Clinical Briefs-By Louis Kuritzky, MD
Clinical Briefs-By Louis Kuritzky, MD
HPV Infection as a Risk Factor for Squamous-Cell Carcinoma of the Head and Neck
Human papillomavirus (hpv) is a well recognized oncogenic substrate for cervical cancer, as well as other anogenital cancers. HPV DNA has been found in some head and neck cancers. In persons with head and neck cancer who do not harbor HPV DNA, it is conceivable that they have suffered previous transient HPV infection that has passed. HPV capsid antigen antibody indicates past HPV infection in the absence of HPV DNA.
Data were obtained from almost 1 million Scandinavians who donated serum samples to serum banks, all of whom were negative for head and neck cancer at the time of their donation. In this population, 292 head and neck carcinomas were ultimately identified.
Because cigarette smoking is a potent risk factor for head and neck cancer, level of smoking was ascertained by measurement of serum cotinine. Smokers were stratified by cotinine levels, which separates those exposed to passive smoke, light-to-moderate smokers, and heavy smokers. Statistical relationships between head and neck cancer and HPV were adjusted for smoking status.
In persons with head and neck cancer, the odds ratio for HPV antibody presence was more than doubled. As has been demonstrated for genital cancer, not all HPV subtypes produce risk; in this trial, HPV-16 was the only subtype associated with increased risk.
Though this study does not prove causation, the relationship is plausible and merits further focus on the role of HPV-16 as a head and neck cancer oncogenic trigger.
Mork J, et al. N Engl J Med. 2001; 344:1125-1131.
Cognitive Behavior Therapy for Chronic Fatigue Syndrome
Chronic fatigue syndrome (cfs) has been characterized as a symptom complex of persistent fatigue, without demonstrable organic cause, of at least 6 months duration. Pharmacologic treatment results have been generally disappointing. Prins and colleagues performed a randomized trial of cognitive behavior therapy (CBT) compared to support groups and placebo in a large population of CFS patients (n = 278). The purpose of the support group comparator was to address criticisms of previous studies that simply providing a supportive attention to the patient might account for the benefit observed with a counseling therapy. Hence, a support group (including a therapist, but without performance of CBT) should provide a plausible clarification of this issue.
CBT and support group sessions were provided as 11-16 brief (1-1.5 hour) encounters over 8 months time; the placebo control group was given no intervention.
At the 8 months conclusion of the trial, CBT produced a statistically significant improvement (over placebo and support group subjects) in Karnofsky performance status, psychological well-being, and quality of life. Persons assigned to the support group fared no better than the placebo group, despite uniformly positive evaluation of the support group experience. One of the most encouraging aspects of this study was that therapists enrolled had not had prior experience in CBT; hence, we may be hopeful that counselors with varying levels of experience may anticipate favorable outcomes when CBT is provided for CFS.
Prins JB, et al. Lancet. 2001;357: 841-847.
Use of Statins and Risk of Fractures
Geranylgeranylpyrophosphate (GGPP) is a protein that exerts control over osteoclast-mediated bone resorption. Statins (ie, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) block production of mevalonic acid, a precursor of GGPP. It has been suggested that currently used osteoporosis treatments like bisphosphonates may have an effect upon bone resorption through GGPP suppression in this same pathway. Recent epidemiologic data have suggested that statins may reduce fracture risk.
van Staa and colleagues studied a large population (n = 81,880) of cases from general practices in the United Kingdom of persons who had sustained a fracture (vertebra, clavicle, humerus, radius, ulna, carpal bone, hip, ankle, or foot), and compared this information with an equal body of age and sex-matched controls. Odds ratios were determined for use of statins vs. non-use of statins and likelihood of fracture.
Regardless of statin dose studied, no difference in odds ratio of fracture between current statin users and non users was discerned. This lack of effect was unaltered by duration of use of statin dose. van Staa et al suggest that the previously reported observational reports of statin-associated reduced fracture rates may have been due to the confounding effects of obesity in these patients.
van Staa TP, et al. JAMA. 2001;285: 1850-1855.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.