HPV

How Marijuana Accelerates Growth of HPV-related Head and Neck Cancer Identified

University of California San Diego School of Medicine researchers have identified the molecular mechanism activated by the presence of tetrahydrocannabinol (THC) — the ingredient that causes people to feel the euphoria or “high” associated with cannabis — in the bloodstream that accelerates cancer growth in patients with human papillomavirus (HPV)-positive head and neck squamous cell carcinoma.

“HPV-related head and neck cancer is one of the fastest growing cancers in the United States. While at the same time, exposure to marijuana is accelerating. This is a huge public health problem,” said Joseph A. Califano III, MD, senior author and professor and vice chief of the Division of Otolaryngology in the Department of Surgery at UC San Diego School of Medicine.

Head and neck squamous cell carcinoma is the sixth most common cancer worldwide. These cancers begin in the cells that line the mucous membranes inside the mouth, nose and throat. Approximately 30 percent of cases of this disease are related to HPV infection, and it is these cases, in particular that are on the rise. Califano suggested increased marijuana use may be a driving factor.

Previous studies have linked daily marijuana exposure to an increased prevalence of HPV-related throat cancer. However, a mechanism linking cannabis exposure to increased growth of the cancer was unknown.

Reporting in the January 13, 2020 online edition of Clinical Cancer Research, a journal of the American Association for Cancer Research, researchers outline how the presence of THC in the bloodstream activates the p38 MAPK pathway, which controls programed cell death called apoptosis. When activated, p38 MAPK prevents apoptosis from occurring, thus allowing cancer cells to grow uncontrollably.

Working with Chao Liu, MD, visiting scientist at UC San Diego and a physician at China’s Central South University, and other colleagues, Califano and team used animal and human cell lines to show that THC turns p38 MAPK on and were able to stop the growth of HPV-positive head and neck cancer by turning off the pathway.

The team then analyzed blood samples from patients with HPV-related throat cancer who had their genomes comprehensively mapped to define activated gene pathways. Similar to the cell lines, the blood samples showed p38 MAPK activation and loss of apoptosis in tumors from patients with THC in their blood.

The authors said studies and public opinion suggestions that THC and other cannabis products have cancer-fighting properties need additional, more critical evaluation. Past studies showing anticancer effects of THC and other cannabinoids often used levels of THC higher than those found with recreational use, but doses used recreationally clearly activate a cancer-causing pathway, said Califano.

“We now have convincing scientific evidence that daily marijuana use can drive tumor growth in HPV-related head and neck cancer,” said Califano. “Marijuana and other cannabis products are often considered benign, but it is important to note that all drugs that have benefits can also have drawbacks. This is a cautionary tale.”

According to the Centers for Disease Control and Prevention (CDC), HPV infections are responsible for approximately 35,000 new cancer diagnoses each year in the United States. Infection is so common that nearly all men and women will get at least one type of HPV at some point in their lives. Most clear up on their own, without the person ever knowing they’ve had it.

Several vaccines are available that can prevent the majority of HPV-related cancers. The vaccines work best when they are given before a person is exposed to the virus. The CDC recommends vaccinating boys and girls age 11 to 12 years old but it can be administered as early as age 9.

According to the National Institute on Drug Abuse, 15 percent of youth 12 to 17 years old and 47 percent of adults age 26 and older have used or tried marijuana.

Together, a low HPV vaccination rate and an increase in marijuana use among youth has the makings of a storm, said Califano, physician-in-chief and director of the Head and Neck Cancer Center at Moores Cancer Center at UC San Diego Health.

Moores Cancer Center is one of only 51 National Cancer Institute-designated Comprehensive Cancer Centers in the country and the only such center in San Diego County.

Treatment options for patients with early- or late-stage head and neck cancers include minimally invasive surgery, reconstruction and rehabilitation, proton therapy and other radiation therapy, innovative clinical trials and targeted therapy, including immunotherapy.

The Head and Neck Cancer Center provides comprehensive care that includes counseling, education and support groups, nutrition, dental rehabilitation, speech and language therapy and social workers to help patients through every step of the process beginning with diagnosis to support lifelong wellness.

Califano and team are now looking at whether cannabidiol, or CBD, has a similar effect to THC. CBD is another major chemical compound found in marijuana, but does not produce the “high” and is now commonly used in various over-the-counter products, such as lotions, ointments and edibles.

In addition, the team is investigating whether p38 MAPK can be targeted with drugs to stop HPV-related head and neck cancer from growing.

Co-authors include: Chao Liu, Sayed Sadat, Koji Ebisumoto, Akihiro Sakai, Bharat Panuganti, Shuling Ren, Yusuke Goto, Sunny Haft, Takahito Fukusumi, Mizuo Ando, Yuki Saito, Pablo Tamayo, Huwate Yeerna, William Kim, Jacqueline Hubbard, Andrew Sharabi and J. Silvio Gutkind from UC San Diego; and Theresa Guo from Johns Hopkins Medical Institutions.

