March 5, 2016 Summary of the I naugural GOCF Advocacy. GOCF Award - - PowerPoint PPT Presentation

March 5, 2016

Summary of the I naugural GOCF…

Advocacy…….

GOCF Award for

• Commitment
• Courage
• Innovation
• Leadership

• Regional variations and

disparities

• Strategies to improve
• utcomes
• Early diagnosis – screening –

clinical assessment

• Biomarkers and prevention
• Partnering with public,

media and governments

Global Oral Cancer Status Regional Disparities

Anil Chaturvedi

• Decline in Oral cancers but increase in OPH in the

USA

• Declining mortality in USA
• I n crease in Alcohol and tobacco consumption in N E

Europe

• Growing problem of areca nut + tobacco in South Asia
• Sub mucous fibrosis is endemic in South Asia
• Lack of Cancer Registries in many resource poor

nations in South and South East Asia

• Lack of expertise in Epidemiology

Understanding Gaps in the Oral cancer Continuum Developing Strategies to improve Outcomes Saman Warnakulasuriya

• The tragedy of late stage presentations
• Alarming lack of public awareness
• Diagnostic delay in primary care, and professional

delay in secondary care

• Regional and National awareness programs –

Are they working ? All nations do not have national programs available

• Commercial sector is central to research
• I mprove awareness and access to care
• Programs in Spain, Argentina, China and USA

To Screen or Not to Screen.. Who, Why, Where and When ? Paul Speight

• The value of currently available screening tests
• Population based screening studies , I ndia and

Japan

• Kerala study a huge effort but a stimulus for

research – showed stage migration but no survival benefit

• Cost effectiveness of screening
• Currently inadequate evidence to support screening
• Need more randomized screening trials to show

efficacy

Clinical Assessment and Emerging Technology for Early Detection Ross Kerr

• Risk assessment of oral lesions
• OPMDs - 2005
• Natural history of OPMDs
• Light based agents
• Cyto pathology & DNA Cytometry
• Morphometrics + Biomarkers
• Telemedicine in O C surveillance

Ross Kerr scale for evaluation of tools for OPMDs

Biomarkers and Chemoprevention Where are we? Miriam Rosin and Silvio Gutkind

• Progression models and biomarkers
• Genome marker based technology (gMART),

LOH,EGFR

• Quantitative pathology
• Opportunities for clinical trials in Asia
• TCGA for pre cancer models
• Statistical validation of Biomarkers and a

collaborative global consortium

• Chemoprevention trials ( Metformin trial )

Oral Caner Heterogeneity

Geographic, Anatomic, Epidemiologic and Genetic

Empowering the Public to Drive Policy Development The role of Media, Govts, and Not for Profit Organizations Pankaj Chaturvedi

• Losing the war on Oral Cancer ????
• Advocacy vs awareness..Advocacy, Advocacy, Advocacy…
• I mpact of advocacy……Euromonitor 2014
• Tobacco sale to minors
• ATA control, Tobacco cessation and visual inspection
• Oral Cancer Foundation initiatives – Awareness
• HANCA… Oral cancer control…. Look into your mouth
• Ben’s story
• Tobacco free kids…
• Social Media and I nternet

Making an impact on Oral Cancer …

Oral Cancer - I ncidence Stage of Disease: Early Advanced Developed Nations: 60 - 70% ~ 30-40% Developing Nations: < 30% > 70 %

Oral Cancer

Cure Rates Stage I – I I 75 – 90 % Stage I I I – I V 35- 50 %

Very little progress in improving survival in advanced stage disease over last few decades, in spite of intensification of treatments

Oral Cancer

Cost of Care Stage I – I I Simple & I nexpensive

with high rewards

Stage I I I – I V Extensive &

Expensive with low rewards

Oral Cancer

I n Early Staged Cancers Genetic Mutations TCGA – Drivers of progression and predictors of high risk of recurrence

Mutational Profiling ( TCGA, whole exome sequencing) may predict the behavior of a treated early staged Oral cancer, and warrant the need for additional

treatment to prevent / reduce the risk of recurrence

This would reduce the mortality in early staged cancers (from 10-25 % ) and improve cure rates, and quality of life

Oral Cancer

I n Advanced Staged Cancers Genetic Mutations TCGA – Drivers of progression

Mutational Profiling may predict the behavior of a treated advanced stage Oral cancer, but, unlikely to alter the mortality risk, since these patients have already received most aggressive treatments. The important step moving forward would be to reduce the incidence of advanced stage disease at presentation, by awareness and early detection, by screening… and to realize stage migration

Oral Cancer

Prevention Risk Factors awareness Governmental legislation Societal commitments Awareness campaigns, Rallies, Media, Movie theatres, T V, Newpapers, Magazines, Public figures, Politicians, Movie stars, I dols,…….

Oral Cancer

Concerted efforts, moving forward

Stage Migration, from advanced to early stage presentation by awareness and Early Diagnosis Gene expression profiling and mutational analysis of early stage tumors for treatment intensification, to prevent / reduce recurrence Efforts at prevention and reduction of incidence by cessation, and banning of known risk factors with increased awareness, and legislation etc..

• Efforts to achieve Stage Migration
• Gene profiling and Treatment

I ntensification

• Prevention

Thank You