HPV

Updated HPV vaccine recommendations follow big HPV infection drops shown in new study

Source: www.forbes.com
Author: Tara Haelle

A vial of the human papillomavirus (HPV) vaccine Gardasil. (AP Photo/Charles Rex Arbogast)

Adults up to age 45 are now recommended to discuss with their doctors getting the human papillomavirus (HPV) vaccine, which prevents 3% of all cancer in women and 2% of all cancer in men—an estimated 34,000 cancers a year in the U.S. Following confirmation from the director of the Centers for Disease Control and Prevention (CDC), the recommendations also extend the age in men from age 21 to age 26, the same as in women.

The decision from the CDC’s Advisory Committee on Immunization Practices (ACIP) July 26 came the same day The Lancet published the largest study to date on the vaccine’s effectiveness. The meta-analysis of 65 studies found drops of 31%-83% of HPV infections and genital warts in men and women, depending on age and diagnosis.

HPV is responsible for nearly all cervical cancer, over 90% of anal cancer, 70% of oral, throat and neck cancers and over 60% of penile cancer. Though HPV is primarily transmitted through sexual contact, non-sexual transmission occurs as well.

Previously, the HPV vaccine had been recommended for females and males in a series of two doses up to age 14 or three doses up to age 26 in women and age 21 in men. Men ages 22-26 could also get the vaccine.

ACIP’s unanimous vote to extend the recommendation to age 26 in men corresponds to evidence showing the vaccine’s substantial benefits for men. In fact, research shows men to be up to six times more likely than women to develop an oral infection with the highest risk strain of HPV.

ACIP’s 10-4 vote regarding adults ages 27-45 who haven’t received the HPV vaccine emphasizes shared decision-making with their providers. The HPV vaccine is not licensed by the FDA for adults older than 45 since data on its effectiveness does not exist for this age group.

The “decision from ACIP emphasizes what the data has shown—that the HPV vaccine is safe and effective for use in patients ages 27 to 45, and that use of the vaccine in this age group should be the result of shared decision-making between patients and their trusted physicians,” Christopher M. Zahn, M.D., vice president of Practice Activities at the American College of Obstetricians and Gynecologists (ACOG) said in a statement.

“Obstetrician-gynecologists are encouraged to discuss with their patients ages 27 to 45 the potential benefits of HPV vaccination, addressing the reduced efficacy compared to vaccination within the younger target age range as well as the reduced risk of high-grade disease and cervical cancer,” Zahn said, adding getting the vaccine at the recommended age of 11-12 years offers the most benefit.

“Women’s decisions will also likely consider their individual circumstances, preferences, and concerns, and the role of the obstetrician-gynecologist is to provide unbiased information in a balanced, thorough way in order to aid that decision-making,” he said.

New research finds big drops in HPV-related infections

The new study found that HPV infections with strains 16 and 18 dropped 83% among girls ages 13-19 and by 66% among women ages 20-24 up to eight years after vaccination.

The HPV 16 and 18 strains in Gardasil cause 70 percent of all cervical, vaginal, vulvar and anal cancers. Gardasil 9 also protects against HPV 6 and 11, which cause 90% of genital warts, and against five other strains (31, 33, 45, 52, and 58). Together, the strains in Gardasil 9 represent 90% of HPV-related cancers.

HPV infections caused by HPV 21, 33 and 45 cut in half (54%) among vaccinated girls ages 15-19, according to the new research. Similarly, genital warts diagnoses fell by 67% in these girls and by 48% in boys of the same age. Older men (up to 24) and women (up to 29) also saw declines in genital warts by 31%-54%.

Rates of grade 2 cervical neoplasia, a precursor to cancer, also dropped by half (51%) in screened girls 15-19 and by 31% in women 20-24 years.

Cervical cancer can take up to 20 years to develop, so the vaccine, first approved in 2006, has not been available long enough for a sizable evidence base showing a reduction in cancer incidence. Dramatic declines in HPV infection rates, however, are expected to translate to similar declines in HPV-caused cancer rates, and immunity from the vaccine is long-lasting.

Multiple large reviews of the HPV vaccine have found it to be among the safest vaccines available. While the actual shot itself can be particularly painful, the only regularly reported side effects are pain, redness and soreness at the injection site and, in some teens, temporary fainting, which is common with many vaccines in adolescents. Among 13,000 people in the clinical trials for Gardasil 9, five people also reported fever, allergy to the vaccine, asthmatic crisis, headache and tonsillitis, though not all of these were determined to be caused by the vaccine.

