Author: Lisa Salmon
Most people think of a mouth ulcer as a minor irritation that will disappear in a few days. Normally they’re right. But if the ulcer doesn’t heal and lasts longer than three weeks, it could be a sign of something more sinister: mouth cancer.
Mouth, or oral, cancer, which can affect the lips, tongue, cheeks and throat, is one of the UK’s fastest-growing cancers. In the past decade, incidences have risen by 41% and, of the 5,000 people diagnosed with the disease every year, it kills around 2,000 of them. That’s one every five hours.
About 70% of mouth cancers are detected at a late stage, which dramatically reduces the chances of survival. Yet if the cancer is detected early, more than 90% of people survive.
For that reason, the British Dental Health Foundation (BDHF) has organised Mouth Cancer Action Month. In November, the organisation aims to raise awareness of the condition – which recently struck the film star Michael Douglas – so that people recognise the warning signs and are regularly checked for mouth cancer by their dentist.
Signs include ulcers which haven’t healed after three weeks and lumps, or red or white patches, in the mouth, all of which can be mistaken for something less serious.
In addition, swelling below the neck or chin, pain when chewing or swallowing, or a feeling that you have something in your throat that can’t be swallowed, can also indicate the disease.
If you have any of these symptoms, it’s probably wise to follow the Mouth Cancer Action Month slogan – if in doubt, get checked out.
Dr Nigel Carter, chief executive of the BDHF, explains: “The big problem with mouth cancer is late presentation. That happens in most cases – like Michael Douglas.”
At the point of diagnosis, Douglas’s cancer was a stage four – the most advanced. The actor has reportedly said that his throat had been bothering him for several months before the cancer was eventually diagnosed.
“His chances of survival are minimal, frankly, even though he can afford the best treatment,” warns Carter.
The 65-year-old actor has admitted that his illness was probably caused by a lifetime of drinking and smoking. Tobacco use and drinking alcohol are indeed the prime risk factors for mouth cancers and are connected to around 75% of cases. Even if you’re now an ex-smoker, it could take as long as 20 years after quitting before your risk diminishes.
The historical likelihood of more men using tobacco than women may explain why 50 years ago mouth cancer was five times more common in men than women. Today, it’s only twice as common.
Carter explains: “Social habits changed in the Sixties and Seventies, and we’ve now got more women around that have been smoking and drinking for longer, which is probably why the numbers are increasing.”
In addition, alcohol and tobacco work together to increase mouth cancer risk, so if a person uses both, they increase their chances of developing the condition by up to 30 times.
Overall, oral cancer rates may also be increasing because there’s a larger ethnic minority population in the UK, and some of them chew tobacco, another risk factor.
A poor diet is also a contributory factor, as is HPV (human papillomavirus), which has also been linked to cervical cancer.
The link to HPV may explain why an increasing number of young people are developing mouth cancer, says Carter – although the issue is by no means clear cut.
He asks: “With the whole of that young age group, is the mouth cancer because they smoke and drink – if they do – or is it down to HPV?”
About 25% of mouth cancers in the UK are diagnosed in the under-40 age group, and a quarter of those have no apparent risk factors.
“Research has shown a link between HPV and mouth cancer through oral sex, which helps to explain the increase in mouth cancer cases in young people, particularly among men.”
Experts say HPV could overtake tobacco and alcohol as a major risk factor for mouth cancer within the coming decade.
On a positive note, vaccination against HPV could help protect against mouth cancer, although the UK vaccination programme is currently only for girls and women.
However, dental check-ups, the best way of detecting mouth cancer, are available for everyone – although currently only 50% of people go to the dentist regularly.
BDHF research has found that a quarter of people have never heard of mouth cancer, and less than half can name the risk factors.
“Although there’s a death from mouth cancer every five hours, how do you get people to be self-aware when they don’t even realise they can get cancer in that area?” asks Carter.
“If in doubt, get checked out. In all probability there’s not going to be an issue – but if there is one, you stand a much better chance by catching it early.”
Individuals can make sure they have no signs of the condition by requesting a mouth cancer check-up from their dentist, although many dentists carry out the checks as a routine part of their examination.
One such dentist is Catherine Kershaw, who also offered free mouth cancer checks to non-patients during a previous Mouth Cancer Awareness Week. Her Leeds practice was swamped by demand.
One of Kershaw’s patients died from mouth cancer after not having a dental check-up for three years.
The woman, in her 50s, had noticed a mouth ulcer that wouldn’t heal.
Kershaw says: “It was very obviously mouth cancer – it wasn’t massive, it was just a small ulcer, but you can tell. She had surgery, but three months later she was dead.”
She stresses that if the problem is picked up before a patient complains of symptoms, there’s a 90% chance of them still being alive in five years.
“If they come with symptoms, that likelihood is less than 50%. That’s why it’s best to go to the dentist to get regularly screened, because the dentist, if they’re looking properly, should pick the problem up and your chances of survival are much better.”
“Don’t go to your dentist with a problem – go without one.”