Men and Women Experience Oral Cancer Pain Differently

Dentistry Today


Men and women alike are victims of today’s increasing rates of oral cancer, though it affects men and women in different ways when it comes to pain, according to the New York University (NYU) College of Dentistry. Postdoctoral fellow Nicole Scheff, PhD, has received a National Institute of Dental and Craniofacial Research grant to investigate whether immune cells in the oral cancer environment contribute to these differences.

“The incidence of oral cancer is increasing, particularly among young people and women. While most patients of both sexes suffer from oral cancer-related severe chronic pain, research conducted at the NYU Oral Cancer Center has demonstrated that women with oral cancer experience more cancer-related pain than men,” said Scheff.

“Complicating matters, the etiology of oral cancer pain is unknown,” said Brian L. Schmidt, DDS, MD, PhD, director of the NYU Oral Cancer Center. “And opioid drugs do not effectively alleviate oral cancer pain. Based on her findings, she hypothesizes that infiltrating neutrophils in the cancer microenvironment contribute to sex difference in oral cancer pain.

Scheff will use the 2-year, $120,000-plus F32 grant to acquire additional training in a clinical setting and to pursue a translational hypothesis with potential for immediate clinical impact. Her study combines components of immunology, cancer biology, and pain neurobiology in a preclinical model of oral squamous cell carcinoma and in human patients. Her research has 2 specific aims:

  • To determine if the relationship between neutrophil infiltration and cancer pain differs by sex in oral cancer patients
  • To determine the impact of neutrophil infiltration on oral cancer pain using a preclinical model of carcinogenesis

Scheff will determine if the patient’s sex affects the relationship between neutrophil count and reported pain score using a pain questionnaire. The study population will include more than 50 tongue cancer patients, with about 25 of each sex. Scheff expects that male patients reporting less pain will have a greater number of infiltrating neutrophils in the cancer microenvironment.

Scheff’s data suggest that increased neutrophil infiltration is responsible for reduced oral cancer pain, though a direct relationship has not yet been demonstrated. Scheff will remove neutrophils from the model during oral cancer development. In the absence of neutrophil infiltration, she will assess oral cancer pain behavior and quantify and categorize inflammation in the tongue cancer environment.

Scheff expects oral cancer pain behavior to increase with the loss of neutrophils. She also predicts that her studies, focused on the roles of immune cells in the cancer environment in males and females, will aid in discovering a sex-specific mechanism of analgesia that has the potential to be exploited to improve pain management for both sexes.

By employing a translational research strategy focused on the neurobiology of oral cancer pain, I expect to gain a better understanding of neuron-immune cell communication in the cancer environment,” Scheff said. “Understanding the biological differences between men and women during cancer progression will improve clinicians’ ability to treat and prevent pain in all people.”

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