Oral Cancer Foundation News Team - A

About Oral Cancer Foundation News Team - A

This author has not yet filled in any details.
So far Oral Cancer Foundation News Team - A has created 2010 blog entries.

British Association of Oral and Maxillofacial Surgeons praise HPV vaccination study

Source: www.nationalhealthexecutive.com
Author: staff

The British Association of Oral and Maxillofacial Surgeons (BAOMS) has welcomed new study findings from the two-year Cancer Research study in Scotland that the HPV vaccination for boys may substantially reduce head and neck cancer. BAOMS had been involved in successfully lobbying for the extension to the HPV to boys last year in England and Northern Ireland.

Life-threatening HPV-related cancers can develop during middle age, but boys had been excluded from the national HPV vaccination programme. Currently the cost of treating HPV-driven mouth and throat cancer to the NHS is approximately £30m a year.

Since the UK-wide immunisation scheme for girls aged 12 and 13 was introduced in 2008, data shows a reduction of up to 90% of pre-cancerous cells in the smear tests among women aged 20.

BAOMS Chair, Patrick Magennis, said: “Between 2010 and 2012 nearly 2,000 men had HPV-related head and neck cancer.

Over half of these oropharyngeal cancers are caused by HPV, and in the last decade alone the incidence of these cancers has doubled in the UK population.

“Current evidence suggests that vaccination of boys in their teenage years will prevent them from developing HPV-related cancers in middle age, so the introduction of male vaccination is timely.”

He welcomed the publication of the new study, which found that, over two years, in the 235 male patients in Scotland with head and neck cancer, HPV was present in 60% of cases. The findings follow an earlier report, which suggested routine vaccination of schoolgirls in Scotland with HPV had led to a dramatic reduction in cervical disease in later life.

Oral and maxillofacial cancer surgeons’ specialist skills include removing mouth, jaw and tongue cancer and replacing the missing parts with flesh and bone borrowed from the leg, hip or arm. They say that effective and timely cancer treatment for HPV-positive oropharyngeal cancer has excellent survival results. But patients frequently have serious and debilitating life-long side-effects from treatment that have a profound impact on the quality of life of the cancer survivors.

How dental professionals can help patients with xerostomia

Source: www.dentistryiq.com
Author: Jennifer Pettit, CRDH

Xerostomia affects up to 65% of the population, according to the American Academy of Oral Medicine.1 Many patients might experience dry mouth and accept it as a part of their life without seeking treatment or mentioning it to a health-care professional. It is important to recognize the signs of xerostomia to help reduce patients’ symptoms and prevent the consequences it carries.

Xerostomia is the reduction of salivary flow. The majority of saliva is produced by the parotid gland, followed by the lingual and submandibular glands. Saliva plays multiple roles in the oral cavity. It carries enzymes to help us digest food. It moistens food to create a bolus for easy passage through the esophagus. It also carries buffering agents to neutralize the pH of the oral environment, which can help prevent demineralization of tooth structure and caries lesions. It protects the oral mucosa and tongue from irritants such as bacteria and fungus. Lastly, it cleanses the teeth of small food particles.1

Hyposalivation is associated with many factors. According to the American Dental Association, more than 400 medications cause dry mouth as a side effect.2 The most well-known prescriptions to cause dry mouth are antipsychotics, anticonvulsants, bronchodilators, and certain hypertension medications.2 Other factors contributing to low saliva flow are aging, smoking, radiation therapy to the neck and head, and some diseases and conditions such as HIV/AIDS, diabetes, rheumatoid arthritis, thyroid dysfunctions, and Sjögren’s syndrome, just to mention a few.2

Oral manifestations of xerostomia include dry or chapped lips, mouth sores, fissured tongue and mucosa, salivary threads while talking, enamel erosion, and rampant caries. Symptoms described by patients are a burning or tingling sensation of the mucosa and tongue, difficulty swallowing dry foods, bad breath, altered taste buds, thirst, and cotton mouth.3

Once you have reviewed a patient’s medical history and medication list, there are many products you can recommend. To start off, a wide variety of over-the-counter medications can treat the symptoms of xerostomia. The most popular brands are Biotene (GSK), Act, Colgate, and TheraBreath, and they are available as mouthwashes, lozenges, xylitol mints and gums, gels, and sprays. Most over-the-counter products help to stimulate salivary flow or are used as a saliva substitute. These are typically used as needed throughout the day.

