non-genital sex, the spread of HPV has become more prevalent and, in turn, the incidence of HPV-related throat cancer has increased dramatically over the past decade,” said Van Zyl.

“These young people could never imagine that they might develop throat cancer so it is imperative that they visit the dentist regularly.”

Van der Merwe urged women to visit a gynaecologist once a year for an examination to detect precancerous cells before they develop into cervical cancer.

“At Tygerberg hospital yesterday we saw 16 patients with cervical cancer. Most present themselves too late for treatment,” said Van der Merwe.

 

 * This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Dental groups dispute Consumer Reports cancer screening story

Source: http://www.drbicuspid.com
By:  Donna Domino, Features Editor
Date: April 5, 2013

 

The dental community is up in arms over a recent Consumer Reports article that claims oral cancer screening is one of several medical tests that are overrecommended and unnecessary for all but high-risk patients.

The article, which appears in the March 2013 issue, concluded that “most people shouldn’t waste their time” on most diagnostic tests, including chairside visual screenings for oral cancer.

“Most people don’t need the test unless they are at high risk, because the cancer is relatively uncommon,” Consumer Reports wrote.

But the ADA and the Oral Cancer Foundation vehemently disagree with the magazine’s conclusions, asserting that visual screening can result in earlier diagnosis of oral cancer and other oral diseases.

The Consumer Reports article recommends only three cancer tests — cervical, colon, and breast — as worthwhile, and includes oral cancer screening among “eight to avoid” tests: ovarian, pancreatic, testicular, prostate, bladder, lung, oral cavity, and skin cancer.

The magazine said its ratings were based mainly on reviews from the U.S. Preventive Services Task Force.

Early diagnosis critical

According to Consumer Reports, the medical community has “systematically exaggerated” the benefits of screening while downplaying the harms, such as unnecessary radiation and biopsies.

The ADA quickly registered its disappointment with the recommendations and sent a letter — co-signed by the American Academy of Oral & Maxillofacial Pathology — to the editors of Consumer Reports, noting that noninvasive visual and tactile oral cancer screenings are typically included in oral exams and can result in earlier diagnosis of oral cancer and other oral diseases.

Brian Hill, executive director of the Oral Cancer Foundation who had stage IV bilateral cervical lymph node metastases when his oropharyngeal cancer was discovered, also took issue with the magazine’s recommendations.

“I disagree categorically,” he told DrBicuspid.com. “It isn’t an invasive exam, there’s no radiation (no long-term exposure issue), it is painless, it’s usually free, and you’re already sitting in the dentist chair. Why would you not get it?”

The problem is there’s no good screening mechanism to identify the high-risk group, he added.

“Obviously, tobacco users and those who consume high levels of alcohol have been the historic high-risk group. But with HPV [human papillomavirus] 16 becoming the fastest-growing segment of the oral cancer population, we have a new problem: we cannot sort the group of people with persistent viral infections from the general population today,” Hill said, noting that many people with HPV infections don’t know they have it as there are no outward, obvious signs or symptoms.

Some 99% of those with HPV infections clear the virus through normal immune response (within two years if you use the cervical cancer model), and only 1% will develop oral cancer, he added.

“To use the logic that oral cancer does not occur frequently enough to warrant getting the screening is myopic,” he stated. “One American dies every hour of every day of the year from oral cancer. That is not something to ignore. We can no longer realize who is high- or low-risk.

The American Cancer Society also endorses oral screenings and recommends that “doctors examine the mouth and throat as part of a routine cancer-related checkup” in its policy guidelines.

False positives and biopsies

John Santa, MD, MPH, director of the Consumer Reports Ratings Center, acknowledged that the magazine struggled with including oral cancer screening among the tests that were not recommended.

“I think this is more of an issue with doctors than dentists,” he told DrBicuspid.com. “While it’s laudable that all these organizations recommend oral cancer screening, I would ask them to produce evidence that shows it saves lives.”

In addition, Dr. Santa noted, cancer screenings can produce false positives, resulting in unnecessary biopsies, and data from the U.S. Preventive Services Task Force and Cochrane Review research did not support routine oral cancer screening.

In fact, a recent study in the Journal of the American Dental Association found that clinical oral exams have a poor overall performance as diagnostic methods for predicting dysplasia and oral squamous cell carcinoma. But a 2010 report by a panel convened by the ADA Council on Scientific Affairs endorsed routine visual and tactile examinations in all patients during dental appointments (JADA, May 2010, Vol. 141:5, pp. 509-520).

