Early screening, diagnosis, and treatment planning saves lives.
Every hour of every day in America someone dies of Oral Cancer. Oral Cancer is the sixth most common diagnosed form of cancer in the United States. Presently 30,000 patients are diagnosed annually with oral cancer. The 5-year survival rate is only 50%, accounting for 8,000 deaths each year. Oral Cancer risk factors include tobacco use, frequent and/or excessive alcohol consumption, a compromised immune system, past history of cancer, and the presence of the HPV virus.
The American Dental Association states that 60% of the US population sees a dentist every year. Just doing "opportunistic" cancer screenings of the existing patient population which visits a dental office every day, would yield tens of thousands of opportunities to catch oral cancer in its early stages. One of our goals is to initiate an effort within the dental community to aggressively screen all of the patients who visit their
When found early, oral cancers have an 80 to 90 % survival rate. Unfortunately at this time, the majority are found as late stage cancers, and this accounts for the very high death rate of about 50% at five years from diagnosis.
The death rate for oral cancer is higher than that of cervical cancer, Hodgkins disease, cancer of the brain, liver, testes, kidney, or skin cancer (malignant melanoma). If you expand the definition of oral cancers to include cancer of the larynx, for which the risk factors are the same, the numbers of diagnosed cases grow to 41,000 individuals, and 12,500 deaths per year in the US alone.
The death rate associated with this cancer is particularly high due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized area. Besides the metastasis, at these later stages, the primary tumor has had time to invade deep into local structures. Oral cancer is particularly dangerous because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease, have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for 5 to 10 years after the first occurrence. There are several types of oral cancers, but 90% are squamous cell carcinomas.
Age, gender, race, and ethnicity
While he majority of people are over the age of 40 at the time of discovery, it does occur in those under this age. Exact causes for those affected at a younger age are now becoming clearer in peer reviewed research.
From a gender perspective, for decades this has been a cancer which affected 6 men for every woman. That ratio has now become 2 men to each woman. Again, while published studies do not exist to draw finite conclusions, we will probably find that this increase is due to lifestyle changes, primarily the increased number of women smokers over the last few decades.
The human papilloma virus, particularly versions 16 and 18, has now been shown to be sexually transmitted between partners, and is implicated in the increasing incidence of young non-smoking oral cancer patients. This is the same virus that is the causative agent in more than 90% of all cervical cancers.
Smoking prevalence remained at the highest among American Indians/Alaska Natives at 40 percent in 1998. Prevalence among African-Americans (24.7 percent) and Caucasians (25.0 percent) remained higher than among Hispanics (19.1 percent) and Asians/Pacific Islanders (13.7 percent).
It is a cancer which occurs twice as often in the black population as in whites, and survival statistics for blacks over five years are also poorer at 33%, versus 55% for whites.
Risk Factors
SMOKING - Oral Cancer & Tobacco
When tobacco and alcohol use are combined, the risk of oral cancer increases 15 times more than non-users of tobacco and alcohol products."
Worldwide, 47 percent of men and 12 percent of women smoke a total of 6 trillion cigarettes a year. In the U.S., 600 billion cigarettes are smoked every year." (World Health Organization, 1999).
About four million people die worldwide each year as a result of smoking. In the United States, tobacco use is responsible for nearly one in five deaths, killing more than 400,000 Americans each year. This is more than the number of people who would die every year if three jumbo jets crashed each day with no survivors."
Secondhand smoke
Secondhand smoke kills as many as 62,000 Americans annually from heart disease. (CalEPA, 1997).
Measurements of the carbon monoxide (CO) concentration at a cigar party and a cigar banquet in a restaurant showed indoor CO levels comparable to those measured on a crowded California freeway."
"Some 88% of the non-smoking U.S. population has cotinine(indicator of exposure to tobacco smoke) in their blood." (Pirke et al., 1996).
Tobacco smoke is as dangerous to non-smokers as firsthand smoke is to smokers themselves. The EPA has classified tobacco smoke (containing 43 carcinogens) as a Class A carcinogen - a known cause of human cancer.
ABOUT NICOTINE
"Scientists have found that nicotine is as addictive as heroin, cocaine or amphetamines, and for most people, more addictive than alcohol," states the article "Nicotine, Harder to Kick than Heroin," published in the New York Times Magazine.
"Nicotine is similar in all critical measures to prototypic drugs of abuse such as cocaine, morphine and heroin."
"Nicotine is a poison used as an insecticide."
