By Michelle Kratt
I am sure that you have heard of HPV (human papillomavirus)? Did you know that some types of HPV can cause oral cancer? Recent studies in the United States indicate that HPV is now the leading cause of head and neck cancers at 64%, even rising above smoking, tobacco chewing, and drinking alcohol.
Oral cancer accounts for 2% to 4% of all cancers diagnosed annually in the United States. The number of oral cancer cases is steadily rising, and today it is showing up in younger patients. More than 37,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause more than 8,000 deaths, killing roughly one person per hour, 24 hours per day. Of those 37,000 newly diagnosed individuals, only slightly more than half will be alive in five years. The death rate for these types of cancer is so high not because it is hard to discover or diagnose, but because it is caught too late in its development, with 70% found in Stage III or IV.
Aside from the usual risk factors — tobacco and alcohol, ultraviolet light, poor nutrition, immune system suppression, lichen planus, and history of cancer — the addition of HPV as a risk factor for oral cancer has made it extremely difficult to easily define high-risk individuals (25% of mouth cancers and 35% of throat cancers are caused by HPV). Another risk factor, although controversial, is ill-fitting dentures. It has been suggested that long-term irritation of the lining of the mouth caused by poorly fitting dentures is a risk factor, since poorly fitting dentures can tend to trap agents that have been proven to cause oral cancer, such as alcohol and tobacco particles.
The dental community is the first line of defense against oral cancer. According to the ADA, 60% of the U.S. population sees a dentist every year. Unfortunately, published studies show that currently less than 15% of those who visit the dentist regularly report having had an oral cancer screening. Screening everyone is the only way to find oral cancer at the very early stages and decreasing the death rate.
It is important that everyone from the dental community to the public population realize that a visit to the dentist is not just to have your teeth cleaned or have a crown done. It is actually a matter of life and death. Dental examinations, including an oral cancer screening when done properly, will save lives.
Where should you begin?
- Instill a call to action for patients to come back to your practice and be screened annually, just as they do with their physician for other diseases.
- Screen EVERYONE regardless of their age or traditional risk factors. You cannot tell who has HPV; often patients who have this virus won’t have any sores or other visible signs.
- Educate your patients and your community about oral cancer and its risk factors.
- Educate yourself and your team. It is always best to update your screening skills and maybe invest in some of the diagnostic technology out there (ViziLite, Microlux D/L, VELscope, and Orascoptic DK).
Remember, it’s not your job to diagnose. Your job is discovery of suspect tissue and conditions. Perform a thorough exam and know what to look for. Many benign conditions in the mouth mimic oral cancer. When you find an abnormality, it is important to find out if it has persisted for more than two weeks. Conditions that do not resolve within two weeks deserve a definitive diagnosis through the appropriate referral process. It’s important to reassure the patient that most things like this are not serious, but it is better to be safe and know for sure. By doing so, you’ll find out that what you saw was nothing at all or that you’ve saved the patient’s life.
When it comes to oral cancer and saving lives, the primary responsibilities of the dental community are creating awareness, discovery, diagnosis, and referral. The most important step in reducing the death rate from oral cancer is early discovery. There is no one who has a better opportunity to make an impact better than dental professionals.
April is Oral Cancer Awareness month. If you are not already screening your patients with one of the many products that are now available, this is the perfect time to start. The Oral Cancer Foundation has great marketing products, such as awareness buttons, for your team and patients.
For more information on implementing an oral cancer screening program in your practice, visit www.oralcancerfoundation.org or www.ada.org.
Michelle Kratt brings more than 20 years of dental office experience to her new role in administration and practice-management consulting with Amy Smith Consulting, LLC. Michelle’s history and experience in dentistry is impressive. She is a fellow of the American Association of Dental Office Managers (AADOM) and the Association of Dental Implant Auxiliaries. She is also the founder and president of NEDAT Study Club for dental administrative team members, and was recently recognized by AADOM for her efforts in this capacity. She can be reached at [email protected] or [email protected].