The most effective way to reduce cervical cancer has been and remains regular screenings. However, screenings only detect early development of abnormal tissue that could become cancerous whereas the HPV vaccine prevents the viral infections that leads to those tissue abnormalities in the first place.

Since there is no current way to screen for throat/mouth/neck or anal cancer in women or men (or penile cancer in men), the HPV vaccine remains the only way to prevent those cancers.

July, 2019|Oral Cancer News|

HPV vaccine benefits ‘exceed expectations,’ may lead to elimination of cervical cancer

Source: NBC News
Date: June 27, 2019
Author: Katie Sullivan

A new study suggests that the benefits of the vaccine extend to people who aren’t vaccinated — meaning the more people who are vaccinated, the better.

The HPV vaccine is far more effective than expected, with benefits extending beyond those who receive the vaccine, a study published Wednesday finds.

The new study, published in The Lancet, suggests that the more people who receive the vaccine, the better. That’s because vaccination not only reduces rates of HPV infection and the presence of precancerous cells in the cervix in people who receive the vaccine, it also reduces rates of HPV-related diseases in people who were not vaccinated.

The findings come as a U.S. federal advisory panel recommended Wednesday that the HPV vaccine be given to both men and women up to age 26.

HPV, or human papillomavirus, is the leading cause of cervical cancer. The virus can also cause other cancers, including cancers of the penis, head and neck, as well as conditions like genital warts.

The HPV vaccine was first introduced in 2006. Since then, more than 115 countries and territories have implemented it in their vaccination programs. The World Health Organization recommends that girls ages 9 to 13 receive two doses of the vaccine.

“The impact of the HPV vaccination has actually exceeded expectations,” said Lauri Markowitz, associate director of science for HPV at the Centers for Disease Control and Prevention, who worked on the study. “The trials showed that HPV vaccines are very effective, and data from the real world has confirmed that.”

Indeed, the reductions in HPV infections and precancerous cells “are a first sign that vaccination could eventually lead to the elimination of cervical cancer as a public health problem,” the study’s lead author, Mélanie Drolet, an epidemiologist at Laval University in Canada, said in a statement.

The Lancet study expanded upon a 2015 meta-analysis that had looked at the real-world effects of the vaccine. The new analysis was updated to include a total of 65 studies, which spanned eight years and included more than 60 million people living in 14 countries. Each study measured either changes in the number of new HPV infections, genital warts diagnoses or cases of abnormal cells associated with cervical cancer in countries before and after they adopted routine HPV vaccination in girls. (Two countries included in the analysis, the U.S. and Australia, also recommend the vaccine for boys.)

The impact of the HPV vaccination has actually exceeded expectations.

The researchers found that, in these countries, there was a significant decrease in the prevalence of two strains of HPV that cause 70 percent of cervical cancers, HPV 16 and 18. (There are more than 100 strains of HPV, 14 of which are known to cause cancer. The HPV vaccine protects against up to 9 strains.) In addition, there was a decrease in the prevalence of precancerous cells in the cervix, which can develop into cancer.

What’s more, in countries where at least half the population that was targeted for vaccination had actually received the vaccine, researchers saw evidence of herd immunity, meaning there was a decrease in the prevalence of HPV-related diseases even among those who weren’t vaccinated. This is because vaccination leads to fewer HPV hosts.

These countries also saw a decrease in genital warts diagnoses among unvaccinated boys and older women. And among girls within the age groups targeted for vaccination, there were fewer diagnoses of three HPV strains that the vaccine does not specifically protect against, a phenomenon called cross-protection. Countries in which people in multiple age groups received the vaccine also saw a greater decrease in HPV-related disease.

“This paper shows that with a broader age range that’s targeted, you’ll find greater impact in your vaccination program,” Markowitz told NBC News.

Lagging vaccination rates

Despite the widespread benefits of the vaccine, however, HPV vaccination rates in the U.S. are still lagging behind those of other adolescent immunizations. The U.S. was the first country to implement HPV vaccination for both genders, but the CDC has found that many parents and health care providers don’t yet see a need to vaccinate boys. Parents have also expressed concerns about the vaccine and its costs, the CDC found.

According to Debbie Saslow, managing director of HPV and gynecological cancers at the American Cancer Society, the lagging rates are not entirely because parents are against vaccinating their kids; rather, the way some doctors are presenting the vaccine also plays a role.

Two required vaccinations, for tetanus and meningitis, are administered at the same time as HPV, around age 12. Saslow said HPV is usually presented as an optional third vaccine at that time, and one that patients can delay another year.

“Providers often think they’re recommending all three vaccines, but they’re actually making the third, the HPV vaccine, optional,” Saslow told NBC News. “They’re just suggesting it or doctors are setting it apart from the other two in some way.”

