drinking

Team approach improves oral cancer outcomes

Source: www.drbicuspid.com
Author: Donna Domino, Features Editor

Providence Cancer Center in Portland, OR, is one of a growing number of facilities that is working to improve care for patients with oral cancer and head and neck cancers through a multidisciplinary program that brings together a spectrum of treatment providers.

To illustrate the challenges many oral cancer patients face, R. Bryan Bell, MD, DDS, medical director of the Oral, Head and Neck Cancer Program at Providence, described the extreme effects the illness and its treatment had on one of his patients. The woman had undergone surgery, chemotherapy, and radiation for her oral cavity cancer.

“This was a beautiful 32-year-old woman who had lost all her teeth and couldn’t chew,” Dr. Bell told DrBicuspid.com. “She had aged about 40 years during treatment, and she just looked awful. But she had no means of affording needed dental rehabilitation, which would have cost about $60,000. People need to see what happens when you don’t restore these patients.”

Dr. Bell used the woman’s case to convince officials at Providence Health, which oversees the medical center, of the need for a multidisciplinary approach for these patients. The new cancer treatment center, which opened last month, is a unique collaboration between dental and medical oncology specialists.

The center provides coordinated care for oral cancer patients who often need expensive and complex dental rehabilitation, regardless of their ability to pay, according to Dr. Bell. His team includes head and neck surgical oncologists, radiation oncologists, medical oncologists, otolaryngologists, neuro-otologists, and a maxillofacial prosthodontist. The hospital gets some money from Medicaid, but the program is aided by the fact that Providence is one of the biggest healthcare providers in the U.S.

“That’s what really makes us unique,” Dr. Bell explained. “We’re integrating dentistry into the multidisciplinary head and neck cancer treatment team.” In fact, Oregon is at the forefront of implementing coordinated care organizations, which are designed to deliver Medicaid services throughout the state, he added.

The unusual approach bridges the gap for patients dealing with the broad-ranging aftereffects of cancers of the oral cavity, head, and neck.

“We have a disconnect in this country regarding medical and dental care, and it’s particularly acute regarding cancer patients,” Dr. Bell observed.

Most people have affordable access to care for common dental procedures such as restorations and root canals, he noted, but oral cancer patients often need extensive and expensive oral treatment.

“A majority of patients undergoing head and neck cancer treatment, and cancer treatment in general, will have some sort of oral health problem, and many need significant dental care — whether it’s as simple as a filling or crown or as complicated as bone graft reconstruction with implant supported prosthetic rehabilitation,” Dr. Bell said. “For many of these patients, the price tag is in excess of $40,000 to $50,000.”

Changing risk factors
The Providence center treats more than 200 head and neck cancer patients annually; of these, about 150 involve cancers of the oral cavity. The youngest oral cancer patient was 19, and the oldest was 100, Dr. Bell said.

Becky Roth, 49, is one of a growing number of patients that Dr. Bell sees who develop oral cancer despite having no traditional risk factors, such as smoking and drinking. Surgeons removed most of her tongue and the lower segment of her mandible. Microvascular surgery was done to harvest her fibula to reconstruct her mandible; her second fibula was removed when Roth’s cancer recurred. A titanium plate was used to hold the fibula in place.

“We take a large segment of fibula bone with the muscle, soft tissue, and skin attached to it and do some carpentry on it to fashion it in the shape of a mandible as best we can,” Dr. Bell explained.

Surgeons often use the fibula osteocutaneous free flap, which is very common in head and neck centers, he added.

Despite losing both fibulas, Roth has been able to resume one of her passions — running — and has posted some of her personal best times. “She’s just a remarkable person,” Dr. Bell said.

Dr. Bell has noticed a growing number of oral cancer patients, particularly with cancers in the oropharynx and oral cavity. “That’s where we’re really seeing a difference in the change of demographics,” he said. “We’re seeing more younger patients — men and women who never smoked or rarely drank alcohol, like Becky.”

The majority of patients with oropharyngeal cancer have human papilloma (HPV)-driven cancers, but that’s not necessarily the same with oral cavity cancer, he noted.

