early detection

Global cancer statistics

Corresponding author: Ahmedin Jemal, DVM, PhD, Surveillance Research, American Cancer Society

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

March, 2011|Oral Cancer News|

Expand the search for oral cancer

Dentistry’s responsibilities remain vital in stopping cancer deaths

By: Donna Grzegorek, RDH

Source: RDH magazine

As dental professionals, we have a remarkable opportunity to affect the health and well-being of each patient we treat. This responsibility manifests itself in patients’ expectations, which is to inform them of disease at the earliest possible moment. This is the fifth consecutive year in which there has been an increase in the rate of occurrence of oral cancers; yet, for several decades the mortality rates for this insidious disease remained virtually unchanged. OCF As dental professionals and health-care providers, we have an obligation to be vigilant in our commitment to early detection, raising awareness, and the management of the cancer for which we as a profession are held accountable.

Approximately 37,000 Americans will be diagnosed with oral or pharyngeal cancer this year. This menacing disease will cause 8,000 deaths, killing approximately one person per hour, 24 hours a day. Of these 37,000 newly-diagnosed individuals, only slightly more than half will survive five years. The mortality rate for oral cancer is higher than that of other cancers we hear about routinely such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of the testes, and endocrine system cancers such as thyroid or skin cancer (malignant melanoma). If you expand the definition of oral cancers to include cancer of the larynx, for which the risk factors are indistinguishable, the number of diagnosed cases grows to approximately 50,000 individuals and 13,500 deaths per year in the United States alone. Worldwide, the problem is much greater, with 640,000 new cases being diagnosed each year.

The brutal reality

The death rate associated with oral cancer is particularly high, not because it is hard to discover or diagnose, but because the cancer is routinely discovered late in its development. Often, it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is appreciably worse than when it is caught early in a localized intraoral area. In addition to the metastasis at these later stages, the primary tumor has had time to invade deep into local structures.

Oral cancer is particularly perilous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing secondary tumors. Patients who survive a first encounter with the disease have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for five to 10 years after the first occurrence. There are several types of oral cancers, but approximately 90% are squamous cell carcinomas. According to the Oral Cancer Foundation, it is estimated that approximately $3.2 billion is spent in the United States each year on treatment of head and neck cancers.

Human papilloma virus connection

One of the most common virus groups in the world today affecting the skin and mucosal areas of the body is the human papilloma virus. Over 120 different types/versions of HPV have been identified. Most HPVs of this type are very common, harmless, noncancerous, and easily treatable. There are other forms of HPV, which are sexually transmitted, and some of these are a serious problem. The most common of these are HPV-16, HPV-18, HPV-31, and HPV- 45.

Two types of genital tract HPV in particular, HPV-16 and HPV-18 are known to cause the vast majority of cervical cancers, and recent studies show one of them, HPV-16, to be linked to oral cancer as well. In the oral cavity, HPV-16 manifests itself primarily in the posterior regions such as the base of the tongue, the oropharynx, the tonsils and the tonsillar pillars. These oncogenic versions of HPV are also responsible for other squamous cell carcinomas, particularly the anus and penis.

It has now been established that the pathway that brings people to oral cancer contains at least two distinct etiologies: one through tobacco and alcohol and the other via the HPV virus, particularly HPV-16. In the broadest terms, they can be differentiated into HPV-related cancers and non-HPV positive tumors.

Researchers now feel that HPV positive tumors occur most frequently in a younger group of individuals than tobacco-related malignancies. Tobacco oral cancers occur most frequently in the fifth through seventh decade of life. The HPV positive group is the fastest growing segment of the oral cancer population.

Oral Cancer Foundation takes a strong stand

The Oral Cancer Foundation has taken the following position regarding the HPV connection: “We strongly believe that in a younger population of nonsmoking oral cancer patients, HPV is presenting itself as the dominant causative factor. Since the historic definition of those who need to be screened is now changed by this newly defined HPV etiology, and is no longer valid, it is not possible to definitively know who is at risk for the development of the disease, and who is not.

“Simply stated, today anyone old enough to have engaged in sexual behaviors which are capable of transferring this very ubiquitous virus needs to be screened annually for oral cancer. For this reason we are strong promoters of opportunistic annual screenings to catch this disease at its earliest possible stages, when it is most vulnerable to existing treatment modalities and survival rates are the highest.