Funding for this research came, in part, from the National Institute of Dental and Craniofacial Research and National Institute of Health (R01 DE023347, U01CA217885, R01HG009285, R01CA121941 and P30CA023100).

January, 2020|Oral Cancer News|

Cervical pre-cancer rates down 88% in decade since HPV vaccinations began – first findings

Source: The Conversation
Date: April 19, 2019
Author: Kevin Polluck

Cervical cancer is the third most common cancer among women in the UK under the age of 35 after breast and skin cancer. In the majority of cases, the cancer only develops if the patient is infected with human papillomavirus (HPV) types 16 or 18. This virus is mainly transmitted between people having vaginal, anal or oral sex. At some point in their lives, four in five people will be infected by HPV strains – as many as 14 can cause cancer in total. According to recent studies, other cancers heavily linked to HPV infections include head-and-neck, vulvo-vaginal and anal.

In an effort to reduce rates of cervical cancer, a number of countries launched immunisation programmes in the late 2000s, starting with Australia in 2006. The UK and its devolved governments launched a school immunisation programme in 2008 to vaccinate all girls aged 12-13. To speed up the time lag associated with achieving the benefits of vaccination, they also kicked off a three-year catch-up programme for girls aged up to 18 years.

A decade on, we are finally able to publish the first results. The data relates to Scotland, since it was cervically screening women from the age of 20 until 2016 – before falling into line with the minimum age of 25 used in the rest of the UK. This meant that Scotland obtained screening data for the 2008-09 cohort before the change in screening age. Scotland also has very detailed information about take-up rates, which have been very high: running to approximately 90% in Scotland for the routinely vaccinated girls and 65% for the older girls vaccinated as part of the catch-up programme.

For the first time, we can now confirm that the vaccination programme has begun to profoundly alter the prevalence of HPV 16 and 18 among Scottish women – and presumably elsewhere as well.

The study

My team performed an eight-year study of the women eligible for the Scottish national vaccination and cervical screening programmes. We looked at their vaccination status, year of birth, indicators of deprivation and whether they lived in urban or rural areas. Using complex statistical modelling, we were able to calculate the effect of vaccination on cervical pre-cancer. Though not all pre-cancer becomes cancer, all cancer requires pre-cancer. Cervical pre-cancer occurs quicker than cancer and therefore this focus has allowed us to see the impact of the vaccine earlier.

Among women born in 1995-96 – the first group to go through the regular vaccination programme in 2008/09 – there has been an 88% reduction in rates of cervical pre-cancer. This is a fall in incidence from 1.44% to 0.17%.

Not only that, women born in these years who had not received the vaccine were also less likely to develop cervical pre-cancer. This was because the high vaccine uptake meant that HPV incidence was much lower in their age group, thanks to a phenomenon known as “herd protection”. This is particularly good news, since this group is also less likely to attend cervical screenings.

The findings clearly show that the routine HPV vaccination programme for girls aged 12 to 13 has been a resounding success. This is consistent with the fact that we have also seen a big fall in high-risk HPV infection in Scotland in recent years. The obvious conclusion is that we are going to see far fewer cases of cervical cancer in years to come.

From September, the UK is going to extend the vaccination programme to boys – becoming one of numerous countries to do so. This is in response to the fact that rates of head and neck cancer are rising in men: approximately 60% of head and neck cancer is associated with HPV16 infection, and should therefore be mostly preventable through vaccination. This programme should also mean that high-risk HPV infections among the population should be eliminated more quickly, which should have knock-on benefits for rates of HPV-driven cancers.

Meanwhile, in parts of Canada, HPV vaccinations are now being offered to uninfected women as part of the cervical screening process. This may protect older women from developing cervical cancer. This process may be adopted internationally, including the UK. When we look at the picture as a whole, eliminating the HPV virus, and making huge inroads into the various cancers that it helps develop, is now becoming a realistic possibility.

 

 

January, 2020|Oral Cancer News|

Single dose of HPV vaccine may be as effective as three

Source: www.laboratoryequipment.com
Author: Michelle Taylor, Editor-in-Chief

More than a decade after the introduction of a vaccine that has been proven to stave off 90 percent of human papillomavirus-caused cancers, only half of U.S. adolescents have completed the 3-shot series. While part of that can be attributed to adolescents and adults who question the validity of the vaccine, the majority is due to unawareness of or forgetting the need for additional doses, lack of insurance and non-frequent contact with the medical system.

But, a new study from researchers at the University of Texas Health Science Center at Houston, has revealed a single-dose regimen may be equally as effective as the current 2- to 3-dose system.