The fact that HPV is a sexually transmitted infection could also be a hard concept for parents to come to terms with. Saslow said beliefs about sex may be a factor that deters parents from opting to have their children vaccinated against HPV.

“Despite all that, vaccination rates are continuing to grow,” she said.

Indeed, the number of adolescents in the U.S. who received at least one dose of the HPV vaccine has increased by 5 percent each year since 2013. The CDC recommendseveryone receive the first dose by age 12. Though adults up to age 45 can still be vaccinated, the vaccine may be less effective. And while the WHO does recommend that girls 9 to 13 get vaccinated against HPV, it does not yet recommend that all genders receive the vaccination. That could change in response to study results that continue to show the vaccine has substantial impact on public health.

Cancer prevention

That impact on public health is cancer prevention. Ultimately, that’s the “main goal of the HPV vaccination program,” Markowitz said. “We’re seeing an impact on one of the HPV outcomes that is close to a cancer outcome.” (Because cervical cancer can take decades to develop, it’s not yet possible to study the effects of the vaccine on cervical cancer rates, Drolet noted in the statement.)

In particular, the study found the HPV vaccine led to a reduction in the rates of abnormal pap smear findings. Pap smears are used to detect abnormal cells in the cervix that can sometimes develop into cancer. Five to nine years after a population was vaccinated against HPV, the researchers found a more than 50 percent reduction in cases of these pre-cancerous cells in girls 15 to 19. In vaccinated women 20 to 24, there were one-third fewer cases of these cells.

A separate study, published in April in The BMJ, found a 90 percent reduction in cases of pre-cancerous cells in young women in Scotland within the first decade of introducing the HPV vaccine.

But vaccination is only one piece of cervical cancer prevention; screening is also necessary.

Whether or not a person has received the HPV vaccine, getting cervical cells regularly tested — through Pap tests and HPV screening — is still a crucial to reducing cases of cervical cancer and early detection, said Diane Harper, senior associate director of the Michigan Institute for Clinical and Health Research. Rates of invasive cervical cancer dropped significantly in the U.S. when cancer screening was introduced in the 1940s, and there were less than half the number of cases in 2007 that there were in 1973, largely due to screening.

“Vaccination and screening together make a program,” Harper told NBC News. “Very few HPV cases progress into cancer, but the only way we’re going to find those that do is through the screening program.”

June, 2019|Oral Cancer News|

British Association of Oral and Maxillofacial Surgeons praise HPV vaccination study

Source: www.nationalhealthexecutive.com
Author: staff

The British Association of Oral and Maxillofacial Surgeons (BAOMS) has welcomed new study findings from the two-year Cancer Research study in Scotland that the HPV vaccination for boys may substantially reduce head and neck cancer. BAOMS had been involved in successfully lobbying for the extension to the HPV to boys last year in England and Northern Ireland.

Life-threatening HPV-related cancers can develop during middle age, but boys had been excluded from the national HPV vaccination programme. Currently the cost of treating HPV-driven mouth and throat cancer to the NHS is approximately £30m a year.

Since the UK-wide immunisation scheme for girls aged 12 and 13 was introduced in 2008, data shows a reduction of up to 90% of pre-cancerous cells in the smear tests among women aged 20.

BAOMS Chair, Patrick Magennis, said: “Between 2010 and 2012 nearly 2,000 men had HPV-related head and neck cancer.

Over half of these oropharyngeal cancers are caused by HPV, and in the last decade alone the incidence of these cancers has doubled in the UK population.

“Current evidence suggests that vaccination of boys in their teenage years will prevent them from developing HPV-related cancers in middle age, so the introduction of male vaccination is timely.”

He welcomed the publication of the new study, which found that, over two years, in the 235 male patients in Scotland with head and neck cancer, HPV was present in 60% of cases. The findings follow an earlier report, which suggested routine vaccination of schoolgirls in Scotland with HPV had led to a dramatic reduction in cervical disease in later life.

Oral and maxillofacial cancer surgeons’ specialist skills include removing mouth, jaw and tongue cancer and replacing the missing parts with flesh and bone borrowed from the leg, hip or arm. They say that effective and timely cancer treatment for HPV-positive oropharyngeal cancer has excellent survival results. But patients frequently have serious and debilitating life-long side-effects from treatment that have a profound impact on the quality of life of the cancer survivors.

June, 2019|Oral Cancer News|

Queensland scientist develops new HPV cancer vaccine

Source: 9News
Date: May 22, 2019
Author: 9News Staff

*click Source to view video*

Former Australian of the Year Professor Ian Frazer has developed a vaccine aimed at treating HPV-related cancers of the head, neck, throat and tongue.