Also, oral oncologists are reporting seeing more young people who don’t have the usual risk factors such as smoking or drinking but are developing oral cancer.

Close to 42,000 Americans will be diagnosed with oral or pharyngeal cancer, and it kills more than 8,000 patients annually, according to the Oral Cancer Foundation, which notes the mortality rate for oral cancer is higher than that of cancers such as cervical cancer or Hodgkin’s lymphoma.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Reply to this article that was posted on the Dr. Bicuspid website article by OCF Founder Brian Hill

I put no weight on what the U.S. Preventive Services Task Force and Cochrane Review have to say about this since their determination was based on the evidence that no peer review studies have been done to show that oral cancer screening has any impact on long-term outcomes.  They are actually right, but there is a caveat here.

The fact that there have been no peer-reviewed studies is only partly true. There was a landmark study, published in Lancet which is a strictly peer reviewed, respected journal, done in India by several researchers from different countries which did find significant benefit to early discovery through screening, but Cochrane disagreed with the protocol for the study which looked at tens of thousands of people offer a protracted period of time, (about a decade). The study found a huge reduction in deaths as a result of opportunistic screening. What they really did not like about the study was that the screeners were NOT DOCTORS in many of the cases. So just think of that – you have a study which shows about a 25% reduction in deaths or better, and EVEN WITH NON DOCTORS DOING MANY OF THE SCREENINGS, you have this great outcome. So they subjectively omitted it from the materials they reviewed to come to their conclusion. More so, something much more obvious.  Even with the absence of a study, their conclusion is not proof of a negative, that screenings have no value, it is actually proof that THERE ARE NO STUDIES. Nothing more. Having addressed this on several occasions with groups that do these “meta analysis ” types of reviews and then draw conclusions from them, I have never gotten a satisfactory answer to this question, “Where is the study that shows that parachutes save lives?”  The government (FAA) mandates that I wear one when flying aerobatics, so they obviously think it is a good thing and would save my life in a mishap, and our military pilots fly with one on every mission, so they obviously buy into the value of a parachute to save your life as well. But where is the study that proves it?  One does not exist. There is plenty of anecdotal evidence, and lots of published stories of them saving lives, but no peer reviewed study or paper anywhere. If you exclude common sense, or what is self evident from your conclusion, you would have to have a statement that there is no evidence that parachutes save lives.

So if this is the case, it begs the question as to why are there no studies? The most obvious answer to this question is that no one is going to spend millions of dollars to do a study on something which is self evident.  I asked this question of a H&N surgeon who is routinely up to his elbows in someone’s blood, who stated that his job would be drastically reduced if we were finding more cancers at earlier stages.

So this makes the next question pretty obvious. We know from the best database of disease rates and outcomes in the US, the SEER database (Surveillance, Epidemiology, and End Results) which is how we track incidence, causes, and outcomes in the US, that stage one oral cancer patients have better outcomes, and stage four patients have poorer outcomes. This should not surprise anyone. Stage one people have besides longer lives, far fewer treatment related morbidity issues to get to a point of no disease (NED).

The real question is HOW DO YOU GET TO BE A STAGE ONE FIND AT TIME OF DISCOVERY? There are two possible pathways to this. The first would be what OCF and many others including the ADA have always advocated for, and that is OPPORTUNISTIC screening. This is screening of an entire population or group of people, not just those with complaints or with known high risk factors like tobacco use, but everyone that your practice sees. This concept is even more important today since we no longer can, with the fast rise of HPV16 as a prime driver of oral / oropharyngeal cancers, identify easily the high risk group (outside of tobacco users) in the American population.

The second means to becoming a stage one find at time of diagnosis would be SELF DISCOVERY. This would mean that a population of people were knowledgeable enough to recognize that something is not right in their mouth, neck, etc. and take themselves to the doctor to have it explored in detail, before it got too far out of control. OCF is working on a public outreach and creating a dialog with the American public directly to raise awareness not just of the disease that too few have even heard of, but of the early warning signs and symptoms that should concern them enough that they self refer to a doctor for evaluation.  These are the only two reasonable pathways to becoming a stage one find, which today happens too infrequently in our country.

So I state once again, that Consumer Reports missed this by a mile and is backpedaling to trying and justify a position that is categorically without merit. They have done a significant disservice to their readers by suggesting that just because in their opinion, 42,000 people is too small a group to be concerned with, that skipping the screening is the proper answer.  Dr. Santa should meet some oral cancer patients; see their pain, their inability to speak ever again, to never eat normally, to no longer have the ability to kiss their loved ones and be facially disfigured, just some of the huge drop in quality of life issues that they live with -IF they are one of the lucky ones to be in the 57% that even survives to five years.  Perhaps his attitude about screening and self defense of his finding would be less cavalier.