“It is clear from data that HPV is a sexually transmitted disease, it is clear that HPV causes oropharynx cancer, and it is clear the risk for developing HPV-driven oropharynx cancer increases with the number of sexual partners,” he said. “But presumably people have been having oral sex longer than the last 15 years. Just because we haven’t identified what else is involved doesn’t mean there are no other contributing factors.”

Dr. Bell supports the use of HPV vaccines for young girls and boys. “I have an 8-year-old son, and I’ll certainly get him vaccinated in the next six or seven years.”

New technology, new treatments
New technology and multidiscipline treatments have vastly improved the quality of life for oral cancer patients, Dr. Bell pointed out.

“I think that’s where we’ve really come a long way in the last couple of decades,” he said. “While we’ve made only modest improvements in overall survival rates — 58% of such patients will be alive in five years, which hasn’t changed much in the last 50 years — where we have made tremendous strides is in our ability to restore patients to form and function. Patients are now living longer with their cancer, and they’re living much more functional lives.”

Dr. Bell described how improved treatments have affected patients like Roth. “We can remove two-thirds of her mandible and reconstruct it with vascularized tissue and implants, and give her teeth to chew with, to speak with, to swallow — all those things,” he said.

New technology and surgical methods are decreasing the adverse effects of chemotherapy and radiation therapy in a personalized way, he added.

“We’re trying to match the disease with the cure,” he said — by using robotic surgery, for example.

“We are now able to approach tumors in the back of the throat and base of the tongue with a surgical robot in a manner that used to take a much larger operation and splitting the jaw,” Dr. Bell explained.

Transoral robotic surgery (TORS) has allowed reduced doses of radiation therapy and even the elimination of chemotherapy in a significant number of patients, he noted. Dr. Bell was among the first surgeons in Oregon to use TORS after it was approved by the U.S. Food and Drug Administration.

One area that still needs improvement, however, is the routine refusal of most insurers to cover the dental care many oral cancer patients need.

“If you have your leg cut off from sarcoma, Medicaid, Medicare, or medical insurance would invest the $40,000 or $50,000 to give that patient a prosthesis,” he said. “So why doesn’t that occur in the oral cavity just because it’s a dental problem? Patients and healthcare providers need to be advocates to our policymakers to carve these areas out of dentistry.”

January, 2013|Oral Cancer News|

Periodontitis increases risk of oral leukoplakia

Source: www.drbicuspid.com
Author: Donna Domino, Features Editor

Periodontitis increases the risk of developing oral leukoplakia and mucosal lesions that are predisposed to become oral cancer, according to a study in Oral Oncology (September 2012, Vol. 48:9, pp. 859-863).

The findings provide clues into the complex relationship between systemic and local disease, noted the study authors from the University of Greifswald in Germany.

The development of oral cancer proceeds through discrete molecular changes that are acquired from loss of genomic integrity after continued exposure to environmental risk factors. It is preceded in the majority of cases by clinically evident, potentially malignant oral disorders, the most common of which is leukoplakia, the researchers noted.

Leukoplakia is an asymptomatic lesion in the oral mucosa. Oral cancer — especially oral squamous cell carcinoma — often develops out of these lesions, they added. Studies have shown that as many as 18% of oral premalignant lesions will develop into oral cancer. In addition, periodontal sites are often involved in proliferative types of leukoplakia.

The oral cancer rate attributed to leukoplakia is between six and 29 per 100,000, according to the authors. Smoking and drinking alcohol are the main risk factors for this disease, but acute infections in the oral cavity may contribute to the risk.

Inflammatory markers
The study evaluated 4,310 German residents ages 20 to79 from 1997 to 2001. After five years, 3,300 participants were available for follow-up.

The periodontal assessment included probing depth, clinical attachment loss, plaque, bleeding on probing, and the number of teeth. Among the study population, 123 (2.9%) of the participants had oral leukoplakia, compared with 246 people in the control group who did not have oral lesions.