Prescription saliva substitutes, such as Caphosol (Eusa Pharma), NeutraSal (OraPharma), and SalivaMax (Forward Science), are available as well. The FDA has approved two systemic medications that need to be prescribed by a medical professional.2 One of them is pilocarpine, known by its brand name Salagen, which is a tablet to treat oral dryness associated with radiation therapy. The second is cevimeline, also known by its brand name Evoxac, a pill used to treat oral dryness associated with Sjögren’s syndrome. The newest prescription spray available on the market is 3M Xerostomia Relief Spray, which is the only lipid-based solution that coats the mucosa, throat, and tongue to prevent water loss and restore elasticity. All medications, both over-the-counter and prescription, should be taken with caution, as they may have their own side effects and contraindications.

Patients should be encouraged to receive an in-office application of 5% fluoride varnish. Home care should include a prescription-strength fluoride toothpaste, such as Colgate Prevident 5000 or 3M Clinpro 5000. GC America also offers two at-home treatments: GC Dry Mouth Gel to lessen symptoms and MI Paste to be applied as a topical tooth cream after brushing and flossing. MI Paste contains calcium, phosphate, and fluoride to remineralize teeth. A formula without fluoride is also available. Other recommendations you can make include using lip balm, sipping on water or licking ice cubes, and avoiding tobacco, alcohol, and salty or spicy foods.3

Dental professionals should keep an eye out for dry mouth signs as a preventive measure and guide patients through the many options available to reduce their symptoms. Over-the-counter medications might not be a cookie-cutter solution for everyone, and some trial and error might be necessary for patients to find the best product to treat their symptoms without causing any additional side effects.

References

1. Sankar V, Rhodus N; AAOM Web Writing Group. Xerostomia. American Academy of Oral Medicine website. https://www.aaom.com/index.php%3Foption=com_content&view=article&id=107:xerostomia&catid=22:patient-condition-information&Itemid=120. Updated October 15, 2015.

2.Center for Scientific Information; American Dental Association Science Institute. Xerostomia (Dry Mouth). American Dental Association website. https://www.ada.org/en/member-center/oral-health-topics/xerostomia. Updated August 27, 2018.

3Sankar V, Rhodus N; AAOM Web Writing Group. Dry Mouth. American Academy of Oral Medicine website. https://www.aaom.com/dry-mouth. Updated October 15, 2015.

Author:
Jennifer Pettit, CRDH, is a full-time dental hygienist at HQ Dontics, a prosthodontics office in Miami, Florida. She graduated from Miami Dade College in 2010 and has always had a passion for dental health. She takes pride in educating patients to prevent disease and finding the best solutions to suit their needs.

Merck’s Keytruda wins FDA approval to treat head and neck cancer

Source: www.pharmalive.com
Author: staff, Reuters Health

Merck & Co Inc said on Tuesday its blockbuster cancer drug Keytruda won approval from the U.S. Food and Drug Administration to treat a type of head and neck cancer.

The drug was approved for use as a monotherapy, as well as in combination with a common chemotherapy regimen, to treat previously untreated patients with head and neck squamous cell carcinoma, Merck said.

The approval is based on results from a late-stage trial, where Keytruda showed a significant improvement in overall survival in cancer patients, Merck said.

Keytruda, a type of immunotherapy called a PD-1 inhibitor, is already an approved treatment for several forms of cancer, including lung and skin cancers.

Head and neck cancer includes tumors in the mouth, tongue, nose, sinuses, throat and lymph nodes in the neck.

Merck estimates that there will be more than 65,000 new cases of head and neck cancer diagnosed in 2019 in the United States.

Keytruda works by increasing the ability of patients’ immune system to help detect and fight tumor cells.

The drug has been amassing approvals as a standalone therapy and in combination with other drugs to treat several forms of cancer. It is the leading immunotherapy for treating lung cancer, ahead of rival drugs from Bristol-Myers Squibb, Roche and AstraZeneca.

Keytruda, first approved for advanced melanoma in 2014, is Merck’s most important growth driver. It has overtaken Bristol’s Opdivo as the industry’s immuno-oncology leader with sales expected to top $10 billion this year and $20 billion in 2024, according to IBES data from Refinitiv.

