The Oral Cancer Advocate

Major changes have taken place at the American Dental Association. Recently the board decided to terminate the employment of the two top individuals at the organization rather abruptly. While there no doubt were accumulative reasons for which this action was taken, I think there is little doubt that their position to allow a commercial company’s marketing rhetoric to become the face of the ADA oral cancer awareness program played a part in all this. Undoubtedly this will trigger a rethinking of the relationship with Oral CDx, and if that continues, it will likely take a very different form. This would be a good thing in my mind. It is hard to imagine that (now involved as they should have been in the beginning), the ADA’s Science Council – which has a fair sampling of oral surgeons and oral pathology individuals on it – will rubber stamp the CDx brush biopsy rhetoric which has played to date.

Those who have read previous postings here, may remember my observations on what happened at the American Medical Association when their hired leadership decided to become intimate with the Sunbeam corporation, adopting Sunbeam’s sales and promotional materials, and flying those corporate colors under the AMA banner…. the trustees showed them the door very soon thereafter. My observation that similar fates could be avoided by anyone who was paying attention at the ADA, proved out. Money for these professional societies is a powerful draw, and at the core of the ADA/CDx relationship it was there, more than 9 million dollars over three years. CDx had it, the ADA wanted it, and in the end the organization proved that their logo and identity could be bought. I do not find this unusual, or for that matter new when you look at the last couple decades of the ADA’s behavior. There is little doubt that the money generated from their ADA seal of approval program generated significant revenues for the association.

The public must remember that their charter is to serve the needs of their constituents, dentists. They should not think that any created illusion, for instance that the public interest is the ADA’s prime focus, is actually little more than a distortion of reality. I wish to make it clear. This is as it should be. Their charter is to see to the needs of dentists, and as a private society with only dentists as members, this is completely appropriate and expected of this kind of organization. But the ADA would like to appear to the public as less of what is essentially a trade union, and more as a benevolent public service organization. They are not a public service organization. Efforts to create this organizational persona confuse the public, and I am in favor of more transparency, or at least the ADA visibly being what they actually are. It doesn’t detract from anything, or make them bad guys to be the protectors of the interests of dentists. And this does not mean that they do not have programs that the public benefits from, it just means that those are secondary to their primary function. Pushing Oral CDx’s marketing agenda for profit in a world in which they are viewed as what they really are isn’t problematic. However it does become so when they try to appear a champions of the public welfare, and at the same time put out a message that has a for profit motive associated with it, which distorts the reality of what a biopsy brush is and can do.

While I feel this major change needed to happen, they were getting at least part of the message right. A message that the public does not hear enough. Oral cancer is out there, and an annual screening – done opportunistically – for oral cancer will save lives. My hope now is that they will continue with an awareness program that puts DISCOVERY in first place, and any techniques for DIAGNOSIS in second. But I have little hope that CDx will wish to fund something other than their position that their brush cytology system “prevents oral cancer,” which I and others strongly disagree with.

One has to wonder why the ADA has not partnered up with non competitive public service entities like the Oral Cancer Foundation to work together towards what would seem symbiotic goals. With dentists being one of the primary mechanisms to engage in opportunistic screenings to reduce the death rate and treatment morbidity, I think they should use their strengths to work with OCF and others to get dentists up to speed on screening, to institute mandatory CE credits in oral cancer and early detection (I mean how many more CE credits do you need on bleaching, veneers, and Invisalign tooth straghtening?), so we can be sure that they know what to look for, how, and where, and help a non profit with fewer financial and infrastructure assests fulfill a needed mission that is in the public (and the ADA’s) interest.

For years the ADA has always been the 800 pound gorilla in any relationship. Their way or the highway. I hope that the new leadership (supported by trustees who get all this) will reach out to make real change in the world though these kinds of relationships. None of this compromises their ability to be the champions of dentist’s interests, and it might make both them and dentists real champions in the long run….

Tags: Oral Cancer News, Screening, The ADA by oc advocate
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A recent study conducted in Groningen, The Netherlands, may prove to be the Holy Grail for cancer survivors, since the vast majority are living with significantly compromised salivary function. Radiation treatments often have much of the major salivary glands within the field of radiation. This is deadly to the delicate glands. What follows is an abstract of some very promising work that may improve the quality of life for these survivors.

Head and neck cancer is the fifth most common malignancy and accounts for 3% (not a U.S. statistic) of all new cancer cases each year. Despite relatively high survival rates, the quality of life of these patients is severely compromised because of radiation-induced impairment of salivary gland function and consequential xerostomia (dry mouth syndrome).

In this study, a clinically applicable method for the restoration of radiation-impaired salivary gland function using salivary gland stem cell transplantation was developed. Salivary gland cells were isolated from murine submandibular glands and cultured in vitro as salispheres, which contained cells expressing the stem cell markers Sca-1, c-Kit and Musashi-1. In vitro, the cells differentiated into salivary gland duct cells and mucin and amylase producing acinar cells. Stem cell enrichment was performed by flow cytrometric selection using c-Kit as a marker. In vitro, the cells differentiated into amylase producing acinar cells.

