HHC study supports web-based care plans for head, neck cancer patients

Author: John Stearns

A joint study by the Hartford HealthCare (HHC) Cancer Institute and the Memorial Sloan Kettering (MSK) Cancer Center has demonstrated benefits of a web-based care plan for patients with head and neck cancer as a tool to better cope with side effects of treatment.

A web-based tool to help patients with head and neck cancer better deal with effects of their cancer treatment has proved beneficial to patients and doctors, according to a HHC doctor involved in developing the tool and studying its effectiveness.

“The compelling reason to do this work is because head and neck cancer has changed,” said Dr. Andrew Salner, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, HHC’s lead doctor on the joint study with MSK.

Head and neck cancer, once mostly associated with heavy drinkers and smokers who had other chronic diseases, is showing up more in younger and healthier patients, he said. That’s because of the prevalence of human papillomavirus (HPV), now the leading cause of the cancers that often target the tonsils and back of the tongue.

HPV is the most commonly sexually transmitted infection in the U.S. HPV is equally divided among males and females, the latter who’ve been getting vaccinated against HPV to prevent cervical cancer, but oral cancers are happening more prevalently and are appearing in males and females, Salner said. As such, boys and girls are now recommended for the vaccine before they become sexually active to hopefully prevent future disease, he said.

Immunization rates were 38 percent for boys and 50 percent for girls in 2016, Salner said.

Most people with HPV will not develop cancer, according to HHC, but for those who do, treatment outcomes are good, but the effects of head and neck cancer treatment can cause difficulty with taste and swallowing, dental problems, jawbone injury, underactive thyroid and other issues, Salner said.

The study of 43 head and neck cancer patients in Hartford and New York tracked the benefit of a web-based care plan tailored to their specific cancer, treatment and side effects. Historically, so-called survivorship care plans were fairly generic in addressing issues patients might or might not encounter, Salner said.

“This study was unique because it personalized the side effects for the tumor site and the treatment for each patient,” Salner said. It offers specific effects to watch for, some of which may not show up for years after treatment, ways to help prevent problems, cope with treatment side effects and timelines for follow-up medical screenings.

“The patients really appreciated all components of the care plan,” which also included a 60- to 90-minute meeting to review with medical staff.

HHC and MSK are talking with the National Cancer Institute to do a much wider study of the care plan, Salner said. He also wants to examine how to scale up the plan for larger populations and integrate it into patients’ medical records.

Salner and Dr. David Pfister, chief of head and neck oncology services at the MSK Cancer Center, will discuss the study and link between HPV and head and neck cancer in a talk this afternoon, from 4 to 5, at the Hartford Hospital Wellness Center at Blue Back Square, West Hartford.

February, 2018|Oral Cancer News|

7 million American men carry cancer-causing HPV virus

Author: Nicholas Bakalar

The incidence of mouth and throat cancers caused by the human papilloma virus in men has now surpassed the incidence of HPV-related cervical cancers in women, researchers report.

The study, in the Annals of Internal Medicine, found that 11 million men and 3.2 million women in the United States had oral HPV infections. Among them, 7 million men and 1.4 million women had strains that can cause cancers of the throat, tongue and other areas of the head and neck.

The risk of infection was higher for smokers, for people who have had multiple sex partners, and for men who have sex with men. Frequent oral sex also increased the risk. The rate was higher among men who also had genital HPV. (Almost half of men aged 18 to 60 have a genital HPV infection, according to the Centers for Disease Control and Prevention.)

Neither age nor income made a difference in high-risk oral infection rates, but rates among non-Hispanic blacks were higher than other races and ethnicities.

HPV vaccination is recommended starting at age 11 or 12 and is effective, said the senior author, Ashish A. Deshmukh, an assistant professor at the University of Florida, and “it’s crucial that parents vaccinate boys as well as girls.”

The lead author, Kalyani Sonawane, also at the University of Florida, said that behavioral change is important, too, particularly smoking cessation. “The difference in oral HPV infection between smokers and nonsmokers is staggering,” she said.

October, 2017|Oral Cancer News|

Eight updates in oral head and neck cancer

Author: staff

Oral Head and Neck Cancer Awareness Week — led by the Head and Neck Cancer Alliances and supported by the American Academy of Otolaryngology — raises awareness and promotes cancer screenings throughout the United States.