“Ensuring boys and girls receive their first dose is a big challenge in several countries and a majority of adolescents are not able to complete the recommended series due to a lack of intensive infrastructure needed to administer two or three doses,” said the paper’s senior author Ashish Deshmukh, assistant professor at UTHealth School of Public Health. “If ongoing clinical trials provide evidence regarding sustained benefits of a one-dose regimen, then implications of single-dose strategy could be substantial for reducing the burden of these cancers globally.”

Deshmukh’s study examined the difference in the prevalence of HPV infection in a total of 1620 women aged 18 to 26 of whom 1,004 were unvaccinated, 616 received at least 1 dose of HPV vaccine 106 received just 1 dose, 126 received 2 doses and 384 received 3 doses.

Compared with unvaccinated women who had a HPV infection (4-valent vaccine types [6,11,16 and 18]) prevalence of 12.5%, women who received at least one dose showed significantly less prevalence—2.4% for women with 1 dose, 5.1% for those with 2 doses and 3.1% for those who received all 3 doses.

According to the paper recently published in JAMA Network Open, there was no significant difference in prevalence for 1 dose versus 2 doses or 1 dose versus 3 doses. Additionally, differences were not statistically significant for cross protection (HPV types 31, 33, and 45), and other high-risk HPV types (HPV types 35, 39, 51, 52, 56, 58, 59, and 68).

Using a multivariable logistic regression model, the authors predicted the probability of HPV infection (types 6, 11, 16, 18) to be higher in unvaccinated women (7.4%) compared with women who received 1 dose (2.3%), 2 doses (5.7), or 3 doses (3.1%).

According to the CDC, 34,800 new cancer diagnoses are linked to human papillomavirus (HPV) annually. The virus is thought to account for more than 90% of all cervical and anal cancers, more than 60% of all penile cancers, and approximately 70% of all oral cancers. While the study authors stressed it is too early for people to rely on a single dose for protection against these cancers, they are encouraged by the results of their research.

“The current HPV vaccine dosing regimen can be cumbersome for people to understand. If one dose is proven effective in trials, the vaccine regimen will be simplified,” said lead author Kalyani Sonawane, also an assistant professor at UTHealth School of Public Health. “This will help improve the coverage rate among adolescents that are currently below the Healthy People 2020 goal and possibly will also increase the momentum of uptake in the newly approved age group.”

January, 2020|Oral Cancer News|

Test that looks at your spit to tell if you have mouth or throat cancer caused by HPV ‘could save thousands of lives if rolled out for doctors to use’

Source: www.dailymail.co.uk
Author: Connor Boyd, Health Reporter

A saliva test that diagnoses mouth and throat cancer caused by HPV could save thousands of lives each year, a study suggests. Scientists at Duke University in North Carolina discovered the test was 80 per cent accurate at spotting the killer diseases.

Doctors say it is able to detect the cancers early on, giving patients much higher hopes of surviving their battle. Before it can be used in hospitals around the world, further trials will be needed to confirm the technology works. But the researchers are hopeful, claiming the cheaper test – which gives results in as little as 10 minutes – has significant ‘potential’.

Rates of oral cancers are soaring in the Western world, with the number of patients diagnosed in the UK having doubled in a generation. US doctors have also seen a similar spike in the diseases, which can be caused by human papilloma virus (HPV).

The infection – spread through oral sex, as well as anal and vaginal intercourse – is thought to cause around 70 per cent of all cases. Other risk factors include drinking excessive amounts of alcohol over long periods of time and smoking cigarettes.

Professor Tony Jun Huang, study co-author, said there are around 115,000 cases of oropharyngeal cancers each year across the world. He said it is ‘one of the fastest-rising cancers in Western countries due to increasing HPV-related incidence, especially in younger patients’.

Orophayngeal cancer starts in the oropharynx, the back of the throat which includes the base of the tongue and tonsils. It sits under the branch of head and neck cancers, which also includes mouth cancer – another type that can be caused by HPV. Detecting the disease early can boost survival odds from 50 per cent to 90 per cent, according to the NHS. But patients are often not diagnosed until they become advanced, partly because their location makes them difficult to see during routine clinical exams.

The new test uses a chip developed to isolate tiny micro-particles, known as exosomes, in saliva.These particles are secreted into body fluids and several types of cancers are known to multiply their numbers. Exosomes are responsible for transferring molecules between cancer and various cells.

The new test isolates them by filtering out larger particles in the saliva and probing the exosomes for DNA shed by tumours. It also scans fluid in the mouth for HPV-16, one strain of the STI that can put people at risk of oropharyngeal cancer. The test takes five minutes to conduct and a further five to process the results. Experts also said it is cheap – but did not elaborate on the cost. In comparison, current biopsies take around eight hours because they need to be sent away to be assessed by a surgeon.

Professor Huang said: ‘It is paramount that surveillance methods are developed to improve early detection and outcomes.’ He added the successful detection of HPV from saliva ‘offers advantages including early detection, risk assessment, and screening’.