Keytruda brought in revenue of $7.17 billion for Merck in 2018, while Bristol’s Opdivo earned $6.74 billion.

Antibodies against HPV16 can develop up to 40 years before throat cancer is diagnosed

Source: www.eurekalert.org
Author: news release

An international group of researchers has found that antibodies to the human papilloma virus type 16 (HPV16) develop in the body between six to 40 years prior to a clinical diagnosis of throat cancer, and their presence indicates a strong increased risk of the disease.

The study, which is published in the leading cancer journal Annals of Oncology [1] today (Wednesday), also found that having HPV16 antibodies increased the risk of throat cancer far more in white people than in black: nearly 100-fold in white people, but 17-fold in black people.

Patients with HPV-associated throat cancer tend to respond better to treatment than those whose cancer is not associated with the infection; the researchers say this may partly explain the worse survival rates among black patients.

The main causes of throat cancer (known as oropharyngeal squamous cell carcinoma, OPSCC) are smoking, alcohol use and infection with HPV16. In the USA the proportion of OPSCCs attributable to HPV16 is around 70%; in some European countries a similar proportion is caused by HPV16, although this varies from country to country. [2]

Dr Mattias Johansson, a cancer epidemiologist at the International Agency for Research on Cancer (IARC) in Lyon, France, who led the research, said: “Importantly, the proportion of throat cancers caused by HPV16 has been increasing over the past few decades, particularly in men, and in some countries the overwhelming majority are now caused by the virus.

“Investigating the range in time prior to diagnosis in which HPV antibodies develop is important to understand how many years an individual who tested positive would be at increased risk, and also gives important insight into the natural history of the disease. In this study we found that antibodies can, in some cases, develop several decades prior to diagnosis of cancer. If rates of throat cancer continue to rise in the future, this biomarker could provide one means to identify individuals at very high risk of the disease who may benefit from specific preventive measures.”

The researchers from Europe, North America and Australia, who were part of the HPV Cancer Cohort Consortium, looked at 743 patients with throat cancer and compared them with 5,814 people without cancer who were the control group [3]. In the years before any diagnosis of cancer, all patients provided at least one blood sample, which was tested for antibodies against the HPV16 cancer-causing E6 protein, and 111 patients provided multiple samples over a period of up to 40 years. The median (average) time between first blood sample collection and a diagnosis of OPSCC was just over 11 years.

Specifically, they found that HPV antibodies were present in only 0.4% of people in the control group (22 out of 5814), but were detected in 26.2% of OPSCC patients (195 out of 743). Antibodies were present in 27.2% of white people before diagnosis with OPSCC (191 of 701) and in 7.7% of black people (3 of 39). This means that the presence of HPV16 antibodies was associated with a 98.2-fold increase in the risk of OPSCC in white people and a 17.2-fold increase in black people.

The first author of the study, Dr Aimée Kreimer, senior investigator at the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA, said: “We also found that people diagnosed in more recent calendar years were more likely to have HPV antibodies, which is consistent with what we know about the increase in the proportion of throat cancers that are due to HPV16. Although there were some people with HPV antibodies detected prior to 1995, this was relatively rare.”

The researchers found that HPV16 antibodies tended to appear in people aged between about 40 to 80 years old – the median age at which antibodies were detected was 52 years, while the median age of diagnosis with OPSCC was 62. As there is no suitable, evidence-based way to test for OPSCC before symptoms appear, more research will be needed before HPV16 antibodies could be used to detect OPSCC in its early, pre-symptomatic stages.

Dr Kreimer said: “Although HPV16 antibodies could be a way to identify people at very high risk of cancer, we are currently missing the critical next steps in the screening process. Also, even though the antibody marker was very good at discriminating between those who would develop cancer and the controls who would not, with such a rare cancer, many people would still be likely to have a false-positive results.”

Dr Johansson concluded: “Future studies will focus on the most appropriate way to follow-up individuals who test positive for HPV16 antibodies and whether there is a way to identify pre-malignant lesions, as well as alternative ways of reducing the risk of eventually developing OPSCC. In other words, there is a long way to go before this biomarker can be used in clinical practice. While vaccination against HPV holds promise in preventing HPV-related cancers, we will not see a resulting reduction in throat cancers for several decades.”

