Cervical cancer virus fuels oral cancer type, too

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WASHINGTON (AP) — A prolonged sore throat once was considered a cancer worry mainly for smokers and drinkers. Today there's another risk: A sexually transmitted virus is fueling a rise in oral cancer.

The HPV virus is best known for causing cervical cancer. But it can cause cancer in the upper throat, too, and a new study says HPV-positive tumors now account for a majority of these cases of what is called oropharyngeal cancer.

If that trend continues, that type of oral cancer will become the nation's main HPV-related cancer within the decade, surpassing cervical cancer, researchers from Ohio State University and the National Cancer Institute report Monday.

"There is an urgency to try to figure out how to prevent this," says Dr. Amy Chen of the American Cancer Society and Emory University, who wasn't part of the new research.

While women sometimes get oral cancer caused by the HPV, the risk is greatest and rising among men, researchers reported in the Journal of Clinical Oncology. No one knows why, but it begs the question of whether the vaccine given to girls and young women to protect against cervical cancer also might protect against oral HPV.

HPV vaccination is approved for boys to prevent genital warts and anal cancer, additional problems caused by human papillomavirus. But protection against oral HPV hasn't been studied in either gender, says Dr. Maura Gillison, a head-and-neck cancer specialist at Ohio State and senior author of the new research. That's important, because it's possible to have HPV in one part of the body but not the other, she says.

A spokeswoman for Merck & Co., maker of the HPV vaccine Gardasil, said the company has no plans for an oral cancer study.

Monday's research was funded by the NCI and Ohio State. Gillison has been a consultant to Merck.

There are nearly 10,000 new cases of oropharyngeal cancer a year, and overall incidence has risen by 28 percent since 1988 even as other types of head-and-neck cancer have been declining.

Tobacco and alcohol have long been the main causes of these tumors, which occur in the tonsils, base of the tongue and upper throat. But over the past few years, studies have shown HPV is playing a role in that rise, probably due to an increase in oral sex even as tobacco use was dropping.

The new study took a closer look, tracking HPV over time by directly testing tumor tissue from 271 patients that had been stored in cancer registries in Hawaii, Iowa and Los Angeles. The proportion that were HPV-positive rose from just 16 percent in the late 1980s to nearly 73 percent by the early 2000s.

Translate that to the overall population, and the researchers concluded that incidence rates of the HPV-positive tumors more than tripled while HPV-negative tumors dropped by half.

Oral cancer has always been a bigger threat to men than women. Gillison says women account for only about 1 in 4 cases, and their incidence is holding steady while men's is rising. That raises questions about gender differences in sexual behavior or whether oral HPV infection is likely to linger longer in men.

While HPV is the most common sexually transmitted infection, studies show women's bodies usually clear the virus from the cervix quickly; only an infection that persists for years is a cancer risk. It's not known if oral HPV acts similarly or even is as common.

Nor is it clear if oral sex is the only way it's transmitted, cautions Dr. Gregory Masters of the American Society for Clinical Oncology, an oncologist at Delaware's Helen Graham Cancer Center.

Regardless, just over 11,000 cases of cervical cancer will be diagnosed this year, a number that has been dropping steadily thanks to better Pap smears. (It's too soon to know what difference vaccination will make.) Gillison's team calculated that annual cases of cervical cancer will drop to 7,700 by 2020 — compared with about 8,700 cases of HPV-positive oropharyngeal cancer by then, about 7,400 of them in men.

The cancer society's Chen urged caution about those numbers, saying more data is needed. But she says two things are clear: First, patients with HPV-linked oral tumors have better survival odds than those with other types of this cancer, possibly because they tend to be younger. Studies are beginning to test if they can scale back today's treatment and thus suffer fewer long-term side effects such as problems with speech and swallowing.

And "just because you're not a smoker or drinker doesn't mean you can't get throat cancer," Chen says — so get checked for symptoms like a throat that's sore for longer than two weeks.

___

EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press.

