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'Fundamental' findings in oral cancer prediction
24th Feb 2010
Dr Kalu Ogbureke. Photo by Medical College of Georgia
The presence of certain proteins in pre-malignant oral lesions may predict oral cancer development, a new study reveals.
The findings, which help eliminate the guesswork in some cases, 'are fundamental," according to lead author of the study, oral and maxillofacial pathologist Dr Kalu Ogbureke.
Dr Ogbureke, from the Medical College of Georgia School of Dentistry, explained: ‘Several years ago we discovered that three SIBLINGs – osteopontin, bone sialoprotein and dentin sialophosphoprotein – were expressed at significantly high levels in oral cancers. Following that discovery, we began to research the potential role of SIBLINGs in oral lesions before they become invasive cancers.'
SIBLINGs (Small Integrin-Binding Ligand N-linked Glycoproteins) are a family of five proteins that help mineralise bone but can also spread cancer and have been found in cancers including breast, lung, colon and prostate.
The study, published online this week in the journal Cancer, examined 60 archived surgical biopsies of pre-cancerous lesions sent to MCG for diagnosis and the patients' subsequent health information.
Of the biopsies, 87% were positive for at least one SIBLING protein – which the researchers discovered can be good or bad, depending on the protein.
As an example, they found that the protein – dentin sialophosphoprotein – increases oral cancer risk fourfold, whereas bone sialoprotein significantly decreases the risk.
Dr Ogbureke said: 'The proteins could be used as biomarkers to predict [the potential of a lesion to become cancerous]. That is very significant, because we would then be in a position to modify treatment for the individual patient's need in the near future.'
Pre-cancerous oral lesions, which can develop in the cheek, tongue, gums and floor and roof of the mouth, are risk factors for oral squamous cell carcinoma, which accounts for more than 95% of all oral and pharyngeal cancers.
Treatment so far has been hindered because of clinicians' inability to predict which lesions will become cancerous.
'When we treat these lesions now, there's an implied risk of under- or over-treating patients,' Dr. Ogbureke said. 'For example, should the entire lesion be surgically removed before we know its potential to become cancer, or should we wait and see if it becomes cancer before intervening?'
Further complicating the matter is that the severity of dysplasia, or abnormal cell growth, in a lesion can be totally unrelated to cancer risk. Some mild dysplasias can turn cancerous quickly while certain severe dysplasias can remain harmless indefinitely.
Dr Ogbureke said: 'If we're able to recognise these lesions early and biopsy them to determine their SIBLING profile, then oral cancer could be preventable and treatable very early.'
He now plans to design a multi-centre study that incorporates oral cancer risk factors, such as smoking and alcohol consumption, to further investigate their relationship with SIBLING protein expression.
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