Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
HNSCC, Vaping and HPV; Enhancing our Diagnostic Abilities and Knowledge Base Bradley E Jones CDR, DC, USN Learning Objectives At the conclusion of this activity, the participant will be able to: 1. Improving our diagnostic abilities of premalignant and early stage HNSCC. 2. Developing an intelligent base of knowledge regarding the use of electronic cigarettes and their effects on the oral cavity. 3. 5 things every dentist should know about HPV related HNSCC White Patch Differential (and red) • Hyperkeratosis, acanthosis • Epithelial dysplasia • Squamous Cell Carcinoma • Infectious and Inflammatory HNSCC • 95% of oral cavity cancers are squamous cell carcinoma • Usually ages 50-70 years, 90% men • Represent 4% of malignant tumors in men and 2% in women; 30,000 new cases annually in US with 8,000 subsequent deaths • Recent trends show reduction overall in oral cancer deaths but increase in black men, black women and women overall How do we find more intraoral disease and disease at earlier stages? • A 43yo male presented with a persistent white patch on the ventral tongue. Epithelial Dysplasia – 26 yo M Anterior Middle Posterior Candidiasis – 65 yo M Hx of SCCa Candidiasis – 36 yo M • An 81 yo female with long history of oral leukoplakia presented recent onset raised lesion of the right buccal mucosa. Conventional Oral Squamous Cell Carcinoma 61 yo M 65 yo M 58 yo M 83 yo F HPV-Associated Oropharyngeal Squamous Cell Carcinomas • HPV is associated with a specific subset of head and neck cancer: Oropharyngeal SCCa (tonsil and BOT) • Distinctive features include: – – – – – – Younger age (mean age 52-56 yrs) Patients often have no risk factors (smoking/drinking) HPV does not appear to act synergistically with tobacco or alcohol May be clinically occult and present with neck mass as the first sign > 80% of current cases are HPV positive 95% + HPV sub-types 16 or 18 (same HPV found in cervical cancer) • Prognostically significant Human Papilloma Virus (HPV) and Oropharyngeal Squamous Cell Carcinoma • The oropharynx includes the following sites – – – – Base of the tongue Tonsillar region Soft palate and uvula Pharyngeal walls HPV+ Oropharyngeal Squamous Cell Carcinoma HPV+ Oropharyngeal squamous cell carcinoma 66 yo M HPV 16/18 p16 Follow-up for overall survival began on the date of cancer diagnosis and ended at death or the last day of follow-up (November 1, 2009, for Hawaii; December 31, 2007, for Iowa; and May 31, 2010, for Los Angeles). (Chaturvedi A K et al. JCO 2011;29:4294-4301) ©2011 by American Society of Clinical Oncology Current News Items • • Oral cancer virus affects 7 percent of Americans, study finds; also linked to cervical cancer (AP, Published: January 26/JAMA online 2012) – “Millions may have oral HPV, but fewer than 15,000 Americans get HPVlinked oral cancer each year.” Ask the ADA Question: – Do the HPV vaccines (Cervarix and Gardasil*) protect against oropharyngeal cancers caused by HPV? – Answer: The vaccines protect against HPV-16 and HPV-18, which have been identified in approximately 90 to 95 percent of HPV-positive oropharyngeal cancers. However, it will likely be decades before their effectiveness in preventing oropharyngeal cancers is known. • A 49yo female presented with an incidental finding of an exophytic lesion on the ventral tongue. Sq Papilloma Heck’s Disease Sq Papilloma Heck’s Disease • A 36 yo male presented with a raised area on the lower lip. • Dx: Heck’s disease-like verrucous epithelial hyperplasia Cigarette smoking is the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths.1 In 2015, about 15 of every 100 U.S. adults aged 18 years or older (15.1%) currently* smoked cigarettes. This means an estimated 36.5 million adults in the United States currently smoke cigarettes.2 More than 16 million Americans live with a smoking-related disease.2 Current smoking has declined from nearly 21 of every 100 adults (20.9%) in 2005 to about 15 of every 100 adults (15.1%) in 2015 Two Completely Different Products Are Referred To As "E-Cigs" E-cigs, APVs, and Vape Mods Vape ‘Mods’ E-Liquid Ingredients Are Not A Mystery • Juicemaster General INGREDIENTS • vegetable glycerin • propylene glycol (not diethylene) • Flavorings are food-grade, can be natural or artificial, and are limited only by the imagination of the juice maker • pharmaceutical-grade nicotine Many Vapors Use Very Little To No Nicotine • e-liquid in very low to zero nicotine strength (6 mg per ml and below) outsells medium-to-high strengths (12 mg and above) by better than a two-to-one margin The Vapor Is Far Less Harmful Than Cigarette Smoke • "For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk to human health from e-cigarette emissions based on the compounds analyzed." • "Absence of combustion and different chemical composition, leading to less toxic chemicals created and absorbed . . . electronic cigarettes may be a safer alternative to tobacco cigarettes." Vaping Does Help Smokers Quit