The incidence of head and neck cancer caused by the human papilloma virus (HPV) has tripled since the 1970s and could reach epidemic levels in the future, say healthcare experts. However the work of a group of Ohio researchers may bring hope for a safer, more effective therapy for these cancers.

They have discovered how the human papilloma virus (HPV) causes head and neck cancer and designed a drug to block that mechanism.

The research, which focused on head and neck cancer cells, shows that a protein produced by the HPV virus blocks a protein made by the host cell. The cell protein, called p300, regulates a gene called p53. This gene both controls cell division and protects the body against cancer by causing cells to die before they become malignant.

The prospective new drug, called CH1iB, prevents the viral protein from binding with the cell protein. This restores the function of the p53 “tumor-suppressor” gene and triggers the death of the cancer cells.

Currently the standard of care for HPV-positive head and neck cancer uses high-dose cis-platinum, a chemotherapy drug that causes serious side effects that are difficult for patients to tolerate.

Although further testing is necessary, combining CH1iB with a low dose of cis-platinum might one day provide an alternative.

Head and Neck Cancer Awareness

As part of Oral, Head and Neck Cancer Awareness Week®, April 21-27, we want to share important information about these cancers and promote early detection through free screenings.

Quick Facts:

• Oral, Head and Neck Cancers includes cancer in the nasal cavity, sinuses, lips, mouth, thyroid glands, salivary glands, throat, or larynx (voice box).
• The sixth-most-common form of cancer in the world.
• Over 100,000 cases (including thyroid) diagnosed annually in the United States.
• Many dentists conduct an oral cancer screening as part of your annual checkup.
• While symptoms may not always be present, see a doctor if you have:
  • A sore in your mouth that doesn't heal or that increases in size
  • Persistent pain in your mouth
  • Lumps or white or red patches inside your mouth
  • Difficulty chewing or swallowing or moving your tongue
  • Soreness in your throat or feeling that something is caught in your throat
  • Changes in your voice
  • A lump in your neck
• Risk factors for Oral, Head and Neck cancers include: tobacco use, family history, and HPV infection.
• Every adult should get screened, even non-smokers.

Sources:

Ohio State University

Head and Neck Cancer Alliance

Researchers at Rhode Island Hospital have found that adding lubricin, a protein that our bodies naturally produce, to the fluid in our joints may reduce the risk of or even prevent osteoarthritis (OA).

Osteoarthritis currently affects an estimated 20 million Americans and is the most common joint disorder. Osteoarthritis causes inflexibility, pain and stiffness, and is primarily felt in weight-bearing joints such as the knees, hips and spine. Current treatments for osteoarthritis focus on reducing pain and inflammation or joint replacement.

As our population ages, the prevalence of osteoarthritis is expected to increase by 50% over the next two decades.

Joint Lube

The researchers discovered the connection between lubricin and osteoarthritis in part by studying the knees of mice, which genetically lack lubricin, causing an aggressive arthritis in spite of high levels of hyaluronic acid, a viscous fluid that cushions joint. Without lubricin, the resulting friction leads to cartilage cell death.

This finding appears to challenge the current practice of injecting hyaluronic acid alone into a patient's joints. “The lubricant is a protein, not hyaluronic acid,” said study author Dr. Gregory D. Jay.

Patients suffering from this degenerative joint disease either go through a total joint replacement, or are forced to live with pain every day. The researchers believe adding a lubricin replacement to the fluid in joints may in fact prevent osteoarthritis in those who have a genetic predisposition to the illness, or who have suffered significant trauma to the joints.

The researchers are now working to create a replacement for natural lubricin that they hope will significantly improve the treatment options, and ultimately prevention measures, for those with early osteoarthritis or joint injuries.

Sources:

Eureka Alert

Arthritis National Research Foundation

A large study that included over 13,321 women with ovarian cancer found that only 37% received treatment that adhered to guidelines set by the National Comprehensive Cancer Network (NCCN), an alliance of 21 major cancer centers with expert panels that analyze research and recommend treatments.

For the majority of women who did not receive adequate care, missing out on the best treatments may have cost them a year or more of life.

Experience is Key

Cancer experts says poor care is usually the result of doctors and hospitals that see few cases of ovarian cancer and lack expertise in the often aggressive surgery and chemotherapy needed to treat the deadly cancer.