“We believe that this will bring the oral cancer death rate down as early detection and diagnosis takes place, and will reduce the treatment associated morbidity to patients who do present with oral cancers.”

Dentistry’s responsibility

Published studies show that currently less than 15% of those who visit a dentist regularly report having had an oral cancer screening. This is unfortunate when you consider that, historically, the greatest strides in combating most cancers have come from increased awareness and aggressive campaigns directed at early detection.

It is commonplace to annually seek a PAP smear for cervical cancer, a mammogram to check for breast cancer, or PSA and digital rectal exams for prostate cancer. These screening efforts have been successful as a result of increased public awareness of the value of catching cancers in their earliest forms, combined with effective technologies for conducting the examinations.

Oral cancer is no different. It may be potentially easier to obtain public compliance for oral cancer screenings, since unlike many other cancer screening procedures, there is no invasive technique necessary to look for it, no discomfort or pain involved, and it is very inexpensive to have one’s mouth examined for the early signs of disease. Creating awareness, discovery, diagnosis, and referral are the primary responsibilities of the dental community.

It is important for both patients and dental professionals to recognize that a visit to the dental office is no longer about a filling, a crown, or a cleaning but is actually a matter of life and death.

Dental examinations that include a comprehensive screening for oral cancer save lives! The most important step in reducing the death rate from oral cancer is early discovery. No other professional is better positioned for early detection or will be held more accountable than members of the dental community.

Foundation supported by dental hygienists

For the past three years, dental hygienists have supported the Oral Cancer Foundation through fund-raising efforts at the RDH Under One Roof conference. The Oral Cancer Foundation is a national public service, nonprofit entity designed to reduce suffering and save lives through prevention, education, research, advocacy, and patient support activities.

Founded by a Stage IV oral cancer survivor, Brian Hill, the foundation’s goals are supported by a scientific advisory board composed of leading cancer authorities from varied medical and dental specialties, drawn from premier cancer treatment, research, and educational institutions in the United States.

The foundation is primarily supported by, and dependent on, donations that are received from private individuals who mostly come from the ranks of survivors, as well as family and friends of those who have had this cancer. The foundation is an IRS registered nonprofit 501(c)3, public service charity designed for advocacy and service, created to promote change through proactive means in both the public and medical/dental professional sectors.

At the forefront of its agenda is the firm establishment in the minds of the American public for the need to undergo an annual oral cancer screening, combined with an outreach to the dental and medical communities to provide this service as a matter of routine practice.

The Oral Cancer Foundation site provides hundreds of pages of information discussing the rates of occurrence, risk factors that lead to oral cancer, signs and symptoms, treatments, current research, complications of treatment, nutrition, related clinical trials, and current oral cancer related news. There is an additional resource page dedicated to links to other sources of vetted information about oral cancer and treatment institutions. The site (www.oralcancerfoundation.org) is updated weekly and provides a plethora of valuable information for the dental professional.

Hill, the founder and executive director, is an excellent resource and is accessible to dental professionals who seek further information regarding his experiences and/or wish to discuss the topic of oral cancer in greater detail (bhill@oralcancerfoundation.org). Hill encourages dental professionals to become members of the foundation and partners with the foundation in their effort to increase the number of annual screenings that are being performed.

Hill states, “Please check the ‘members only’ segment of our Web site, which discusses oral cancer from a practice management perspective, and where you can obtain resources to assist you with the incorporation of a comprehensive cancer screening program to your practice. The dental community is the first line of defense against oral cancer, through the process of early discovery.”

“By regularly screening for oral cancer,” Hill added, “these practices engrain into the public’s mind that a visit to the dentist is about not just cleanings, cosmetics, and crowns, but potentially saving a life. These truly heroic efforts reflect the highest standards of dentistry and a commitment to providing the optimum in not only dental care, but overall health care to patients. Reducing the death rate from oral cancer is tangible, and doable in the immediate future.”

