According to the World Health Organization, there are more than 529,000 new cases of oral (lip, oral cavity, and pharynx) cancer each year worldwide, with mortality rates reaching up to 292,000 deaths each year.1 In the United States, more than 48,000 individuals will be diagnosed with oral cancer this year with more than 9,500 deaths resulting from this disease, killing roughly one person per hour, 24 hours per day.2
Historically the death rate associated with this cancer is particularly high due to late-stage diagnosis and intervention. Currently, the vast majority of patients with oral cancer are detected through a visual exam and/or are symptomatic, at which point they are likely late stage. As a result, oral cancer often goes undetected to the point of metastasizing. Early diagnosis of oral cancer results in a cure rate of up to 90%.3
While all adults should be screened for oral cancer annually, those who smoke or use smokeless tobacco and/or consume alcohol excessively are at a higher risk for the disease. Another risk factor is exposure to certain types of human papillomavirus (HPV), a common sexually transmitted virus that is contributing to a rise in oral cancer among young adults.
A recent consumer survey on oral cancer showed that while only about a third of those surveyed recall being screened for oral cancer at their last dental checkup, a large majority would like to be screened at every checkup and would like their dental professional to use simple screening tools to assess their risk.
Current Screening Approach
The current standard for screening for oral cancer is a visual/manual oral examination given by the dental or medical professional as part of the annual checkup. This head and neck examination entails bimanual palpation of various external areas of:
- The head and neck including the lower jaw, neck, glands, and lymph nodes of this area;
- The oral cavity including the tongue, cheeks, floor and roof of the mouth, lips, and back of the throat.
During this examination, screeners look for clinical features of oral lesions that might raise suspicion of potential malignancy, including sharp or distinct margins, a red component (color variation), a non-homogenous white component (surface irregularity), persistent ulceration, and size larger than 1 centimeter. The clinician also should view with suspicion any persistent or progressive lesion of the ventrolateral tongue or the floor of the mouth. If any of these types of areas are present, the exam is followed up with a biopsy for any suspicious lesions.
Although the oral cavity is easily accessible for examination and evaluation, the ability to identify this disease in its earliest stages can be very difficult, as early-stage lesions may often be asymptomatic or mimic other conditions, whereas other lesions may not be readily evident in routine examination. Finding the disease in its earliest stages with this screening method therefore is not easy and has often eluded the medical and dental professions.
While there are several types of adjunctive tools that have attempted to address earlier intervention, to date they have all fallen short of making a significant dent in oral cancer mortality rates.
Light-based system options include spectroscopic and chemiluminescent (light-based aid requiring the use of acid or dye). This type of evaluation requires extensive training; it is labor intensive and time consuming for the dentist or dental professional. There is also an available saliva-based test for use when a lesion has already been detected. However, that test misses the opportunity to test prior to a lesion appearing and does not test for specific tumor-initiating stem cell-associated biomarkers.
Today, there are some innovative new tools being introduced that show promise for earlier detection for oral cancer.
One of these is a new test based on technology that measures an unprecedented combination of CD44 and total protein levels, markers clinically validated to be associated specifically with oral cancer, to aid clinicians in the early detection and intervention of oral cancer by assisting in clinical decision-making. This new, promising technology, which uses a combination of CD44 and total protein, makes it easy for dental professionals to incorporate stem cell-associated biomarker information into clinical practice.
This oral rinse-based test is simple for the dentist or dental professional to administer, as well as for the patient to use. Patients swish and gargle an oral solution in their mouth for 10 seconds, the sample is collected in the specimen cup, and then a test cassette is inserted into the specimen cup. Results can be read on the test cassette at 20 minutes.
Conclusion
It is of the utmost importance for dentists and dental professionals to become educated on the proper methods for oral cancer screening. To help save lives, they should also be encouraging their patients to get screened regularly, especially if they are at higher risk. In addition, new technology based on a stem cell-associated biomarker may assist clinical decision-making, thus aiding in the early detection and intervention of oral cancer.
References
1 Oral Cancer Foundation – August 2016 and American Cancer Society Facts and Figures 2016
2 WHO 2014 – 2015 World Cancer Report
3 Pereira LH, Reis IM, Reategui EP, Gordon C, Saint-Victor S, Duncan R, Gomez C, Bayers S, Fisher P, Perez A, Goodwin WJ, Hu JJ, Franzmann EJ. Risk Stratification System for Oral Cancer Screening. Cancer Prev Res (Phila). 2016 Jun;9(6):445-55.
Elizabeth Franzmann, MD, serves as the scientific founder and chief scientific officer of Vigilant Biosciences. In addition to her clinical research activities, she is the director of head and neck research at the Sylvester Comprehensive Cancer Center, part of UHealth – the University of Miami Health System. Also, she is certified by the American Board of Otolaryngology specializing in otolaryngology and head and neck surgery as an associate professor of otolaryngology at the University of Miami Miller School of Medicine. She received her bachelor of science and doctorate of medicine at the University of California, Los Angeles. The University of Miami and Dr. Franzmann hold intellectual property (IP) used in the study and have the potential for financial benefit from its future commercialization. Dr. Franzmann also is an equity holder in Vigilant Biosciences, licensee of the IP used in the study.
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