While funding is still being finalised, a trial of the vaccine is being prepared for people with incurable oropharyngeal cancers.

Professor Frazer, the Scottish-born immunologist who developed and patented the vaccine against HPV-related cervical cancer, has been working on this vaccine for nearly 15 years.

While the cervical cancer vaccine works as a preventative, this new vaccine is a treatment therapy.

It works by teaching the patient’s immune system to target the cancer cells containing HPV. The patient will then be given immunotherapy drugs that supercharge the immune system.

“This is all about a new way to treat cancer using the body’s defence against infection,” Professor Frazer said.

“This might give a second chance at life.”

HPV-related throat cancer kills three Australians every day.

“It’s going to become a major problem in Australia, in fact in the US we’ve seen an increase in HPV-related throat cancers by 225 per cent,” head and neck radiation oncologist Sandro Porceddu said.

Professor Porceddu will conduct the trial at the Princess Alexandra Hospital. It should begin towards the end of this year if a further $700,000 in necessary funding is found.

May, 2019|Oral Cancer News|

Oral HPV DNA Persistence After Head and Neck Cancer Treatment Linked to Disease Progression

Source: genomeweb
Date: May 2, 2019
Author: Staff Reporter

NEW YORK (GenomeWeb) – Persistent traces of human papilloma virus DNA after treatment for HPV-positive head and neck cancer is linked to an increased recurrence risk, a new study has found.

Head and neck cancers affect some 53,000 people in the US each year, according to the National Cancer Institute, and HPV has been implicated in many of those cases. In general, patients with HPV-positive tumors have higher survival rates than those with HPV-negative tumors.

A team of MD Anderson Cancer Center-led researchers collected oral rinse samples from nearly 400 patients with head and neck squamous cell carcinomas at diagnosis and as their treatments progressed. As they reported today in JAMA Oncology, the researchers found that viral load in patients’ oral samples broadly decreased as they underwent therapy. But some patients’ viral loads persisted despite treatment, which was linked to an increased risk of cancer recurrence and death, the researchers reported.

“Our data suggest that a subset of patients with HPV-positive HNSCC at high risk for locoregional recurrence can be identified by detection of persistent, oral HPV after treatment,” MD Anderson’s Maura Gillison and her colleagues write in their paper.

The researchers enrolled 396 patients with oral cavity, oropharyngeal, or unknown primary HNSCC in their study. They tested the patients’ tumors for the presence of 13 high-risk HPV types using an mRNA expression test and found 202 patients had HPV-positive tumors.

At the same time, the researchers collected oral rinse samples from patients at diagnosis, after surgery, and at six months. Additionally, patients who underwent radiotherapy provided weekly oral rinse samples. The researchers tested these samples — a total of 2,922 oral rinse samples — for the presence of HPV using a multiplex PCR-based approach.

At diagnosis, patients with HPV-positive tumors were significantly more likely to have oral rinse samples positive for HPV than were patients with HPV-negative tumors. In particular, the researchers reported that the detection of any oral HPV DNA had a sensitivity of 84 percent, a specificity of 88 percent, a positive predictive value of 88 percent, and a negative predictive value of 84 percent for the diagnosis of an HPV-positive tumor.

The prevalence of oral HPV DNA, though, went down after treatment, the researchers reported. Prior to treatment, the prevalence of HPV DNA in oral rinses that matched that of HPV in the tumor sample was 69 percent. But after primary surgical resection, it was about 14 percent. Its prevalence fell similarly for patients who underwent radiotherapy, going from 85 percent before treatment to 9 percent after radiotherapy.

As expected, overall and recurrence-free survival was higher for patients with HPV-positive tumors than with HPV-negative tumors. Patients with HPV-positive tumors had a two-year overall survival of 91 percent, as compared to 75 percent for patients with HPV-negative tumors.

But for a subset of patients with HPV-positive tumors — about 14 percent — the prevalence of oral HPV DNA didn’t decline with treatment. These patients were more likely to recurrent disease, with about 45 percent experiencing disease recurrence within two years. Additionally, this subset had a lower two-year overall survival of 68 percent.

These patients, the researchers noted, might benefit from increased surveillance or adjuvant therapy.

The researchers added that their findings suggest that oral rinses to detect HPV DNA in head and neck cancer patients might be helpful. They cautioned, though, that its clinical utility might be limited by the need to identify tumor-type infections.

“Ongoing studies will evaluate whether multiplexed detection of plasma HPV DNA can improve these limitations,” the researchers added.