One Less Cancer to Worry About (If Only)

Posted: 02/07/2013

By: Joaquin M. Espinosa

Source: Huffington Post

 

Thankfully, there is one cancer that I no longer have to worry about. I just need to figure out when exactly my seven-year-old twin daughters will have sex for the first time.

In 2013, around 12,000 American women will be diagnosed with invasive cervical cancer and more than 4,000 will die from it. Globally, cervical cancer is the third most common cancer in women worldwide, killing >275,000 every year. But these numbers will go down, must go down, because cervical cancer is now a fully preventable disease. Or isn’t it?

For us cancer researchers, good news is often not good enough and too spread apart. In this long war, we became weary of unfounded celebrations. When asked when exactly our discoveries will make a difference in the clinic, we balk and hesitate, as we have been scarred by the many times that our discoveries did not translate into a cure. Yet this time is different, this victory is unequivocal, scientific research has led to the development of vaccines that can make cervical cancer history. Now all there is left to do is to get people vaccinated. Startlingly, this seemingly simple objective is proving to be a monumental task.

Cervical cancer originates in the lower portion of the uterus, and if not detected and treated early it will eventually metastasize and kill. Virtually all cervical cancers are caused by the Human Papilloma Virus (HPV), which is present in about half of sexually active people. With the advent of easy diagnosis via Pap smears and effective surgical procedures, the rate of cervical cancer deaths dropped steadily in the U.S. during the 20th century, but the numbers have now stabilized. The disease remains a leading cause of death for women in developing countries, where access to screening and treatment is scarce.

The vaccines effectively create immunity against the cancer-causing HPV strains, and if deployed at a large scale they would eradicate cervical cancer as well as other HPV-caused cancers, such as penile cancer and head and neck carcinomas in both males and females. Shockingly, a number of economic, political, and ideological issues now blunt this phenomenal scientific achievement.

For developing countries that need these vaccines the most, the price tag is simply too high. The retail price in the U.S. is about 130 dollars per dose, with three shots required over six months. Encouragingly, the GAVI Alliance recently selected HPV vaccines for support, raising 4.3 billion dollars from donors and negotiating a price of 5 dollars per dose. In sub-Saharan Africa, the HPV vaccination campaign has gathered strong support from leaders and the population, and more than 30 million girls are expected to be vaccinated by 2020, yet another 300 million could benefit in low income countries.

Paradoxically, in the U.S. and other countries where the vaccines are free or affordable to many, unnecessary controversies are delaying their widespread use. Currently, only 30 percent of eligible girls and virtually no boys are receiving the vaccine. Why not? Some prominent politicians have promoted the unfounded claim that the vaccines are not safe. Science proves them wrong, as more than 46 million HPV vaccines had been given in the U.S. with an outstanding safety record. Shockingly, last year five Catholic bishops in Canada banned HPV vaccines from the Calgary Catholic School board, postulating that HPV vaccination would increase sexual activity in their youth. Again, science proves them wrong, as a recent study found no increase in sexual activity among those vaccinated. By the way, the international Catholic Medical Association has no ethical or scientific issue with HPV vaccination.

Perhaps the most insidious obstacle toward HPV vaccination resides in a nasty little parenting decision. When exactly should we vaccinate our boys and girls? The answer is key, because vaccines should be applied at least six months before the first exposure to the virus.

Which brings me back to the key question: when will my daughters have sex for the first time?

Well, in the very specific case of my twin seven-year-old daughters, I don’t think vaccination will be necessary until they are in their early twenties, right? I think is fair to assume at this point that these precious little girls who love their daddy so much will wait until they graduate from college to have sex with their husbands during their honeymoons, right?

Wrong. Wake up, Joaquin.

The average American has their first sexual experience at 16.9 years of age.

Wow, really? Hold on a minute, that can’t be right, I am sure they polled the wrong population. They must have surveyed some very liberal place, like Los Angeles or New York. I am sure that it was much later for women in my circle of friends. I am going to send a few emails to all these women that I respect and admire asking when exactly they had intercourse for the first time.

The answers are in: 17, 15, 14, 16, 14, 15, 14, 15, 16, 23 (the outlier). Average: 15.9. Darn it.

Okay, given the overwhelming evidence, I think I should vaccinate my girls when they turn 13.

