Oral Sex Cause of Throat Cancer Rise

July 29, 2009 - Changing sexual practices have led to a dramatic rise in throat cancer in the United States over the past two decades, and experts say they fear an epidemic of the disease.

The comments were made Wednesday at a news conference held by the American Association for Cancer Research to discuss research into the role of the sexually transmitted human papilloma virus ( HPV) in head and neck cancer.

Increasing rates of HPV infection, spread through oral sex, is largely driving the rapid rise in oropharyngeal cancers, which include tumors of the throat, tonsils, and base of the tongue, said Scott Lippman, MD, who chairs the thoracic department at the University of Texas M.D. Anderson Cancer Center.

Studies of oropharyngeal tumor tissue stored 20 years ago show that only around 20% are HPV positive, Lippman said. Today it is estimated that 60% of patients are infected with the virus.

“The percentage of oropharyngeal cancers that are HPV positive is much higher now than it was 20 years ago,” he said. “This is a real trend, and that is why there is concern of an epidemic given that fact that oropharyngeal cancer is increasing at an alarming rate.”
Changing Face of Throat Cancer

Smoking and alcohol abuse were once considered the only major risk factors for these cancers, but this is no longer the case.

American Cancer Society Chief Medical Officer Otis Brawley, MD, said as many as half of the oropharyngeal cancers diagnosed today appear to be caused by HPV infection.

“Changing sexual practices over the last 20 years, especially as they relate to oral sex, are increasing the rate of head and neck cancers and may be increasing the rates of other cancers as well,” he said.

He added that there is some evidence that oral HPV infection is also a risk factor for a type of cancer of the esophagus.

“The paradigm is changing,” Lippman said. “The types of patients we are seeing now with oropharyngeal cancers are not the patients we have classically seen who were older, smokers, and have lots of other problems. These are young people, executives, a whole different population.”
Oral Sex Not Safe Sex

The experts agreed that it is critical for the public to understand that oral sex doesn’t equal safe sex.

The message was unofficially promoted in the early days of the HIV epidemic and it is still widely believed by many, especially teens.

Studies suggest that teens are often unaware of the risks associated with unprotected oral sex, including the transmission of HPV, chlamydia, and gonorrhea.

“There is a huge public health message here,” Brawley said.

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Students targeted for flu shots

Back in the days of the polio epidemic, health officials decided to immunize children against the deadly disease by administering shots at school. Baby Boomers will recall lining up with schoolmates in the mid-1950s for a quick stick in the arm, and perhaps getting rewarded for the courage with a lollipop or an extra recess.
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Health officials may return to that method of mass inoculation, in an effort to contain the spread of the H1N1 flu virus this fall among school-age children. The 5-to-24-year-old age group was the hardest struck by the virus last spring, when it first arrived in the United States. According to the Massachusetts Department of Public Health, the median age of those infected by the virus was 14.

About a dozen or so school districts in Southeastern Massachusetts have discussed the feasibility of inoculating children at school with state health officials, with Braintree perhaps being the furthest along. The town plans to administer seasonal flu shots to middle and high school students most likely this month and H1N1 inoculations in November, both during school hours.

Nearby Randolph is formalizing plans for seasonal flu shots to be given on a Saturday later this month, and H1N1 vaccinations most likely during school time in November. In Quincy, health officials say discussion is still “fluid,’’ but it appears students will be given shots at school. Plymouth, too, is looking at how to implement an immunization program for its middle- and upper-grade students during the school day, at least for the seasonal flu.

Other districts that have been in discussion with state health officials regarding inoculation of students include Dedham, Easton, Foxborough, Hull, Mansfield, Mattapoisett-Marion, and Weymouth, according to state records. Some of those may also consider inoculations through the schools, either during the school day or through clinics at other times.

A report issued in mid-August by the President’s Council of Advisors on Science and Technology estimates the H1N1 virus could cause 90,000 deaths in the United States this flu season. And according to the US Centers for Disease Control and Prevention, the most effective way to contain the spread of the virus will be “vaccinating as many as possible as quickly as possible.’’

Braintree’s School Committee recently voted to begin with seasonal flu shots for middle and high schoolers during school time in the next few weeks. Information and permission slips for the shots are expected to be forwarded to parents in the next several days.

Vaccine for the H1N1 virus will be shipped to each state in October, so Braintree officials believe a dose can be administered to students by early November.

“It will be free and voluntary,’’ said Marybeth McGrath, Braintree’s director of municipal licenses and inspection, who expects the program to be well-received. “We haven’t had any calls of concern about the vaccine, but we have had some calls in favor.’’Continued...

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Aside from everyday functions of chewing, swallowing, talking and tasting, the tongue has new uses such as steering wheelchairs and helping blind people see. Also in Spain last month, doctors transplanted a tongue as part of a face transplant surgery.

"The tongue is considered very much like the trunk of an elephant or the tentacle of the octopus. It's the same kind of structure with how many shapes, configurations the trunk or tentacle can assume," said E. Fiona Bailey, an assistant professor of physiology at The University of Arizona in Tucson. "Researchers realize there is a lot of potential there."

Transplanting tongues

A team of surgeons in Spain last month performed a face transplant, which is considered the first to include the tongue and jaws.

A 43-year-old man who lost his jaws and tongue after a cancer battle 11 years ago received a transplant for the bottom third of his face, according to the Hospital La Fe in Valencia, Spain. Dr. Pedro Cavadas, the surgical team leader, said the objective was for the patient to recover feeling in his face and also to swallow, talk, feel and taste with his tongue again.
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But the first tongue transplant in 2003 had short-lived results. Doctors in Austria transplanted a tongue to a 42-year-old cancer patient. The cancer returned and the patient died 13 months after the surgery, according to a 2008 article written by his doctors in the journal Transplantation.

