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Thursday, May 23, 2013

Heartburn caused by gastric reflux is a risk factor for laryngopharyngeal cancer

Gastric reflux can reach the upper airway, inducing cellular damage in the epithelial lining. This may be a risk factor for development of laryngopharyngeal squamous cell carcinoma although the medical literature is inconclusive. Frequent heartburn caused by gastric reflux was found to increase the risk for development of throat cancer, and over-the-counter antacids medication may provide protection from it, according to a new study  published in the journal of Cancer Epidemiology, Biomarkers and Prevention.
Researchers from Brown University studied heartburn incidence and medication use in 631 patients with squamous cell cancers of the throat and vocal cords who were not heavy smokers or drinkers, matching them with 1,234 healthy controls.
The investigator found that individuals who had reported a history of frequent heartburn were 78% more likely to have cancer than those who did not. Those with frequent heartburn who took antacids reduced their risk for cancer by 41%, compared with those whose heartburn was not treated.
There was no reduced risk among those taking proton pump inhibitors (i. e., Prilosec, Nexium, Prevacid, Aciphex) or histamine H2 receptor antagonists (i.e., Pepcid, Tagamet, Zantac). However, this may be because those who took such medications were likely to have had severe acid reflux, and not because those drugs are ineffective. The authors recommended that further studies are needed to clarify the possible chemopreventive role of antacid use for patients with gastric reflux.

Michael Douglas shares his treatment experiences for throat cancer and its association with sexually transmitted HPV.

Michael Douglas underwent chemotherapy and radiation treatment in 2011 for stage four throat cancer. He described his difficult personal experiences on the road to recovery in a recent interview. Douglas was shaken when he was diagnosed with late-stage cancer in 2010 after it took his physicians nine months to make the diagnosis. In an interview with the Guardian newspaper, Michael Douglas said that the throat cancer he was diagnosed three years ago was associated with HPV human papillomavirus (HPV) which can be transmitted during oral sex. Through this revelation Douglas pushed the disease onto the mind of millions of Americans who may have become concerned about this cancer for the first time. 

His first symptoms were a sore tooth that resembled a dental infection. He was seen by a periodontist and an otolaryngologist who repeatedly gave him antibiotics without any effect on the pain. After the clinicians assured him that he is better he left to an overseas vacation and only upon his return did another physician discover a walnut-size tumor at the base of his tongue. A biopsy of the tumor lead to the diagnosis of a stage-four throat cancer.
Douglas immediately underwent a grueling eight-week program of chemotherapy and radiation. He was able to avoid a feeding tube but still lost 45 pounds in the process. During the radiation treatment, Douglas was too weak to move around, and stayed confined to a sofa at his home. He currently feels rejuvenated with a new lease on life and is be back at work making movies again.

                    Michael Douglas in 2011 while receiving chemotherapy and radiation

The HPV Type 16, is also known to cause cervical cancer in women. Unfortunately there no early oral screening test for HPV such as the Pap test. The lack of a screening test for oral HPV means that a doctor should be seen as soon as symptoms appear: a lump in the neck, a sore throat or ear pain that persists for two weeks.

There are currently no studies showing that vaccines to prevent cervical cancer from HPV Types 16 and 18,  also prevent HPV related oral cancer. However, these vaccines are recommend for boys and young men.

Most head and neck cancers are caused by tobacco and alcohol. The overall number of cancer caused by tobacco and alcohol are decreasing, while those associated with HPV are increasing. The cancer caused by HPV generally occurs near the base of the tongue; a difficult site to see and test.  

A saliva test can detect an oral HPV infection. However it is not very helpful because 85% of individuals may be colonized with a variety of HPV types and less than 1% of individuals with HPV 16 eventually develop throat cancer.

Currently about a quarter of head and neck cancer are caused by HPV and it is associated with 80% of tonsillar cancer. About 25,000 cases a year are diagnosed in the United States, compared with 226,000 lung cancers. However, it is growing in importance as smoking-related oral cancers decline.Patients with  positive cancer associated with HPV have a lower risk of dying compared to those with HPV-negative cancer.

The growing frequency in oral sex may have contributed to the increase in cancer caused by HPV. Men are twice as likely as women to get it, and it is more common among whites than blacks. Straight men are more likely to get the cancer than gay men perhaps because there may be more HPV in vaginal fluid than on the penis.

Michael Douglas visiting Jerusalem for his son's bar-mitzva on May 2014