Oral Cancer Awareness Month

Oral cancers are becoming increasingly common in Australia, and there is a need to focus on education and early detection to improve outcomes.

Every year, around 5,000 Australians are diagnosed with oral and head/neck cancers, and sadly nearly 1,200 people will die as a result. Oral cancers are the 7^th or 8^th most common of all cancers, but often they are not diagnosed early which leads to poorer outcomes for patients. Oral cancers were given prominence again last year when we learned that John Farnham was being treated for oral cancer.

What many people may have missed in the John Farnham story was that it was his dentist who first detected the cancer and put him on the pathway to treatment. This is often the usual course of events – dental practitioners play a critical role in the early detection of oral cancers as part of routine dental examinations. Oral cancer screening is a specific skillset, and many oral cancers are not immediately obvious on a cursory examination of the mouth.

I recall the first oral cancer that I detected in a patient. Peter* was an older patient who came to see me for the first time, having been an irregular dental attender in recent years. He had a poorly fitting lower denture, and some concerns that something was rubbing against and irritating his tongue. When I looked in his mouth, there was nothing immediately obvious. I was only when I was able to hold and lift his tongue that I was able to observe the quite significant squamous cell carcinoma that you can see here. The delay in seeking care meant that the cancer had progressed to a late stage, and the prognosis for Peter was not good.

Risk Factors

Not surprisingly, tobacco and alcohol are the major risk factors for oral cancers. Tobacco users are twice as likely to develop oral cancer than those who don’t use tobacco, and oral cancer is six time more common in alcohol drinkers than non-drinkers. Oro-pharyngeal cancers (the part of the throat at the back of the mouth) are strongly linked to the human papillomavirus virus (HPV) – the same virus that is linked to cervical cancer.

Males tend to be affected more than females, with around 4 in 5 cases occurring in men, and the peak incidence occurs from about the age of 60 years. This points to the importance of regular dental check-ups to screen for oral cancers, particularly for people who have a history of tobacco and alcohol use. However there appears to be an increasing prevalence in younger females linked to HPV, pointing to the need for further education about the risks.

Treatment

Oral cancer treatment is usually performed by a large interdisciplinary team, with surgery the most common form of treatment, depending on the type, location and stage of the tumour. Treatment often includes radiation therapy, which can have oral health implications for patients, with the most common being reduced salivary flow. This increases the risk of tooth decay, but also has significant quality of life impacts relating to eating.

Oral Cancer Learning Hub

Prevention and early detection are important in improving health outcomes for patients, and oral cancer is no different. A focus on education for dental practitioners and other health care providers is essential to improving the survival rate for oral cancers. The Oral Cancer Screening and Prevention Program is an excellent online education program with a focus on detection for clinicians. It’s a joint initiative of Dental Health Services Victoria, University of Melbourne Dental School, the Australian Dental Association Victorian Branch, La Trobe University Department of Dentistry and the Victorian Department of Health.

This week in dental research

Dental practitioners must comply with strict advertising guidelines imposed by Ahpra. A new study has found that more than 85% of dental practitioner websites in Australia did not comply with legal and regulatory requirements related to advertising. The main issues included displaying false and misleading information (52%), offers and inducements without clear terms and conditions (13%), using written testimonials (12%), creating unrealistic expectation of benefit (34%) and encouraging indiscriminate and unnecessary use of health services (40%).

Last week: If you missed the last few weeks, you can go back and read about Dentistry and COVID-19 - how risky is it?, Work-life balance, Artificial Intelligence in dentistry, Suicidal ideation in Australian dental practitioners and How is public dental care funded in Australia?