Approximately 110,000 people are diagnosed with oral head and neck cancers — which include cancers of the tongue, throat, voice box, nasal cavity, sinuses, lips, thyroid and salivary glands —each year in the United States.

“The best chance of effectively treating these cancers is early on in the disease, and that’s why identification of tumors in their earliest stage improves a patient’s likelihood of survival and the patient’s ability to speak and swallow normally after treatment,” Ilya Likhterov, MD, assistant professor of otolaryngology at Icahn School of Medicine at Mount Sinai, said in a press release from Mount Sinai. “While oral cancer is most commonly linked to long-time smokers and drinkers, younger patients can be affected even if they don’t have obvious risk factors. It is very important to have your mouth examined and pay attention to symptoms such as pain, bleeding, trouble swallowing, or if you notice any wound or ulcer in the mouth that is not healing quickly.”

In conjunction with Oral Head and Neck Cancer Awareness Week, HemOnc Today presents eight updates in oral head and neck cancer.

  • A combination of buparlisib (BKM120, Novartis) and paclitaxel may serve as an effective second-line therapy for patients with recurrent or metastatic squamous cell carcinoma of the head and neck. Read more.
  • Nutrition plays a vital role during all phases of treatment for many cancer types, but it is particularly important for individuals with head and neck cancer, according to Jessica Iannotta, MS, RD, CSO, CDN, and Chelsey Wisotsky, MS, RD, CSO, CDN. Read more.
  • Roughly one in four men and one in five women in the United States have a high-risk form of HPV, according to CDC estimates. Read more.
  • Complete clinical response to induction chemotherapy may serve as a biomarker to identify patients with HPV–associated oropharyngeal squamous cell carcinoma who could benefit from radiation deintensification. Read more.
  • Patients with oral squamous cell carcinoma reported significant declines in the frequency of vaginal and oral sex after their diagnosis, regardless of tumor HPV status. Read more.
  • Adding cetuximab (Erbitux, Eli Lilly) to radiotherapy and cisplatin significantly improved PFS and OS in patients with KRAS-variant head and neck squamous cell carcinoma. Read more.
  • The American Cancer Society endorsed the updated recommendations from the Advisory Committee on Immunization Practices that support a two-dose schedule for boys and girls who initiate HPV vaccination from 9 to 14 years of age. Read more.
  • HPV is an increasingly important cause of oropharyngeal cancer not only among white men, but also among women and nonwhite individuals. HPV also causes a small proportion of nonoropharyngeal head and neck squamous cell cancer. Read more.
April, 2017|Oral Cancer News|

B.C. detection test being used to catch oral cancer in early stages

Author: staff

Doctor says oral cancer is among the deadlier diseases yet rarely talked about.


The Canadian Cancer Society estimates 4,400 people will be diagnosed with oral cancer this year. The deadly disease can often go undiagnosed because it is tough to screen for dormant symptoms. But now, researchers at the University of British Columbia (UBC)  are developing a new test that will be able to detect oral cancer at a much earlier stage.

Dr. Catherine Poh, an oral pathologist who also teaches dentistry at UBC, spoke with the Early Edition’s Rick Cluff about the latest developments.

What can you tell us about this new brushing test you’re working on?
We are a proposing a non-invasive approach to analyse genetic material collected from patients mouths using a simple brush. This can be done by a dentist or at a family doctor’s office.

This test would detect genetic change that happens in human genomes from the cells collected from the mouth. We have shown that it has prediction value for the risk for oral cancer development.

How does your test compare to how oral cancer is detected right now?
Right now the majority of oral cancer has been screened by dentists because many of the oral cancer [diagnosis] come with no pain or no symptoms. Through the dental regular checkups it can be detected early, otherwise patients come with a sore in their mouths that is essentially a delay in the diagnosis.

What symptoms should people look out for?
Many people know your mouth can be sore and that’s not a sign of oral cancer. I’m suggesting people look for a mouth sore that doesn’t heal within three to four weeks or there’s colour change with white or red bumps that don’t get resolved. [This warrants a] checkup from your family dentist or doctors.

