THE NEWS THAT CHANGED EVERYTHING
It was Christmas, 2006. I was “just a dentist” with a thriving practice in cosmetic and restorative dentistry. I was proud of the fact that I continued to educate myself on all aspects of smile design since my graduation from New York University (NYU) College of Dentistry, and believed nothing, save raising 2 wonderful children, could be more rewarding. Then I discovered a lump in my neck. Though I, particularly as a dentist, should have known better, I ignored it for 6 months. Eventually, while getting my teeth cleaned by my hygienist, Dee, I mentioned the swelling. I am forever grateful that she insisted (several times) I get it checked. The diagnosis was stage IV squamous cell carcinoma with primary origin at the base of the tongue (per the American Cancer Society statistics, 90% of all oral cancers are squamous cell, with that region being most common). The cancer, I was told, had metastasized from the (4-cm) tumor in the tongue to the (7-cm) tumor in the lymph node. Though I was the guy who could recite all the latest and greatest information on how to improve one’s oral appearance, I discovered, like most folks, I knew very little about my own potentially deadly disease.
So Much We Still Don’t Know
The next 6 months of that year were a blur of surgery, chemotherapy, radiation, and brachytherapy. Thanks to my wonderful team at Beth Israel Hospital in New York City, as well as my team locally, and along with the support of family, friends, and patients, I am still in remission 8 years after my surgery. But, how could this have happened to me, a dentist who had not smoked in 25 years, rarely drank alcohol since my kids were born, regularly exercised, and ate well? I had no genetic predisposition. I was supposed to be the poster child for good health! I did not know, then, that the National Cancer Institute stated the human papillomavirus (HPV) had been the fastest growing risk factor for oral cancer for several years. It continues to hold that distinction. I had the tumors, as well as my blood, tested for HPV; both results were negative. So how did I get oral cancer?
Not only do I not know where my cancer came from, but I also suspect that we miscategorize the origin of squamous cell carcinoma countless times, merely because we see “smoker” on a health history. We assume, possibly erroneously, that’s where the disease came from. The truth is, we really don’t know precisely. That’s why I stand firm on the necessity of screening everyone (older than 16 years), regardless of what their health history form says.
The OrCA Mission to Find Answers
Today, in Oral Cancer Awareness Month 2016, as it has been for the last 8-plus years, my mission, and my passion, has been to raise awareness with regard to oral cancer. Soon after I was diagnosed, and a few months into treatment, I founded the Oral Cancer Awareness Foundation (OrCA) in the hopes that my illness would “have a purpose,” especially considering the perfect storm. I was a stage IV-oral cancer patient/dentist/son of a dentist/speaker, and perhaps only one of only a few in the country with that distinction. Many kind individuals devoted time and money along the way to help with the process. OrCA is a 501(c)(3) nonprofit organization whose purpose is to raise public and professional awareness of oral cancer, as well as to evaluate and introduce associated techniques and devices most currently available to aid in prevention and early detection. Along with our primary goals and objectives, we now include an educational arm geared toward spreading the word among young folks about the dangers of smoking and drinking, as well as potentially contracting HPV—already at almost epidemic proportions.
Someone dies every hour, of every day, in the United States from oral cancer, and more than 40,000 people are diagnosed every year. When caught in the early stages, it is nearly always curable. At stage IV, as in my own case, only one in 5 patients are expected to survive beyond 5 years. I was one of the incredibly lucky ones. The fact that I can speak—miraculous! From my own perspective, it is imperative that every one of our friends, family, and—in particular—our patients knows to demand an oral cancer screening; and, we as dentists should have a moral obligation to provide the means by which we can lower the mortality rate of this disease. Yet, the ADA has stated that more than half of those who regularly see a dentist report they have never had an oral cancer screening. Screening is not painful or time consuming, so why is this number so appallingly low? Because the public doesn’t know to demand it! And, then, there is always the question of whether insurance will pay for it. My personal experience, when offering screenings, is quite interesting. I offered the screening with an adjunctive device for free for years, and got only a 90% acceptance rate. I then started offering the screening for $29 and 99% accepted the procedure. I guess people believe they get what they pay for!