Donna Grzegorek, RDH, has been practicing full-time clinical dental hygiene for 31 years. She is the recipient of several industry recognitions including Discus Dental’s “Hygienist of the Year,” Sunstar America’s “Award of Distinction,” and ADHA’s “Hygienist Hero.” Donna is a published author, speaker, and key opinion leader. She sits on the advisory committee for a salivary diagnostics company, a board member of the American Academy of Dental Hygiene, a member of the International Federation of Dental Hygienists, and a 31-year member of ADHA. She may be contacted at: dgrzegorek@comcast.net.

Global cancer statistics

Source: HighWire, Stanford University

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. OCF Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally. CA Cancer J Clin 2011. � 2011 American Cancer Society, Inc.

February, 2011|Oral Cancer News|

Global cancer statistics

Source: caonline.amcancersoc.org
Authors: Ahmedin Jemal, DVM, PhD et al.

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries.

Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar.

Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

Source: CA Cancer J Clin 2011

February, 2011|Oral Cancer News|

My dog saved my life, says Sunderland man

Source: Sunderland Echo

By: Katy Wheeler

John and Pauline Douglas were devastated when their dog Diesel had to be put down after developing cancer of the neck.

But it was the late bull mastiff’s symptoms which helped John, 39, realise that he too had the disease.

The dad-of-four, of Tunstall Bank, noticed a lump in his neck in February.

And despite the fact he was told by doctors to rule out cancer, John’s experience with Diesel’s disease convinced him something was seriously wrong – and he pushed for further tests.

His instincts were proved correct and John was diagnosed with cancer, which had spread to his neck, in April – just a week before his wedding day to wife Pauline, 41.

John said: “Because of my age, the fact I don’t smoke and because I am a moderate drinker, I was told not to worry about cancer and that it was just an infection.

“But what happened to Diesel set alarm bells ringing.

“He had the same kind of lump in his neck that would swell up and down. We were told his wasn’t cancer to start with and it was only found late on.

“Even though I was told by a specialist that I didn’t fit the criteria for cancer, the doubt was still niggling and I made such a song and dance that more tests were done.”

As a result of John’s persistence, one of his tonsils was removed and a biopsy revealed the cancer, which had spread to his lymph glands.

After six weeks of radiotherapy and chemotherapy, followed by surgery at Sunderland Royal Hospital, John is now getting his life back to normal.

He is back at work for Vauxhall technical support section.

He said: “I am pushing for normality. The cancer took six months off me. I have my good days and I have my bad days, but I visited the hospital today and they say they don’t need to see me for two months. So today is a good day.”

Such is John’s gratitude to five-year-oldDiesel, who was put down in August last year, he even has a tattoo of him on his leg.

“I owe my life to Diesel. If it wasn’t for him I wouldn’t have been so sure something was seriously wrong. I would urge anyone who is concerned about their mouth and neck to get checked out,” he explained.

As part of Mouth Cancer Action Month, John is backing a campaign to raise awareness of the disease.

Events have been held across the region to promote early detection which improves survival chances.

December, 2010|Oral Cancer News|

Late-stage cancer detection in the USA is costing lives

Source: The Lancet

In the USA, cancer is the most common cause of death in people aged between 49 and 80 years. In 2007, 562 875 cancer deaths were reported, which account for about 23% of all deaths. Cancers of the lung, colorectum, breast, and prostate are the most common and have the highest mortalities. In high-income countries remarkable progress has been made in cancer management and care, and although cancer incidence continues to rise, due to the influences of ageing, lifestyle, and population growth, mortality has fallen and survival rates are improving for several cancers, largely because of advances in screening, early detection, and treatment.

So in light of this progress, the US Centers for Disease Control and Prevention (CDC) report published last week makes for troubling reading, showing as it does that almost half of colorectal and cervical cancers and a third of breast cancers are being diagnosed at a late stage when treatment is less effective. The study is the first nationwide examination of stage-specific cancer incidence rates and screening prevalence for breast, cervical, and colorectal cancer by demographics including age and race or ethnic origin. The study found a lower uptake of screening and the presentation of symptoms late in low-income and ethnic minority communities, who also had longer delays in getting their diagnosis and treatment after an abnormal test. All these factors have been well documented to be associated with a late diagnosis for over a decade, so it is disappointing to see that cancer care is still failing the same patient groups. A further finding was the wide variation in late-stage diagnosis across different locations, which is a sad reflection of the fragmented health-care system in the USA. The CDC also reported that people without appropriate health insurance had less access to services despite the Patient Protection and Affordable

Care Act that is supposed to cover recommended screening tests by supporting people financially through co-payments.

