HPV Vaccination Recommended for Boys and Girls for Prevention of Oropharyngeal Cancer

October 21, 2010 — Human papillomavirus (HPV) is a risk factor for oropharyngeal squamous cell carcinoma (OSCC), and might account for the steady increase in OSCC incidence, even in subjects who do not smoke or consume alcohol, according to Swedish researchers.

A review of recent studies, conducted by Trobjorn Ramqvist, MD, and Tina Dalianis, MD, PhD, and published online October 13 in Emerging Infectious Diseases, suggests that changes in sexual practices are behind the surge in OSCC cases linked to sexually transmitted HPV. The key factors appear to be multiple sex partners, starting sexual activity at a younger age, and increased oral sex.

The data are startling. For example, from 1970 to 2002, tonsillar cancer (which is the most common OSCC) increased in Stockholm, Sweden, by 2.8-fold, and by 2006/07, 93% of all tonsillar cancers in that city were HPV-positive.

Dr. Dalianis, who is professor of tumor virology and the head of the Department of Oncology–Pathology at Karolinska Institutet in Stockholm, told Medscape Medical News that "we realized that there was an increase in HPV-induced tonsillar cancer, but we did not realize it was so eminent until we separated the 2 groups (HPV-negative and -positive tonsillar cancer cases) the way we did."

The most common OSCC is tonsillar cancer, followed by base of tongue cancer. Overall 5-year survival for OSCC is about 25%, and HPV-positive OSCC generally has better clinical outcomes than HPV-negative disease.
Dr. Dalianis said that HPV (most commonly type 16) was found in 45% to 100% of OSCCs in various studies.
"It was also observed that patients with HPV-positive OSCC were younger and lacked the traditional risk factors of smoking and alcohol consumption," the authors write. "We suggest the increased incidence of OSCC depends on HPV infection and results in an increased proportion of HPV-positive OSCCs."

Dutch Expert Questions Proportions of HPV Positivity
Using data from the Swedish Cancer Registry, the researchers found that the incidence of HPV-positive tonsillar tumors almost doubled over each decade from 1970 to 2007, for a cumulative 7-fold increase over that period.
Similarly, HPV-positive base of tongue cancers increased from 54% in 1998/99 to 84% in 2006/07.

However, another expert, asked to comment on the study by Medscape Medical News, raised questions about the high proportion of HPV-positive tumors found in the Stockholm registry data.

Boudewijn J.M. Braakhuis, PhD, is from the section of tumor biology in the Department of Otolaryngology/Head and Neck Surgery at VU University Medical Center in Amsterdam, the Netherlands. Dr. Braakhuis, whose work focuses on oral and oropharyngeal cancers, said that the proportion of HPV-positive OSCCs in the Amsterdam area is about 20%.

Dr. Braakhuis said that the Swedish analysis is hampered by the lack of a standardized method for measuring HPV involvement. Dr. Braakhuis's group proposes doing p16 staining followed by general primer polymerase chain reaction with typing, which might reduce the risk for false positives.

The Case for HPV Vaccination
Dr. Dalianis said that there is a significant association of HPV-positive tonsillar cancer with early initial sex, and with the number of oral or vaginal sex partners. She also noted that one study reported "that not only oral sex, but also open-mouthed kissing, was associated with the development of oral HPV infection."
Noting that this could mean that oral-to-oral contact might play a role in oral HPV transmission, Dr. Dalianis said that this has implications for the timing of vaccinating children to prevent HPV.

Dr. Dalianis is "a strong supporter of giving the HPV vaccine to both girls and boys," and writes that "it is crucial to monitor the effects of the present HPV vaccination, not only on the incidence of cervical cancer but also on the incidence of OSCC."

Dr. Braakhuis agreed: "One may expect that vaccination will decrease the number of HPV-positive oropharyngeal cancers" after decades.
Another important point uncovered in the review is that the incidence of head and neck squamous cell carcinoma is decreasing and OSCC is increasing, which might presage a risk for overtreatment if the intensified regimens used for head and neck squamous cell carcinoma are applied to HPV-positive OSCC, which has a better prognosis than HPV-negative disease.

"It is possible that increasing numbers of OSCC patients with a better prognosis are being treated with intensified therapy. As a result, many patients have substantial chronic unnecessary side effects. It is therefore necessary to identify which patients need and which do not need intensified treatment," the study authors write. The suggestion is that OSCC patients with HPV-positive tumors who have never smoked might be candidates for less intensive treatment.

Dr. Dalianis and Dr. Braakhuis have disclosed no relevant financial relationships.

Doctors Remove Tooth Stuck in Man’s Ear for 33 Years

Published October 18, 2010 | FoxNews.com

Doctors finally discovered the cause of a 47-year-old man’s ear pain
and constant ear infections, which has been plaguing him since he was
a teenager.

Stephen Hirst, who lives in the U.K., had a tooth stuck in his ear,
The Star reported.

“It’s a mystery how it got there,” Hirst said. “I would think it’s a
first tooth, looking at it, because it can’t be big enough to be an
adult tooth. I think it’s a bottom tooth, one of the front incisors.”

