“OCC's purpose is to improve the quality of life for oral cancer patients through financial support so that they may face the world with peace and dignity during and after medical treatment.”(2) HPV is a leading cause of oral cancer. We should be providing an annual oral cancer screening to all patients. Early detection and treatment increases survival rates significantly.(1) April is Oral Cancer Awareness month and the Oral Cancer Foundation (OCF) invites you to join in a national screening campaign to end oral cancer.(3) Awareness of prevention and early diagnosis of this disease by the public is low. Cures rates are also low. Approximately 43,250 people in the U.S. will be newly diagnosed with oral cancer this year.(3) Oral health care professionals are often the first ones to see the disease. While smoking and tobacco use are still major risk factors, the fastest growing segment of oral cancer patients is young, healthy, nonsmoking individuals due to the connection to the HPV virus.(3) Professional involvement and public awareness is vital to educate our communities about oral cancer awareness, prevention and early detection. A study looked at the increasing rates of oropharyngeal cancers recently as a result of increasing rates of HPV infection.(4) This increase has largely been attributed to changes in sexual practices in the 1960-70s. There is little data regarding incidence, trends, and treatment outcomes in patients younger than 45 years. The purpose of this study was to investigate these factors among younger patients with oropharyngeal cancers born in this time period. The authors stated that SEER analysis showed a continual increase in oropharyngeal cancers in the <45 year old U.S. population which is likely HPV-related (grade III/IV).(4) This increase is mainly seen among whites while decreasing trend is seen among blacks. The prevalence in this age group suggests either non-sexual modes of HPV transfer at a younger age or a shortened latency period between infection and development of oropharyngeal cancers.(4) These patients have an encouraging prognosis and are likely to live longer while dealing with treatment-related side effects negatively impacting their quality of life. This group of younger patients should be studied for prevention and treatment strategies, including possible de-escalation of therapy in HPV-positive patients. A JAMA study provides us with preliminary evidence that neck mass and sore throat as the initial symptoms of patients with oropharyngeal squamous cell carcinoma. Patients who were HPV-positive usually exhibited a neck mass as the initial symptom while HPV-negative patients more often had symptoms related to the primary tumor site, including sore throat, dysphagia, and/or odynophagia.(5) And another study comes with fairly good news! There are usually many questions about oral leukoplakia, its cause and does it lead to cancer. Oral leukoplakia is an adherent white plaque on the oral mucosa that cannot be attributed to other diseases.(6) It does not indicate that a premalignancy or malignancy is present. This systematic review wanted to report on four controversial issues regarding oral leukoplakia, including the role of tobacco and alcohol use, its conversion into oral squamous cell carcinoma, the division between premalignant and nonpremalignant oral leukoplakia, and whether proliferative verrucous leukoplakia is a specific entity or rather a form of multifocal leukoplakia. The conclusion was studies propose that most oral leukoplakias are benign and do not develop into cancer. Also, there is no conclusive evidence that tobacco smoking and alcohol consumption cause oral leukoplakia. The upshot for clinicians is that to exclude epithelial dysplasia or malignant transformation of epithelium, a biopsy is required for definitive histologic diagnosis of all white lesions that cannot be attributed to a specific etiology.(6) For a step-by-step video on the oral cancer examination, visit the National Institute of Dental and Craniofacial Research (NIDCR) website.(7) Click here to see a poster that is available for your operatory.(8) Eva Grayzel, an oral cancer survivor, has an informative website with a wealth of information, including the six-step screening.(9) To view her video, Oral Cancer Save-A-Life Rap, visit the website.(10)
There are a number of oral cancer detection devices on the market, including the VELscope, Identafi, and others. Forward Science Technologies has a product that uses fluorescence technology, a blue light that allows a clinician to identify oral cancer, pre-cancer and other abnormal lesions at an earlier stage.(11) The OralID kit has two pairs of eyewear: a fitted pair and another for use over glasses. There are also options for clinical imaging, as the kit comes with a SmartFilterID for clinical photo documentation. For more information, visit the website.(11)
Forward Science Technologies launched CytID, at the one-year anniversary of the launch of OralID. CytID is a liquid-based cytology test to complement the florescence technology of OralID. CytID was for clinicians once they have identified a suspicious lesion with OralID fluorescence screening.(12) Robert J. Whitman, MSE, CEO, Director of Clinical Education at OralID, stresses the importance of using current technology and being proactive. “With oral cancer on the rise, many clinicians are being more proactive when identifying suspect lesions with OralID fluorescence screening," he said. "As our clinicians keep demanding tools to gain more information, CytID was created for those situations 'when you need to know more' regarding suspect lesions. As we continue to move science forward, we have combined OralID and CytID to create the first ever oral health protocol in the dental industry, the FACT oral health protocol, Fluorescence Assessment and Cytology Test, to detect oral cancer at its earliest stages, thus saving more lives.”
Although the increased public awareness of oral cancer made possible by the marketing of screening adjuncts is acknowledged, the implication that such technologies may improve detection of oral cancers and precancers beyond conventional oral examination alone has yet to be scrupulously confirmed, according to one study.(13)
The paper systematically and critically examined the literature associated with current oral cancer screening (2008) and case-finding aids or adjuncts such as toluidine blue, brush cytology, tissue reflectance and autofluorescence. The characteristics of an ideal screening test are outlined in the article and the authors pose several questions for clinicians and scientists to consider in the evaluation of current and future studies of oral cancer detection and diagnosis.
For a link to the six-step screening poster, click here.
There is NO EXCUSE not to perform oral cancer examinations!
References 1. http://oralcancercause.org/oral-cancer-awareness-month/. 2. http://oralcancercause.org/. 3. http://oralcancerfoundation.org/events/oral-cancer-awareness-month.php. 4. Gayar OH, Ruterbusch JJ, Elshaikh M, Cote M, Ghanem T, Hall F, and Siddiqui F. Oropharyngeal Carcinoma in Young Adults-An Alarming National Trend. International Journal of Radiation Oncology Biology Physics. Volume 87, Issue 2, Supplement , Page S436, 1 October 2013. 5. McIlwain WR, Sood AJ, Nguyen SA, and Day TA. Initial Symptoms in Patients With HPV-Positive and HPV-Negative Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg. Published online March 20, 2014. doi:10.1001/jamaoto.2014.141 6. Arduino PG, Bagan J, El-Naggar AK, Carrozzo M. Urban legends series: oral leukoplakia. Oral Dis 2013;19(7):642-659. doi:10.1111/odi.12065. 7. https://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/TheOralCancerExam.htm. 8. https://www.nidcr.nih.gov/NR/rdonlyres/480BBD43-DEFB-44CC-B5DF-6CCD17EAA042/0/OralCancerPoster.pdf. 9. http://www.sixstepscreening.org/. 10. https://www.youtube.com/watch?v=448ah5QS4rY. 11. http://www.oralid.com/index/. 12. http://www.cyt-id.com/. 13. Lingen MW1, Kalmar JR, Karrison T, Speight PM. Oral Oncol. 2008 Jan; 44(1):10-22. Epub 2007 Sep 6.