Nicotine is the agent in tobacco that is capable of causing addiction or dependence. Cigarettes have on average, a total nicotine content of about 8.4 milligrams, while many popular brands of cigars will contain between 100 and 200 milligrams of nicotine. When inhaled, nicotine gets to a person's brain in seven seconds, twice as fast as intravenous drugs. Nicotine affects the brain and central nervous system by changing the level of neurotransmitters and chemicals that regulate mood, learning, alertness and ability to concentrate. Nicotine increases the heart rate, but it constricts the blood vessels, thereby reducing circulation. It can act like a stimulant or a sedative, depending on the level of nicotine in the body and time of day. Smoking also causes the release of endorphins, which create a tranquilizing effect. A tolerance for nicotine begins to develop with the first dose. Therefore, the level of use must increase to maintain its effects and to prevent withdrawal symptoms.
tobacco use in all its forms is number one on the list of risk factors. At least 75% of those diagnosed are tobacco users.When you combine tobacco with heavy use of alcohol, your risk is significantly increased, as the two act synergistically.Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others.
Quitting Tobacco
“Quitting smoking is easy. I've done it a thousand times." - Mark Twain
In 1994, an estimated 69 percent of U.S. smokers wanted to quit. In fact, 46 percent attempted for at least one day. (American Cancer Society)
Cigarette smokers die younger than nonsmokers. In fact, smoking decreases a person's life expectancy by 10-12 years. Smokers between the ages of 35 and 70 have death rates three times higher than those who have never smoked. Smoking causes everything from premature wrinkling of the skin, bad breath, and yellow nails, to heart disease, emphysema, chronic bronchitis, peripheral vascular disease, and cancer. It's never too late to quit.
People who stop using tobacco, even after many years of use, can greatly reduce their risk of all smoking related illnesses, including oral cancer.
Besides these, there are physical factors such as exposure to ultraviolet radiation, prolonged exposure to sunlight, and exposure to x-rays.
Biological factors include viruses and fungi, which have been found in association with oral cancers. The human papilloma virus, particularly HPV16 and 18, have been implicated in some oral cancers. HPV is a common, sexually transmitted virus, which infects about 40 million Americans. There are about 80 strains of HPV, most thought to be harmless. But 1% of those infected, have the HPV16 strain which is a causative agent in cervical cancer, and now is linked to oral cancer as well.
Possible signs and symptoms
In its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your dentist or doctor can see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages.
It may appear as a white or red patch of tissue in the mouth, or a small indurated ulcer which looks like a common canker sore. Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional. Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. Individuals that use chewing tobacco, are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingiva) covering the lower jaw (mandible).The base of the tongue at the back of the mouth, and on the pillars of the tonsils, are other sites where it is commonly found. If your dentist or doctor decides that an area is suspicious, there are several ways to go about detecting oral cancer. Early signs may or may not be detectable through visual or radiographic examination. However we use state of the art technology for early detection and treatment, which could possibly be missed during regular dental examination. Due to complex nature of the way lesions present in oral cavity, it can sometimes be challenging to recognize potential cancerous and pre cancerous conditions by mere visual examination and the problem can go undetected for long period of time. Therefore to help our patients we at Sunshine Dental PC, have FDA approved early detecting tools to help recognize unknown,unseen early signs of oral cancer. . However the most reliable tool is to have a biopsy done of a suspected lesion. It is possible that your general dentist or medical doctor, may refer you to a specialist to have the biopsy performed. This is not cause for alarm, but a normal part of referring that happens between doctors of different specialties.
Treatment
After a definitive diagnosis has been made and the cancer has been staged, treatment may begin. Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative specialists. The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, or for those patients who have confirmed distant metastasis of the disease.
Prior to the commencement of curative treatment, it is likely that other oral health needs will be addressed. The purpose is to decrease the likelihood of developing post therapeutic complications. Teeth with poor prognosis from periodontal problems, caries, etc. may be extracted. This avoidance of post radiotherapy surgery is important as it can sometimes induce osteonecrosis, a condition which can develop when tissue damaged by radiation exposes the underlying bone. The bone, which has lost its ability to efficiently repair itself due to reduced blood supply, again from radiation exposure, yields a chronic and difficult to treat situation. A thorough prophylaxis, or cleaning will likely be done as well.
Whether a patient has surgery, radiation and surgery, or radiation, surgery, and chemotherapy, is dependent on the stage of development of the cancer. Each case is individual.
The above information has been compiled from following references:
Oral Cancer Foundation May 2007, LED Dental Inc., May 2007.
The above information has been compiled from following references:
Oral Cancer Foundation May 2007, LED Dental Inc., May 2007.
For Existing Sunshine Dental Patients - In the Event of a Dental Emergency Call: (315) 681-0100