April is National Oral Cancer Awareness Month. We now know oral and oropharyngeal cancers are associated with the HPV 16 virus, as well as cervical, anal, and penile cancers. My challenge to you is in raising awareness of this disease and looking for it with every patient treatment and especially during all oral exams.

I’m not sure how many of us are doing regular oral cancer exams, but I’m guessing it’s not enough. Many years ago, I was having lunch with a colleague who’d missed oral cancer on the lateral border of her mother’s tongue; the disease had progressed to a radical neck dissection. 

I recall telling her “I don’t have time to do oral cancer exams.” My attitude came even after I’d done a table clinic in my senior year of dental school at the state dental convention entitled “Oral Cancer: If You Don’t Look, You Won’t Find It.” Her response was “you’d better take time.”

We get busy running from room to room, just trying to get through the day and oral cancer exams may be the one thing we skip, but at what cost? Let’s look at the statistics of oral and oropharyngeal cancers provided by the National Cancer Institute: Surveillance, Epidemiology, and End Results Program:

There were 49,670 new cases of oral and oropharyngeal cancer reported in 2017. That’s just under 3% of all new cancer cases diagnosed. Of those cases, it is estimated that 9,700 cases will result in death. Although these numbers have improved from 1975, could it be better?

The Oral Cancer Foundation: HPV/Oral Cancer Facts states there are several forms of the HPV virus, some two hundred different strains. They report “most are harmless and do not cause cancer;” the primary concern is HPV number 16 which is associated with oral and oropharyngeal cancers as well as cervical, anal, and penile cancers.

We can talk about statistics all day, but it all comes down to daily contact with our patients and the responsibility of  looking for abnormalities, especially since there are so many areas in the mouth and oropharynx to look at and palpate. I’d like to take this time prompt our Dental Hygienists to be looking as well, as four eyes are better than two.

After that lunch with my colleague (in the 1980’s), it’s a step I do not skip in my exams. In fact, it’s what I start with even before looking at the patient’s teeth. I figure if they’ve got a life-threatening cancer, who cares about their teeth? 

I work under an insurance company that requires we send any suspicion of oral cancer to the patient’s MD for a referral. I fill out the referral to the oral surgeon and instruct the patient to take the referral to their MD in the hope their MD will sign it and refer the patient. 

Recently, I referred a patient with a suspicious patch on the floor of his mouth to his MD. The MD pulled back his lower lip and said, “you don’t need an oral surgeon” and the issue was dropped. This isn’t the first time this has occurred, but the second in less than a year. 

In the early nineties, an oral surgeon told me I’d referred more patients for biopsies than all other referrals combined. I knew this patient had a cancerous lesion, yet I was blocked from getting proper care for him because of the insurance company. I urged him to call the insurance company for a proper referral.

In private practice I had an older couple present as new patients and choose to discontinue with my practice. I had done oral cancer exams on both and their reasoning behind not continuing in my care was that I was “practicing outside the scope of my profession; that I was practicing as a physician.” If that’s their reasoning I say, “oh well.”

I know a medical education studies little or nothing of the oral cavity. I’ve learned this from former medical supervisors, colleagues whose education went from dentistry to medicine and relatives who are physicians. A premed friend I met in predent classes said he spent less than three hours on the study of the mouth back in 1984. My niece in med school in 2008 said she didn’t study the mouth at all, and a supervising MD in 2011 called it a deep, dark mysterious hole. My bottom-line thought? Look, look, look, and document, document, document. I’d rather be wrong a hundred times for referring than wrong just once for not referring.

 

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“The time is always right to do what is right”
- Martin Luther King, Jr.