Who does oral cancer affect?
Traditionally 75 per cent are smokers and drinkers, however we’re aware there are a number of rising incidents within the younger non-smoker, non-drinker group. Studies show increasing risks of tongue cancer for women aged 18 – 44.

We don’t know [the exact reason] yet. There are people talking about chronic inflammation and infection so we are looking for more details into that aspect.

If it is caught early on, what does that mean for someone’s chances of beating cancer?
Right now, 1 in 2 patients will die in five years so it’s a deadly disease. If caught early…the chance for easier treatment increases. Early detection is the key to really improve a better outcome.

We promote that patients over 80 should have a regular check up for the disease with their family doctor.

Canadian court orders three major tobacco companies to pay billions in damages

Author: Natalie Alcoba



Three tobacco giants have been ordered by a Canadian court to pay billions of dollars in moral and punitive damages to nearly 100,000 smokers, in what has been hailed as an “historic judgment” by the plaintiffs in Quebec.

Imperial Tobacco Canada, Rothmans, Benson & Hedges, and JTI-Macdonald were found to have violated their general duty not to cause injury to another, their duty to inform their clients of the risks and dangers of their products, and their obligation not to mislead their clients. A Quebec Superior Court slapped the three cigarette manufacturers — which have already vowed to appeal — with damages totaling CAD $15.5 billion ($12 billion US), to be split among them.

The ruling means that plaintiffs suffering from lung or throat cancer are entitled to receive CAD $80,000 or $100,000 ($63,000 or $80,000), while those afflicted with emphysema can receive CAD $24,000 or $30,000 ($19,000 or $24,000), plus the interest accumulated since 1998, which is when the lawsuit commenced.

“Today marks an important day for the victims of tobacco who have waited almost 17 years for this moment”, said Mario Bujold, executive director of the Quebec Council on Tobacco and Health on Monday.

Imperial Tobacco was held responsible for CAD $10.5 billion ($8.3 billion), while Rothmans, Benson & Hedges bear responsibility for CAD $3.1 billion ($2.4 billion), and JTI-Macdonald the remaining CAD $2 billion ($1.6 billion).

“By choosing not to inform either the public health authorities or the public directly of what they knew, the Companies chose profits over the health of their customers,” Justice Brian Riordan wrote in his 276-page judgment. “Whatever else can be said about that choice, it is clear that it represent a fault of the most egregious nature and one that must be considered in the context of punitive damages.”

Two class actions were heard as part of the same trial. One, spearheaded by the Council, included 99,957 Quebec smokers and ex-smokers who had developed emphysema, lung cancer, or throat cancer. A second class action was much broader, representing 918,218 people addicted to tobacco in Quebec. While the Quebec Council on Tobacco and Health said the judge sided with the plaintiffs in both cases, only those in the first group will receive compensation.

But Rothmans, Benson & Hedges said the cases are “far from over”, a sentiment shared by the other manufacturers.

“We will vigorously appeal this lower court’s judgment, and believe that we have very strong legal grounds to overturn the judgment in its entirety,” RBH spokeswoman Anne Edwards said in a statement.

She noted that not a single class member, in nearly three years of trial, “showed up to say that he or she was unaware of the risks of smoking,” and said given the “prevailing law and common sense” the judgement should not stand.

JTI-Macdonald Corp. also said it “fundamentally disagrees” with the judgment and intends to file an appeal.

“Since the 1950s, Canadians have had a very high awareness of the health risks of smoking. That awareness has been reinforced by the health warnings printed on every legal cigarette package for more than 40 years,” it said in a statement, adding that the company complies with all Canadian and Quebec laws.

In its statement, Imperial Tobacco Canada called it “astounding to be handed this decision when the federal government has set the standard for the conduct of Imperial Tobacco Canada with which the company has always complied.”

Still, Andre Lesperance, one of the lawyers involved in the case for the plaintiffs, said on Monday that the companies “lied” to their customers and “hurt their right to life,” The Canadian Press reported.

“It’s a great victory for victims as well as for society in general,” he said.

Keratinization may be prognostic in certain head and neck cancers

Author: T. Cooper

Keratinization may be prognostic for patients with oropharyngeal squamous cell carcinoma, according to results of a retrospective, cross-sectional study.

