Source: Timescolonist

Author: Johnathan Skuba

In 2003, an estimated 3,100 Canadians were newly diagnosed with oral cancer. That same year, 1,090 people died of the disease. In the U.S., oral cancer kills roughly one person per hour, 24 hours a day. Of those newly diagnosed, only half will survive five years later, and this terrifying death rate has not declined for decades.

Those statistics are frightening, but the good news is that early detection plays a major role in preventing or curing oral cancers. The first line of defence is the dentist. They are specifically trained to recognize even subtle changes in the mouth and take action.

Pre-malignant lesions usually manifest as white patches (leukoplakias) that can look like small calluses. They could be benign and nothing but skin thickened by trauma or normal wear and tear of oral tissues. Of greater concern are spots that become ulcers, bleed, rapidly change appearance or that are obviously getting larger. Red patches (erythroplakia) should also be examined as they too could represent cancerous tissue. If any such spots are present and either enlarge or don’t improve within 10-14 days, or if they disappear and then recur, patients are advised to see their dentists as soon as possible.

Once in the chair, patients will find that dentists do not take chances, especially when the spots appear in areas where normal trauma is unlikely, such as the soft palate of the mouth or under the tongue. When such spots are seen, and particularly when there is no known cause, the dentist will strongly recommend followup and refer the patient to an oral pathologist or an oral and maxillofacial surgeon for consultation and possible removal and biopsy. If the dentist believes that the lesion is likely not cancerous but still a possible concern, they may choose to closely monitor the area over a short time and make a referral if it remains suspicious upon followup.

“The best thing is to remove all suspicious lesions,” says Dr. Seema Ganatra, an oral pathologist who teaches at the University of Alberta. “Oral cancer has a similar progression to many other cancers such as cervical cancer. When dysplasia (abnormal cells) is seen, these cells may evolve into cancer cells if they are not removed. It is impossible to predict which lesions will go on to become cancer. Followup screening and patient education complete the cycle.”

Regular dental checkups are essential to protect one’s health, since early detection can save lives. Reducing risk factors is another way to promote good health, Ganatra says.

“Not surprisingly, people who smoke are at high risk for oral cancer, but so are those who consume large amounts of alcohol. People who are both heavy smokers and drinkers have 18 times the risk of developing oral cancer.”

Smokeless tobacco, cigars and pipe smoking are every bit as dangerous as cigarettes, she adds. And those with these increased risk factors who don’t regularly see a dentist face even greater peril.

“By the time their symptoms worsen enough for them to seek medical help, they are usually in the advanced stages of the disease.”

At present, 95 per cent of oral cancers are found in people over 45, but an alarming trend points to younger people getting the disease from another source. In people who don’t smoke or drink, there is a rise in oral cancer (and certain other cancers) due to specific strains of the human papilloma virus (HPV), a sexually transmitted infection most commonly associated with genital warts. According to the Oral Cancer Foundation, HPV-linked oral cancer is the fastest-growing segment of the oral cancer population.

Dentists have a number of screening tools such as rinses and fluorescent lights to help them spot signs of oral cancer, but visual diagnosis and biopsy remain the best detection methods, Ganatra says. “It is in the pathology lab that we have a better chance of making the diagnosis.”

Public awareness is key to lowering the incidence of oral cancer. Reduce or remove risk factors like tobacco, alcohol and unprotected sexual activity. Have regular dental checkups and schedule another appointment if you see unusual spots in your mouth or experience symptoms like fatigue or a hoarse throat in the absence of a cold or flu. Follow your dentist’s advice on prevention and treatment.

“Screening is vital,” says Ganatra. “Two-thirds of oral cancers are found in the late stages; if we had caught them early, those people might still be alive.”

Dr. Jonathan Skuba is a past president of the Alberta Dental Association and College. He has been in general practice in Edmonton since 2001.