CLEVELAND - A test being developed at Case Western Reserve University may someday be able to predict if someone will get oral cancer, as well as detect the disease much earlier.
Researchers at CWRU's School of Dental Medicine and University Hospitals Case Medical Center's Department of Otolaryngology are working together on a pilot study to see the test – measuring the amount of naturally occurring antibacterial proteins in the mouth - can be used to more quickly detect head and neck cancer, including oral cancer, the most common type of head and neck cancer.
Ten patients already have been recruited for the study; an additional 50 – perhaps even more - will be enrolled during the yearlong study. Adult patients with questionable lesions will be evaluated.
Researchers will test to see if those lesions are cancerous, and if the cancer is caused by the human papilloma virus, or HPV.
About the study
- For physicians interested in referring a patient, call CWRU at 216-368-3948. Patients interested in making an appointment for an evaluation should call UH at 216-844-5578.
HPV is a sexually transmitted infection; in recent years, researchers have studied the relationship between the increase in head and neck cancer rates and HPV, which is spread through oral sex.
At the center of this study is an antimicrobial protein called human beta-defensin-3 (hBD-3), and its role in the development of HPV and non-HPV associated head and neck cancer.
The notion of hBD-3 being part of a family of proteins was being pursued in the early 2000s by different research groups across the country, who discovered it in different parts of the body.
CWRU researchers discovered it in the oral cavity, in saliva, the lining of the mouth and in pre-cancerous tissues there, said Dr. Aaron Weinberg, associate dean and chair of the Department of Biological Sciences at the dental school.
"It's Mother Nature's own antibiotic," Weinberg said of the protein, which prevents the estimated 700 species of bacteria, as well as viruses and fungi that live in the mouth, from invading the body and causing disease.
"We have ability to kill bacteria when it tries to invade mucosa," he said. "It has the ability to thwart bacteria when we have wounds – when we burn our palate, bite our tongue or our lips.
"They kill the invading organisms; that's why we don't get sick when we bite our tongues," Weinberg said.
While hBD-3 has its good qualities, it also has a hand in the development of head and neck cancer. CWRU researchers recently found that when cancerous (HPV and non-HPV related) and precancerous lesions are present, hBD-2 – another in the family of proteins found in the mouth's lining – disappears, while the levels of hBD-3 increases.
Through saliva samples, an oral rinse and biopsies of questionable lesions, researchers will measure each patient's levels and ratio of hBD-2 and hBD-3; whether HPV-16 (the HPV type most commonly associated with head and neck cancers) is present; and whether the patient has cancer.
Weinberg, the study's lead investigator, is working with Dr. Chad Zender, a head and neck surgeon at UH's Ear, Nose & Throat Institute.
Head and neck cancer patients are getting younger, said Zender, who treats benign and cancerous lesions of the mouth and throat.
"The biggest change is the demographic; it's 40- to 50-year-olds without the traditional risk factors [of smoking and heavy alcohol use]," he said.
A patient will have a mouth sore or a lump in the neck that doesn't go away in a week or two, Zender said. "Their only complaint is, 'I have a lump in my neck.' And they don't have a sore throat or other problems."
The majority of patients with HPV-related cancers, especially of the tonsils and tongue, are successfully treated. In fact, they typically have better health outcomes than patients with non-HPV related cancers in the same area.
"If the test allows us to identify lesions with a higher tendency to be more aggressive and more invasive, we can treat patients earlier in the disease process," Zender said.
The study may expand beyond Cleveland; researchers are opening similar trials at sites in China and Uganda, two countries where the rates of head and neck cancer have climbed.