Reasons why HPV16-driven throat cancer has increased in recent decades include changes in sexual practices that started in the middle of the 20th century and a decrease in tonsillectomy rates, which results in more tissue being available for infection by the virus.

The main limitation of the study is the difference between the groups of patients who took part in the study. For example, the group with the longest period of time between first collection of blood and diagnosis of OPSCC came from Norway, while other patient groups tended to have fewer blood samples collected over shorter timescales.

The research was carried out in collaboration with Dr Tim Waterboer, Head of Infection and Cancer Epidemiology, at the German Cancer Research Centre (DKFZ) in Heidelberg, Germany, who developed the HPV16 antibody test.

Notes:
[1] “Timing of HPV16-E6 antibody seroconversion before OPSCC: findings from the HPVC3 consortium”, by A.R. Kreimer et al. Annals of Oncology. doi:10.1093/annonc/mdz0138

[2] Oropharyngeal cancer starts inside the throat directly behind the nose, and can include the base of the tongue and tonsils. It is still a relatively rare cancer. Worldwide there are approximately 500,000 cases of head and neck cancers, of which OPSCC is one type. It is twice as common in men as in women.

[3] Of the 743 OSCC patients, 66% were from Europe, 30% from North America and 4% from Australia.

Researchers training AI mobile app to detect early signs of oral cancer

Source: www.beckershospitalreview.com
Author: Andrea Park

Computer scientists have secured funding to develop artificial intelligence that can automatically identify signs of early-stage oral cancer using an existing screening app.

The project will build upon Cancer Research Malaysia’s Mobile Mouth Screening Anywhere (MeMoSA) app, which is currently used to capture images of the oral cavity for remote interpretation by oral medicine and surgical specialists. Researchers from the U.K.’s Kingston University and Malaysia’s University of Malaya will train a deep learning system to distinguish between thousands of photos with and without signs of oral cancer, then integrate that system into the app.

“Our challenge is to develop deep learning models that demonstrate a high accuracy and prediction of disease,” said lead researcher Sarah Barman, PhD, a professor of computer vision at Kingston. “If we find this approach is reliable enough, artificial intelligence could be used for other forms of disease screening with a wide range of possible applications in the field of medical diagnostics.”

‘Game-changing’ new treatment for cancer patients available in Canada

Source: www.ctvnews.ca
Author: Jackie Vandinther, Digital Content Editor

In the last three years, David Hutson has beaten both throat and skin cancer. Now he’s hoping a new form of radiation treatment will help him overcome the prostate cancer he was diagnosed with last September. Hutson is the first patient in the world to experiment with a new cancer-killing technology called MR-Linac.

Radiologists from the Christie Hospital Manchester in the United Kingdom help cancer patient David Hutson out of the MR-Linac radiation machine in Manchester, U.K. in May 2019

Patient David Hutson receives radiation treatment for his prostate cancer using an MR-Linac machine at the Christie Hospital Manchester in Manchester, the United Kingdom in May 2019. (ITN)

“I feel very lucky indeed that I’m having this treatment. I feel very confident in this technology,” he says from the Christie Hospital Manchester in the United Kingdom.

“And from my diagnosis, it’s going to help me to defeat this third bout of cancer.”

Normally, radiotherapy is carried out in two stages. First, a scan of the tumour is made. Then a dose of radiation is delivered.

Part MRI scanner and part radiation machine, the MR-Linac allows doctors to do both tasks at once; they can visualize the tumour in real time while beaming high-energy radiation to the area. The result is on-the-spot imaging and targeted treatment in one shot.

Because doctors can give more precise and intense doses of radiation, the groundbreaking technology could treat cancers with unprecedented safety and efficiency. MR-Linac could also be an effective treatment for forms of cancer that move, or that are normally impossible to treat with radiation because of their proximity to vital organs, like the pancreas or liver.

Ananya Choudhury, a clinical oncology consultant at Christie Hospital Manchester, believes the new cancer-fighting technology has huge potential.

“If we can do that, then we can not only treat the patients with radiotherapy, but we can increase the dose to try and increase the cure rate,” he says.

Toronto’s Sunnybrook Hospital currently houses the only MR-Linac machine in Canada. Sunnybrook is also a founding member of an international consortium of doctors and experts leading the charge in developing this state-of-the-art device. Other members include medical centres in the United Kingdom, the United States and the Netherlands.

