Does Taking Vitamins Prevent Cancer?

The US Preventive Services Task Force (USPSTF) has the job of weighing the benefits and harms of multivitamins for the primary prevention of cardiovascular disease of cancer.

The Annals of Internal Medicine reports the Kaiser Permanente Center for Health Research reviewed two large trials of 27,658 individuals followed over a ten year period.  No clear evidence of risk or benefit was found in either men or women.

Based on their findings, the USPSTF does not recommend for or against taking vitamins or minerals alone, or in pairs, or as a multivitamin to prevent cardiovascular disease or cancer.

Robert G. Tupac, DDS, FACP, Inc., Diplomat, American Board of Prosthodontics
5060 California Ave., #170
Bakersfield, CA 93309
 (661) 325-1275

New Cancer Study: Gene Sequencing of Infected Mice Mapped

Mice Genetic Mutations Also Found in Human Head and Neck Cancers

I have previously written about how gene research has become one of the major thrusts in the medical treatment of disease entities.

Now, there is a report from the Washington University School of Medicine in St. Louis.  The gene sequencing of mice infected with carcinogen-induced Murine oral squamous cell carcinoma was mapped.  Then the mutations observed and their metastasis signatures were compared with human data sets from 324 patients with the disease.

They found that the genetic mutations present in mouse tumors were also found in human head and neck cancers.  Furthermore, they were able to identify more aggressive tumors with 93% accuracy.

Source:  JADA 8/1/2014, vol, 145, no. 8,  802

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Mouth and Throat Cancer Rates Increasing

The journal Otolaryngology-Head and Neck Surgery has noted an increase in the incidence of oropharyngeal squamous cell carcinoma in patients younger than 45 years over the time period from 1973 to 2009.  In addition, there was an increase, from 28% to 43%, in the proportion of grade III/IV tumors.  Treatment for this type of cancer involves surgery, often in combination with radiation therapy.  As with any cancer, early detection is most important.  For this type of tumor, the five year survival rate is 54%.  The rising incidence is thought to be related to transmission of the human papilloma virus (HPV) and changes in sexual practices.  This is added evidence is support of vaccinating both boys and girls to prevent disease.

Source:  HealthDay News


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

E-cigarettes: What and Why?

An e-cigarette is a battery-powered device which simulates tobacco smoking.  They are touted as a smoke-free, safer, more convenient, and socially acceptable alternative to smoking tobacco cigarettes.  Typically, they use a heating element to vaporize a liquid solution that contains nicotine and flavorings, plus other chemicals and potential toxins.

Their safety is being debated.  The CDC believes that there is enough evidence to say they are less harmful than smoking a pack of conventional cigarettes, but has issued warnings because of the lack of regulation of the ingredients.  E-cigarettes are known to contain cancer-causing agents.

While The New England Journal of Medicine reported that the majority of users treat e-cigarettes as a cessation aid for quitting smoking, the World Health Organization is on record saying that their efficacy to aid in smoking cessation has not been demonstrated scientifically.  Furthermore, because they can be ordered online without age verification, there is concern that they may be a "gateway product" for adolescents.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Pancreatic Cancer Biomarkers Found in Saliva

The Journal of the American Dental Association this month reports a study at UCLA that identified salivary biomarkers for pancreatic cancer.  Dr. David Wong, previously featured in this blog, in the Journal of Biological Chemistry, conducted a study on mice which showed that pancreatic tumor derived molecules are transported from the source of the tumor into saliva as biomarkers.  The importance of the study is that systemic disease can be detected in saliva, which represents a significantly less invasive diagnostic test than previous methods.

Source:  JADA, Jan 1, 2014, vol. 145, p. 20


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Baby Boomers And Cancer

According to the Journal of the American Medical Association, ten thousand baby boomers reach the age of 65 each day in the United States.  It is estimated that the incidence of cancer in this group will increase 67% between 2010 and 2030.

The geriatric population is complicated by age-related physical and psychological changes.  As a result of living longer, they have more involved medical histories.  This population of cancer patients is bound to put a strain on the medical delivery system.

