Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Sunday, April 21, 2013

Oral Cancer

Eva Grayzel
Several events recently have caused me to rethink Oral Cancer.  First, April is Oral Cancer Awareness month, then, Roger Ebert died from a Parotid Gland lesion that took the typical quality of life path to a lingering death.  There was a story on NPR about two very large-population, longitudinal studies that seemed to indicate a limited value in screening for oral cancer as an effective means of reducing death.  Finally, there was a presentation by a truly amazing speaker and oral cancer survivor named Eva Grayzel, who spoke at the annual Leadership Conference of the Alliance to the American Dental Association.

early squamous
I was Mary’s guest at the AADA conference and asked Ms. Grayzel why the per capita death toll from oral cancer has not changed since Mary’s grandmother died from it some seventy years ago.  For instance, this year 8,000 will die, many more than from cervical or mammary cancer: a frightening statistic.  Even more alarming is the fact that an increasing number will have none of the common risk factors: tobacco use, alcohol problems, or even exposure to ultra-violet radiation.

Her answer was that our dentists and dental staff are not yet aware of the subtleties of early recognition and are too quick to advise, “Come back if it doesn’t get better.”  My take is a little different.

When the ADA made detection its primary focus several years ago with a great advertising campaign and Ms. Grayzel as a speaker at the Opening Ceremonies of the Annual Meeting, the expectation was that more dentists would do more thorough examinations and might get paid for it because there were two new diagnostic aids on the market.  Dr. Oz felt this was true and a few years later did a show trying to do just that.

But it didn’t work out that way.

More important, and we didn’t realize it at the time, an insidious causative agent was coming on the scene: a relationship between the HPV virus and oral cancer.  Knowledge of this has not immediately resulted in implementation of some possible safeguards.  For instance a vaccination for HPV has proved controversial because of the links to the sexual transmission of HPV.  I recently saw a compelling video targeted to the susceptible young population.

The celebrity of some of those who contracted oral cancer may also pump up the volume of public demand for thorough, screening.  Michael Douglas, Blythe Danner and Jack Klugman have made videos trying to increase public awareness of the threat.

Another promising possibility is Salivary Diagnostics, which I am told is only months away from a $30 test that will identify markers of cancer that is ACTIVE, not just pre-disposition markers.  The test won’t tell you where the cancer is but will certainly improve the chances of early detection.

One of the more interesting findings about cancer screening by dentists and staff is that many patients don’t know the exam was performed.  And fewer yet demand that it be done.  I was surprised at the comment of one dentist at the AADA presentation.  He said he felt the insurance company’s failure to pay separately for screening limited the number of screenings performed.  I would hope not, but if a salivary test was effective, I would believe the insurance companies would gladly pay for that procedure.  It might even be paid for as a medical, rather than a dental procedure.

In the meantime one of my dentists, a Periodontist is offering patients a chance to sign on for a screening service additional to the observation screening done my most dentists at the examination appointment. I assume it involves one or both of the diagnostic tools seen on Dr. Oz.

Next post will share with you a recent trip to plays Mary and I have seen in years past.  I’ll title it a Playbill Reverie.  Please come visit.

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