A Promising Future for Much Earlier Detection
There are several methods and devices available for oral cancer screening. For example, there is a relatively new and reasonably priced oral screening light (OralID.com). With this technology, the clinician can even take a picture with a smartphone and share it with another professional (oral surgeon) who does not even need to own the device. Then, if warranted, the patient can be referred to have a biopsy of the lesion (still “the gold standard”). There is no reason why every practice should not have at least one modern screening technology onboard to make it easier to find this deadly killer.
Today, the most promising new and scientifically proven method to determine if a patient is at high risk for oral cancer is a simple and noninvasive “spit test” (SaliMark OSCC [Perirx.com]). This easy-to-perform risk stratification test is designed to make a more informed decision about referral for early biopsy. It costs approximately $200 for the test, but that seems like a very small price to pay compared to the more than $1,000,000 my own treatment cost me and my insurance company. (By the way, that was in only the first year following my diagnosis.)
For those still unable to use the most up-to-date screening techniques, I urge all clinicians to at least do a manual oral cancer screening. When doing this, keep in mind that the majority of oral cancer tumors are at the base of the tongue. A thorough intraoral screening includes grabbing the tongue using gauze and pulling it out just to the point of discomfort, so that one can clearly view the posterior lateral sides and base. If my dentist had done that every 3 months at my hygiene appointments, maybe he would have seen the cancer before it was the size of a super ball and it was stage IV. Imagine what I would have paid to be diagnosed at earlier stage III (with “only” a 50% chance of dying within 5 years)?
Every Dentist Can and Must Lead the Fight
So, where do we go from here? For me, personally, I continue to offer support to individuals who have been diagnosed with oral cancer. I receive communications from patients across the world, and I respond to them all. My greatest joy is speaking to dentists, hygienists, and dental staff members on the importance of oral cancer screening. For OrCA, we continue in our mission to raise awareness of oral cancer. Each year, with the help of caring local donors, we sponsor a music festival to raise awareness. And, in partnership with OrCA, the Dr. Marvin Hamburg Oral Cancer Education Fund (named to honor my dad, who was also a dentist passionate about promoting awareness of the devastating disease that nearly took his son’s life) will launch a national educational platform focused on causes, prevention, and promoting awareness of oral cancer. This fund will also provide a scholarship to a student of our alma mater, the NYU College of Dentistry. OrCA, and the OrCA Army of volunteers, continues the pledge to do our parts. For my peers—and your friends and loved ones—I hope you will continue to educate yourselves on the causes, prevention, and treatment of oral cancer. Much of this information is available on the OrCA website. There, in addition to our own goals and current news regarding oral cancer and related matters, we offer links to several other organizations which we believe are informative and helpful. I urge you to visit 4orca.org.
DENTISTRY IS NOT ONLY ABOUT BEAUTY AND FUNCTION
In 2007, I was especially proud of the many beautiful smiles I had created. While I still enjoy the techniques and creativity of that professional avenue, for a stage IV cancer survivor, it can never again hold a candle to what I now hold dearest in my heart and mind. Let’s face it, creating a beautiful smile is a great service, but awareness, prevention, and early detection of oral squamous cell cancer saves lives. As clinicians, our highest priority should be doing everything possible to save lives.
I am confident that we will begin to take the responsibility to do what is right; to finally begin the work to decrease the death and serious complication rates for oral cancer through implementing regular, thorough, and more advanced early detection screenings.
Dr. Hamburg has been a practicing dentist in the Hudson Valley, NY, region since 1983. He has lectured in many forums, including Tufts Dental School and New York University College of Dentistry, on both cosmetic dentistry and oral cancer. In 2008, after personally being treated for stage IV oral cancer, he formed the nonprofit Oral Cancer Awareness Foundation (OrCA), to raise awareness of this potentially fatal disease. Dr. Hamburg and OrCA have been featured in several dental publications, and in Newsweek magazine. He can be reached via the website hvdentalarts.com.
Disclosure: Dr. Hamburg reports no disclosures.