The test was a collaboration between Duke University, the University of California and University of Birmingham in Britain.

Orophayngeal cancer killed 2,722 Britons last year and took the lives of 9,750 people in the US, figures show. New cases of the disease in the UK have risen to 8,302 a year, a jump of 135 per cent compared with 20 years’ ago.

According to the researchers, this technology can also be used to analyse blood, urine, and plasma. The findings were published in the Journal of Molecular Diagnostics.

The Oral Health Foundation last month urged people to wise up to the causes of the ‘devastating’ disease, mainly HPV and alcohol. Dr Nigel Carter OBE, chief executive of the OHF, said: ‘While most cancers are on the decrease, cases of mouth cancer continue to rise at an alarming rate.

‘Traditional causes like smoking and drinking alcohol to excess are quickly being caught by emerging risk factors like the human papillomavirus (HPV).

‘We have seen first-hand the devastating affect mouth cancer can have on a person’s life.’

December, 2019|Oral Cancer News|

How the ADA Oral Cancer Policy Amendment Will Affect Your Practice

Source: Dentistry Today
Date: November 29th, 2019
Author: Jo-Anne Jones

The ADA recently announced an expansion to its policy on oral cancer detection recommending that dentists and dental hygienists perform routine examinations for oral cancer includingoropharyngeal cancer for all patients.

Passed by the ADA House of Delegates in September, this change was brought about to align with concerns from the Centers for Disease Control and Prevention (CDC) over the escalating numbers of diagnosed cases of oropharyngeal cancer linked to the human papillomavirus (HPV).

While HPV-related oropharyngeal cancer has risen by 225% over the past two decades, oral cancer linked to the historical etiologic pathways of tobacco and alcohol use has declined by 50%. The ADA’s policy also aligns with support for the HPV vaccine, as 70% of oropharyngeal cancers in the United States are related to HPV, according to the CDC.

Dentists and dental hygienists play a critical role in opportunistic screening on all adult patients despite whether they possess the historical risk factors of using tobacco products or alcohol. There is a distinct knowledge gap in today’s population to fully understand that a non-smoker and non-drinker may in fact be at risk for oral and oropharyngeal cancer due to HPV.

It is our responsibility to educate our dental patients about all of the risk factors that exist for both oral and oropharyngeal cancer. Now more than ever, it is critically important to extend our screening practices, both visual and tactile, to every adult in the practice on an annual basis.

Only about a third of adults in the United States report being screened for oral cancer, representing a strong disconnect in our ability to improve earlier discovery rates and improve treatment outcomes.

As dental professionals, it is critical that we elevate our understanding of the escalating profile of HPV-related oropharyngeal cancer. Researchers once predicted that cases of HPV-related oropharyngeal cancer would surpass the leading HPV-related cervical cancer by 2020. Yet recent data from national registries has now confirmed that HPV-related oropharyngeal cancer became the leading HPV-associated cancer in 2015.

How common is HPV-related oropharyngeal cancer? About 53,000 Americans will be diagnosed with oral and oropharyngeal cancer this year. Close to 20,000 of those cases will occur in the oropharyngeal area, with 70% related to HPV.

The CDC also reports that HPV is so common that almost all sexually active adults will have an infection in their lifetimes, with most of the population clearing the infection with no repercussions. In contrast, a persistent infection with a high-risk strain such as HPV-16 can transform into oral or oropharyngeal cancer.

This transformation may take anywhere between 15 and 30 years. It seems to be targeting a much younger profile of white, non-smoking males age 35 to 55 with a four-to-one incidence of gender predisposition of males over females.

HPV has an affinity for lymphoid tissues and occurs most commonly in the tonsillar areas and the base of the tongue, with a smaller percentage occurring anteriorly in the oral cavity. Due to limited visual acuity, it is important to know and recognize the subtle symptoms that may accompany a posteriorly positioned tumor of HPV origin.

The following symptoms may be among the first distinguishable signs of the presence of oropharyngeal cancer:

  • Bleeding in the mouth or throat
  • Hoarseness or a change in the voice
  • A lump in the throat or the feeling that something is stuck in the throat
  • Continual lymphadenopathy or persistent neck masses despite antibiotic therapy
  • Slurred speech or difficulty articulating certain sounds
  • A tongue that tracks to one side when stuck out
  • Asymmetry in the tonsillar area
  • A persistent or recurring throat infection that doesn’t fully resolve with antibiotics
  • Unilateral earache
  • A persistent cough

Oral cancer can be very subtle, so it is extremely important to use magnification such as loupes and a dedicated light source or headlight to be able to discern early visible changes. The paradox that exists is that abnormal cellular differentiation typically starts at the basement membrane. By the time it becomes visible, it has progressed to a later stage of development.

Tactile palpation is paramount in uncovering any areas of hardness or induration possibly suggesting a mass or a tumor that is not yet clinically visible.