The new study bears this out as more than 80% of them were treated by “low-volume” providers – surgeons with 10 or fewer cases a year and hospitals with 20 or fewer cases.

“If we could just make sure that women get to the people who are trained to take care of them, the impact would be much greater than that of any new chemotherapy drug or biological agent,” said Dr. Robert E. Bristow, the director of gynecologic oncology at the University of California, Irvine, and lead author of the new study.

What Works

Since ovarian cancer is often diagnosed in late stages when it has spread inside the abdomen, an aggressive approach requiring the skills of a gynecological oncologist is needed. Studies have shown that survival improves if women have surgery called debulking, to remove all visible traces of the disease. Taking out as much cancer as possible gives chemotherapy drugs a better chance of killing whatever is left. The surgery may involve removing the spleen, parts of the intestine, stomach and other organs, as well as the reproductive system.

Unfortunately many women are operated on by general surgeons and gynecologists. Some inexperienced doctors may find the cancer unexpectedly during surgery and try to remove it, but may not get all of the cancer.

In addition to aggressive surgery, another treatment called intraperitoneal chemotherapy (IP) may be appropriate but often only available in major treatment centers. It involves pumping drugs directly into the abdomen and can increase survival up to 15 months.

Ask the Right Questions

You can increase your chances of survival by seeking out doctors and hospitals that follow NCCN guidelines for ovarian cancer which specify surgical procedures and chemotherapy, depending on the stage of the disease.

Dr. Bristow suggests that women should also ask surgeons how often they operate on women with ovarian cancer and how often they achieve complete debulking. This is not the time to hesitate to ask questions for fear of offending the doctor.

Sources:

National Comprehensive Cancer Network

New York Times

Much of current cancer research is focused on what is often called “personalized medicine” or “targeted therapies.” In short, this means that doctors and researchers are often collaborating with drug companies and genetic labs to identify unique characteristics and potential weaknesses of individual cancers in order to develop drug therapies aimed at these vulnerabilities.

For example, British researchers studying a particularly deadly form of lung cancer called Small Cell Lung Cancer (SCLC) made a significant breakthrough by locating the cancer’s “Achilles heel.” They found that SCLC cells grown from human tumors rely on a protein called Aurora kinase for survival.

In their report, they suggest that 'targeted' therapeutic strategies should focus on testing Aurora kinase inhibitors, several of which have already been developed by pharmaceutical companies for other types of cancer.

The researchers also went on to show that Aurora kinase inhibitors are also effective in killing SCLC cells with high levels of the “MYC” cancer gene. About 7% of patients diagnosed with SCLC have MYC gene amplification.

Currently chemotherapy for SCLC kills both cancerous cells and non-cancerous cells indiscriminately and results in often severe side effects. The researchers hope that new clinical trials will bear out the effectiveness of Aurora kinase inhibitors to target SCLC’s weaknesses, while sparing healthy cells.

Source:

Science Daily

 

Building on previous research that suggested there may be a more meaningful way to distinguish different types of multiple sclerosis, a new study has defined two categories of MS based on differences in RNA transcription sequences. The researchers hope this novel screening method may help steer clinicians toward more effective therapies.

After analyzing RNA extracted from blood cells of patients with multiple sclerosis, they found distinct sets of RNA molecules in the patient samples. These unique sets distinguished two types of multiple sclerosis, MSa and MSb, based on the level of disease activity. Patients in the MSa category have a higher risk for relapse.

Knowing the category a person with multiple sclerosis is in may help doctors make more informed treatment decisions. For example, if you fall into the MSa category and are more likely to experience relapse, your doctor may consider a stronger treatment.

"These results motivate us to improve these distinctions with further research so that we may reach our goal of identifying the best treatment for each individual who has multiple sclerosis," said lead researcher Philip De Jager, MD, PhD with Brigham and Women’s Hospital.

This study, say researchers, is an important step towards the goal of personalized medicine in MS. But much work remains to be done to fully understand under which circumstance and in combination with which other information these different sets of RNA signatures may become useful in a clinical setting.

About MS

About 400,000 Americans have MS, a chronic, sometimes disabling autoimmune disease that affects the central nervous system. The central nervous system includes the brain, spinal cord and optic nerves so symptoms are often widespread and may include fatigue, numbness in the limbs, balance and coordination problems, bladder or bowel dysfunction, vision problems, pain, or even paralysis.

