Source: Aspen Dental
April is Oral Cancer Awareness Month. According to Brian Hill, founder and executive director of the Oral Cancer Foundation, as many as 40,000 people in the United States will be told they have oral or pharyngeal cancer in 2012. Some of them may be sitting in your dental chair today. With one person dying of oral cancer every hour of every day, and more than 50% of those diagnosed not living more than 5 years, this is a reminder to screen every patient yourself, and encourage your dental hygiene staff to do the same.
About 100 people are diagnosed with oral cancer every day in the United States. Few people are aware that the death rate for oral cancer is higher than for many other types of cancers, which is because oral cancer often is not discovered until it has reached later stages. This is particularly true for human papilloma virus number 16 (HPV16)-related oral cancer, which occurs most frequently in the posterior areas of the mouth—at the base of the tongue, around the tonsils, and in the oropharynx—where it’s harder to spot without a very thorough exam. To further complicate things, HPV16-related cancer does not always present the tell-tale physical characteristics, including lesions, that are easily distinguished from healthy oral tissues. This is not good news, because HPV16 has reached epidemic levels in the United States: of the 37,000 incidences of oral cancer, about 20,000 (up to 60%) can be linked to HPV, according to Hill.
Oral cancer accounts for 85% of the cancers grouped under “head and neck” cancers. If the number of larynx cancer cases (for which the historic risk factors; tobacco and alcohol are the same) is added to the oral cancer category, we’re now talking 50,000 people diagnosed yearly and 13,500 deaths per year in this country. More than 640,000 new cases occur worldwide annually. These stats do not include brain cancer, which is its own category.
“Late discovery and misdiagnosis are the biggest problems,” Hill says. “I’m a very typical example of this.” Hill was misdiagnosed with an infection by a physician when a painless lump appeared on the side of his neck. When it had not resolved after a course of antibiotics, Hill, who had a background in dentistry, insisted on having a needle aspiration biopsy. Testing resulted in a diagnosis of HPV16-related squamous cell carcinoma, a very deadly cancer. Fourteen years after extensive surgery, and both radiation and chemotherapy, he has since heard from literally thousands of people that they were misdiagnosed more than once, told not to worry about it, or were merely given antibiotics. “Why are so many people diagnosed late?” Hill asks. “Because, according to one study,probably under 20% of dentists are performing oral screenings.” 1 Another problem is that public awareness about oral cancer, its early signs and symptoms, and its changing etiology, is low. Additionally, oral cancer has historically been linked to long-term tobacco use and high alcohol consumption (or a combination of both), with associated lesions usually seen in the anterior areas of the oral cavity. With the prevalence of HPV16-related oral cancer increasing at an alarming rate, and tobacco-related cancers on the decline, it is critical that dental and medical professionals re-educate the public to understand the current risk factors and the need for an annual professional screening.
The Impact of HPV16
It was reported in 2009, before the advent of HPV-related cancers, that oral cancer incidence rates were more than twice as high in men as in women, and both were on the decline.2 That was before HPV-infected individuals became the fastest growing segment of the oral cancer population. HPV16 is a human papillomavirus related to more than 150 other HPV versions, over 40 of which can be easily sexually transmitted.3 Nine of these are known to be cancer causing. HPV’s were directly linked to cervical cancer, also squamous cell carcinoma, which was the number one killer of women in 1948. “Using the cervical cancer model, once ‘opportunistic’ screening and PAP testing became routine, the cervical cancer death rate dropped 71% in 10 years,” Hill notes. “We have no ‘viruscide’. But we do have an HPV vaccine that can be administered before young people become sexually active.” This is important information to share with patients, because 50%-80% of Americans will have HPV in their lifetime according to the Center for Disease Control and Prevention (CDC). About half of all men and more than 3 out of 4 women will be diagnosed with it at some point.4
Detection vs Diagnosis
Signs and symptoms or oral cancer, if there are any, range from a sore area or lesion that bleeds easily, a lump or thickening of tissues in the mouth or neck, ear pain, indurations or hard spots in the mucosa, or a red or white patch or ulceration that does not resolve within 2 weeks. If any of these are evident, the patient should return within 7-14 days to confirm either persistence or resolution. Later symptoms include difficulty chewing, swallowing, and/or moving the tongue or jaws.2
Early stage (1 and 2) lesions, which may not be readily evident during a routine exam, usually are asymptomatic and often mimic other conditions.5 It is important for dentists to acknowledge that malignant and benign lesions are virtually indistinguishable clinically, and their biological relevance cannot be assessed based on their appearance.5 Most resources advise referring any persistent abnormalities to a specialist. “We have a highly defined referral system in dentistry,” Hill points out. “You don’t have to learn anything new; you don’t have to be the expert. You just have to refer suspect tissues up the professional chain for proper evaluation/biopsy. There are many kinds of oral lesions. You may see only 3 cancer cases in 20 years of practicing dentistry, but every time you find something, especially in stage 1 or 2, you have the opportunity to save a life. Dentists are the first line of defense.”
The American Cancer Society estimated in 2009 that almost 90% of oral cancers are squamous cell carcinomas, and more than 97% of these cancers occur in adults 35 years and older.5 People ranging in age from 25-50 who never smoked are the fastest growing group being diagnosed with HPV16-related oral cancer.6
Standard treatment usually involves radiation therapy and surgery, and often chemotherapy.2 Relative survival rates vary by stage at the time of diagnosis—in 2009, about 83% survived 1 year after diagnosis, 60% 5 years after diagnosis, and 49% after 10 years.2 However, today, the 5-year survival rate is only about 57% when you include all stages of the disease at time of discovery. This high death rate is directly tied to late discovery, when treatments are less effective.7 Studies reveal that oral and pharyngeal cancer are diagnosed at a localized stage in only one-third of patients in the United States.5 It’s time to make a difference.
The Oral Cancer Foundation
The Oral Cancer Foundation (OCF) is a national public service, non-profit organization dedicated to oral cancer prevention, education, research, advocacy, and patient support activities. Its website, www.oralcancerfoundation.org, provides vetted information about rates of occurrence, risk factors, signs and symptoms, treatments, current research, complications, nutrition, clinical trials, related news, links to other sources, and treatment institutions. A free, anonymous, 8700-member patient/survivor discussion forum is open to the public, providing insights and inspiration. OCF also has a free RSS oral cancer news feed you may subscribe to which is updated several times a week. OCF is a valuable resource for patients, students, and practicing medical and dental professionals.
Visit oralcancerfoundation.org to learn of its Oral Cancer Awareness Month initiatives (such as hosting a free screening event in April), and find information to share with your patients.
This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.