Shades of Big Tobacco: How (and why) Juul bought an entire issue of a scientific journal

Source: Salon
Date: July 20th, 2021
Author: Jon Skolnik

 

Facing the imminent threat of corporate death, the embattled e-cigarette maker Juul is pulling out all the stops in its fight to convince the Food and Drug Administration that its vaping products are more beneficial than harmful.

If that sounds like a stretch, it probably is. Last month, Juul settled a $40 million lawsuit that accused the company of luring in teens to use its flavored vape products, allowing Juul to avoid the potential PR nightmare of a widely covered jury trial. Juul has also spent tens of millions in federal lobbying efforts over the past several years, presumably in an effort to block comprehensive regulations on the sale of e-cigarettes.

But the most bizarre Juul news came two weeks ago, when the New York Times reported that the company had funded an entire issue of a scientific journal, in which every article presented evidence that vaping is a beneficial harm-reduction practice that can wean smokers off tobacco cigarettes.

Last month, the American Journal of Health and Behavior (AJHB), a 44-year-old academic journal that has published many nationally recognized scholars, released a special edition specifically devoted to the question of whether e-cigarettes are harmful or helpful. The 219-page issue is unusual not just by virtue of its niche subject matter — e-cigarettes are a relatively new phenomenon in the field of health behavior — but also because its publication was bankrolled entirely by one source: Juul Labs.

This fraught episode comes at an exceptionally tumultuous time for the vape maker. In early 2019, Juul, a company founded just four years earlier, was riding a wave of explosive success, boasting $1 billion in revenue. Sales had grown by 641% from 2016 to 2017 alone. A national survey in 2019 found that nearly 30% of U.S. high school students reported using e-cigarettes in the last month, with 60% of them naming Juul as their preferred brand.

In 2018, the tobacco giant Altria — previously known as Philip Morris — took a 35% stake in Juul, believing the acquisition might help recover some of the company’s losses from an overall decline in U.S. cigarette sales over the past several decades. Only a few months later, however, disaster struck. A mysterious respiratory ailment, clearly linked to vaping, sickened more than 1,000 people in the U.S., and by the fall of 2019, 34 vape users had died from lung injuries. Facing an array of potentially devastating lawsuits and pressure from the Food and Drug Administration (FDA), Juul voluntarily pulled its products from many store shelves and canceled its youth advertising campaigns, rapidly losing more than 30% of its market share.

Now Juul remains in something like corporate limbo, awaiting FDA approval to continue selling its vape products in the U.S. The agency will likely decide this year whether the alleged health benefits of Juul products outweigh their potentially addictive qualities. It’s not entirely surprising, then, that Juul wanted to subsidize an entire edition of a medical journal: Its survival as a corporation is on the line.

But is the Juul-sponsored journal ethical? That’s a murkier question than it might appear. The special issue of AJHB makes no attempt to conceal the fact that essentially all the studies it contains were funded and facilitated by Juul. As The American Prospect notes, a cursory glance at the journal’s “Conflict of Interest” statements reveals that 18 co-authors of articles in the special issue are Juul employees.

Five other co-authors work at PinneyAssociates, a firm that “provides consulting on harm reduction exclusively to JUUL Labs,” as its senior scientific adviser, Dr. Saul Shiffman, told Salon by e-mail. “We participate in JUUL’s work to publish their scientific research to inform the public dialogue about tobacco harm reduction,” he added. An additional three co-authors are involved in the Centre for Substance Use Research, another consulting firm that has a contract with Juul. Nearly every study in the issue features the brand name in its title, and all of them effectively conclude that Juul’s products are a safe form of harm reduction.

As one paper in the journal, a study based on population modeling, puts it, “after considering both potentially beneficial and potentially harmful transitions and based on the available evidence to date — the (continued) availability of ENDS [i.e., vape products such as Juul’s] in the US is likely to have a positive impact on population mortality.”

The edition’s closing perspective, written by Dr. Karl O. Fagerström, a Swedish psychologist who specializes in smoking cessation and “tobacco harm reduction,” waxes a bit more philosophical. “Because it is unlikely that humankind will give up drugs, nicotine included,” he writes, “the findings from the studies presented in this issue suggest that ENDS, and JUUL in particular, can be an acceptable substitute for more harmful cigarette alternatives.” (It is duly noted that Fagerström has served as a paid consultant to Philip Morris International and British American Tobacco.)

Outside the world of corporate-sponsored research, the existing scientific literature is mixed, at best, on the question of whether products like Juul offer effective means of smoking cessation. One study from the University of California, San Francisco, found last year that Juul’s products deliver “more nicotine to the blood per puff than cigarettes or previous-generation e-cigarettes (e-cigs) and [impair] blood vessel function comparable to cigarette smoke.”

Another study published this year in Pediatrics, the official journal of the American Academy of Pediatrics, found that e-cigarette smokers are three times more likely to switch to tobacco cigarettes later on. Other studies have found that e-cigarettes elevate the risk of heart disease, high cholesterol and depression.