NOTE: This research was paid for in part by the Oral Cancer Foundation,www.oralcancer.org

May, 2019|Oral Cancer News|

Twitter lends insight to HPV-associated oral cancer knowledge

Source: www.oncnursingnews.com
Author: Brielle Benyon

The incidence of human papillomavirus (HPV)-associated oral cancer has risen in recent years, and the virus has now surpassed tobacco and alcohol use as the leading cause of the disease. In fact, while the HPV vaccine is typically associated with preventing cervical cancer, there have been more cases of HPV-associated oral cancer than there have been cervical cancer.1

While the link between oral cancer and HPV may be well-known to healthcare professionals, researchers at Howard University recently took to Twitter to get a glimpse into the public’s knowledge about the topic.

“By looking at the social media data, we wanted to know what people are hearing about oral cancer – especially HPV-caused oral cancer,” study co-author Jae Eun Chung, PhD, associate professor in the Department of Strategic, Legal & Management Communication at Howard University, said. “We wanted to see what the gaps are between the knowledge of the healthcare professionals and the public.”

The researchers collected 3,229 unique tweets over the course of 40 weeks using search terms such as “HPV or papilloma” and “mouth or oral or throat or pharyngeal or oropharyngeal.” They then used a program called nVivo 12.0 to conduct a content analysis that looked at certain phrasing, terms, and themes that commonly appeared.

More than half (54%; 1679 total) of the tweets had information about prevention, while 29% (910) were about the causes of oral cancer. Far fewer tweets were about treatment (5%; 141), diagnosis (3%; 97), symptoms (1%; 42), and prognosis (1%; 25).

Interestingly, the researcher discovered a prominence on the risk of HPV-associated oral cancer in men, with tweets that referred to males outnumbering tweets that referred to females in a 3:1 ratio. Also, the most popular hashtag used in the dataset was #jabsfortheboys, appearing in 89 tweets.

“There was a heavy emphasis on the risk of HPV-associated (oropharyngeal cancer) among men, which is different than what we see with HPV vaccination among girls,” Chung said. “That was very positive news to us, because HPV-associated (oral cancer) rates are higher among the male population and HPV vaccination rates are higher among girls.”

While spreading HPV vaccination and oral cancer is important on a global scale, the United States might have some catching up to do, as the 5 most mentioned Twitter users discussing the topic were located outside of the US–1 in New Zealand, 2 in Australia, and 2 in the United Kingdom.

“That’s kind of sad, because there are more Twitter users from the United States than from any other country,” Chung said.

Ultimately, Chung explained, these findings outlined an area where the country can benefit from more education and social media campaigns.

“In conclusion, this study provides some insight as to how the public makes sense of HPV-associated oral cancer,” she said. “More education and campaigns are needed, and US residents can benefit from more active involvement of US-based health education.”

Reference
1. Chung JE, Mustapha I, Gu X, Li J. Understanding public perception about human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) through Twitter. Presented at: D.C. Health Communication Conference; Fairfax, Virginia; April 26-27, 2019.

May, 2019|Oral Cancer News|

The HPV Vaccine Is Already Dramatically Lowering Rates of Cervical Disease

Source: Gizmodo
Date: 04/03/19
Author: Ed Cara

A new study out Wednesday in the BMJ is the latest to showcase even the short-term benefits of the human papillomavirus (HPV) vaccine. It found that the routine vaccination of preteen girls in Scotland, starting in 2008, led to drastically lower rates of cervical disease by the time the girls turned 20. That included conditions known to raise the risk of cervical cancer later on in life.

There are over 100 different types of HPV that regularly infect humans. Most types cause no symptoms at all, while some can cause annoying but harmless warts on our hands, feet, or genitals, depending on where they like to call home. High-risk HPV types, however, linger in the cells that line the surfaces of our body, triggering changes that can eventually turn them cancerous. These HPV types account for nearly all cases of cervical cancer, as well as a substantial proportion of cancers in the mouth, throat, anus, and penis.

We’ve had a vaccine available for two of the most common high-risk types of HPV since 2006, when it was at first recommended only for teen girls. Over the years, the window of opportunity for getting the vaccine has expanded, as has the number of HPV types it protects against. The newest version protects against seven high-risk types that account for 90 percent of cervical cancers (along with two types that cause genital warts). And young boys and men are now also encouraged to get the vaccine, as are women up to age 45.

