Head-and-neck surgeons buoyant about new, just-right robot

Source: newsroom.uw.edu
Author: Brian Donohue

You know how great it feels when someone makes a pie or cake just for you? University of Washington Medicine head and neck surgeons have been feeling that kind of love lately, and on Feb. 5 they shared the first slice, so to speak, with patient Steven Higley.

Surgical assistants work near patient Steven Higley on Feb. 5. Lead surgeon Jeff Houlton is obscured by the robotics.

The cake in this story is actually a da Vinci robotic-assist system built especially for head and neck procedures. It is easier to maneuver than the robotic device they’ve used for the past decade, which was designed for operations to the chest and abdomen.

Higley underwent surgery to have a cancerous tonsil and part of his throat removed. Sitting at a console a few feet from the patient, Dr. Jeff Houlton manipulated the miniature surgical tools emanating from the robot’s single port, positioned just outside Higley’s open mouth. It was UW Medicine’s first trans-oral surgery with the new tool.

“If you think about laparoscopic surgery in the belly area, robotics provides the advantage of multiple mechanical arms approaching from different angles,” Houlton said. “But it’s a challenge to have three robotic arms that all need to go through a patient’s mouth. With this machine, the three arms are designed to come through one garden hose-like entry port and then articulate out from there.

“Pretty interesting, though, that in the past 10 years we built a nationally recognized practice for robotic head and neck surgery with a device designed for a different part of the body,” he added, laughing.

The new robot’s single port, left, through which all surgical instruments travel. At right, Dr. Jeff Houlton manipulates the instruments from a distant console. Photos by Randy Carnell, UW Medicine

Higley’s radical tonsillectomy entailed the removal of a margin of tissue beyond the visible tonsil and tumor. Houlton’s incisions exposed cranial nerves and branches of the carotid artery. Working in tight quarters with such vital anatomy, Houlton and his head-and-neck colleagues in surgery, Brittany Barber and Neal Futran, welcome the improvement in maneuverability.

Head and neck cancers represent only 3% of all oncology cases in United States. But case numbers are rising, Houlton said, with increased incidence of throat cancer involving human papillomavirus (HPV), as was the case with Higley, 68.

“Most of these cancers are HPV-mediated rather than smoking- and drinking-related,” Houlton said. “We call it an epidemic because it’s a viral cancer that’s gone up significantly since about the year 2000. In terms of HPV, cancer of the oropharynx (mouth, throat and tongue) is actually more common than cervical cancer now.”

Higley’s cancer came to light last fall after a yearly physical with his Olympia-based physician.

“I had no trouble swallowing, no pain,” Higley recalled. “I didn’t notice anything until my doctor said, ‘Hey, this looks like something we should check out.’ ” His referral to UW Medicine led to a biopsy in mid-December, and on Dec. 23, he learned that he had cancer.

“I’m glad they found it early and so is my wife,” Higley said. “If I could’ve had surgery the next day, it would’ve been OK with her.”

After the robotic part of the surgery, Houlton incised Higley’s neck and removed more than a dozen lymph nodes to be biopsied for cancer cells. Higley hopes they’ll concur with the pre-surgery PET scan that indicated his cancer was constrained to the tonsil.

Patient outcomes data suggests Higley’s prognosis is encouraging: 90-95% of patients who undergo surgery for this cancer survive five years or more.

Higley is already swallowing liquids and soft foods, but he’ll manage sore throat for about a month, Houlton said.

2021-02-12T18:43:12-07:00February, 2021|Oral Cancer News|

Distinct subtypes and potential treatment options found in analysis of head and neck cancers

Source: www.cancernetwork.com
Author: Matthew Fowler

Data published in the journal Cancer Cell presented possible new treatment options and elaborated on the contributions of key cancer-associated genes, phosphosites, and signaling pathways in human papillomavirus (HPV)­–negative head and neck squamous cell carcinomas (HNSCC).1

The data systematically recorded information regarding the disease, with multi-omic analysis determining 3 distinct subtypes with high potential for treatment with respective available therapeutics.

“This study extends our biological understanding of HPV[-negative] HNSCC and generates therapeutic hypotheses that may serve as the basis for future preclinical studies and clinical trials toward molecularly guided precision treatment of this aggressive cancer type,” wrote the investigators.2

The first subtype, called CIN for “chromosome instability”, was determined to have the worst prognosis. It was associated with the larynx, a history of smoking, and increased instability of chromosomes. The research team suggested that this cancer type would respond best to CDK4/6 inhibitor treatment given its relation to aberrations of the CCND1 and CDKN2A genes as well as a high activity of the CDK4 and CDK6 enzymes.

