Oral cancer is on the rise: Consumer Reports falls short

April 1, 2013
Oral cancer survivor Eva Grayzel strongly disagrees with the recommendations in Consumer Reports that an oral cancer screening is "unnecessary." She says, "If you consider the time a screening takes, the cost, and the lack of education about the early signs of this disfiguring disease, I think you will agree with me."

The buzz about human papillomavirus (HPV) hit the oral cancer world hard and fast: it’s the fastest growing cause of oral cancer. No longer is the male over the age of 60 who uses tobacco the only patient who requires a screening for oral cancer. Now, it includes younger patients. The new face of oral cancer is the one who doesn’t smoke or drink. The new face of oral cancer looks more like mine.

My name is Eva Grayzel. At age 33, I was diagnosed with stage IV squamous cell carcinoma of the lateral tongue. I never smoked and rarely consumed alcohol. When the painful ulcer on the side of my tongue near my front molar didn’t heal, I went to the first of many visits to my dental practice as well as to a group of oral and maxillofacial surgeons.

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Nine months later, after being bounced back and forth between dentists and oral surgeons with recommendations to use salt water rinses and pain-relieving gels, shave my molars, and/or wear a night guard to protect my tongue from the constant irritation of my teeth, I was finally diagnosed at a major medical center with stage IV oral cancer.

I strongly disagree with the recommendations in Consumer Reports that an oral cancer screening is "unnecessary." If you consider the time a screening takes, the cost, and the lack of education about the early signs of this disfiguring disease, I think you will agree with me.

Let’s start with the author of the Consumer Reports article, Dr Jeffrey Starke, a pediatrician and infection control officer at Baylor College of Medicine in Texas. Cancer is not his expertise. The oral cavity in the world of medicine is considered dental and not medical. A more reliable source about screening the oral cavity for cancer should be from an oral and maxillofacial surgeon, oral pathologist, or dentist with an oral medicine certification. The American Dental Association recommends every dental exam include an oral cancer screening.

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Let’s look at the pros and cons of an oral cancer screening. First, consider the time factor. Many tests require a significant amount of time like a mammogram, which Dr. Starke recommends. In addition to the time it takes to take all the images of both breasts, women need to undress and redress, using limited space in the facility. Oral cancer screenings take about three minutes, and can be done easily during their dental chair time.

Now let’s consider the cost. Most screening tests require expensive equipment and a microscopic evaluation involving additional specialists. Oral cancer screenings only require a bright light, gauze, tongue depressor, mirror, and a commitment to save lives. It’s like having your blood pressure taken, or your heart listened to with a stethoscope.

The Pap smear, a test Dr. Starke recommends, is expensive. However, when it became the standard of care, the death rate diminished to close to zero. Cervical cancer is similar to oral cancer. The quality of the tissue is similar as is the moistness of the location. If we had a standard of care for screening the mouth, whether it is by dental or medical professionals, more oral cancers would be caught in their early stages that would in turn improve the morbidity and the five-year survival rate.

If my treating dental professionals knew more about the growing number of young nonsmokers being diagnosed, I’m sure they would have suspected the possibility of cancer. A late diagnosis, which is unfortunately very common for oral cancers, can steal everything which makes life worth living: the ability to speak, communicate, socialize, and eat. I’m one of the lucky ones to regain my voice and articulation, which is why I feel an obligation to speak out and save lives. For the couple of minutes it takes to do an oral cancer screening, wouldn’t it be worth it to get one?

One major difference between almost every screening test mentioned in the article, and the screening for oral cancer is EDUCATION. Most people know to visit a doctor if they notice an unusual shaped spot on the skin, feel an abnormal lump in the breast or prostate, see blood in their stool or saliva, or experience unusual bloating or pain. After all, it may be cancer.

The education doesn’t exist for the general public when it comes to oral cancer. Almost everyone gets canker sores, and almost no one knows that a persistent sore is a sign of oral cancer. Most people get hoarse or have a sore throat, but do they know that if it’s a chronic condition it could be a sign of oral cancer? Probably not. Is anyone doing a self-exam in their own mouths, as some of us do for the breast and prostate? My guess again would be no.

I just met an anesthesiologist who works in a cancer hospital in California and was recently diagnosed with late-stage oral cancer. I asked, “When you visited your dentist with the lump on the floor of your mouth, did you have any idea it could be oral cancer?” He did not. When I asked, “Then, when you went to an ENT months later for hoarseness, did it occur to you that oral cancer was a possibility?” It did not. When I asked, “When you developed the lump in your neck another few months later, did it cross your mind it could be oral cancer?” His answer was, “No.”

When I asked if he received an oral cancer screening when he visited his dentist, he said, “If I got a screening, I wouldn’t be in this dire situation!”

Celebrities aren’t immune to oral cancer either. Gwyneth Paltrow’s father died of oral cancer. He was friends with Michael Douglas and even though Douglas had numerous appointments for his hoarse voice, his treating physicians didn’t realize they were dealing with oral cancer until it was in its late stage.

The point is, even some medical professionals don’t recognize the early signs of oral cancer ... and often they don’t even know the LATE signs! Where does that leave the general public if we are not even getting a regular oral cancer screening?

With the new association between HPV and oral cancer, it’s more critical than ever that every patient receive an oral cancer screening. The only way to prevent a late diagnosis of the disease is through education and screening. Just like we know to get a mammogram for breast cancer and a Pap smear for cervical cancer, patients need to hear the words, “I’m performing an oral cancer screening.” Patients need to be educated about what dental professionals look for during a screening.

The influential nature of printing a statement about the importance of oral cancer screenings in Consumer Reports can have deadly repercussions on the general public who know so little about this often debilitating and deadly disease.

Oral cancer can be, literally, right under your nose and you don’t need a lab test to detect it. A standard intraoral and extraoral exam isn’t an invasive test; it doesn’t hurt, and only takes minutes. You don’t even have to take your clothes off! Oral cancer is very survivable when diagnosed early. With a knowledgeable health-care provider, oral cancer can even be diagnosed in a precancer stage ... but not if no one is checking.

Eva Grayzel is the founder of the oral cancer awareness campaign www.SixStepScreening.org. She speaks internationally, motivating health-care professionals to perform oral cancer screenings and educate patients about the early signs.