Cancer Moonshot Takes Aim at Tobacco and HPV-related Cancers

The recently released Cancer Moonshot Task Force report to President Barack Obama outlines strategies for increasing prevention of tobacco- and human papillomavirus (HPV)-related cancers. Citing the high number of tobacco-linked cancer deaths and low utility of the HPV vaccine among adolescents, the Task Force will seek to unite federal agencies and work with local and state governments to increase access to preventative care and services.

The Task Force plans to reduce tobacco-related cancer deaths by increasing access to smoking cessation programs. In 2009, the Massachusetts Tobacco Cessation and Prevention Program reported a 26% decrease in smoking prevalence among Medicaid recipients in just 2.5 years. Taking this program as a model, the Task Force will combat smoking in the Medicaid population by increasing health promotion, counseling, and access to medications and by lowering financial barriers to care. One of the mechanisms by which the Task Force hopes to achieve meaningful declines in smoking is through the Centers for Disease Control and Prevention’s (CDC’s) 6|18 Initiative, which endeavors to reduce the prevalence of 6 high-burden health conditions, including tobacco use, by utilizing 18 evidence-based interventions.

The Task Force also plans to increase uptake of the HPV vaccine through the National HPV Vaccination Roundtable, a continuing partnership between the CDC and the American Cancer Society that began in 2014. The HPV vaccine is primarily targeted to 11 and 12-year-olds. According to the Task Force report, only 42% of girls and less than 30% of boys have receive the vaccine. The Task Force will increase awareness of HPV-related cancers and the benefits of the vaccine among healthcare providers and the public. The Task Force will conduct immunization surveillance and send reminders about the vaccine through the Immunization Information System, a confidential immunizations database run by the CDC.

Current evidence shows decreased oral infection rates by HPV-16, the strain associated with oropharyngeal cancer, in those who receive the HPV vaccine. Studies assessing a cancer preventative effect are not yet available.

The Cancer Moonshot is a $1 billion effort to double the rate of progress of cancer prevention, diagnosis, and treatment. The Moonshot was announced in President Obama’s 2016 State of the Union Address and is led by Vice President Joe Biden. Other strategies outlined in the report center around driving scientific discovery, data sharing, public-private partnerships, multidisciplinary research, and patient-centered care.

National Academies of Science Hosts Workshop on the State of Regenerative Medicine

The Forum on Regenerative Medicine of the Health and Medicine Division (HMD) of the National Academies of Science held a workshop entitled, “State of the Science in the Field of Regenerative, Medicine: Challenges of and Opportunities for Cellular Therapies”. Experts and stakeholders in academic and industry research, patient advocacy, and law and ethics addressed both the promise and challenge of regenerative medicine.

Cell, tissue, and organ damage due to illness, injury, or aging is a growing health concern. Regenerative therapies for craniofacial, neurological, and muscular tissues damaged from tumors or injury could change the course of painful, debilitating, and even fatal diseases. Scientists have made key discoveries, such as cell reprogramming, that have propelled regenerative medicine forward, but formidable scientific, technological, and regulatory hurdles remain.

Lorenz Studer of the Sloan Kettering Institute discussed challenges with verifying cell types, understanding the stages of cell maturation most compatible with transplantation, accurately recapitulating human physiology and pathology in animal models, coaxing cells to adopt a three-dimensional architecture and to communicate with each other and different cell types, and overcoming the persistent threat of host rejection. Furthermore, for these therapies to become commercially viable, researchers will have to overcome manufacturing challenges in scalability, reproducibility, and quality control that will require significant technological advances, workforce training, and financial investments.

A persistent theme through the workshop was the length of time required for significant advances to occur. Studer recounted his two-decade journey in dopamine neuron regeneration for the treatment of Parkinson’s Disease. Ultimately, Studer and colleagues were able to graft the neurons into a mouse model of Parkinson’s Disease and demonstrate symptomatic relief. Anthony Oro of Stanford University described a similar 18-year effort in skin regeneration for the treatment of epidermolysis bullosa, a potentially fatal connective tissue disorder that can result in severe and painful blistering and squamous cell carcinoma. Currently, Oro’s work is in early-phase, proof-of-concept clinical trials.

Pat Furlong, President of Parent Project Muscular Dystrophy, gave a particularly compelling presentation from the perspective of a patient advocate. Furlong integrated current challenges and pitfalls of regenerative therapies in muscular dystrophy with her personal story of losing two sons to the disease. Furlong stressed the importance of exercising caution and restraint when communicating with patients and relatives about therapies still in the experimental stage.