Patients with oral leukoplakia showed significantly higher measures of periodontal parameters, especially bleeding on probing and gingival attachment loss, the study found. Despite a high variance, the leukoplakia group also exhibited a higher incidence of tooth loss, and there were more diabetics than in the control group (22% versus 13%).

Gingivitis (as characterized by bleeding on probing) is associated with the occurrence of leukoplakia in a dose-dependent manner, the researchers found.

“From the results it may be concluded that there is a continuously increasing risk of leukoplakia with increasing severity of periodontitis or gingivitis,” they wrote. “Increased concentrations of inflammatory markers suggest that tissues irritated by defense processes such as periodontitis are vulnerable to premalignant transformations.”

These study findings echo a 2011 study by researchers in India that showed elevated levels of salivary interleukin-6 — which was used as a marker of malignant progression — among patients with leukoplakia and periodontitis (Clinical Oral Investigations, October 2011, Vol. 15:5, pp. 705-714). Excluding people with periodontitis, the researchers found the leukoplakia cases still had elevated levels of systemic markers of inflammation. Good oral hygiene (brushing at least twice a day) was associated with decreased risk.

One limitation of the German study was that the oral lesions were not biopsied, the researchers noted.

“Our findings give new hints into the complex interrelationship between systemic and local diseases,” they concluded. “Periodontal inflammation may be considered an additional risk acting synergistically with smoking and/or metabolic factors.”

October, 2012|Oral Cancer News|

Dentists asked to help in curbing mouth cancer

Source:
Author:

The increasing cases of oral cancer have pushed the Cancer Research UK to ask dentists to look for cancer related symptoms in their patients. By checking the mouth properly, dentists can gauge whether or not a person is prone of developing mouth cancer.

Mouth cancer can be lethal if timely treatment isn’t provided to the patients. Smoking and heavy drinking could be one of the reasons behind causing mouth cancer. Chewing tobacco is yet again contributing to mouth cancer. While examining the patients, the dentists have been advised to look for cancer contributing factors.

It is estimated that by 2030 there will be an increase in the number of mouth cancer patients. People under the age group of 50 years are growing becoming victim of mouth cancer. Oral sex is yet another factor that could lead to mouth cancer.

People need to be made aware about the growing incidences of mouth cancer so that innocent lives could be saved. Avoiding heavy drinking, smoke and unhygienic oral sex can help in preventing mouth cancer. Besides, dentists can also help in saving lives by detecting mouth cancer earlier through regular checkups. It is hoped that the dentists will take serious note of the recommendations.

September, 2012|Oral Cancer News|

Rating HPV biomarkers in head, neck cancers

Source: www.sciencecodex.com

Not all head and neck cancers are created equal. Those started by infection with the human papillomavirus are less often fatal than those with other causes, such as smoking. Detection of a reliable fingerprint for HPV could help patients avoid unnecessarily harsh treatment. A new study finds that while one popular biomarker for HPV is not a reliable predictor of mortality from the cancers alone, combinations of some biomarkers showed much more promise.

“Everybody who has studied it has shown that people with virally associated disease do better,” said Karl Kelsey, aprofessor of epidemiology and pathology and laboratory medicine at Brown University, and corresponding author of the study in Cancer Research. “There are now clinical trials underway to determine if they should be treated differently. The problem is that you need to appropriately diagnose virally related disease, and our data suggests that people need to take a close look at that.”

In the study, Kelsey and his multi-institutional team of co-authors measured the ability of a variety of biomarkers to predict mortality from head and neck squamous cell carcinoma (HNSCC). Their data came from hundreds of adult head and neck cancer patients in the Boston area that they have been tracking since late 1999. As part of that data set, they were able to look at blood serology and tumor tissue samples, and they interviewed participants about risk behaviors such as smoking and drinking.

DNA alone not reliable
One of the most important findings of the study, Kelsey said, is that extracting and amplifying the DNA of HPV in tumors, a popular notion among doctors given its success in confirming HPV’s role in cervical cancers, is not particularly helpful in predicting eventual mortality from head and neck cancer.

