• 5/14/2007
  • Westchester County, NY
  • Linda Lombroso
  • Lower Hudson Online (www.thejournalnews.com)

It was nearly five years ago that Margaret Belair received chilling news: The sensitive spot on her tongue was far more than a pizza burn or a cold sore.

It was oral cancer.

Belair, who’d just given birth to a baby boy, was stunned.

“It didn’t look or feel hard,” says the 41-year-old mother of two, who lives in Somers. “It was just a weird irritation of the tongue, just slightly discolored, and it felt like a big canker sore.”

Despite the shock of the diagnosis, Belair was fortunate. After an operation to cut out a portion of her tongue – and the precautionary removal of several lymph nodes in her neck – all she needed was eight weeks of speech therapy (to relearn how to pronounce certain sounds) and eight weeks of physical therapy (to build up the strength in her neck).

For Brian Hill, the news was not as good. By the time his oral cancer was caught in 1997, it had metastasized to his lymph nodes. Nobody expected him to survive.

Although the treatment was brutal – including radiation that destroyed his salivary glands and destroyed a portion of his neck – Hill ended up beating the odds.

He has since founded the Oral Cancer Foundation, a national nonprofit research and advocacy organization, and has become an outspoken champion for early detection of the disease.

One of the problems in catching oral cancer early, say experts, has been a longstanding lack of awareness on the part of patients and dental professionals. Although those at high risk for the disease continue to be tobacco users who are heavy drinkers – and African-American men – the Oral Cancer Consortium notes that 25 percent of oral-cancer victims have no known risk factors.

Hill says he wasn’t a smoker or drinker, and never imagined the hard lump on his neck had started out as oral cancer.

“I had no physical manifestation of pain or discomfort or illness all the way up to Stage Four,” says Hill, who lives in California. “That’s one of the dangers of the disease: that you can have it and not realize that some manifestation is taking place.”

Belair says she also had no risk factors, but remains convinced that an earlier bout with the human papilloma virus – which has been linked to cervical cancer – played a role in her diagnosis with oral cancer.

Researchers have made headway in establishing a link between HPV and oral cancer, says American Dental Association spokesman Dr. Sol Silverman Jr. Hill believes the connection is very real.

“The fastest-growing segment has nothing to do with alcohol or tobacco. It has to do with the HPV virus,” says Hill. “So now, when a patient walks into a dental office, you can’t say they’re not at risk for oral cancer. Because anybody old enough to have had sex or is a smoker or drinker needs to be screened. It doesn’t matter what age they are or what gender.”

This year, according to the Oral Cancer Foundation, about 34,000 Americans will be diagnosed with the disease. Experts agree, however, that no matter what the cause of oral cancer, there is a bright side: If detected early, the five-year survival rate jumps to more than 80 percent.

That’s why the American Dental Association is urging patients to get regular oral-cancer exams.

“If there’s no deviation from normal, it literally takes only 30 or 40 seconds,” says Silverman, professor of oral medicine at the University of California San Francisco School of Dentistry. “It’s not a big deal.”

What are some of the warning signs?

“If you find anything that deviates from normal – a red spot, a white spot, an ulcer, a lump – then it deserves more time to either do a procedure in that particular office or refer the patient,” says Silverman. “On top of that, if you find a deviation from normal and it’s been there for three weeks or so, and a diagnosis has not been established, that indicates that a biopsy should be performed to get a definitive diagnosis.”

When Dr. Larry Honigman, a dentist who practices in Hartsdale, sees an area in the mouth that looks suspicious, he does a brush biopsy. “You take what looks like a tiny wire brush, just scrape the lesion, fix it on a glass slide and put it into a mailer,” says Honigman. Within a few days, the results come back to the dentist.

“They’ll tell you for certain if there’s nothing there that requires further examination, and if they find something suspicious or potentially malignant, we call the patient back for a full biopsy or send them to the oral surgeon for a full histological evaluation.”

Honigman and his staff also palpate (examine by touch) the neck and jaw area, using their hands to feel for anything out of the ordinary. “Hygienists are a really important part of the team in evaluating for oral cancer,” says Honigman. “In my practice, in maybe the last 10 years, I’ve had hygienists pick up maybe two lesions that were malignant.”

Dr. Kenneth Magid, a professor of aesthetics and high technology at New York University, says it is unfortunate that most oral cancers are detected at Stage Three or Four, when 5-year survival rates are under 50 percent. “The problem, for the most part, is that early oral cancer looks like everything else. It looks like a million other injuries and changes in the tissue in the mouth,” says Magid, of Advanced Dentistry of Westchester in Harrison. “It’s a red spot or a white spot. We see them all the time.”

Magid, however, is particularly excited about a new FDA-approved device called the VELscope, which uses a bright blue light to highlight changes in the mouth that are not visible to the naked eye.

Using the device, says Magid, has an added an extra step to his regular oral-cancer screening.

“The first part of the oral-cancer examination is we ask the patient if there are any sores in the mouth, any swellings, any painful areas, any hoarseness that hasn’t gone away, or any difficulty swallowing,” he says. The subsequent visual and manual examinations include a look inside the mouth with the VELscope – which, says Magid, “makes things that would look like everything else stand out like sore thumbs.”

As he explains, under ordinary light, suspicious areas of the mouth can appear remarkably similar to healthy tissue.

“In the earlier stages, it’s not red or white. It looks like everything else,” he says. “The VELscope can actually find it before it breaks through the tissue.”

He routinely uses the VELscope to help examine patients like T.J. Lupero, a volunteer firefighter from Mamaroneck. During a recent checkup, Magid directed the blue light inside Lupero’s mouth, pushing the tongue down as he looked into the pharynx.

“When we’re looking through the lens, I don’t see the blue light. What I see is all the normal tissues in the mouth glowing green, and I’m looking for anything that doesn’t glow green.”

As Magid explains, however, a dark spot visualized through the VELScope can also be caused by a bruise or injury – and doesn’t necessarily mean oral cancer. That’s why Magid will likely call the patient back for a recheck in 10 days.

The VELscope, Magid stresses, is merely a focusing device to help catch changes in the mouth before they turn dangerous.

“It is not diagnostic,” he says. “To be diagnostic, you have to take a sample of the cells.”

Dentists and hygienists must also be adequately trained in order to do a proper oral exam, says Hill. They should not rely solely on high-tech devices.

“If I gave you a car and said, ‘Here are the keys to it’ and you didn’t know the first thing about roads, driving and what signs look like, do you think you’d be a very good driver? No,” says Hill. “So if you don’t know how to do a proper exam to begin with, using this device doesn’t improve your lot in life very much as far as being a good screener.”

Yet Hill is optimistic that a simple test of saliva will one day become the gold standard, pinpointing genetic markers for oral cancer long before the disease strikes. “Salivary diagnostics in the future will mean, say, five years from now when you go to your dentist, the screening will initially be you spitting into a test tube, and you know the assistant who puts the little napkin around your neck?” he says. “She’s going to collect it and test it.”

Until then, however, vigilance remains the best weapon against oral cancer.

“The trick, whether you come to this through tobacco or through a virus, is that if we find it early, the survival rates are extremely high,” says Hill. “So early detection is the key.”