In vivo, intra-glandular transplantation of a small number of c-Kit(+) cells resulted in long-term restoration of salivary gland morphology and function. Moreover, donor-derived stem cells could be isolated from primary recipients, cultured as secondary spheres and after re-transplantation ameliorate radiation damage. Our approach is the first proof for the potential use of stem cell transplantation to functionally rescue salivary gland deficiency.

Authors:
IM Lombaert, JF Brunsting, PK Wierenga, H Faber, MA Stokman, T Kok, WH Visser, HH Kampinga, G de Haan, and RP Coppes

Tags: Oral Cancer News, Treatment by oc advocate
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The sexually transmitted virus that causes cervical cancer in women is poised to become one of the leading causes of oral cancer in men, according to a new study. The HPV16 virus now causes as many cancers of the upper throat as tobacco and alcohol, probably due both to an increase in oral sex and the decline in smoking, (the historically dominant risk factor) researchers say.

The only available vaccine against HPV, made by Merck & Co. Inc., is currently given only to girls and young women. But Merck plans this year to ask government permission to offer the shot to boys. Experts say a primary reason for male vaccinations would be to prevent men from spreading the virus and help reduce the nearly 12,000 cases of cervical cancer diagnosed in U.S. women each year. I might add that by not doing gender based vaccination, we will reduce the overall reservoir of the virus in the US which is currently ubiquitous in the population. But the new study should add to the argument that there may be a direct benefit for men, too. The study was published February 1, 2008, in the Journal of Clinical Oncology.

“We need to start having a discussion about those cancers other than cervical cancer that may be affected in a positive way by the vaccine,” said study co-author Dr. Maura Gillison of Johns Hopkins University. Of course she is referring the the rapidly rising numbers or oropharyngeal, base of tongue, and tonsillar cancers we are seeing in both males and females.

Human papillomavirus, or HPV, is the leading cause of cervical cancer in women. It also can cause genital warts, penile and anal cancer, and oral cancers — risks for males that generally don’t get the same attention and press as cervical cancer. Previous research by Gillison and others established HPV as a primary cause of the estimated 5,600 cancers that occur each year in the tonsils, base of tongue and upper throat. It’s also been known that the virus’ role in such cancers has been rising. It is in fact, the primary cause of cancers in these anatomical sites.

The new study looked at more than 30 years of National Cancer Institute data on oral cancers. Researchers categorized about 46,000 cases, using a formula to divide them into those caused by HPV and those not connected to the virus. They concluded the incidence rates for HPV-related oral cancers rose steadily in men from 1973 to 2004, becoming about as common as those from tobacco and alcohol.

The good news is that survival rates for the cancer (when caused by a viral etiology) are also increasing. That’s because tumors caused by HPV respond better to chemotherapy and radiation, Gillison said. “If current trends continue, within the next 10 years there may be more oral cancers in the United States caused by HPV than tobacco or alcohol,” Gillison said.

Studies suggest oral sex is associated with HPV-related oral cancers, but a cause-effect relationship has not been proven as the only viral transfer mechanism for these cancers. Other researchers have suggested that even unwashed hands can spread it to the mouth as well. Gillison however pointed toward sex as an explanation for the increase in male upper throat cancers, and her previously published work documents this in the New England journal of Medicine. In women HPV-related upper throat cancers declined significantly from 1973 to 2004.

Merck’s vaccine, approved for girls in 2006, is a three-dose series priced at about $360. It is designed to protect against four types of HPV, including one associated with oral cancer. Merck has been testing the vaccine in an international study, but it is focused on anal and penile cancer and genital warts, not oral cancers, said Kelley Dougherty, a Merck spokeswoman. “We are continuing to consider additional areas of study that focus on both female and male HPV diseases and cancers,” Dougherty said. Merck officials praised Gillison’s research, saying it will elevate the importance of HPV-related oral cancers. As I have posted here before, I believe that Gillison’s work should be mandatory reading for all those that have the opportunistic ability to discover early these very deadly posterior mouth cancers (Dentists, oral hygienists, and members of the ENT profession.)

In a typically guarded observation, Government officials and the American Cancer Society say they don’t know yet whether Merck’s vaccine will be successful at preventing disease in men. No data from the company’s study are available yet. Indeed, it’s not clear yet that the vaccine even prevents the HPV infection in males, let alone cancer or any other illness, said Debbie Saslow of the American Cancer Society. However in speaking with experts in the virus research community, I believe that if Merck’s current trials show that it can prevent persistent HPV 16 infections, that the logical extension of that fact would indicate that without the persistent infection, there would also be no mechanism for the disease process to take place. Keep in mind that tobacco will still be a major player in the incidence of oral cancers, and we are looking at a subset population of people with oral cancer when speaking of HPV16.

Merck plans to seek U.S. Food and Drug Administration approval for the vaccine in men later this year, meaning a government decision would be likely in 2009.

Tags: HPV, Oral Cancer News, The Changing Demographics by oc advocate
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When I started writing this site, I was sure that it was something that would remain non-political, but in this post I break that choice.

