ORAL CANCER SCREENING

You may not normally associate your visit to the dentist with the possibility of oral cancer, this is in fact a reality and we are in the best position to screen you. Before we go into details of our screening process and protocols, here are a few facts you should know about oral cancer:

Oral Cancer is three times more prevalent than cervical cancer and, every year, twice as many people die from Oral Cancer as opposed to cervical cancer.

Treatments for Oral Cancer have not changed – or improved – over the past 30 years and survival rates remain relatively low.
Survival rates for Oral Cancer are entirely dependant on early detection. Quite simply, the earlier it is discovered, the better the survival rate.

Although the highest risk patients are those over 40 years of age with a history of chronic tobacco and alcohol use, the patient segment with the fastest diagnosis rate, are those 18 to 50 years without any apparent risk factors.  In fact, where we would see one oral cancer patient every 10 years, lately, we have seen as many as 2 per year!

In addition to alcohol and tobacco usage, high risk categories include:

• Genetic predisposition/family history to Oral Cancer
• Excessive exposure to sunlight
• Human Papilloma Virus* (This sexually transmitted virus is present in more than 20% of the population and is a known factor in Cervical Cancer. It is felt that this is one of the major factors in the unusual increase of oral cancer among middle-aged university-educated professionals.)

If you are a new patient, your examination will start with a review of your head and neck region. This will include palpation (to examine by touch) of all the structures around your jaws and will include lymph node palpation in the soft areas just under your lower jaw as well as along the anterior parts of your neck. (Please let us know if you have any unusual lumps, especially if they are relatively new). From the external palpation, we will visually inspect your facial skin as well as all areas of your mucosa (the moist skin in your mouth and throat) for any unusual lumps or changes in the surface characteristics of your mucosa.

What happens if we find something unusual?

Well, this is a lot more common than you may think and oral cancer is not the first thing that comes to mind. If we do find something that is unusual, we implement our Soft Tissue Protocol (STP), which may include any of the following:

• Obtain a history for the lesion (an area of abnormal appearance). It’s quite possible that it’s a result of biting trauma (taco chips, hard foods, etc) or due to a burn.
• See if it’s bilateral (on both sides). This would make it more likely a dermatological condition.
  Associate it with other dermatological conditions such as exzema, psoriasis, lichen planus, etc.
• Photo-documentation and Visual Fluorescence imaging (Velscope).
• Staining with a diagnositc dye, e.g. Toluidine Blue.
• 14 to 30 day follow up depending on the nature of the lesion.
• Referral to a relevant specialist:  Oral Surgeon, Oral Medicine specialist, Dermatologist, ENT, or the BC Cancer Agency.

It’s important to note that our protocols are not open-ended. This means that until the protocol is ‘closed’ you remain in our system until we are satisfied that the lesion has resolved, been identified or passed on to an appropriate specialist. Please note that it is not our role to diagnose oral diseases such as Oral Cancer but to screen for any abnormalities. The good news is that over 99% of all detected lesions either disappear or are considered benign.

What can you do to reduce the risk of oral cancer?

Aside from the obvious such as quitting tobacco usage, moderation in alcohol consumption and avoidance of excessive sun exposure, you should also maintain optimal dental health as well as maintain your regular visits to our office. Statistics clearly indicate that those with the lowest survival rate are those that do not visit the dentist on a regular basis. Remember, early detection is the key to improving survival.
Once you are a Patient of Record, you will be returning to our practice for ongoing evaluation. During each visit, you will undergo the normal visual and palpation examination as per the normal recall examination protocol. In addition to this, we would advise a yearly Velscope examination of your oral soft tissues. As this entails additional equipment and personnel, there will be an additional fee for this procedure.

For more information on the topic of Oral Cancer, you may wish to follow these links:
Oral Cancer Foundation
American Dental Association
BC Oral Cancer Prevention Program