Sources:

Brigham and Women’s Hospital

National Multiple Sclerosis Society

Separate studies have found that aspirin and tamoxifen, a drug initially developed for breast cancer, may be effective treatments for prostate cancer.

One study found that among men with prostate cancer, those who took aspirin for other medical conditions were nearly half as likely to die of their cancer as the men who didn’t take aspirin.

The study involved nearly 6,000 men of which about one-third were taking aspirin or other anticoagulants. Over 10-years, the researchers calculated, the prostate cancer death rate for those taking aspirin was 3 percent, compared with 8 percent for those who did not.

The aspirin users were also significantly less likely to experience a recurrence of prostate cancer or have the disease spread to the bones.

This research adds to the growing body of evidence that aspirin may be effective for many types of cancer throughout the body. Aspirin use has already been found to have an effect on colon cancer.

As for how aspirin works on cancer, Dr. Otis Brawley of the American Cancer Society said he believes that aspirin’s anti-inflammatory properties may play a role in the prevention of both heart disease and cancer.

“Inflammation may not cause a cancer, but it may promote cancer — it may be the fertilizer that makes it grow,” Dr. Brawley said.

Tamoxifen for Side-Effects

In the tamoxifen study, researchers analyzed the results of four independent clinical trials that examined the use of tamoxifen to manage the side effects of a common prostate cancer treatment, androgen-suppression therapy.

Androgen-suppression, which blocks testosterone activity, can slow the progression of advanced prostate cancer. But these drugs can cause side effects such as breast enlargement and pain that may stop men from undergoing the treatment.

During the one-year study, the researchers found that tamoxifen reduced the risk of breast enlargement and breast pain in men at quarterly exams compared to men who did not take tamoxifen. The drug was also minimized painful breast symptoms better than radiation therapy or treatment with the aromatase inhibitor anastrozole, which is also used to treat breast cancer.

As a result, few of the men treated with tamoxifen stopped taking their medication during their year of treatment. And there were no significant side effects of tamoxifen reported.

Sources:

PubMed

New York Times

BMC Medicine

New data on prostate cancer mortality rates is good information for men to know, but it may not make decisions about treatment any easier. Furthermore, the new research probably won’t end the longstanding debate in the medical community questioning the use of PSA screening for the cancer or whether or not to even treat the disease in some men.

According to the new study, if you have prostate cancer you have about an 11% chance that you’ll die from it. The odds are more likely that’s you’ll die of something else--like cardiovascular disease.

The study authors say their research reinforces the idea that the key to longevity is embracing an overall healthy lifestyle--like eating a balanced diet, managing your weight, getting regular exercise, and not smoking.

Study Details

The study used data from the U.S. Surveillance, Epidemiology, and End Results Program and the Swedish Cancer and Cause of Death registries to analyze the causes of death among more than 700,000 men. The U.S. data was for 1973-2008 and the Swedish data covered 1961-2008.

• Over these periods, 52% of the Swedish men with prostate cancer died and 30% of American men with prostate cancer in the study.
• Of these deaths, only 35% of the Swedish men died directly from prostate cancer and only 16% of American men died from the disease itself, the investigators found.
• As the study continued, fewer men died from prostate cancer while deaths from heart disease remained the same.
• By the last five years of the study, 29% of Swedish men with prostate cancer died from it as did 11% of American men, the researchers calculated.
• Deaths from prostate cancer varied by age and year of diagnosis. The most deaths were among older men and among men diagnosed before screening for PSA began, they added.

Clinical Implications

When doctors were asked to comment on the study findings, opinions varied widely. Some believe the study is justification for screening only high-risk men for prostate cancer, which includes African-American men and men with a family history of prostate cancer. Others like Dr. Durado Brooks, director of prostate and colon cancer at the American Cancer Society, argue against PSA screening saying that it too often "leads down the path of unnecessary treatment."

"Men should understand that not every prostate cancer needs to be found and every prostate cancer that's found does not necessarily need to be treated," he said.

With such diverse opinions in the medical community, it’s easy to see why men need all the information available to make a decision about their health. There just isn’t a clear-cut answer on this issue.

Source:

Health Day

Findings from two studies focusing on breast cancer detection and treatment may help women make better healthcare choices.

Mammogram or Thermography?