To read an article on possible solutions, see: www.chemotherapyadvisor.com on the care of geriatric cancer patients.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Cigar Smoking and Cancer

Cigarettes vs Cigars

Cigarette smoking causes cancer.  Is it the same for cigar smoking?  Cigars are composed usually of a single type of tobacco, rather than a blend, which is air-cured and fermented.  While a cigarette contains less than one gram of tobacco, a cigar can have up to 20 grams of tobacco.  The National Cancer Institute has established that cigars:

• have a higher level of cancer-causing substances (nitrosamines) than cigarettes
• have more tar, for every gram of tobacco smoked
• have a higher level of toxins, because the wrapper is nonporous and the burning of the tobacco is less complete, resulting in higher concentrations of toxins

Cigars Causes Cancer

Cigars cause cancer of the oral cavity, larynx, esophagus and lung.  It may also cause cancer of the pancreas.  Daily smokers, particularly those who inhale, are at increased risk for developing heart disease.
Even if smoke is not inhaled, high levels of nicotine are absorbed through the lining of the mouth.  Since a single cigar can potentially provide as much nicotine as a pack of cigarettes, cigars are addictive.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Smokeless Tobacco and Cancer

Smokeless tobacco is tobacco that is not burned.  It is available in different forms: chewing tobacco is loose leaves or bricks, and snuff is finely cut or powdered and either loose or in pouches.

Risk of Cancer

Smokeless tobacco contains at least 28 chemicals that have been found to cause cancer.  The level of tobacco-specific nitrosamines, formed during the growing, curing, fermenting and aging of the tobacco, is directly related to the risk of cancer.

The International Agency for Research on Cancer has reported that smokeless tobacco causes oral cancer, esophageal cancer and pancreatic cancer.  Furthermore, it is associated with and may cause heart disease, gum disease and oral lesions other than cancer.

Smokeless Tobacco Is Additive

Smokeless tobacco is also considered addictive because of the amount of nicotine absorbed by the lining of the mouth.  When absorbed through mouth tissues, the nicotine goes directly into the bloodstream and is transported to the brain.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Movember: Tips About Prostate Cancer

Movember is the movement during the month of November that brings awareness to prostate cancer and men's health.  Prostate cancer is the most common cancer in men and the second most common cause of death from cancer.

According to the Centers for Disease Control, in 2010 over 196,000 men in the United States were diagnosed with prostate cancer and 28,560 men in the US died from prostate cancer.  This positive approach can lower a man's risk for the disease:

• a diet high in soy products, vegetables, fish and nuts can help prevent the disease
• being active makes one healthier overall and boosts the immune system and also decreases chances of the disease
• regular, routine examinations by a physician lead to early detection and treatment and increases survival rate

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Radiation Therapy

If you are going to have radiation therapy for cancer of the head or neck, your oral exam play an important part of your therapy.  One month before therapy, there will be an oral health examination  and prophylaxis.  Any necessary dental treatment will be scheduled in consultation with the radiation oncologist.  Present or potential problem teeth in the proposed radiation field will be extracted, allowing at least 14 days of healing for any oral surgical procedure.  To prevent tooth demineralization and radiation decay, custom carrier trays will be fabricated to cover all tooth structures for daily home application of fluoride gel, beginning before the initiation of therapy.  Close attention is paid to keeping your teeth clean, your mouth moist, and watching for any signs of tissue irritation or infection.  Sometimes it is advisable to not wear any removable appliances during this period.  For the  first six months, cleaning can be necessary as often as every 4 to 8 weeks.  Muscle exercises may be useful for painful or weak chewing muscles.  Continued fluoride application for remaining teeth is recommended if dry mouth persists, even if this is a lifelong effort.  Use of dentures or other removable appliances may be limited by the friability of the tissues.  Any tooth extraction or surgery on irradiated bone should be conservative, using antibiotic coverage and possible hyperbaric oxygen therapy.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Oral Cancer Ups Suicide Risk

Cancers combined for men, women, and children continued to decline in the United States between 2004 and 2008, according to the Center for Disease Control and Prevention, as reported in the May 2012 issue of the journal CANCER. 

