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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.
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.
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early squamous |
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.
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Leukoplakia |
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.
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UCLA's OFNASET |
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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