Last month I attended a lecture given by Dr. Donald M. Cohen, the division head of Oral and Maxillo-facial Pathology at the UF Dental School. Among other topics, much time was given to explaining the recent rise in Oral Cancer (OC).
Who gets oral cancer?
OC used to be almost exclusively found in people over age 65 who were heavy drinkers and smokers. This made sense since we have known for years that tobacco and alcohol are carcinogens. The longer one uses these substances, the greater the damage to the tissues, and the more likely this damage will lead to cancer. However in recent years, dentists have seen a rise in cancer in younger patients. Patients in their 50’s, sometimes 40’s, and even much younger have been diagnosed. Worse still, these patients didn’t fit the usual smoker/drinker profile. In fact, while the overall rate of oral cancer with the old profile is going DOWN, the rate of cancer with the new profile is not only going up, it now surpasses the old. The net effect is that total oral cancer diagnoses per year are now going up. What is driving this change?
It seems that this change is almost certainly linked to the spread of the Human Papillomavirus or HPV. In it’s various forms, HPV is responsible for common warts, plantar and genital warts. HPV is a very common virus that has over 100 varieties or genotypes. Of these about 11 are high risk for cancer. It is also responsible for almost all cervical cancer.
The virus is everywhere!
HPV is very common. It is the most common sexually transmissible disease. By age 50, as many as 60-85% of sexually active people will have had HPV at some point in their lives. But in most cases the infection clears naturally to an undetectable level. Whether it is truly gone is a matter of debate. It may persist at a very low level, until perhaps a change in the immune system allows it to recur.
We check all our patients for oral cancer during comprehensive or periodic exams. I think it is the most important part of the exam. You can examine yourself as well. Besides lumps and bumps, look for white patches, red patches or white/red mixed patches. If there is a something that exactly matches on the other side of your mouth, it is almost certainly supposed to be there. The ones that don’t match are the ones to watch. And watch is what you need to do. Pizza burns, tortilla chip injuries and cheek biting can look like cancer. All these things will clear up within a week, two weeks at most. If the spot persists longer than that, you should have us look at it.
Some dentists charge an extra fee to use an oral rinse coupled with a special light that claims to identify oral cancer. I have looked at these lights, and the research behind them and have chosen to not incorporate them into the practice for several reasons. For one, (and Dr. Cohen confirmed this), I’ve not found any research which shows that these lights reveal anything which is not visible to the unaided, trained eye. In fact, they cause all sorts of innocent things to glow as though they are cancer. You still have to know what you are looking at. Secondly, we would have to charge $50 or so for the materials, every exam. If I felt it would it would help us identify even one case of cancer we would adopt it. If you know our practice, you know we don’t skimp on technology. Anything that helps my patients, I buy. But I won’t drive up the cost of routine visits without good cause.
HPV also causes cancer of the oropharynx, and throat as well. These are NOT areas which we dentists can see. While we can see the small area in the throat directly behind the tongue, we don’t look up into the nasopharynx, or down into the throat. If you feel a lump in your neck, change in your voice, sore throat, difficulty swallowing etc. you need to see your physician.
Hopefully, in the future we will see a steep decline in oral cancer from HPV. Vaccines like Gardasil, if given young enough will stop the spread of the worst strains of HPV. This will take years to really impact the current trend however.