NIDCR houses an active program in tissue engineering and regeneration and director Martha Somerman is a forum member. Furthermore, several AADR members are actively involved in and making significant contributions to regenerative research for periodontal disease, temporomandibular joint disorders, and other diseases of the dental, oral, and craniofacial complexes. AADR staff will continue to monitor and communicate future HMD activities in regenerative medicine.

 

Dental Quality Alliance Seeks Comments on Proposed Performance Measures

The Dental Quality Alliance (DQA) of the American Dental Association is seeking comments on the proposed measures in their interim report entitled, “Testing DQA Adult Dental Quality Measures”, before finalizing these measures in December.  The report outlines oral healthcare performance measures based on claims data for the following:

  • Periodontal Evaluation for Adults with Chronic Periodontitis
  • Ongoing Care in Adults with Chronic Periodontitis
  • Topical Fluoride Application for Adults at Elevated Caries Risk

The Executive Summary provides a helpful and concise table of the proposed measures. A table of descriptions of the codes in the Executive Summary are listed below. It should be noted that the Executive Summary includes other criteria for determining the respective measures. Please send any comments on the proposed measures to Seun Ajiboye at sajiboye@iadr.org by COB on October 20, 2016 to assist AADR in developing a response.

 

Markers for Chronic Periodontitis
Code Description
D4240 Gingival flap (4 or more teeth/quad)
D4241 Gingival flap (1-3 teeth/quad)
D4260 Osseous surgery (4 or more teeth/ quad)
D4261 Osseous surgery (1-3 teeth/quad)
D4341 Scaling and root planing (4 or more teeth/quad)
D4342 Scaling and root planing (1-3 teeth/quad)
D4910 periodontal maintenance

 

Markers for Periodontal Evaluation
Code Description
D0180 comprehensive periodontal evaluation – new or established patient
D0120 periodic oral evaluation – established patient
D0150 comprehensive oral evaluation – new or established patient

 

Markers for Ongoing Care
Code Description
D1110 prophylaxis – adult
D4910 periodontal maintenance
D4341 periodontal scaling and root planing – four or more teeth per quadrant
D4342 periodontal scaling and root planing – one to three teeth per quadrant

 

Markers for Elevated Caries Risk
Code Description
D0602 Caries risk assessment & documentation, with a finding of moderate risk
D0603 Caries risk assessment & documentation, with a finding of high risk

 

Markers for Topical Fluoride Application
Code Description
D1206 topical application of fluoride varnish
D1208 Topical application of fluoride – excluding varnish

AADR Members Accept the Advocacy Challenge

During the summer AADR issued an Advocacy Challenge calling on our members to meet with members of Congress during the summer recess period. Members of Congress need to hear from their constituents about the value and importance of dental, oral and craniofacial research because they will be making critical funding decisions this fall. AADR members Dr. Ben Franklin Warner from the University of Texas Health Science Center at Houston School of Dentistry met with Sen. Cruz (R-TX) staff. Also, dental students Elizabeth Guirado and Adam Parikh from Illinois met with Sen. Durbin’s (D-IL) staff.

Jessica Hart, Deputy Director of the Southeast Region for Senator Ted Cruz (R-TX) met with the University of Texas Health Science Center of Houston School of Dentistry researchers

Jessica Hart, Deputy Director of the Southeast Region for Senator Ted Cruz (R-TX) met with the University of Texas Health Science Center of Houston School of Dentistry researchers

Dr. Warner reported that approximately a dozen members from the University of Texas Health Science Center at Houston School of Dentistry discussed the importance of increased Congressional funding for NIH, NIDCR, and the concern with student debt and the workforce.

“We emphasized that current funding decisions not only have immediate effects, but also have long-range impact on the next generation of researchers, clinicians as well as the health of all Americans. The staff expressed that they were impressed with our research and clinic facilities during the tour of our buildings. They indicated that as a result of our meeting, they became more aware of the importance of dental research,” Dr. Warner stated.

Elizabeth Guirado,  Tran Nguyen, aide for Sen. Durbin (D-IL) and Adam Parikh

Elizabeth Guirado, Tran Nguyen, aide for Sen. Durbin (D-IL) and Adam Parikh

The Illinois dental students also encouraged Sen. Durbin to support funding for NIH and NIDCR. After their meeting, Elizabeth Guirado stated, “Adam and I felt very confident that NIH/NIDCR funding was a priority for Senator Durbin  and his staff.” Meeting with members of Congress in their home state is a critical component of successful advocacy campaigns. AADR applauds our members who responded to the call for action and encourage others to engage in this important activity. For more information about how to be involved please contact the AADR Director of Government Affairs Carolyn Mullen by email at cmullen@aadr.org.