Jo-Anne Jones, RDH

53,000 Americans will be diagnosed with oral cancer this year.  Unfortunately, the incidence of oral cancer continues to increase each year. Despite our best efforts through professional channels and public educational campaigns, we are simply not making the inroads in earlier detection of oral cancer as we are with other cancers.  Close to 1/2 of those diagnosed today will not be alive in five years and for the ‘lucky’ ones who do survive life as they knew it has forever changed. Living with permanent disfigurement, the outcomes of heavy head and neck radiation and the daily fear and reality of recurrence are merely a sampling of the altered quality of life that prevails for the oral cancer survivor.    

The optimistic ‘contradiction’ that is often quite confusing is the publication of an improved 5 year survival rate for oral and oropharyngeal (back of the mouth including base of the tongue, tonsils and throat).   For many decades, the survival number at 5 years from diagnosis was about 50% and presently is 57%. The cause of this improved rate is not due to increased or improved screening techniques aiding in earlier discovery or medical discoveries leading to superior treatment outcomes. It is directly correlated to the rapidly increasing incidence of a very common virus causing oral and oropharyngeal cancers that reacts more favorably to treatment modalities resulting in increased survival rates.  This is being referred to as an epidemic in the medical and dental communities.

You may be at risk and not know it!   Even though you are a non-smoker and not a heavy drinker you could be at risk for oral and oropharyngeal cancer.   The culprit…the Human papillomavirus or HPV. HPV is so common that the CDC (Centers for Disease Control) state that almost every sexually active American will have an infection in their lifetime.   Because of the prevalence of the virus, almost every sexually active person is exposed to the cancer-causing strains of the virus as they begin to engage in sexual activity. The greater the number of partners, the greater the risk, however it may be the first sexual partner that initiates contact with a high risk strain.    It is important to note that there are over 200 strains of the Human papillomavirus of which nine have been identified to be cancer causing. HPV-16, a high risk strain, accounts for the vast majority of oral and oropharyngeal HPV-related cancers. It is through a persistent infection with a high risk strain, such as HPV-16 that presents an increased risk for a transformation to malignancy. For most, the virus like the common cold, is dealt with and cleared by a functioning immune system.  

It was predicted that HPV-related oropharyngeal cancer would surpass the leading HPV-related cancer of the cervix by the year 2020.  In fact, HPV-related oropharyngeal cancer surpassed HPV-related cervical cancer in 2015 based on widespread collection of data from national registries throughout the U.S.   

It is also important to note that although HPV-related oral and oropharyngeal cancers are the fastest growing segment, smoking and alcohol related oral cancer still comprise the majority of cases in the oral cavity.   These historic risk factors play a large part and a critical role in elevating risk for oral cancer. Typically these cancers are found in the mouth itself with high risk areas being the palate, tongue and floor of the mouth.   

Early discovery saves lives!  An oral cancer screening exam which includes an examination of the head and neck performed annually by a dental professional is of critical importance.   Lymph nodes in the neck and complete assessment of the inside of the mouth should all be included in the oral cancer screening exam. A visual exam accompanied by palpation of all areas outside and inside the mouth is integral to elevating the opportunity to discover anything abnormal in an earlier stage.   ‘What to Expect from an Oral Cancer Screening Examination’ may be viewed at the following link:

www.dentalhygienecanada.ca/oralcancer

The dilemma that exists though is the fact that oral cancers often start at the basement membrane.  By the time they become visible, the cancer is often in the later stages. In fact, almost 70% of oral cancers are found at the advanced or later stage.  Close proximity to the lymph nodes also makes this a cancer that has an ability to spread faster. Late stage discovery greatly impacts the 5 year survival rates.     The key to saving lives is earliest possible discovery of an abnormal finding. When an abnormal finding is discovered in the early or localized stage, 5 year survival rates are impacted significantly accompanied by an improved quality of life for survivors.

VELscope, the leader in enhanced oral cancer screening assessments uses a safe blue light to see areas beneath the surface in a totally new way that may not have been apparent with white light examination.  That means early discovery of abnormal tissue changes and better outcomes. A VELscope exam follows the head and neck examination and literally takes a couple of minutes to perform. A suspicious area may be simply the result of biting your check or may be indicative of something more serious.  Either way identifying abnormalities in early stages is critical. It is important to have any sore or discolored area of your mouth without an identified possible cause, that does not heal within 14 days, be investigated further or followed up to ensure resolution.

Another important aspect of identifying oral cancer in its earlier stages is the self-examination of your mouth on a monthly basis.   Checking your mouth monthly helps you identify any new or different areas that previously did not exist. The self-examination technique and ‘what to look for’ may be found at www.checkyourmouth.org. The same rules apply…anything abnormal that does not heal within 14 days must be assessed further by a healthcare professional.  Don’t delay.

In summary there is much you can do to improve your opportunities to find oral cancer in its earliest stages.   Find a VELscope practice near you. Simply follow this link and enter your address to find a practice that is dedicated to earliest discovery of oral cancer. Tap into the best that science and technology has to offer and provide yourself with the best possible chance for early discovery of oral cancer. ‘Check Your Mouth’ monthly by doing a self-examination. Be an advocate for your own health. Knowledge is power. Use it!