This week I had the opportunity to talk to a family that has recently lost their son to oral cancer. A man in his early thirties, a non smoker, athlete, and a father of two daughters. There are many aspects to this tragedy that I could explore here. The lack of early detection screenings in his dental appointments, his ignoring some hoarseness that persisted for several months, the treatments that were conducted initially by a small, local city hospital with minor cancer capabilities – which did not bring to bear all the potentially beneficial medical assets soon enough, and much more. But this particular entry is about the recent ruling by the high courts related to who in our population may have access to drugs which are not yet approved, but have shown potential in the trials to date and may even save a life. The current state of the situation is that there has been a ban on their use, regardless of the willingness of a patient to fully accept the risks associated with that use. Most of the patients who have petitioned for this ability have been in terminal disease states with no other hopes. Certainly the drug manufacturers have been quiet about much of this as they are regulated by the FDA’s rulings, but you have to believe that they too would be interested to see if a particular drug had impact or not, if only from a scientific perspective and not a compassionate one.

I can think of no greater means by which this administration, under the leadership of President Bush (and those that support his power base) has debilitated our country, for decades into the future, than his appointments to the judiciary and specifically to the supreme court. US Court of Appeals judge Thomas Griffith has ruled this week that “there is no right, deeply rooted in this nation’s history and tradition, of access of experimental drugs to the terminally ill.” It must be noted that Griffith, recently appointed by Bush, is a relatively young man. As such he has the potential to be making inane comments like this for decades to come. It is no surprise that Bush’s newly conservative weighted Supreme Court supported this ruling, and refused to hear the case themselves.

This is yet another instance, Iraq comes to mind immediately, in which “compassionate conservatives ” are willing to kill people in order to protect them. This distinction is not just academic, it is much more. What conservatives on the courts refuse to comprehend, is that the Bill of Rights is a list of rights that the citizens of this country grant to the government, NOT vice versa. The ruling should have been that the government has no fundamental right to deny potentially life saving or life extending drugs and treatments to dying patients… particularly when all parties concerned are cognizant of the inherent risks, willing to accept the consequences of their decisions, and no others are harmed through the process in any manner.

There were options and opportunities, granted with significant inherent risks for this young man with oral cancer. We will never know if those options would have given him a few more months with his family to communicate that which is now forever unsaid, or even to have defeated this disease and lived on. Thank you judge Thomas Griffith – I wonder how you would feel, were this you in a life and death battle, and how that might impact your decision making process. One only has to remember the reversal of opinion from other compassionate conservatives, like Ronald Regan and his wife, when they found themselves on the other side of a horrible disease issue that they failed to champion when the chance was theirs. Lastly, I note the recent statements made by John McCain, the current conservative front runner for the white house. There are many things to like about this man, but his recent statement that we might still be in Iraq a hundred years from now made my jaw drop… which was then followed by a statement to appease the conservative base, that he would appoint more conservative judges to the supreme courts were he elected. Remember that 6 of the nine judges will be 70 or older next year. I do not favor a liberal court, but one that has balance, and whose opinions are not based in ideological agendas. Our next president can take us to more of the same in judicial conservatism, or to balance. Any thinking person should consider this as one of the core issues when they cast their next ballot.

Tags: Oral Cancer News by oc advocate
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The Oral Cancer Foundation has partnered with yet another celebrity to help get the word out about oral cancer. They clearly understand the power that TV and movie personalities bring to raising public awareness, the first essential component to bringing the death rate down. Ms. Pinter is in good company with other OCF partners – three-time Emmy winner Jack Klugman, and two-time Emmy winner and Tony winner Blythe Danner (Gwyneth Paltrow’s mom for those who do not follow these kinds of things). Anyone reading my postings to date and looking at my links, can tell that I am a fan of OCF’s work. The only thing I do not get, is why they do not capitalize on these celebrities to help them raise funds. Clearly as a small non-profit charity they can’t be bringing in the kind of donations that the big guns like the American Cancer Society and the breast cancer folks do. Someone who is in a financial realm which I do not personally inhabit needs to look at these guys. They get more done for less than anyone else out there. What could they do if they had some financial support? Anyway, what follows is their press release on this relationship.

Actress Colleen Zenk Pinter Partners with the Oral Cancer Foundation to Raise Public Awareness

Two time Emmy nominated actress Colleen Zenk Pinter, best known for her long running role as Barbara Ryan on CBS’s As the World Turns, has teamed up with the Oral Cancer Foundation to share the story of her battle against oral cancer, and raise public awareness of a disease which kills more Americans each year than more commonly known cancers.

Zenk Pinter’s first stop was CBS’s The Early Show. In an interview with co-anchor Hannah Storm, Zenk Pinter revealed how a seemingly stubborn canker sore turned out to be a stage-two malignant oral cancer, requiring several surgeries to reconstruct her tongue, and months of radiation treatments. Zenk Pinter explained to Storm that she believes that her cancer was caused by the human papillomavirus. “I had absolutely none of the historic risk factors for this cancer, I never used tobacco and only drank socially,” she said, referring to the two other common causes of the disease.

“In fact, young Americans who have none of the historic risk factors are the fastest growing segment of oral cancer patients in the country,” Brian Hill, executive director of the Oral Cancer Foundation says, “and we believe the culprit behind the surge in cases is HPV16, the same virus that causes cervical cancer.”