To get a better sense of how this strange edition of a previously respected journal came into being, Salon contacted dozens of people listed as associate editors or senior associate editors at AJHB — none of whom are paid for their work there. Virtually none of them knew about the Juul-sponsored edition prior to its release.

“There was certainly no email sent out to any of the editors that this was going to happen,” Dr. Richard Olmstead, a research psychologist at UCLA’s Semel Institute for Neuroscience and Human Behavior, and an associate editor of AJHB, told Salon. “I think there would have been quite a bit of pushback had there been some forewarning about it.”

Dr. Carl Fertman, a professor emeritus at the University of Pittsburgh’s School of Education and an associate editor at the journal, described the special issue as a “complete surprise.”

“There was no transparency,” he said in an interview with Salon. “I don’t want to be associated with this journal. It’s upsetting.”

“I think it’s fairly unusual that a single company would sponsor a special issue,” another associate editor told Salon, asking not to be identified by name. “I was surprised to see they called out a specific company in every article.” This person added that was “different” from anything they’d seen before in “any scientific behavioral journal.”

A number of editors, however, acknowledged that there’s nothing new about seeing corporations sponsor scientific research they believe will be favorable to their bottom line.

For decades, the tobacco industry worked diligently to steer the scientific consensus away from the conclusion — now universally accepted — that cigarette smoking causes lung cancer, emphysema and other serious or life-threatening health problems. Central to that strategy was ginning up fake controversy by pushing junk science that appeared to contradict the overwhelming weight of scientific and medical evidence. Tobacco companies poured money into shadowy front groups that supported dubious science, paid consultants to prepare “expert” testimony to Congress and regulatory bodies and suppressed internal research findings that made clear that the companies themselves understood their products were killing people.

In 1998, a torrent of secret internal documents from a number of tobacco giants was released to the public as part of the Tobacco Master Settlement Agreement. By the early 2000s, the veil was just about lifted. Ruling on a landmark Justice Department suit back in 2006, U.S. District Judge Gladys E. Kessler found that several big-name tobacco companies, including Philip Morris, had systematically defrauded the American public with a decades-long effort to launder pro-tobacco “science” through academic and government channels.

To be clear, Juul is not a tobacco company. It makes and sells e-cigarettes, aka “vapes,” which contain no tobacco and are meant to simulate the experience of smoking cigarettes. They deliver high doses of nicotine to the brain through water vapor, often flavored in various ways. Whether vaping is “safe” remains an unsettled question, but it’s not the same thing as smoking.

Still, the fact Altria holds a significant interest in Juul creates an uncomfortable parallel, even if the two companies’ products would seem to be in competition. Juul’s decision to bankroll an entire edition of a medical journal struck many people as reminiscent of the Big Tobacco playbook.

Following AJHB’s publication of the special edition, a number of editors resigned from the journal, according to New York Times reporting later confirmed by Salon. Most editors declined to comment on the scientific merit of the papers published in the special edition. But there are reasons to be dubious about how the journal’s peer-review process worked in this case.

Before studies are published in any scientific journal, they are typically subject to peer review, in which experts in the relevant field read the papers and offer comments. As AHJB states in its ethical guidelines: “To decrease bias during the editorial process, we employ the classic double-blind peer review process. … The Editor-in-Chief transmits reviewer evaluations and comments to the corresponding author, usually within 4 weeks.”

AJHB editor-in-chief Dr. Elbert Glover, however, apparently told reviewers that the issue was about e-cigarettes in general — and then offered them cash rewards to complete their reviews within a week, according the the Philadelphia Inquirer. Many editors told Salon that in itself was unusual. Only after reviewers reportedly began to ask questions about “fishy” aspects of the studies did Glover reveal that the entire issue was funded by Juul. One reviewer told the Inquirer that the design of one particular study seemed so biased that she recommended it be rejected outright. “I thought, ‘No way it wasn’t funded by Juul,'” she said.

In an email exchange with Salon, Glover acknowledged that he had been privately approached by Juul, who personally paid him $57,500 to publish the edition. (Glover is the sole owner of the publication.) He maintained, however, that the peer review process was conducted in good faith.

“Reviewers were not initially notified regarding the funder of the special issue as it has been journal policy to not identify the funder of special issues during the review process,” Glover wrote to Salon. “However, during the review process, one reviewer requested the identity of the funder. As a result of the reviewer’s response, I decided to share the identity of the funder with all the reviewers of the special issue.”

Asked whether he believed it was appropriate to publish a corporate-sponsored special issue without consulting the other listed editors, Glover responded that it had not occurred to him, saying he “was more concerned about the science and did not consider who funded this issue.”

“I should have been more perceptive to their issue,” he said. “In retrospect, it was probably an error but I still do not understand the ability to ignore science and allow negative bias to enter into the decision.

“My philosophy is to allow the scientific merit to determine publication, not personal bias. Just because the tobacco industry lied, manipulated data and currently promote a product that causes death, does not mean that I have to compromise my values.”