Despite this increase in recommended age, getting vaccinated while young provides the most benefit, since it’s incredibly easy to contract HPV once a person becomes sexually active. But rates of childhood HPV vaccination in places like the U.S. are still abysmally low. According to one estimate, only 35 percent of children are fully vaccinated by age 15 (the current guidelines call for kids to begin their vaccination from age 11 to 12, with only two shots needed if they get both by age 15; otherwise three shots are required). That low adherence rate not only hampers the protective effects of the vaccine, it also complicates efforts by researchers to study the real-world impact of the vaccine on a population.

In countries like Scotland, though, routine HPV vaccination was quickly adopted and made commonplace, thanks to a nationally funded vaccination program that targeted 12- to 13-year-old girls starting in 2008, along with a later program that targeted older teens. But there are other factors that make Scotland an ideal country to test the value of widespread HPV vaccination, according to lead author Tim Palmer, a pathologist at the University of Edinburgh.

“Up until June 2016, we started [cervical disease] screening at age 20, so we’re one of the first countries to have immunized women attend for screening,” he told Gizmodo via email. “We are also one of the few countries to be able to link directly the fact that an individual had or had not been vaccinated and her screening outcome many years later.”

Palmer and his team looked at the records of more than 130,000 women in Scotland who received one of these cervical screenings at age 20. They compared women vaccinated for HPV as young girls to slightly older women vaccinated during the catch-up program and to unvaccinated women born in 1988.

Compared to these unvaccinated women, they found, the women vaccinated as young girls were far less likely to have any kind of cervical disease, defined as the growth of abnormal cells in the cervix. Most importantly, the rate of growths classified as a cervical intraepithelial neoplasia (CIN) grade 3 also dropped substantially, by nearly 90 percent. That’s crucial because a CIN3 growth puts women at their greatest risk of someday developing cervical cancer. According to Palmer, the 90 percent reduction they found is the largest drop seen with CIN3 in any population where HPV vaccination is available.

“Thus, we are confident that the reduction in CIN3 will lead to a reduction in cancers,” Palmer said.

The high vaccination rate in Scotland also had indirect effects, they found. The rate of cervical disease in the minority of women who were eligible but did not get vaccinated dropped as well, meaning vaccine coverage was high enough to provide some herd immunity (put simply, the more protected a population is from a disease, the less opportunity the disease has to spread to unprotected people). As expected, women who were older when vaccinated still had a lower rate of cervical disease than unvaccinated women, but not to the same degree as those who got the vaccine when young.

All in all, Palmer said, the study shows that Scotland’s HPV program has been an unmitigated success, one that will continue to pay off for decades. And Scotland’s early success story should provide plenty more motivation for other countries to drive up their own local vaccination rates.

That said, it’ll still take some time before we can really be sure that cervical cancer rates will similarly plummet, since many women develop it in their mid 30s and 40s. But Palmer says his team is already at work studying screening data that might show the vaccine’s effectiveness at preventing earlier cases of cancer.

The growing success of the HPV vaccine might eventually lead to changes in how we screen women for cervical cancer, Palmer said, since there’ll be fewer total cases of cancer to catch—a welcome problem, obviously.

“Ultimately, when routinely immunized women form the majority of the women eligible for screening, the need for cervical screening programs should be reviewed; they may no longer be justified,” he said. “However, this point will not be reached in Scotland for at least 25 or 30 years. Before that stage, the frequency and number of screening tests will need to be reviewed; there are suggestions that just two or three tests in a screening ‘lifetime’ will be adequate.”

Currently, in the U.S., it’s estimated there are 12,000 new cases of cervical cancer annually.

April, 2019|Oral Cancer News|

Flossing and going to the dentist linked to lower risk of oral cancer

Source: www.livescience.com
Author: Yasemin Saplakoglu, Staff Writer

Regularly flossing and going to the dentist may be tied to a lower risk of oral cancer.

That’s according to findings presented March 31, here at the American Association for Cancer Research (AACR) annual meeting.

In the new study, researchers analyzed the dental health behaviors of patients who were diagnosed with oral cancer between 2011 and 2014 at the ear, nose and throat clinic at The Ohio State University Comprehensive Cancer Center. The patients’ behaviors were compared to those of non-cancer patients who came to the clinic for other reasons, such as dizziness or an earache. [7 Odd Things That Raise Your Risk of Cancer (and 1 That Doesn’t)]

All of the patients in the study had responded to a survey that included questions about how often they flossed, how often they went to the dentist, how sexually active they were and if they smoked or drank alcohol.

Oral cancer can be divided into two categories: those driven by the sexually transmitted human papillomavirus (HPV) and those that aren’t, said lead study author Jitesh Shewale, a postdoctoral fellow at the University of Texas MD Anderson Cancer Center in Houston. (Smoking and drinking are both risk factors for non-HPV oral cancers.)