Patient delay can be a major factor behind late diagnosis; many patients are unaware of (or ignore) the symptoms of cancer; and health literacy, cultural attitudes towards seeking medical care, fear and embarrassment of a cancer diagnosis, and difficulties navigating the health-care system all play a part. But physicians can add to delays by failing to recognise sentinel signs and by failing to triage the right patients forward for further investigation. Symptoms of early cancer can be non-specific and mistaken for other conditions, a factor behind the late presentation of ovarian or pancreatic cancers, for example. Biomarkers could have a role in helping to identify and stratify high-risk populations. Education of both the patient and general physician is essential to move to an early diagnosis of cancer. For example, if patients have a family history of certain cancers, such as colorectal or breast cancer, then these individuals can present earlier than might be expected. Both patient and physician should be aware of these indicators and appropriate screening programmes made available to all who need them.

A shortcoming of the CDC report is the lack of discussion about the nature of diagnostic tests and the challenges they present. For colorectal cancer, the fecal occult blood test is not discriminative, and the follow-up tests of sigmoidoscopy or colonoscopy are invasive and not without risk. Although, encouragingly, the recent trial of once-only flexible sigmoidoscopy screening has been shown to be safe and practical. However, overdiagnosis and overtreatment can limit the effectiveness of screening in the general population; thus, identification of high-risk groups is crucial. There is a need for better initiatives to support the development of specific tests for particular cancers and to direct treatment to specific patient groups.

Several initiatives to promote early diagnosis in symptomatic patients are noted in the report and should be credited. The CDC have recently established the Colorectal Cancer Control Program, which provides funding to 25 states and four tribal organisations to promote screening and follow-up care to low-income individuals who are uninsured for screening. The CDC’s National Comprehensive Cancer Control Program provides funding and technical assistance to all states and minority community organisations to develop and implement coordinated cancer control plans to provide a continuum of services including prevention, early detection, treatment, survival, and palliation.

Efforts to identify people most at risk of cancer and those who are difficult to reach must continue to be a priority if the alarming statistics in the CDC report are to improve. More research aimed at improving diagnostic tests and biomarker development would complement and improve early clinical diagnoses, and should go hand-in-hand with the removal of patient and physician barriers to effective cancer care.

December, 2010|Oral Cancer News|

Practical strategy for oral cancer management in dental practices published in UK

Source: www.medicalnewstoday.com
Author: staff

The British Dental Association (BDA) has published a practical guide to help dental professionals combat the growing problem of oral cancer. It reiterates the importance of the early detection of the condition, stressing the improved chances of patient survival in cases where early diagnosis takes place. The proportion of patients with oral cancer who die is higher than for cervical, breast or prostate cancers, the guide points out. It also warns that some patients are beginning to take legal action against dentists alleging failure to detect the condition.

The BDA guide, Early detection and prevention of oral cancer: a management strategy for dental practice, offers practical advice on preventing, detecting and managing oral cancer. It addresses both the clinical aspects of the condition and the management of relationships with patients. It explains the risk factors for the disease, provides guidance on talking to patients about examinations and offers tips on medical history taking and record keeping. It also explores taboos around the practitioner’s right to explore patients’ lifestyle choices that can cause oral cancer, such as drinking, smoking and chewing tobacco, and offers advice on how to overcome them.

Professor Damien Walmsley, the BDA’s Scientific Adviser, said:

“The magnitude of the problem of oral cancer in the UK is growing. While the treatment of many cancers is leading to an improvement in survival rates, the same cannot be said for oral cancer. Early detection is absolutely vital to addressing this situation.

“General dental practitioners and their teams are ideally placed to lead the fightback, but they face many practical difficulties including patient resistance to practitioners’ advice on lifestyle factors. This publication provides in-depth guidance on overcoming those problems and involving the whole dental team in the effective prevention, detection and treatment of the disease.”

