Oral cancer has a higher incidence in Asia and in the US accounts for 9,575 deaths a year. Delay in diagnosis is the main cause of death and continues to rely on the patient presenting to the doctor and physical examination. Unfortunately GP medical doctors and general dentists, who look in the mouth all the time, may not be experienced enough to detect early cancer changes and this may result in missing the condition and hence late diagnosis . In early stage 1 disease, 5 years survival can be as high as 80-90% and unfortunately only 2 or 3 patients out of 10 are alive after 5 years if the diagnosis is at Stage 4. Studies confirm that survival does correlate with stage of disease and making early diagnosis and treatment is optimal for this disease who will have less major functional , cosmetic and psychological problems which can be due to dysfunction of ability to speak, swallow, breathe and chew. The best scenario is when patient is screened and precancerous changes or early cancer is detected and these patients get almost a 100% cure rate and minimal surgical morbidity.
The most important screening “tool” is the experienced clinician. A detailed history is just as important as the careful examination of the whole oral cavity. To detect precancerous changes, our clinic uses the velscope to help Dr Fan in the decision to biopsy the lesion or not and hence reduces unwarranted biopsies. Dr Fan has been treating oral cancers for last 30 years.
Some cancer / precancer cases detected in our clinic:
Oral Sex, Human Papilloma Virus and Oral Cancer
Unfortunately there is an increase in incidence of oral cancer in the younger adults worldwide (as high as 11.3% in patients below 45 years old) and they do not have the same risk factors such as smoking or alcohol consumption.
40 yrs old female executive non smoker/drinker with oral cancer
It has been found that oral cancer developing in these younger patients may be related to oral sexual activity with the transmission of the human papilloma virus.
Testing for the Human Papilloma Virus (HPV)
Screening using HPV testing is generally not recommended for detection of HVP related cancers except for cervical cancer and not for men unless there is a high risk of HIV.
The role of HPV vaccination against oral cancer remains unclear though it is recommended in young girls who are not yet sexually active to have the vaccination to prevent cervical cancer.
The best screening tool for oral cancer at the moment is still a good thorough clinical examination by an experienced Oral & Maxillofacial surgeon.
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Dr Victor Fan
MB BCH; BAO (UK)