The investigators analyzed a number of protein elevations of basal factors in the second subtype discovered, which was in turn called Basal. These represent the most basic proteins necessary for gene transcription activation. The subtype had both high activity in the EGFR signaling pathway and high expression of the AREG and TNFA molecules. This led the investigators to suggest that treatment with monoclonal antibodies targeting EGFR would best treat this subtype.

Immune, the final subtype, was discovered among patients who did not smoke and had high expression of multiple immune checkpoint proteins. The data suggest patients with this subtype would respond best to immune checkpoint inhibitors.

The overall data found high potential for treatment response in 32% of patients with the CIN subtype, 62% of those with the basal subtype, and 83% with the immune subtype.

“This study extends our biological understanding of HPV-negative HNSCCs and generates therapeutic hypotheses that may serve as the basis for future studies and clinical trials toward molecularly guided precision medicine treatment of this aggressive cancer type,” Daniel Chan, PhD, principal investigator on the trial and director of the Center for Biomarker Discovery and Translation at the Johns Hopkins University School of Medicine, said in a press release.

The team also determined that there were 2 modes of activation of EGFR. This determination suggests a potentially new way to stratify this cancer type based on the number of molecules bound to EGFR. Moreover, the investigators concluded that the loss of the ability to produce immune responses is credited to the widespread deletion of immune modulatory genes.

Investigators from both the United States and Poland analyzed 110 treatment-naïve primary HNSCC tumors and matched blood samples. A total of 66 tumors matched normal adjacent tissues.

“We have made the primary and processed datasets available in publicly accessible data repositories and portals, which will allow full investigation of this extensively characterized cohort by both the HNSCC and broader scientific communities. We also expect wide application of the demonstrated proteogenomics framework to future studies of HNSCC and other cancer types,” the investigators concluded

References:
1. Huang C, Chen L, Savage SR, et al. Proteogenomic insights into the biology and treatment of HPV-negative head and neck squamous cell carcinoma. Cancer Cell. January 5, 2021. doi: 10.1016/j.ccell.2020.12.007

2. Researchers create comprehensive database of head and neck cancers. News release. Hopkins Medicine. January 7, 2021. Accessed January 25, 2021. https://www.hopkinsmedicine.org/news/newsroom/news-releases/researchers-create-comprehensive-database-of-head-and-neck-cancers

2021-02-03T10:49:17-07:00February, 2021|Oral Cancer News|

Timing and intensity of oral sex may affect risk of oropharyngeal cancer

Source: www.eurekalert.org
Author: Research News

Human papillomavirus (HPV) can infect the mouth and throat to cause cancers of the oropharynx. A new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society, has found that having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer. The study also shows that having oral sex at a younger age and more partners in a shorter time period (oral sex intensity) were associated with higher likelihoods of having HPV-related cancer of the mouth and throat.

Previous studies have shown that performing oral sex is a strong risk factor for HPV-related oropharyngeal cancer. To examine how behavior related to oral sex may affect risk, Virginia Drake, MD, of Johns Hopkins University, and her colleagues asked 163 individuals with and 345 without HPV-related oropharyngeal cancer to complete a behavioral survey.

In addition to timing and intensity of oral sex, individuals who had older sexual partners when they were young, and those with partners who had extramarital sex were more likely to have HPV-related oropharyngeal cancer.

“Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer,” said Dr. Drake. “As the incidence of HPV-related oropharyngeal cancer continues to rise in the United States, our study offers a contemporary evaluation of risk factors for this disease. We have uncovered additional nuances of how and why some people may develop this cancer, which may help identify those at greater risk.”

Full Citation:
“Timing, number, and type of sexual partners associated with risk of oropharyngeal cancer.” Virginia E. Drake, Carole Fakhry, Melina J. Windon, C. Matthew Stewart, Lee Akst, Alexander Hillel, Wade Chien, Patrick Ha, Brett Miles, Christine G. Gourin, Rajarsi Mandal, Wojciech K. Mydlarz, Lisa Rooper, Tanya Troy, Siddhartha Yavvari, Tim Waterboer Nicole Brenner, David W. Eisele, and Gypsyamber D’Souza. CANCER; Published Online: January 11, 2021 (DOI: 10.1002/cncr.33346).

Personalized vaccines: the new frontier in cancer treatment

Source: www.wildcat.arizona.edu
Author: Udbhav Venkataraman

Exciting results from a new clinical study showed that a personalized vaccine combined with an immunotherapy drug had a promising response rate in patients with advanced incurable head and neck cancer.