But it’s precisely because of the tobacco industry’s dark history of lies and manipulative spin that Glover should have come clean about Juul’s sponsorship from the beginning, say experts on the other side of the issue.

“The problem is that the tobacco industry has a decades long history of spinning science to meet its regulatory, legal and PR needs,” wrote Dr. Stanton Glantz, former director of the Center for Tobacco Control Research and Education, in a blog post responding to AJHB’s special issue.

As one meta-analysis of research data found in 1998, “the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry.”

A number of AJHB editors told Salon that any study funded by an interested party, especially a large corporation, should be met with heightened scrutiny. One said it was “a red flag when the authors are part of the organization that sponsored the research,” adding: “It doesn’t mean that one can dismiss all of the findings, but it needs to be carefully scrutinized.”

It remains unclear which way the wind is blowing for Juul. In September 2019, the FDA issued a formal warning to the company, making clear that “before marketing tobacco products for reduced risk, companies must demonstrate with scientific evidence that their specific product does in fact pose less risk or is less harmful.”

“JUUL has ignored the law,” the department added, “and very concerningly, has made some of these statements in school to our nation’s youth.”

Months later, it was reported that Juul had begun beefing up its scientific staff, hiring a number of former FDA officials and recruiting researchers in hopes of clearing potential regulatory hurdles. Last July, Juul submitted a Premarket Tobacco Product Application (PMTA) to the FDA, providing “detailed scientific data from over 110 studies totaling over 125,000 pages evaluating the product’s impact on both current users of tobacco products and nonusers, including those who are underage.”

The Juul-sponsored special issue of AJHB is one aspect one part of the company’s PMTA, a Juul spokesperson told Salon in a statement.

“The research in the special issue derives from an extensive research program designed to provide the US Food and Drug Administration’s Center for Tobacco Products with information, scientific data, and analysis to determine whether JUUL products are appropriate for the protection of public health,” the statement read. “This determination, through the submission of Premarket Tobacco Product Applications (PMTAs), is based on a rigorous, science-based process. Indeed, FDA has received not only the findings and reports reflected in the published papers, but also the subject-level data and other supporting information required through the PMTA process.”

In April of this year, six major health organizations — including the American Academy of Pediatrics, the American Cancer Society, the American Heart Association and the American Lung Association — wrote a letter to the FDA urging the agency to reject Juul’s Premarket Tobacco Product Application.

“The devastating combination of appealing flavors that appeal to youth, targeted marketing strategies, and technological innovations that deliver a powerful hit of nicotine, has caused enormous damage to public health, primarily through youth uptake,” they wrote. “Because of this, no JUUL products currently on the market can meet the public health standard, and therefore, none should be authorized by CTP or be allowed to stay on the market.”

The FDA is expected to rule on Juul’s application by Sept. 9.

Study: Secondhand smoke exposure significantly increases risk of developing mouth cancer

Source: www.studyfinds.org
Author: Stephen Beech, SWNS writer

When most people think about the dangers of smoking, they probably consider the risks of cancer for the smoker. Although it’s common knowledge secondhand smoke is also dangerous, a new study is revealing just how devastating that exposure can be. Researchers say exposure to secondhand smoke can increase the risk of oral cancer by a staggering 51 percent.

Oral cancer, or cancers of the mouth, include those affecting the lip, oral cavity, and throat. These cancers account for almost 450,000 new disease cases and more than 228,000 deaths every year globally.

Scientists say that significant risk factors for these forms of cancer include tobacco smoking and use of smokeless tobacco products. Drinking alcohol can also increase the risk of oral cancer. Tobacco smoke represents the largest amount of human exposure to chemical carcinogens and causes a fifth of cancer-related deaths worldwide.

However, active smokers are not the only people who suffer from these chemicals. Researchers examining data from 192 countries find 33 percent of male non-smokers, 35 percent of female non-smokers, and 40 percent of children have experienced exposure to involuntary smoking through inhaling secondhand tobacco smoke.

Previous research also shows that inhaling secondhand smoke can cause several other diseases, including lung cancer. Although tobacco smoking can cause oral cancer, there is less evidence proving whether or not secondhand smoke also leads to the disease.

Long-term smoke exposure doubles cancer risks
A team from Britain, Portugal, Spain, and the United States evaluated the potential association between secondhand smoke exposure and the risk of oral cancer. Their review analyzed five existing studies involving more than 6,900 people. Among those participants — from Asia, Europe, North America, and Latin America — 3,452 had been exposed to secondhand smoke and 3,525 had not.

Their analysis, appearing in the journal Tobacco Control, reveals the more than 50-percent greater risk of mouth cancer due to secondhand smoke exposure. Additionally, exposure lasting more than 10 to 15 years increases the risk of oral cancers by more than twice the rate in comparison to people with no exposure to tobacco smoke.

