By JoAnn Gurenlian, RDH, PhD
On June 18, 2011, I had the pleasure of offering the continuing education program entitled “Providing Care for Women with Cancer” at the ADHA Annual Session. This course recognizes the unique experiences of women as they face the challenges of cancer care, and emphasizes how oral health professionals can support women undergoing cancer treatment by managing the oral effects of cancer therapy.Currently, there are over 1.5 million individuals diagnosed with cancer and almost 41% of the U.S. population will develop cancer at some point in their lives.(1,2) These figures indicate that oral health professionals will be encountering patients going through cancer therapy in their practice settings. Dentists and dental hygienists need to be part of the oncology team to help address the oral side effects of radiation and chemotherapy.This course highlights cancer information related to ovarian, cervical and breast cancers. Currently, ovarian cancer is the 5th leading cause of death in women ages 35-74.(3) Most individuals with cancer are initially asymptomatic. Signs of ovarian cancer are often mistaken for gastrointestinal disorders leading to delay in detection and treatment. If detected early, the 5 year survival rate is 90%; however, only 20% are found at this stage. If detected at Stage III or higher, the survival rate is as low as 29%.(3)
On June 18, 2011, I had the pleasure of offering the continuing education program entitled “Providing Care for Women with Cancer” at the ADHA Annual Session. This course recognizes the unique experiences of women as they face the challenges of cancer care, and emphasizes how oral health professionals can support women undergoing cancer treatment by managing the oral effects of cancer therapy.Currently, there are over 1.5 million individuals diagnosed with cancer and almost 41% of the U.S. population will develop cancer at some point in their lives.(1,2) These figures indicate that oral health professionals will be encountering patients going through cancer therapy in their practice settings. Dentists and dental hygienists need to be part of the oncology team to help address the oral side effects of radiation and chemotherapy.This course highlights cancer information related to ovarian, cervical and breast cancers. Currently, ovarian cancer is the 5th leading cause of death in women ages 35-74.(3) Most individuals with cancer are initially asymptomatic. Signs of ovarian cancer are often mistaken for gastrointestinal disorders leading to delay in detection and treatment. If detected early, the 5 year survival rate is 90%; however, only 20% are found at this stage. If detected at Stage III or higher, the survival rate is as low as 29%.(3)
New diagnostic tests for ovarian cancer include the Ovarian Pap Test, OVA 1 and CA 125 with blood level protrein HE4. New treatment options being investigated for ovarian cancer include Poly (ADP-ribose) polymerase (PARPs), tumor vaccines, monocolonal antibodies such as farletuzumab and catumaxomab, and consolidation therapy.(4-7) Table I provides a list of clinical trials ongoing related to ovarian cancer.Table I: Clinical Trials related to Ovarian Cancer
For additional trials, visit www.curetoday.com/trialcheck.Cervical cancer in the U.S. is on the rise. It was estimated that 12, 200 women would be diagnosed with cervical cancer and 4,210 would die of this disease in 2010.(2) Part of this increase may be associated with risk factors attributed to HPV infection, lack of regular PAP tests, multiple sexual partners, and failure to use protection during sexual intercourse. Early changes of cervical cancer are asymptomatic.
