Oral Cancer Screening for Today's Population:

Feature Article

Oral Cancer Screening

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for Today’s Population: Is Your Practice Up to Date

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by Jo-Anne Jones RDH

42,000 Americans will be diagnosed with oral or pharyngeal cancer this year. Oral cancer 8,000 lives killing 1 person/hour, 24 hours per day. Of those 42,000+ newly diagnosed individuals, only slightly more than half will be alive in 5 years. Worldwide, the problem is much greater with 640,000 new cases being found each year.

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The face of oral cancer is changing. As the dental communit y and an integral par t of the interdisciplinar y healthcare net work, we need to re-evaluate our clinical protocols related to oral cancer screening. No longer can we be confident in identif ying those of our patient population who may be at risk. A virally and sexually transmit ted etiology is fueling the escalation in orophar yngeal cancer.

when swallowing, unilateral ear pain, feeling of something caught in the throat, continual lymphadenopathy, slurred speech, asymmetr y in the tonsillar area and a tongue that tracks to one side when stuck out.

How can we as dental professionals combat this pandemic? First of all, by recognizing that there are cer tain high risk anatomical areas. For non-HPV related oral cancers the anterior segment of the tongue, the floor of the mouth and the palate are key areas to be examined closely. For HPV-related oral and orophyar yngeal cancer, the high risk areas include the posterior segment of the tongue, the tonsillar areas and the orophar ynx.

Is it time to explore the of fering of an adjunctive screening device that will enhance your assessment of the oral cavit y for earlier discover y of an abnormal lesion? We’re simply not making the inroads that we need to make. Oral cancer is still claiming too many lives too soon. Our patients deser ve to live long healthy lives. Our patients deser ve to be screened for early discover y of oral cancer. Our patients deser ve to be treated the way we would want to be treated.

Be proactive. You may just save a life.

Approximately 79 million Americans are infected with human papillomavirus (HPV), and approximately 14 million people will become newly infected each year.

Some HPV t ypes can cause cer vical, vaginal, and vulvar cancer among women, penile cancer among men, and anal and some orophar yngeal cancers among both men and women. Other HPV t ypes can cause genital war ts among both sexes. Each year in the United States an estimated 26,000 new cancers at tributable to HPV occur.

A comprehensive ex traoral and intraoral examination should be conducted on an annual basis at minimum. Magnification is critical! If you are not wearing loupes and bet ter still loupes and a headlamp you are going to miss the subtle changes that may be the first clinical manifestation of an abnormal lesion.

Other subtle signs we can’t af ford to ignore include, however are not limited to, hoarseness, continual sore throat not responding to antibiotics, pain or dif ficult y

The problem is that we are still discovering the majorit y of oral cancers or dysplastic lesions at a later stage. This greatly impedes the sur vival rate. The Journal of the American Dental Association published their findings regarding the limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma (OSCC). “On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs of ten are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions”.

Jo-Anne Jones is a proud supporter of the Oral Cancer Cause. Her mission is to elevate awareness within the professional community related to the changing profile of oral and oropharyngeal cancer. Jo-Anne has shared this powerful message with dental professionals across Canada, the US, the UK and Ireland.

Anne joins the 2013 Top 25 Women in Dentistry and is a Dentistry Today CE Leader.

This article has been reprinted as published on www.VELscope.com

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of dysplactic lesions were not discovered with white light examination Dysplastic lesions discovered with VELscope and undetected by white light alone Dysplastic lesions detected by both VELscope and white light

CLINICAL IMPLEMENTATION STRATEGIES With the aid of the VELscope® Vx System your practice can detect any oral mucosal abnormality that could be cause for concern including oral cancer and pre-cancer, as well as a wide range of other types of oral disease.

Introducing the VELscope® Vx to Patients We suggest that the patient become familiar with the following benefits of a VELscope® Vx exam:

State-of-the-art assessment tool for discovering oral health problems, including oral cancer.

Routine aid in the quest for both oral and systemic health.

Simple, painless, non-invasive, inexpensive (and possibly covered by insurance).

Adds only 2 minutes to a routine oral hygiene exam.

Early discovery leads to less invasive treatment and bet ter outcomes.

Using the VELscope® Vx Blue-Spectrum Light These are just a few of ways that the VELscope® Vx can be integrated into a practice:

To inspect oral mucosa for an abnormal fluorescence response.

Following the standard head and neck exam (i.e., white light exam and palpation).

As part of a robust oral assessment process.

Upon Discovering an Abnormality

The following steps will provide the best course of action for patients:

If an abnormality is discovered during the course of an exam, first at tempt to determine its cause based on all of the clinical information acquired during the oral assessment process.

If appropriate, af ter addressing the presumed cause, schedule a follow-up visit with the patient in 2-3 weeks to see if the abnormality has resolved.

Persistent oral lesions require further assessment that normally includes biopsy or referral for additional diagnostic evaluation.

Pride Institute 2013-14 “Best of Class” Technology Award: VELscope® Vx Enhanced Oral Assessment System

ABOUT ORAL CANCER

Every hour of every day in North America someone dies of oral cancer. Historically the primary risk factors for oral cancer included tobacco use, frequent and/or excessive alcohol consumption, a compromised immune system, and past history of cancer, with a high percentage of victims being males over the age of 40.

Benefits of Early Detection

We believe that the key to increasing the percentage of oral cancers discovered in early stages is two-fold:

First, to ensure that all patients are screened at least annually for oral cancer using the conventional “white light” exam (a visual and manual examination of the oral cavity, head, and neck).

Second, to supplement that conventional exam with an exam using an ef fective adjunctive screening device.

According to the SEER database:

Found early, oral cancer’s five-year survival rate is 80% to 85%.

Found late, oral cancer’s five-year survival rate is only about 50%

Oral Squamous Cell Carcinomas (OSCC) OSCC make up over 90% of all oral cancers:

Because of its appearance OSCC is dif ficult to dif ferentiate from the other relatively benign lesions of the oral cavity.

Early OSCC and potentially malignant lesions can appear as a white patch (leukoplakia), or as a reddened area (ery throplakia), or as a red and white (ery throleukoplakia) mucosal change under standard white light examination.

These cellular changes are of ten non-detectable to the human eye (even with magnification eyewear) under standard lighting conditions.

Of ten, when the lesion becomes visible, it has advanced to invasive stages.

The high mortality rate is directly related to the lack of early detection of potentially malignant lesions.

When diagnosis and treatment are performed at or before a Stage 1 carcinoma level, the survival rate is 80%-to-85%.

Early Screening May Affect Mortality Rates

The impact of HPV is one reason that, despite the decline in tobacco usage, oral cancer is one of the few cancers whose incidence rate has not improved in the past 50 years.

The cancers that have seen a major decline in the mortality rate have included colon, cervical, and prostate cancer, and the primary reason is increased screening and earlier detection. We feel there is every reason to believe that increased screening and earlier detection will have the same effect on the mortality rate of oral cancer.

Dental Explorer | Third Quar ter 2014

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