“This systematic review and meta-analysis supports a causal association between secondhand smoke exposure and oral cancer,” researchers write in a media release. “Moreover, the analyses of exposure response, including by duration of exposure (more than 10 or 15 years) to secondhand smoke, further supports causal inference.”

“The identification of the harmful effects of secondhand smoke exposure provides guidance to public health professionals, researchers, and policymakers as they develop and deliver effective secondhand smoke exposure prevention programs and adopt appropriate measures to implement guidelines in Article 8 of the World Health Organization’s Framework Convention on Tobacco Control,” the team concludes.

Addressing unmet needs for head and neck cancer awareness month

Source: www.targetedonc.com
Author: Sara Karlovitch

Head and neck cancers, also known as squamous cell carcinomas of the head and neck, account for nearly 50,000 cases of cancer per year in the United States.

April is head and neck cancer month. According to the American Association for Cancer Research (AACR), alcohol and tobacco use are major risk factors for developing head and neck cancers. However, infection with the cancer-causing types of the human papillomavirus (HPV) also increases the risk for certain forms of the cancer, as well as eating preserved or salted foods, poor oral hygiene, occupational exposure to wood dust, asbestos, and synthetic fibers, radiation exposure, and Epstein-Barr virus infection in endemic regions, including southeast Asia.

Head and neck cancers are more common among men than women. Additionally, most patients who are diagnosed with this type of cancer are 50 years or older. Symptoms include a lump or sore on that does not go away or heal, difficulty swallowing, changes in voice, or a sore throat that does not resolve or heal.

Trials such as the KEYNOTE-048 study (NCT02358031), which investigated the use of pembrolizumab (Keytruda) as a first line treatment for recurrent or metastatic squamous cell cancer of the head and neck, have changed how head and neck cancers are treated. While many patients recover, many are still affected by life-long disabilities as the result of their disease and treatment.

Stuart J. Wong, MD, a medical oncologist, professor, and director of the Center for Disease Prevention Research at the Medical College of Wisconsin, discussed the KEYNOTE-048 trial, advances in head and neck cancers, and current unmet needs in this patient population in an interview with Targeted Oncology.

TARGETED ONCOLOGY: Can you discuss the evolution of treatments for patients with head and neck cancer?

WONG: Probably the biggest evolution is the integration of immune oncology into our treatment of head and neck cancer. We now have a first line indication for the use of an immune checkpoint inhibitor for patients with recurrent/metastatic head and neck cancer. This has been very successful in improving the overall survival for this patient population. Based upon the success of these agents in the recurrent and metastatic setting, there have been many new studies launched to test immune oncology agents into earlier stages of disease and to test novel immunotherapy combinations. The results of many of those studies are still anxiously being awaited.

TARGETED ONCOLOGY: What are your preferred first-line and later-line treatments in this setting?

WONG: My preferred first line is off of a clinical trial, pembrolizumab. The results of the KEYNOTE-048 study are very exciting and a huge help for patients, however we’re still not satisfied with that. My first choice, if at all possible, is to enroll patients in a clinical trial. Roughly about 20% of the patients with recurrent metastatic disease may have long-term survival with the use of pembrolizumab. Other patients receive benefits that may improve their survival, which is fantastic, but we’re not satisfied with those results and want to have higher response rates and more patients who would benefit from this therapy and more patients that have long-term survival. The only way we can do this is enroll patients in clinical trials and push the envelope even further and find strategies to improve the outcome of our patients.

TARGETED ONCOLOGY: What are some clinical trials of therapies in this setting right now, including for PD-L1 inhibitors and EGFR inhibitors?

WONG: The most exciting area of research are studies for patients who have progressed on an immune checkpoint inhibitor or have shown initial refractory disease. The most intriguing studies out there are for cellular therapies or other immune strategies. These novel therapies alone or in combination with an immune checkpoint inhibitor may overcome that initial resistance or subsequent resistance. There are many different strategies that are being explored. We are anxiously awaiting their results. As of yet, none of these strategies have proven to be successful compared with standard strategies. But I think in the next few years, we’re going to have some really dramatic results; something that will improve the outcome of this population of patients.

TARGETED ONCOLOGY: Can you talk about the role of low dose radiation for these patients?

WONG: This is an exciting area of research. The idea is that many of our patients with HPV-associated cancer have a favorable outcome and that you might be able to decrease the intensity of therapy and improve their outcome is a very promising strategy. A group from Memorial Sloan Kettering Cancer Center has led an interesting pilot study in which they decrease the intensity of the radiation using a significantly lower dose but kept cisplatin in the treatment regimen. Those results are very promising. The subsequent study of this paradigm and a larger multicenter trial would potentially warrant a sea of change in the way we manage patients. There are other strategies that are attempting to do the same thing. But this is an exciting area of research and something that patients seem to be very interested in exploring. We look forward to clinical trials that employ this technique.

TARGETED ONCOLOGY: Please go into detail on some of the unmet needs that are still relevant in the space.

