Tobacco and alcohol consumption have been considered the main risk factor for oral cancer along with poor oral hygiene and genetics. This type of oral cancer is most frequently seen after the age of 40 years, with a peak at 60 years of age. Today, focus has shifted towards infection with Human Papillomavirus as an additional primary risk factor for oral cancer, increasingly affecting young adults aged between 20 and 44 independent of tobacco and alcohol consumption.
HPV can be transmitted to the mouth via multiple pathways; however, its main transmission pathway is sexual. It is the most common sexually transmitted viral infection. Over 120 types of HPVs have been identified with different biological behaviors. Low risk HPVs cause benign wart-like lesions in the mouth, while high risk HPVs are associated with cancer including oral cancer. The role of HPV in oral cancer is supported by findings of this virus in tumor tissues.
This is crucial; unfortunately, oral cancer is mostly recognized when symptomatic and at a late stage, where the survival rate is still low, at approximately 50 percent at five years. Although oral cancer is a relatively uncommon condition with a life time risk of less than 1 in 90, its risk is greater than that of brain and esophageal cancers, according to data from the National Cancer Institute.
Oral cancer stems from the mucosa lining the mouth. As the tumor grows, it destroys vital tissues in the mouth affecting chewing and swallowing and frequently spreads to the lymph nodes in the neck area. The outcome of late detection and treatment is devastating.Surgical removal of the tumor is usually recommended and still results in the sacrifice of several functional and esthetic organs, often leaving patients with feeding tubes to sustain nutrition. So, like all other cancers, prevention and early detection are paramount.
Controlling tobacco and alcohol consumption, understanding HPV transmission pathways, improving oral hygiene, and eating a diet high in fruits, vegetables and plant-based foods in addition to early detection of pre-cancerous lesions by dental and other healthcare professionals are among the prevention strategies.
Any lesion that lasts more than 2 weeks after its probable cause is identified and eliminated should not be ignored and requires further investigation. Visual oral cancer screening is currently a part of regular dental examinations. Additional non-invasive diagnostic aids are being utilized such as tissue auto-fluorescence where abnormal tissue appears darker when exposed to light with a specific wavelength. Definitive diagnosis is still achieved by complete or partial removal of suspicious lesions followed by microscopic analysis.
— Samer Alassaad is in private dental practice in Davis. Contact him at [email protected]