For example, among 94 patients for whom the researchers could assess the predictive value of all the biomarkers in the study, HPV DNA was present in tumors of 59 patients and absent in 35. Among the 59 who had the DNA, 23 of them, or 39 percent, had died. Among the 35 without the DNA, 13 of them, or 37 percent had died.

“You can’t just do PCR [a DNA amplification technique] of the virus in the tumor and assume it means much,” Kelsey said.

More promising combinations
Among several other potential HPV biomarkers in patients, the most reliable predictors of mortality turned out to be certain combinations of them, particularly antibodies to the E6 and E7 proteins that are expressed by the virus and have the effect of turning off cells’ ability to suppress tumors.

Kelsey and his colleagues found that measuring blood serum levels of antibodies that respond to E6 and E7 helped to assign meaning to measures of HPV DNA in tumors. Among people who had both HPV DNA and E6/E7 measurements, those with HPV DNA in tumors who were E6/E7 negative died in 30 of 56 cases, while those with HPV DNA in tumors who were E6/E7 positive died in only eight of 55 cases.

Levels of E6 and E7 antibodies in blood also proved telling in combination with staining tumors to detect the p16 protein, which indicates that tumor-suppression has been inactivated. Among patients in whom both those tests were both run, those with p16 overexpression who were E6/E7 negative had a much higher rate of death (11 in 17 cases) than people who did not overexpress p16 and were E6/E7 positive (3 in 9 cases) or those who overexpressed p16 and who were also E6/E7 positive (6 in 37 cases).

“Our study strongly suggests that the combination of detection of HPV 16 DNA in HNSCC tumors or p16 immunostaining with E6/E7 antibodies represents the most clinically valuable surrogate markers for the identification of patients with HNSCC who have a better prognosis,” Kelsey and his co-authors concluded.

In a companion paper published simultaneously in Cancer Research another team found that measuring viral load and patterns of viral gene expression were also useful markers.

Source: Brown University

September, 2012|Oral Cancer News|

Even one drink can raise cancer risk – research

Source: www.nzherald.co.nz

Just one alcoholic drink a day may increase the risk of cancer, according to a new study, which estimates that light drinking is responsible for 34,000 deaths a year worldwide.

New research based on more than 150,000 men and women shows that light drinking increases the likelihood of cancer of the mouth, pharynx, oesophagus and breast.

One drink a day increased the risk of cancer of the oesophagus by almost a third, according to the study being reported in the Annals of Oncology, which analysed data from more than 200 research projects. Low alcohol intake increased the risk of oral cavity and pharynx cancer by 17 per cent, and breast cancer in women by 5 per cent.

“Alcohol increases the risk of cancer even at low doses,” say the researchers.

“Given the high proportion of light drinkers in the population, and the high prevalence of these tumours, especially of breast cancer, even small increases in cancer risk are of great public health relevance.”

When it comes to enjoying your favourite drink and looking after your health, advice has often been complicated. Evidence suggests that drinking in moderation may decrease the risk of heart disease, type-2 diabetes and dementia, leading many to believe a glass of wine a day is good for you.

But the damaging effects of drinking are well known. An estimated 2.2 million deaths a year worldwide are linked to alcohol, according to the report, and 3.6 per cent of all cancers are attributable to drinking alcohol.

Until now, almost all the evidence has come from studies that focused on people drinking moderate or large amounts of alcohol, or binge drinkers, and not those who drink less.

In the new study, researchers from the University of Milan and other centres in the US, France, Canada, Iran and Sweden, estimated that, in one year alone, 24,000 deaths from oesophageal cancer, 5000 from oral and pharyngeal, and 5000 from breast cancer, were due to light drinking.

The study defined light drinking as up to one drink a day or 12.5g or less of ethanol. Data on 92,000 light drinkers and 60,000 non-drinkers was used to calculate the overall cancer risk. No link was found with other cancers that have been associated with heavier drinking, including colon, liver and larynx.

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “This study adds to the evidence linking alcohol consumption to several types of cancer, and confirms that even light drinkers have a small but definite increase in the risk, particularly for those parts of the body, such as the throat and oesophagus, that come into direct contact with alcohol.