BDA members can access the guide free of charge here.

Notes
1. Early detection and prevention of oral cancer: a management strategy for dental practice was edited by Professors Paul Speight (University of Sheffield), Saman Warnakulasuriya (King’s College London and World Health Organisation Collaborating Centre for Oral Cancer, UK) and Graham Ogden (University of Dundee).
2. It is published during Mouth Cancer Action Month (MCAM) 2010, which takes place in November. The month is organised by the British Dental Health Foundation (BDHF) and is supported by a group of organisations including the BDA. Details of MCAM 2010 are available here.

Source:
British Dental Association (BDA)

November, 2010|Oral Cancer News|

Diagnosis for Michael Douglas highlights oral cancer risk

Source: www.dental-tribune.com
Author: Fred Michmershuizen, DTA

After it became known recently that the Academy Award winning actor Michael Douglas has been diagnosed with oral cancer, dental professionals around the world seized on an opportunity to urge members of the public to pay more attention to key risk factors and early warning signs of the disease.

The Academy Award winner was diagnosed with a tumor in his throat, and he now faces an eight-week course of chemotherapy and radiotherapy. This high-profile case has brought oral cancers into the limelight, and oral health experts are keen to make the public more aware of the key risk factors and early warning signs.

The British Dental Health Foundation is calling for more attention to be paid to mouth cancers. The foundation is advising the public to regularly check their mouths.

Douglas quit smoking in 2006, after a long “half a pack a day” habit. Yet, according to the foundation, the possibility of developing oral cancer remains higher for ex-smokers than non-smokers for 20 years after quitting.

Tobacco is considered to be the main cause of mouth cancer, with three in four cases being linked to smoking, according to the foundation. Drinking in excess is also a known factor, with those who both smoke and drink to excess being up 30 times more likely to be at risk.

“It is crucial the public know about the risk factors and early symptoms as early detection can save lives,” said Dr. Nigel Carter, chief executive of the British Dental Health Foundation. “Survival rates can increase from just 50 percent to over 90 percent with early detection, yet over two thirds of cases are diagnosed at a late stage.”

Other risk factors include a poor diet. Research has shown that an increased intake of fish, vegetables, fruit and eggs can help lower risks of cancer. The human papilloma virus (HPV) is also linked to the disease, with U.S. studies linking more than 20,000 cancer cases to HPV in the past five years. The virus can be transmitted via oral sex.

“Many people have not heard of mouth cancer and do not realize how common it is,” Carter said. “The latest figures show that men over the age of 40 are twice as likely to develop the condition as women.”

If Douglas’ initial treatment is unsuccessful, follow-up treatment is likely to be either a partial or complete laryngectomy, which can cause voice changes or the loss of voice completely, the foundation said.

Carter added: “This case shows just how devastating and life-changing mouth or oral cancer can be and it really is vital the public know what to do if they spot a problem.”

Early warning signs include: a non-healing mouth ulcer, red or white patches in the mouth and any unusual lumps or swelling. The foundation advises anyone with any of these symptoms to visit their dentist for further examination.

November, 2010|Oral Cancer News|

“Staggering” lack of awareness of mouth cancer revealed

Source: Dental Health Foundation

A NEW SURVEY undertaken by British Dental Health Foundation has revealed an alarming lack of awareness about the causes and symptoms of one of the UK’s fastest growing cancers – mouth cancer.

Despite the recent case of actor Michael Douglas, who is suffering from advanced throat cancer, the answers from over 1,000 members of the public who were questioned in the survey for Mouth Cancer Action Month supported by Denplan reveal that there is only limited knowledge and understanding of this potentially deadly disease.

One person in 10 claimed not even to have heard of mouth cancer.

Chief Executive of the Foundation, Dr Nigel Carter, said: “After recent high profile coverage of the Michael Douglas case it is staggering to see that some people still have no awareness at all of the condition.”

Dr Carter added: “It is vital that the public have a greater awareness because survival rates increase massively with early detection from just 50 percent to 90 percent. The public need to be aware of the risk factors and whether they are in a high risk group and how they can self–examine or who they can turn to if they’re concerned.”

