We noticed you're blocking ads.

Keep supporting great journalism by turning off your ad blocker.

Questions about why you are seeing this? Contact us

Font Size

- Aa +

Tue 7 Oct 2008 04:00 AM

Font Size

- Aa +

The big tissue

In the ranks of public health threats, it is among the most stubborn - and the most deadly. MED discovers why both dentist are still struggling to improve oral cancer detection.

In the ranks of public health threats, it is among the most stubborn - and the most deadly. MED discovers why both dentist are still struggling to improve oral cancer detection.

In 2007, it is estimated that as many as 400,000 cases of oral cancer were diagnosed worldwide. When you consider that the five-year survival rate for those afflicted by oral cancer has hovered on the lower side of the 50% mark for almost 50 years, the figure makes for dismal reading.

Yet considering it is the sixth most common malignancy in the world, oral cancer has a relatively low profile among the general public. Indeed, dentists are now encouraged to refer to the disease as mouth cancer - supposedly a more recognisable term for patients.

The problem is that many of the people that are at risk to these symptoms…typically don't go to the dentist that often.

But as the competitive nature of modern dentistry places more and more emphasis on aesthetics, are dentists themselves doing enough to screen patients for oral cancer? When chair-time equals revenue, how can dentists afford the time to screen for its symptoms? MED hears from the dentists on the front line in the fight against oral cancer.

Pitching an idea

While most dentists are more than willing to screen patients for oral cancer, there are others who are ready to go that extra mile. At a recent baseball game in New York's Queens County, Dr Stuart Kessner, a general dentist with his own practice, led a team of dentists that offered free, two-minute oral cancer screenings to spectators before and during the action.

"The idea with the baseball game is that you can reach these sort of people in a painless, friendly atmosphere," explains Kessner. "Obviously there are no results given there, that's not exactly what people go to watch baseball for, but we can refer cases on to local hospitals."

Kessner and his colleagues also struck a deal with the New York Mets to try and reach every member of the crowd, not just the ones that they had the time to examine. "We distributed a brochure at the game in an attempt to educate people about the risks," he says.

Dr Kessner believes those most at risk from oral cancer are also least likely to visit a dentist. But just because someone doesn't take a proactive approach to oral health doesn't mean they deserve to fall off the healthcare radar, he argues. If dentists, and dental associations, really want to make a difference then they need to target the members of their community at most risk to oral cancer.

"The absolute key to catching oral cancer is to get it early - and you can do that with a simple two minute test that looks at the floor of the mouth, the inside cheek and the roof," he explains. "The problem is that many of the people that are at risk to these symptoms, whether its through tobacco or alcohol, typically don't go to vsit the dentist that often."

What is vital, argues Kessner, is that when any dentist receives a new patient that the first thing that they do is conduct a thorough screening for oral cancer - and not just for high-risk patients, either.

"I would hope that every dentist is screening for oral cancer with each new patient - the way I was taught at Columbia was that you had to try and treat the whole of the patient," he says. "Even if it is an emergency procedure you should be obligated to test for oral cancer - it should be the first thing that any dentist does."

Screen time

The problem is not one of knowledge, but of time constraints, argues Dr Louis Malcmacher. A practising general dentist, Malcmacher also acts as a consultant to the Council on Dental Practice of the American Dental Association.

"The average dentist is very aware of the symptoms of oral cancer but most dentists only do an examination, not a screening," he points out. "They look...and feel with their hands for anything unusual."This is a much quicker process for time-strapped dentists, but perhaps helps to explain why there has been no improvement in mortality rates for oral cancer over the past 50 years. "The problem is that if a dentist finds it at this stage, oral cancer is usually fairly advanced and patients only have a five-year survival rate of about 25-50%," claims Malcmacher.

The poor survival rate for oral cancer should be a mark of shame for the dental industry. When compared to other serious diseases, the lack of progress in tackling oral cancer is bewildering. Malcmacher believes that the fault lies with the regulatory bodies.

"The topic is absolutely not given enough importance by dental associations and government bodies," he states flatly. "Oral cancer is one of the few cancers where mortality rate has gone up in the last 40 years while most other cancers have gone down. The key is that the entire dental industry works together to make people pay more attention to the oral cancer arena."

The average dentist is very aware of the symptoms of oral cancer but most dentists only do an examination, not a screening.

Still, the dental industry itself seems to be catching on. New screening technologies for oral cancer are starting to reach the market and make their way into practices. But first, the technology needs to be accepted by the industry and incorporated into academic curriculum.

"At the moment, they do cover oral cancer screening in dental schools but they do not cover screening technologies," says Malcmacher. "The one I use the most is the Vizilite Plus - this is the most well-tested oral cancer screening test on the market and also is the only one that helps identify the oral cancer lesion."

Malcmacher even argues that dentists should be given incentives to pursue continuing education in the area of screening technologies.