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Doubts over cervical cancer jab

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28 September 2011 Last updated at 00:36 GMT By Michelle Roberts Health reporter, BBC News The human papilloma virus can cause cervical cancer and genital warts The UK government may have chosen the least cost-effective vaccine to immunise teenage girls against viruses that cause cervical cancer, a data study suggests.

In 2008, the Department of Health picked the cheaper of two options - a vaccine called Cervarix.

But the Health Protection Agency (HPA) concludes that a different vaccine, Gardasil, could provide better value.

Cervarix would need to be £19 to £35 cheaper to match Gardasil's payback.

Although it is not known what deal the government was able to strike with GSK, the pharmaceutical company that manufactures Cervarix, the NHS list price for the drug is £80.50 per dose.

In comparison, Gardasil, made by Merck & Co, is £88.50 per dose.

The current tender for the vaccination is due to run out before the end of 2011.

The authors of the study in the British Medical Journal stress that "considerable uncertainty" remains about the differential benefit of the two vaccines, and say both are good at cutting human papilloma virus-related cervical cancer rates. And they say it is up to the government to decide which vaccine to buy.

Both vaccines protect against HPV types 16 and 18, which cause more than 70% of cervical cancer cases.

But Gardasil also protects against types 6 and 11, which cause genital warts.

Continue reading the main story HPV is passed on through genital contact, usually during vaginal and anal sex, as well as during oral sexCertain strains (6, 11, 16 and 18) can cause genital warts in men and women, while other strains (especially 16, 18 and 39) can cause cervical cancerThere is no treatment for the virus itselfThe Cervarix vaccine is routinely offered by the NHS to young girls in the UK before they become sexually active, to protect against strains 16 and 18, which cause the majority of cervical cancersProponents of Gardasil say this makes it a better choice vaccine because this disease is widespread.

A study published earlier this year by Dr Kate Soldan, also of the HPA, and colleagues estimates that genital warts - the most common viral sexually transmitted infection diagnosed in sexual health clinics in England - cost the NHS about £17m a year.

Taking into account this new research and other emerging evidence, the HPA researchers have revised an earlier estimation of the cost-benefits of the two jabs.

When Mark Jit and his colleagues last informed the government back in 2008 as it was deciding which vaccine to plump for, and they suggested that Cervarix would have to be £15 to £23 cheaper per dose to be as cost-effective as Gardasil.

But now they say the difference in price tag is more like £19 to £35.

Up for tender Continue reading the main story

We worked closely with the HPA on this study and the findings have fed into discussions around the new vaccine contract”

End Quote Department of Health spokesman A Health Protection Agency spokeswoman said: "This study confirms that the national HPV immunisation programme, using either of the available HPV vaccines, is highly likely to offer valuable protection against cervical cancer. This is additional to the considerable benefits provided to women by the National Cervical Screening Programme.

"Deciding which vaccine to use for national immunisation programmes is a complex task. Many factors, including the cost of the vaccine, must be taken in to account.

"The Department of Health will use the results of this study as part of its decision-making process when reviewing its current vaccine choice."

A Department of Health spokesman said discussions about which vaccine to buy in the future were concluding and that "an announcement will be made in due course".

He added: "England has one of the most successful HPV vaccination programmes in the world. We worked closely with the HPA on this study and the findings have fed into discussions around the new vaccine contract."

Meanwhile, new research suggests introducing a test for HPV alongside regular smear tests reduces the number of women needing further investigation by more than a third.

The study, published in the British Journal of Cancer, examined more than 10,000 women aged 25 to 64 whose first smear test had shown mild or borderline abnormalities in the cervix.

HPV testing is currently being incorporated into England's cervical cancer screening programme, and will be fully rolled out within the next year.

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Study: IUD's lower cervical cancer risk

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Women who use IUDs are roughly half as likely to develop cervical cancer as women who have never used one, a study found.Intrauterine devices (IUDs) prevent unwanted pregnanciesAs an added benefit, they may also help protect against cervical cancerWomen who use IUDs are roughly half as likely to develop cervical cancer

(Health.com) -- Intrauterine devices (IUDs) prevent unwanted pregnancies, and as an added benefit they may also help protect against cervical cancer, according to a new study in the Lancet Oncology, a British medical journal.

