• 6/1/2007
  • Hyannis, MA
  • Robin Lord
  • Cape Cod Times (www.capecodonline.com)

In one photograph, the patient’s gums look pink and smooth, a sign to a dentist that, at first glance, all is well. But in the second photo, taken with a new oral screening tool, two dark round spots are revealed on the same patient’s gums. They may be a sign of malignancy.

The Velscope, a machine on the market only since November, consists of a thin wandlike device with a high-intensity blue light and magnifier at the end. It offers health care professionals a way to see, through the gums, whether cancer is lurking below the surface. Normal tissue will reflect the scope’s light and glow. Abnormal tissue absorbs it and shows a dark opaque image.

On Cape Cod, at least two dentists, Dr. William Sheier of Orleans and Dr. Stephen McGrail of Yarmouth, already have installed the $6,000 machine in their offices.

McGrail says he planned to look at new dental chairs when he went to the annual dental show in Boston in January. The Velscope caught his eye, and within a half-hour of seeing it demonstrated, he had bought one.

“I usually let new technology prove itself before I buy it, but this is the most exciting thing out there,” he says. “It shows you things you normally would miss and puts them in the forefront.”

Finding ways to better detect oral cancer is important because about 90 percent of people who contract the disease die within five years, McGrail says. The survival rate has not improved in the last 20 years because by the time it is detected by the naked eye, it often has spread to other areas, he says.

“I think this machine probably could change that survival rate,” he says.

McGrail is still training on the Velscope, and uses it only on his most high-risk patients right now, at no charge. He is putting together a brochure to send to all of his patients, and says he will eventually recommend it for everyone, with a fee attached.

Sheier is so excited about it, he already has started offering it to all of his patients.

“I can save a life (by using it),” Sheier says.

Before having the Velscope, he was limited to a visual exam using a bright white light that can pick up white or red spots that may spell trouble. By that time, if the spot is malignant, it is already Stage 1 cancer, he says. As with most cancers, the earlier oral cancer is caught, the better the survival rate.

Oral cancers include cancer in any of the following areas: lips, lining of the lips and cheeks, teeth, floor of the mouth under the tongue, front two-thirds of the tongue, bony top of the mouth, gums and small area behind the wisdom teeth.

Since Sheier installed the Velscope machine in February, he already has sent a few patients to oral surgeons for biopsies after finding suspicious dark spots that could not be seen under the white light.

Convincing oral surgeons of the Velscope’s value is an important piece of the puzzle, McGrail says. If dentists are sending patients with lesions that can be seen only under the Velscope, the surgeon will be challenged to find the right borders of the cancer, he says.

The Velscope was developed by Vancouver-based LED Medical Diagnostics Inc., in conjunction with the British Columbia Cancer Agency. The National Institutes of Health in the U.S. assisted the development with $50 million in funding.

The technology is based on changes in fluorescence in human tissue when abnormal tissue is present.

Sheier tried another product, called Visalight, that works on the same principle. With it, a patient rinses with a special liquid and a disposable ultraviolet light is shone into the patient’s mouth. But he found that the taste was so bad, patients did not want to have the screening.

Patients who choose to have the Velscope screening are charged $55, according to Charlotte Randall, a hygienist in Sheier’s office. So far, no insurance companies will cover the cost, she says.

“It’s been met with great reception,” she says. “People are a lot more preventive with their health care these days.”

Although most people may think tobacco use puts individuals at the greatest risk for oral cancer, it is “by no means” the only risk factor, Sheier says. Any mechanical or chemical irritant to the mouth, such as heavy drinking and certain oral herpes, also puts people at risk, he says.

If caught early, oral cancer is very treatable, Randall says. If detected further down the line, treatment can be invasive and disfiguring, she says.

When a patient visits Sheier’s office, the hygienist will do a preliminary check of the mouth. She is looking for discolorations, such as red or white spots, and is feeling for any lumps, Randall says. Other things, such as blocked ducts, can cause lumps. Since many oral cancers in people who smoke begin at the edges of the tongue, the hygienist will pull the tongue slightly to check all areas, she says.

After that, if the patient agrees, the hygienist then does a check with the Velscope. The same areas are checked with the device as were checked with the preliminary exam.

Looking through the device into someone’s mouth you see a greenish glow emanating from the tissue. That indicates all is as it should be, Randall says.

McGrail says he eventually will recommend annual screenings for people in their 20s and semiannual screenings for older patients who are at risk from smoking or heavy drinking.

Letter sent to the editor by OCF

Its an important device and a good article, but there is plenty of misinformation in it as well. Oral herpes for instance (herpes simplex), is NOT associated with oral cancer. It is the human papilloma virus, particularly version 16 (HPV16) that is the oncogenic viral culprit. The Vizilite system mentioned is NOT the same technology as this. It looks at tissue reflectance, not tissue fluorescence. Two very different ideas… and that special liquid? Vinegar. Something that we have known since the 40’s which desiccates the tissues and allows abnormalities (then on the cervix) to be seen more readily. The NIH was not involved with the development of the VELscope, however it has over the course of the last decade given lots of financial grants to researchers that were looking at the issue of human tissue fluorescence. LED was not the recipient of any of this money. Our system of spending money on core research which becomes public domain, allows companies to commercialize important science finds, which is what has happened here. The worst misconception in the article is the notion of why oral cancer survival is low. “The survival rate has not improved in the last 20 years because by the time it is detected by the naked eye, it often has spread to other areas, he says.” Actually because so few doctors have been involved in basic visual and tactile screening for the disease, and the American public was unaware that an annual screening was something they should engage in, 66% of the time oral cancers are discovered as late stage three and four killers. (Article published by Horowitz et. al of the NIH/NIDCR) This isn’t so much because they are hard to see, it has more to do with the fact that professionals have not been looking for it. Precancerous lesions, and early highly survivable stage one and two oral cancers, the vast majority of the time, are visible to the naked eye or can be felt with the gloved finger. Chronic irritation of tissues is a minor POTENTIALLY causative factor, and chemical irritants (a pretty broad term for what is really so far only documented as high alcohol consumption) makes you think of more than the second most common cause, alcohol consumption to excess. And the five year death rate is really bad, but hardly 90%. It is about 52%, still unacceptable for a disease whose precancerous signs can mostly be seen with the naked eye, and which could be significantly lower were there a national effort in early detection of oral cancer. All my corrections aside, I commend these doctors for wanting to be more involved in early detection. That indeed will save lives. Brian Hill, Founder, The Oral Cancer Foundation. www.oralcancer.org