Oral Cancer Screenings Now Considered Standard of Care in Dentistry

October 13, 2011 -- LAS VEGAS - The statistics are chilling: Oral cancer now kills nearly three times as many people as cervical cancer. Every hour, someone dies from the disease. This year, 37,000 Americans will be diagnosed with oral cancer, and 25% of them will die of it.

So it is crucial that dentists check their patients for it regularly, according to John Flucke, DDS, a general dentist from Lee's Summit, MO, who writes a technology blog and lectures regularly about dental technologies.

"It's under the radar," he said, referring to the fact that the rising occurrence of oral cancer has not been widely reported.

In a presentation on oral cancer at the ADA annual session this week, Dr. Flucke stressed the importance of dentists incorporating oral cancer screening into their regular practice routines.

“Dentists really are oral physicians.”
— John Flucke, DDS

Since dental professionals have been trained to spot unhealthy characteristics in the mouth and many medical doctors often don't check the oral cavity, dentists should make it part of routine exams, he said.

"Dentists really are oral physicians," Dr. Flucke said.

Only 20% of the U.S. population gets annual oral cancer screenings, according to the National Cancer Institute.

Incidence of the disease is growing, especially among those who don't fit the traditional profile. Instead of older people who drink and smoke, oral cancer has become more common among people between 25 and 50 years old. Studies show it is increasingly being linked to human papillomavirus (HPV) 16 and 18 among people who have had more than three sex partners, Dr. Flucke said.

He starts oral cancer screening of patients when they are 15 years old and repeats it every six months. Such screening only takes three to five minutes for a visual exam and physical palpation, Dr. Flucke said.

HPV-related oral cancers generally occur in the posterior regions of the mouth, including the pharyngeal tonsil, he noted.

Most oral cancers are survivable if detected early. However, most are not found until the disease is in the later stages, when five-year survival rates drop to 20% to 30%.

"I tell patients if they have trouble swallowing for prolonged periods to get it checked, or if they notice anything lumpy, bumpy, or that feels out of place," Dr. Flucke advised.

Suspicious lesions or inflamed areas could result from injuries, so dentists should do follow-up checks 10 days later, he recommended.

The escalating incidence of HPV-related oral cancers, particularly after actor Michael Douglas' battle with oropharyngeal cancer, has increased awareness among medical professionals and the public about the disease.

The incidence in oral cancer patients younger than age 40 has increased nearly fivefold, with many patients having no known risk factors, according to the ADA. Only 57% of all oral cancer patients will still be alive five years after their diagnosis, according to the American Cancer Society.

Staff training, especially with hygienists, and discussing new protocols for oral cancer screening is important, Dr. Flucke said.

If dentists are sufficiently concerned to refer a patient to an oral surgeon for biopsy, he advised practitioners to assure the patient that it does not mean they have oral cancer, just that it is important to be cautious.

As part of his oral cancer screenings, Dr. Flucke uses DentalEZ's Identafi device, which uses fluorescent technology to detect mucosal abnormalities. The small, cordless device uses a combination of white, violet, and green-amber multispectral wavelengths to find suspicious lesions.

Oral Cancer Linked to Virus

Increase in Oral Cancers Linked to HPV

The human papillomavirus is contributing to the growing number of  head and neck cancers in the United States, according to a new study Monday in the Journal of Clinical Oncology.

The study found that the number of cases of oropharyngeal cancer - cancers of the tonsil, back of the mouth (throat) and base of the tongue - has been on the rise since the mid-1980s.  The study suggests that one reason could an increase in the number of people having oral sex resulting in oral human papillomavirus  exposure.

Researchers say these cancers fall into two categories–those caused by tobacco and alcohol and those caused by the sexually transmitted virus, HPV. They now believe approximately 70% of all oropharyngeal cancers are caused by HPV infection.

"We used to think of oropharyngeal cancer as one cancer," said senior author Dr. Maura Gillison, The Ohio State University Comprehensive Cancer Center in Columbus. "Now we know the disease is comprised of two biologically and epidemiologically distinct cancers. This new understanding will increasingly enable us to improve and better personalize care for patients with each form of the disease."

Researchers tested cancer tissue samples from almost 6,000 patients in Hawaii, Iowa and Los Angeles between 1984 and 2004. They found the HPV-positive cancers increased 225% while HPV-negative oropharynx cancers dropped 50%–most likely because of a reduction in smoking and tobacco use. Even so, patients with HPV-positive cancers live longer.

"Patients with HPV positive cancers have better survival rates," said principal investigator Dr. Anil Chaturvedi of the National Cancer Institute. "The precise reasons for the survival benefits are not clear, but tumors in HPV-positive patients tend to have less genetic damage. Because of that, they are more responsive to cancer therapies like radiation treatment."

"The HPV status of a patient's tumor is the single greatest determinant of whether a person lives or dies after a diagnosis of local-regionally advanced oropharynx cancer," Gillison said. "HPV-positive patients have an approximate 60% reduction in risk of death after their diagnosis when compared to HPV-negative patients."

