COLUMBUS, Ohio – A trip to the dentist can sometimes give you more than you bargained for: In some cases, it’s a dentist who may be the first to discover that a nagging sore or odd-looking white patch is not merely an annoyance, but an early form of oral cancer.
“Dentists are the very best when it comes to finding early lesions in the mouth that could eventually wind up being cancerous,” says Dr. Susan Mallery, an oral pathologist and member of the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
Studies show that dentists and dental hygienists may be the most thoroughly trained and the most sensitive to early, subtle changes in the mouth that could signal trouble later on. In other words, they may be able to spot problems that other primary care providers may miss.
And when it comes to oral cancer, the earlier it’s discovered and treated, the better the chances of making a full recovery.
Oral cancers make up only a small fraction of the number of new cancers in the U.S. every year, but they are some of the deadliest. Currently, about half of all oral cancers are first detected after they have already had opportunity to take root and spread. At that point, they are difficult to cure. The American Cancer Society estimates that only about half the people diagnosed with oral cancer will survive longer than five years.
Mallery readily admits new treatments are desperately needed.
Her laboratory is currently investigating a variety of agents that range from anti-angiogenesis drugs such as endostatin, to natural products like extracts from freeze dried black raspberries, to see if they may be able to suppress the conversion of precancerous to cancerous cells. Recently, she and her collaborators, Drs. Gary Stoner and Peter Larsen, obtained approval for a clinical trial to see if the black raspberry extracts can block the progression of precancerous oral lesions in humans.
Since the risk of oral cancer increases with age, clinicians are expecting an increasing number of cases in the coming years because large numbers of baby boomers are just beginning to enter their most vulnerable, cancer-prone decades.
"In short, this is a time when increased attention to periodic screening is so important,” says Mallery.
While oral cancer is still more prevalent among men, dentists are seeing an increasing incidence among women, probably because more women are choosing to smoke. People at higher risk of developing oral tumors include anyone who uses tobacco products in any form and who drinks alcohol on a regular basis.
Mallery says catching oral cancer in its earliest phase is critical, pointing to the success of screening in reducing deaths from other types of cancer.
“Just look at what has happened with cervical cancer in recent years. In many, less developed countries, cervical cancer still takes a terrible toll among women. But here in the United States, where there is about a 75-80 percent compliance with regular and routine screening, the incidence of cervical cancer has dropped significantly, and deaths have declined dramatically. That’s a good model for us to follow.”
About 90 percent of oral malignancies are squamous cell carcinomas, meaning they originate in the lining of the mouth or tongue. And some sites in the mouth – particularly where pooling of saliva may occur – are more vulnerable than others. These areas, including the sides and undersurface of the tongue, the floor of the mouth, the soft palate at the back of the mouth and the tonsils, are the most common cancer sites, representing about half of all cases.
“Cancer in its earliest stages can make the lining of the mouth or the tongue look just a little bit different – maybe red or white, or with little bumps,” says Mallery.
She says patients need to be on the lookout for any of the following signs or symptoms:
* A sore that bleeds easily or does not heal
* A change in the color or texture of any part of the mouth or tongue
* Pain or numbness in any part of the oral cavity
* A white or velvety red patch that does not wear off
“It’s a tragedy that so many people develop oral cancer when it’s so easy to spot them during a checkup. We may not be able to catch or cure every single case, but regular screenings would help us be much more effective in controlling this terrible disease,” says Mallery.
The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, part of the Comprehensive Cancer Center at The Ohio State University, is the only freestanding cancer hospital in the Midwest. It is a national and international leader in translational research and clinical care, and one of the charter members of the National Comprehensive Cancer Network. U.S. News & World Report has consistently ranked The James as one of the nation’s best cancer hospitals.# # #
Medical Center Communications