Tag Archives: oral cancer

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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HPV, Oral Cancer & Gum Disease

According to the CDC, more than 36,500 new cases of mouth and throat cancer are diagnosed every year. The 5 year survival rate is only about 50%.

But that rate is a whole lot better in cases where the cancer is detected early. That’s why, in my office, oral cancer screening – using VelScope – is included in every adult patient’s exam at least once a year.

A recent paper underscores why this matters.

Published last month in Head & Neck Oncology, the study confirms that

oral sex with multiple partners is one of the significant risk factors for oral cancer and oropharyngeal cancer. Young people, who increasingly practice oral sex especially with many partners, may be driving the increase in these cancers.

The culprit, as we’ve discussed before, is HPV (human papillomavirus). More known for causing cervical cancer, HPV is also a major cause of oral cancer. In fact, it’s surpassed tobacco as the leading risk factor: While smoking rates have plummetted, oral cancer rates have soared. And that risk increases along with sexual activity. According to the current research,

HPV infection is likely to be sexually acquired with increased risk of oropharyngeal cancer with either many (more than 26) lifetime vaginal-sex partners or six or more lifetime oral-sex partners.

Why is the mouth so vulnerable to HPV transmission?

It must be remembered that the oral cavity is a battlefield of healing mucosal micro abrasions which could in the right circumstances of altered local host defenses allow viral inculcation, infection and entrenchment leading to somatic genetic change. Changes in immuno-tolerance at these “special” immuno-modulating sites…combined with further environmental triggers then lead to cancerous changes. Basically, viral “genes load the gun and environment pulls the trigger.”

So maybe it’s no surprise that earlier research has suggested a connection between gum disease and oral cancer. The initial study found that precancerous lesions were twice as prevalent – and tumors, four times as prevalent – in those with periodontal disease than those with healthy gums. Inflammation appears to be the key factor, as lead author Dr. Mine Tezal recently discussed in an interview with Dr. Bicuspid about her ongoing research:

The results of our recent study suggested an association between chronic local inflammation and tumor HPV status of head and neck cancers. HPV infects only basal cells of the epithelium and gains access through breaks in the mucosa….

In this inflammatory environment, HPV is also shed in greater amounts leading to increased risk of viral transmission. If prospective studies in cancer-free populations confirm that chronic inflammation is a significant factor in the natural history of oral HPV infection, the public health implications would be important.

Thus, another cancer-preventive measure, she suggests, is to control inflammation in the mouth. And she likewise confirms what the Head & Neck Oconology paper showed: frequency of exposure to the virus matters. A lot.

HPV is a commonly transmitted virus and the majority of the infections are cleared rapidly by the immune system without causing disease. Rather than the mere presence of the virus at one time point, its persistence is critical for the development of HPV-related diseases. [emphasis added]

Learn more steps you can take to lower your risk of oral cancer from my earlier post “The Oral Cancer Pandemic & How You Can Keep Yourself Safe.”

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Raspberries, Piercings & Smoking – Oh, My!

So back to blogging, following up on a few older posts with more recent items I ran across during the hiatus…

Nontoxic Oral Cancer Treatments

We’ve looked at causes and early detection of oral cancer, but then what? Well, if a pair of recent studies holds up, we just might wind up treating precancerous lesions with raspberries.

“Part of the biggest clinical challenge,” says Dr. Susan Mallery in DrBicuspid’s report on her work, “is that we cannot currently identify which lesions will progress to oral cancer. Having nontoxic and effective treatment options available would be a great benefit to both patients and healthcare practitioners.”

In a 2010 study in Pharmaceutical Research, Dr. Mallery’s team found that applying a black raspberry gel directly to the lesions kept precancerous cells from becoming cancerous.

Based on the known mechanisms by which berry compounds function at the cellular levels, researchers speculate that the promising gel trial results reflect activation of two related pathways – apoptosis and terminal differentiation – in the premalignant cells. The ultimate benefit is that damaged cells don’t continue to divide and are therefore not retained.

A new study by the team, published in Molecular Pharmaceutics, showed similar efficacy of patch-delivered fenretinide, a synthetic vitamin A compound. The authors suggest that these “chemopreventives” could be used alone or in rotation, though the raspberry gel was enough for many.

“We’re getting a pretty good handle on what enzymes you need and how you metabolize the compounds, which will give a predictive indicator if you’re going to be a good responder to the raspberry gel alone,” Dr. Mallery said.