Dr. Julie Bauman, chief of Hematology and Oncology at the University of Arizona College of Medicine — Tucson, led a phase one clinical trial with the pharmaceutical company, Moderna, to test the combined use of personalized vaccines created from tumor DNA with the immunotherapy drug pembrolizumab.

Of the 10 patients involved in the study, five of the them responded to the treatment, meaning 30% of the cancer mass had decreased. Furthermore, two of the patients completely responded, meaning that cancer could not be detected.

Molly Cassidy is one of those two patients. What was initially determined to be a stress-related ear-ache turned out to be an aggressive case of squamous cell carcinoma, a form of head and neck cancer.

Head and neck cancers impact the linings of the mouth and throat. Risk factors for this disease include alcohol consumption, smoking and other environmental carcinogens that we are all exposed to. It can also be caused by human papillomavirus (HPV).

Cassidy did not fit this profile at all.

“I’m HPV-negative. I didn’t drink. I didn’t smoke. I’m a woman. I was the first person in my family to have cancer. I was 35 when I got my diagnosis,” Cassidy said. “I was also in really good health … To hear that I had cancer was really surprising.”

With an initial prognosis that the cancer was curable, Cassidy underwent a standard but invasive surgery followed by a grueling series of radiation and chemotherapy sessions over the next few months.

Just a week after completing Cassidy’s initial treatment plan, the cancer returned aggressively. She had several tumors in her neck and they were spreading to her lungs. Her prognosis became bleaker.

“Having such a quick recurrence was not a good sign … they put me on a palliative plan and I was told I need to get my affairs in order,” Cassidy said. “I wasn’t expected to live for more than a year.”

Cassidy now had advanced incurable head and neck cancer which occurs when an initial cancer treatment fails and the cancer returns. This combined with the fact that she was HPV negative made her eligible for Bauman’s clinical study.

One of the recent frontiers of cancer research has been immunotherapy — harnessing our immune systems to fight cancer. Our immune system is able to detect and attack foreign invaders in our bodies, including cancer cells. However, these cells develop ways to hide from the immune system.

Immunotherapy can involve using medication to activate and train the immune system to recognize and eliminate these cancer cells. When this treatment is effective, the response can be long-lived.

“I can give you chemo and drive you to a complete response, but as soon as chemo is not there, the cells that are left become resistant and grow back,” Bauman said. “Immunotherapy leaves behind an army of T-cells that if the cancer rears its ugly head again, will presumably kill it.”

According to Bauman, the current U.S. Food and Drug Administration-approved therapies are non-specific. These therapies generally activate the T-cells of the immune system which recognize foreign invaders. This method means that T-cells that recognize cancer cells would be activated. This method of therapy however has a low effectiveness rate.

“In head and neck cancer, this class of therapy is successful 10-15%of the time … We want that to be more often,” Bauman added.

Furthermore, there can be auto-immune side effects because T-cells that recognize our own healthy tissues may start attacking those very tissues.

This is where new and fascinating technology comes into the picture: personalized vaccines. This approach is a specific approach, where T-cells are activated based on the mutations of the patient’s cancer.

After taking a sample of cancer cells from the patient, those cells’ DNA is sequenced. Using a computational algorithm, the cancer DNA is compared to the patient’s healthy DNA to find the specific mutations present in that patient’s cancer. From all those mutations, Moderna is able to synthesize a messenger RNA vaccine, which can be used to train the appropriate T-cells to recognize abnormal proteins from these cancer cells.

A helpful video about the process can be found at the UA Health Sciences website. The clinical trial consisted of using both this personalized vaccine approach with the FDA approved T-cell activator pembrolizumab.

“The trial is the combination of using those mutations almost like a trojan horse … educating the immune system to see those mutated proteins at the same time as we give the unbridled T-cell activator,” Bauman said. “We’re awakening T-cells, but we’re saying this is the particular class of T-cells that we are calling.”

For the trial, each patient was given two doses of pembrolizumab over six weeks. During this time, the vaccine was developed by Moderna. After the vaccines were created, the patients received one dose of their vaccine every three weeks for nine weeks along with the pembrolizumab, and the cancer was monitored using a CAT scan.

And the results show that the vaccines are safe. This seems really promising and exciting to pursue.

“Although it is only 10 patients, and we have to not only overpromise … it is a really strong signal to expand the study and to see if we continue to see what we saw with these 10 patients,” Bauman said.

“When I was going into treatment, I was really ill and the treatments themselves were pretty hard on me. Cancer treatment is no walk in the park,” Cassidy said. “But once I got through the treatment’s initial side effects, I started to notice an increase in my energy and I wasn’t in as much pain.”