Ouch. The thought of taking two 13-year-old teenagers to the doctor for an HPV vaccination is freaking me out. What if they start asking questions about the vaccine? What am I going to say, that it’s just another flu shot? I could not possibly tell them the truth about the vaccine, because if I did it would surely lead to a conversation about sex. Now, that’s scary. Furthermore, by telling the truth I would be implying that they are ready for sex, which of course they would not be. I wish I could vaccinate them right now, before this whole thing gets any more awkward.

HPV vaccines can be administered as early as nine.

OK, I will vaccinate them at nine. Better yet, maybe I don’t have to be there; they could go with their mom. Yes, that’s right, they will go with Mom.

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

2013-02-08T13:46:55-07:00February, 2013|Oral Cancer News|

Attitudes Toward HPV Vaccination For Boys

Source: Medical News Today
Date: 01 Feb 2013

 

A new Boston University School of Medicine (BUSM) study has found that low-income and minority parents/guardians were receptive toward vaccinating boys against Human Papilloma Virus (HPV). However, racial/ethnic differences emerged in attitudes regarding school-entry mandates. The findings appear online in the journal Clinical Pediatrics.
Although low-income and minority men have higher rates of oral HPV infection and are more likely to suffer from HPV-related diseases including penile, anal and oral cancers, few studies have examined parental attitudes after the HPV vaccine was approved for males in 2009.

This study aimed to provide an in-depth understanding of how low-income and minority parents view HPV vaccination for boys using open-ended interview questions. The analysis was based on the Health Belief Model which measures perceived severity, susceptibility, benefits and barriers.

Researchers led by corresponding author, Rebecca Perkins, MD, MSc, assistant professor of obstetrics and gynecology at BUSM, interviewed 120 parents and legal guardians of boys age 11 to 17 who accompanied them for physician visits between December 2011-2012. All subjects were read a short educational paragraph explaining HPV and HPV vaccination prior to answering questions.

Perceiving the severe consequences of being exposed to HPV, most parents/guardians saw more benefits than barriers to vaccinating boys against HPV. Researchers found the most prominent barrier to vaccination was lack of information about the long-term efficacy and safety of the vaccine, specifically for males.

“This study indicates that most parents would accept HPV vaccination for their sons just as readily as for daughters. Future research should explore the effects of the 2012 recommendations for routine vaccination for males on parental attitudes and uptake of HPV vaccination among both sexes,” said Perkins.

Although race/ethnicity revealed no differences in parent/guardians’ views towards vaccinating boys, minority study participants were more likely than white participants to support school-entry mandates, requiring children to receive the HPV vaccine.

Results from this study suggest that low-income and minority parents/guardians are inclined to accept HPV vaccination for boys with the aim of protecting them from cancer and other diseases, but would like more information specifically related to HPV in males. More African-American (73 percent) and Latino (86 percent) than Caucasian (44 percent) participants supported school-entry mandates, but all feel that requirements should apply to both genders.

 

 * This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

2013-02-04T11:56:10-07:00February, 2013|Oral Cancer News|

HPV vaccine issue returns to legislature

Source: abcnews4.com

Date: January 14, 2013

by Stacy Jacobson

CHARLESTON, S.C. (WCIV) — A local state representative will introduce a bill that would give middle school students better accessibility to information about the Human Papilloma Virus vaccine and to the vaccine itself.

Gov. Nikki Haley vetoed the bill last year. But lawmakers wanted to try again.

HPV can cause cervical cancer, as well as head and neck cancer, doctors said.

Therese Speer is a mother of three, and grandmother of four. She knew what it was like to worry as a parent.

“More information is always a benefit to parents. The more you know, the more informed decision you can make,” Speer said.

She said she supports a new bill called the Cervical Cancer Prevention Act. Rep. Bakari Sellers (D-90th District) proposed it.

“The CDC just stated the cost of cervical cancer in South Carolina is upwards of $25 million. This is something we can head off,” Sellers said.

The bill would make information about the HPV vaccine more available to seventh grade students. The bill would also allow the South Carolina Department of Health and Environmental Control to offer the vaccine through school.

“When that information is provided and parents have opportunity to speak to pediatrician about this vaccine, they overwhelmingly accept it,” MUSC gynecologic oncologist Dr. Jennifer Young-Pierce said.

Officials said the bill had no mandates, only options.

“Too often, people get info from friend or Internet that doesn’t have the most up-to-date information. This is requiring us to provide information to our children’s parents,” Young-Pierce said.

Sellers said only eight states other than South Carolina have fewer deaths from cervical cancer.

Former first lady and mother of four Jenny Sanford said the bill would also save the state money.