The greatest prognostic value may be among patients who have p16-negative and nonbasaloid tumors, as well as those who are smokers, results showed. Keratinization may result histologically following hematoxylin-eosin staining that is associated with adverse outcomes in head and neck cancers, particularly oral cavity squamous cell carcinoma.

Hadi Seikaly, MD, FRCSC, professor of surgery and divisional director and zone section head for otolaryngology – head and neck surgery at the University of Alberta, and colleagues assessed the prognostic value of keratinization in a large cohort of patients. Subgroup analyses evaluated results based on p16 status, basaloid differentiation and smoking status.

The researchers used a prospectively collected database to identify 208 patients with oropharyngeal squamous cell carcinoma diagnosed and treated at a single tertiary cancer center between 2002 and 2009. The mean age of the patients was 58.4 years (range, 32-95 years), and the male-to-female ratio was 3.4 to 1.

The analysis included 146 smokers, 59 nonsmokers and three participants for whom smoking data were not available. Tissue microarrays were generated from each patient’s specimens stained with hematoxylin-eosin and immunohistochemical markers. Each image was scored for the presence of keratinization and/or basaloid differentiation, as well as p16 status.

Five-year disease-specific survival based on keratinization served as the primary outcome measure. Of the 208 samples, 112 were nonkeratinizing. The 96 patients with keratinizing samples were more likely to have advance-stage disease and be p16-negative.

The rate of 5-year disease-specific survival was significantly higher among those with nonkeratinizing tumors compared with those that were keratinized (63.3% vs. 44.8%; P=.007), the researchers said.

Results of subgroup analyses showed nonkeratinization was linked to better disease-specific survival among patients with p16-negative and nonbasaloid tumors, as well as among those who were smokers.

Patients who smoked and had p16-negative keratinizing tumors demonstrated the lowest rate of 5-year disease-specific survival (26.7%) among any subgroup.

One of the researchers reported an unpaid consultant role with and travel reimbursement from AstraZeneca.

Cooper T. JAMA Otolaryngol Head Neck Surg. 2015;doi:10.1001/jamaoto.2014.3335

January, 2015|Oral Cancer News|

Government anti-smoking campaign cost just $480 per quitter, study finds

Author: Lenny Bernstein

At $48 million, the first government mass media campaign to convince cigarette smokers to quit would seem a pricey luxury, especially since that sum purchased just three months of television ads from March through June of 2o12. But a new study of its cost effectiveness, released Wednesday, determined that it cost just $480 for each smoker who quit and $393 per year of life saved.

The graphic videos featured pleas from former smokers who had suffered amputated limbs, oral and throat cancer, paralysis, lung damage, strokes, and heart attacks. One of the most haunting showed Terrie Hall, a 52-year-old North Carolina woman whose larynx was removed after she was diagnosed with throat cancer. In the ad, she spoke with the help of an artificial voice box. Hall later died.

The campaign and the analysis were both conducted by the Centers for Disease Control and Prevention, but Saul Shiffman, a University of Pittsburgh psychology professor who has spent decades studying smoking habits, said there is no doubt it was a tremendous bargain for the public and, especially, the smokers who quit or added years to their lives. One standard used in studying such interventions considers them cost effective at $50,000 per year of life gained–more than 100 times the cost of the campaigns.

Medical interventions, such as heart and lung surgery commonly needed by long-term smokers are much more expensive than that, Shiffman noted. The money spent on the campaign “would pale next to the money we spend for medical treatment for smokers who otherwise are going to have a heart attack and lung cancer,” he said.

CDC Director Thomas Frieden said the campaign is “an example of an investment that saves lives and money. Most smokers want to quit. Tips show that people can, and can save literally tens of thousands of lives, and has done so at a cost vastly lower than the cost of most other health interventions.”

Shiffman and Tim McAfee, director of the CDC’s Office on Smoking and Health, noted that the tobacco industry spends about $8 billion annually to promote its products. Funding for the campaign, which continued in subsequent years, comes from the Affordable Care Act.

A previous study of the effort determined that more than 100,000 people gave up smoking for six months or more, considered permanent abstinence for the purposes of the research. Another 100,000 quit for shorter periods of time and 1.6 million tried to quit after seeing the ads.

