Actor Michael Douglas' recent revelation that he has stage IV oropharyngeal cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations.
— Brian Hill, executive director,
Oral Cancer Foundation
The actor's cancer includes a walnut-sized tumor at the base of his tongue, and he will require radiation therapy, chemotherapy, and surgery. Douglas says his doctors told him he has an 80% survival rate if it hasn't spread to his lymph nodes.
While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to the human papillomavirus (HPV). There are approximately 130 versions of HPV but only nine cause cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation.
"Tobacco is no longer the only bad guy," he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it continues on this trend line, it will replace tobacco as the primary cause of oral cancers."
Dentists can play a key role in catching the disease in its early stages if they check for it during examinations, Hill pointed out. "But many dentists think it's such a rare disease that they don't bother to screen for it," he said. "Most Americans have never even heard of oral cancer, but it's not as rare or uncommon as people would like to think it is. This is why an opportunistic screening by the dental community is so important."
Hill, a nonsmoker, got the same diagnosis as Douglas in 1998 and underwent radiation therapy, chemotherapy, and surgery. Since Hill's oral cancer had metastasized to both sides of his neck by the time it was discovered, surgeons removed the right side of his neck to remove the lymph nodes there. He has been cancer-free for 10 years and said there are a lot of stage IV survivors out there.
"I'm on this side of the grass and that's all that's important," he said, adding with a laugh, "I'm not pretty, but I'm still here."
Oral cancer screening tips
According to the Oral Cancer Foundation, an oral cancer screening includes a systematic visual examination of all the soft tissues of the mouth, including manual extension of the tongue to examine its base, a bimanual palpation of the floor of the mouth, and a digital examination of the borders of the tongue, and examination of the lymph nodes surrounding the oral cavity and in the neck.
"Any sore, discoloration, induration, prominent tissue, irritation, or hoarseness that does not resolve within a two-week period on its own, with or without treatment, should be considered suspect and worthy of further examination or referral," the foundation's website states.
In the last decade, the demographics of oral cancer have changed dramatically, according to Hill and other experts, pointing to the sexual revolution and accompanying increase in the prevalence of oral sex. Today almost half of those diagnosed with the disease are younger than 50 years old -- with some as young as 20, according to Hill -- and they are usually nonsmokers. According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer. The incidence in oral cancer patients younger than age 40 has increased nearly fivefold, with many patients with no known risk factors, according to the ADA.
"Social and sexual behaviors have changed," Hill said. "Oral sex is more common. The virus is spreading, especially among young people because sexual contact is more common, and this virus is not only ubiquitous in our society, but the mechanism of transfer is very simple."
Until 2000, scientists were unsure if HPV caused oral cancer, Hill said, but definitive research in 2000 revealed it as a distinct etiology for the disease, and more recent studies have supported this finding.
The disease is dangerous because often there are no symptoms in the early stages that a person might notice. "It's a very insidious disease," Hill explained. He recalled that it was not until a lymph node became swollen that Hill realized something was wrong. Even then, it was not painful, he said.
But an alert dentist will notice subtle signs and symptoms in a simple three to five minute visual and tactile exam, Hill noted. "There will be things he'll pick up on, and that's why we're urging that the dental community to become more involved in oral cancer screening," he said.
Approximately 36,000 new cases of oral cancer are diagnosed each year in the U.S., according to the ADA, and some 25% of those people will die of the disease. Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis, Hill said. Approximately 100 people in the U.S. will be diagnosed with oral cancer every day, he added, and one person will die every hour from it.
And when celebrities get oral cancer, it helps bring about much needed public awareness about the disease, said Hill, noting that, in addition to Michael Douglas, such luminaries as Sigmund Freud and Ulysses S. Grant have been among its victims.
"When somebody famous gets the disease, it finally gets the world's attention," he noted.
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