After adjusting for factors such as age, gender, socioeconomic status and race, the researchers found that oral HPV-negative people who went to the dentist less than once a year had nearly twice the risk of developing oral cancer than those who went once a year or more. Similarly, oral HPV-negative people who flossed less than once a day had over twice the risk than those who flossed more. In other words, poor oral hygiene was linked to increased non-HPV oral cancer risk.

The study didn’t find an association between poor dental hygiene and oral cancer in those who also had oral HPV, however.

The researchers hypothesize that the oral microbiome may play a role in the association between oral hygiene and cancer risk. In previous research, scientists from the same team found evidence that “poor oral hygiene practices causes a shift in your oral microbiome,” Shewale told Live Science. That shift “promotes chronic inflammation and [can lead to] the development of cancers.” HPV-positive oral cancers mostly affect the base of the tongue and the tonsils region, while HPV-negative cancers mostly affect oral cavities, which are more affected by oral hygiene, he added.

Denise Laronde, an associate professor in dentistry at the University of British Columbia who was not a part of the study, said that the new research was “interesting” but added that it was too early to draw conclusions. (The study found an association between oral hygiene and cancer risk, but did not show cause-and-effect.)

Still, “a lot of the times people look at their oral health as almost disconnected from the rest of their body,” Laronde told Live Science. “But so many systemic diseases are reflected in your oral health and vice versa.”

Laronde added that the new research will hopefully raise awareness about the importance of flossing. “We all know people say they floss way more than they do,” she said. But studies like this raise awareness that “you’re not just flossing to keep your teeth, you’re flossing to maintain your health.”

The findings have not yet been published in a peer-reviewed journal.

April, 2019|Oral Cancer News|

Robot that can cut out hard-to-reach throat tumours through patients’ mouths: Pioneering operation reduces need for chemo and radiotherapy

Source: www.dailymail.co.uk
Author: Fiona McCrae, Roger Dobson

British surgeons are using a cutting-edge robot to remove difficult-to-reach throat tumours – through the mouths of patients.

The pioneering operation is designed to dramatically reduce the need for gruelling radiotherapy and chemotherapy, which can leave patients unable to swallow and dependent on a feeding tube for life.

With growing numbers of people developing throat cancer, it is more important than ever to have a range of effective treatments that lessen the impact on quality of life, says Asit Arora, consultant head and neck surgeon at Guy’s & St Thomas’ NHS Trust in London.

Once most common in elderly people with a history of drinking and smoking, rates of head and neck cancers have soared by 31 per cent in the past 25 years and are now as common in people in their 50s as in those in their 80s.

The 90 minute operation is designed to dramatically reduce the need for gruelling radiotherapy and chemotherapy, which can leave patients unable to swallow and dependent on a feeding tube for life

Much of the rise is attributed to HPV – a range of viruses that can be passed on during intimate and sexual contact. At least 80 per cent of the adult population carries some kinds of HPV on their skin, although most will never know it. In some cases, HPV can cause skin or genital warts, and other types are a known cause of cervical and anal cancers.

HPV can also infect the mouth and throat and is now to blame for at least half of throat cancers in the UK. Until a tumour occurs, the infection is typically symptomless.

Conventional treatment for early-stage throat cancer involves either powerful radiotherapy and chemotherapy to destroy the tumour, or laser surgery to cut it out.

Courses of radiotherapy and chemotherapy are time-consuming – some patients make up to 30 trips to hospital over a few months. The treatment can also damage the jaw and the swallowing muscles, meaning patients cannot eat without the help of a feeding tube.

Laser treatment is more gentle on the body but it can be difficult to cut out a hard-to-reach cancer completely and most patients need radiotherapy afterwards. Some also need chemotherapy.

Using the robot, the surgeon can zero in on the tumour and cut it away precisely. With the patient under general anaesthetic, the surgeon controls the robot with his hands and feet. One of the robot arms holds a 3D camera, while two others wield tiny instruments that can be passed through the mouth and into the throat, and turned and twisted in ways impossible with the human hand alone.

Surgery in the mouth and throat can be challenging because you are working in very small areas, manipulating surgical instruments in a tight space where there are important nerves and blood vessels to be avoided,’ says Mr Arora, who has pioneered robotic surgery for throat cancer in the UK.

‘With the latest robotic systems, we can be more targeted than ever before in how we treat these throat conditions in order to reduce unwanted side effects, particularly related to swallowing.’

