Oral Cancer
Prevention and Early DetectionDate: October 14, 2019
RISK FACTORS
Tobacco
E-cigarettes
Marijuana*
Alcohol
HPV 16/18
Periodontal Disease
Weakened Immune System
Excessive Sun Exposure
Betel Nut Consumption
* The role of marijuana is still unclear, research is contradictory. The mode of administration plays a big role, as we do not want combustibles lingering in our mouth.
Risks may change based on location of cancer
Oral Cancer
Anterior 2/3 of Tongue
Lateral Borders of Tongue
Lips
Cheeks
Floor of mouth
Hard palate
Oropharyngeal
Back 1/3 of tongue
Soft palate
Tonsils
Throat
*HPV is the leading cause of Oropharyngeal cancers
PREVENTION
HPV Vaccination
Gardasil®, Gardasil®9, Cervarix® (no longer available; last doses expired 11/16); recommended around puberty.
Gardacil® was approved in the US in 2006, so anyone around puberty or teenage years at that time, may have been offered the vaccination). On 10/5/18, the FDA announced Gardacil 9® is now approved for men and woman, up to age 45! See the press release here.
The vaccinations DO protect against strains 16/18!
Smoking cessation
(10 years no smoking, risk returns to that of non-smoker)
Fewer than 21 alcoholic beverages per week
Diet high in Fruits and Vegetables
*Marijuana
Salivary testing for Oral HPV infection (OralDNA®
and FidaLab offer oral HPV detection)
Adjunctive oral cancer screening
SPF Chap Stick
*The role of marijuana is still unclear, research is contradictory. The mode of administration plays a big role, as we do not want combustables lingering in our mouth.
Human Papillomavirus
A closer look at HPV
Most common sexually transmitted infections; however, recent research is suggesting that there may be other modes of transmission.
There are nearly 200 types of HPV, only a few strains (16/18 mainly) are associated with oral cancer. Other strains cause warts, or no symptoms at all.
Most sexually active individuals will have HPV at some point, often our body can suppress/erradicate the infection; persistent infections are more likely to cause a problem.
While HPV does not travel throughout our body, if you have had an HPV cancer elsewhere (i.e. cervix), you are at greater risk of oral HPV cancer (the virus may have entered at multiple sites).
No cure for HPV, only prevention and early diagnosis.
OralDNA® and Fidalab offer salivary screening to detect HPV16/18; however, it does not look at past or future infections. It provides a snapshot at the patient’s active HPV status at that moment. It is believed that HPV may have a long dormancy period (possible decades), during which time a screening test will not detect its presence.
More sexual partners increases risk of infection
HPV oral cancer is more frequent in men than women (4:1)
High risk strains appear to be transferred only through direct contact (even kissing), while some of the lower risk strains may transmit more easily.
HPV vaccinations DO provide protection against HPV 16 & 18; MD’s generally recommend patients get the two series vaccination around puberty.
Current findings indicate HPV may hide within biofilm in the tonsils crypts.
A Closer Look at E-Cigs
These pose a high risk for Oral cancer. There are numerous known carcinogens in the formulas; however, the formulas are not regulated, so the manufacturers do not have to identify the included carcinogens.
A Closer Look at Alcohol
An average of 2-3 drinks per day increases one’s risk for oral cancer. While most research agrees alcohol in mouth rinse is not enough to increase risk of OC (when used as directed), the alcohol containing mouth rinse should be counted towards one’s alcohol exposure. It is probably wise to recommend a non-alcohol mouth rinse to anyone with risk factors for OC.
Oral Cancer Screening
There are a variety of screening tools available, here are Kathryn’s favorites! They identify both red and white lesions, are small and easy to use.
Oral ID™ // Fluorescence; hand held light, reflecting green on healthy tissue and dark on areas of concern.
VELscope® // Fluorescence; hand held
Identafi® 3000 // Fluorescence; small, hand held device
Billing: Some offices charge to use adjunctive tools for OC Screening, while other’s offer it for free. Whether you charge or not, the CDT is D0431.
Encourage your patients to do their own oral cancer self screening at home. You can recommend www.checkyourmouth.org for a step by step guide for a self exam.
Current research and discussion about Oral Cancer
Researchers are looking into the effectiveness of vaccinating older individuals against HPV, after beginning sexual activity. October 2018; FDA approved Gardacil 9® for men and women up to age 45.
Marijuana; some research seems to imply it may minimize the risk of certain types of oral cancer, while increase the risk of there types of oral cancer. It can be a challenge to find quality research on this, as marijuana is still not legal at the federal level.