For My Patients And For Dentists
Oral Cancer Awareness Can Save The Life Of A Friend or Loved One
If you’re a patient or colleague of mine, you probably know that I am a promoter of extra intra oral exams. This bit of information is for both my patients and my colleagues. My interest in the inclusion and proper execution of these exams (during a routine hygiene and new patient visit) began many years ago when a friend told me a story of her mother, a breast cancer survivor, that was diagnosed with head and neck lymphoma. She discovered a ‘lump’ under her cheekbone while applying face cream. Neither her Dentist nor her Hygienist, whom she saw every 3 months, were in the habit of providing head and neck exams. However, every Dentist and Dental Hygienist I meet confirms they indeed learn how to do extra and intra oral exams in school. Yet, a survey published in the Journal of Dental Hygiene in the fall of 2015 states that almost all Dental Hygienists reported they did not perform extra oral palpation and only one third performed intra oral exams.
ORAL CANCER STATISTICS
Unfortunately, the survival rate for oral cancer has not significantly improved in decades. In fact the death rate associated with oral cancers is higher than that of cervical and testicular cancers, Hodgkin’s lymphoma, laryngeal cancer, and endocrine system cancers such as thyroid or skin cancers like malignant melanoma. In 2014, for the 8th year in a row, there was an increase n the rate of occurrence of intra oral cancer. In 2007 alone, there was an 11% jump.
- 43,250 new cases in 2014, about 118/day
- 90% squamous cell carcinomas
• 30% begin in the tongue
• 17% in the lip
• 14% on the floor of the mouth
- More than 8,000 will die, 1 person/hour, 24 hours/day
- Only 57% will be alive in 5 years
• Survivors often endure major functional, cosmetic and psychological burdens due to dysfunction or loss of the ability to speak, swallow, breathe and chew
- 80-90% survival with early diagnosis/treatment
- Survivors have 20 times higher risk of developing a second cancer
$3.2 billion spent each year on treatment
When including cancer of the larynx in the category of oral cancer, statistics increase:
- 54,000 new cases diagnosed in 2014 with 13,500 deaths per year.
TYPES OF HEAD AND NECK CANCER
About 85% of cancers in the group known as head and neck cancers, begin in the oral cavity. Brain cancer is not included as it is a category unto itself. There are five main types of head and neck cancer:
- Laryngeal and Hypopharyngeal Cancer – the larynx (voice box), located at the top of the trachea is a tube shaped organ, the hypopharynx (gullet) surrounds the larynx
- Nasal Cavity and Paranasal Sinus Cancer – paranasal sinuses surround the nasal cavity.
- Nasopharyngeal Cancer – nasopharynx is the air passageway at the upper part of the throat behind the nose
- Oral and Oropharyngeal Cancer includes the mouth, tongue, middle of the throat from tonsils to tip of larynx
- Salivary Gland Cancer
Thyroid cancer is also a growing concern in US. Incidence rates for both men and women have been increasing and researchers are working to figure out why
- 63,000 adults. estimated diagnosis 2015
• 15,000 men
• 48,000 women
- Almost 2,000 estimated deaths
• less than 800 in men
• less than 1000 in women
- 5th most common cancer in women
- 98% five-year survival rate for papillary, follicular, medullary
- 55% five-year survival rate for cancer that has spread outside the thyroid to other parts of the body
- Anaplastic thyroid cancer is associated with a much lower survival rate
RISK FACTORS FOR THE DEVELOPMENT OF ORAL & THYROID CANCERS
The mortality rate for oral cancers is particularly high, not because it’s harder to discover, but because it’s most often discovered in advanced stages of development. It is important to note that 1 out of 4 oral, head and neck cancers, especially in patients over the age of 50, are detected in patients who do not smoke or drink alcohol. It follows then that every patient should be screened for oral cancer at least once per year, more often for those with increased risk. In addition, we must be familiar with risk factors for the development of thyroid cancer.
For My Colleagues – WALKING THE TALK!
I hope by now you are asking yourself, “What can I do?” The very best plan of action is to immediately start including extra oral exam followed by an intra oral exam for every patient. Here are some suggestions to get you started.
- SET A PROTOCOL: Doctors, you must instruct your Hygienists: tell them to begin to provide extra ad intra oral exams for everyone, lead by example. You should be the one to provide this service for every new patient.
- HANDS-ON PRACTICE:
- Visit sixstepsscreening.org and follow the steps for intra oral exam.
- Tongue and Gauze
- Lip & Cheek Roll
- Double-Digit Probe
- Palate Tickle
- Neck Caress
- Tonsil Ahhhh
- EDUCATE: Tell patients about the risk factor for head and neck/thyroid cancer
- Tobacco Cessation 1.800.QUIT-NOW/www.Smokefree.gov
- Be concise in description and avoid technical terms
- Use benefit statements: ‘early detection, ability to see beyond the naked eye’
- Inform the patient of what you are viewing to alleviate anxiety
- Be prepared to answer questions (Role Play!)
Providing extra and intra oral exams for every patient is not only the standard of care, it’s the responsibility of both the dentist and the dental hygienist. The importance of systematic approach to the oral, head and neck cancer examination cannot be overstated. It is indeed lifesaving! I’m part of the change! I believe oral cancer screening saves lives! Do you?