Hirst said he was often in so much pain, he would “scream” in agony,
and he has been to countless doctors trying to figure out what the
problem was. Doctors at the Royal Hallamshire Hospital in Sheffield,
South Yorkshire, England told him they were determined to find the
problem and offer a solution.

“The nurse put a suction tube in my ear and cleaned it, then (tried) a
microscope probe,” Hirst said. “Finally, she used some tweezers and
got it out.”

Hirst said his ear pain is gone for the first time since he was 14.

Click here to read more about this story from The Star.

http://www.thestar.co.uk/news/My-tooth-in-ear-agony.6583975.jp

Tooth Brushing and Heart Disease

June 7, 2010 — Individuals who do not brush their teeth twice a day have an increased risk of heart disease, a new study shows [1].

The study was published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK).

The researchers note that while it has been established that inflammation in the body (including mouth and gums) plays an important role in the buildup of atherosclerosis, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease.

High fructose intake associated with higher blood pressure

July 12, 2010 — High fructose intake in the form of added sugar is independently associated with higher blood pressure (BP), according to the results of a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES 2003 to 2006), reported online ahead of print July 1 in the Journal of the American Society of Nephrology.

"The recent increase in fructose consumption in industrialized nations mirrors the rise in the prevalence of hypertension, but epidemiologic studies have inconsistently linked these observations," write Diana I. Jalal, from University of Colorado Denver Health Sciences Center in Aurora, and colleagues. "We investigated whether increased fructose intake from added sugars associates with an increased risk for higher BP levels in US adults without a history of hypertension."

In the study sample of 4528 adults without a history of hypertension, median fructose intake was 74 g/day, which is approximately equivalent to 2.5 sugary soft drinks each day. Increased fructose intake of at least 74 g/day was independently and significantly associated with higher odds of elevated BP levels, after adjustment for demographics; comorbid conditions; physical activity; total kilocalorie intake; and dietary confounders including total carbohydrate, alcohol, salt, and vitamin C intake. Increased risk associated with fructose intake of 74 g/day or more was 26% for a BP cutoff point of 135/85 mm Hg or higher, 30% for a BP cutoff point of 140/90 mm Hg or higher, and 77% for a BP cutoff point of 160/100 mm Hg or higher.

"These results suggest that high fructose intake, in the form of added sugar, independently associates with higher BP levels among US adults without a history of hypertension," the study authors write.

Depressed People Eat More Chocolate

May 3, 2010 — A new cross-sectional study suggests individuals with depressive symptoms eat more chocolate, but it does not explain why.

"There is a lot of lore about chocolate and depression and precious little in the way of scientific evidence, which is what motivated us to do this study," Beatrice A. Golomb, MD, PhD, of the Department of Family and Preventive Medicine, University of California, San Diego, told Medscape Psychiatry.

The study, published in the April 26 issue of the Archives of Internal Medicine, included 931 adults not using antidepressants. The mean age of study subjects was 57.6 years and mean body mass index was 27.8 kg/m² or less; 70.1% were male, 80.4% were white, and 58.8% were college educated. Subjects provided information on chocolate consumption (frequency and amount) and completed the Center for Epidemiological Studies-Depression (CES-D) scale.

Subjects who screened positive for depression, defined as a CES-D score of 16 or higher, reported consuming significantly more chocolate than those not screening positive for depression (8.4 vs 5.4 servings per month; P = .004).

Those with CES-D scores of 22 or greater, indicating probable major depression, consumed 11.8 servings of chocolate per month (P value for trend < .01). These associations were evident for men and women.

According to the researchers, several nutrient factors that could be linked to mood, such as increased caffeine, fat, carbohydrate, or energy intake, bore no significant correlation with mood symptoms, suggesting relative specificity of the chocolate finding.

"The study," Dr. Golomb emphasized, "does not address the issue of whether chocolate is beneficial or harmful in terms of mood, as this is an observational and cross-sectional study."

"A lot of people perceive that they get a mood lift when they eat chocolate; whether that's true or whether that’s short lived, which is why people with higher depression scores are still seen as eating more chocolate," is unclear, Dr. Golomb said.

There was no evidence in the study that chocolate had a sustained benefit on mood. "In our sample, if there is a 'treatment benefit,' it did not suffice to overcome the depressed mood on average," she and colleagues note in their report.

Future prospective studies are needed to elucidate the foundation of the chocolate-mood association and determine whether chocolate has a role in depression "as a cause or cure," they conclude.

Commenting on the findings, Gordon Parker, MD, PhD, of the School of Psychiatry, University of New South Wales, Australia, who was not involved in the study, said people who crave chocolate and judge it as beneficial when depressed may be "more likely to have certain personality styles." These personality styles that underpin chocolate cravings reflect "neuroticism or what we would call emotional dysregulation."

"Thus, rather than view chocolate craving as a symptom, it may well be an attempt by individuals who are emotionally dysregulated to reset their ‘mood state,’ and then this invites the question as to what are the components in chocolate that might settle emotional dysregulation."

Oral Cancer on the Rise

Approximately 35,000 people in the US will be newly diagnosed with oral cancer in 2010. This is the fourth year in a row in which there has been an increase in the rate of occurrence of oral cancers, in 2007 there was a major jump of over 11% in that single year.

http://oralcancerfoundation.org/

Headache Prevention

Dental Implants: An Overview

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