Dr. Mark Lingen, Professor of Pathology at the University of Chicago School of Medicine says, “Colleen was very typical of most Americans in their lack of knowledge of oral cancer. Awareness and routine screening is particularly important, since early discovery is directly correlated to positive outcomes from treatment. HPV is the most common sexually transmitted disease in the United States. At least 50 percent of American adults will acquire the virus at some point in their lives. HPV16, one of the most destructive strains of the virus, was definitively linked to oral cancer in 2001. Research has also established that the virus, which can easily be transferred, may even be a more significant risk factor than tobacco in the younger portion of the population.”

“Colleen is an amazing woman”, said Hill. “Even BEFORE she had begun her treatments for the cancer, she contacted me and wanted to become an advocate for early detection and increased awareness. She was clearly taken by surprise to have developed this cancer. Most people at that point in the process are only thinking of themselves, and getting through the really tough treatments successfully. Her willingness to talk publicly about her very personal and painful battle with oral cancer is certainly courageous, and the desire to help others is palpable when you speak with her. Her story and high profile celebrity as a well-known TV actress will have enormous impact educating the public about this deadly and disfiguring disease. This is one of the purest examples of altruistic, celebrity power being used to better other people’s lives. We are lucky to have this partnership with Colleen.”

Now cancer-free, Zenk Pinter urged viewers of The Early Show to get regular oral cancer screenings. “Your dentist should be doing an oral cancer exam at every visit,” Zenk Pinter said. “It’s a simple 5 minute, painless exam that may save your life.”

The Early Show was only the first of what is on the public awareness schedule for Zenk Pinter. A recent interview with Soap Opera Digest is already on the newsstands, and interviews with other magazines have been scheduled. In December she will film a TV Public Service Announcement on the need for early detection through annual screenings. OCF will distribute the PSA to TV stations across the country at the beginning of 2008.

About Colleen Zenk Pinter
Ms. Zenk Pinter has worked professionally since the age of nine as an actress. Besides her long time association with As the World Turns, in which she has appeared in over 2,000 episodes, Colleen made her Broadway debut in Bring Back Birdie. Her film debut was in John Huston’s adaptation of Annie. Her benevolent and philanthropic association with health causes is not new, and for decades she has donated time to work with the Easter Seals, the March of Dimes, the Cystic Fibrosis Foundation and Bread to Roses, one of the first AIDS hospice programs. For more information about Colleen’s background, go to http://www.astheworldturns.net

The Oral Cancer Foundation, founded in 2000, is a national non-profit charity based in California. The foundation advocates for better public understanding of the disease and engages the medical and dental communities to be more involved in early detection. The foundation maintains a Web site with information for patients, the public, and health care providers at www.oralcancerfoundation.org. It is supported through tax-deductible public donations which can be made at http://www.oralcancerfoundation.org/membership/membership.htm

Tags: Oral Cancer News by oc advocate
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What follows are some interesting works involving berries and cancer. Please note that while some of this is very interesting, it is a long way from being something that can be applied usefully today. These are very preliminary looks at things, and I put thm up on the blog to let people know some of the novel trains of thought people are pursuing. While it won’t hurt you to eat a ton of berries, and it certainly would be healthy, the evidence does not support a proven idea that you should suff yourself with these tasty fruits to do more than eat a nutritious food for your body. At this point in time whether there is any efficacy for them in relationship to cancer in humans is still a quuestion. But it’s, berry, berry interesting….. ( I can’t believe that I just typed that lame play on words.)

Dark fruits like blueberries, blackberries as well as papaya could be used to stop mouth cancer cells spreading through the rest of the body. They could also reduce the risk of mouth cancer, according to research published in the Journal of Cancer Research.

The study, carried out at the University of Hong Kong, found that as well as suppressing the spread of cancer, a substance called lupeol found in blueberries and other “super fruit” also reduced the size of the tumour three times faster than conventional drugs. When the two were used together they were even more successful. The compound works by blocking a natural protein called NFkB which helps to grow and repair all cells – even cancerous ones. Tests on mice also suggested that, unlike conventional drugs, lupeol would not cause the patient to lose weight.

Dr Nigel Carter, chief executive of the British Dental Health Foundation, said, “We already knew a healthy diet, including at least five portions of fruit and vegetables each day, could reduce a person’s risk of developing mouth cancer. “However the news that certain fruits might help to combat mouth cancer in people who have already developed the condition is a real revelation. “It is true that this research is still in its early stages. However, the suggestion is the lupeol compound could be more effective than traditional drugs in preventing the growth of mouth cancer cells.”

In anothger study, Ohio State University researchers found black raspberries may protect against esophageal cancer by reducing the oxidative stress that results from Barrett’s esophagus, a precancerous condition usually caused by gastroesophageal reflux disease. Reflux disease causes stomach acid to continually splash back up into the esophagus.