Having completely responded to her treatment, Cassidy is now able to live a normal life. She has spoken with various dentists and used her platform to help educate people about the prevalence and signs of oral cancers and the importance of understanding what the inside of our mouths are supposed to look like.

“It also brought forth what are the most important things for me — my son and husband and the importance of slowing down and enjoying my time with my family,” Cassidy said.

There are many new things that Bauman is looking into researching further. As they expand the trial to 40 participants for the next phase of trials, she is exploring how to optimize the vaccine.

“If we can selectively educate the immune system … we can have a therapy that is active, could drive a permanent response and not be toxic or harsh on the rest of the body,” Bauman said.

Bauman also mentioned that this optimization might mean potentially experimenting with a different drug than pembrolizumab for treatment, although this is a great start. They have also taken samples of the T-cells from the patients to see which types of mutations the T-cells respond best to.

“People who have advanced in cancer … have extraordinary suffering because cancer is uncontrolled in this area where things are critical to our humanity, like talking and breathing and eating and kissing and smiling. To be able to reverse that suffering and offer that hope is uniquely gratifying,” Bauman said.

2020-12-09T06:51:37-07:00December, 2020|Oral Cancer News|

Mouth cancer in the UK at record high

Source: www.hippocraticpost.com
Author: staff

New cases of mouth cancer in the UK have risen to a record high, according to the findings of a new report.

  • New figures show there have been 8,722 new cases of mouth cancer in the UK last year.
  • This is an increase of 58% compared to ten years ago and 97% compared to 20 years ago.
  • Data released in a new report to coincide with November’s Mouth Cancer Action Month.

Figures collected by the Oral Health Foundation show that 8,722 people in the UK were diagnosed with the disease last year, increasing by 97% since 2000.

Mouth cancer cases in the UK have soared for the 11th year in a row and have more than doubled within the last generation.

The findings are part of the charity’s new State of Mouth Cancer UK Report 2020/21 and have been released to coincide with November’s Mouth Cancer Action Month.

Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation, believes with mouth cancer cases continuing to rise, more must be done to raise awareness of the disease.

Dr Carter says: “While many cancers are seeing a reduction in the number of people affected, mouth cancer is one of very few that is sadly going the other way. Established risk factors like smoking and excessive alcohol have been joined by emerging causes like the human papillomavirus (HPV). This has changed the profile of the disease quite considerably over recent years and mouth cancer can now affect anybody.

“The disease can have a devastating and lasting effect on a person’s life. It can change how somebody speaks, it makes eating and drinking more difficult, and often leads to changes to a person’s physical appearance. Because of this, it also takes a heavy toll on a person’s mental health too.

“One of the biggest challenges we face regarding mouth cancer is how little educational support it receives from government and public health bodies. As part of Mouth Cancer Action Month, we will be working with thousands of organisations to improve awareness of the disease so that more people are able to recognise the early warning signs.”

Statistics from governing health bodies across the UK show around two-in-three (67%) mouth cancers are recorded in men while three-in-four (78%) are in the over 55’s.

Mouth cancer is most likely to occur in the tongue, contributing to more than one-in-three (34%) cases. Mouth cancer can also appear in the tonsils, the roof and floor of the mouth, lips and gums.

The early warning signs of the disease include mouth ulcers that do not heal within three weeks, red or white patches in the mouth, or unusual lumps and swellings. Persistent hoarseness could also be a symptom.

Dr Catherine Rutland, Clinical Director at Denplan, part of Simplyhealth, speaks about the importance of knowing how to spot mouth cancer early and acting quickly if you notice anything out of the ordinary.

Dr Rutland says: “Self-checks and regular dental visits are extremely important for spotting mouth cancer in its initial stages, yet public awareness of mouth cancer actually remains very poor – around 3 out of 4 people said they did not know what the symptoms of mouth cancer are in the Oral Health Foundation’s latest research. Many mouth cancer cases are caught far too late. For a significant proportion of patients, a delay of three to six months in diagnosis and treatment will affect the likelihood of achieving long-term survival.

“Be ‘mouthaware’ and alert to any unusual changes to the mouth, head or neck. Mouth ulcers lasting more than three weeks, unexplained persistent lumps, red patches and white patches are all signs that should be checked by a dentist. If you notice anything out of the ordinary, don’t wait. Book an appointment with your dentist so that they can examine you.

“For Mouth Cancer Action Month this November, make sure you know the basics. Learn how to perform a quick self-check (visit mouthcancer.org), know what to look for and where mouth cancer occurs. By doing this, you give yourself the best possible chance of overcoming mouth cancer.”

Roy Templeton (59) from Beauly, Inverness, was diagnosed with mouth cancer of the tonsils. Now given the all clear, Roy says his experience of mouth cancer will never leave him.

