The number of new oral cancer cases is approaching 7,000 a year, which has grown by almost a third in the last decade alone. It is thought to result in more than 2,000 deaths every year, claiming more lives than testicular and cervical cancer combined. With these numbers still on the rise the importance of early diagnosis and treatment can not be stressed enough.
The key is education – both of the profession and public. General awareness of oral cancer and the danger it poses is very low amongst the population, and I don’t think people realise how widespread the disease is. As we know, the risk is increased with habits such as smoking or drinking, especially when the two are combined. The statistics also show that oral cancer affects more males than females, and age is another influential factor – the over 40s are a particularly high risk category. That said, we are finding an increased prevalence in women and younger people, as well as those who wouldn’t be considered high risk.
Early diagnosis and treatment have long been established as crucial in order to improve survival rates. Detection of oral cancer in its early stages has been proven to reduce mortality as it is more easily, and therefore more successfully, treated and the survival rate has been shown to increase from 50 per cent to 90 per cent.
HPV
The human papillomavirus (HPV) is a huge cause for concern in modern times. Up to eight out of 10 people will be infected with the virus at some point in their lives, but as main strains of the infection are mostly harmless, it is the types linked to cancer which are most worrying (usually type 16 and 18). HPV is one of the leading causes of cervical cancer, of which around 3,300 cases are diagnosed each year in the UK. HPV-16 has also been found to be present in more than 30 per cent of patients with oropharyngeal cancer, with links to oral cavity cancers as well. Due to the virus being spread through oral sex we are seeing a different demographic of patient presenting with regards to HPV related oral cancer. The increase in figures within this area has been so sharp that the number of oral cancer patients presenting with HPV might overtake those who are heavy smokers and drinkers.
The subject of vaccination against HPV infection remains somewhat controversial around the world, but some believe it is step in the right direction. The HPV Action group has been in discussions with the Government about offering the vaccine routinely to young boys as well as girls, following the example set by Australia with a blanket vaccination programme, in an attempt to eradicate the virus. The evidence is currently being reviewed by the Joint Committee on Vaccination and Immunisation, which is expected to publish a report and recommendation in 2015.
What can we do?
Particular attention needs to be given to opportunistic screening for oral cancer when seeing patients for routine checkups. It is important, and a mandatory element of CPD, to remain up-todate with the latest information and research findings in the field. We need to have the knowledge and the skills to recognise the early symptoms and follow the pathways in place.
As we don’t see it every day, it’s important to have the confidence to refer patients whenever a suspicion is aroused. A specific referral is also important – provide a description of the suspicious lesion, its size and shape, and make it clear that your concerns are with regards to potential oral cancer. The referral pathway will be accelerated because of this, ensuring the patient is seen by a specialist within two weeks.
The majority of professionals already include oral cancer checks as part of their every day patient screening, but vigilance remains vital as very early symptoms could still easily be missed. This simply comes back to training and professional education, and there are many places you can go to access information and advice.
The free oral cancer module, developed by IDH for the Association of Dental Groups, was designed to increase awareness amongst the dental profession and help tackle the rising numbers. It is highly interactive and available for free to all healthcare professionals in the UK. Dental professionals who wish to apply for a CPD certificate upon completion can do so for £25 excluding VAT, £5 of which goes directly to the British Dental Health Foundation. Following its success in 2013, the module is very comprehensive and includes videos from the chief executive of the BDHF, Nigel Carter, as well as an interview with a patient who shares their own story of fighting oral cancer. Providing various perspectives and once again highlighting the importance of early detection, a live demonstration of the screening process is also incorporated.
The statistics of oral cancer may still be rising, but by remaining vigilant, keeping up-to-date and raising awareness, we really can make a difference.