“Specifically in the case of Barrett’s patients, reflux of the stomach and bile acid contribute to ongoing oxidative damage. Thus, our hypothesis is that feeding a food that is high in potential protective constituents, such as antioxidants, vitamins, minerals and other phytochemicals, may help restore the oxidative balance,” lead researcher Laura Kresty said. People with Barrett’s esophagus typically are 30 to 40 times more likely to develop esophageal cancer, which has a poor five-year survival rate of 15 percent.

The team gave 32 grams to 45 grams of black raspberries daily for six months to 20 patients with Barrett’s esophagus. They analyzed changes in blood, urine and tissue before, during and after the treatment, and found lower levels of some of the chemical markers of oxidative stress in both urine and tissue samples. Black raspberries previously have been shown to reduce the risk of oral, esophageal and colon cancer in animal models, according to the researchers, who called for further study in humans.

Ohio has another take on berries as well. Gary Stoner, PhD, a scientist at the OSU Comprehensive Cancer Center – James (OSU CCC-James) who has spent years conducting food-based cancer-prevention studies, says one serving should involve black raspberries, blackberries or strawberries. Stoner and colleagues have found that all three exhibit anticancer properties in rodents, but their more extensive studies have involved black raspberries. “Black raspberries have high levels of anthocyanin pigments that give the berries their color and act as antioxidants to reduce cellular DNA damage caused by oxygen radicals and carcinogens in the body,” says Stoner. “The more antioxidant activity, the more a berry can inhibit cancer.”

Stoner’s studies began in the 1980s when he examined ellagic acid, a compound that inhibits carcinogen-induced cancer in animals. Seeking natural sources of this compound, his team examined many fruits and found it most abundant in berries. They then began testing the berries’ ability to inhibit chemically induced esophageal and colon cancer in rodents. Collaborating with the OSU College of Food, Agricultural and Environmental Sciences, Stoner’s team found that freeze-dried strawberries, black raspberries and blackberries, when added to the diets of rodents, prevented carcinogen-induced esophageal cancer by 60 percent compared with rodents on normal diets. They found that black raspberries inhibited carcinogen-induced adenocarcinoma in the colon of rodents by up to 80 percent.

At first they thought ellagic acid was principally responsible, but Stoner says they realize the inhibitory activity cannot be attributed to just one substance. “We think other components, such as anthocyanins and other polyphenols, and the vitamins and minerals in berries, are also responsible,” he says. “Now we are trying to find out what natural compounds are the most effective cancer fighters.”

In July 2003, he received a $2.7 million, five-year grant from the NCI to examine mechanisms by which freeze-dried black raspberries prevent cancer in rodent esophagus. “The goals,” Stoner says, “are to better understand how berries block and suppress cancer activity and to develop a ‘cocktail’ of chemopreventive agents for preventing human esophageal squamous cell carcinoma.”

The berry findings were presented at the International Conference on Frontiers in Cancer Prevention Research, being held in Philadelphia, Pennsylvania.The National Cancer Institute-funded trial included 30 participants, 20 of whom had identifiable precancerous lesions, and 10 normal controls. Each of the participants was instructed to gently dry the lesion sites (or a pre-selected control site for the normal participants) and rub the gel into the area four times a day, once after each meal and at bedtime.

After six weeks, about 35 percent of the trial participants’ lesions showed an improvement in their microscopic diagnosis, while another 45 percent showed that their lesions had stabilized. About 20 percent showed an increase in their lesional microscopic diagnoses. Importantly, none of the participants experienced any side effects from the gel. “The trial was designed to test the safety of the gel and detect any possible toxicity, but the next obvious step is a multicenter, double-blind, placebo-controlled Phase II study,” Mallery said. “Such a study would enable us to determine that the black raspberries are the active factor and not just the gel base or the act of drying and rubbing the lesions.”
The researchers also collected cell samples from the lesion sites of each participant before and after treatment in order to study the genetics and biology of the lesions. The majority of patients with precancerous lesions at the start of the trial showed elevated levels of COX-2 and iNOS, two proteins closely correlated with inflammation and malignant progression. Following treatment, Mallery says, levels of those proteins in the treated lesional epithelial cells decreased dramatically.

Mallery and her colleagues also examined samples for three tumor suppressor genes in order to determine what researchers call “loss of heterozygosity,” whether or not a cancer cell has lost one of its two copies of the gene. Such loss greatly increases a cell’s chances of losing the benefit of the tumor suppressor genes due to a second mutation or gene silencing event. Following the trial, the researchers noted that many lesions returned to normal, retaining both copies of each tumor suppressor gene. “We speculate that the chemopreventive compounds in black raspberries assist in modulating cell growth by promoting programmed cell death or terminal differentiation, two mechanisms that help “reeducate” precancerous cells,” Mallery said. “Oral cancer is a debilitating disease and there is a desperate need for early detection and management of precancerous lesions,” Mallery said. “While screening can help detect the disease early — and survival rates are definitely improved the earlier the disease is caught — many of these precancerous lesions recur despite complete surgical removal. There are currently no effective chemopreventive treatments which could conceivably serve as either adjunctive or alternative approaches to surgery.”