Roy says: “Although I had heard of mouth cancer, I wasn’t aware how terribly common it was, and I didn’t know anybody personally who had had it. Any conversations I’d heard about people with mouth cancer had given me the impression it happens to much older people and especially those who heavily drank or smoke. I didn’t smoke and I was a moderate drinker, so the diagnosis really came as a shock.

“Going through cancer treatment had a big effect on me mentally. It crystallised in my own mind that life is quite precious. When it comes to opportunities arising in your life, either in work or your personal life, you want to grab every moment more than ever before.

“I was quite fortunate that I went to my GP early when I found something not right. If you have any inkling something is wrong, I would urge you to get it looked at. Getting checked out early could save your life.”

Spotting mouth cancer early is crucial for beating the disease. Early detection boosts the chances of survival from 50% to 90% while also dramatically improving a person’s quality of life.

Sadly, far too many mouth cancers are caught in the late stages of the disease. Latest annual reports show mouth cancer claims 2,702 lives a year, which on average is one person every hour.

2020-11-04T11:53:47-07:00November, 2020|Oral Cancer News|

There has to be more to dental hygiene than this: A systemic approach

Source: www.dentistryiq.com
Author: Michelle Strange, MSDH, RDH

Due to the COVID-19 pandemic, there will be added pressure on dental hygienists as patients return to our practices. During the lockdown, patients did not have access to our services. Now that the doors have reopened, patient treatments have begun with a renewed focus on protection from the virus.

Even though practices will be extra busy, now is a great time to make some changes to our services. What if we stop simply reacting to the apparent problems and instead make the shift from purely corrective to a preventive dental service, and from oral health to holistic health?

A holistic approach
Dentistry has the potential to assimilate and integrate into the holistic health approach. Until now, patients and other health professionals have considered a visit to a dental office as totally separate from other health care. Patients often view their twice-a-year visits as mandatory checkups and “cleanings” but fail to grasp the entire value we provide. Dental health is connected to our entire well-being and is even thought to be related to heart health.1

Poor dental hygiene may lead to a higher susceptibility to the human papillomavirus that can contribute to mouth and throat cancers.2 In 2013, a study from the University of Central Lancashire School of Medicine and Dentistry pinpointed a specific oral bacteria, Porphyromonas gingivalis, as present in the brains of four out of 10 participants with dementia.3 Research has found that erectile dysfunction,4 type 2 diabetes,5 irritable bowel syndrome,6 and sleep apnea7 may also be connected to poor oral hygiene.

This intertwined relationship between dental care and overall health care must carry through to the relationship between patients and dental professionals, both dentists and hygienists. Imagine the impact we could have if hygienists take up our deserved role as holistic health specialists!

The mouth is one of the mirrors of patient health, just like the skin, and we must use this information to guide our patients in their search for optimal well-being. We should take time to inform our patients about these connections with health and become client educators. If we take the holistic approach and help them become healthier, they will understand there is more to the role of the dental hygienist than just scaling their teeth.

Start the conversation
In a 2017 study, 64% of respondents between the ages of 18 and 64 visited the dentist in the last year,8 meaning that 36% did not. Moreover, of those who did, the majority walked in for their annual health insurance-covered prophies. In reality, dental hygienists offer and do so much more, including providing treatment of early-onset periodontal disease. We want the best for patients, but sometimes we don’t provide them with information and treatments that can help them become truly healthy. We might think they are not interested or they are only interested in a “free cleaning” from their insurance coverage. However, by not offering a more comprehensive package, a patient’s health journey may be compromised.

Instead, start a conversation with clients outlining the importance of dental health for their overall health and consider offering a set of standard tests. Implementation of tests similar to those provided by physicians, including blood pressure screening, heart rate, oxygen[KB2] , and checking other vital signs are all within the purview of hygienists. Include charting bleeding sites (using currently available software),9 oral cancer screenings,10 airway assessment, nutritional counseling, and salivary testing to help prevent patients from being susceptible to illnesses such as cardiovascular disease, dementia, and oral cancers through early diagnosis.11 Doing all this before picking up a scaler offers an unprecedented level of care.

Not only is this time in history an opportunity for us to expand our roles as health practitioners, but it is also our duty. Our patients have a right to an accurate, complete diagnosis and treatment plan. The American Dental Hygienists’ Association Standards for Clinical Dental Hygiene Practice outlines the importance of considering all aspects of a patient’s health.12 Hygienists are already highly trained and have the skills and access to procedures to offer the highest quality of care, but unfortunately, many fail to embrace this opportunity to provide comprehensive care adequately.