Playing it safe

But is the case for screening technology really that clear? Dr Vinod Joshi, the founder of the UK's Mouth Cancer Foundation, is not convinced. "In the past there have been treatments that are supposed to make it easier to screen for mouth cancer, but what they found was that, when compared to the normal screening method with a good light source, there was not really a significant improvement," he claims.

"I think most professional dentists are actually waiting for a little more evidence to come out before deciding if this is something they should be using."

Because the early diagnosis of oral cancer is so vital, Joshi believes it borders on malpractice to pass-up traditional methods completely for newer screening technology. He also points out that it can be very damaging to your practice's reputation if a screening technique led to a misdiagnosis.

"During every normal check-up a dentist should be examining the patient for mouth cancer - it is very important that they are able to distinguish between normal ulcers and the symptoms of mouth cancer," he warns.

Joshi cites a court case underway in the UK where a dentist stands accused of not diagnosing mouth cancer early enough. Proof, he says, that you can never be to too careful, or too vigilant, when it comes to oral cancer screening.

Where money might be more effectively spent, is by increasing the amount of resources available on the topic to dentists. "One of the things that you hear often from both medical and dental professionals is that they feel that they could do with more information about mouth cancer and its risk factors," Joshi remarks.

These aids would be particularly useful for doctors, he adds. In a recent study, only 5% of doctors surveyed in a specific region of the UK knew that a red patch of oral mucosa could be a symptom for oral cancer.Other UK-based studies have shown that undergraduate medical students were less likely to examine patients' oral mucosa routinely and less likely to advise patients about risk factors for oral cancer.

It was also shown that alcohol was rarely identified as a risk factor, which underscores Joshi's argument that spending money on educating doctors would prove a strong investment.

Looking after number one

It's been suggested that money spent on oral cancer should be spent at the source. If you can get the general public asking questions, then dental practitioners are duty-bound to answer them.

"When you look at other cancer awareness programs, some organisations have done an outstanding job at creating a very high awareness for certain types of cancer," argues Dr Louis Malcmacher. "In the US, every woman knows how to do a breast cancer self-exam and have routine mammograms, and everyone over the age of 50 knows it's time for a colonoscopy - these types screenings have saved lives."

Malcmacher has created a website, oralcancerselfexam.com, which aims to offer a similar self-screening service for oral cancer. He believes that the potential impact on identifying the disease could be tremendous.

"An established self-exam for oral cancer would be a huge help in finding abnormalities or incipient oral cancer lesions early," he argues. "This kind of self-exam is easy to do, does not require any special equipment, and will help familiarise people with their own mouths."

Malcmacher argues that most patients know about oral cancer in general, but it is this sort of specific advice that could really impact on mortality rates. "Getting patients on board to fight this dreaded disease is crucial and long overdue, and dentists should institute early detection screening as soon as possible," he says. "Patients are looking for dentists who take the issue of oral cancer seriously."

Pictures of health

To improve the record against oral cancer, it is clear that there will have to be greater collaboration between the traditionally frosty fields of medicine and dentistry. High-risk candidates might typically be bad at attending a dentist, but the chances are that they have seen a physician recently. But what seems to be the single greatest factor is the necessity for clear visual guidelines for both doctors and dentists to follow.

Dr Vinod Joshi admits that bodies such as Cancer Research UK have been forward thinking in their approach to oral cancer, but argues there needs to be a more widespread effort. "They were given some money and...[produced] an information sheet about mouth cancer and developed guidelines for dentists and doctors," he states.

"But what dentists and doctors actually want is to have a little cookbook - they want to be able to look at a picture and match it against the mouth. These educational aids are really the key to tackling mouth cancer."

MED FACTS: Market leaders

The dental industry has not been slow to react to the need for oral cancer screening and treatment. Here are some of the leading products on the market today.

ViziLite:An oral lesion identification and marking system that is used as an adjunct to the conventional head and neck examination.

The system is comprised of a chemiluminescent light source to improve the identification of lesions and a blue phenothiazine dye to mark those lesions identified by ViziLite.

TBlueTM:A patented, toluidine blue-based metachromatic dye. It is used to further evaluate and closely monitor changes in ViziLite-identified lesions. The theory is that living cells will differentially accumulate toluidine blue based on parameters related to metabolic activity.

ALAtherapy:Experimental treatments of leukoplakia with photodynamic therapy combined with aminolevulinic acid (ALA) have been proposed as a pre-emptive treatment method.

ALA concentrates in cancer cells when taken orally and becomes active when exposed to a certain kind of light.

During treatment, the ALA is activated by laser light and kills off abnormal cells, such as those which are found in leukoplakia.

Arabian Business: why we're going behind a paywall

For all the latest health tips & news from the UAE and Gulf countries, follow us on Twitter and Linkedin, like us on Facebook and subscribe to our YouTube page, which is updated daily.
Real news, real analysis and real insight have real value – especially at a time like this. Unlimited access ArabianBusiness.com can be unlocked for as little as $4.75 per month. Click here for more details.