Enhanced oral cancer screening with a device such as the VELscope Vx from Apteryx Imaging may reveal what is not visible to the naked eye. It employs direct fluorescence visualization, which has been used successfully in the cervix, lungs, and colon. Using a proprietary wavelength, it gives clinicians the opportunity to visually penetrate the tissue surface to reveal the basement membrane.

The VELscope Vx is an assessment tool, however, and it does not convey a diagnosis. The golden rule always applies. Any oral abnormality that exists beyond 14 days is suspect and requires referral for further evaluation.

The Oral Cancer Foundation offers comprehensive information to help healthcare professionals and the general public to learn more about HPV’s connection with oral and oropharyngeal cancer. In April of 2019, the group launched the “Check Your Mouth” campaign to educate the public about the importance of self-examination of the oral cavity between dental appointments.

The impetus behind this project was to improve earlier discovery rates by having the public self-refer should they find anything new or abnormal that persists beyond 14 days. Cards may be ordered free of charge from the Oral Cancer Foundation store for distribution to dental patients.

Lastly, sharing information regarding the HPV vaccine is one of the strongest prevention methods we have today to make positive inroads in minimizing this type of cancer. The Food and Drug Administration has approved the HPV vaccine for both boys and girls and expanded the use of Gardasil 9 to include individuals age 27 through 45.

Together, we can have an impact on the earlier discovery of oral and oropharyngeal cancer.

Disclosure: Jo-Anne Jones is a KOL and consultant with Apteryx Imaging.

Ms. Jones is the president of RDH Connection, an educational and clinical training company dedicated to quality education and team training. In the midst of preparing to present her extensive research on HPV-related oropharyngeal cancer to her national association, a loved one was diagnosed with late stage HPV-positive tonsillar cancer and lost her life 16 months later. Jo-Anne proudly partners with the Oral Cancer Foundation in conveying the urgent need for changing the way in which we screen for oral cancer to meet the needs of today’s population. She can be reached at jjones@jo-annejones.com.

Late stage head and neck cancer in the U.S. sees increasing incidence

Source: www.cancernetwork.com
Author: Hannah Slater

A study released in Cancer indicates that there is an increasing incidence of late stage head and neck cancer (HNC) in the U.S., mostly due to an increasing incidence of oropharyngeal cancer, most likely due to HPV-related disease in patients diagnosed at stage IVC.1

Blacks, males, those who are underinsured or uninsured, and those who are unmarried tend to fare worse than others. The presented research highlights the need for continuous public health efforts toward the early detection of HNC.

In this cohort of 57,118 patients with stage IV HNC, the age-adjusted rates for stage IV HNC significantly increased by 26.1% (6.11 per 100,000 person-years in 2004 to 7.70 per 100,000 person-years in 2015). Despite a decreasing overall incidence of stage IV HNC in black patients (adjusted OR, 1.28; 95% CI, 1.22-1.34), they along with males (adjusted OR, 3.95; 95% CI, 3.80-4.11) had significantly increased risks of being diagnosed with late-stage HNC.

“In the absence of a mortality benefit for asymptomatic mass screenings, as per the U.S. Preventive Services Task Force oral cancer screening guideline, it is critical that there is sustained public awareness and education regarding the early detection of HNC, and prevention through cancer risk mitigation practices,” the researchers wrote.

Although black males had the highest risk of being diagnosed, the most significant change in annual incidence patterns was driven by white males (annual percent changes, 3.13; P < .01). A significant increase in incidence occurred in the population >50 years, with males tending to be younger at the time of diagnosis than females.

Of all primary tumor sites, the oropharynx was the most likely site for a late-stage diagnosis. The incidence of oropharyngeal cancer has increased dramatically in the U.S. within the last 40 years and is predominantly experienced by white males. Approximately 75% of cases of oropharyngeal cancer are associated with human papillomavirus (HPV), and these tumors often present with small primary tumors and larger cystic regional lymph node metastases as the first notable symptom.

Although patients with oropharyngeal cancer typically have a better prognosis, they also remain at risk of having positive lymph nodes and developing distant metastasis. Research indicated that the oropharynx, an HPV-related site, was the only site to experience a significant increase in the incidence of metastatic stage IV disease.

“If rates of true late-stage HNC continue to rise, it remains paramount to identify those patients who are at risk of potentially worse prognoses when HPV status is unknown,” the researchers wrote.

Stage IV was defined using the American Joint Committee on Cancer (AJCC) sixth edition stage classification as stages IVA, IVB, IVC, and IV not otherwise specified. With recent changes in AJCC staging, future studies are warranted to describe incidence trends based on new staging guidelines.