By offering such a high level of care, patients will see that dental hygienists are professionals who are a crucial part of their health journey, and they will feel more cared for, too.

References
1. Gum Disease and Heart Disease — What You … – WebMD. 25 Sep. 2009, https://www.webmd.com/oral-health/features/healthy-teeth-healthy-heart. Accessed Jun. 23, 2020.

2. Norton A. Poor oral hygiene tied to cancer-linked virus. WebMD. Aug. 21, 2013. https://www.webmd.com/oral-health/news/20130821/poor-oral-hygiene-tied-to-cancer-linked-virus-study-finds. Accessed Jun. 23, 2020.

3. Locke T. Can poor dental health cause dementia? WebMD. Jul. 31, 2013. https://www.webmd.com/oral-health/news/20130731/dental-health-dementia. Accessed Jun. 23, 2020.

4. Men’s sexual health may be linked to periodontal health. American Academy of Periodontology. Dec. 4, 2012. https://www.perio.org/consumer/erectile_dysfunction. Accessed Jun. 23, 2020.

5. Leite RS, Marlow MN, Fernandes JK. Oral health and type 2 diabetes. Am J Med Sci. 2013;345(4):271-273. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623289/. Accessed Jun. 23, 2020.

6. Fourie NH, Wang D, Abey SK, et al. The microbiome of the oral mucosa in irritable bowel syndrome. Gut Microbes. 2016;7(4):286-301. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988452/. Accessed Jun. 23, 2020.

7. Huang Y-S, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol. 2013 Jan 22;3:184. ttps://pubmed.ncbi.nlm.nih.gov/23346072. Accessed Jun. 23, 2020.

8. Table 37. Dental visits in the past year, by selected characteristics: United States, selected years 1997-2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hus/2018/037.pdf. Accessed Jun. 23, 2020.

9. Dental practice software. Capterra. https://www.capterra.com/dental-software/. Accessed Jun. 23, 2020.

10. Froum S. 10 steps to perform an oral cancer screening. Dentistry iQ. May 28, 2015. https://www.dentistryiq.com/dentistry/oral-cancer/article/16350620/10-steps-to-perform-an-oral-cancer-screening. Accessed Jun. 23, 2020.

11. LeBeau J. Dentistry’s proactive role in preventing disease. Compend. 2013;34(1). https://www.aegisdentalnetwork.com/cced/2013/01/dentistrys-proactive-role-in-preventing-disease. Accessed Jul. 13, 2020.

12. Standards for clinical dental hygiene practice – revised 2016. American Dental Hygienists’ Association. https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. Accessed Jul. 13, 2020.

2020-09-04T10:31:03-07:00September, 2020|Oral Cancer News|

Most parents of unvaccinated teens have no intention of getting HPV vaccine for their kids, study finds

Source: www.newstribune.com
Author: Kasra Zarei, The Philadelphia Inquirer

The human papillomavirus (HPV) vaccine has been proven to prevent certain types of oral and genital cancers and other health problems. However, in a study published this week in Lancet Public Health, researchers found that more than half of the parents of adolescents who have not received the HPV vaccine had no intention to initiate the vaccine series for their children.

Using data from a nationally representative survey of U.S. adolescents, the study authors estimated national-level and state-level parental intent to initiate and complete the HPV vaccine series for their kids. In states including Idaho, Montana, Nebraska, North Dakota, Oklahoma, and Utah, more than 65 percent of parents of unvaccinated adolescents had no intention to initiate the HPV vaccine series.

According to the most recent data by the Centers for Disease Control and Prevention, Wyoming and Mississippi have the lowest HPV vaccine rates at roughly 50 percent. The new study found of parents of unvaccinated adolescents in these states, almost 62 percent and 57 percent, respectively, did not intend to initiate the HPV vaccine for them.

Lack of parental intent to complete the vaccine series was lowest in the District of Columbia, at nearly 11 percent, and Rhode Island, at 20 percent. HPV vaccination is mandated in both regions.

In Philadelphia, HPV vaccine coverage is among the highest in the country — roughly 71 percent in 2018, according to CDC data. Still, in Pennsylvania, between 60-65 percent of the parents of unvaccinated adolescents do not intend to have their kids start the vaccine.

“I was surprised that the intent to vaccinate (for HPV) is this low,” said Cynthia DeMuth, a primary-care pediatrician in Harrisburg and the Pennsylvania chapter immunization representative for the American Academy of Pediatrics, who was not involved with the study.

The HPV vaccine guidelines recommend adolescents who start the vaccine series before their 15th birthday receive two doses, or three doses if they start after their 15th birthday.