In March 2019, Health Canada approved a medical device license for the MR-Linac, a move that clears the machine to be sold commercially and used for research in Canada.

A new way to predict complications after larynx cancer surgery

Source: www.eurekalert.org
Author: News release – Michigan Medicine, University of Michigan

Rebecca Hoesli, M.D., and Matthew Spector, M.D., evaluate an image from the studey

A technique that illuminates blood flow during surgery predicted which head and neck cancer patients were likely to have issues with wound healing. It could enable surgeons to make adjustments during surgery or recovery to improve outcomes.

A team of surgeons at the University of Michigan Rogel Cancer Center found the approach so successful in a clinical trial that they closed the study early.

Most people with larynx cancer will have radiation and chemotherapy. But about one-third of the time, the cancer will return or will prove resistant, leaving surgery as the next option.

At this point, tissue damage from the radiation adds challenges to the operation. When the surgeon closes the wound, damaged tissue can interfere. For about 40% of patients, this will lead to a pharyngocutaneous fistula, a hole in the neck where saliva can leak out. It can cause bleeding or infections, keeping patients in the hospital longer, and in 10% of cases sending them back to the operating room to fix it.

“Radiation damage is something you can’t always see. There have been very few examples in the literature that would explain or predict who’s going to have a complication,” says Matthew E. Spector, M.D., assistant professor of otolaryngology-head and neck surgery at Michigan Medicine. Spector is the senior author on a paper made available online in February ahead of final print publication in May in Annals of Surgical Oncology.

Researchers enrolled 41 patients who were undergoing laryngectomy after radiation. After removing the tumor but before closing the throat, anesthesiologists gave the patients an intravenous injection of a type of medical dye, indocyanine green. The dye circulates within about 40 seconds. Surgeons then use laser angiography, which illuminates the dye, allowing them to observe blood flow.

The results were clear-cut: patients with lower blood flow had a significantly higher risk of developing a fistula, whereas patients with high blood flow had a very low risk of wound complications.

Knowing this, Spector suggests a few possible interventions. One could be cutting out a wider margin of tissue to get a cleaner, healthier edge. Another possibility is to keep high-risk patients in the hospital longer, while sending the low-risk patients home more quickly.

The laser angiography approach would be straightforward to implement in many setting. It’s already used by other surgeons, including in breast reconstruction, so many hospitals already own the equipment. The technique has little impact on patients because it can be administered so quickly while they are still under anesthesia. Reactions to the indocyanine are minimal.

Researchers are developing a randomized clinical trial to assess whether cutting back more tissue leads to fewer fistulas in the high-risk group.

“We need to find an intervention that can lower this risk,” Spector says.

Oral rinse could improve mouth pain associated with radiation therapy

Source: www.specialtypharmacytimes.com
Author: staff

An oral rinse containing diphenhydramine, lidocaine, and antacids, was found to significantly decrease pain caused by oral mucositis in patients undergoing radiation therapy for head and neck cancer compared with placebo, according to a study published in JAMA.

The multi-institution, randomized, double-blind, placebo-controlled phase 3 clinical trial was led by Robert Miller, MD, an emeritus Mayo Clinic radiation oncologist.

“Our group published a study in 2012 showing that an oral rinse of doxepin reduced oral mucositis-related pain compared to placebo,” Miller said in a press release. “However, there were no large randomized controlled trials studying the potential benefits of magic mouthwash.”

The researchers evaluated 275 patients between November 2014 and May 2016. The study revealed that treatment with both doxepin and the mouthwash combination significantly reduced pain associated with oral mucositis compared with placebo.

The doxepin and mouthwash combination treatment was also well-tolerated by patients, according to the study.

“Radiation therapy may cause mouth sores because it is designed to kill rapidly growing cells, such as cancer cells,” co-author, Terence Sio, MD, a Mayo Clinic radiation oncologist, said in a press release. “Unfortunately, healthy cells in your mouth also divide and grow rapidly, and may be damaged during radiation therapy, which can cause discomfort. We’re glad to have identified a proven method to help treat the discomfort of this side effect.”