Women who use IUDs are roughly half as likely to develop cervical cancer as women who have never used one, the study found. Nor does IUD use appear to increase the risk of human papillomavirus (HPV) infection, a known cause of cervical cancer.

European researchers combined and analyzed data from nearly 20,000 women around the world who participated in various studies and surveys between 1985 and 2007. The new analysis does not prove that IUDs directly prevent cervical cancer; it simply suggests that the devices are associated with a lower risk of cancer for reasons that aren't fully understood.

Health.com: Which birth control method is best for you?

"This study does not show cause and effect," says Mehdi Moslemi-Kebria, M.D., a gynecologic oncologist at the Cleveland Clinic who was not involved in the new research. "For that you would need a prospective, randomized study. But this does tell us with pretty good accuracy that an IUD is not a risk factor for cervical cancer."

Compared to women who had never used an IUD, the study participants who had used the devices had 44% lower odds of developing squamous cell carcinoma, by far the most common type of cervical cancer. They also had 54% lower odds of developing adenocarcinoma cancers and a mixed type of cancer known as adenosquamous carcinoma.

Roughly 12,000 women in the U.S. -- the majority of them over 30 -- receive a cervical cancer diagnosis each year, according to the Centers for Disease Control and Prevention. Most cases are caused by a persistent infection with HPV, a common sexually transmitted virus that is usually defeated by the body's immune system. (Pap smears can tell if HPV is damaging the cervix.)

Health.com: Top 10 myths about safe sex

In the study, which was funded by the World Health Organization (WHO) and several other government and philanthropic organizations, IUD use neither increased nor decreased the risk of HPV infection. The rates of infection were the same among women who had used an IUD as among those who hadn't, even after researchers took into account various risk factors for HPV, such as a woman's number of sexual partners, the number of Pap smears she'd had in her life, and her menopausal status.

Although they have no firm evidence, the researchers speculate that the contraceptive devices may disrupt HPV's cancer-causing mechanism. The devices may cause a low-level immune-system response that fights cancer cells, for instance, or their insertion and withdrawal may physically remove precancerous lesions, the study notes.

Health.com: 7 common birth control side effects

"More research is definitely needed to study the biological mechanisms by which IUDs may induce this risk reduction," says the lead author of the study, Xavier Castellsagué, M.D., a cancer epidemiology researcher at the Institut Català d'Oncologia, in Barcelona, Spain.

Whatever the mechanism, it seems to work quickly. Women who used an IUD for less than a year were no more likely to be diagnosed with cervical cancer than women who'd had an IUD implanted for several years.

There are two kinds of IUD available in the U.S., both of which are T-shaped and made from molded plastic. One uses copper as a contraceptive, and the other prevents pregnancy by releasing the hormone progestin into the uterus. Both are extremely effective forms of birth control, but because the study did not include data on the type of IUD used, the authors were unable to assess whether one type of IUD is more likely than another to lower the risk of cervical cancer.

Health.com: Amazing moments in birth control

The new findings do not mean that women worried about cervical cancer should be fitted for an IUD, says Karl Ulrich Petry, M.D., a gynecologic oncologist at the Klinikum Wolfsburg, in Germany.

Petry, who wrote an editorial accompanying the study, points out that HPV testing and Pap smears already reduce the risk of cervical cancer by 80% to 90%.

"Women in countries with screening programs are well protected," he says. "Cervical cancer is a preventable disease -- we have more tools to prevent this cancer than any other malignancy in humans. Women should really use [HPV] vaccine and screening to protect themselves from this cancer."