But even among kids who receive the first dose, many parents don’t intend to have their child complete the series, the study found. Nationally, almost a quarter of the parents of adolescents who received the first dose of the vaccine had no intention to complete the series. In states like Arkansas, Florida, Georgia, Hawaii, Idaho, Utah, and West Virginia, that percentage was even higher at more than 30 percent.

Research suggests parents’ main driver is perceived safety of the vaccine, which may be due to past reports of adverse effects since the vaccine’s approval in 2006.

“It’s a safe and effective vaccine, and there haven’t been any serious adverse events related to the vaccine,” DeMuth said.

Studies have since proven rates of cancers that are prevented by the HPV vaccine have greatly decreased. Experts estimate widespread HPV vaccination has the potential to reduce new cervical cancer cases around the world by as much as 90 percent.

Lack of knowledge about the vaccine and lack of recommendations from health-care providers are also reasons expressed by parents with no intent to vaccinate their kids.

“Adults between the ages of 18 to 45 don’t even know what HPV is, and there is a vaccine to protect it,” said Kalyani Sonawane, professor in the department of management, policy, and community health at the University of Texas Health Science Center and lead author of the study.

There are also perceptions the vaccine is not needed for younger teens who may not be sexually active, as HPV is mainly sexually transmitted.

When declining the HPV vaccine, “sometimes parents say their child is too young and isn’t sexually active, and they’ll think about it for next year,” DeMuth said. “But the vaccine works better at young ages — the antibody levels are higher at a younger age with two shots compared to three shots at older ages.”

These trends worry experts who say it could cause a rise in HPV-related cancer rates.

“Particularly among girls, the coverage rate has not improved. If parents are not intending to vaccinate their kids, in the future, we could expect to see an increase in HPV-associated cancers,” Sonawane said.

Sonawane said while people may not think about HPV like measles, for which low vaccine coverage can lead to outbreaks, HPV is still an infectious disease and can remain in the body for years. HPV-related cancers are already on the rise by almost 3 percent. Experts caution if vaccine coverage doesn’t improve, increases in HPV-related cancers are only going to get worse.

Health care professionals and pediatricians can play an immediate role in addressing these potential health concerns.

“A strong recommendation from the provider is one of the most significant things providers can do,” DeMuth said. “The longer it’s been out, the more confident I am it’s safe, and the better I feel about giving a strong recommendation for the vaccine.”

Researchers take head and neck cancer by the throat

Source: www.brisbanetimes.com.au
Author: Stuart Layt

Research has identified more weak spots in a deadly type of head and neck cancer that it is hoped will lead to more effective treatments.

Oropharyngeal cancer can affect the base of the tongue, the tonsils, soft palate and parts of the throat, and almost half of all cases in Australia are caused by the human papillomavirus (HPV).

Current immunotherapies target two protein receptors on the cancer; however, they have had mixed success.

Lead researcher Professor Rajiv Khanna from QIMR Berghofer said they had identified four more spots on the genome of the cancer that they believed could be targeted by immunotherapy.

“Everybody has been trying to make immunotherapies that target those two antigens, but what we have found is that while those two are important, we were ignoring some of the other antigens,” Professor Khanna said.

“We took immune cells out of our patients and effectively asked them what they could “see” other than [the two proteins] E6 and E7, and actually they could see others.”

The study analysed immune cells taken from 66 oropharyngeal cancer patients at the Royal Brisbane and Women’s Hospital and the Princess Alexandra Hospital.

Co-lead author Professor Sandro Porceddu, the director of radiation oncology research at the Princess Alexandra Hospital, said they were now developing therapies based on the research.

“We’re already working on developing better killer T-cell immunotherapies that recognise all, or a combination, of these proteins,” Professor Porceddu said.

“Different combinations of the proteins are present on different patients’ cancer cells, so we will develop immunotherapies with different bunches of keys for different patients.”

At present, the cancer is treated with a combination of chemotherapy and radiation therapy, but it is hoped an effective immunotherapy will eventually become the standard treatment.

Oropharyngeal cancers are the sixth-most-common type of cancer worldwide, with US actor Michael Douglas diagnosed with stage four oral cancer in 2010, before going into remission after aggressive radiation treatment and chemotherapy.

Douglas credited HPV for his cancer but later said he was a heavy smoker and drinker, habits that also increase the risk of developing the disease.

In Queensland the incidence rate for the cancer type has increased by 162 per cent in men and 40 per cent in women over a 15-year period, according to data from the Cancer Alliance Queensland.

That is despite the development of the HPV vaccine from Professor Ian Frazer and his team at the University of Queensland in the early 2000s.

