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Dentistry Striving to Improve Early Detection of Oral Cancer

ShanahanDid you know almost 42,000 Americans will be diagnosed with oral and throat cancers this year, or that oral cancer kills one American every hour and that the five-year survival rate of those diagnosed is only slightly more than 64 percent?

Oral cancer’s incidence rate has increased the last five years in a row. The mortality rate for oral cancer is higher than the rates for cervical cancer (12,200 per year), Hodgkin’s lymphoma, laryngeal cancer, testicular cancer, thyroid cancer and skin cancer.

Forty percent of oral cancers are found in patients who do not present with any of the traditional risk factors or any other significant lifestyle risks. The traditional risks are considered more than 40 years of smoking, using smokeless tobacco (baseball great Tony Gwynn recently died from smokeless tobacco), alcohol and previous history of oral cancer.

The risk in oral cancers outside these traditional causes is increased by HPV (human papilloma virus). This is especially true in the increase we are seeing in patients under the age of 40 who are non-smokers. Oral HPV increases your risk of oral cancer 50 times and any prior infection with HPV increases your risk nine times.

HPV and oral cancer has increased by 225 percent in last three decades when other cancers are decreasing across the board. The symptoms of mouth or throat cancer can include:

• a sore or irritation that doesn’t go away

• red or white patches

• pain, tenderness or numbness in mouth or lips

• a lump, thickening, rough spot, crust or small eroded area

• difficulty chewing, swallowing, speaking or moving your tongue or jaw

• a change in the way your teeth fit together when you close your mouth

When cancer is detected and treated early, treatment-related health problems are reduced.
 During your dental visit, your dentist can talk to you about your health history and examine these areas for signs of mouth and/or throat cancer. The screening will consist of a visual inspection of the mouth and palpation of the jaw and neck. Recent studies have shown that a clinical oral exam alone may not detect and discriminate reliably between different types of changes in tissues that may lead to oral cancer.

Oral cancers are more difficult to detect in early stages despite our best efforts with a clinical oral exam. If found in early stages, the five-year survival rate is 83 percent, which is great. Unfortunately, with cancers found in later stages, the survival rate drops to 34 percent.

Oral cancers are found late because of the lack of a good public awareness campaign and there is not a comprehensive screening program to look for the disease early.

An example of a comprehensive screening program is the Pap smear for cervical cancers. Although it has its issues since its introduction in the 1950s, the incidence of invasive cervical cancer has declined dramatically. Between 1955 and 1992, cervical cancer incidence and death rates have declined in the United States by more than 60 percent.

In dentistry, we have several oral cancer screening devices that have been on the market that have not made significant market penetration for a number of reasons. First is the cost of devices. The devices are expensive and the insurance industry has not embraced the technology and does not cover the expense of the exam with this technology, leaving patients having to pay out of pocket so it is viewed as not needed.

Some of the technologies have had mixed results. Several use messy dyes and have high per patient costs, which have many of my professional colleagues looking for a good answer.

I have been trying numerous types and have not been satisfied with the results. I have finally found a system I have faith in and believe we can implement in our office to the direct benefit of our patients.

OralID is the name of the product. It uses fluorescence technology for a simple, efficient screening tool. The reason we have chosen this system is that we can screen our patients at no cost to the patient. The system has no consumable per use item so each time we screen we do not have to charge our patients for the screening.

After reading the staggering statistics on the progression of oral cancers in the U.S., we decided we want to be part of the progressive solution. We purchased the equipment so we can provide this service to our patients and we needed to eliminate money as a barrier.

If we see an area of concern, we can monitor for two weeks. If it still is a concern, we can send a swipe sample off for analysis to determine if further action is needed. Regular visits to your dentist can improve the chances that any suspicious changes in your oral health will be caught early, at a time when cancer can be treated more easily.

In between visits, it’s important to be aware of the previous signs and symptoms and to see your dentist if they do not disappear after two weeks. I hope to never have to discuss with a patient that he or she has oral cancer, but I hope if I do it’s because we caught it early and we have increased the chances for positive outcomes.

If you would like more information on oral cancer, you can use the American Dental Association’s public portal at ADA.org or visit Oralid.com.

By Bryan J. Shanahan, DDS

Dr. Bryan Shanahan attended NAU and has practiced general dentistry in Flagstaff for more than 20 years. He can be reached at bjshanahan@aol.com.

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