There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.

Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.

While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.

The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.

An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.

Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.

How tongue tie can affect babies

When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.

Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.

Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.

Where to get advice

If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.

Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.

When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.

Getting a tongue tie assessment

During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.

They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.

Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.

Treatment options

The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.

Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.

If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.

There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.

Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.

We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.

Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health.

Fear of cancer returning is one of the top health concerns. And managing this fear is an important part of cancer treatment.

But how likely is it to get cancer for a second time?

Why can cancer return?

While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms.

This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called metastasis.

Actor Hugh Jackman has gone public about his multiple diagnoses of basal cell carcinoma (a type of skin cancer) over the past decade.

The exact reason why cancer returns differs depending on the cancer type and the treatment received. Research is ongoing to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people.

What are the chances of cancer returning?

The risk of cancer returning differs between cancers, and between sub-types of the same cancer.

New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by 31-68%. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning.

For most types of cancer, the highest risk of cancer returning is within the first three years after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning.

Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed.

What about second, unrelated cancers?

Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) shortly after being treated for breast cancer.

Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one.

Australian research from Queensland and Tasmania shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population.

Who’s at risk of another, unrelated cancer?

With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer.

Reasons for such cancers include different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors.

The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is relatively small when compared with the (sometimes lifesaving) benefits of these treatment and procedures.

While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years.

Similarly, in a large US study only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years).

The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer.

People diagnosed with cancer as a child, adolescent or young adult also have a greater risk of a second, unrelated cancer.

What can I do to lower my risk?

Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment.

Maintenance therapy may be used to reduce the risk of some types of cancer returning. However, despite ongoing research, there are no specific treatments against cancer recurrence or developing a second, unrelated cancer.

But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of cancer returning and getting a second cancer.

Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute and Terry Boyle, Senior Lecturer in Cancer Epidemiology, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.