The overall rate of new cancer diagnoses (or incidence) among men decreased by an average of 0.6% per year between 2004 and 2008; and for women by 0.5% per year from 1998 to 2006, with level rates from 2006 to 2008.  The special feature section highlights the effects of excess weight and lack of physical activity on cancer risk.  Esophageal adenocarcinoma, cancers of the colon and rectum, kidney cancer, pancreatic cancer, endometrial cancer, and breast cancer among postmenopausal women are associated with being overweight or obese.  Several of these cancers also are associated with not being sufficiently physically active.  For more than 30 years, excess weight, insufficient physical activity, and an unhealthy diet have been second only to tobacco as preventable causes of disease and death in the United States.  The journal notes that continued progress against cancer in the United States will require individual and community efforts to promote healthy weight and sufficient physical activity among youth and adults. 


Source:  CDC, March 28, 2012   


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Get Off Your Duff!

Whether you're at work or at home, sitting can be hazardous to your health.  Studies show an increased risk of heart disease, cancer, obesity and metabolic syndrome for those who sit for long periods of time.  In addition, these studies also point out that moderate exercise does not offset the increased risk.

The solution seems to be less sitting and more movement overall.  So, find the ways that you can accomplish that objective by making changes in your daily choices.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Antibiotic Failure in Obese Patients

Obesity rates are rising, and the epidemic is associated with increased rates of heart disease, certain cancers, and diabetes.  Obese patients have higher rates of infection and therefore more frequent use of antibacterial medications.

Antibiotic Failure

A recent study in Pharmacoepidemiol Drug Saf analyzed 6,179 patients to see if obese patients had higher rates of antibiotic failure than non-obese patients.  The authors took several factors into account: BMI category (overweight or obese), comorbidities, lifestyle factors (smoking and drinking), time of year (such as "flu season"), MRSA, history of antibiotic use, age, sex, and income.  They noted "first" the antibiotic prescription as a baseline and subsequent additional or modified antibiotic prescriptions or hospitalizations.
Of the study participants, 828 (13.4%) had an ATF (antibiotic failure) event during the follow-up period, of which 807 (97%) required additional prescriptions or modifications in antibiotic regimens, and 21 (3%) resulted in hospital admissions, readmissions, or death from an infectious cause.

Of the 828 patients who experienced ATF, nearly 64% were either overweight or obese.  Obese patients were significantly more likely than non-obese to have ATF.

For more information, see: www.empr.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Don't You Want The Most Informed Doctor?

Dental Treatment

I am often amazed by how organized medicine's treatment of cancer has become.  Nowadays, tumors are classified into highly specific levels (size, shape, extent, involvement of lymph nodes, etc.).  This detailed information about the diagnosis has been categorized and statistically verified and treatment methods have been researched for every level and correlated with success rates.  The end result is that, if you have cancer, the kind of cancer, its seriousness and the most successful manner in which it can be treated is spelled out.
Cancer treatment got this way because thorough records were kept, methods analyzed statistically and the research was compiled so that the care patients received was based on scientific evidence.  Hence, the term "evidenced-based care".  The dental literature these days is full of articles on evidence-based care for dental treatment--translating research into clinical practice.  

Prosthodontist

All licensed dentists must take a required number of hours of continuing education yearly to maintain licensure.  The requirements for specialists are even greater.  A large part of the additional three years of training of a prosthodontist is a comprehensive review of the literature.  In addition, the thorough and exhaustive examination of the board certification process requires knowledge of not only the past, but also the most current literature, and a minimum of five years of experience in the specialty.  The testing required during the recertification process--keeping board certification up to date--is just as rigorous.  Board Certified specialists have more verified training in concentrated areas to better serve the complicated needs of their patients.  Board Certification assures patients their tailored treatment will follow the roadmap dictated by scientific research.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Cancer Treatment and Recovery Tips

WebMD has a great article on maintaining physical and mental health when dealing with cancer treatment, recovery and retreatment:

1. Make day-to-day health a priority, including taking regularly scheduled medications and some form of daily exercise approved by your physician. 

2. Consult with a dietician because the foods you eat are as important as medication for fuel for body functions. 

3. Attend all follow-up appointments with physicians and take necessary tests. 

4. Listen to your body and report symptoms, including both short and long term side effects of your disease and treatment, to your physician. 