According to Mallery, the development of black raspberries as potential cancer-fighters is the result of decades of research into identification of naturally derived chemopreventive compounds by Ohio State researcher Gary D. Stoner, Ph.D., an emeritus professor at Ohio State University’s College of Medicine and Public Health. Clinical studies stemming from his research are currently underway for oral, esophageal and colorectal cancer.
The gel looks deceptively like black raspberry jam, but it certainly does not taste like something you would want to spread on toast, Mallery says. The bioadhesive gel, which contains 10 percent freeze dried black raspberries, is devoid of many of the tasty sugars found in native berries.
The black raspberry gel was manufactured by the University of Kentucky’s Good Manufacturing Production (GMP) facility. NanoMed Pharmaceuticals is partnering with OSU investigators Mallery, Stoner and Peter E. Larsen D.D.S. and Russell J. Mumper, Ph.D., of the University of North Carolina, in product development.

Tags: Chemoprevention, Oral Cancer News by oc advocate
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Does what we know about brush biopsy in cervical cancer screening have any meaning when using brush biopsy screening in a different location? The Papanicolaou (Pap) smear (brush biopsy) is commonly used to screen for cervical cancer, and since its introduction in organized screening programs in resource-rich countries it has been successful in dramatically reducing the incidence of cervical cancer. However, the sensitivity of the Pap smear is low, and so testing for DNA of the causal agent of cervical cancer, the human papilloma virus (HPV), either as an alternative or in conjunction with a Pap smear, is being recommended by the CDC.

Mayrand et al. reported the results of the first screening round of the Canadian Cervical Cancer Screening Trial, in which over 10,000 women aged 30 to 69 years were randomly assigned to receive either a Pap smear or an HPV DNA test approved by the US Food and Drug Administration to screen for high-grade cervical intraepithelial neoplasia. Women with positive test results underwent colposcopy and biopsy, as did a random sample of women who tested negative. The sensitivity of HPV testing was 94.6%, whereas that of Pap testing was 55.4%. The specificity was 94.1% for HPV testing and 96.8% for Pap smears. In a second study reported in the New England Journal of Medicine, over 12,000 women aged 32 to 38 years were randomly assigned to receive either an HPV test plus a Pap smear or, as a control, a Pap test alone. The results of this trial found also that the HPV testing was significantly more effective. A shift from cellular to viral tests, coupled with education and vaccination, will clearly contribute to more efficient control of cervical cancer.

Having this information available to us now, the ADA program on oral cancer early detection with what is essentially the same kind of brush cytology, seems misguided. The brush collection of cells is the same regardless of the type of tissue that you are collecting them from. When considering the cervix, it is a very small area and a general brushing of the area is possible. The mouth does not lend itself to such a generalized collection process because of its size, and therefore the sampling of something visible that is evident to the screener is necessary. What the ADA program needs to talk about is early DISCOVERY – without that, there is nothing to put a biopsy brush on anyway. The ADA program is all about DIAGNOSIS, which of course cannot take place until DISCOVERY happens first. They seem to have put the cart before the horse, and the emphasis in the wrong place.

One argument from the manufacturer is that the shape of the bristles on their brush are different than conventional cytology brushes, and that when rubbed against the tissue hard, (until blood appears) that they are collecting cells from ALL layers, and therefore to compare the two is inaccurate. I have spoken with several oral pathologists at two local dental teaching institutions and they are not big believers in the technique. (Granted, a very small sample.) A conventional incisional or punch biopsy still has to be sent to them if this brush system finds a positive.

Bottom line in all this is that the selectivity and specificity of the Oral CDx system seems an academic point. We do not have in the US a dental profession that is compliant in doing OPPORTUNISTIC screenings of their entire patient populations on a regular and systematic basis.

If a general practitioner of dentistry, otolaryngology, or medicine finds tissue which appears to them to be abnormal, and the patient has told them that it has existed over a period of 14 days or longer, or they recall the patient in that period and find that it still exists, I believe the appropriate thing to accomplish at that point is to obtain a definitive diagnosis of what it is. This cannot be accomplished with a brush cytology system. A positive result from this system still requires surgical biopsy. The more appropriate action would be to either do a punch or incisional biopsy should they feel competent, or better yet, to use the well established referral system to obtain a second opinion, biopsy and diagnosis. This may be to an oral medicine specialist, an oral surgeon, or otolaryngologist with additional training in head and neck surgery, who is familiar with oral malignancies and other pathologies. This not only serves the patient well by obtaining another informed opinion as to what the malady is, but it also (for those not completely conversant in oral pathologies), it ensures that any tendency to “watch and wait” will not be engaged in. This is the worst thing that can be done, and invariably leads to delayed diagnosis, and poorer outcomes for those who do have a malignancy.

This whole system only works if we have compliant screeners, something which do not exist in abundance in the US today.

Tags: Adjunctive Screening Devices, HPV, Oral Cancer News, Screening, The ADA by oc advocate
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A single HPV virus

Scientists are only beginning to discover the hidden role of some viruses and bacteria. The almond-shaped lump on Brian Hill’s throat didn’t make sense to him. The doctor said it was a symptom of advanced oral cancer, but Hill had never smoked a cigarette or chewed a plug of tobacco, considered the main causes of the disease when he was diagnosed in 1997. So why was it there? Not until four years later did Hill get an explanation for his brush with death: a microbe called human papilloma virus-16 had apparently moved into his tonsils, gradually turning normal cells into cancer. Hill, now 59, had become part of a wave of relatively young nonsmokers who contracted oral cancer from the sexually transmitted virus, fueling an overall increase in new cases.