“I think it just makes good budget sense. I think the numbers I’ve seen are to vaccinate the population, it might be $1 million or $1.5 million total. And yet, we already spend $6 to $10 million treating that same population,” Sanford said.

Speer said awareness was all she could ask for as a parent.

“I say get the information out there, in the hands of people who need to make decisions,” she said.

Doctors also said boys should get the vaccine because they carry HPV. They also said the Centers for Disease Control ruled the vaccine safe.

Officials said the cost of the information component will be around $200,000. Most children are covered by insurance, officials said.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

2013-01-16T11:27:50-07:00January, 2013|Oral Cancer News|

High HPV Immunization Rates Achieved With PATH Initiative

Source: Medscape.com

August 30, 2012 (Montreal, Quebec) — Exceptionally high immunization rates against human papillomavirus (HPV) have been achieved in target-aged girls in India, Peru, Uganda, and Vietnam as a result of a PATH initiative, researchers told delegates here at the Union for International Cancer Control World Cancer Congress 2012.

Vivien Tsu, PhD, MPH, director of the HPV vaccines project at PATH, reported that a minimum of 80% — and in some countries well over 90% — of school-aged girls received at least 1 dose of the HPV vaccine in the 4 countries to which the initiative has been directed over the past several years.

“The reason the program was successful in these countries, and likely many others, is that there is visible government endorsement and involvement in the program,” Dr. Tsu explained. “For the most part, people trust that the government is trying to help them, so if the government is saying ‘this is worth doing,’ the community participates.”

As Dr. Tsu noted, cervical cancer — at least 70% of which is caused by HPV types 16 and 18 — is a major health issue for women in low- and middle-income countries, with a projected incidence in 2030 of more than 750,000 women. In North America and Europe, cytology has been extremely effective in detecting cervical cancer and, more important, precursor lesions.

However, in low- and middle-income countries, “cytology has failed to have much of an impact,” Dr. Tsu explained, because these countries lack the necessary resources to offer widespread cervical cancer screening.

Fortunately, the 2 currently available HPV vaccines (Gardasil and Cervarix) have been shown to safely and effectively protect against HPV 16 and 18, she added.

Importantly, both vaccines have also been prequalified by the World Health Organization (WHO), which is necessary for their widespread uptake. Based on WHO recommendations, girls 9 to 13 years of age are the main target group for HPV vaccination.

In an effort to demonstrate that target-aged girls can be successfully vaccinated, PATH directors rolled out 3 vaccine delivery strategies: a school-based HPV program, a community health HPV-based program, and an extension of an already existing outreach program to members of the community.

The process of “parental consent varied from country to country,” Dr. Tsu noted. In general, the Ministry of Health in each country dealt with the vaccine as they do any other vaccine. “Parents either signed an authorization allowing their daughters to be vaccinated or, if they did not want their child to be vaccinated, the child could simply say no, and they weren’t vaccinated,” she explained.

The initiative relied on a pulsed media campaign; the heavy use of radio spots during the weeks prior to immunization helped concentrate publicity.

In total, more than 66,000 young girls were eligible for the HPV program. As Dr. Tsu noted, 97% of the target age group in Vietnam received at least 1 dose of the vaccine and 96% received all 3 doses.

In India, 88% of the target group received at least 1 dose and 79% received all 3 doses. Immunization rates were also very high in Uganda, with more than 96% of eligible girls receiving 1 dose and 89% receiving all 3 doses. In Peru, more than 80% of eligible girls received all 3 doses.

“There was little difference in the coverage between strategies,” Dr. Tsu observed. “We saw that with strong community mobilization efforts and training of healthcare workers, the program can be successful.”

Dr. Tsu noted that healthcare workers who delivered the vaccine and teachers in schools where the HPV vaccine program was administered need to be trained to answer questions about the vaccine. “If the administrators don’t know the answers to [questions that are raised], they can’t inspire the confidence that is needed to make the program successful.”

A crisis communication plan also needs to be put into place to deal with any rumors that arise related to the vaccine and to dispel their potentially negative influence quickly.

Session chair Silvana Luciani, from the Pan American Health Organization, pointed out that the vaccines are “an important part of cervical cancer prevention.”

“What PATH is doing on some of its demonstration projects is really yielding critical information on the implementation of these vaccines and showing us that it is feasible, that you can attain high coverage rates. It’s one thing to have the vaccine, the actual implementation is quite another,” Luciani added.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

2012-08-31T11:09:43-07:00August, 2012|Oral Cancer News|
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