Copyright Health Magazine 2010

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HEALTH MANAGEMENT. Study: IUD's lower cervical cancer risk

Women who use IUDs are roughly half as likely to develop cervical cancer as women who have never used one, a study found.Intrauterine devices (IUDs) prevent unwanted pregnanciesAs an added benefit, they may also help protect against cervical cancerWomen who use IUDs are roughly half as likely to develop cervical cancer
(Health.com) -- Intrauterine devices (IUDs) prevent unwanted pregnancies, and as an added benefit they may also help protect against cervical cancer, according to a new study in the Lancet Oncology, a British medical journal.
Women who use IUDs are roughly half as likely to develop cervical cancer as women who have never used one, the study found. Nor does IUD use appear to increase the risk of human papillomavirus (HPV) infection, a known cause of cervical cancer.
European researchers combined and analyzed data from nearly 20,000 women around the world who participated in various studies and surveys between 1985 and 2007. The new analysis does not prove that IUDs directly prevent cervical cancer; it simply suggests that the devices are associated with a lower risk of cancer for reasons that aren't fully understood.
Health.com: Which birth control method is best for you?
"This study does not show cause and effect," says Mehdi Moslemi-Kebria, M.D., a gynecologic oncologist at the Cleveland Clinic who was not involved in the new research. "For that you would need a prospective, randomized study. But this does tell us with pretty good accuracy that an IUD is not a risk factor for cervical cancer."
Compared to women who had never used an IUD, the study participants who had used the devices had 44% lower odds of developing squamous cell carcinoma, by far the most common type of cervical cancer. They also had 54% lower odds of developing adenocarcinoma cancers and a mixed type of cancer known as adenosquamous carcinoma.
Roughly 12,000 women in the U.S. -- the majority of them over 30 -- receive a cervical cancer diagnosis each year, according to the Centers for Disease Control and Prevention. Most cases are caused by a persistent infection with HPV, a common sexually transmitted virus that is usually defeated by the body's immune system. (Pap smears can tell if HPV is damaging the cervix.)
Health.com: Top 10 myths about safe sex
In the study, which was funded by the World Health Organization (WHO) and several other government and philanthropic organizations, IUD use neither increased nor decreased the risk of HPV infection. The rates of infection were the same among women who had used an IUD as among those who hadn't, even after researchers took into account various risk factors for HPV, such as a woman's number of sexual partners, the number of Pap smears she'd had in her life, and her menopausal status.
Although they have no firm evidence, the researchers speculate that the contraceptive devices may disrupt HPV's cancer-causing mechanism. The devices may cause a low-level immune-system response that fights cancer cells, for instance, or their insertion and withdrawal may physically remove precancerous lesions, the study notes.
Health.com: 7 common birth control side effects
"More research is definitely needed to study the biological mechanisms by which IUDs may induce this risk reduction," says the lead author of the study, Xavier Castellsagué, M.D., a cancer epidemiology researcher at the Institut Català d'Oncologia, in Barcelona, Spain.
Whatever the mechanism, it seems to work quickly. Women who used an IUD for less than a year were no more likely to be diagnosed with cervical cancer than women who'd had an IUD implanted for several years.
There are two kinds of IUD available in the U.S., both of which are T-shaped and made from molded plastic. One uses copper as a contraceptive, and the other prevents pregnancy by releasing the hormone progestin into the uterus. Both are extremely effective forms of birth control, but because the study did not include data on the type of IUD used, the authors were unable to assess whether one type of IUD is more likely than another to lower the risk of cervical cancer.
Health.com: Amazing moments in birth control
The new findings do not mean that women worried about cervical cancer should be fitted for an IUD, says Karl Ulrich Petry, M.D., a gynecologic oncologist at the Klinikum Wolfsburg, in Germany.
Petry, who wrote an editorial accompanying the study, points out that HPV testing and Pap smears already reduce the risk of cervical cancer by 80% to 90%.
"Women in countries with screening programs are well protected," he says. "Cervical cancer is a preventable disease -- we have more tools to prevent this cancer than any other malignancy in humans. Women should really use [HPV] vaccine and screening to protect themselves from this cancer."

