Why are African Americans more likely than Caucasians to be not only diagnosed with head and neck cancer, but also die from the disease?

• While the answer isn’t a simple one, differences in lifestyle, access to care and tumor genetics may, in part, be to blame, according to a new study from Henry Ford Hospital.
• The study also finds that African Americans are more likely to be past or current smokers, one of the primary risk factors for head and neck cancer.
• “We’re really trying to understand why African Americans with head and neck squamous cell carcinoma do so poorly,” says study lead author Maria J. Worsham, Ph.D., director of research in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford.
• “Using a comprehensive set of risk factors that are known to have some bearing on the disease, we’re able to gain a better understanding of what contributes to racial differences and work to help improve patient care.”
• Results from the study will be presented on Sept. 14 in San Francisco at the American Academy of Otolaryngology-Head & Neck Surgery Foundation Annual Meeting. The study was funded by a NIH grant.
• This year alone, it’s estimated that 52,140 news cases of head and neck cancer will be diagnosed, and roughly 11,460 will die in 2011 from oral cavity, and pharyngeal and laryngeal cancers.
• African Americans are more likely to be diagnosed with late-stage head and neck squamous cell carcinoma (HNSCC) and have a worse five-year survival than Caucasians. It’s unknown whether significant biological rather than socioeconomic differences account for some of the disparities in outcomes.
• To get at the root of these differences, Dr. Worsham and her research team used a large Detroit multi-ethnic group of 673 patients with HNSCC. Most notably, 42 percent of the study group is African American.
• The researchers also took a very broad approach to the study, by examining many of the intertwined variables influencing health and disease to look for differences among African Americans and Caucasians.
• In all, the study focused on 136 risk factors, including demographics (age, race, gender), smoking and alcohol use, access to care and type of cancer treatment (radiation and/or surgery). Tumor characteristics, including stage, biology and genetics, also were examined.
• Much of the disparities seen among African Americans with head and neck cancer can be traced to access to care barriers, including insurance, that prevent them from getting timely and high-quality medical care, often resulting in late stage diagnosis.
• Henry Ford researchers found that: • While 88% of African Americans in the study had medical insurance, the majority had Medicare or Medicaid instead of private health insurance. • African Americans also were more likely to be unmarried or living alone, both of which previous studies suggest have a negative impact on quality of life and survival. • In terms of cancer treatment, African Americans in this study were more than two times more likely than Caucasians to receive radiation therapy. Often times, if the tumor is extensive or it is not feasible to completely remove it, radiotherapy is initially given to try to shrink the tumor. The study showed fewer African Americans (43%) opted for surgery than Caucasians (49%). • The tumor tissue samples also held important clues. African American tumors were six to seven times more likely to present with lymphocytic response, which essentially is an entourage of immune system cells. These cells behave not only as first responders against tumors, but can also produce growth factors (chemicals) that feed tumor growth, such as forming blood vessels. • Compared to Caucasian tumors, African American tumors were almost two times more likely to have loss of the CDKN2A (cyclin-dependent kinase inhibitor 2A) gene and gain of the SCYA3 (small inducible cytokine A3) gene. CDKN2A is important to cell cycle regulation, and the SCYA3 gene product has dual roles of tumor lymph node metastasis and local host defense against tumors in HNSCC.
• “Understanding and accounting for factors contributing to differences in head and neck cancer racial groups will ultimately aid in eliminating disparities and saving more lives from this devastating disease,” says Dr. Worsham.

written by Otolaryngology Conference

A revolutionary surgical technique for treating perforations of the tympanic membrane (eardrum) in children and adults has been developed at the Sainte-Justine University Hospital Centre, an affiliate of the Université de Montreal, by Dr. Issam Saliba. The new technique, which is as effective as traditional surgery and far less expensive, can be performed in 20 minutes at an outpatient clinic during a routine visit to an ENT specialist. The result is a therapeutic treatment that will be much easier for patients and parents, making surgery more readily available and substantially reducing clogged waiting lists.

“In the past five years, I’ve operated on 132 young patients in the outpatient clinic at the Sainte-Justine UHC using this technique, as well as on 286 adults at the University of Montreal Hospital Centre (CHUM) outpatient clinic,” says Dr. Saliba. “Regardless of the size of the perforation, the results are as good as those obtained using traditional techniques, with the incomparable advantage that parents don’t have to lose an entire working day, or 10 days or more off school in the case of children.”

The technique, which Dr. Saliba has designated “HAFGM” (Hyaluronic Acid Fat Graft Myringoplasty), requires only basic materials: a scalpel, forceps, a probe, a small container of hyaluronic acid, a small amount of fat taken from behind the ear and a local anesthetic. The operation, which is performed through the ear canal, allows the body by itself to rebuild the entire tympanic membrane after about two months on average, allowing patients to recover their hearing completely and preventing recurring cases of ear infection (otitis). Because it requires no general anesthetic, operating theatre or hospitalization, the technique makes surgery much more readily available, particularly outside large hospital centres, and at considerably lower cost.

