Tag Archives: cancer screening

Oral Cancer: To Screen or Not to Screen?

April is Oral Cancer Awareness Month, and this year, it’s involved some controversy.

It began with the release of a Consumer Reports article that included oral cancer screening among 8 “to avoid.”

“Most people,” they wrote, “don’t need the test unless they are at high risk, because the cancer is relatively uncommon.”

Not long after, a government task force said “that there is not enough published evidence to recommend for or against screening for oral cancer by primary care professionals.” Though dentists aren’t considered “primary care professionals” in this case, it’s an easy detail to miss.

So is CR right about when they say such testing isn’t necessary?

While it’s true that oral cancer used to be rather rare, with mostly smokers and heavy drinkers being at risk, that’s no longer the case. As we’ve noted before, rates have been skyrocketing, largely due to the human papillomavirus, or HPV. More than 35,000 new cases are diagnosed each year, and the 5 year survival rate is only 50%. Part of the reason for that last statistic is that many oral cancers are detected quite late – which is why dentists have been speaking up more and more about the benefits of early detection.

Unlike many other kinds of cancer screening, a screen for oral cancer is hardly invasive. At minimum, it involves a visual exam that can quickly and easily be done as part of a routine dental exam.

oral_cancer_check

Many also use technology to aid to visual screening. In our office, we have a device called VelScope, which uses a blue excitation light to make healthy areas appear fluorescent and problem areas, dark. This isn’t some extra procedure; once a year, it’s a part of every adult patient’s exam.

Brian Hill, executive director of the Oral Cancer Foundation, nicely sums up the case for screening:

It isn’t an invasive exam, there’s no radiation (no long-term exposure issue), it is painless, it’s usually free, and you’re already sitting in the dentist chair. Why would you not get it?

Indeed.

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The Need to Talk About Oral Cancer

The British Dental Health Foundation recently distributed some interesting UK survey results on oral cancer. Reading their media release, I wondered: Would US survey results be similar?

What they found:

  • 88% of the public would like to be checked for oral cancer at their dental appointments.
  • 89% of dentists check for signs of oral cancer.
  • 68% use tools like VELscope to check for cancer.

More, every dentist surveyed – 100%! – said that they consider it their role to promote oral cancer awareness. And yet the BDHF found that

  • 84% of dentists do not explain the risks and symptoms of mouth cancer to their patients.
  • Almost half – 43% – do not provide oral cancer educational material to patients.

How do you effectively “promote awareness” then?

Earlier this year, I wrote about the sharp increase in oral cancer rates:

Once upon a time, oral cancer was a disease limited largely to tobacco users and heavy drinkers. For all others, the risks were thought to be very low, and the rate of disease remained fairly steady.

And then it started going up. And fast.

How fast?

Between 1974 and 2007, cases of white men with oral cancer shot up by 225%.

At the same time, there was a five fold increase in young adults with oral cancer.

Incidence has especially skyrocketed for women. In 1950, for every 6 men who developed oral cancer, only one woman did. Today, that ratio has narrowed to 2 : 1.

Clearly, oral cancer is something we need to be talking about, dentists and patients alike. So it’s no surprise that the BDHF’s media release about this survey focused so sharply on the need for better communication.

Chief Executive of the Foundation, Dr Nigel Carter…said: “Good communication in healthcare is vital for both the professional and the patient. In dentistry it allows the dentist to explain certain procedures, which can often be very technically-minded. The patient can then come back with any further questions they may have about the treatment, what is involved and what may happen afterwards. If either of these roles is ineffective then it can lead to a failure of communication.”

“Mouth cancer cases are increasing at a phenomenal rate due to choices in lifestyle such as smoking and alcohol. The disease, its symptoms and risk factors need to be discussed honestly and openly more often and there’s no better place to start than at a dental check-up.

“Knowing the risks and learning how to self-examine are key when it comes to the early detection of mouth cancer, where it can dramatically improve survival rates to 90 per cent. Without early detection, half will die – it really is a silent killer.”

If you’re not sure your dentist checks for cancer at your regular appointments, just ask. Ask your dentist to explain the procedures and what he or she looking for. Talk with him or her about any risk factors you may have and preventive steps you can take.

I can’t speak for all dentists, of course, but as a dentist, it’s important to me that you understand what we’re doing and why we’re doing it, as well as what you can do to gain and sustain more optimal oral health in general. After all, dentists are doctors, too – physicians whose specialty involves the teeth and oral cavity. You know how the word “doctor” came about? The English word comes from the Latin word docere, which means “to show, teach or cause to know.”

Teaching is part of our job.

To learn more about key risks and symptoms of oral cancer – as well as why we’re seeing so much more of it these days – see my earlier post, “The Oral Cancer Pandemic & How You Can Keep Yourself Safe.”

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The Oral Cancer Pandemic & How You Can Keep Yourself Safe

Once upon a time, oral cancer was a disease limited largely to tobacco users and heavy drinkers. For all others, the risks were thought to be very low, and the rate of disease remained fairly steady.

And then it started going up. And fast.

How fast?

Between 1974 and 2007, cases of white men with oral cancer shot up by 225%.

At the same time, there was a five fold increase in young adults with oral cancer.

Incidence has especially skyrocketed for women. In 1950, for every 6 men who developed oral cancer, only one woman did. Today, that ratio has narrowed to 2 : 1.

What happened?

HPV – human papilloma virus. This sexually transmitted virus, most known for causing cervical cancer, is now a major cause of oral cancer. Over half of us are at risk for contracting HPV at some point in our lives.

Perhaps you saw the recent episode of Dr. Oz dealing with these issues. If you missed it, you can watch it here – and I highly recommend that you do. He gives an excellent, plain-language overview of the issue, including discussion of warning signs/early symptoms and demonstrations of the different exams your dentist should perform so that if you do develop cancer, it can be caught and treated as early as possible.

As a rule, I screen each of my adult patients for cancer once a year using a tool called VELscope. This technology lets us look beneath the mouth’s soft tissues for lesions and abnormal growths that may indicate beginning oral cancers. VELscope testing is completely non-invasive and painless. We just aim a blue excitation light at the tissues and see how they respond: healthy areas appear fluorescent and problem areas, dark. I’ve used this device in my practice for several years now – not as an “extra” but as an essential.

If VELscope detects a problem, the next thing we do is an oral CDX brush test, which Dr. Oz’s guest dentist describes as a “pap smear for the mouth.” This procedure, too, is non-invasive and painless. We merely use a special brush to take a sample of cells from the problem area(s), save them on a slide and send them to a lab for analysis.

You can see these early detection methods demonstrated in Part 4 and Part 5 of the Dr. Oz video – screening tools that help save lives by letting us find the cancer early enough for effective treatment.

Of course, the best course of action is to prevent the cancer from occurring in the first place. Key things you can do to lower your risk:

  • Be sure your dentist gives you an oral cancer screening at least once a year if not at every visit. If he or she doesn’t – or if you’re not sure – ask for one.
  • Limit alcohol use.
  • If you smoke or chew tobacco, quit. (And if you don’t, don’t start.)
  • Practice safer sex. Always use condoms and/or dental dams, or completely abstain from oral sex.

Also be aware of these warning signs and contact your dentist immediately if you develop one or more of them:

  • A white or red patch in your mouth, or a sore that doesn’t heal within two weeks
  • Sore throat or ear pain, typically on just one side of the head, that doesn’t go away within two weeks
  • A lump in your neck
  • Voice changes or hoarseness that last more than a week

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