Source: Medscape Medical News
I know what you’re thinking. Yes, HPV (human papillomavirus or genital warts) is a sexually transmitted disease which has been related with a specific cancer. Evidence appears to be mounting (sorry, I had to) that the incidence of oral HPV cancer has increased since the 70′s. According to statistics in the International Journal of Cancer (2009: 125:362-366) rates of HPV related oropharyngeal (mouth and throat) cancer were 23.3% in the 1970′s, 57% in the 199o’s and up to 93% in 2006-20007.
Why the increase in oral cancer? According to researchers it’s due to an increase in oral in general. Yes, some things do write themselves. Apparently it can take from 15 to 30 years for HPV to develop into cancer. While there is some concession that much of this is speculation as people are not necessarily candid in providing such information to researchers, the implications for treatment could be significant.
It is medically accepted that HPV causes cancer. In fact, the molecular mechanisms are well known enough for the development of the available HPV vaccine. Currently, the HPV vaccine is targeted to young women for the prevention of cervical cancer, which can originate from HPV. The vaccine was also recently approved for use with young men to prevent genital wart infection.
But could the same vaccine eventually be used to prevent against HPV-related oral cancer? Well, one would expect that it might, however, genital surfaces and fluids do differ from oral surfaces and fluids so no one is actually certain. The efficacy of the currently available HPV vaccine appears clear. But is it cost effective? That is, will big pharma seek to develop a vaccine for something potentially ineffective and potentially socially problematic.
Not as unusual as it might seem given our Puritanical heritage. Remember, if the studies correlating sexual behavior with increased incidence of oral HPV are correct this would seem to limit the transmission of this type of cancer to an act still defined as sodomy in many states in the United States and criminalized in some.
Perhaps the only other social-medical parallel would be with the medical marijuana debates going on in most states. Where medicine and societal “norms” or “values” intersect is where we start getting into problem territory. The manufacturers and marketers of the HPV vaccine took a lot of criticism for essentially targeting school-aged girls. When one finally “gets over” the fact that school-aged girls are sexually active the criticism seems nonsensical. A vaccine which could potentially prevent women from dying in their middle age from cancer inherently seems like a worthy investment. We will follow the emerging debate on this one.
~Posted by D.M. Schwadron, Esquire
Source: New England Journal of Medicine; BBC Health
Dutasteride (Avodart according to GalxoSmithKline) is used to treat an enlarged prostate. It works by blocking the production of a natural substance that enlarges the prostate. This shrinks the prostate, relieves symptoms of BPH (benign prostatic hypertrophy), such as frequent and difficult urination, and decreases the chance that surgery will be needed to treat this condition.
Why am I telling you this? Have I suddenly started working for GlaxoSmithKline and wish to pitch their on-patent medications to stave off the competition from the generics? No. Not at all. I’m telling you because the results of a 4 year study of some 6,500 men taking dutasteride showed a 23% lower risk of prostate cancer compared with those taking a placebo (a fake pill, typically made of sugar).
This isn’t the first study to initially show promise. In 2003, a study of men taking finasteride, a BPH drug now marketed as Propecia by Merk. (Yes for hair loss), was said to also lower the risk of prostate cancer. However, there were issues with the aggressive nature of the tumors found in that group. Oh and both medications can cause sexual dysfunction and frequent and painful urination.
The Glaxo funded study (you had to know that) looked at men aged 50 to 75 years in the “high risk” for prostate cancer category given elevated PSA scores but without demonstrable cancer. Among those with a family history of prostate cancer, those also taking dutasteride are reported to have cur their risk of developing cancer by 31.4%. Why the disparate numbers? It’s not clear. And what about the tumors that did develop? The researchers felt that those found during the trial were likely present to begin with but too small to be detectable. According to them, this suggest that the drug shrinks early prostate tumours or keeps their growth at sub-detectable levels. (The later of which doesn’t appear to be all that helpful).
The proponents of the study believe that the drug might offer thousands of men a simple way to reduce their risk of disease. This would mean that more men with a high PSA could potentially avoid unnecessary or more involved treatment including surgery on the prostate, chemotherapy and radiation and all of the attendant side effects and symptoms which follow.
Others, like Dr. Helen Rippon of the Prostate Cancer Charity, aren’t so charitable. (See what I did there?) According to Dr. Rippon, “[W]e don’t yet know what will happen to these men in the coming years and whether they will still go on to develop the disease [Prostate Cancer] and it will be many years before we know if the drug [dutasteride] can provide any long-term benefit to men.”
~Posted by D.M. Schwadron, Esquire
Source: BBC Health; Journal of Medical Screening
Still think screening for breast cancer doesn’t matter? In this country there is a lot of debate about that very topic. Opponents of screening suggest that it results in over-treatment for “lumps” that may be benign cysts or nothing at all. What is over-treatment? Sometimes simple referral for ultrasound or MRI and sometimes referral to a breast surgeon for aspiration (withdrawing cells through a needle), biopsy (cutting out a portion of the lump) or excision (removal of the lump).
Well the latest study, out of England, focused upon 80,000 women aged 50 and over. (Women in England between 50 and 70 receiving screening every 3 years under the National Health System). The results? Over a period of 20 years, 5.7 (yeah, I don’t know what a .7 person is either) breast cancer deaths were prevented for every 1,000 women screened. 2.3 of those 1,000 women were told they had a lump of unclear significance. Okay, that’s raw numbers, what does it mean? Well, for every 28 cases diagnosed, 2.5 women had their lives saved and 1 woman was over-diagnosed.
According to the authors of the study, “The benefits in terms of numbers of deaths prevented are around double the harm in terms of over-diagnosis.” Projecting forward leads them to believe that, “A significant reduction in breast cancer deaths in association with mammographic screening.”
Because of research such as this the NHS plans to extend mammography to women 47 to 73 by 2012. Meanwhile, here in the United States and with the possible implementation of a National Health Care Service we appear to be going in the opposite direction. Here we debate the costs of screening women under 50. Whether or not it’s prudent. Economically effective. And whether or not too much screening, rather than resulting in more diagnosis and lives saved, results in over-treatment (read more money).
And back across the pond, a spokesperson for Cancer Research UK, Sara Hiom, was quoted saying, “What we need to remember is that detecting cancers earlier generally means improved survival. And we know through trials and through research that breast cancer screening can save lives.”
Deputy Directer of the NHS cancer screening programmes (thats Brit for programs) adds, “There is a risk of over-diagnosis and possible subsequent over-treatment associated with any screening programme” and that, “The latest independent study shows that the risk of over-diagnosis is very much lower than some other recent estimates have claimed and that the benefits [of mammography screening] far outweigh the risks.” Well put.
~Posted by D.M. Schwadron, Esquire