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HEALTH MANAGEMENT. Adult stem cells used to grow cervical vertebrae

Neurosurgery researchers at UC Davis Health System have used a new, leading-edge stem cell therapy to promote the growth of bone tissue following the removal of cervical discs -- the cushions between the bones in the neck -- to relieve chronic, debilitating pain.
The procedure was performed by associate professors of neurosurgery Kee Kim and Rudolph Schrot. It used bone marrow-derived adult stem cells to promote the growth of the bone tissue essential for spinal fusion following surgery, as part of a nationwide, multicenter clinical trial of the therapy.
Removal of the cervical disc relieves pain by eliminating friction between the vertebrae and/or nerve compression. Spinal fusion is used following surgery for degenerative disc disease, where the cushioning cartilage has worn away, leaving bone to rub against bone and herniated discs, where the discs pinch or compress nerves.
"We hope that this investigational procedure eventually will help those who undergo spinal fusion in the back as well as in the neck," said Kim, who also is chief of spinal neurosurgery at UC Davis. "And the knowledge gained about stem cells also will be applied in the near future to treat without surgery those suffering from back pain."
Millions of Americans are affected by spine diseases, with approximately 40 percent of all spinal fusion surgery performed for cervical spinal fusion. Some 230,000 patients are candidates for spinal fusion, with the numbers of potential patients increasing by 2 to 3 percent each year as the nation's population ages.
"This is an exciting clinical trial to test the ability of the bone-forming stem cells from healthy donors to help patients with spinal disease," said Jan Nolta, director of the UC Davis Institute for Regenerative Cures.
"For the past 50 years, bone marrow-derived stem cells have been used to rebuild patients' blood-forming systems. We know that subsets of stem cells from the marrow also can robustly build bone. Their use now to promote vertebral fusion is a new and extremely promising area of clinical study," she said.
The stem cell procedure at UC Davis took place early in August. The patient was a 53-year-old male from the Sacramento region with degenerative disc disease.
In the surgery, called an anterior cervical discectomy, a cervical disc or multiple discs are removed via an incision in the front of the neck. The investigational stem cell therapy then is applied to promote fusion of the vertebrae across the space created by the disc removal.
The stem cells are derived from a healthy single adult donor's bone marrow, and thus are very homogenous, Kim said. They are grown in culture to high concentration with minimal chance for rejection by the recipient, he said.
Adequate spinal fusion fails to occur in 8 to 35 percent or more of patients, and persistent pain occurs in up to 60 percent of patients with fusion failure, which often necessitates additional surgery.
"A lack of effective new bone growth after spine fusion surgery can be a significant problem, especially in surgeries involving multiple spinal segments," said Schrot, co-principal investigator for the study. "This new technology may help patients grow new bone, and it avoids harvesting a bone graft from the patient's own hip or using bone from a deceased donor."
Current methods of promoting spinal fusion include implanting bone tissue from the patient's hip or a cadaver to encourage bone regrowth as well as implanting bone growth-inducing proteins. However, the Food and Drug Administration has not approved the use of bone morphogenetic proteins for cervical spinal fusion. Their use has been associated with life-threatening complications, particularly in the neck.
The leading-edge stem cell procedure is part of a prospective, randomized, single-blinded controlled study to evaluate the safety and preliminary efficacy of an investigational therapy: modified bone marrow-derived stem cells combined with the use of a delivery device as an alternative to promote and maintain spinal fusion.
The study includes 10 investigational centers nationwide. The UC Davis Department of Neurological Surgery anticipates enrolling up to 10 study participants who will be treated with the stem cell therapy and followed for 36 months after their surgeries. A total of 24 participants will be enrolled nationwide.
The study is one of several clinical trials under way in the UC Davis Spine Center and led by Kim. He anticipates launching a clinical trial soon to study the safety of injecting stem cells into disc tissue to repair degenerated discs.
The current study is sponsored by Mesoblast, Ltd., of Melbourne, Australia, which is developing adult universal-donor stem cell products built upon the discovery of adult-derived mesenchymal precursor cells. Kim and Schrot will not be compensated for their participation in the study.

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