Recently, headlines have reported a “very concerning” increase in the number of younger patients in the UK with mouth cancer despite the lack of an obvious reason for a spike in cases. Traditionally, mouth cancer has been considered by many to be an “old man’s disease” – something that young people and women should be less concerned about – with research suggesting that only 20 per cent of women think that they are at risk. Because of this, some patients in these demographics might be flying under the radar. It has been suggested that women, therefore, often miss out on an early diagnosis in a similar way to other supposedly “male” conditions such as cardiac diseases or heart attacks. Some research suggests that, as tobacco use is decreasing, human papillomavirus (HPV) might be to blame for the increasing rates of mouth cancer in younger people.
HPV: what are the risks?
HPV is a virus and there are many different types. It can infect the mouth and throat, with some types (most often HPV 16) leading to mouth and oropharyngeal cancer. In the UK, HPV is thought to be responsible for around 25 per cent of cancers of this kind.
Whilst HPV can be contracted by anyone, with most adults having some form of the virus during their lives, and 10 per cent of men and five per cent of women having it at any given moment, it is generally associated with cervical cancer in women.
This is problematic as it may mean that patients are completely unaware of their level of risk for both HPV and oral cancer, together and separately. Because HPV increases the risk of some types of cancer, including mouth cancer, and causes almost all cases of cervical cancer, the HPV vaccination was developed to help prevent cancer caused by the virus. It is offered to all children in the UK who are between the ages of 11-13.
A study from 2021 found that rates of cervical cancer were reduced by almost 90 per cent in women in their 20s in England who were offered the vaccine at ages 12-13.
Protecting everybody’s oral health
The HPV vaccine has been instrumental in reducing the rates of the virus in the UK population.
However, it’s important that patients understand the risks the virus presents and whether they are at increased risk of mouth cancer. By making patients aware of the signs and symptoms of the early stages of mouth cancer, they will feel more confident about reporting any concerns to you quickly. Because early signs can resemble benign issues, like mouth ulcers, some patients might feel that they are wasting your time by flagging the unusual lesion. As such, it’s important to reassure patients that if they notice anything out of the ordinary and it lasts for three weeks or more, they should book an appointment.
In addition to lingering mouth ulcers, other early signs of mouth cancer might include a red or white patch, a lump, pain, difficulty swallowing, croaky voice, or weight loss. Dental professionals should be checking their patients’ mouths and tongues for these signs at every appointment, and it’s helpful to make patients aware of what you’re checking for so that they can monitor their own health at home when brushing their teeth.
Detecting mouth cancer early
While clinicians will carry out examinations for oral cancer at every appointment, it is important to know what to do if they find something suspicious. Because the early symptoms can be difficult to spot, some dental professionals may doubt themselves about what they’ve seen. As such, it’s important to establish a patient’s level of risk and carry out the right tests before referring the patient for a biopsy or further testing. Additionally, effective tests will help ensure dental professionals do not miss anything. Biopsies are invasive procedures, so it’s important to undertake all necessary pre-diagnostic tests before referring patients.
The BeVigilant OraFusion System, available from Total TMJ, is a solution. The pre-diagnostic test is designed to be used at point of care to establish the likelihood of a cancerous lesion in 15 minutes or less. The device analyses saliva to produce a result of high, moderate, or low level of risk, by detecting biomarkers associated with oral cancer. This is a fantastic system for clinicians who would like to feel more confident about their decision-making when they spot an unusual lesion, offering improved certainty and allowing oral cancer to be detected in stages I and II.
HPV can affect anybody, so it’s important to keep patients informed about the signs and symptoms of oral cancer to help ensure any early signs of the disease are detected as early as possible.
References are available on request.