“People who wish to minimise their risk of cancer can help by cutting down on their drinking.”

Just why light intake increases the risk of some cancers and not others, is unclear. The researchers suggest that with cancer of the mouth, pharynx and oesophagus it may be because the alcohol comes into direct contact with the affected tissue. They suggest the rise in risk for breast cancer may be associated with increased levels of oestrogen, or higher levels of insulin-like growth factors that are produced by the liver after drinking alcohol.

August, 2012|Oral Cancer News|

Survey reveals most are unaware of the causes and symptoms of mouth cancer

Source: www.cosmeticdentistryguide.co.uk
Author: staff

A survey has revealed that most people are unaware of the major risk factors and symptoms of oral cancer.

The SimplyHealth Annual Dental Health Survey revealed that of the 11,785 adults surveyed, 70 percent were unaware of the symptoms of mouth cancer while only 3 percent knew that kissing could increase your risk of moth cancer as a result of exposure to the human papilloma virus (HPV).

A spokesperson for SimplyHealth said that most were aware that smoking and drinking increased the risk of oral cancer, but very few people were aware of the link between oral cancer and the HPV, a virus which is also responsible for some cases of cervical cancer. According to Cancer Research UK, some strains of HPV increase the risk of mouth cancer, which could explain why the disease is becoming more common in young people, as the virus is spread through physical contact.

Dentist Michael Thomas said that it was important for people to be aware of the symptoms of mouth cancer, as well as the causes. As with most forms of cancer, the earlier mouth cancer is diagnosed, the higher the chance of survival.

Only 28 percent of adults surveyed had discussed mouth cancer with their dentist and this is worrying, as dentists are in a prime position to spot the early warning signs and arrange further tests and treatment.

The most common symptoms of mouth cancer include lumps or swellings in the mouth or throat, sores or ulcers that take a long time to heal and red or white patches in the mouth.

April, 2012|Oral Cancer News|

More troops on smokeless tobacco after deployment

Source: Reuters.com

The findings, reported in the journal Addiction, follow other studies that have tied deployment and combat to health risks, including higher rates of smoking and drinking.

“This adds to the list of things we’re learning are associated with combat,” said lead researcher Dr. Eric D.A. Hermes, of the Yale University School of Medicine in New Haven, Connecticut.

It’s not fully clear why some troops take up smokeless tobacco after deployment. But Hermes suspects stress is involved.

That’s because deployment with combat exposure was linked to a higher risk than deployment alone. And troops with symptoms of post-traumatic stress disorder (PTSD) also had an increased risk.

The findings come from the Millennium Cohort Study, an ongoing government project looking at the health effects of military service.

Of more than 45,000 personnel followed from 2001 to 2006, 2 percent started using smokeless tobacco during that time. Another 9 percent had already developed the habit, and kept it up.

Overall, troops who were deployed but did not see combat were almost one-third more likely to take up a smokeless tobacco habit than their non-deployed counterparts. Those odds were two-thirds to three-quarters higher for troops who were in combat or who deployed multiple times.

According to Hermes, those different levels of deployment can be seen as stand-ins for different levels of stress.

So it’s possible that stress plays a role, he said.

Another finding gives weight to that idea. “We also saw a relationship with PTSD symptoms,” Hermes said.

Just under 4 percent of all troops had PTSD symptoms, based on a standard questionnaire. And they were 54 percent more likely to start using smokeless tobacco than troops without symptoms, Hermes and his colleagues found.

There are other factors that, along with stress, might push some deployed troops toward tobacco, according to Hermes.

“You’re not at home, you have more exposure to smokeless tobacco, you’re around more people doing it,” Hermes said. “Maybe it’s all these little things coming together.”

MILITARY TOBACCO USE STILL HIGH

Past studies have found that while tobacco use in the military is declining, it’s still higher when compared to the U.S. public as a whole. In 2005, almost 15 percent of military personnel said they’d used smokeless tobacco in the past year — versus just three percent of Americans overall.