“With the traditional techniques, you have to be on the waiting list for up to a year and a half in order to be operated on. Myringoplasty (reconstruction of the eardrum) using the HAFGM technique reduces waiting times, cost of the procedure and time lost by parents and children. What’s more, it will help clear the backlogs on waiting lists,” Dr. Saliba says.

Perforations of the eardrum
Myringoplasty is surgical procedures to repair the tympanic membrane or eardrum when it has been perforated or punctured as the result of infection, trauma or dislodgement of a myringotomy tube (also known as a pressure equalization tube). Surgical repair of the perforation will allow the patient to recover his or her hearing and prevent repeated ear infections, particularly after swimming or shower. Traditionally, these procedures are performed using what are known as overlay and underlay techniques, which require hospitalization for at least one day, and 10 to 15 days off work. Every year in Quebec, some 750 myringoplasties are performed on adult or child patients.

Details of the study
This world premiere of a new form of eardrum surgery is based on results of a four-year prospective cohort study of 208 children and adolescents, 73 of whom were treated using the new HAFGM technique. This study was published on December 16, 2011 in the scientific journal Archives of Otolaryngology — Head and Neck Surgery by Dr. Issam Saliba, otolaryngologist (ear, nose and throat or ENT specialist), surgeon and researcher at the Sainte-Justine University Hospital Centre affiliated with the Université de Montréal, where he is also professor of otology and neuro-otology. Dr. Saliba is also a surgeon and researcher at the CHUM, where he conducted a similar study, applying the same HAFGM technique to cohorts of adult patients between 2007 and 2010, with publication in the August 20, 2008 issue of the scientific journal Clinical Otolaryngology and subsequently in the February 12, 2011 issue of The Laryngoscope. The University of Montreal and Sainte-Justine University Hospital Centre are known officially as Université de Montréal and Centre hospitalier universitaire Sainte-Justine, respectively.

written by Otolaryngology Conference

• A primary reason that head and neck cancer treatments fail is the tumor cells become resistant to chemotherapy drugs. Now, researchers at the University of Michigan Comprehensive Cancer Center have found that a compound derived from the Indian spice curcumin can help cells overcome that resistance.
• When researchers added a curcumin-based compound, called FLLL32, to head and neck cancer cell lines, they were able to cut the dose of the chemotherapy drug cisplatin by four while still killing tumor cells equally as well as the higher dose of cisplatin without FLLL32.
• The study appears this week in the Archives of Otolaryngology — Head and Neck Surgery.
• “This work opens the possibility of using lower, less toxic doses of cisplatin to achieve an equivalent or enhanced tumor kill. Typically, when cells become resistant to cisplatin, we have to give increasingly higher doses. But this drug is so toxic that patients who survive treatment often experience long-term side effects from the treatment,” says senior study author Thomas Carey, Ph.D., professor of otolaryngology and pharmacology at the U-M Medical School and co-director of the Head and Neck Oncology Program at the U-M Comprehensive Cancer Center.
• That tumors become resistant to cisplatin is a major reason why head and neck cancer patients frequently see their cancer return or spread. It also plays a big role in why five-year survival for head and neck cancer has not improved in the past three decades.
• FLLL32 is designed to sensitize cancer cells at a molecular level to the antitumor effects of cisplatin. It targets a key type of protein called STAT3 that is seen at high levels in about 82 percent of head and neck cancers. High levels of STAT3 are linked to problems with normal cell death processes, which allow cancer cells to survive chemotherapy treatment. STAT3 activation has been associated with cisplatin resistance in head and neck cancer.
• Curcumin is known to inhibit STAT3 function, but it is not well-absorbed by the body. FLLL32 was developed by researchers at Ohio State University to be more amenable to use in people. The current study used the compound only in cell lines in the laboratory.
• In the current study, researchers compared varying doses of cisplatin alone with varying doses of cisplatin plus FLLL32 against two sets of head and neck cancer cells: one line that was sensitive to cisplatin and one line that was resistant.
• They found that FLLL32 decreased the activation levels of STAT3, sensitizing both resistant and sensitive tumor cells to cisplatin. Further, lower doses of cisplatin with FLLL32 were equally effective at killing cancer cells as the higher doses of cisplatin alone.
• Separate studies suggest FLLL32 may not be well-absorbed by the body and researchers are developing a next generation compound that they hope improves on that. The U-M team plans to further study this newer compound for its potential as part of head and neck cancer treatment. Clinical trials using this compound are not currently available.

written by Otolaryngology Conference