Oral Cancer Recurrence Predicted By Gene Signature

Tuesday, November 1, 2011

Oral Cancer Recurrence Predicted By Gene Signature

Oral Squamous Cell Carcinoma (OSCC) is responsible for nearly a quarter of all head and neck cancers. It is one of the leading causes of cancer death - largely due to the failure of current histological procedures in predicting the recurrence of the disease. New research published in BioMed Central's open access journal BMC Cancer shows that a four-gene signature may accurately predict which patients are at higher risk of OSCC recurrence. 

A team of researchers, including Drs. Patricia Reis and Levi Waldron, and led by Dr Suzanne Kamel-Reid and Dr. Igor Jurisica, from the Ontario Cancer Institute at University Health Network (UHN) Toronto, Canada collected cancerous and noncancerous oral tissue samples from patients with OSCC from Toronto General Hospital at UHN. They then used a meta-analysis of five published microarray studies along with their own microarray analysis to reliably identify 138 genes commonly over-expressed in both OSCC and normal margin tissues. Of these genes, a four-gene signature with the highest predictive risk of recurrence was selected. This signature contained cell invasion related genes MMP1, COL4A1, P4HA2 and THBS2. 

The researchers explained, "Our data suggest that histologically normal surgical resection margins that over-express MMP1, COL4A1, THBS2 and P4HA2 are indicative of an increased risk of recurrence in OSCC. Patients at higher risk of recurrence could potentially benefit from closer disease monitoring and/or adjuvant post-operative radiation treatment, even in the absence of other clinical and histopathological indicators. Our findings may be applied to develop a molecular test, which could be clinically useful to help predict which patients are at a higher risk of local recurrence." 

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Many Dentists Turn Down Children On Medicaid/CHIP

Many Dentists Turn Down Children On Medicaid/CHIP

Dentists in the USA are much more likely to offer an appointment to children with private health insurance than those in the combined Medicaid and Children's Health Insurance Program (CHIP) dental program, researchers reported in the journal Pediatrics.

Joanna Bisgaier, MSW, from the Department of Emergency Medicine, University of Pennsylvania, and team set out to determine what impact insurance status might have on a dentist's willingness to arrange an appointment for a child with a fractured front tooth.

Six researchers, pretending to be mothers of a 10-year-old boy, called asking for an urgent dental appointment. They each made two calls, one four weeks after the other. They called a stratified random selection of dental practices on behalf of their supposed child who was enrolled in the states' combined Medicaid and Children's Health Insurance Program (CHIP) dental program. The other half had private Blue Cross dental cover.

Calls were identical except for details on insurance coverage - Private Blue Cross versus Medicaid/CHIP). The researchers worked out what the probability was for each child in getting an appointment, depending on their dental insurance status.

Below are some highlighted results out of 170 paired calls to 85 dental practices, 41 of them participating in the Medicaid program:

• 36.5% of Medicaid/CHIP beneficiaries got an appointment
• 95.4% of privately insured Blue Cross children got an appointment
• Of the dental practices that were enrolled in the Medicaid program, Medicaid/CHIP beneficiaries were 18.2 times more likely to be turned down for an appointment compared to the Blue Cross children

In an Abstract in the journal, the authors wrote:

"Illinois dentists, including those participating in Medicaid, are less likely to see a child for an urgent dental complaint if the child has public versus private dental coverage. These results have implications for developing policies that improve access to oral health care."

The authors believe the following factors may impact on a Medicaid/CHIP beneficiary's chances of having a dental appointment - less patient compliance, burdensome administrative requirements, lower fees, and a negative attitude towards beneficiaries.

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