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 ([email protected]). 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: [email protected].