Less Smoking and Drinking Tied to Oral Cancers

Other Factors at Play

Roxanne Nelson

September 18, 2012 — The prevalence of smoking and alcohol use has declined over the past few decades in patients with oral cavity cancer, according to a new single-institution study. Because these factors are associated with the disease, it is now considered likely that other causes play a role in the pathogenesis of oral cancer.

Researchers from the Memorial Sloan-Kettering Cancer Center in New York City found that during the past 25 years, there has been a progressive decline in tobacco use in this cancer population at their institution. From 1985 to 1990, 80% of patients treated there used tobacco; from 2005 to 2008, 55% did.

In addition, there was a decline in the daily amount of tobacco used. In the early cohort, 55% of patients smoked more than 1 pack per day, whereas in the late cohort, 30% did (P < .001).

The researchers found that alcohol consumption also declined over the decades, from 80% in the early cohort to 67% in the late cohort (P < .007). In addition, the percentage of patients who consumed more than 3 drinks per day decreased from 23% in the early cohort to only 9% in late cohort (P < .001).

These findings were published in the September issue of the Archives of Otolaryngology — Head & Neck Surgery.

Not Quite That Simple

The worldwide incidence of oral cancer is increasing, explained lead author Ian Ganly, MD, PhD, a surgeon at the Memorial Sloan-Kettering Cancer Center. "In the United States, it is actually decreasing, largely due to the reduction in smoking," he said.

But it is not quite that simple, he noted. The number of cases seen at his institution has doubled over what was seen 25 years ago, he reported. "Our numbers are increasing," Dr. Ganly told Medscape Medical News, "but the patient population is quite different. Before it was largely a smoking/alcohol population; now we see more nonsmokers and nondrinkers with oral cancer than smoker and drinkers," he explained.

The researchers do not know why the demographics have changed. He pointed out that the sex and age distribution and disease staging of their patients is the same, and that survival figures are stable.

However, they are seeing more oral tongue cancer in patients younger than 60 years. For patients younger than 60 years, the percentage of oral and nonoral tongue cancer cases is unchanged, Dr. Ganly said. For those younger than 60 years, the percentage of oral tongue cases is increasing and the percentage of nonoral tongue cancer cases is decreasing, he reported.

Other Causes

A recent study showed that the incidence of oral tongue squamous cell carcinoma increased 28% from 1975 and 2007 in people 18 to 44 years of age, as previously reported by Medscape Medical News (J Clin Oncol. 2011;29:1488-1494). Among white people in this age group, the incidence increased 67%; among white women, the incidence jumped a dramatic 111%.

These data "suggest we are seeing a change in the epidemiology of this disease — mainly in oral tongue cancer," said Dr. Ganly. "There must be another cause for this, but we do not know what it is," he acknowledged.

Studies suggest that human papillomavirus (HPV) might be the driver behind a rising increase of oropharyngeal squamous cell carcinoma. Dr. Ganly notes that a change in the oral microbiome might be another cause. "Clearly, more research is needed to identify what is causing this change," he said.

Changing Trends

Oral cavity cancer is the eighth most frequent cancer in the world, and the traditional causes are smoking and alcohol consumption. However, major cancer registries, such as the Surveillance, Epidemiology and End Results (SEER) database, do not collect information on tobacco and alcohol use in patients with cancer, and the current literature in head and neck cancer has not reported on trends in tobacco and alcohol use among patients with oral cancer, note Dr. Ganly and colleagues.

The scarcity of these data is important, according to the researchers, because recent studies of oropharynx cancer have shown a causal change.

After a review of the medical records of patients with oral cavity cancer from 1985 to 2009, the researchers included data from 1617 patients in their analysis.

To compare trends in alcohol and tobacco use, the patients were divided into 5 different cohorts, according to the date of initial surgery: 274 patients were treated from 1985 to 1990; 250 were treated from 1990 to 1994; 315 were treated from 1995 to 1999; 356 were treated from 2000 to 2004; and 422 were treated from 2005 to 2009.

The median age of patients was 62.5 years (range, 15.0 to 97.0 years), 86.5% were white, and 56.0% were men. The most common cancer subsite was oral tongue (49.0%), and 72.0% had T1 or T2 tumors. During the study period, there were no changes in sex or age distribution, but there was an increase in the percentage of nonwhite patients (9.1% to 16.6%). This change is primarily related to the increase in the number of patients of Asian origin.

The researchers report that over time, there was a small increase in the number of buccal mucosa cancer cases and a reduction in the number of cases of floor of mouth cancer.

When stratified by sex, the decrease in the prevalence of alcohol and tobacco use was larger in women than in men. This decrease was statistically significant for men and women who used tobacco (P < .05) but not for those who used alcohol (P = .06).

The authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2012;138:817-822. Abstract

Medscape Medical News © 2012 WebMD, LLC

Send comments and news tips to news@medscape.net.

