Cervical cancer virus fuels oral cancer type, too by Lauran Neergaard
WASHINGTON - 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 fuel- ing 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 cervi- cal cancer, researchers from Ohio State University and the National Cancer Institute report Monday. "There is an urgency to try to fig- ure 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 can- cer 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 popu- lation, and the researchers conclud- ed 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 infec-
tion is likely to linger longer in men. While HPV is the most common sexually transmitted infection, stud- ies show women's bodies usually clear the virus from the cervix quickly; only an infection that per- sists for years is a cancer risk. It's not known if oral HPV acts similar- ly 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 - com- pared 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. AP
Probe: Drug abusers exploiting Medicare benefit by Ricardo Alonso-Zaldivar
WASHINGTON - Medicare's popu- lar prescription program has an unsavory underside. It's an easy tar- get for drug abusers seeking to feed their own addictions or sell painkillers for profit, congressional investigators said in a report released Tuesday.
The Government Accountability Office found that about 170,000
Medicare recipients each received prescriptions from multiple doctors for 14 frequently abused medica- tions in 2008. Not counting related charges for office visits, the cost to the taxpayer-supported program amounted to $148 million. Abuse of prescription medications is a fast-growing drug problem, par- ticularly entrenched among teens and young adults. Sen. Tom Carper, D-Del., who requested investigation,
Feds revise medical rules for transgender inmates
by Lisa Leff
SAN FRANCISCO - Transgender inmates who did not begin treat- ment prior to entering federal cus- tody can now receive hormones, specialized mental health counsel- ing and possibly gender reassign- ment surgery while they are in prison, according to new rules adopted by the U.S. Bureau of Prisons as part of a court settle- ment. A May 31 memo issued to war- dens at the nation's 116 federal prisons and made public by gay rights groups in announcing the settlement Friday states, "current, accepted standards of care" will be applied to inmates who believe they are the wrong gender. Under the bureau's previous pol-
icy, issued in 2005, only federal inmates with a preexisting diagno- sis were eligible for transgender- related care, which was limited to treatments that would maintain them "only at the level of change which existed when they were incarcerated."
The new guidelines mean pris- oners who were previously dis- qualified from treatment because they had not received any on the outside will now be eligible to begin hormone therapy to feminize or masculinize their features and to dress and live accordingly as part of individualized treatment plans. "The treatment plan may include elements or services that were, or were not, provided prior to incar- ceration, including, but not limited to: those elements of real life expe- rience consistent with the prison
said Medicare has a responsibility to not make things any worse. "We have a moral imperative to make sure the public health system is not used to subsidize and intensify a public health crisis," Carper said at a hearing of the Homeland Security and Government Affairs subcommit- tee on federal financial management. Medicare officials say they face legal limitations in what they can do to stop the abuse, although they rec-
12 Chicago Defender • ChicagoDefender.com
• October 5-11, 2011
ognize the problem and have adopt- ed new strategies to confront it. The investigation found brazen conduct indicating that drug abusers have little to fear from exploiting Medicare.
One Medicare recipient in
Georgia got prescriptions for 3,655 oxycodone pills - more than a four- year supply of the painkiller - from 58 different prescribers. Another, in California, got prescriptions for a nearly five-year supply of fentanyl patches and pills from 21 different prescribers. Fentanyl is a very strong
environment, hormone therapy and counseling," the memo from bureau medical director Newton Kendig states.
The policy memo does not men- tion surgical intervention, but National Center for Lesbian Rights Legal Director Shannon Minter said the agreement would permit surgery as a treatment option if prison doctors agree it is necessary for individual inmates.
The May guidance specifically advises wardens that "treatment options will not be precluded sole- ly due to level of services received, or lack of services, prior to incar- ceration."
That language, as well as the ref- erence to accepted standards of care is significant since the World Professional Association for Transgender Health, the profes- sional organization that issues guidelines for treating gender identity disorders, considers geni- tal reconstruction surgery "essen- tial and medically necessary" for some patients suffering from "gen- der dysphoria."
Transgender Rights Project at Gay & Lesbian
Jennifer Levi, director of the Advocates and
Defenders, said that because the memo does not prohibit surgery, 'It leaves open the possibility that the full range of appropriate medical care must be considered in adopt- ing an individual treatment plan." "There is no reason why an incarcerated person should be excluded from receiving surgery if it turned out to be medically neces- sary for that individual," Levi said. AP
narcotic used to treat relentless can- cer pain. Investigators reported the 48 worst abusers to Medicare's fraud unit.
Overall, taxpayers pay three- fourths of the cost of the Medicare prescription drug program, which covers some 28 million seniors and disabled people for about $55 billion a year.
The drug abuse problem might appear relatively minor measured against such statistics, but it can't be dismissed, said Sen. Scott Brown, R- Mass. AP
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