Dental News - Oral cancer: A growing problem, yet a powerful opportunity

Lorne Lavine, DMD

Tue. 3 July 2012

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When you decided to be a dentist, you probably never expected to be in a position to save lives. But the fact of the matter is that all dental professionals today are being counted on to be the first line of defense against oral cancer and other oral diseases. While medical science and healthier lifestyles have succeeded in reducing the number of deaths from most types of cancer, the number of people dying from oral cancer is at an all-time high.

How can this be, given the significant reduction in the number of smokers and tobacco users during the past several decades? The primary explanation is the alarming growth in the number of cases of oral cancer caused by the sexually-transmitted human papilloma virus, or HPV.

In fact, the day will soon be here — if it is not already — when HPV passes tobacco as the No. 1 cause of oral cancer.

Compounding the situation is the fact that more often than not, oral cancer is detected in late stages, when the five-year survival rate is less than 50 percent. When discovered in early stages, however, the survival rate leaps to approximately 82 percent. Earlier detection is clearly the key to reduced mortality and morbidity rates, and the key to earlier detection is the dental practice.

After all, who spends more time looking inside the oral cavity — and who knows more about the oral cavity — than you?

Most experts advise that all patients aged 18 and older receive a comprehensive oral cancer screening at least once a year. (Some would go so far as to have the screenings start at age 14.) At a minimum, the screening should include the conventional exam featuring palpation of the face and neck and visual inspection under white light. This should ideally be a part of every hygiene check-up, yet surveys show that most patients say they have never experienced this kind of exam.

In addition, there are several adjunctive tools that now make it possible to detect cancerous and pre-cancerous lesions that cannot be seen by the naked eye and are not causing any pain or discomfort to the patient. The most popular detection technology in use today is tissue fluorescence visualization.

Over the years, this technology has been supported by more than $50 million in clinical research funded by the National Institutes of Health and other respected institutions. Its use in the oral cavity was pioneered by a collaboration between the world-renowned BC Cancer Agency and BC-based LED Dental.

A recent 620-patient study by Dr. Edmund Truelove of the University of Washington found that LED Dental’s VELscope system detected all 28 lesions that were missed by the naked eye. More than 10,000 VELscope devices are in use worldwide, and the latest generation of this technology — the VELscope Vx — features a lightweight, cordless design and a price tag that is roughly half the price of prior generations.

Exams involving adjunctive devices can add as little as two minutes to the hygiene check up. The devices are usually quite easy to incorporate into the practice and can be administered by hygienists as well as dentists. Fluorescence visualization devices are completely noninvasive and involve no distasteful rinses or messy dyes. The cost to the patient is generally quite reasonable, yet the revenues generated by the screenings can pay for the cost of the device in a matter of months and be a significant contributor to the practice’s bottom line from that point forward.

More important, as public awareness of the threat posed by oral cancer grows, offering exams involving adjunctive devices can be a powerful way to set your practice apart and attract new patients.

Despite these benefits, there appear to be four main reasons why most dentists have still not adopted an adjunctive screening device:

1. No perceived need. Many dentists simply feel they don’t need any help in detecting early stage lesions. If they are correct, then why is oral cancer normally detected in late stages?

2. Insufficient clinical evidence. Many defend their failure to use an adjunctive device by saying they want to wait until enough clinical evidence has accumulated documenting the devices’ efficacy. While you can never have enough clinical evidence, studies such as the University of Washington study cited earlier seem to suggest that these devices can in fact help see what the naked eye cannot.

3. False positives. Some non-users will tell you that adjunctive devices result in too many “false positives.” However, I very rarely hear adjunctive device users make this complaint. Moreover, one must remember that just because a lesion turns out to be non-cancerous does not mean a false positive has occurred. These exams are also intended to turn up a variety of diseases beyond oral cancer, such as bacterial, viral and fungal infections.

4. The “C” word. Some dentists will admit that they simply do not want to have to give a patient the bad news of a cancer diagnosis. This argument ignores the fact that the diagnosis — which can only be made based on a surgical biopsy — is almost always communicated to the patient by an oral surgeon, a general physician or a pathologist.

We have every reason to believe that an increased focus on early detection will lead to a meaningful reduction in the mortality and morbidity of oral cancer. Early detection is a key reason virtually every other kind of cancer is now experiencing reduced mortality rates. In fact, the advent and widespread use of the Pap smear is generally credited with reducing the mortality rate of cervical cancer by roughly 70 percent. There is no reason to believe that enhanced early detection cannot have the same impact on oral cancer.

Treating teeth and gums has always been, and will always be, a noble and important calling. But the dental practice of today and tomorrow is being looked upon to do more; specifically, to be the guardian of its patients’ oral and systemic health. In my view, there has never been a more exciting time to be a dental professional. After all, if it feels good to save a tooth, imagine how it must feel to save a life!

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