Gum disease linked to head and neck cancer

14 sept 2009– The health hazards associated with chronic periodontitis (gum disease) extend way beyond the mouth. For years people have been warned that persistent periodontitis can cause heart disease. Now a new study suggests that gum disease may also be a risk factor for cancers of the head and neck.

As reported in the journal Cancer Epidemiology, Biomarkers, and Prevention, the study included 266 patients with cancers of the head or neck treated between 1999 and 2005, and 207 control subjects.

Periodontitis was determined by alveolar bone loss seen on x-rays, Dr. Mine Tezal, from The State University of New York, Buffalo, and colleagues note. Alveolar bone is the ridge of bone that surrounds the roots of the teeth, holding them in place. Loss of this bone is typically seen with severe periodontal disease.

With each millimeter of alveolar bone loss, the risk of head and neck cancer increased more than 4-fold, the report indicates. (One millimeter is about the size of the head of a pin.) The link was seen even in subjects who had never used tobacco and alcohol.

"Confirmatory studies ... are needed," Dr. Tezal said in a statement.

SOURCE: Cancer Epidemiology, Biomarkers, and Prevention, September 2009.

Chest scans may help monitor spread of head and neck cancer in high-risk patients

22 oct 2008--Among high-risk patients with head and neck cancer, chest computed tomography (CT) may help detect disease progression involving the lungs, according to a report in the October issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.
Developing a second, distant cancer (a metastasis or a new primary cancer) is an important factor affecting survival of patients with head and neck squamous cell carcinoma, which accounts for most head and neck cancers, according to background information in the article. The most common site at which such patients develop new metastases is the lungs, with an incidence of 8 percent to 15 percent. Chest X-rays are the most commonly used screening tool for detecting these malignancies but do not always identify early abnormalities.
Yen-Bin Hsu, M.D., of Taipei Veterans General Hospital, Taiwan, and colleagues evaluated 270 screening chest CT scans performed over 42 months in 192 patients with head and neck squamous cell carcinoma. The scans were categorized as new cases, follow-up cases or recurrent cases, and results classified as normal or abnormal.
Of the 270 scans, 79 (29.3 percent) were considered abnormal, including 54 (20 percent) that identified a malignant neoplasm of the lung and 25 (9.3 percent) showing indeterminate abnormalities. "The rate of an abnormal scan was significantly higher in the follow-up case group (44.2 percent) than in the new case group (14.2 percent)," the authors write. Patients whose cancer was classified as stage N2 or N3 (indicating some degree of lymph node involvement), who had stage IV disease (in which the cancer has spread to another organ), who had recurrent disease or who had a distant metastasis in another site were more likely to have a malignant neoplasm of the lung.
"Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them," the authors write. "Based on the progressive changes in follow-up scans, 44 percent of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small (less than 1 centimeter) solitary nodules, which were usually resectable [operable], carried significantly higher chances (66.7 percent) of being a malignant neoplasm."
"For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan," they continue. "In conclusion, chest CT is recommended for high-risk patients, especially every six months for the first two years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma. High-risk patients include those with N2 or N3 disease, stage IV disease or locoregional recurrence. For patients with indeterminate small (less than 1 centimeter) solitary pulmonary nodules, aggressive evaluation and management are imperative because of the high rate of a malignant neoplasm of the lung."
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(Arch Otolaryngol Head Neck Surg. 2008;134[10]:1050-1054. Available pre-embargo to the media at www.jamamedia.org.)

News from Cancer: Disparities in head and neck cancer patients

10 oct 2008--A new analysis finds considerable disparities in survival related to race and socio-economic status among patients with head and neck cancer. Published in the November 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that earlier diagnosis and greater access to treatment could improve outcomes for these cancers among African Americans and the poor.
A number of studies have examined disparities in cancer survival among different groups to help identify interventions to improve patient outcomes. To investigate factors that impact survival from head and neck cancer, Dr. Leonidas Koniaris and colleagues at the University of Miami School of Medicine reviewed all head and neck cancer cases in Florida between 1998 and 2002. By mining information from the Florida Cancer Data System and the Florida Agency for Health Care Administration dataset, they were able to accumulate data on diagnoses, comorbid conditions, and procedures performed during every hospitalization or outpatient visit among 20,915 head and neck cancer patients during that time.
The review found poorer outcomes were associated with race, poverty, age, gender, tumor site and stage, treatment type, and a history of smoking and alcohol consumption.
Regarding race, the average survival time among Hispanics was 47 months, compared with 40 months among Caucasians and 21 months among African Americans. African American patients were diagnosed at a younger age and presented with more advanced disease compared with Caucasians. For all tumor stages, African American patients had a significantly shorter average survival time than Caucasians, regardless of poverty level. Treatments also differed between these two races: Caucasians were more likely than African Americans to have undergone surgery (45 percent vs. 32 percent), while African Americans were more likely than Caucasians to receive chemotherapy (26 percent vs. 19 percent) and radiation (66 percent vs. 56 percent). However, even among patients who received surgery, African Americans had a shorter survival time than Caucasians.
When assessing socioeconomic status, the investigators found that patients living in communities with poverty levels exceeding 15 percent were diagnosed with head and neck cancer at a significantly younger age, more frequently diagnosed with advanced disease, and had lower average survival was lower across all age groups. Average survival time was significantly shorter in patients from the areas with the highest poverty rates irrespective of what type of therapy was received.
The authors conclude that racial disparities continue to exist in head and neck cancer survival. Socio-economic inequities are also evident in head and neck cancer survival, even when the poor receive treatment for their disease.
"Earlier diagnosis, particularly in those from low socio-economic status groups and amongst African American patients, is needed to improve outcomes," the authors wrote.
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Article: "African American and poor patients have a dramatically worse prognosis for head and neck cancer: an examination of 20,915 patients." Manuel A. Molina, Michael C. Cheung, Eduardo A. Perez, Margaret M. Byrne, Dido Franceschi, Frederick L. Moffat, Alan S. Livingstone, W. Jarrard Goodwin, Juan C. Gutierrez, and Leonidas G. Koniaris. CANCER; Published Online: October 06, 2008 (DOI: 10.1002/cncr.23889); Print Issue Date: November 15, 2008.