• 6/3/2005
  • By Ed Edelson
  • Forbes

Nearly 40,000 lives could be saved worldwide every year through early detection of oral cancer.

That’s the conclusion of a new study in which health-care workers carefully examined the mouths of approximately 170,000 people in India for signs of malignancy.

While the oral health of Indians differs greatly from that of Americans — most notably because many Indians chew a cancer-causing substance called pan-tobacco — the study results “apply to people all over the world, including those in the United States,” said Dr. Rengaswamy Sankaranarayanan.

Sankaranarayanan is head of screening for the French-based International Agency for Research on Cancer, and lead author of the study that appears in the June 3 issue of The Lancet.

That assessment sounds reasonable, agreed Dr. Sol Silverman Jr., a professor of oral medicine at the University of California, San Francisco, and a spokesman for the American Dental Society.

“The prevalence is higher in India than in the United States, but we do have 10 cases per 100,000 population. And even in the latest statistics, only 58 percent survive for more than five years, despite all the improvements in treatment,” Silverman said.

The National Cancer Institute estimates that 30,000 new cases of oral cancer will be diagnosed in the United States this year, with 8,000 deaths from the malignancy.

The new study included nearly 170,000 residents from 13 population clusters in the Trivandrum district of Kerala, India. Residents of seven districts were given up to three rounds of screening by health workers trained to look for spots or growths that were warning signs of cancer. The other residents were given ordinary health care, with no oral inspections.

The death rate from oral cancer was reduced by more than a third through screening of people at high risk because they were heavy users of tobacco and alcohol, the researchers reported.

“This is the first time a significant reduction in mortality is reported following oral cancer screening,” Sankaranarayanan said.

Such screening has been neglected in the United States, Silverman acknowledged, but steps are being taken to remedy that flaw.

“We have started many programs in undergraduate dental school and in continuing medical education for practicing dentists,” he said. “We are emphasizing the importance of and the how-to of oral cancer examination and the importance of early detection.”

But the nature of oral cancer may be changing, said Brian Hill, founder and director of the Oral Cancer Foundation, himself a survivor of the disease.

Oral cancer used to be found almost always in older people who were smokers, Hill said. Now there is an increased incidence in younger people who do not smoke, he said, and there are indications that the cancer is being caused by a strain of human papilloma virus, the agent that causes cervical cancer.

“This is only anecdotal evidence, but it is possible that anyone who is sexually active can get oral cancer,” Hill said.

Dentists and physicians are seeing more cases of oral cancer in younger people, and the possibility of a viral connection is being investigated, Silverman acknowledged. “There are lots of studies of human papilloma virus,” he said.

It’s important for all people who visit a dentist to ask for an inspection of the mouth to detect signs of oral cancer, Silverman said. And everyone, especially smokers and heavy drinkers, should do some self-examination, he said.

“If you see a deviation from normal, seek professional help,” Silverman added. For more information visit www.oralcancer.org or the American Dental association at www. ada.org