• 1/22/2008
  • Houston, TX
  • Lynn Cook
  • Houston Chronicle (www.chron.com)

One American dies every hour from oral cancer.

It’s a startling statistic and one the dentist or hygienist might tell you about at your next routine teeth cleaning. That’s because a growing number of dentist offices are asking patients to pay for a special oral cancer screening or sign a waiver acknowledging they refused the test.

At least 100 area dentist offices are offering patients ViziLite Plus, an exam that typically costs $65 and is rarely covered by insurance. And more dentists are signing up for the swish-spit-and-survey tests, said Jeff Mazzarella, vice president of sales and marketing for Zila, the Phoenix-based pharmaceutical company marketing ViziLite.

Tobacco users and heavy drinkers have long been considered the risk pool for cancers of the mouth. But a third cause — human papillomavirus — has emerged recently, said Grady Basler, director of the Dental Oncology Education Program associated with Texas A&M and Baylor universities.

A recent article in the New England Journal of Medicine links sexually transmitted HPV — especially strains 16 and 18 that cause the overwhelming majority of cervical cancers — to oral cancer incidents in young people between 18 and 39.

After years of declining case reports, cancers of the tongue, tonsils, palate and back of the throat are on the rise again.

Data from the American Cancer Society show more than 34,000 new cases in the U.S. in 2007 — up 11 percent from 2006 and 24 percent over five years. Most oral cancers, which tend to show up as white or red patches, are not found until they have reached later stages or even metastasized into the lymph nodes.

Even though oral cancer only accounted for 2 percent of all cancer diagnoses in the U.S. in 2007, its five-year survival rate has hovered around just 55 percent for more than 40 years.

What has changed over the years is the rate of oral cancer in women.

In the 1950s, it was primarily a male disease, with six men affected for every one woman. Lifestyle factors — including an increasing number of female smokers as well as the rise of HPV, the most common sexually transmitted disease — appear to have narrowed that ratio to 2-to-1.

Peggy Kampa, Zila’s director of clinical operations, said ViziLite’s hope is early detection of oral cancer in patients who don’t have symptoms.

Zila will not disclose how many ViziLite kits have been purchased or how much dentists pay wholesale for the test, but the company says 10,000 dentist offices across the country are using it, and revenue is up almost tenfold year over year.

Patients receiving the test rinse their mouths with a solution that is, essentially, vinegar. That solution removes dead tissue, dries out the mouth and makes potentially dangerous lesions stand out when they might not otherwise be visible to the naked eye.

Then the dentist or hygienist dims overhead lights in the office and uses a disposable light wand to look inside the mouth. Problematic patches of skin shine white.

Dr. Nadarajah Vigneswaran, a professor of diagnostic sciences at the University of Texas Dental Branch at Houston, said it’s debatable whether the latest oral cancer screening exams, including ViziLite and MicroLux, another light-based screening technique, are truly helpful to a broad number of patients.

“With less experienced people like public health workers, then yes, I’m sure this could show them something they missed,” he said.

“The mouth, unlike the prostate or the colon, is right there. You can see it. A good clinician should be able to look around the mouth and identify anything that is abnormal. The oral exam is still the gold standard of care.”

“It’s important to distinguish: This is a cancer screening device, not a diagnostic test. Further evaluation through a biopsy is still the only way to be sure there is cancer,” he said.

Houston dentist Dr. Charles Moser started offering ViziLite three weeks ago and estimates three out of four patients accept the screening.

It has not revealed symptoms requiring follow-up in any of about 60 patients Moser has examined.

“It’s easy and it’s affordable, which is the name of the game. By the time we can find oral cancer visually, it’s usually at Stage 3. While you’re still treatable, obviously, early detection is the key,” he said.

ViziLite’s Web site features success stories, such as an account from Atlanta about a 29-year-old male nonsmoker whose early-stage malignancy was detected under ViziLite.

The “patient has since referred five new patients to our office to have this ViziLite screening performed,” the dental practice reported.

The company’s marketing push to dentists includes a script with information to give callers while on hold — “Alarmingly, more than 25 percent of oral cancer victims have no lifestyle risk factors.”

Zila also encourages dentists to ask patients to sign a consent-to-treatment form if they get the test and a waiver if they decline it.

“You get the test the doctor recommends,” Zila’s Mazzarella said. “The consent-waiver form is about providing consistent care.”

The company also tells dentists it is possible the waiver could mitigate some malpractice issues in the event of a lawsuit involving an oral cancer diagnosis.

Andrew Hung of Missouri City said he and his wife didn’t feel like they were getting a hard sell from their dentist, exactly, but they weren’t comfortable paying out of pocket on the spot for an exam they don’t know much about.

“My impression is that if it were legitimately useful, there should be more insurance coverage of it,” he said. “If it’s truly useful then I will, but I’m low-risk. I’m 35. I don’t smoke or use tobacco, and I don’t even drink. I wouldn’t think I’d need it.”