“Smoking is the thing that everyone talks about,” Hermes said. “But there’s also smokeless tobacco, and it seems to be related to the stress of combat.”

Whether some troops are “treating” their stress with tobacco, or whether the tobacco somehow feeds the stress is not entirely clear, according to Hermes. “There’s still a chicken-and-egg question,” he said.

But the findings suggest that doctors treating military personnel should ask not only about smoking habits, but any use of the smokeless forms of tobacco, Hermes said.

Tobacco products are widely available at U.S. military bases. A 2009 study commissioned by the Pentagon and the Department of Veterans Affairs recommended a phased-in ban on tobacco on military property. But whether that will ever happen remains up in the air.

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

February, 2012|Oral Cancer News|

Men in doubt still don’t get checked out!

Source: www.easier.com
Author: staff

Men are almost twice as likely to die from mouth cancer and statistics consistently show they are less likely to consult with a doctor than their female counterparts. But with rates of incidence and mortality rising at an incredible rate, men can no longer afford to ignore the increasing threat of a killer disease.

Mouth cancer cases in the UK have almost doubled in the last decade, rising to 6,000 every year with almost 4,000 of those coming from men and although there are some clear early warning signs many postpone seeking professional advice, leaving fatality rates of the disease at 50 per cent.

This is supported by data from the Office of National Statistics, which reveals that women are twice as likely to see their GP as men, visiting the doctors an average of six times a year compared to just three for men. Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, puts this failing down to a lack of general cancer health knowledge in men and warns that ignoring the issue can lead to severe problems in future.

Dr Carter said: “For almost all types of cancer, men will die more often than women. There’s no biological reason that this should be the case so the reason must be purely down to the timing of diagnosis. Unfortunately, when men do go to their GP their condition may be at a far more advanced stage and therefore much more difficult to treat.

“By ignoring or dismissing the early and minor symptoms the disease will become rapidly advanced so that when they do seek help it makes it so much harder for treatment to be successful. The message is simple… ‘If in doubt, get checked out.'”

Throughout November, leading oral health charity the British Dental Health Foundation, is running Mouth Cancer Action Month and hoping to improve rates of ‘early detection’, especially in men. One in two people who contract mouth cancer will die without early diagnosis, which can improve the five year survival rate to 90 per cent.

However, while the treatment of many cancers is resulting in an improvement of survival rates, the same cannot be said for mouth cancer, of which the proportion that dies has remained fairly constant over the last ten years.

Dr Carter added: “Regrettably, most men will only resort to seeing their GP because their partner has ‘told’ them to – this must change, as must the education of health issues to all men. The first stage in this process is being able to identify the risks factors. Smoking, drinking alcohol to excess, poor diet and the Human Papilloma Virus (HPV), transmitted via oral sex, are all risk groups of the disease. The good news is that these are environmental and lifestyle choices, which can be avoided and altered.”

Early detection is critical to the survival of mouth cancer sufferers. Learn and recognise the warning signs, which include ulcers which do not heal within three weeks, red and white patches in the mouth, and unusual lumps or swellings in the mouth.

November, 2011|Oral Cancer News|

Using mouthwash can increase cancer risk for smokers

Source: www.independent.ie
Author: Eilish O’Regan, health correspondent

Smokers have been warned to stay away from mouthwash – as it might increase their risk of developing mouth cancer. The combination of smoking and drinking alcohol has been established as increasing the risk of the disease.

Now researchers have warned that may apply even to the alcohol contained in mouthwash. They pointed out that, while the link between the use of mouthwash containing alcohol and the cancer is not firmly established, it is best avoided or limited in use by smokers. The risk was examined by researchers led by dentist Dr John Reidy and colleagues in the Royal College of Surgeons and St James’s Hospital in Dublin.

Around 400 new cases of oral cancer are diagnosed each year in Ireland with two people a week dying from the disease. Symptoms include red and white patches on the lining of the mouth or tongue, a mouth ulcer that does not heal or a swelling that lasts for more than three weeks.