The data was derived by surveying a group of several thousand smokers before and after the ad campaign, McAfee said. About 89 percent said they had seen the ads.

The shocking nature of the campaign was designed to reach smokers, who already know that the habit is likely to sicken and kill them. They told researchers “we don’t want to die early , but we’ve kind of absorbed that message. We don’t want to suffer and we don’t want our families to suffer,” McAfee said.

“What they told us [was you] need to show us in a way that we can understand or believe what the consequences of us continuing to smoke are,” he said. A positive message was included at the end of the ads to highlight the fact that even smokers who quit late in life improve their health and gain quality of life, he said.

Despite declines in smoking rates, about 42 million people in the United States, 18 percent of the population, still smoke. The habit remains the single most preventable cause of death and disease in this country, the study noted.

December, 2014|Oral Cancer News|

Cigarette smoking caused 14 million serious diseases in 2009

Author: Larry Hand

Cigarette smoking remains a major cause of preventable diseases in the United States, with at least 14 million serious medical conditions attributable to smoking in 2009, according to an article published online October 13 in JAMA Internal Medicine.

“These estimates demonstrate that smoking accounts for millions of serious medical conditions in the United States that could be avoided in the absence of cigarette use,” write Brian L. Rostron, PhD, from the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, and colleagues. “Our results also indicate that previous estimates may have substantially underestimated smoking-attributable morbidity in the United States.”

The researchers analyzed multiple sources of data from 2006 to 2012, including 2009 population data from the US Census Bureau, smoking prevalence and disease risk from the National Health Interview Survey of US adults for 2006 to 2012, and data from the National Health and Nutrition Examination Survey of US adults for 2007 to 2010.

Current and former smokers were significantly more likely to have at least one smoking-attributable disease and multiple smoking-related conditions compared with never-smokers. Specifically, almost half of surveyed men and women (47.5% and 44.9%, respectively) aged 65 years and older reported having one or more smoking-related disorder, and almost 17% of men and more than 14% of women reported having multiple such disorders. In contrast, among never-smokers, 34.9% of men and 33.2% of women reported at least one such condition and 9.1% and 7.5%, respectively, reported two or more conditions.

Rates of smoking-related conditions were also elevated among current and former smokers aged 35 to 64 years compared with never smokers. For example, almost 12% of adults at least 35 years old reported having diabetes. The adjusted prevalence ratio compared with never-smokers was between 1.17 and 1.30. The researchers also found high prevalence ratios for lung cancer (range, 4.45 – 9.35) and chronic obsessive pulmonary disorder (COPD; range, 2.02 – 4.00).

Extrapolating from National Health and Nutrition Examination Survey data on COPD prevalence, the researchers estimated 14 million “lifetime major medical conditions” could be attributed to the effects of cigarette smoking in 2009 (95% confidence interval, 12.9 – 15.1 million).

The Centers for Disease Control and Prevention previously published estimates of 8.6 million adults having 12.7 million smoking-attributable conditions in 2000.

The recent US Surgeon General’s report “concluded that previous estimates of the disease burden of smoking could be substantial underestimates, given the absence of several major medical conditions caused by smoking,” the researchers write.

Updated, Expanded
The current report is based on data from about 180,000 people surveyed between 2006 and 2012 compared with previous Centers for Disease Control and Prevention estimates based on data from about 20,000 adults surveyed between 1988 and 1994. The current report is also based on calculations for full variance, which is not generally done, the researchers write. The new report also corrects for underreporting of COPD in self-reported survey data, they add.

“Our study confirms that cigarette smoking remains a major cause of preventable disease in the United States,” the authors conclude. “The resulting estimate indicates that the number of major smoking-attributable medical conditions in the United States is larger than has been previously reported, demonstrating the need for vigorous smoking prevention efforts. The disease burden of cigarette smoking in the United States remains immense, and updated estimates indicate that COPD may be substantially underreported in health survey data.”

Work Remains
In an accompanying commentary, Steven A. Schroeder, MD, from the Division of General Internal Medicine at the University of California, San Francisco, writes that in general, the prevalence of smoking has declined, but that this “decline is excruciatingly slow, and there are still more than 40 million smokers in the United States.” Much of current smoking is among “hard-to-reach” populations, he adds.