Last year the FDA issued warning letters to some healthcare providers who promoted the use of thermography as a substitute for mammography to detect breast cancer. The FDA said there was no scientific evidence showing that thermography when used alone was effective in screening for breast cancer. This is also why the FDA only approved thermography devices as an additional diagnostic tool for breast cancer screening and diagnosis.

A new study confirms the FDA’s position on thermography. Researchers found that thermography missed about 50% of cancers and delivered too many false positives among the 180 women in the study. The researchers also found that 47 percent of the normal breasts got a false positive reading on the thermography scan.

While the thermal imaging technology may have a role in showing temperature and blood flow variances, the current standard for breast cancer detection remains regular breast self exam and mammography. Then if a woman has a suspicious lesion on a mammogram, the follow-up methods are an ultrasound or biopsy, or both.

Radiation Treatment Tradeoffs

Another study sheds light on the risks and benefits of a type of partial-breast radiation called brachytherapy versus whole-breast radiation. With brachytherapy a radioactive pellet is inserted near the lumpectomy site and a catheter may remain in the patient’s breast for one to two weeks.

With whole-breast radiation, beams of radiation are directed at the entire breast over a period of about six weeks.

Researchers found that women who receive brachytherpy may have higher rates of breast cancer recurrence and complications and more mastectomies.

For the study, they looked at rates of mastectomy, mortality and complications following both forms of radiation using data from medicare records of nearly 93,000 women age 67 and older for a four-year period.

Their findings were significant:

• The rates of infection and other complications were about 28 percent among women who received brachytherapy, compared with 17 percent of women who received whole-breast radiation.
• About 4 percent of the women who received brachytherapy had to have a mastectomy within five years of their radiation treatment, compared with about 2 percent of the women in the whole-breast radiation group.
• It is not clear from this study whether mastectomies were actually due to breast cancer recurrence or complications such as fatty-tissue damage in the breast, which was more common in the brachytherapy group.
• The proportion of women diagnosed with invasive breast cancer who received brachytherapy increased from 3.5 percent in 2003 to 12.5 percent in 2007. This increase is probably due to a number of factors including patients wanting a shorter treatment course, say study authors.
• There was no statistical difference between the five-year survival rate associated with brachytherapy.

Brachytherapy Guidelines

According to the American Society for Radiation Oncology, brachytherapy is appropriate for women aged 60 and older with small tumors that have not spread outside of the breast, along with other indicators of less-advanced breast cancer. Data is lacking about the effectiveness of brachytherapy in younger women whose breast cancer is generally thought to be more aggressive.

Weighing the Options

While a shorter course of treatment is attractive, for some patients a greater possibility of having a second procedure and wearing a catheter for brachytherapy are enough to make them steer away from this option.

Sources:

FDA

Health Finder

The Journal of the American Medical Association

If you are diagnosed with cancer or any chronic life-threatening condition, getting a second opinion may not only give you peace of mind, it may save your life. The fact is doctors can and do make mistakes—especially when diagnosing certain rare or complex disorders. And then there is the question of treatment. In meeting with additional doctors, you may learn of other treatment options not presented to you by your original physician.

In a time when you are most vulnerable, a second opinion can increase your degree of clarity and comfort in your diagnosis and give you a better understanding of your condition and treatment options so that you can choose your own path to recovery.

Unfortunately surveys reveal that half of Americans never seek a second opinion and only 3% always seek one for a serious diagnosis. Women in particular are reluctant to seek an additional point of view. Some are concerned they will offend their current doctor, others are overcome by fear and rush to start treatment.

The fact is a good doctor won't be insulted if you decide to ask for a second opinion. And for many serious diagnoses, your health insurance company may require one anyway. (Make sure you contact your health insurance provider regarding the proper procedure for obtaining second or third opinions and what, if any costs, are involved.)

Of course, not everyone should have a second opinion. When you are in the midst of an emergency situation and when diagnostic tests are clear and irrefutable (and there is only one course of treatment), second opinions may not be prudent or necessary.

However it is important to note that there are very few conditions that have only one treatment option. So if you are only presented with only one option, that itself can be a red flag—especially if you have concerns about the treatment plan presented.

The bottom line is this:  If you are uncomfortable with any aspect of the diagnosis or treatment plan, seek additional information about your options. And if that means speaking with another doctor, then consider doing so.  