Studies suggest that trans-oral robotic surgery (TORS) is at least as good as conventional surgery, although a definitive comparison has yet to be carried out, says Mr Arora. But importantly, by cutting out the tumour so precisely, it may reduce the amount of chemotherapy and radiotherapy patients need.

A £4.5 million Cancer Research UK trial into the procedure is now being carried out at Guy’s and hospitals around the country.

Mr Arora has used the method to remove about 30 throat tumours in the year since setting up the service with Jean-Pierre Jeannon, Guy’s clinical director for cancer.

The operation takes 90 minutes and patients are usually discharged after two days. They then undertake rehab, including speech therapy.

Retired policeman David Wonfor, 60, chose to take part in the trial after being diagnosed with early-stage throat cancer last summer. After his operation, David, 60, of Petts Wood, Kent, started on five weeks of low-dose radiotherapy. Although he lost weight and his sense of taste at first, he has now largely recovered, and says he is convinced that his recovery would have been very different if he had had chemotherapy.

March, 2019|Oral Cancer News|

HPV infection may be behind rise in vocal-cord cancers among young nonsmokers

Source: www.eurekalert.org
Author: Public Release Massachusetts General Hospital

A remarkable recent increase in the diagnosis of vocal-cord cancer in young adults appears to be the result of infection with strains of human papilloma virus (HPV) that also cause cervical cancer and other malignancies. Investigators from Massachusetts General Hospital (MGH) describe finding HPV infection in all tested samples of vocal-cord cancer from 10 patients diagnosed at age 30 or under, most of whom were non-smokers. Their report appears in a special supplement on innovations in laryngeal surgery that accompanies the March 2019 issue of Annals of Otology, Rhinology and Laryngology.

“Over the past 150 years, vocal-cord or glottic cancer has been almost exclusively a disease associated with smoking and almost entirely seen in patients over 40 years old,” says Steven Zeitels, MD, director of the MGH Division of Laryngeal Surgery, senior author of the report. “Today nonsmokers are approaching 50 percent of glottic cancer patients, and it is common for them to be diagnosed under the age of 40. This epidemiologic transformation of vocal-cord cancer is a significant public health issue, due to the diagnostic confusion it can create.”

The researchers note that the increase in vocal-cord cancer diagnosis appears to mimic an earlier increase in the diagnosis of throat cancer, which has been associated with infections by high-risk strains of HPV. After initially attributing incidents of vocal-cord cancer in nonsmokers, which they began to see about 15 years ago, to increased travel and exposure to infectious diseases, Zeitels and his colleagues decided to investigate whether HPV infection might explain the diagnosis in younger nonsmokers.

To do so they examined the records of patients treated by Zeitels either from July 1990 to June 2004 at Massachusetts Eye and Ear Infirmary or between July 2004 and June 2018 at MGH. Of 353 patients treated for vocal-cord cancer during the entire period, none of the 112 treated from 1990 to mid-2004 were age 30 or younger. But 11 of the 241 patients treated from 2004 to 2018 were 30 or younger – 3 were age 10 to 19 – and only 3 of the 11 were smokers. Analysis of tissue samples from the tumors of 10 of the 11 younger patients revealed high-risk strains of HPV in all of them.

The authors note that these high-risk-HPV-associated vocal-cord cancers greatly resemble recurrent respiratory papillomatosis (RRP), a benign condition caused by common, low-risk strains of HPV. One of the 11 patients treated by Zeitels had previously been diagnosed at another center with vocal-cord cancer, and when it recurred after being surgically removed, she was misdiagnosed with RRP and treated with a medication that made the cancer worse, leading to the need for a partial laryngectomy.

“Benign RRP of the vocal cords has been a well-known HPV disease for more than a century, and it is very remarkable that there is now an HPV malignancy that looks so similar, creating diagnostic and therapeutic confusion,” says Zeitels, the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School. “It should be noted that these HPV-associated vocal-cord carcinomas are not a malignant degeneration of the benign disease.”

Zeitels adds that HPV vocal-cord cancers are amenable to endoscopic treatment with the angiolytic KTP laser that he developed. “Large-scale studies are now needed to determine the pace of the increase in glottic cancer among nonsmokers, the incidence of high-risk HPV in these cancers and changes in the age and genders of those affected,” he says.

Note:
The lead author of the Annals of Otology, Rhinology and Laryngology paper is Semirra Bayan, MD, previously a fellow in laryngeal surgery at MGH and now at University of Chicago Medicine; William Faquin, MD, PhD, MGH Pathology, is a co-author. The study was supported by the Voice Health Institute, the National Philanthropic Trust, and the Eugene B. Casey Foundation.

March, 2019|Oral Cancer News|

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