Gillison says about 95% of the HPV-positive oropharynx cancers were caused by HPV16, a strain targeted by Gardasil and Cervarix, the two vaccines currently on the market to prevent cervical cancer. Gardasil is manufactured by Merck & Co. and Cervarix is made by GlaxoSmithKline.

Gardasil was approved in 2006 for use in females  ages 9-26 to help prevent cervical cancer and genital warts. It was approved in 2009 for  males9-26 to reduce the risk of genital warts. It has not been recommended for use in preventing HPV-associated cancers, according to the National Cancer Institute. Cervarix was approved in 2009 for use in females 10-25. It is not approved for males.

The findings are important because the increase in these cancers has been relatively rapid compared with other HPV associated cancers like cervical cancer, Chaturvedi says. With cervical cancer, incidence rates have declined over time because of screening, but currently there is no screening in place for oropharyngeal cancers.

"Should the observed declines in cervical cancer and the observed increases in HPV positive oropharyngeal cancers continue into the future," Chaturvedi said.  "HPV positive oropharyngeal cancers will be the leading HPV associated cancers over the next decade–by around 2020."

There were almost 35,000 new cases of oral and oropharyngeal cancers this year, according to the American Cancer Society. While about 7,000 Americans will die this year, death rates associated with these cancers has actually been declining over the last 30 plus years.

"The burden of invasive HPV-caused cancers will shift from women to men in the US, largely due to the rise of HPV-positive oropharynx cancers among men," Gillison said. "HPV infection and its consequences have long been considered a women's problem, and women will continue to bear the brunt of the morbidity associated with the infection. However, gender equity is being achieved with regard to the burden of HPV-caused cancers. HPV infection is therefore a problem for both men and women."

Using Infrared Cameras to Search for Breast Cancer

Here is How They Work:

A cell puts out energy as it grows and divides into multiple cells. The faster this growth occurs, the higher is the energy output. This energy output increases the heat; that is, a breast cancer is, among other things, a severe inflammation that does not respond to normal anti-inflammation drugs, whether they are OTC or prescription. 

This increase in energy production has been known for a very long time. In the 1960s and 1970s, Xerography was used, but the printouts of the pictures taken of the breast hot spots took the form of a series of life-size pictures on sheets of computer paper that might be yards long. The sheer inconvenience of Xerographic heat detection made it impracticable and eventually it was largely though not totally abandoned. What we now know as traditional mammography, which is radiation-based and was in use before Xerography was tried, took its place. 

But problems with mammography abound. There are many false positives, which must be ruled out by biopsy, and much more serious, there are many false negatives. Breast cancer is the second leading malpractice-related condition with most lawsuits arising out of misdiagnosis and delayed treatment. One problem is that a mammogram may be negative, even for women with a breast lump, but a negative mammogram does not definitively rule out breast cancer. Further tests are necessary. Another problem is that women under 50 can get breast cancer, but many doctors will assume a diagnosis of breast fibrocystic disease because of their age. 


It is in that area of women under 50 years old that infrared camera, viewing their digital images on computer screens rather than yard-long paper, are the most useful. Although fibrocystic breast disease puts out some heat, it does not involve the very rapid cell growth and proliferation seen in cancer. For that reason, an infrared camera will show a much hotter image on a cancer than on a cyst or fibroid. This lowers the likelihood of a false positive and a false negative. According to a brochure on Breast Health, infrared screening is especially appropriate for younger women (30 to 50) whose denser breast tissue makes it more difficult for mammography to be effective. 

However, infrared cameras also have limitations. The most important one is that infrared cameras do not have the penetrating effectiveness of radiology. Therefore, a cancer an inch from the skin will almost certainly be picked up by infrared photography, but a cancer clinging to the back of the breast wall will be missed. This cancer will probably be missed by traditional mammography as well. 

Ultimately, the responsibility for breast cancer detection falls to each individual woman. She must see to it that the early detection guidelines are followed.  Annual Infrared Imaging (thermography) screening for women of all ages.  Mammography, when considered appropriate for women who are aged 50 or older. A regular breast examination by health professional Monthly breast self-examination. Personal awareness for [sic] changes in the breast.  Readiness to discuss quickly any such changes with a doctor. 

That last is critically important. Most women quickly become aware of changes in their breasts, but all too many women won't report the changes to their doctors because they are afraid they have breast cancer and somehow convince themselves that if they don't have the cancer confirmed medically it will go away. The best technology in the world will not save a woman from a breast cancer if she won't allow to be diagnosed or treated.

by Anne Wingate, Ph.D

About the Author

My first mammogram, when I was in my late 20s, was a Xerograph. I still remember how LONG that sheet of paper was. My mother and her mother both died of breast cancer. Last year I was on an every three months mammography schedule, but after one last month they put me back on an every six month schedule. I have read every book on breast cancer I could get my hands on, including some from the University of Utah's medical school library.