As the disease progresses, signs may include abnormal vaginal bleeding or discharge, pelvic pain and pain during sexual intercourse. Most early stages of cervical cancer can be treated effectively with in-office procedures such as conization, cryosurgery or LEEP. Cervical cancer can be prevented by using protection during sexual activities, limiting risk behaviors, and being vaccinated against HPV. (8-12)Other than skin cancer, breast cancer is the most common type of cancer in women. More than 207,000 women will have breast cancer and over 54,000 will die from this disease. In addition, the rates of breast cancer in men are rising.(2) Women are advised to perform a monthly self-examination of their breasts and note any changes in how the breasts and nipples look and feel. Early detection has led to a five year survival rate of 89% with most cancers being localized.(2)New research related to breast cancer has focused on prevention, detection, predicting and treating breast cancer through targeted genetic testing, as well as targeted drug therapies.(13-24) For those women who have breast cancer, there is an opportunity for their sisters to participate in longitudinal studies with the National Institutes of Health including the NIEHS Sister Study and the Two Sister Study. For more information about these studies, contact 1-877-4-SISTER or www.sisterstudy.org.Caring for women with ovarian, cervical and breast cancer requires offering additional time and attention in the dental hygiene practice setting to provide education about managing oral side effects of chemotherapy and radiation. Teaching each patient how to perform a daily mouth exam and to look for signs of mucositis, herpetic lesions and fungal infection is an important step in managing these infections quickly and effectively. Patients should be advised to contact the office immediately if they notice any oral problems. In addition, this course offers a protocol for working with individuals undergoing cancer therapy to maintain oral health. For more information about this course, contact [email protected].References
1. American Cancer Society: Cancer Facts & Figures 2010. Atlanta: American Cancer Society, 2010.2. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER website, 2011.3. Altekruse SF, Kosary CL, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2007, National Cancer Institute. Bethesda, MD, seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER website, 2010.4. Fong PC, Boss DS, Yap TA, et al. Inhibition of poly(ADP-ribose) polymerase in tumors from BRCA mutation carriers. N Engl J Med. 2009;361:123-134.5. Heiss MM, Murawa P, Koralewski P, et al. The trifunctional antibody catumaxomab for the treatment of malignant ascites due to epithelial cancer: Results of a prospective randomized phase II/III trial. Int J Cancer. 2010 Apr 27.6. Li J, Dowdy S, Tipton T, Podratz K, Lu WG, Xie X, Jiang SW. HE4 as a biomarker for ovarian and endometrial cancer management. Expert Rev Mol Diagn. 2009 Sep;9(6):555-66.7. Spannuth WA, Sood AK, Coleman RL. Farletuzumab in epithelial ovarian carcinoma. Expert Opin Biol Ther. 2010 Mar;10(3):431-7.8. Ault KA, Future II study group. Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet. 2007 Jun 2;369(9576):1861–1868.9. Lutgens L, van der Zee J, Pijls-Johannesma M, et al. Combined use of hyperthermia and radiation therapy for treating locally advanced cervix carcinoma. Cochrane Database Syst Rev. 2010 Mar 17;3:CD00637710. Monk BJ, Sill MW, Burger RA, Gray HJ, Buekers TE, Roman LD. Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2009 Mar 1;27(7):1069−1074. Epub 2009 Jan 12.11. Monk BJ, Mas Lopez L, Zarba JJ, et al. Phase II, open-label study of pazopanib or lapatinib monotherapy compared with pazopanib plus lapatinib combination therapy in patients with advanced and recurrent cervical cancer. J Clin Oncol. 2010 Aug 1;28(22):3562−3569. Epub 2010 Jul 6.12. Van Pachterbeke C, Bucella D, Rozenberg S, et al. Topical treatment of CIN 2+ by cidofovir: results of a phase II, double-blind, prospective, placebo-controlled study. Gynecol Oncol. 