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April is Oral and Head and Neck Cancer Awareness Month, a time to pause to consider the ravages of this disease and rededicate our efforts as oral health care providers to do our part to find oral and oropharyngeal cancers at an early stage.
Hopefully, by now, each of us is well aware of the importance of our role to search for signs of oral and head and neck cancer in each of our patients and how we can make a significant impact in the staggering statistics associated with this disease: One American dies each hour of every day from oral cancer.
When found at an early stage, the survival rate is between 80 and 90 percent; but, unfortunately, most oral cancers are discovered at an advanced stage and, as a result, 43 out of every 100 people with oral cancer will die from their disease within five years of diagnosis.
But is that it? Is that all we need to know about oral cancer…to know the stats, and recommit to doing thorough head and neck examinations for all of our patients only to all back into our once-in-a-while-when-I-think-about-it screenings by mid-May? I hope not! This year, I challenge you to learn more about oral and head and neck cancers. Realize that you are a soldier on the front lines against a disease that forever changes the lives of those who are diagnosed with it. Make your commitment against oral cancer last 12 months-not 12 days-then recommit each and every April to do more to make an positive impact on the health, not just the oral health, of your patients.
So, as you strive to learn more about oral and head and neck cancer, here are five things to get you started: my top five reasons to really think about oral cancer:
5. Three letters: H - P - V
With the increased prevalence of infections of the human papilloma virus (HPV), we are seeing occurrences of oropharyngeal cancers in younger and younger patients-sometimes in young adults in their 20s or 30s. HPV is the most common sexually transmitted infection in the U.S. and can be transmitted through genital contact including oral sex. According to Centers for Disease Control and Prevention (CDC), almost every sexually active person will acquire HPV at some point in their lives. For most, the virus is cleared naturally by the immune system, but in others, it becomes a catalyst that leads to cellular changes causing cancer. Many people with HPV-related oropharyngeal cancers are otherwise healthy and do not match the long-accepted demographic profile of an older male with a history of smoking tobacco and drinking alcohol. For this reason, it is imperative that a thorough head and neck exam be completed for each patient who may be sexually active. Know the warning signs for oropharyngeal cancer as they are sometimes difficult to observe clinically without the aid of nasal endoscopy or a flexible laryngoscope. Even though it may be an uncomfortable discussion, make sure your patients are aware of the risks of HPV-related oropharyngeal cancer and that the causative factor is a sexually-transmitted infection. For more information about HPV, visit the CDC site at cdc.gov/hpv/index.html or the Oral Cancer Foundation at oralcancerfoundation.org/hpv/.
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4. New weapons to help wage war against cancer
Research built on the Human Genome Project has provided new tools for dentists and hygienists to aid in conducting the most advanced and individualized thorough head and neck examinations ever. A chairside test built upon more than a decade of research from the National Cancer Institute’s Early Detection Research Network is now on the market. The test measures salivary mRNA transcriptome markers that are discriminatory for oral squamous cell carcinoma. By utilizing information regarding certain gene expression in the presence of cancer, specifically oral squamous cell carcinoma that accounts for approximately 90 percent of all oral and head and neck cancer, the test can detect the presence of early stage squamous cell carcinoma-even carcinoma in situ-and hopefully avoid unnecessary biopsies, or, even better, prompt an urgent biopsy of a lesion that previously might have been approached with a wait-and-see attitude.
3. Oral cancer doesn't affect just the mouth.
Oral cancer affects the whole person. While the primary tumor may reside in the oral or oropharyngeal anatomical structures, so often, the malignant cells will travel to the lymphatic system. Even the most advanced treatment modalities often come with life-changing effects that prevent pre-cancer function in simple daily tasks such as swallowing and speaking. Immunosuppression and thrombocytopenia may place the oral cancer patient going through chemotherapy at great risk for systemic life-threatening infections or bleeding issues, while external beam radiation therapy may cause blistering of the skin and severe burns and loss of facial hair in men. Oral effects often include long-term or permanent xerostomia, oral mucositis and an increased risk for osteoradionecrosis. Non-oral long-term effects such as carotid stenosis, muscular atrophy and esophageal constriction are often experienced by survivors. And these are just the physical changes. Consider the psychological stress of fighting a potentially deadly disease or the emotional distress of not being able to eat dinner with your family at your favorite restaurant because you cannot tolerate the spices in the food or you are afraid you might choke to death if the food is not pureed. Imagine the loss of identity for those who wake up every morning and see someone else looking back at them in the mirror-a person they do not know-a person does not even resemble their reflection prior to reconstructive surgery. Why wouldn’t we, as health care professionals, do all that we can to prevent anyone from having to suffer through this kind of agony?
2. The survivors’ new normal
Fortunately, as advances in oncology care are realized, more people are surviving oral and head and neck cancers. Yes, it is true and terribly sad that we lose many good people to this ugly disease each and every day, but for those who live beyond oral cancer, we must be ready to meet their needs. Oral and head and neck cancer survivors deserve our attention to their unique needs. They need oral health care providers who understand their journey, know the limitations of care that are applicable to them as individuals based solely upon their treatment. Cancer survivors of all types are realizing that individualized medicine is the new norm. Individualized care is not some “next wave” that we will see 20 years from now-it is here now. Prepare yourself and your staff to know the needs of oral and head and neck cancer survivors. Be able to offer to them the excellence in care that you provide the rest of your patients by understanding their unique needs. Be willing and able to meet them where they are and realize you can improve the quality of life for an oral cancer survivor by providing him or her the oral health care he or she wants and deserves.
1. You will see these patients in your office.
With the aging of the Baby Boomer generation, we are seeing an increase in the number of cancer cases. It is estimated that by the year 2024, more than 19 million people in the U.S. will be living with cancer, up from approximately 14.5 million in 2014. As more and more patients are seeking oncology care close to home, there is a new need for dentists and hygienists to know how to care for oral cancer patients. These will be your patients of record…people you have known for years, with whom you have an established doctor/patient relationship. They will want you to take care of them when that time comes. Be prepared. Know how cancer treatment affects not only the intraoral structures, but also how you must be prepared to play a role on their cancer care team. Form alliances with medical and radiation oncologists in your community. Know how you can, and should, be there to manage the oral health of your patient during their battle with cancer and beyond.