WONG: The biggest one, I think, is that in clinical research, we still have a small minority of patients with head and neck cancer who enroll in clinical trials. There are many causes for this, but we cannot make progress in the treatment of these cancers unless we have more opportunities for patients to go on clinical trials and more clinical trials to offer to patients. It is frustrating that our progress is slow and that we cannot offer more advances to patients. There are some diseases where a much higher percentage of patients are treated on clinical trials initially and then when they recur, clinical trials are really part and parcel of the standard management of certain diseases. We don’t have that luxury in head and neck cancer, and this is something that we need to overcome. There is a desire for patients and for their physicians to make quicker progress. We cannot do that unless we have more resources at our fingertips to allow that to happen, and to make more progress on our patients.

I think the other big area that is in need of progress is supportive care oncology. Many of the treatment modalities that we utilize to cure or attempt to cure our patients have significant morbidity. The adverse effects linger with patients, sometimes for the rest of their life. While we’re happy that our patients are able to have their lives extended, or in some cases be cured, it makes us very frustrated that they do so at the expense of, sometimes, lifelong disabilities. We need more research into supportive care and survivorship issues. Many of us are very dedicated to this. But again, that runs into the issue that we have limited resources; there’s not as much funding for this kind of research. This is, I would say, a very big unmet need and frequently doesn’t rise to the top of discussion when we talk about cancer therapy and clinical trials.

TARGETED ONCOLOGY: Are there any specific upcoming trials or therapies that you think show promise in head and neck cancer?

WONG: If you would ask me in 2 months, I might have some really good ideas for you. I always look forward to our upcoming American Society of Clinical Oncology Annual Meeting. I’m sure this one promises to show some really exciting results. I guarantee in the next few years, we’re going to be making some exciting progress with respect to new technologies, especially cellular therapy strategies and immune oncology strategies. I can’t put bets on one line of research as being the most promising but there are many exciting lines of evidence that are being explored in ongoing clinical trials and clinical trials that are on the drawing board. I simply would say stay tuned and hopefully we’ll have some exciting news in the near future.

Reference:
Head and Neck Cancer Awareness Month. AACR. Accessed April 13, 2021. https://bit.ly/3sgeRHA

Artificial intelligence being trained to predict risk of developing oral cancer

Source: thestreetjournal.org
Author: staff, NHS

The diagnosis of oral cancer could be ‘revolutionised’ by using artificial intelligence to predict whether someone is likely to develop the disease, experts have said.

Experts led from the Universities of Sheffield and Warwick have teamed up to investigate how machine learning could be applied to aid doctors in early detection.

Diagnoses of oral cancers — including those of the mouth, tongue and tonsils — have increased by almost 60 per cent over the last decade, team noted. The risk of such cancers is heightened by such factors as alcohol consumption, increasing age, insufficient fruit and vegetables, tobacco and viral infection.

Doctors evaluate the likelihood of pre-cancerous changes in the lining of the mouth — so-called oral epithelial dysplasia — developing into cancer using 15 criteria. As this approach is highly subjective, however, there is considerable variation in how patients are treated following biopsy — and a more objective system is needed.

The diagnosis of oral cancer could be ‘revolutionised’ by using artificial intelligence to predict whether someone is likely to develop the disease, experts have said.

‘The precise grading of oral epithelial dysplasia is a huge diagnostic challenge, even for experienced pathologists, as it is so subjective,’ said clinical dentist Ali Khurram of the University of Sheffield.

‘At the moment a biopsy may be graded differently by different pathologists, the same pathologist may even grade the same biopsy differently on a different day.’

‘Correct grading is vital in early oral cancer detection to inform treatment decisions, enabling a surgeon to determine whether a lesion should be monitored or surgically removed,’ he added.

‘Machine learning and artificial intelligence can aid tissue diagnostics by removing subjectivity, using automation and quantification to guide diagnosis and treatment.’

‘Until now this hasn’t been investigated, but artificial intelligence has the potential to revolutionise oral cancer diagnosis and management by ensuring accuracy, consistency and objectivity.’

The researchers plan to use samples of tissue — alongside at least five years of patient follow up data — to train an algorithm to consider the statistical correlation between classifiers and survival rates.

This will then guide doctors as to help them make an informed decision on what to recommend for the given patient’s treatment.

‘People often feel threatened by AI, however rather than replacing a doctor’s expertise, exceptionally high-level of training and experience, the technology can help to assist their decision-making and compliment their skills,’ added Dr Khurram.

‘This will help them to give a more accurate assessment and enable them to recommend the most beneficial treatment pathway for individual patients which will hope will help to improve survival rates.’

‘The pilot project will pave the way towards the development of a tool that can help identify pre-malignant changes in oral dysplasia, said computational pathologist Nasir Rajpoot of the University of Warwick.

This, he explained, is ‘crucial for the early detection of oral cancer.’

‘Successful completion of this project carries significant potential for saving lives and improving patient healthcare provision.’