2009 Oct;115(1):69-74. Epub 2009 Aug 3.13. Baselga J, Gelmon KA, Verma S, et al. Phase II trial of pertuzumab and trastuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer that progressed during prior trastuzumab therapy. J Clin Oncol. 2010 Mar 1;28(7):1138-44. Epub 2010 Feb 114. Blackwell KL, Burstein HJ, Storniolo AM, et al. Randomized study of Lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer. J Clin Oncol. 2010 Mar 1;28(7):1124-30. Epub 2010 Feb 1.15. Brenton JD, Carey LA, Ahmed AA, et al. Molecular classification and molecular forecasting of breast cancer: Ready for clinical application? J Clin Oncol. 2005;23:7350–7360.16. Burstein HJ, Sun Y, Dirix LY, et al. Neratinib, an irreversible ErbB receptor tyrosine kinase inhibitor, in patients with advanced ErbB2-positive breast cancer. J Clin Oncol. 2010 Mar 10;28(8):1301-7. Epub 2010 Feb 8.17. Citron ML, Berry DA, Cirrincione C, et al: Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: First report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21:1431–1439, 2003.18. Clarke M, Collins R, Darby S, et al. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 365:1687–1717.19. Coleman RE, Winter MC, Cameron D, et al; AZURE (BIG01/04) Investigators. The effects of adding zoledronic acid to neoadjuvant chemotherapy on tumour response: exploratory evidence for direct anti-tumour activity in breast cancer. Br J Cancer. 2010 Mar 30;102(7):1099-105. Epub 2010 Mar 16.20. Gnant M, Mlineritsch B, Luschin-Ebengreuth G, et al; Austrian Breast and Colorectal Cancer Study Group (ABCSG). Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol. 2008 Sep;9(9):840–849. Epub 2008 Aug 19.21. Goodwin PJ, Ennis M, Pritchard KI, et al. Prognostic Effects of 25-Hydroxyvitamin D Levels in Early Breast Cancer. J Clin Oncol. 2009 May 18.22. Ross J, Hatzis C, Symmans F, et al. Commercialized multigene predictors of clinical outcome for breast cancer. Oncologist. 2008;13:477–493.23. Vogel VG, Costantino JP, Wickerham DL, et al. Update of theNational Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing breast cancer. Cancer Prev Res (PhilaPa). 2010 Jun;3(6):696-706. Epub 2010 Apr 19.24. Winer EP, Carey LA, Dowsett M, Tripathy D. Beyond anatomic staging: Is it time to take a leap into the molecular era? American Society of Clinical Oncology Educational Book. Alexandria, Va: American Society of Clinical Oncology; 2005Organizations and websites
National Ovarian Cancer Coalition (NOCC)[email protected]888-ovarianOvarian Cancer National Alliance[email protected]866-399-6262Gilda Radner Familial Ovarian Cancer RegistryToll-free number: 1-800-OVARIAN (1-800-682-7426) Web site: www.ovariancancer.comNational Cancer Institute (NCI)www.cancer.gov800-4-CANCERNational Center for Complementary and Alternative Medicinewww.nccam.nih.gov866-464-3615National Cervical Cancer Coaltion (NCCC)www.nccconlin.orgNational HPV Cancer Coalition (see NCI above)Susan G. Komen Foundationwww.komen.org877-GOKOMEN or 877-465-6636
1. American Cancer Society: Cancer Facts & Figures 2010. Atlanta: American Cancer Society, 2010.2. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER website, 2011.3. Altekruse SF, Kosary CL, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2007, National Cancer Institute. Bethesda, MD, seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER website, 2010.4. Fong PC, Boss DS, Yap TA, et al. Inhibition of poly(ADP-ribose) polymerase in tumors from BRCA mutation carriers. N Engl J Med. 2009;361:123-134.5. Heiss MM, Murawa P, Koralewski P, et al. The trifunctional antibody catumaxomab for the treatment of malignant ascites due to epithelial cancer: Results of a prospective randomized phase II/III trial. Int J Cancer. 2010 Apr 27.6. Li J, Dowdy S, Tipton T, Podratz K, Lu WG, Xie X, Jiang SW. HE4 as a biomarker for ovarian and endometrial cancer management. Expert Rev Mol Diagn. 2009 Sep;9(6):555-66.7. Spannuth WA, Sood AK, Coleman RL. Farletuzumab in epithelial ovarian carcinoma. Expert Opin Biol Ther. 2010 Mar;10(3):431-7.8. Ault KA, Future II study group. Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet. 2007 Jun 2;369(9576):1861–1868.9. Lutgens L, van der Zee J, Pijls-Johannesma M, et al. Combined use of hyperthermia and radiation therapy for treating locally advanced cervix carcinoma. Cochrane Database Syst Rev. 2010 Mar 17;3:CD00637710. Monk BJ, Sill MW, Burger RA, Gray HJ, Buekers TE, Roman LD. Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2009 Mar 1;27(7):1069−1074. Epub 2009 Jan 12.11. Monk BJ, Mas Lopez L, Zarba JJ, et al. Phase II, open-label study of pazopanib or lapatinib monotherapy compared with pazopanib plus lapatinib combination therapy in patients with advanced and recurrent cervical cancer. J Clin Oncol. 2010 Aug 1;28(22):3562−3569. Epub 2010 Jul 6.12. Van Pachterbeke C, Bucella D, Rozenberg S, et al. Topical treatment of CIN 2+ by cidofovir: results of a phase II, double-blind, prospective, placebo-controlled study. Gynecol Oncol. 2009 Oct;115(1):69-74. Epub 2009 Aug 3.13. Baselga J, Gelmon KA, Verma S, et al. Phase II trial of pertuzumab and trastuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer that progressed during prior trastuzumab therapy. J Clin Oncol. 2010 Mar 1;28(7):1138-44. Epub 2010 Feb 114. Blackwell KL, Burstein HJ, Storniolo AM, et al. Randomized study of Lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer. J Clin Oncol. 2010 Mar 1;28(7):1124-30. Epub 2010 Feb 1.15. Brenton JD, Carey LA, Ahmed AA, et al. Molecular classification and molecular forecasting of breast cancer: Ready for clinical application? J Clin Oncol. 2005;23:7350–7360.16. Burstein HJ, Sun Y, Dirix LY, et al. Neratinib, an irreversible ErbB receptor tyrosine kinase inhibitor, in patients with advanced ErbB2-positive breast cancer. J Clin Oncol. 2010 Mar 10;28(8):1301-7. Epub 2010 Feb 8.17. Citron ML, Berry DA, Cirrincione C, et al: Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: First report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21:1431–1439, 2003.18. Clarke M, Collins R, Darby S, et al. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 365:1687–1717.19. Coleman RE, Winter MC, Cameron D, et al; AZURE (BIG01/04) Investigators. The effects of adding zoledronic acid to neoadjuvant chemotherapy on tumour response: exploratory evidence for direct anti-tumour activity in breast cancer. Br J Cancer. 2010 Mar 30;102(7):1099-105. Epub 2010 Mar 16.20. Gnant M, Mlineritsch B, Luschin-Ebengreuth G, et al; Austrian Breast and Colorectal Cancer Study Group (ABCSG). Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol. 2008 Sep;9(9):840–849. Epub 2008 Aug 19.21. Goodwin PJ, Ennis M, Pritchard KI, et al. Prognostic Effects of 25-Hydroxyvitamin D Levels in Early Breast Cancer. J Clin Oncol. 2009 May 18.22. Ross J, Hatzis C, Symmans F, et al. Commercialized multigene predictors of clinical outcome for breast cancer. Oncologist. 2008;13:477–493.23. Vogel VG, Costantino JP, Wickerham DL, et al. Update of theNational Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing breast cancer. Cancer Prev Res (PhilaPa). 2010 Jun;3(6):696-706. Epub 2010 Apr 19.24. Winer EP, Carey LA, Dowsett M, Tripathy D. Beyond anatomic staging: Is it time to take a leap into the molecular era? American Society of Clinical Oncology Educational Book. Alexandria, Va: American Society of Clinical Oncology; 2005Organizations and websites
National Ovarian Cancer Coalition (NOCC)[email protected]888-ovarianOvarian Cancer National Alliance[email protected]866-399-6262Gilda Radner Familial Ovarian Cancer RegistryToll-free number: 1-800-OVARIAN (1-800-682-7426) Web site: www.ovariancancer.comNational Cancer Institute (NCI)www.cancer.gov800-4-CANCERNational Center for Complementary and Alternative Medicinewww.nccam.nih.gov866-464-3615National Cervical Cancer Coaltion (NCCC)www.nccconlin.orgNational HPV Cancer Coalition (see NCI above)Susan G. Komen Foundationwww.komen.org877-GOKOMEN or 877-465-6636
JoAnn R. Gurenlian, RDH, PhD, is President, Gurenlian & Associates, and President-Elect, International Federation of Dental Hygienists.To read previous articles in RDH eVillage FOCUS from 2011 written by JoAnn Gurenlian, go to articles.
