The American Cancer Society estimates about 34,300 new cases of oral cancer will be diagnosed in the U.S. this year. Men are affected more than twice as often as women (24,100 new cases in men versus 10,200 in women). The most common sites for oral cancer are the tongue, tonsils and lip. However, the cancer can occur on any part of the oral cavity, including the interior lining of the lips and cheeks, the gums, hard palate and the floor of the mouth below the tongue. More than 90 percent of the cancers are squamous cell carcinoma.
The most common risk factor for oral cancer is tobacco use. Researchers report that 80 percent of oral cancers can be linked to cigarettes, cigars, smokeless tobacco and pipes. Alcohol is also an important risk factor. However, the combination of tobacco and alcohol use is particularly risky, increasing the risk for oral cancer by as much as 100 times that of people who neither smoke nor drink. People who spend a significant amount of time outdoors are at higher risk for lip cancer. Some research also suggests a diet low in fruits and vegetables may be associated with an increased risk for oral cancer. Poor oral hygiene, improperly fitting dentures and rough tooth surfaces may also increase risk.
The death rate from oral cancer is decreasing. Still, 6900 men and women will die from the cancer this year. Of the 80 percent who survive, some will require extensive surgery to remove the cancer, leading, in some cases to disfigurement and diminished quality of life.
The Role of HPV
HPV refers to the Human Papilloma Virus, the virus that is commonly associated with cervical cancer. In the past few years, researchers have found an association between HPV and several other types of cancer, including oral cancer. The American Cancer Society reports that HPV may be the cause of up to 30 percent of all oral cancers. There are several strains of HPV, but types 16, 18, 31, 33, 35, 39, 45, 52, and 58 are considered to be the highest risk for cancer.
HPV doesn't cause any symptoms, so patients usually don't know they are infected with the virus. Now, there's a test available in many dental offices to detect HPV in saliva, called OraRisk HPV. Dawn Rickert, D.M.D., Dentist practicing in New Hope, PA, says the test is very easy to use. The patient gargles with a sterile saline solution for 30 seconds and spits the contents into a collection tube. She adds that it's important to do a thorough gargle to pick up cells from the back of the throat and base of the tongue, where HPV (if present) is commonly found. The collection tube is capped, labeled and placed in a shipping bag for mailing to a processing laboratory.
Rickert says the results are typically available within one to two weeks. The dentist gets an e-mail notification that the report is available and can be accessed online. If HPV has been detected in the sample, the report will list the type of strain and potential risk profile for oral cancer.
When patients have a positive report, Rickert brings them back into the office to discuss other oral cancer risk factors and to perform a thorough check for suspicious lesions. If no lesions are found, the patient will be retested in another 12 months. Even if the test is negative, Rickert still recommends retesting in another five years because patients can acquire HPV sometime in the future.
A positive test result isn't a guarantee that a person will develop oral cancer. However, it does mean there is a probable higher risk. Rickert says if a patient is found to be at higher risk, more frequent exams can be done to detect the cancer is early stages, when the chance of survival is much greater.
Research compiled and edited by Barbara J. Fister
For general information on oral cancer:
American Association of Oral and Maxillofacial Surgeons, http://www.aaoms.org/oral_cancer.php
American Cancer Society, http://www.cancer.org
National Cancer Institute, http://www.cancer.gov
Oral Cancer Foundation, http://oralcancerfoundation.org