What is Mouth Cancer?
Mouth cancer, also known as oral cancer, is where a tumour develops in the lining of the mouth. It may be on the surface of the tongue, the insides of the cheeks, the roof of the mouth (palate), or the lips or gums.

Tumours can also develop in the glands that produce saliva, the tonsils at the back of the mouth, and the part of the throat connecting your mouth to your windpipe (pharynx). However, these are less common.

Symptoms of mouth cancer include:

  • sore mouth ulcers that don’t heal within several weeks
  • unexplained, persistent lumps in the mouth that don’t go away
  • unexplained, persistent lumps in the neck that don’t go away
  • unexplained looseness of teeth, or sockets that don’t heal after extractions
  • unexplained, persistent numbness or an odd feeling on the lip or tongue
  • sometimes, white or red patches on the lining of the mouth or tongue – these can be early signs of cancer, so they should also be investigated
  • changes in speech, such as a lisp

See your GP or dentist if these symptoms don’t heal within three weeks, particularly if you drink or smoke heavily.

Source: NHS

2020-11-04T12:05:12-07:00November, 2020|Oral Cancer News|

Smell of a person’s breath may help identify early cancers

Source: www.theweek.in
Author: staff

Cancer researchers from Flinders University have reported significant progress in developing a method to test exhaled breath profiles which accurately differentiate head and neck cancer from non-cancer patients.

Previous studies elsewhere have indicated that the exhaled breath condensate can reveal gene mutations or DNA abnormalities in patients with lung cancer.

The global quest to use a person’s breath analysis for rapid, inexpensive and accurate early-stage testing for cancer and other diseases has taken a leap forward.

The Australian researchers collected breath samples from 181 patients suspected of having early-stage head and neck squamous cell carcinoma (HNSCC) before any treatment began.

“We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting head and neck cancer, which in time may result in a simple method to improve treatment outcomes and patient morbidity,” says lead researchers Dr Roger Yazbek and Associate Professor Eng Ooi.

Worldwide, head and neck cancer accounts for 6 percent of all cancers, killing more than 300,000 people per year globally. Tobacco, alcohol and poor oral hygiene are known major risk factors for this cancer.

A surge in human papilloma virus (HPV)-associated head and neck cancers is seeing these cancers affecting a much younger population, the researchers say.

Current therapies are effective at treating early-stage disease, however late-stage presentations are common, and often associated with poor prognosis and high treatment-related morbidity.

In the Australian study, a selected ion flow-tube mass spectrometer was used to analyse breath for volatile organic compounds. Using statistical modelling, the Flinders researchers were able to develop a breath test that could differentiate cancer and control (benign disease) patients, with an average sensitivity and specificity of 85 percent.

Diagnosis was confirmed by analysis of tissue biopsies.

“With these strong results, we hope to trial the method in primary care settings, such as GP clinics, to further develop its use in early-stage screening for HNSCC in the community,” says co-lead author Dr Nuwan Dharmawardana.

The study has been published in the British Journal of Cancer.

Vaping e-cigarettes could increase the risk of oral disease, study finds

Source: technology.inquirer.net
Author: staff

New American research has found that individuals who use e-cigarettes could be at risk of developing oral diseases in the future, which could range from gum disease to cancer.

Carried out by researchers at The Ohio State University, the new study looked at a group of 123 people with no signs of oral disease. The group included 25 smokers, 25 non-smokers, 20 e-cigarette users, 25 former tobacco smokers who used e-cigarettes and 28 people who smoked both tobacco cigarettes and e-cigarettes.

The team collected plaque samples taken from under the gums of the participants to analyze the bacteria in this part of the mouth; bacteria here is the last line of defense against disease as it is the least likely to be disrupted by environmental changes in the mouth, such as food, toothpaste and tobacco.

The researchers then carried out DNA deep sequencing of the bacteria’s genomes to identify what types of microbes were living in participants’ mouths and what their functions were.

The findings, published in the journal Science Advances, showed that although the e-cigarette users didn’t have signs of active disease, their oral bacteria composition was similar to that of people with severe periodontitis, a severe gum infection that can lead to health problems such as tooth loss, and, if left untreated, is a risk factor for serious conditions such as heart and lung disease.

The effect of e-cigarette smoking was also seen with or without nicotine, which the researchers say suggests that it is the heated and pressurized liquids in e-cigarette cartridges that are making vapers’ mouths a welcoming environment for a dangerous combination of microbes.

Even long-term current and former cigarette smokers had worse oral profiles linked to using e-cigarettes after just three to 12 months of vaping.

“Vaping is such a big assault on the oral environment, and the change happens dramatically and over a short period of time,” said Purnima Kumar, senior author of the study.

“If you stop smoking and start vaping instead, you don’t move back toward a healthy bacterial profile but shift up to the vaping profile,” Kumar explains. “Knowing the vaping profile is pathogen-rich, you’re not doing yourself any favors by using vaping to quit smoking.”

The researchers say this is the first human study on the effects of e-cigarette exposure in the mouth, and like previous research into e-cigarettes, also questions their safety.