5. Join a support group for an opportunity to meet other survivors with similar life experiences.  

6. Speak with a social worker, or a religious mentor if more support is needed beyond what friends and family provide.  

7. Schedule activities that you enjoy including hobbies, work, and spending time with loved ones.  Living in fear of disease progression will not stop its growth--the energy is more useful if spent living life today as fully as possible. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Understanding Lupus

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood and kidneys.  It is of special interest to me because my wife has the disease, and so do many of my patients.  Here are some facts to help understand the disease:

• it is an autoimmune disease that causes inflammation and tissue damage
• it is chronic and last a lifetime
• it is not contagious--it can't be caught or given away
• it is not like or related to cancer
• it is not like or related to HIV or AIDS
• it can cause a mild skin rash or achy joints, or can effect internal organs
• it is unpredictable, as symptoms can appear, disappear or change
• it can be mild or life-threatening and requires treatment by a physician
• with appropriate medical care, most people with non-organ threatening lupus lead a full life

Source: Lupus Foundation of America

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Men's Cardiovascular Fitness in Middle Age and Cancer Risk

A 20 year study reported at the American Society of Clinical Oncology (ASCO) Annual Meeting documents that cardiovascular fitness in middle-aged and older men is a strong independent predictor of the risk of developing lung and colorectal cancer and is a definite predictor of mortality rates from lung, colorectal and prostate cancer.

The Cooper Center Longitudinal Study followed over 17,000 men and measured their fitness by walking on a treadmill.  The treadmill exercise test was more predictive than body weight.  Significant reduction in cancer risk and cancer mortality rates were noted  with increased fitness level.

For more detailed information, see:  www.chemotherapyadvisor.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Treatment May Never Be Finished--Our Committment To You

Living with uncertainty

Science seeks certainty. The problem in medicine and dentistry is that the body is complex and our knowledge is incomplete. Doctors and patients who want certainty can't be satisfied completely. (deBronkart)  

In my own case, my cancer surgeon says there's a 5% chance my cancer will return, so, while my odds are good, there's no way to predict.  So we live, with uncertainty, because we are human.  

Experience tells me that the more complex the treatment plan is, the greater the chance of complications. This is the essence of informed consent, of answering all questions regarding treatment options before one is chosen. 

Closest to success

Expectations have to be realistic when nature is replaced with prosthetics, be it implants, crowns, veneers, partials or dentures. Both dentist and patient giving their best gets the closest to success, especially when things must be discussed anew when treatment isn't working.  Science keeps pushing toward certainty, but disease doesn't wait. 

Treatment is therefore never finished and is a collaboration of patient and practitioner.  

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Bisphosphonate-Related Osteonecrosis in Cancer Patients

As reported in the American Dental Association Journal, the prevalence of bisphosphonate-related osteonecrosis in patients with cancer could be as high as 13.3%, which is more common than previously thought.  Bisphosphonates are the group of medications commonly used to treat bone weakening in older patients.  An important side effect is the risk, though small, of bone necrosis in sites that are surgically exposed, as in dental extractions or dental implant placement.  The authors examined studies in this area and separated out those with documented follow-up (those in which dental experts participated) and found the rate, in cancer patients, to be 13.3% instead of the previous reported average of 6.1%.  For patients without cancer, the prevalence of BON (bisphosphonate-related osteonecrosis) for patients receiving oral bisphosphonates is 0.10%.  The implications of this new information for the dental practice are: the possibility of deferring oral surgery and considering non-surgical approaches such as root canal therapy, fixed bridgework or removable partial dentures for patients who are receiving antiresorptive therapy.  JADA 2/2012

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Melanoma Survivors Must Remain Vigilant

A new study finds that cancer survivors are at increased risk for cutaneous melanoma, one of the most aggressive forms of skin cancer.  Cutaneous melanoma is the 5th most diagnosed cancer in US men and 7th most commonly diagnosed in women.  Overall incidence is increasing; death rates have decreased little, despite survival gains for other types of cancer.  Ultraviolet radiation exposure is the greatest risk factor for cutaneous melanoma.  Researchers analyzed data from US patients with melanoma as a first primary cancer and patients who were diagnosed with melanoma after surviving a previous cancer.  Among patients age 45 or older at first cancer diagnosis, the risk of developing cutaneous melanoma was much higher among those previously diagnosed with melanoma or other skin cancers, ocular melanoma, breast cancer or lymphoma.  Results suggest the need for continues skin surveillance in melanoma survivors as the risk remains elevated for over 15 years.


Source: Archives of Dermatology

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309