Time to take action… Against oral cancerUncategorised
Posted by: The Probe 3rd November 2020
November is recognised both within and outside the dental profession as Mouth Cancer Action Month. It has become a huge annual campaign run by the Oral Health Foundation, designed to raise awareness of the risks, signs and symptoms of oral cancer. This year it is, perhaps, even more important than it has ever been. With significant disruption to dental services across the country and restricted access to care, many patients will have missed routine check-ups in recent months. This means that someone with early signs of the disease could have gone under the radar.
Mouth and oropharyngeal cancers are diagnosed in approximately 1 in 75 men, and 1 in 150 women, with most people being over 60-years-old. That equates to an estimated 7,800 new cases in the UK each year.[i] Sadly, mouth and pharyngeal cancers are the sixth most common malignancies worldwide, with a high mortality rate of just over 50%.[ii]
Studies have suggested that reducing the risk factors for mouth cancer is an effective way of decreasing both morbidity and mortality of the disease. One of the most obvious places to start is with smoking cessation. This can lead to a 50% reduction in the risk of mouth cancer within five years and a decade after stopping, people approach a risk level similar to never-smokers.[iii]
Alcohol consumption is another major risk factor – roughly 30% of current mouth cancer cases are caused by excessive drinking.[iv] A 2018 study published in The Lancet demonstrated that any alcohol consumption came with a risk of developing some form of cancer, though the risks rise in-line with consumption levels.[v]
Human papillomavirus (HPV) is newer on the scene but is becoming a major risk factor for oral cancer. It is believed to be the primary cause of tonsillar cancer in the US and Europe.[vi] There are over 100 different types of HPV, 15 of which have been associated with cancers.[vii] The exact mechanisms are still being researched, but the virus is thought to cause infected cells to mutate, increasing the chance of them becoming cancerous.[viii]
Finally, there is evidence to suggest that diet could impact on risk of oral cancers as well.[ix] Being overweight or obese has been linked to a higher risk of cancers of the mouth, pharynx and larynx.[x]
Above and beyond the usual risk factors, the COVID-19 pandemic may have led to further issues. For example, the lack of access to routine dental care might have prevented an individual from seeking advice about a suspicious lesion. Without regular professional screening, someone else may unknowingly be showing the early signs of oral cancer, which could go completely undetected for some time yet. The best-case scenario is that this results in a delayed diagnosis, while missing it altogether is also possible if the patient is nervous about returning to the practice and therefore puts off a visit. Indeed, the impact of COVID-19 on oral cancer diagnoses has been highlighted by various professionals in the field[xi] and will be an area of importance when routine patient appointments gain momentum once again.
What can we do as a profession?
Despite the many tasks and challenges already faced by the dental profession, it is important that we don’t take our foot off the pedal when it comes to oral cancer. There are various ways of promoting the importance of early diagnosis, along with information on risk factors and self-checks, many of which can be quick, easy and low-cost. For example, why not use this year’s Mouth Cancer Action Month to run a social media campaign and post key facts each day or week? Alternatively, consider sending an e-newsletter out to your patient-base with the basic information they need.
The Oral Health Foundation organises several events and campaigns that you, your team and your patients can safely get involved with as well. These include the #BlueLipSelfie social media campaign, the Blue Ribbon Appeal or Blue Wednesday on 18th November (you could dress up in blue or turn your website blue for the day).
Aside from patient education, it is also crucial that the dental team are confident in their abilities to refer cases that appear suspicious. You can get your knowledge and skills up-to-date with the very latest information, research and concepts in the field by attending key sessions at the British Dental Conference and Dentistry Show 2021. There will be two days of lectures and interactive sessions presented by globally-leading speakers who will deliver a wealth of information and inspiration for all members of the team. Among the CPD available will be core subjects like oral cancer, as well as many other hot topics to help individuals and teams optimise their patient care and encourage the long-term stability of their practices. In addition, why not take the opportunity to meet representatives from the Oral Health Foundation on the exhibition floor for more information on how you could help raise awareness of oral cancer?
This has been a difficult time for many, but it’s important not to let oral cancer make someone’s life even harder where possible. This November, it’s time to take action.
The next British Dental Conference and Dentistry Show will be held on Friday 21st and Saturday 22nd May 2021, Birmingham NEC, co-located with DTS.
[i] Cancer Research UK. About mouth and oropharyngeal cancer. https://www.cancerresearchuk.org/about-cancer/mouth-cancer/about [Accessed August 2020]
[ii] The Mouth Cancer Foundation. Facts & figures. What is mouth cancer. https://www.mouthcancerfoundation.org/get-info/mouth-cancer [Accessed August 2020]
[iii] van der Waal I. Are we able to reduce the mortality and morbidity of oral cancer; some considerations. Med Oral Patol Oral Cir Bucal. 2013;18(1):e33-e37. Published 2013 Jan 1. doi:10.4317/medoral.18486
[iv] Cancer Research UK. Mouth and oropharyngeal cancer. Risks and causes. https://www.cancerresearchuk.org/about-cancer/mouth-cancer/risks-causes [August 2020]
[v] Griswold, MG et al. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018. 392(10152); 1015-1035. DOI:https://doi.org/10.1016/S0140-6736(18)31310-2
[vi] Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M. HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014;34(5):299-309.
[vii] NHS. Can oral sex give you cancer? https://www.nhs.uk/live-well/sexual-health/can-oral-sex-give-you-cancer/ [Accessed August 2020]
[viii] Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1-17. doi:10.1128/cmr.16.1.1-17.2003
[ix] NHS. Mouth cancer. Causes. https://www.nhs.uk/conditions/mouth-cancer/causes/ [Accessed august 2020]
[x] World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at www.dietandcancerreport.org [Accessed August 2020]
[xi] Al-Maweri SA, Halboub E, Warnakulasuriya S. Impact of COVID-19 on the early detection of oral cancer: A special emphasis on high risk populations. Oral Oncol. 2020 Jul; 106: 104760. doi: 10.1016/j.oraloncology.2020.104760
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