Another vaping hazard: less-healthy mouths

Source: www.usnews.com/
Author: Serena Gordon, HealthDay Reporter

Your lungs might not be your only concern if you’re trying electronic cigarettes — your mouth may pay the price, too. Vaping alters the natural bacteria found in the mouth, leaving you more vulnerable to oral infections and inflammation, a new study reports.

The researchers said this study is the first to show that vaping can alter the natural balance of beneficial bacteria (microbiome) in the mouth, adding to the list of potential health effects associated with e-cigarette use.

“Cells that are exposed to e-cigarettes are more susceptible to infections,” said the study’s senior author, Deepak Saxena. He’s a professor of basic science and craniofacial biology at NYU College of Dentistry in New York City.

Saxena said that e-cigarettes also lead to increased inflammation, which harms oral health. And once someone develops inflammation, it’s possible to develop white patches in the mouth called leukoplakia that sometimes develop into cancer. However, this study doesn’t have enough long-term evidence to show whether or not these changes could lead to oral cancers in the future, Saxena said.

“Our study is just one piece of this big puzzle on e-cigarettes, and I would advise people to not use them. If you have not started, don’t start. Nicotine is highly addictive,” he said.

A U.S. Centers for Disease Control and Prevention report from November suggested that as many as one out of every five U.S. high school students had vaped in the last month. That’s especially concerning since more than 2,500 Americans have been hospitalized with lung injuries traced back to e-cigarette use. An additive sometimes used when people vape is suspected as a trigger for these injuries. Fifty-four people have died as a result.

People who smoke traditional tobacco cigarettes are known to have a higher risk of gum disease and oral infections. Tobacco causes changes in the mouth’s usual environment that dampen the immune system response and let bad bacteria flourish, the researchers explained.

E-cigarettes have been considered less harmful, but there hasn’t been a lot of research, particularly long-term studies on the new devices.

For the new study, the research team recruited 119 participants, including roughly equal numbers of people who didn’t smoke or vape, people who smoked tobacco cigarettes, and those who had only used e-cigarettes. The researchers performed oral exams and collected saliva samples to test for the bacteria living in the participants’ mouths.

Almost three-quarters of tobacco smokers showed signs of gum disease or infection. Forty-three percent of e-cigarettes users also showed signs of these problems. Only 28% of the nonsmokers had signs of gum disease or infection.

When they tested for bacteria, the researchers found different types of predominant bacteria in the three groups.

“We found there is a shift in the microbiome of e-cigarette users, making it much closer to that of regular cigarette smokers,” Saxena said.

Co-author Xin Li, an associate professor at NYU College of Dentistry, noted that the researchers can’t say if e-cigarettes are more dangerous for oral health than traditional tobacco cigarettes.

“We saw a similar trend to inflammation and periodontitis (a serious gum infection), but I don’t think we can draw any conclusions about whether e-cigarettes are more harmful,” she said.

If you vape and have concerns about these potential changes, Saxena suggested taking greater care with your oral health and perhaps seeing your dentist more frequently. Li said maybe probiotics can help restore the microbiome in the mouth. But both noted these steps haven’t been studied yet.

Li said if you are using e-cigarettes to help with quitting traditional tobacco cigarettes, try to use e-cigarettes for the shortest time you can. Plan on how you’ll cut back. Don’t plan to use e-cigarettes indefinitely, she advised.

Ronald Burakoff is chairman of dental medicine at Long Island Jewish Medical Center and North Shore University Hospital in New York. He said the study’s findings make sense.

“This article describes in detail some of the adverse outcomes associated with [e-cigarette] usage. Firstly, it increases the amount of bacteria in the mouth; secondly, it promotes inflammation of the gums,” Burakoff said. He added that these changes could lead to an increased risk of infection.

Note: The study was published online Feb. 26 in iScience.

2020-02-27T09:26:31-07:00February, 2020|Oral Cancer News|

Healthy diet may avert nutritional problems in head, neck cancer patients

Source: medicalxpress.com
Author: University of Illinois at Urbana-Champaign

At least 90 percent of head and neck cancer patients develop symptoms that affect their ability or desire to eat, because of either the tumor itself or the surgery or radiation used to treat it. These problems, called nutrition impact symptoms, have wide-ranging negative effects on patients’ physical and mental health and quality of life.

However, patients who eat foods high in antioxidants and other micronutrients prior to diagnosis may reduce their risks of developing chronic nutrition impact symptoms up to one year after being diagnosed with head or neck cancer, according to a recent study led by researchers at the University of Illinois.

The scientists analyzed the dietary patterns of 336 adults with newly diagnosed head and neck cancers and these patients’ problems with eating, swallowing and inflammation of the digestive tract. This painful inflammatory condition, called mucositis, is a common side effect of radiation treatment and chemotherapy.

The mitigating effects of a healthy diet were particularly significant in people who had never smoked and in patients who were underweight or normal weight at diagnosis, who often experience the greatest eating and digestive problems during treatment, said Sylvia L. Crowder, the paper’s first author.