The results of the survey reveal that it is the older members of the public who are most aware of mouth cancer, with more than 96 percent of those interviewed saying that they had heard of it.

Dr Carter added: “This sounds good as the majority of cases occur in the over 50s but now more young people are being diagnosed with mouth cancer it is important that everyone is aware of the problem. The survey also shows that women are more aware of the disease than men – yet men are twice as likely as women to suffer with mouth cancer.”

The results of the survey show that over a third of the public questioned dramatically underestimated the prevalence of the disease by answering that mouth cancer was responsible for one death every day in the UK. In fact, mouth cancer causes a death in the UK every five hours and is now responsible for more deaths than cervical and testicular cancer combined.

Dr Carter continued: “Rates of mouth cancer have increased by over 40 percent over the last decade and this year’s figures from Globecan show a worrying 10 percent increase over last year’s figures to very nearly 6,000 new cases a year. Despite this there is not always a great deal of publicity surrounding it, so people just do not realise how common and dangerous it is which is why we run Mouth Cancer Action Month every November in the UK.”

Statistically worldwide, an estimated 405,000 new cases are diagnosed each year and over two–thirds of cases in the UK are detected at a late stage. During the campaign the Foundation is encouraging people to self–examine for mouth cancer. Self–examination is important because there are early warning signs to look out for, such as a mouth ulcer that doesn’t heal for over three weeks, or red and white patches on the gums or tongue or any unusual swelling or lumps in the mouth. The campaign strap line is “If in doubt…get checked out” and the Foundation advises that anyone who thinks they have any of these symptoms to visit their dentist as early detection is vital. The dental team have a vital role to play in carrying out opportunistic screening at every recall visit and using this opportunity to educate their patients about mouth cancer, risk factors and self awareness and examination.

Tobacco remains the main risk factor for the disease and alongside excessive alcohol consumption is responsible for three in four cases. Poor diet is also a risk factor and advice for patients should be to have a balanced, healthy diet including five portions of fruit and vegetables every day.

The Human Papilloma Virus (HPV) spread via oral sex is an increasing concern to oral health experts and a recent study in the US connected over 20,000 cancer cases to HPV in the last five years. Experts now suggest it may rival tobacco as the main cause for mouth cancer in the next decade. Younger people and those with multiple sexual partners are most at risk.

October, 2010|Oral Cancer News|

Can saliva-based HPV tests establish cancer risk and guide patient management?

Source: Oral and Maxillofacial Pathology doi:10.1016
Author: Mark W. Lingen, DDS, PhD Section Editor, Oral and Maxillofacial Pathology

Head and neck squamous cell carcinoma (HNSCC) is the 6th most common malignancy in the world today.1 Despite numerous advances in treatment, the 5-year survival rate has remained modest. This poor outcome is due to several factors, including delayed diagnosis. Therefore, improved early detection and effective prevention strategies are critical components for management of this malignancy. The etiology of classical HNSCC has been attributed to chronic exposure to tobacco and alcohol.2 In addition, there is now sufficient evidence to support the contention that high-risk forms of the human papillomavirus (HPV) are a major causative factor for HNSCC of the tonsil, base of tongue, and oropharynx.3-8 The increasing importance of HPV in oropharyngeal HNSCC has raised considerable concern and uncertainty among healthcare professionals and patients. For example, I am often asked to describe the clinical features of HPV-associated premalignant lesions. Unfortunately, to my knowledge, the clinical spectrum of HPV-associated premalignant disease has not been adequately described. Furthermore, because this subset of HNSCC often develops in hard to- examine locations, such as tonsillar crypts, it can be exceedingly difficult to even identify the carcinomas. In the absence of such information, how can clinicians identify patients that are at increased risk for harboring an HPV-associated premalignant lesions or HNSCC?

Recently, a large commercial diagnostic lab began offering a saliva-based test for the identification of oral HPV infections. As a result of this new offering, I have been bombarded with queries from dentists who have two recurring questions: (1) Will my patient develop HNSCC if they have a positive test? (2) What should I do for my patient if they have a positive test? The company’s website states that their test provides the dentist with information that will “establish risk for HPV-related cancer and determine appropriate referral and monitoring conditions.” Unfortunately, given what we know, or more appropriately what we don’t know, it is unclear how this test will provide answers to the real-world patient management questions that confront dentists.