However, experts warn the impact of widespread immunisation programs for HPV will not be felt for decades.

The research has been published in the Journal of Experimental Medicine.

Fighting throat cancer with T cells

Source: www.miragenews.com
Author: press release, Centenary Institute

Research led by the Centenary Institute has discovered that immune cells accumulating within the tumor environment, called tumor-resident T cells, are a critical determinant in survival rates of patients suffering from throat cancer.

Reported in the prestigious ‘Journal for ImmunoTherapy of Cancer’, the research suggests that strategies aiming to boost these T-cells at tumor sites could be beneficial to patients.

“Oropharyngeal squamous cell carcinoma (OPSCC) is a form of throat cancer. It can be caused by environmental factors such as smoking or by human papillomavirus infection (HPV), the same virus that causes cervical cancer in women,” said Ms Rehana Hewavisenti, lead author of the study and researcher at the Centenary Institute and the University of Sydney.

“We knew that patients with HPV-related OPSCC had far better clinical outcomes compared to other OPSCC patients but we didn’t know why,” she said.

In examining over sixty patient samples, Ms Hewavisenti and her colleagues discovered that increased levels of tumor-resident T cells, whether in HPV or non-HPV OPSCC cases, was clearly associated with improved patient survival outcomes.

“It was the accumulation of these immune T-cells, in and around the tumour site that appeared to be key,” said Ms Hewavisenti.

The researchers also found in their study that HPV OPSCC patients generally had far higher levels of tumour-resident T cells compared to their non-HPV OPSCC patient counterparts.

“We think these HPV positive patients tended to have better clinical outcomes as HPV infection is likely to favor the accumulation of these beneficial T-cells within the tumor area,” she said.

Dr Mainthan Palendira, Head of the Centenary Institute’s Human Viral and Cancer Immunology Laboratory and senior author on the research paper believes the research findings have major implications.

“Now that we understand how important this immune response is in relation to OPSCC, we can begin developing new treatment strategies focused on recruiting these favourable tumor-resident T cells directly to tumors,” he said.

Dr Palendira believes that looking at the amount of these T-cells in cancer could help clinicians to personalize the best treatment approach for individual patients.

“We also think that our research demonstrating viral (HPV) links with this tumor-resident T cell accumulation could help in future cancer vaccine development efforts too,” he said.

Experts release new guidelines for studies into most effective treatments for HPV-positive throat cancer

Source: en.brinkwire.com
Author: provided by University of Birmingham, United Kingdom

Heightened caution is needed when considering de-escalation trials for patients with Human papillomavirus (HPV)-positive oropharyngeal cancer (OPC), to ensure minimal harm to patients, new guidelines from a group of international head and neck cancer experts have suggested.

HPV-positive oropharyngeal cancer is a cancer of the throat caused by the human papillomavirus—a common, but symptomless group of sexually transmitted viruses. Instances of many throat and neck cancers have declined as smoking rates have fallen, whereas HPV-positive OPC has increased, largely affecting younger patients.

The standard course of treatment for this disease is a combination of cisplatin (a common chemotherapy drug) and radiotherapy. The younger age of the patient population, significantly improved prognosis, and relatively minimal morbidities caused by the standard treatment pathway have led to the popularisation of the concept of treatment de-escalation as a way to improve the quality of life of patients by reducing dosage or frequency of treatment.

These new recommendations, published today in the Journal of Clinical Oncology have been created by the Head and Neck Cancer International Group, a group of experts from nineteen countries, led by the University of Birmingham, UK. The guidelines have been prompted by the recent results of the first three randomised de-escalation trials which suggested a clear detriment in survival when cisplatin is omitted or substituted to minimise side effects.

After a review of available HPV-positive OPC literature, the guidelines recommend an overall need for caution when considering de-escalation options, even in instances where there appears to be possible favourable disease outcomes. Experts also recommend a revised approach to how findings are evaluated during phase II studies to ensure that any potential risks to survival are identified and only if none are present should phase III trials follow.

The guidelines also recommend that de-escalation trials should only be considered for well-defined, very low risk groups and only when there is a strong rationale for investigating a particular treatment strategy. Additionally harm-minimisation techniques should be considered as an alternative. Importantly, treatments should not be implemented into clinical practice before high level evidence is available.

Corresponding author Professor Hisham Mehanna, Director, Institute of Head and Neck Studies and Education (InHANSE) at the University of Birmingham said: “Clinicians and researchers have to be careful when planning and undertaking de-escalation studies, as trials to date have that harm can befall patient. Very controlled and small strides need to be taken when evaluating a possible de-escalation strategy, especially one that removes cisplatin.”

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