Crowder is a research fellow in the Cancer Scholars for Translational and Applied Research program, a collaborative initiative of the U. of I. and Carle Foundation Hospital in Urbana, Illinois.

“While previous work has established that the presence of nutrition impact symptoms is associated with decreased food intake and weight loss, no studies have examined how pre-treatment dietary intake may influence the presence of these symptoms later in the course of the disease,” Crowder said.

In the early 2000s, researchers hypothesized that consuming antioxidant supplements might protect patients’ normal cells from damage during radiotherapy, enabling them to better tolerate treatment and higher dosages.

Accordingly, prior research by Anna E. Arthur, a professor of food science and human nutrition at the U. of I. and the current study’s corresponding author, indicated that eating a diet of whole foods abundant in antioxidants and phytochemicals improved recurrence and survival rates in head and neck cancer patients.

Like Arthur’s prior research, the new study was conducted with patients of the University of Michigan Head and Neck Specialized Program of Excellence.

Data on patients’ tumor sites, stages and treatment were obtained from their medical records. More than half of these patients had stage 4 tumors at diagnosis.

Prior to starting cancer treatment and again one year post-diagnosis, the patients completed a questionnaire on their diet, tobacco and alcohol use, and quality of life. Patients reported whether they experienced any of seven nutrition impact symptoms—such as pain or difficulty chewing, tasting or swallowing foods and liquids—and rated on a five-point scale how bothersome each symptom was.

In analyzing the patients’ eating habits, the scientists found that they followed either of two major dietary patterns—the Western pattern, which included high amounts of red and processed meats, fried foods and sugar; or the prudent pattern, which included healthier fare such as fruits and vegetables, fish and whole grains.

Patients who ate healthier at diagnosis reported fewer problems with chewing, swallowing and mucositis one year after treatment, the scientists found.

“While the origin and development of nutrition impact symptoms are complex and varied, they generally share one common mechanism—cell damage due to inflammation,” said Arthur, who is also an oncology dietitian with the Carle Cancer Center. “The prudent dietary pattern has the potential to reduce inflammation and affect the biological processes involved in the pathogenesis of these symptoms.”

The scientists hypothesized that some patients may begin eating healthier after being diagnosed with cancer, potentially counteracting the pro-inflammatory effects of their previous dietary habits.

Reverse causation was possible too, they hypothesized—patients’ lack of symptoms may have enabled them to consume a broader range of foods, including healthier whole foods, before their cancer was discovered.

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.

Research to examine possible links between periodontal disease and oral cancer

Source: eu.dental-tribune.com
Author: Dental Tribune International staff

As worldwide oral cancer rates continue to climb, our understanding of what causes the disease to occur, thankfully, also continues to grow. Tobacco use and excessive alcohol consumption have been established as primary risk factors, and researchers are now investigating another potential source for this condition: the bacteria that cause periodontal disease.

The research is being led by Dr Louise Belfield, a lecturer in biomedical science at the University of Plymouth’s Peninsula Dental School, in collaboration with the university’s Institute of Translational and Stratified Medicine. Since cancer requires blood vessels to grow and metastasise, the research team is planning to build on existing evidence that shows how certain bacteria that cause periodontal disease are linked to angiogenesis.

To do so, the research team will develop miniature tumours and blood vessels in a laboratory setting, adding the bacteria with the aim of clarifying how they function and what effect they have on the blood vessels.

According to a press release from the university, if the research ascertains that the bacteria make the blood vessels grow more rapidly and similarly to those associated with tumours and identifies the process by which this is achieved, the results could form the basis of a new screening programme to detect oral cancer risk earlier. This would make it possible to begin treatment in a more timely manner.

“We know that tumours in the mouth, unlike many other tumours, are in constant contact with bacteria, but we don’t know exactly how the bacteria affect tumour and vessel growth yet,” said Belfield.

“The bacteria may not cause the cancer, but they may do something to make the progression of the cancer speed up. One way they could do this is via the blood vessels, encouraging them to grow more rapidly or in a way which helps the tumour to grow. So if we find out what this is and how it works, it can help us develop and put screening processes in place to detect and reduce the numbers of those bacteria,” she continued.

Dental Tribune International (DTI) has previously reported on a study which confirmed the crucial role of dental professionals in detecting oral cancer early. This early detection can greatly improve the prognosis of sufferers.

“Oral cancer is a horrific disease with poor survival rates—only around 50% of those diagnosed are alive five years later. It is an in-your-face, no-hiding, disfiguring disease, and the treatment can be very protracted, complex and costly,” said Dr David Conway, Professor of Dental Public Health at the University of Glasgow’s School of Medicine, Dentistry and Nursing, in an interview with DTI last year.

“The earlier it is detected, however, the better the outcome can be,” Conway added.

2019-11-06T09:45:25-07:00November, 2019|Oral Cancer News|
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