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Saliva versus serum as a diagnostic fluid

The fundamental question to be asked is “Why use saliva when you could just as easily use a blood specimen?” Serum is the gold standard of diagnostic media; however, there are circumstances where saliva has a decided advantage over serum. Compared to serum, saliva has significant diagnostic and logistical advantages as a diagnostic fluid. Saliva is a clear, colorless liquid, while serum may become milky when lipemic, red when blood cells are hemolyzed (due to trauma), and icteric (in the presence of liver disease).6 These color fluctuations alter serum and may affect colorimetric assays, making it difficult to produce a consistent blank. They also may interfere with the true values of the serum assay when compared to the consistent clarity of the assay standards. Since serum possesses more proteins than saliva, assaying trace amounts of factors (for example, oncogenes) may increase the risk of non-specific interference and the chance for hydrostatic (and other) interactions between the factors and the abundant serum proteins.

From a logistical perspective, the collection of saliva is relatively safe (for example, no needle punctures are required), non-invasive, and relatively simple and it may be collected repeatedly without causing the patient discomfort. It does not require specialized training or special on-site equipment and lends itself readily to testing at home or at dental clinics, where individuals are available for periodic oral examinations. This method of diagnosis could reach many individuals who lack access to preventive care, either for personal, logistical, or economical reasons.

Summary

Salivary protein levels have real potential to assist in the diagnosis, treatment, and follow-up care of breast cancer. At present, proteins associated with the EGF pathway appear to be the most promising ones to study; however, none of the putative salivary markers have received FDA approval concerning their sensitivity and specificity or false positive rate among a large population of healthy and diseased individuals. Additionally, there are no current insurance codes to cover the cost of performing such a test. These are barriers that scientists and health care practitioners must overcome.

It is possible that co-operation between dentists and physicians could combine salivary tests with more traditional approaches for verification, resulting in a rapid and reliable diagnosis of breast cancer. Salivary levels of proteins might then be utilized to judge tumor response during treatment. Protein levels might indicate that chemotherapy is not effective against a particular type of cancer.

Salivary tests also could be used to judge success post-treatment. For example, if protein levels do not return to normal after surgery, a physician might recommend chemotherapy.

Finally, regular salivary tests could be prescribed for women who have recovered from breast cancer to ensure that the cancer remains in remission.

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