Oral cancer

Open wide and say 'aaaahhhhhhh' 'cause there's m ore to oral hygiene than preventing tooth decay

Open wide and say 'aaaahhhhhhh' 'cause there's m ore to oral hygiene than preventing tooth decay

April 29, 2002|BY KEVIN CLAPP

You might awaken one day with a sore in your mouth.

There could be a painless red or white patch on your lips, tongue, the lining of your mouth.

One day you could wake up with a lump in your cheek. Or have a sore throat that never seems to go away.

The impulse might be to dismiss it - maybe you inadvertently bit your tongue or side of your mouth. Maybe it's a virus that you just can't shake.

Such thoughts could prevent launching an active offensive against a disease that kills more than 8,000 annually.

No pain

"The problem with oral cancer is people don't think about it. It rarely hurts," says Chambersburg, Pa., oral surgeon Roy Himelfarb. "Most people look at that stuff and go into almost complete denial. They'll let it go and go and by the time they see us, it can be incurable or devastating in terms of the amount of surgery followed by radiation followed by chemotherapy."


Incidence of oral cancer may not be striking - roughly 30,000 new cases will be diagnosed this year - but the five-year survival rate of 50 percent should serve as sufficient shot across the bow.

Symptoms are often ignored in the early stages, and diagnoses can come too late to help.

Among early symptoms are mouth sores that do not heal or hurt. This distinguishes them from another ulcer, the canker sore.

"Numerous patients say it looks like a little ulcer, it doesn't bother me," says Dan Cornell, director of radiation oncology at John R. Marsh Cancer Center at Robinwood. "Most cancers, carcinomas you can spot a mile away."

Painless white or red sores in the mouth that do not heal; a lump on the lip or in the mouth; numbness of the tongue; swelling of the jaw; and the feeling that something is caught in the throat are all indicators of oral cancer.

Problem is, according to Linda K. Clarke, a head and neck nurse specialist at The Milton J. Dance Jr. Head and Neck Rehab Center at Greater Baltimore Medical Center, patients can be eager to attribute symptoms to something routine.

"The more people know about their bodies and health situation, the healthier they'll be," Clarke says. "And awareness is the first step."

Education is needed

Between 1994 and 1998, according to figures in the Maryland Department of Health and Mental Hygiene Annual Cancer Report issued in September 2001, there were 9.6 reported cases of oral cancer per 100,000 people. By comparison, the incidence rate for cervical cancer was 9.5 per 100,000.

In his Chambersburg practice, Himelfarb estimates he sees an average of 15 cases a year, significant because he is one of several oral surgeons in the area.

"Fifteen cases out of a single practice is quite a lot," he reasons. "Multiply me by the other practices and that's a fair amount."

Across the board, health care professionals report one problem as being a lack of education about the disease among physicians, dentists and the general public.

To combat the situation, the health department and Walnut Street Dental Clinic convened an education summit April 12.

The Oral Cancer Seminar at Robinwood Medical Center served to educate close to 200 health care professionals about oral cancer, screening and screening procedures.

"When you compare it to lung cancer or breast cancer there are fewer numbers," says Washington County Health Officer Bill Christoffel. "One of the things that makes people aware of cancer is that they all know someone who had cancer, and you don't have that as much with oral cancer."

As bad as the educational disconnect, Clarke says, is a chasm between races, socio-economic groups and incidence of oral cancer.

According to statistics from the Maryland Department of Health and Mental Hygiene Maryland oral cancer Web site,, more blacks die from the disease than whites, and 24 percent of diagnoses in the state are among black males.

But it should come as no surprise that smokers are at the greatest risk of oral cancer, which can afflict lips, cheeks, tongue, throat or the roof of the mouth.

Alcohol abuse and family history also make people more apt to contract oral cancer. But with 80 percent to 90 percent of diagnoses hailing from tobacco use, according to the American Cancer Society, snuffing smokers' butts is a priority.

Take it from a reformed smoker. Himelfarb lit up two packs of unfiltered cigarettes a day for 23 years and says dropping the habit is crucial.

"You might as well take a blowtorch, stick it in your mouth and blow it away, because smokers have an unreal incidence of not only lung cancer but oral cancer," he says. "For a smoker, it's a death wish."

Early detection saves lives

One of the goals of the April 12 seminar was to introduce physicians to a relatively new screening measure, a brush that swabs cells from a questionable area of the mouth and can be sent to a lab for study.

Himelfarb prefers an incision biopsy instead. Regardless of method, early detection can save patients from pricey surgical, radiation and chemotherapy treatments.

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