Twitter lends insight to HPV-associated oral cancer knowledge

Source: www.oncnursingnews.com
Author: Brielle Benyon

The incidence of human papillomavirus (HPV)-associated oral cancer has risen in recent years, and the virus has now surpassed tobacco and alcohol use as the leading cause of the disease. In fact, while the HPV vaccine is typically associated with preventing cervical cancer, there have been more cases of HPV-associated oral cancer than there have been cervical cancer.1

While the link between oral cancer and HPV may be well-known to healthcare professionals, researchers at Howard University recently took to Twitter to get a glimpse into the public’s knowledge about the topic.

“By looking at the social media data, we wanted to know what people are hearing about oral cancer – especially HPV-caused oral cancer,” study co-author Jae Eun Chung, PhD, associate professor in the Department of Strategic, Legal & Management Communication at Howard University, said. “We wanted to see what the gaps are between the knowledge of the healthcare professionals and the public.”

The researchers collected 3,229 unique tweets over the course of 40 weeks using search terms such as “HPV or papilloma” and “mouth or oral or throat or pharyngeal or oropharyngeal.” They then used a program called nVivo 12.0 to conduct a content analysis that looked at certain phrasing, terms, and themes that commonly appeared.

More than half (54%; 1679 total) of the tweets had information about prevention, while 29% (910) were about the causes of oral cancer. Far fewer tweets were about treatment (5%; 141), diagnosis (3%; 97), symptoms (1%; 42), and prognosis (1%; 25).

Interestingly, the researcher discovered a prominence on the risk of HPV-associated oral cancer in men, with tweets that referred to males outnumbering tweets that referred to females in a 3:1 ratio. Also, the most popular hashtag used in the dataset was #jabsfortheboys, appearing in 89 tweets.

“There was a heavy emphasis on the risk of HPV-associated (oropharyngeal cancer) among men, which is different than what we see with HPV vaccination among girls,” Chung said. “That was very positive news to us, because HPV-associated (oral cancer) rates are higher among the male population and HPV vaccination rates are higher among girls.”

While spreading HPV vaccination and oral cancer is important on a global scale, the United States might have some catching up to do, as the 5 most mentioned Twitter users discussing the topic were located outside of the US–1 in New Zealand, 2 in Australia, and 2 in the United Kingdom.

“That’s kind of sad, because there are more Twitter users from the United States than from any other country,” Chung said.

Ultimately, Chung explained, these findings outlined an area where the country can benefit from more education and social media campaigns.

“In conclusion, this study provides some insight as to how the public makes sense of HPV-associated oral cancer,” she said. “More education and campaigns are needed, and US residents can benefit from more active involvement of US-based health education.”

Reference
1. Chung JE, Mustapha I, Gu X, Li J. Understanding public perception about human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) through Twitter. Presented at: D.C. Health Communication Conference; Fairfax, Virginia; April 26-27, 2019.

‘Whitish patch’: increase in oral dysplasia in young adults

Source: www.medscape.com
Author: Kristin Jenkins

Most 8-year-olds with a wiggly tooth expect the Tooth Fairy to tuck some money under their pillow. In the case of one little Canadian boy, his wiggly tooth got him an incisional biopsy, a diagnosis of oral squamous cell carcinoma (OSCC), a partial maxillectomy, and a defect that was closed with local advancement flaps.

“This was the most unusual case we’ve seen,” said Marco A. Magalhaes, DDS, PhD, assistant professor of oral pathology and oral medicine in the Faculty of Dentistry at the University of Toronto in Ontario, Canada.

“OSCC predominantly affects patients 40 years of age and older,” write Magalhaes and colleagues in a case study report published in November 2016 in Oral Surgery Oral Medicine Oral Pathology Oral Radiology. “It is extremely rare in patients younger than 20 years of age.”

The clinical, radiographic, and histologic findings in this young patient were distinctive. Although the diagnosis and treatment were challenging, the clinical course was favorable at follow-up, the authors said. This case illustrates the fact that even pediatric patients can be at risk for OSCC. Magalhaes said that he and other dentists are concerned about the rising number of OSCC cases in patients who are in their 20s and 30s. These patients have no known risk factors and are often without symptoms. Many are diagnosed with high-grade oral epithelial dysplasia (OED) that rapidly progresses to cancer, Magalhaes told Medscape Medical News.