Articulo del cancer de Sigmund Freud

Lean ela rticulo de la evolucion y tratamiento del cancer de Sigmun Freud, para el lunes de la proxima semana.

INTRODUCTION

In May 1999 members of the West Kent Medico- Chirurgical Society visited the city of Thessaloniki, in Greece. As part of the activities, we organised a scientific meeting about historical medical subjects. It was sug- gested, that I, an Oral and Maxillofacial Surgeon, should speak to our English colleagues about Sigmund Freud’s oral cancer. Many of those who attended the meeting wanted to see the publication of Freud’s illness, which has elements of a great classical epic (comical at times, but always courageous and tragic).

This great man and maxillofacial surgeon did all the necessary operations (33 procedures in all) and made most of the prostheses required for rehabilitation. For 16 subse- quent years, he provided care and support during Freud’s illness. This meant a great commitment as it required nu- merous and frequent appointments. In 1924 alone 74 ap- pointments were needed. A graphic representation of this period was done in German by Pichler himself, but in an obscure form of shorthand invented by his father. The only other person who understood the shorthand writing was Pichler’s secretary, who copied all the notes in clear handwriting in the German language. The translation into English was done by Dr Lagos Levy and the accuracy of the translation was revised by Dr Maxim Shur, Freud’s faithful friend and physician. The Freud museum at 20, Maresfield Gardens, Swiss Cottage, London was Sigmund Freud’s home for the last year of his life from 1938 to 1939.

La mandibula de los Habsburg

Quienes son estos representantes del prognatismo heredado

whonamedit.com buscar biografias¡¡¡¡¡

{821} and the Systematized Nomenclature of Medicine (http://snomed.org). Behaviour is coded /0 for benign tumours, /3 for malignant tumours, and /1 for borderline or uncertain behaviour.

• Biography of Rudolf Ludwig Karl Virchow

  Rudolf Virchow is considered the most prominent German physician of the 19th century, his long and successful career reflecting the ascendancy of German medicine after 1840. Virchow pioneered the modern concept of pathological processes by his application of the cell theory to explain the effects of disease in the organs and tissues of the body. He emphasized that diseases arose, not in organs or tissues in general, but primarily in their individual cells. Moreover, he campaigned vigorously for social reforms and contributed to the development of anthropology as a modern science. He worked vigorously to make the methods of natural science supreme in the medical sciences.
• 
  
• Rudolf Ludwig Karl Virchow

1) Lepra cell. 2) the lacunae in osseous tissue containing the bone cells; also the bone cells themselves. 3) connective tissue cells between the laminae of fibrous tissue in the cornea. These are also known as corneal corpuscles..

Description

1) Lepra cell.
2) The lacunae in osseous tissue containing the bone cells; also the bone cells themselves.
3) Connective tissue cells between the laminae of fibrous tissue in the cornea. These are also known as corneal corpuscles.

PADRE DE LA PATOLOGIA BUCAL

Thomas Bond's New Book of Oral Diseases is dedicated to Thomas E. Bond Jr., M.D., of Baltimore, Maryland, who was the first professor of oral pathology, wrote the first textbook of oral pathology and is considered by some to be the Father of Oral & Maxillofacial Pathology.  His text, A Practical Treatise on Dental Medicine, was published from the U.S. in 1848, with second and third editions published in 1850 and 1863.  The book was initially produced by Dr. Bond at the request of the first national dental association, the American Association of Dental Surgeons.

Our new 4th edition of Bond's Book is intended as a comprehensive review of the field of oral and maxillofacial pathology, with an emphasis on the clinical features of disease.  Diseases are grouped according to common tissues of origin or common etiologies, but alternate indexes are available, including an alphabetical listing and a differential diagnosis listing.  Topics and references are updated periodically as new information becomes available.  The 4th edition was published on the web in 1999 as an incomplete manuscript.  It is expected to be completed by February, 2001.

Que opinan?????

Olympics-Performance Enhancing Dope: Should Sport Ban Cannabis?

By Kate Kelland

LONDON (Reuters) Aug 06 - The expulsion of an American judo player from the London 2012 Olympic Games on Monday after he tested positive for marijuana prompted scientists to question the sense behind the drug's inclusion on the World Anti Doping Agency's (WADA) banned list.

Few experts think marijuana, or cannabis, can do much to enhance the kind of speed, strength, power or precision that Olympic athletes strive for.

And many wonder whether the expensive time and effort of sporting drug testers might be better spent catching serious cheats who top up their blood with EPO or pop anabolic steroids to boost testosterone levels and muscle growth.

"There's no evidence cannabis is ever performance enhancing in sport, and since its use is legal in a number of countries, there's no reason for it to be banned by WADA," said David Nutt, a professor of neuropsychopharmacology at Imperial College London.