He concludes, “Tobacco control has been called one of the most important health triumphs of the past 50 years. Yet, although we have come a long way, there is still much more to be done, with the number of smokers worldwide now just short of 1 billion people.”

Source: JAMA Intern Med. Published online October 13, 2014

October, 2014|Oral Cancer News|

Hard-to-watch commercials to make quitting smoking easier

Author: Andrew Adam Newman

Telling smokers that their habit shortens life expectancy by at least 10 years might seem like an effective way to get them to quit. But it turns out there is something even scarier: living with disfiguring disease.

Dr. Tim McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, was overseeing focus groups of smokers to help shape a smoking-cessation advertising campaign in 2011 when this became clear.

“Telling smokers that you’re going to lose 11 to 12 years of your life expectancy if you continue to smoke, and that if you quit in your 30s you can gain 10 of those back, seemed pretty powerfully motivating to us,” said Dr. McAfee.

But smokers’ response to such messages was that it would not happen to them, Dr. McAfee said. What they feared more than an untimely death, it turned out, was chronic illness.


“They were less motivated by the fear of dying than the fear of suffering, of disability, of disfigurement, and of being a burden to those around them,” Dr. McAfee said.

Introduced in 2012, the C.D.C. campaign, “Tips From Former Smokers,” by Arnold Worldwide in Boston, features people who did not quit until smoking had taken a grave toll. The ads ostensibly offer practical advice about how to function with smoking-related ailments, but the real message is to avoid such predicaments by kicking the habit.

A new series of commercials includes one featuring Shawn Wright, a chef who lives in Spokane, Wash., who was 50 at the time it was shot. Mr. Wright, who started smoking at around age 14 and had a pack-and-a-half-a-day habit, lost his larynx to throat cancer in his late 40s and now has a dime-size stoma, a hole in his throat.

The commercial opens with a title card, “Tips from a former smoker,” and Mr. Wright in the shower, the water running behind him. Mr. Wright, who has a voice prosthesis implanted in his throat and must cover his stoma with a finger to speak, says with a gravelly voice, “When you have a hole in your neck, don’t face the shower head.” He is also filmed pushing a lawn mower (“Keep the stoma covered when you’re outside”) and sitting at a dining room table (“Get used to eating only soft foods”).

At the close of the spot, as he looks in a mirror, he sticks a tool with a brush on the end into the hole in his neck, saying, “Clean out your speech valve twice a day.”

Another new commercial features Amanda Brenden, of Eau Claire, Wis., who attributes smoking throughout her first pregnancy to her daughter’s being born two months prematurely and weighing only three pounds.

In the commercial, she demonstrates how she could not hold her newborn daughter, who was confined to a neonatal incubator. As she opens a small oval door on the incubator, tears well in her eyes. “My tip to you,” she says, “is speak into the opening so your baby can hear you better.”

Public service announcements generally rely on donated ad space, and they run infrequently and during programming with lower viewership. But the federal effort gets its funding through the Affordable Care Act, with the C.D.C. spending a total of $102.5 million to produce and place the ads in 2012 and 2013, and it is budgeted to spend an additional $60.2 million this year.

Kenneth E. Warner, a public health professor at the University of Michigan and founder of the university’s Tobacco Research Network, said funding made a big difference in the success of antismoking campaigns.

“Campaigns that are mounted by an organization that is paying for them are hugely different from other P.S.A.s, which typically rely on donated ad space and get very little time and not much coverage,” Mr. Warner said. His research suggests that well-funded antismoking campaigns are the third-most-effective measure for reducing smoking levels, behind high cigarette taxes and laws against smoking in certain places.

The 2012 C.D.C. campaign was the subject of a 2013 article in The Lancet, which credited the ads with motivating 1.6 million smokers to try to quit — with more than 100,000 of them successfully doing so. The telephone number promoted in the campaign, 1-800-QUIT-NOW, received about 365,000 calls during the 12 weeks that the ads ran in 2012, more than twice the number of calls in the same period of 2011.

To date, the campaign has featured 26 people, including a few nonsmokers who had asthma attacks because of secondhand smoke. Some of the smokers had conditions like Buerger’s disease, which may result in the amputation of limbs and extremities; oral and lung cancer; and gum disease that resulted in the loss of most or all of their teeth.