“When you look at the distribution of cases of oral dysplasia or carcinoma, you see that they tend to occur in older males in their 50s with a history of smoking and a low risk of [malignant] transformation,” he explained.

“What we are seeing in practice, however, is a lot of dysplasia in younger individuals without risk factors. These cases are the most concerning,” he commented.

At the time of presentation, patients may say, “I’m not sure why I’m here, but I saw a whitish patch in my mouth,’ ” said Magalhaes.

Others may be asymptomatic and have “absolutely no concerns,” he pointed out. “Unfortunately, this story is becoming more common.”

Nonhealing Sore in Mouth
Oral cancer usually presents as a nonhealing sore that is often painful. OED can be more difficult to diagnose because it manifests as a faint whitish or red patch anywhere in the oral cavity.

The gums, tongue, soft palate, and the inside of the cheeks can be affected. Most commonly, the floor of the mouth is affected.

Currently, Magalhaes and colleagues are conducting a review of more than 3000 cases of dysplasia in Ontario to determine group distribution, pattern, and, potentially, risk factors.

Although oral cancer has multiple causal factors, Magalhaes noted that smoking is “by far” the most significant and well-recognized risk factor. Heavy alcohol consumption is also a well-known risk factor. Human papillomavirus accounts for 5% to 6% of oral cancers, he noted.

A regular dental checkup is important, and early detection is critical for survival, Magalhaes emphasized.

For high-grade OED, the risk for progression to frank carcinoma is 18% to 30%, he noted. For moderate-grade OED, the risk is 10% to 15%, and for low-grade oral dysplasia, it is 1% to 4%.

“Physicians should reinforce to their patients the importance of dental checkups at least twice a year,” Magalhaes said. “This alone would increase the chances of early lesion detection.”

Review of Biopsy Specimens
A recent review of 63,483 biopsy specimens submitted by dentists to the Toronto Oral Pathology Service (TOPS) primarily from 2005 through 2015 bears this out. The review, led by Magalhaes, was published online April 25 in the Journal of the American Dental Association.

TOPS is operated by the Faculty of Dentistry at the University of Toronto and is one of the largest oral pathology services in Canada, noted Magalhaes, who works there.

The results show that generally, the incidence of OED (2679 cases) and OSCC (828 cases) in Ontario remained stable from 2005 to 2015. It also showed that when it comes to early detection of oral lesions, dentists have seriously stepped up their game. During the 10-year period, detection of OED by dentists increased 3.8-fold. The number of OSCC cases they detected doubled. OSCC accounted for about 10% of all oral cancers in the province in 2015.

“These biopsy specimens were submitted mostly by specialists in oral and maxillofacial surgery, periodontics, endodontics, and oral and maxillofacial pathology and oral medicine,” the authors write.

“However,” they continue, “informal discussion with clinicians who submitted the biopsy specimens has indicated that the initial detection of the mucosal abnormality was often accomplished by the general practice dentist, dental hygienist, or both, who referred the patient to specialists for evaluation, biopsy, and case management.”

The study also shows that potentially malignant lesions made up 4.68% of all cases and that OED accounted for 90%. An increased awareness of early lesions with malignant potential can result in early diagnosis and decreased morbidity and mortality from OSCC, the researchers say.

Both dentists and patients appear to be maintaining a high index of suspicion, according to Magalhaes.

“Dentists are increasingly aware of the presence of these early lesions and are either biopsying them themselves or sending them for biopsy,” he explained. “We’ve also noticed that patients are more aware of mouth changes and are asking dentists about lesions that they have identified.”

During a routine dental checkup, an examination for early signs of oral cancer is performed. This includes inspection of the lymph glands in the neck and a check of all mucosal surfaces in the oral cavity for signs of ulcers or red or white patches.

The severity of OED determines treatment, noted Magalhaes. In cases of low-grade OED, the lesion is monitored every 6 months, and a repeat biopsy is performed if warranted. A high-grade OED that is accessible and relatively well contained is treated with complete surgical excision. This is followed by monitoring two or three times a year. When the lesion is diffuse, affects 60% of the oral cavity, or extends into areas that are difficult to access without significant morbidity, the patient is closely monitored with examinations four times a year, he said.

Source:
J Am Dent Assoc. Published online April 25, 2019. Abstract

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Nov;122:e179-e185. Full text