"I can't think of any sport in which it would be an advantage. And it seems ludicrous that someone could quite legally smoke cannabis in Amsterdam in the morning and then come over to London in the afternoon and be banned from competing."

The heart of the problem is where to draw the line between performance enhancing drugs - which many experts agree should be prohibited in sports because they make the contest unfair - and recreational drugs, which have little bearing on performance but could give sport a bad image.

SCIENTIFIC OR POLITICAL?

Since marijuana is a forbidden drug on WADA's current list, athletes face a two-year ban if it is found in their system while they are in competition.

But the anti-doping body does not sanction athletes who test positive for marijuana outside of competition times, while they are in training camps or during rest periods.

Scientists say this smacks of double standards and suggests WADA bans cannabis for political rather than scientific reasons.

"The problem is the elite athletes should be seen as role models for young kids, and so they ban cannabis because they don't want to have the image of gold medalists smoking joints," said one British-based sports scientist who asked not to be identified because of the sensitivity of the issue.

A photo of the American swimming champion Michael Phelps smoking marijuana through a glass pipe "bong" in 2009 sparked criticism from the U.S. Olympic Committee.

In a statement released shortly after the picture was published by a British tabloid newspaper, Phelps admitted to smoking pot and apologized for what he described as "bad judgment." But he faced no sporting sanction for his behavior because it was not "in competition."

Experts say that row, as well as Monday's ruling on American judoka Nick Delpopolo - who said he inadvertently ate the drug in a marijuana brownie - is far more to do with the image of sport than any form of cheating.

"It's hard to imagine how smoking a joint or eating marijuana brownies is going to help somebody in judo," said Michael Joyner, a member of the Physiological Society and a researcher at the Mayo Clinic in Minnesota in the United States.

"My advice to WADA is that they should focus on drugs that are clearly performance enhancing in the sports where they are clearly performance enhancing."

SENSITIVE ISSUE

Some national sporting bodies are also kicking back against WADA's stance.

Australia's Coalition of Major Professional and Participation Sports called in May for marijuana to be removed from the list saying it was wrong to group it with performance enhancing drugs like human growth hormone and steroids.

Substances on WADA's banned list should meet two of the following criteria: they are proven to be performance enhancing, they are dangerous to the health of athletes, or they are contrary to the spirit of sport.

While there are few signs that marijuana can enhance sporting performance, there is evidence to suggest it could have a negative impact.

Studies have shown that THC - the ingredient in cannabis that induces the "high" - increases blood pressure and heart rate while also decreasing cardiac stroke volume, leading to diminished peak performance.

It can also slow reaction times, cause problems with coordination, reduce hand-eye coordination, and interfere with visual perception.

Anti-doping authorities were not keen to discuss the issue on Monday. Officials at UK Anti-Doping declined to comment, and an email sent by Reuters to WADA's media relations office asking for a statement on why cannabis is banned got no response.

Reuters Health Information © 2012 

 

Para los que les interesa la endodoncia

Experimental evidence supports the abscess theory of development of radicular cysts

P.N.R. Nair, BVSc, DVM, PhD (Hon),a Göran Sundqvist, DDS, PhD,b Ulf Sjögren, DDS, PhD,b Zurich, Switzerland, and Umeå, Sweden UNIVERSITY OF ZURICH AND UMEÅ UNIVERSITY

Objective. The objective of this study was to experimentally induce inflammatory cysts in an animal model so as to test the hypothesis that radicular cysts develop via the “abscess pathway.” Methodology. Twenty-eight perforated custom-made Teflon cages were surgically implanted into defined locations in the back of 7 Sprague Dawley rats. A week after the implantation of the cages, a known quantity of freshly grown, close allogeneic oral keratinocytes in phosphate buffer solution (PBS) was injected into each cage. One cage per animal was treated as the control that received only epithelial cells. The remaining 3 cages of each animal were trials. Seven days post epithelial cell inoculation; a suspension of 0.2 mL of Fusobacterium nucleatum (108 bacteria per mL) was injected into each of the 3 trial cages. Two, 12, and 24 weeks after the inoculation of the bacteria, the cages were taken out, and the tissue contents were fixed and processed by correlative light and transmission electron microscopy. Sixteen of the 21 trial cages could be processed and yielded results.

Results. Inoculations of epithelial cells followed 1 week later by F. nucleatum into tissue cages resulted in the development inflammatory cysts in 2 of the 16 cages. The 2 cages contained a total of 4 cystic sites. None of the control cages showed the presence of any cyst-like pathology. Conclusions. Inflammatory cysts were induced by initiating acute inflammatory foci (abscess/necrotic area) by bacterial injection that got enclosed by a proliferating epithelium. This finding provides strong experimental evidence in support of the “abscess theory” of development of radicular cysts. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;xx:xxx)