According to the CDC, HPV is so common that nearly all sexually active men and women get the virus at some point in their lives. Oropharyngeal cancers have traditionally been caused by tobacco and alcohol; however recent studies have suggested that about 70% of cancers of the oropharynx may be linked to HPV.2

References:
1. Thompson-Harvey A, Yetukuri M, Hansen AR, et al. Rising Incidence of Late-Stage Head and Neck Cancer in the United States. Cancer. doi:10.1002/cncr.32583.
2. CDC. Human Papillomavirus (HPV) Statistics. CDC website. cdc.gov/std/hpv/stats.htm. Published January 4, 2017. Accessed November 21, 2019.

November, 2019|Oral Cancer News|

How to encourage vaccination against HPV cancers? Drexel study suggests taking a cue from anti-vaxxers

Source: www.inquirer.com
Author: Marie McCullough

To persuade more people to get the cancer-preventing HPV vaccination, public health groups should emulate a tactic of the anti-vaccine movement, concludes a Drexel University study of Instagram posts.

The researchers aren’t suggesting that vaccine proponents spread misinformation on social media, as vaccine foes do. But the study found that emotional, personal accounts with photos of youngsters — a staple of anti-vaccine content — get way more “likes” than the dispassionate, factual messages typical of pro-vaccine posts.

“By studying what makes these messages so effective, we can improve fact-based, pro-vaccination messaging,” said senior author Philip M. Massey, a community health researcher at Drexel.

The study, which analyzed 360 Instagram posts from April to August of last year, was conducted before Facebook — the owner of Instagram — announced this spring that it would curb anti-vaccine messages. But such content still abounds, because Facebook’s crackdown is limited to recommendations and ads.

Before the crackdown, a majority of Facebook ads spreading vaccine misinformation were funded by just two groups, one led by Robert F. Kennedy Jr.’s World Mercury Project, according to a study published this month in the journal Vaccine.

Another study, in JAMA Pediatrics in September, found that 13 years after Merck’s Gardasil vaccine was hailed as a revolution in cancer prevention, most Americans still don’t know that HPV (human papillomavirus) is a family of sexually transmitted germs that can cause oral and genital cancers, and most doctors still aren’t promoting the shots.

The immunization is recommended for boys and girls at age 11 or 12, before they become sexually active, and as “catch-up” shots to age 26. But only about half of U.S. teens have been fully vaccinated, federal data show. (Adults ages 27 to 45 can opt for the immunization, although they are less likely to benefit.)

Despite low uptake, many studies show vaccination has reduced genital warts and precancerous lesions that can progress to cancer. (It will take more time to see the impact on cancer rates.)

But studies also show that while cervical cancer rates have declined over the last 20 years because of routine Pap screening, rates of mouth and throat cancers in men have risen more than 200%, and anal cancers in women have risen 150%.

Scientific groups and global health authorities who continue to monitor the vaccine assert that it is safe and does not cause chronic pain, heart arrhythmias, autoimmune diseases, life-threatening allergic reactions, stroke, neurological disorders, premature ovarian failure, miscarriages, or other health problems.

But that does not prevent vaccine foes from saying it does.

“So many sad stories on here,” a woman posted recently on the Facebook page Gardasil Class Action Australia. “Here’s mine. I had Gardasil in 2007, had a miscarriage in early 2008, and now have chronic fatigue and fibromyalgia. It’s so hard to be a good mum and give the kids what they need and the house clean when you’re sooo tired and your body aches.”

The Drexel study found that 46% of anti-vaccine posts on Instagram featured personal narratives, compared with 28% of pro-vaccine posts. Each anti-vaccine message got an average of 86 likes, compared with 24 likes per pro-vaccine post.

The paper, published in the journal Health Education and Behavior, has only a few examples of actual pro and con posts, including these:

“Your child can get protection for HPV cancers during the same visit they are protected against other serious diseases,” says the U.S Centers for Disease Control and Prevention.

“Jamie is not doing well after her first Gardasil vaccine for HPV prevention. She keeps turning yellow, wants to throw up and pass out,” says a post that shows a teenage girl folded over her knees in a chair.

Although the study does not propose potential pro-vaccine narratives, Massey said in an interview that developing and testing such messages on parents of preadolescents is the next step in his research.

He pointed to a recent Merck TV commercial as an example of a pro-vaccine message that “pulls at the heartstrings.” It portrays a young woman or young man with HPV-related cancer, voicing over a retrospective of photos and videos going back to age 11 or 12. The man speculates that his parents didn’t know about HPV or the vaccine, then his tween self asks, “Right, Mom? Dad?”

“The bottom line,” Massey said, “is that there’s a great opportunity to incorporate storytelling into our pro-vaccine messages.”

