November is Lung Cancer Awareness Month

According to the American Cancer Society, here are more than 400,000 lung cancer survivors in the U.S. today.(1) Nationally, more than 160,000 deaths are expected, accounting for 28 percent of all cancer deaths. In 2012, more than 226,000 Americans will be diagnosed with lung cancer.(2) Symptoms include persistent cough, change of color or blood in phlegm, wheezing and recurrent pneumonia or bronchitis. Unexplained weight loss, bone pain, aching joints and a tired feeling can also be symptoms of the disease. According to the National Cancer Institute, tobacco smoke causes most cases of lung cancer and is by far the most important risk factor for lung cancer.(2) Whether or not you were a smoker, it’s important for you to protect your body from smoke. Avoid secondhand smoke from smokers near you. If you smoke, talk with an expert about quitting.(3,4,5) It’s never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer. Lung cancer forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

Source: National Cancer Institute So what does this have to do with us, as oral health care professionals? A beautiful smile not only looks great, but may also decrease the risk of developing certain cancers. A Japanese study reported that tooth loss was associated with greater risk of lung, esophageal, and head and neck cancers.(6)

After studying over 5,000 cancer patients in Japan and over 10,000 cancer-free participants, the results showed tooth loss greatly increased the risk of developing cancers. People with tooth loss were 136 percent more likely to develop esophageal cancer, had a 68 percent increased risk of developing head and neck cancer and a 54 percent greater chance of developing lung cancer. The researchers believe bacterial infection and inflammation caused by poor oral hygiene lead to tooth loss and could possibly be causing the increased risk for cancer. Poor diet may also lead to tooth loss. Oral problems have also been associated with increased risk for heart disease, stroke, diabetes, and pregnancy problems. This study, as many others, demonstrates how important it is for patients to strive for optimal oral health. It is important to brush and clean interdentally daily, as well as visits with dental professionals for regular examinations and preventive prophylaxis. Following a balanced diet is also vital for optimal health. One of the treatments for lung cancer is chemotherapy. It may be used alone, with radiation therapy, or after surgery. Side effects of chemotherapy usually involve cells that line the digestive tract, and can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Our role is to help patients with these problems.(7) We can also help with nutritional counseling and can suggest ways to help patients meet nutrition needs. The NCI booklet, Eating Hints, has many useful recipes and lists of foods that can help with side effects.(8)

Treatment for lung cancer with two intravenous bisphosphonates can cause both short- and long-term side effects. Short-term side effects that may occur immediately after receiving these drugs are flu-like symptoms such as fever, chills, and muscle aches. These side effects are often mild, do not last long, and tend not to recur following future bisphosphonate treatments.

The long-term side effects have been reported in some cancer patients treated with these intravenous bisphosphonates include osteonecrosis (ONJ). ONJ is literally “dead bone” of the jaw, and is a rare dental condition. It is an area of exposed jaw bone that shows no sign of healing after eight weeks. The condition can cause feelings of pain or numbness in the affected area.

As most cases of osteonecrosis of the jaw have occurred in patients treated with intravenous bisphosphonate drugs – mainly pamidronate (Aredia) and zoledronic acid (Zometa) – there is concern, but no proof, that ONJ is a side effect of these medications. Osteonecrosis of the jaw is much more likely to occur after an invasive dental procedure, such as an extraction.

Lung cancer patients should have a careful examination before starting therapy with pamidronate or zoledronic acid, and follow good oral health procedures.(9) Additional information can be found in the Bone and Cancer Foundation publication “Osteonecrosis of the Jaw – Information for Cancer Patients”.(10)