One subject of the ads, Terrie Hall, who was first featured in 2012, appeared in another ad in 2013 as her throat cancer spread to her brain. She died in September 2013, at age 53. Graphic commercials and online videos featuring Ms. Hall, who is featured posthumously in the current ads, have been viewed more than 5.5 million times on YouTube.

Mr. Wright, the throat cancer survivor shown in current ads, was filmed in 2012, when he was featured in an ad that included others with stomas, but this year marks the first time he appears solo.

Now 53, Mr. Wright said it could be difficult to watch himself in the ad.

“When I see myself in a compromising position, it does get to me a little bit,” he said. “But if people see me and know a little bit about my story, they might have second thoughts about even starting to smoke, and you just put your modesty aside when you’re doing the right thing.”

New study claims children who use snus before age 16 are more likely to become cigarette smokers

Source: Reuters Health

Author: Shereen Jegtvig

Norwegians who started using snus before age 16 were more likely to become cigarette smokers than those who started using snus later in life, according to a new study.

Snus is moist smokeless tobacco developed in Sweden. It’s contained in a small pouch, and unlike regular chewing tobacco, it doesn’t make the user spit.

Research suggests snus has lower levels of chemicals called nitrosamines than cigarettes and may be less harmful.

In Norway, snus has become a smoking cessation aid and most older snus users are former smokers.

But snus is also becoming increasingly popular among young Norwegian adults, many of whom have not smoked cigarettes. And although research is divided, the current thinking is that snus use reduces the likelihood of taking up smoking.

The authors of the new study wanted to know more about when people start using snus, to see if that ties into whether they also begin smoking cigarettes.

“I already knew about the research investigating associations between snus use and later smoking, but discovered that snus debut age had not been mentioned in that research,” Ingeborg Lund told Reuters Health in an email.

Lund is a researcher with the Norwegian Institute for Alcohol and Drug Research – SIRUS, in Oslo. She and her colleague Janne Scheffels published their study in Nicotine and Tobacco Research.

The researchers analyzed surveys of Norwegian teenagers and adults conducted from 2005 to 2011.

Out of 8,313 people, 409 were long-term snus users who had started using snus before cigarettes or never used cigarettes. Of the snus users, 30 percent were long-term smokers.

Just over one third of the snus users started using snus before age 16. The researchers discovered those participants had two to three times the odds of becoming lifetime smokers, compared to people who began using snus after age 16.

They also found that early snus users had about the same rate of cigarette smoking as non-snus users. About 23 percent of early snus users were current smokers at the time of the survey, compared to only six percent of people who started using snus when they were older.

“Snus use seems to protect against smoking if the snus debut does not happen too early during adolescence,” Lund said.

She said it’s particularly important to keep teenagers tobacco-free until they are at least 16 years old.

“At younger ages, even if they start with a low risk product such as snus, there is a high risk that they will switch to – or add – other high-risk products, such as cigarettes,” she said. “This risk is reduced when they grow older.”

Since snus use is much less common in other countries, Lund said she doesn’t know if these results can be generalized outside of Norway and Sweden.

Lucy Popova, from the Center for Tobacco Control Research and Education at the University of California, San Francisco, told Reuters Health the new study was “interesting.” She was not involved in the research.

“Earlier initiation of snus basically makes it a gateway to tobacco use, to cigarette use in the future,” she said.

Popova explained that traditional Swedish snus is less dangerous than cigarettes.

“But it’s not harm-free, and (what) is really bad is when people start using both products because of increased rates of cardiovascular disease, pancreatic cancers and other problems,” she said.

Snus is fairly new to the U.S., and Popova said the version made in the U.S. isn’t like the traditional Swedish product.

“A research study found that it’s different from the traditional low-nitrosamine snus in Sweden – it’s not necessarily going to be as low-harm,” she said.

Popova is concerned with heavy promotion for smokeless tobacco products like snus.

“There’s been a lot of studies showing that more advertisement for tobacco products makes it more likely that children will use tobacco products,” she said, “and it’s important to keep youth tobacco-free as long as possible.”

RESEARCH SOURCE: Nicotine and Tobacco Research, online February 5, 2014.

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

February, 2014|Oral Cancer News|