November, 2019|Oral Cancer News|

Despite only a 50% HPV vaccination rate in adolescents, cervical precancer incidence rates drop

Source: www.targetedonc.com
Author: Tony Berberabe, MPH

Although a vaccine for the human papillomavirus (HPV) is widely available, an average of 34,800 HPV-associated cancers attributable to the virus, including cervical, vaginal, vulva, penile, anal, and oropharynx were reported in the United States from 2012 through 2016, according to data published in Morbidity and Mortality Weekly Report.1 The estimated number of cancers attributable to HPV types targeted by the 9-valent HPV vaccine (9vHPV) is also rising. These recent increases are due in part to an aging and growing population and increases in oropharyngeal, anal, and vulvar cancers, lead author Virginia Senkomago, PhD, MPH, an epidemiologist and senior service fellow at the Centers for Disease Control and Prevention in Atlanta, Georgia, said in an email.

Although HPV vaccination is an important component of cancer prevention, only about 50% of adolescents have received the vaccine. Of cancer cases attributable to the HPV types targeted by the vaccine, 19,000 (59%) occurred in female patients and 13,100 (41%) occurred in male patients.

But there is some good news.

Senkomago said HPV infections and cervical precancers have dropped significantly since the vaccine was introduced. Infections with HPV types have dropped 86% among teenage girls. Among vaccinated women aged 20 to 24 years, the percentage of cervical precancers caused by the HPV types most often linked to cervical cancer dropped by 40%. The vaccination is recommended through age 26 for all individuals, especially for those who were not vaccinated when they were younger. The vaccine is not recommended for individuals older than 26 years, but some adults between 27 and 45 years may decide to get the HPV vaccine based on a discussion with their clinician. HPV vaccination provides less benefit to adults in this age range, as more have already been exposed to HPV, said Senkomago.

Further, it is anticipated that compliance should increase because the original 3 doses every 2 months now seems to be getting replaced by 2 doses with similar efficacy rates.

Previous annual estimates of cancers attributable to the types targeted by 9vHPV were 28,500 (2008-2012),2 30,000 (2010-2014),3 and 31,200 (2011-2015).4

“HPV is a distinct subset of head and neck cancers. It now exceeds cervical cancer as a major health burden in the [United States] because, in part, there’s no effective screening strategy,” said Robert L. Ferris, MD, PhD, director of the University of Pittsburgh Medical Center’s Hillman Cancer Center in Pittsburgh, Pennsylvania, and co–physician editor in chief of Targeted Therapies in Oncology. A number of challenges exist in the treatment of patients with HPV-positive head and neck cancer, Ferris said. These include lack of a screening tool and relatively low adherence to vaccination. The disease also has a long latency period,5 adding to the difficulty in treatment.

“These patients don’t have traditional risk factors,” Ferris continued. “They may just present to their doctor with a lump in the neck area with very few symptoms. They usually have no history of tobacco use or exposure history, so they can be overlooked for weeks and months before a needle biopsy is ordered. Needle biopsy can be diagnostic.”

Of the 32,100 HPV cancer types, those with the highest incidence were oropharyngeal and the lowest was vaginal (FIGURE 1), the report said.1

“We are striving to vaccinate as many people as possible. Right now our goals are identifying groups with the lower rates, such as people who live in rural areas, and working to remove unique barriers to vaccination they may face,” Senkomago said.

Senkomago added that the most surprising finding was that oropharyngeal cancer was the most common cancer attributable to HPV types targeted by 9vHPV in most states, except in Texas, where cervical cancer was most common, and in Alaska, New Mexico, New York, and Washington DC, where estimates of oropharyngeal and cervical cancers attributable to the 9vHPV-targeted types were the same (FIGURE 2).1

In particular, Senkomago said, these findings can inform community oncologists of the burden of HPV-associated cancers, especially in light of the increase of cases of oropharyngeal, anal, and vulvar cancers. Increasing awareness of the burden of the 7 HPV-associated cancers, individually and as a group, is a powerful prevention tool. Oncologists can advocate for strategies such as screening and HPV vaccination. In addition, community oncologists can work together with cancer survivors to engage communities to vaccinate and get screened as appropriate, she said.

Ferris cautioned against changing treatment algorithms too soon, especially before prospective clinical trials result are fully analyzed. “We need specific clinical trials before we can reduce the intensity of therapy because we don’t want to impair the very good survival, which can be 80% to 90%, in these patients and put that at risk,” he said. “We don’t want to jeopardize that strong survival rate. Those prospective clinical trials are ongoing, and those results should be reported out intensively in 2020, 2021, and beyond.”

