• 7/17/2005
  • Middleton, PA
  • Jo Ciavaglia
  • Bucks County Courier Times

The mouth pain was so easily ignored that Jerold Wilck doesn’t remember when he first noticed it. He saw the sore, but figured he had bitten his tongue.

Weeks passed; the sore didn’t heal. Strange, Wilck thought.

As a longtime dentist, he knew oral abnormalities are fairly rare and usually are nothing troubling. Colleagues looked at his mouth, and none suspected a problem.

“That is what happens with most people,” he said.

It’s the reason most people with oral cancer die. Wilck could have been one of them, but a doctor in his Middletown dental practice suggested he get a biopsy.

Now, he’s spreading the word about the importance of early detection of this common, yet often ignored, cancer. An oral cancer screen should be part of every routine dentist visit, he and other medical experts say.

Every year, 30,000 new cases of oral cancer are diagnosed – more cases than leukemia and cancers of the stomach, pancreas and kidney.
At 8,000 deaths a year, oral cancer kills more people than melanoma, the most serious form of skin cancer.

If caught early, as Wilck’s was, the survival rate is 80 percent to 90 percent, according to the Oral Cancer Foundation, based in Newport Beach, Calif.

But about 75 percent of oral cancers are diagnosed in the advance stages – a year or two after the symptoms are noticed. By that time, survival rates drop to less than 20 percent.

“It’s much more common than you might think, but you don’t hear about it,” said Brian Hill, founder and executive director of the Oral Cancer Foundation.

While the cancer is largely found in people over age 45, its rates are rising among younger people. Between 1973 and 1997, there was a 60 percent increase in oral cancer patients under age 40, according to a 2002 New York Medical College study.

And while tobacco and heavy alcohol use are the leading risk factors, 25 percent of oral cancer patients had no risk factors – Wilck included.

Wilck, 59, said he quit smoking at age 18 and is only a social drinker. He found the cancer on his tongue, the most common place it occurs.

The oral cancer death rate has remained unchanged for 50 years, which Hill partly blames on a lack of awareness and screening by professionals. Unlike other cancers, there is no national policy or program to address oral cancer, Hill said.

In April, Wilck underwent surgery to remove a paperclip-length piece of his tongue and 30 lymph nodes. The cancer was caught early, and after physical and speech therapy, he returned to work in May.

Wilck said his brush with oral cancer prompted changes at his practice, KWH Dental Associates.

Recently, the staff participated in a two-hour seminar on the latest techniques for detecting oral cancers, including more hands-on exams than his office had done.

Earlier this month, employees started sporting quarter-size buttons with the words, “I look for it.”

After cancer screenings, patients get buttons with the words, “I had one” to raise awareness about the importance of screenings.

Soon, the practice will offer two procedures designed to detect oral cancer early. One is a ViziLite exam, a 10-minute, $25 checkup designed to detect any cell changes in the mouth area. The other is a brush biopsy, where a wire brush scrapes suspicious legions or spots to test them for cancer.

The Pennsylvania Dental Association has focused more attention on oral cancer over the last few years, spokesman Rob Pugliese said.

Three years ago, the American Dental Association ran a national billboard campaign stressing the importance of early detection.

The state chapter highlighted the issue in its professional magazine but hasn’t surveyed members about their screening practices, Pugliese said.

Most dental offices do oral cancer screenings as part of routine checkups, but many aren’t thorough, national experts say.

About 53 percent of dental hygienists do a head and neck exam and oral cancer screenings on patients, according to a 2003 study by Case Western Reserve University.

Published studies show less than 15 percent of people who regularly visit a dentist report having an oral cancer screening, according to the Oral Cancer Foundation.

Compounding the problem is only 60 percent of the American population visits a dentist annually.

“The truth of the matter is, that [dentists] cannot be [doing adequate screenings] because we’re finding 66 percent of the time [patients with] late-stage cancer,” Hill said.

He said that’s what happened to him. While he said he saw his dentist regularly for checkups and cleanings, “no one was screening me for oral cancer.”

Two dentists, two hygienists, and a specialist who put a crown on a tooth near the lesion all missed it. The doctor who diagnosed Hill six years ago told him the sore has been there for 18 months.

“This is a problem in dentistry. We could be doing a lot more to check for the disease,” Hill said. “It’s still being missed way too often.”