How Body Piercing Can Go Wrong

A while back, we looked at a few of the problems oral piercings can cause for your teeth and gums – from infection to pushing teeth out of alignment. But there are others.

Last month, the American Journal of Clinical Dermatology published a comprehensive review of “the medical consequences of body piercing.” First, there are those that can crop up regardless of where the piercing is.

Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation.

Then there are “site-specific” problems. Of concern to dentists:

Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal.

What the report doesn’t go into, though, are concerns of biological, holistic or integrative practitioners over punching through acupuncture points and housing metal in the body. These can block and disturb energy along the meridians, which can damage health over time. You can learn more about the issue in this helpful overview.

Smokers Avoid the Dentist

Not long after we looked at why smokers need to kick their habit before getting treatment for gum disease – a disease that affects tobacco-users disproportionately – the CDC released some new and sad data on smokers, dental problems and dental care.

The CDC looked at 2008 survey responses from more than 16,000 adults ages 18 through 64.

More than a third of smokers reported having three or more dental problems, ranging from stained teeth to jaw pain, toothaches or infected gums. That was more than twice as much as people who never smoked.

But 20 percent of the smokers said they had not been to a dentist in at least five years. Only 10 percent of non-smokers and former smokers had stayed away that long, the study found.

Smokers seem to be aware their dental health is worse “but they’re not doing anything about it,” said Robin Cohen, a CDC statistician who co-authored the new report.

Why not?

Half said they couldn’t afford it, which makes sense: Smoking rates are higher among lower income groups, it’s an expensive habit and the amount and type of damage it causes can quickly inflate a dental bill. I suspect fear plays a role, too – fear of The Lecture, as noted before, and fear of finding out just how bad the problems are.

Unfortunately, the avoidance tactic usually ends up costing much more. According to a study in the Journal of Periodontology, patients with gum disease who did without periodontal treatment could only replace 4 teeth before they were spending more than they would have for a lifetime of periodontal care.

A lifetime!

“Feasible”?

Last, a headline – from a story about recent UK debates on the use of mercury amalgam in dentistry:

Well, amalgam fillings are sure as heck not feasible in any term!

Images by Lottery Monkey, jpmatth and Savannah Roberts, via Flickr

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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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Lifestyle Choices Increase Mouth Cancer Risks

New research has shown that young adults are increasing their risks of oral cancer through the lifestyle choices they make.

The number of young people being diagnosed with mouth, throat and food pipe cancer has doubled, and researchers believe this is due to excessive smoking, drinking and unhealthy diets among the young.

These cancers – known as upper aero-digestive tract cancers – are responsible for 10,000 deaths in the UK alone.

Researchers at Aberdeen University conducted a five year study, which examined 350 patients under the age of 50 with UADT cancers and compared the results to 400 people who did not have the disease. It was discovered that nine in 10 of the cancers had been caused by smoking, drinking and a lack of fruit and vegetables in the diet.

Professor Macfarlane, who led the study, said, “Our study aimed to determine whether smoking, alcohol consumption and low fruit and vegetable intake remained the most significant risk factors for UADT cancers in this age group, or whether other ‘novel’ factors, including genetics and infection, could be relatively more important.

“The results of our study further emphasize that the message we need to be communicating to the public remains the same – that smoking, drinking and diet are the major triggers of these diseases at all ages.”

Tobacco is considered to be the leading cause of mouth cancer, and those who drink alcohol and smoke to excess are up to 30 times more likely to develop the condition. Alcohol aids the absorption of tobacco in the mouth, which transforms saliva into a deadly cocktail that damages cells and can turn them cancerous.

Around a third of cases are thought to be linked to an unhealthy diet. Increasing evidence suggests that Omega 3, found in fish and eggs, can help to lower risks, as can high-fiber foods such as nuts, seeds, whole wheat pasta and brown rice.

Another key risk factor for mouth cancer is the Human Papilloma Virus (HPV). US studies have linked more than 20,000 cancer cases to the virus in the last five years. Transmitted via oral sex, people with multiple sexual partners are more at risk. Oral health experts suggest HPV may rival tobacco and alcohol as the most common risk factor.

Mouth cancer is twice more common in men than in women, though an increasing number of women are being diagnosed with the disease. Previously, the disease has been five times more common in men than women. Initial signs of the disease include a non–healing mouth ulcer, a red or white patch in the mouth, or unusual lumps or swelling in the mouth.

 

From a British Dental Health Foundation media release

Image: ndanger/Flickr

 

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