Viruses such as human papilloma may be the most overlooked bad guys in the war on cancer, silent invaders that contribute to more than a dozen malignancies and may cause 15 percent of the cancer cases worldwide each year. “What we know about HPV-16 as a cancer causer is just the tip of the iceberg,” said Hill, founder of the Oral Cancer Foundation, which funds research for a disease that strikes 34,000 Americans annually and is caused by the same virus that can lead to cancers of the cervix, vulva, anus, and penis.

The cancer toll from germs – both viruses and bacteria – may turn out to be higher as researchers discover more of these elusive microbes and how they do their grim work. Currently, scientists can’t even estimate how many viruses afflict human beings, let alone how they impact human health. Some suspect that unknown viruses may be causing cancers that are now blamed on something else, much the way doctors believed that stress and spicy foods caused stomach ulcers until scientists discovered the real culprit – bacteria – in 1982.

“There are a lot of infectious diseases that we just don’t know about, including a lot of cancers,” said Dr. Matthew Meyerson, a cancer genetics researcher at the Dana-Farber Cancer Institute in Boston and the Broad Institute of Cambridge. Unfortunately, he said scientists have not come up with a simple way to identify unknown viruses lurking inside human genes. But it’s already clear that cancer is more contagious than most people realize: everyday acts of intimacy such as kissing and lovemaking potentially transmit viruses from one person to the next that, for an unlucky minority, will cause cancer years later as the genetic damage to cells slowly mounts. For instance, people who have oral sex with six or more partners triple their risk of developing oral cancer due to the transmission of the papilloma virus, according to a recent study from Johns Hopkins University in Baltimore.

Yet, medical advice on how to prevent cancer usually centers on avoiding tobacco, sunlight, cancer-causing foods, and environmental pollution, with only secondary mention of the need for protection against infections by cancer-causing viruses. “We worry about ‘Should I eat those french fries or that apple?’ but we don’t manage our infections. I don’t say, ‘I think I’ll have a little less Epstein-Barr virus today,’ ” said Dr. Julie Parsonnet, a researcher at Stanford Comprehensive Cancer Center in California who focuses on infectious diseases. “We are probably focusing on the wrong thing.”

Ultimately, Parsonnet believes that infections from viruses and bacteria combined account for at least a quarter of cancers and more in developing countries where untreated infections are more common. However, Parsonnet hopes the advent of the vaccine against cervical cancer, Gardasil, in 2006, may have begun to raise awareness. The maker, Merck & Co., ran national television advertisements that depicted average women expressing their surprise that cancer could be brought on by a viral infection. “That for the first time brought infections to the public mind as a cause of cancer,” Parsonnet said.

Scientists suspected long ago that cancer could be an infectious disease: 19th-century physicians observed that cervical cancer was common among prostitutes and rare among nuns, suggesting the disease was spread through sex. But it wasn’t until the last 50 years that researchers began to draw the direct connection between viruses – organisms that need to get inside healthy cells in order to survive – and the nation’s second leading killer. Even now, researchers are still figuring out exactly how the viruses cause cancer.

The human papilloma virus makes proteins that corrupt cells inside body openings such as the mouth and vagina, causing the cells to live longer and reproduce more frequently. Unchecked, the genetically defective cells can grow and spread, disfiguring and potentially killing its victims. But only one-third of the more than 100 strains of papilloma have been linked to cancer, and even those trigger cancer in a tiny fraction of infected people: More than 20 million women will be infected with papilloma virus this year, for instance, but only about 11,000 will be diagnosed with cervical cancer.

A second group of cancer-causing viruses, hepatitis B and C, attack the liver, where they take over healthy cells and also cause inflammation that further damages the cells. Millions of people carry these viruses with virtually no symptoms, but the 10 percent of patients who suffer chronic liver inflammation have an increased chance of developing cancer, cirrhosis, or liver failure.

Viruses often prey on people already suffering from another disease that has weakened their immune systems, making them more vulnerable. The Kaposi sarcoma associated herpesvirus is best known in this country for striking HIV patients, causing widespread skin lesions and sometimes death when the cancer spreads to the lungs. The Kaposi virus illustrates how viruses can cause cancer without being detected: In addition to taking over some cells to use as “hosts,” the Kaposi virus quietly kills neighboring cells, allowing cancer to spread without any genetic “fingerprint” left behind. Dr. Preet Chaudhary, the University of Pittsburgh medical school researcher who discovered Kaposi’s cell-killing ways, believes that other viruses may do the same thing, but no one has noticed. “It is possible that the actual cancers that are linked to viral infections are much more common than we realized,” said Chaudhary.

Scientists don’t know why different viruses are so selective in causing cancer, but Parsonnet believes the answer lies in the complex relationship between humans and the viruses inside them. The difference between a harmless virus and a deadly infection, she said, may come down to very specific details, or a cascade of unconnected events. “Maybe herpes causes cancer but only if you previously had CMV (cytomegalovirus) and an exposure to hepatitis A before you were three,” she speculated.