General Guidelines:

Here are some basic guidelines that may help you decide when and how to get a second opinion.

Both men and women should seek a second opinion:

• for any diagnosis of cancer or a chronic illness
• for any type of non-emergency surgery
• when your doctor recommends long-term medication that has potential side effects
• if you are not feeling better despite repeated visits to your doctor
• when you have been told there is no further treatment that can help you
• for a rare condition

Women should get another opinion for certain gender-specific health issues:

• Hysterectomy – It’s the second most common surgery among American women and yet many doctors think there are less invasive ways to deal with some problems that lead to hysterectomies.
• Unresolved cardiac problems – Studies show that women who present with the same risk factors as men do not get the same treatment. The symptoms of cardiovascular disease in women are usually different and the diagnostic procedures to detect problems differ for women than men. All of this means that women’s heart problems often go undetected and untreated. So women must be persistent and seek a second opinion –preferably with a specialist in women’s heart disease. Read more about women and heart disease here.
• Breast and Gynecological Cancers – As treatment options vary and some are controversial, women should always seek a second opinion from a specialist in these cancers.
• Autoimmune diseases – Women are more likely to have lupus, rheumatoid arthritis and other auto immune diseases that are difficult to diagnose. Seeing a specialist can help confirm the diagnosis and provide information about the latest treatment options.

Getting a Referral

Once you decide you need a second opinion, there are two schools of thought on whether this referral should or should not be provided by the original physician. Some suggest that you look outside of your current doctor’s referral circle if you want a truly objective viewpoint. Here are a few options to consider:

• Ask your current doctor for the name of a specialist.
• Contact your insurance company for a specialist in your network.
• Contact local medical societies and academic medical centers.
• Check to see that the consulting doctor is certified by the American Board of Medical Specialties.
• Some hospitals, like the Cleveland Clinic, now provide online consultations. These are only appropriate when an opinion can be made based on objective criteria such as an imaging study, stress test, or pathology results.

Meeting with Another Doctor

Before you meet with a second doctor, you’ll need to ask your first doctor for copies of your medical records, original x-rays, lab and test results so you can take them with you. While you’re making the request, ask for a set of copies for your own records. If you are dealing with a serious illness, you will want this information for your own knowledge and understanding.

When you meet with the second doctor, ask them if they agree with the first diagnosis and treatment plan. You may also want to ask more specific questions such as:   

• Is this the latest form of treatment? Are other types of treatment available?
• Do I really need this treatment? What is the best timing for this treatment?
• What are the pros and cons of this treatment?

Making a Decision

What if there is a conflicting opinion? Many times the first opinion confirms the first, but when there is a conflict, you may need to seek a third opinion. You can also ask the first two doctors to explain their decisions in greater detail.

In the end, you are in charge of your care. While second opinions may seem costly and time-consuming, getting all the information you need to feel comfortable with your decision is critical.

 

Sources:

The Daily Beast

WebMD

For all the folks who believe in the value of homeopathy -- an alternative form of medicine developed in Germany more than 200 years ago based on the principles of similars and dilutions -- there are just as many patients and health professionals who are adamantly against it and, often, loudly so.

Yes, the naysayers have good points: According to the National Center for Complementary and Alternative Medicine, research on the safety of homeopathic treatments has been limited and the science behind them isn't consistent or logical. That said, I bet many of them will be surprised to learn that the true benefit of homeopathy -- similar to acupuncture or the placebo effect -- isn't in the remedies dispensed but the consultative process for patients, according to a recent study.

Researchers at the University of Southampton came to appreciate the mind-body benefits of homeopathy while monitoring the health of 83 rheumatoid arthritis (RA) patients who participated in a series of homeopathic consultations over 24 weeks while continuing with their conventional treatments.

Interestingly, both physicians and patients reported significant reductions in many RA symptoms, including pain reduction, better moods and less swelling, leading scientists to conclude -- separate from homeopathic remedies -- that it's the consultation process focused on the patient and not on the "disease of the day" that made all the difference.

These results say very loudly -- to me anyway -- that the way a doctor works with his/her patient to promote better health is just as important as the prescriptions they may or may not write during their consultations. Besides, we've seen what happens when doctors don't communicate very well…

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Rheumatology November 13, 2010 Free Full Text Study

The Telegraph November 14, 2010

ScienceDaily November 15, 2010