April is Oral Cancer Awareness Month, turning the attention of our profession towards this insidious disease. There are many misconceptions and shocking truths surrounding oral cancer today, and every dental professional needs to be aware of them.
One of the first misconceptions is the prevalence of oral cancer. Many consider oral cancer to be somewhat rare. However, about 132 individuals will become victims of an oral cancer diagnosis each day in the U.S. alone, totalling over 48,000 annually. An estimated 9,570 people will die of this cancer this year. Those who survive have to contend with disfigurement due to late stage discovery, severe xerostomia, dietary restrictions, chronic pain, and the threat of recurrence on a day-to-day basis.
Secondly, a huge misconception pervading the public at large is the confidence that non-smokers are not at any inherent risk for oral and/or oropharyngeal cancer. In fact, data supports a 50% decline in the incidence of smoking related oral and oropharyngeal cancer and a 225% increase in HPV (human papillomavirus) related oral and oropharyngeal cancers over the same study timeframe (1984-2004).
HPV increasingly has been shown to be associated with squamous cell cancers of the oropharynx (near the base of the tongue and tonsillar areas). It is estimated that nearly all sexually active men and women will have an HPV infection in their lifetime.
Most of the population will deal with the virus without any significant repercussions. A persistent infection with a high-risk strain such as HPV-16 poses a grave risk, though, of the development of oral and oropharyngeal cancer. Based on the available data, the incidence of HPV-positive oropharyngeal cancers could surpass the leading number of HPV-associated cervical cancers in the U.S. by 2020. The virus is commonly transmitted through sexual activity, namely oral sex.
Another shocking truth is that despite its relative ease in diagnosis compared to other cancer sites in the body, oral cancer is routinely discovered in its later stages. If the cancer is diagnosed at an early stage, the 5-year survival rate is 83%. Only about a third of cases are diagnosed at this earlier stage. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 62%. If the cancer has spread to a distant part of the body, the 5-year survival rate drops to 38%. The most recent Surveillance, Epidemiology, and End Results (SEER) National Cancer Institute Surveillance Research Program illustrates the probability of surviving 5 years following a diagnosis of oral cancer.
With the focus on the escalating rise of the non-traditional oral and oropharyngeal cancer profile, it is imperative that we do not overlook the obvious risk associated with tobacco and alcohol use. Youth trends with smokeless tobacco and the combination of binge consumption of alcohol and tobacco products have all heightened the risk factors related to the development of oral cancer. Also, our dental patient population today is quite culturally diverse, with many patients retaining habits through the immigration process such as the use of betel quid and the areca nut.
Lastly, the myth surrounding the attainment of “false positives” by adjunctive screening devices needs to be addressed. With the continual increase in incidence of oral and oropharyngeal cancers and the prevalence of later stage discovery, it is clear that we are not doing enough.
“On the basis of the available literature, the authors determined that a COE (clinical oral examination) of mucosal lesions generally is not predictive of histologic diagnosis,” reported the Journal of the American Dental Association. “The fact that OSCCs (oral squamous cell carcinomas) often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.”
The Journal of Oral Pathology and Medicine published a study to examine the use of an LED Dental VELscope utilizing direct fluorescence visualization (FV) by dental practitioners as an aid in decision-making during screening for cancer and other oral lesions. Deciding when a patient needs to be referred is a critical and difficult decision. The results of the study involving the screening of 2,404 patients over 11 months supported the conclusion that integrating FV into a process of assessing and reassessing lesions significantly improved this model.
Subsequently, the Journal of the American Medical Association published a study entitled “Fluorescence Visualization-Guided Surgery for Early Stage Oral Cancer” demonstrating a significant reduction in the rate of local recurrence of early-stage squamous cell carcinoma and high-grade precancerous lesions in patients where VELscope tissue FV was used to assist in determining the surgical margin for excision, compared to those patients where conventional methods were used.
“The results of this important clinical study will be of great interest to oral cancer patients and practitioners alike,” commented Dr. David Gane, CEO of LED Dental. “It adds to the growing body of peer reviewed literature that corroborates the use of VELscope as an effective adjunct in oral cancer treatment, while further supporting its use in concert with a comprehensive oral examination to screen for the presence of oral cancers and pre-cancers.”
We know the statistics. Now it is time to beat the odds and sound a call to action for every one of us to perform a head and neck examination including an oral cancer screening on every adult every year. We also must utilize the best tools to elevate the opportunity to discover this disease in its earliest stages. Loupes for magnification and better visual acuity and adjunctive screening tools that show what may not have been visible with a white light examination are the least we can offer to our deserving patients.
If you or a family member were dealing with an undetermined medical condition, would you not want the best that science had to offer for early stage discovery? As the age-old golden rule says, “in everything, then, do unto others as you would have them do to you.”
Jo-Anne Jones is the president of RDH Connection Inc., an educational and clinical training company dedicated to excellence in quality education and team training, and has joined the 2016 Dentistry Today CE Leaders for the sixth consecutive year. She also recently received the Elizabeth Craig Award of Distinction in recognition of her exceptional and ongoing commitment to promoting the dental hygiene profession. In the midst of preparing to present her extensive research on HPV-related oropharyngeal cancer to her national association, she and her family were dealt a crushing blow with a loved one who was diagnosed with late stage HPV-positive tonsillar cancer and lost her life to this disease 16 months later. Jo-Anne proudly partners with the Oral Cancer Foundation in conveying the urgent need for changing the way in which we screen for oral cancer to meet the needs of today’s population. She can be reached at jjones@jo-annejones.com.
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