Although the report focused on only the 9vHPV vaccine, a quadrivalent vaccine is also available. Investigators are evaluating whether any shift in the subtypes of HPV that cause cervical or head and neck cancer has been detected with the implementation of the quadrivalent vaccine. Senkomago said scientists continue to evaluate HPV types before and after vaccine introduction in population-based studies. To date, they have not found any evidence that type replacement is occurring.6

References:
1. Senkomago V, Henley J, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human papillomavirus—attributable cancers—United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2019;68(33):724-728. doi: 10.15585/mmwr.mm6833a3.
2. Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus–associated cancers — United States, 2008–2012. MMWR Morb Mortal Wkly Rep. 2016;65(26):661-666. doi: 10.15585/mmwr.mm6526a1
3. Cancers associated with human papillomavirus, United States—2010–2014. Centers for Disease Control and Prevention website. cdc.gov/cancer/uscs/about/data-briefs/no1-hpv-assoc-cancers-UnitedStates-2010-2014.htm. Accessed September 12, 2019.
4. Cancers associated with human papillomavirus, United States—2011–2015. Centers for Disease Control and Prevention website. cdc.gov/cancer/uscs/about/data-briefs/no4-hpv-assoc-cancers-UnitedStates-2011-2015.htm. Accessed September 12, 2019.
5. Human papillomavirus (HPV). Centers for Disease Control and Prevention website. cdc.gov/hpv/parents/cancer.html. Accessed September 10, 2019.
6. Mesher D, Soldan K, Lehtinen M, et al. Population-level effects of human papillomavirus vaccination programs on infections with nonvaccine genotypes. Emerg Infect Dis. 2016;22(10):1732-1740. doi: 10.3201/eid2210.160675.

November, 2019|Oral Cancer News|

Oral sex blamed for rise of mouth cancer in UK

Source: www.medicaldaily.com
Author: Darwin Malicdem

The number of people diagnosed with mouth cancer has significantly increased by 135 percent over the past 20 years in the United Kingdom. Experts believe the increase comes amid the growing number of Brits engaging in oral sex.

Nonprofit Oral Health Foundation (OHF) issued a report showing oral cancer rates “have more than doubled in a generation” across the U.K. In 2018 alone, seven people died every day from the disease in Great Britain and Northern Ireland.

“While most cancers are on the decrease, cases of mouth cancer continue to rise at an alarming rate,” Nigel Carter, chief executive of the OHF, told the Daily Mail. “It changes how somebody speaks, it makes eating and drinking more difficult, and often changes a person’s physical appearance.”

The foundation said the sexually transmitted human papillomavirus (HPV) caused 73 percent of the oropharyngeal mouth cancers. But drinking alcohol also contributed to the higher rates of the disease in the U.K.

OHF said 33 percent of mouth cancer diagnoses over the past decades were linked to consumption of alcoholic beverages. Smoking was associated with 17 percent of the cases.

The foundation launched Mouth Cancer Action Month in early November that aims to spread awareness of mouth cancer and its signs and symptoms.

“We want everyone to be more mouth aware during this year’s campaign,” Carter said in a press release. “This means being able to identify the signs and symptoms of mouth cancer, understand what is more likely to put us at greater risk, and importantly, know where to go if you spot anything out of the ordinary.”

He added early diagnosis has been effective to prevent deaths in the past years. Philip Lewis, of the Mouth Cancer Foundation, also highlighted that public awareness programs and self examination would help address the health issue.

In the U.S., the number of mouth cancer is also increasing. The Oral Cancer Foundation reported that nearly 54,000 Americans are being diagnosed with the disease every year.

Mouth cancer kills one person per hour in the country, leading to 13,500 deaths every year.

November, 2019|Oral Cancer News|

Health department official on HPV vaccine: “What are we waiting for?”

Source: www.mynews13.com
Author: Rebecca Turco

Despite studies from the CDC showing the effectiveness of the HPV vaccine at preventing certain types of cancer, some parents are still hesitant to get their children vaccinated.

  • 92% of almost 35,000 cancers could be prevented by vaccine
  • Doctor: Some parents may think vaccine promotes sexual behavior
  • County Health Departments offer HPV vaccine for free

Dr. Raul Pino, the interim administrator of the Orange County Health Department, wants to change that.

Among the estimated 34,800 cancers probably caused by the human papilloma virus between 2012 and 2016, an estimated 92% could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.

“We have a vaccine that prevents some type of cancers, and now we’re questioning if we should take the vaccine,” he said. “It will not only prevent penile cancer or vaginal cancer or cervical cancer, but also oral, esophagus and tonsils.

“So what are we waiting for?”

Pino thinks some parents might be hesitant because of the widely spread, but disproven, belief that vaccines are linked to autism. Then, there are other parents who think giving their child the vaccine is promoting sexual behavior. HPV is the most common sexually transmitted infection.

“The reality is, I think what the parents have to present to themselves in this debate, is what is the paramount objective here?” Pino said. “Is the paramount objective to offer protection to the individual, or is the paramount objective to prevent the behavior?”

Officials recommended that children receive the multi-dose HPV vaccine years before becoming sexually active, anywhere from 9 to 12 years old. A little more than half of teens, 51 percent, received all recommended doses of the vaccine last year, according to the CDC.

The HPV vaccine is not a required immunization for students in Florida. County health departments offer the vaccine for free.

October, 2019|Oral Cancer News|