The Centers for Disease Control and Prevention (CDC) estimates that 20 million Americans are currently infected with HPV and that 6 million new individuals are infected each year.9 In addition, they estimate that at least 50% of sexually active adults will be infected with HPV in their lifetime.9 Further, the CDC estimates that 33,000 men and women will develop an HPV-associated malignancy this year, and that 12,000 of these cancers will be HNSCC.9 Why is there a considerable difference between rates of HPV infection and the incidence of HPV-associated cancers? In general, the HPV DNA must become integrated into the host genome (rather than remaining episomal) to be oncogenic. Fortunately, this integration occurs at a fairly low frequency. Therefore, the mere presence of HPV in a saliva test does not necessarily establish a patient as being at higher risk place for developing cancer. The company has also suggested that repeated oral HPV testing is an effective monitoring tool because serial tests will identify patients with persistent infections, which are more likely to undergo malignant transformation. While persistence of HPV infection may increase cancer risk, what is the evidence that serial HPV tests will specifically identify only those patients with persistent oral HPV infections? The natural history of cervical HPV infections is well documented. Surprisingly, there is very little known about the natural history of oral infections. However, the available data suggests that the natural history of oral and cervical HPV infections may be very different.10 For example, we do not know the clearance rates of oral infections versus cervical infections. Given the robust lymphoid tissue present in Waldeyer’s ring, one could hypothesize that oral HPV infections may be cleared at a faster rate. Given these and other uncertainties, the clinical relevance and management implications of a positive repeat monitoring test are unclear. On the one hand, a positive test may indicate that an individual has a persistent HPV infection, thus placing them at higher risk for developing HNSCC. Alternatively, a positive repeat test may simply reflect a scenario of multiple independent infections in which each viral infection was cleared prior to the subsequent re-infection. Therefore, if we do not fully understand the natural history of oral HPV infections, how will the oral HPV test aid clinicians in establishing appropriate management protocols?

The era of molecular diagnostics is upon us, with new tests introduced daily. Some of these tests may aid clinicians in their quest to improve the diagnosis, prevention, and treatment of many different diseases. However, at this time, the current saliva-based HPV test would appear to be a “test looking for a disease,” with limited clinical utility. I would respectfully urge clinicians to consider the fact that just because we can perform a test does not mean that we should. To be of true clinical benefit, a diagnostic test should have clear scientific evidence that it will aid in the treatment decision making process. In support of this concept, I would encourage readers to review the article by Jaeschke et al.11 This seminal article provides an appropriate discussion and clinical decision making framework for clinicians when considering whether or not to perform a particular test. Mark W. Lingen, DDS, PhD Section Editor, Oral and Maxillofacial Pathology doi:10.1016/j.tripleo.2010.06.002

References:
1. Jemal A, Siegel R, Ward D, Hao Y, Xu, J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249.
2. Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res. 1988;48:3282-7.
3. Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and –unrelated oral squamous cell carcinomas in the United States. J Clin Oncol 2008;26(4):612-9.
4. Gillison ML, D’Souza G, Westra W, Sugar E, Xiao W, Begum S, Viscidi R. Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. J Natl Cancer Inst 2008;100:407-20.
5. Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst 2000;92:709-20.
6. D’Souza G, Kreimer AR, Viscidi R, Pawlita M, Fakhry C, Koch WM, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl Med 2007;356:1944-56.
7. Fakhry C, Westra WH, Li S, Cmelak A, Ridge JA, Pinto H, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 2008;100(4):261-9.
8. Schlecht NF. Prognostic value of human papillomavirus in the survival of head and neck cancer patients: an overview of the evidence. Oncol Rep 2005;14:1239-47.
9. Centers for Disease Control and Prevention. http://www.cdc.gov/ std/HPV/STDFact-HPV.htm#common
10. D’Souza G, Fakhry C, Sugar EA, Seaberg EC, Weber K, Minkoff HL, et al. Six-month natural history of oral versus cervical human papillomavirus infection. Int Cancer 2007; 121:143-50.
11. Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994; 271:703-7.

August, 2010|Oral Cancer News|