Meyerson of Dana-Farber said it may be time for a systematic approach to studying cancer-causing viruses. The Human Genome Project, which identified the 25,000 or so human genes, could help researchers find microbial invaders in human tissue and fluids: If scientists find genes that aren’t in the genome, they must be from a nonhuman source such as viruses or bacteria. “Once we find the first new pathogen with this approach, the field will explode,” Meyerson predicts.

In the meantime, oral cancer survivor Hill and his wife get tested regularly to see if the papilloma virus has returned, and he wants health officials to do more to fight viruses now. Hill’s California-based Oral Cancer Foundation (www.oralcancer.org) is pushing to get the new cervical cancer vaccine, which protects girls against HPV-16 and HPV-18, to be offered to boys as well – something the vaccine makers are investigating. It’s possible, he said, to eradicate one major cancer-causing virus a generation from now. “We must act now.”

This article was authored by Scott Allen of the Boston Globe

Tags: HPV, Oral Cancer News, The Changing Demographics by oc advocate
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This poster is from the US Government printed in 1938. We have known about the necessity for early detection for a long, long time….

NEWPORT BEACH, Calif., Nov. 20 /PRNewswire/ — The Oral Cancer Foundation announced today that three researchers working in areas of early oral cancer detection would be the foundation’s first grant recipients.The grants, which were made as an ongoing commitment to each researcher, were awarded to Dr. Maura Gillison of Johns Hopkins School ofMedicine, Dr. David Wong of the University of California at Los Angeles, and Dr. Ann Gillenwater of the University of Texas MD Anderson Cancer Center. “We are supporting research that moves our early discovery agenda forward,” the foundation’s executive director Brian Hill said. “Early detection is our first front in reducing the death rate from oral cancer, and we believe these research programs all will have a huge impact on how and when people are diagnosed with the disease.

Early detection and staging is directly correlated to better long-term outcomes for patients. “The disease affects more than 34,000 Americans each year, and more than 8,000 will die from it annually. At the present time two-thirds of cases are caught in the cancer’s later stages when prognosis is poor. At 5 years from diagnosis survival for all stages combined is approximately 50%. While other cancers have seen a decline in incidence and death, occurrence of oral and oropharyngeal cancers have increased in recent years, 11% in 2007 alone. “Public awareness of the disease is low, and screening models used incorrectly or inconsistently are largely to blame for the high death rate,” Hill said. “We could be doing a better job of early discovery. Patients need to know that an annual screening is inexpensive, painless, and takes only five minutes. But the lack of awareness-in both the health care community and the public’s mind-of the newly defined viral etiology of oral cancer is now also to blame.”Oral cancer has been most usually associated with tobacco use, often in combination with alcohol consumption. However, new research over the last decade has pointed to the human papillomavirus (HPV-16), the same virus that causes the vast majority of all cervical cancers, as a significant risk factor, especially in cases affecting young non-smoking men and women.

Grant recipients.

Dr. Maura Gillison

Maura Gillison, MD, PhD, assistant professor of epidemiology of Johns Hopkins School of Medicine, merited headlines across the globe for her research on the role the HPV virus plays in the etiology of oral cancer, and without ambiguity defined the link between the two. Her work has changed the demographic norms for those previously considered at risk for the disease, and has broad implications for developing preventative measures for HPV-positive patients and treatment options for oral cancer patients with HPV-derived cancer.

Dr. David Wong

David Wong, DMD, DMSc, director of the UCLA Dental Research Institute, is a nationally recognized expert in the emerging field of salivary diagnostics. Wong’s work will yield an accurate, noninvasive test for very early detection of oral cancer, and likely other high-impact systemic diseases within a few years. It is the first viable option for conducting mass public screenings for oral cancer using only a small amount of saliva and a computer chip which looks for specific biomarkers. Given the shift in etiology of oral cancer cases away from the obvious potential patient identifiers like smoking to the less easily detectable virus, Wong’s research will be instrumental in identifying those most at-risk for the disease.

Dr. Ann Gillenwater

Ann M. Gillenwater, MD, associate professor, department of head and neck surgery, the University of Texas MD Anderson Cancer Center, has been part of a pioneering team in the use of tissue fluorescence as a discovery tool in oral cancers. Tissue fluorescence, in which a specific spectrum of light is used to differentiate healthy cells from those which are not, will allow the health care professional to identify more readily areas of suspect tissue that may be missed in a conventional white light visual screening. This will improve the opportunity for early diagnosis, thus improving patient outcomes.

The Oral Cancer Foundation, a 501(c)3 non profit charity, founded in 2000, advocates for better public awareness of the disease, provides patient support mechanisms, and engages the medical and scientific communities to be more involved in the process of early detection. The foundation conducts screening events across the country and maintains a web site with hundreds of pages of information for patients, the public, and healthcare providers at http://www.oralcancer.org.

Tags: HPV, Oral Cancer News, Salivary Diagnostics, Screening, The Changing Demographics by oc advocate
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