Saliva may hold the key to early diagnosis of oral cancer, according to researchers at Baylor University Medical Center at Dallas who hope a new three-year pilot study will lead to better methods of detecting the deadly disease.
Funded by a $200,000 Cancer Prevention and Research Institute of Texas (CPRIT) grant, the metabolomics-based study will compare biomarker levels in the saliva of oral cancer patients, healthy volunteers and those with oral inflammatory diseases. If variances are found, physicians could someday use them for screening and treatment, finding and fighting cancer before symptoms develop.
Currently, routine dental exams often detect oral cancer, but at a late stage, when the five-year survival rate is less than 63 percent.
"When people go to an oral hygienist, they often receive a thorough exam in the oral cavity to make sure there are no growths there," said Teodoro Bottiglieri, PhD, director of the Center of Metabolomics at the Baylor Scott & White Health Institute of Metabolic Disease. He is a co-investigator of this study alongside principal investigator, Yi-Shing Lisa Cheng, DDS, MS, PhD, associate professor of diagnostic sciences with the Texas A&M University Baylor College of Dentistry. "But if they're identifying them at that point, it's already quite advanced. You really don't want to wait until that point because the cancer can be aggressive," Dr. Bottiglieri said.
For this study, researchers will focus on oral squamous cell carcinoma, which comprises more than 90 percent of oral cancers. Previous research has found more than 100 biomarkers that could indicate the disease, but those markers also are present in other dental problems. This study would be the first to distinguish cancer from those common problems, which could help prevent false positives in the future.
"Almost all of the salivary biomarker research focuses on comparing the salivary components in cancer versus non-cancerous patients or healthy controls," Dr. Cheng said. "But they really haven't expanded to individuals who have common oral inflammatory diseases but do not have cancer. Often, inflammation presents when cancer cells are present in the mouth, so we're trying to find the biomarkers that could distinguish between the two."
Researchers will focus on two unique, complementary approaches that both involve mass spectrometry, a technique that precisely identifies metabolites. In a targeted approach, the team will study a panel of specific metabolites and amino acids, including vitamin B9 folate, since women with low folate levels have shown an increased cancer risk. The untargeted approach involves general analysis of over 400 metabolites that the team will map against a library of known compounds.
Each approach could yield valuable insights for both preventing and treating oral cancer.
"If we find metabolic targets, it will be useful as a diagnostic test, but will also give us some information on which part of the metabolism is abnormal," Dr. Bottiglieri said. "And that may lead to a potential target for treatment, so it's a two-fold purpose."
If results prove promising, a saliva-based cancer test could come within the decade—but not before large-scale clinical research to validate the data.
"This really is a pilot study," Dr. Bottiglieri said. "And it will give us information on how best to go forward with a much larger study, because we can do a power analysis to see what the variability and data are like with these metabolites—since a lot of this methodology is very novel. But after a much larger trial, we'd be in a closer point where we would be able to say, 'Yes, we have a good test.'"
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