A transplant recipient has to take immune suppressing drugs so he or she won't reject the new organ. But this puts the person at risk for cancer recurrence because of the weakened immune system, said Dr. Douglas Chepeha, a head and neck surgical oncologist at the University of Michigan Comprehensive Cancer Center in Ann Arbor.

Unlike liver or kidney transplants, reconnecting the tongue is also more complex because of its nerves, said Chepeha, who is the director of the microvascular program.

"A nerve is not like a single wire in your house," he said. "When we say a nerve, there are literally thousands if not hundred thousands of tiny little fibers. It'll be like taking a fiber optic cable and cutting it -- let's say that cable had 100,000 fibers in it -- how do you realign it?"

Chepeha said: "If we can get some way of knowing which way to hook the nerves up, someday it'll work better. Right now, we're not there."

Driving wheelchairs

A new kind of wheelchair allows people who cannot use their hands and feet to steer using simple tongue movements. This technology can assist people who have spinal cord injuries, said Maysam Ghovanloo, an assistant professor in the School of Electrical and Computer Engineering at the Georgia Institute of Technology.

Unlike hands and feet, the tongue has a distinct advantage because it doesn't connect to the spinal cord, he said.

To use the wheelchair, a magnet the size of a lentil sits on the driver's tongue affixed by edible glue. When the person in the wheelchair touches a certain tooth with his or her tongue, the wheelchair moves -- for example, a left tooth, the wheelchair will turn left. Magnetic sensors trace the movement of the tongue and transmit the directions to get the wheelchair moving.

"The tongue is always moving, but the technology is smart enough to tell the difference between natural movements and the tongue movements [meant to steer the wheelchair]," Ghovanloo said.

Researchers conducted clinical trials this summer in which people with spinal cord injuries navigated through an obstacle course using their tongues. Those who had recently been injured were more receptive to driving with their tongues than others who have gotten used to the existing technology, Ghovanloo said.

The tongue-driven wheelchair is not available to the public yet, pending more clinical trials in 2010.

Aiding vision

Researchers devised an instrument to allow users to "see" through the tongue. Called the BrainPort, the vision device sits on the tongue to help blind people get a sense of their environment.

The device, which is the size of a postage stamp, connects to a digital video camera. The camera paints the visual scene in front of a person by turning it into gentle stimulations on the tongue that feel like bubbles. For example, when a person moves across the room, the device creates vibrations across the tongue to resemble the movement.

Aimee Arnoldussen, a neuroscientist at the device maker's company, Wicab Inc., said scientists turned to the tongue because "the tongue has a high density of nerve endings, which makes it sensitive."

Other parts of the body, such as the back, were not sufficiently sensitive. The fingertips were sensitive enough, but people wanted full use of their hands to grip a cane or to grab objects.

Placing the device "on the tongue inside the mouth, frees the hands to interact with environment," Arnoldussen said. Plus, the device can be hidden in the mouth.
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The device is still in development, but Arnoldussen said the company hopes to make it available to the public within the next year.

E-tongue senses sweet

Scientists at the University of Illinois at Urbana-Champaign developed a handheld device the size of a business card, which can taste the sweetness in food and drinks. This could lead to the first electronic tongue that would be able to identify sources of sweetness.

"We could determine what sweetener would be in your tea," researcher Christopher Musto told CNN Radio.

The device can distinguish among 14 kinds of sweeteners, from natural sugars to artificial ones such as Splenda. Musto described two possible applications: This would be a first step toward an electronic tongue and second, it could be a handheld device that would determine what sweetener and the amount.

Study: Swine flu easily overtakes other strains

WASHINGTON – Put swine flu in a room with other strains of influenza and it doesn't mix into a new superbug — it takes over, researchers reported Tuesday.

University of Maryland researchers deliberately co-infected ferrets to examine one of the worst fears about the new swine flu. But fortunately, the flu didn't mutate. The researchers carefully swabbed the ferrets' nasal cavities and found no evidence of gene-swapping.

The animals who caught both kinds of flu, however, had worse symptoms. And they easily spread the new swine flu, what scientists formally call the 2009 H1N1 virus, to their uninfected ferret neighbors — but didn't spread regular winter flu strains nearly as easily.

In other words, it's no surprise that swine flu has become the world's dominant strain of influenza. It's not under evolutionary pressure right now to mix and mutate while it has a clear biological advantage over other kinds of flu, concluded the Maryland team led by virologist Daniel Perez.

The Maryland study, funded by the National Institutes of Health, reinforces concern about how easily swine flu may sweep through the country.

"The results suggest that 2009 H1N1 influenza may out-compete seasonal flu virus strains and may be more communicable as well," said Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases. "These new data, while preliminary, underscore the need for vaccinating against both seasonal influenza and the 2009 H1N1 influenza this fall and winter."

Seasonal flu vaccine is available around the country now, and swine flu vaccine is expected to arrive in mid-October.

The U.S. has closely watched how swine flu rapidly dominated the Southern Hemisphere's winter, as authorities here prepare a fall resurgence. In Australia alone, eight of every 10 people who tested positive for influenza had the new pandemic strain. While it seems no more deadly than seasonal flu, it claims different victims: Seasonal flu kills mostly people over 65. The new swine flu spreads most easily in children and young adults, and so far has killed mostly people in their 20s, 30s and 40s.

The study is posted on PLoS Currents: Influenza, a Web site operated by the Public Library of Science to rapidly share scientific flu information.