The most effective way of preventing mouth cancer is to quit smoking and limit consumption of alcohol, say experts. The researchers said they were concerned about the effects the alcohol in the mouthwash had and it was therefore “prudent” to restrict its use by smokers who are considered “high-risk” for mouth cancer. Around three-quarters of mouth cancers arise due to a patient both smoking and drinking, according to the study in the Journal of the Irish Dental Association.

August, 2011|Oral Cancer News|

With HPV-related head and neck cancers rising, focus on treatment and vaccination

Source: blogs.wsj.com/health
Author: Laura Landro

A form of head and neck cancer associated with the sexually transmitted human papillomavirus is on the rise, especially in men, the WSJ reports.

Fast-rising rates of oropharyngeal cancer — tumors in the tonsil and back-of-the-tongue area — have been linked to changes in sexual behavior that include the increased practice of oral sex and a greater number of sexual partners.

But HPV-positive cancer has also been reported in individuals who report few or no sexual partners. It may also be possible for the virus to be transmitted to an infant via an infected mother’s birth canal. An HPV vaccine is routinely recommended for girls because the virus can cause cervical cancer.

The rise in HPV-positive head and neck cancers is leading to a new focus both on treatment of the disease, and whether recommending routine vaccination for boys could prevent oral infections and cancers. (A CDC advisory panel said in 2009 that it was fine for boys to get the vaccine, but recommended against routine administration.)

Eric Genden, chief of head and neck oncology at Mt. Sinai Medical Center, tells the Health Blog that when treated appropriately, patients with HPV-positive cancers have an 85% to 90% disease-free survival rate over five years. By contrast, patients with HPV-negative head and neck cancers, which are often associated with smoking and drinking, typically have more advanced disease when the cancer is detected and face a five-year survival rate of only 25% to 40%, Genden says.

HPV-induced head and neck cancer responds well to almost all forms of cancer therapy including surgery, external beam radiotherapy and chemotherapy. At Mount Sinai, the use of robotic surgery and radiation –with no chemotherapy required — resulted in three-year survival rates of 90% and significantly improved quality of life for patients, its studies show. Robotic surgery is less invasive than non-robotic tumor surgeries, minimizing complications and recover time.

Philip Keane, a 52-year old photographer and father of three , had the surgery last July at Mount Sinai, followed by a six-and-a-half week course of radiation at Memorial Sloan-Kettering Cancer Center. Keane says he’s switched to a healthier diet, and didn’t develop many of the symptoms of radiation he was warned about, such as mouth or neck sores. He says that during his therapy, he was able to continue working and doing everything he did before he got sick, and is now cancer-free.

On the vaccine front, at a meeting next month the CDC plans to review data on the issue of the cost and benefits of routinely recommending HPV vaccination for boys.

Michael Brady, chair of the department of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio and chairman of the infectious disease committee for the American Academy of Pediatrics, says the AAP is awaiting any updates before changing its own policies: routine recommendation for girls at age 11 to 12 (with catch-up for teens and young women who have not received the vaccine, up to age 26 years) and a permissive recommendation for boys — meaning families or teens can get it if they ask for it.

Brady explains that the gender discrepancy for HPV vaccine occurred because initial studies for safety and effectiveness were done in females and the idea was a high coverage rate in females would result in protection of heterosexual males via herd immunity.

But low coverage of females by the vaccine means that there is minimal protection of heterosexual males, and there’s increasing evidence of the impact of HPV-related genital, oral and anal cancers in men. There is also no value in a female vaccine program for homosexual men. “All [this leads] to a realization that males would benefit from the HPV vaccine,” Brady says.

The CDC’s own permissive recommendation for young men allowed for payment through the Vaccines for Children program, and a Merck spokeswoman says more commercial insurers are paying for the vaccine for males. But Brady says vaccines with that level of recommendation tend to not be discussed at physician visits, and administration of HPV vaccine to males has been very low.

Moreover, while clear evidence of a cost benefit in girls was shown prior to the release of the vaccine, cost/benefit data for males are still being determined. “The more that people look; the more that it is clear that males would benefit by receiving the HPV vaccine,” Brady says. “The discussion is [over] whether it merits a routine recommendation.”