Oral cancer — early detection can save lives
I had just returned from dinner to start my evening hours at 5:15 p.m.
For more on this topic, go to www.dentaleconomics.com and search using the following key words: oral cancer, cancer, early detection, squamous cell carcinoma.
I had just returned from dinner to start my evening hours at 5:15 p.m. on March 22, 2005, when my office manager handed me the fax from the oral pathology department at Temple University.
Diagnosis and treatment
The diagnosis from the previous Friday's biopsy of my tongue was squamous cell carcinoma. I was shocked! I thought, "I'm a dentist with no risk factors. This can't be happening to me." I was 59 years old.
I immediately made an appointment with Dr. John Ridge, the chief of head and neck surgery at Fox Chase Cancer Center. It was his opinion that due to the early detection, the treatment of choice was a partial glossectomy and a modified neck dissection. My surgery was planned for the next week. The radiation oncologist would later confirm, "No radiation and no chemo!"
The morning of the surgery was spent with my wonderful and supportive family. My two adult children joined my wife and me waiting for the OR to become available. The three hours of surgery were easy for me. For those waiting, it's always more difficult. I was released from the hospital three days after surgery. The surgical pathology report was excellent. It said there were clear margins of the tongue and 30 clear nodes.
I spent the next week or so trying to figure out how I was ever going to eat solid foods and speak normally again. Drinking a bottle of Ensure took half a day, and it took an hour to get down two teaspoons of Tylenol with codeine. My first bite of solid food was on day 10. It's amazing how I never felt hungry until that first bite.
Due to the neck dissection, my left arm and neck had limited range of motion. My speech was also affected. With the help of my physical and speech therapists at Fox Chase, it took about three months to regain full range of motion in my arm and neck and to start speaking normally again. I went back to work in three-and-a-half weeks with a reduced schedule, and I was soon able to resume a full schedule.
During my recovery at home, I surfed the Internet and found the Oral Cancer Foundation. I immediately joined and began participating in their online forum. As stated on their Web site, "… the Oral Cancer Foundation is a national public service, nonprofit entity designed to reduce suffering and save lives through prevention, education, research, advocacy, and support." It was started by Brian Hill, an oral cancer survivor who had a strong dental background as the owner of Implant Support Systems Inc., a dental implant manufacturing company.
Early detection advocacy
After spending time on the OCF forum, I realized how lucky I was. I e-mailed and phoned many people I met on the forum and I quickly saw what others were going through after surgery, radiation, and chemotherapy. It was at that time that I decided I had to make early detection awareness a major part of my life and career. If it could happen to me — a dentist with no risk factors — it could happen to anyone.
I decided that the first place to start was in our office. We are a large practice of three general dentists, four specialists, three hygienists, and a total staff of 24. We upgraded our clinical oral cancer screening protocol.
It wasn't too long after my return to work that my office manager and I thought it would be a good idea to reach out to the community by getting an article in the local newspaper. I could tell my story and what we were now doing in the office for oral cancer screenings and the importance of early detection.
After an interview with the paper's health reporter, they ran the story on July 17, 2005. It was also about the same time that we updated our office Web site, www.kwhdental.com, with a page about early detection of oral cancer.
Prior to the American Dental Association's annual session in Philadelphia in October 2005, I had made contact with their videographer and arranged a meeting with him to tape an interview during the meeting.
I told him my story and he said that in his 15 years with the ADA, no dentist had ever contacted him about a personal experience with oral cancer. He made no promises, but he hoped that the interview could be used in some future ADA campaign about early detection. To date, this has not happened.
Two years ago I set up a booth with volunteers from my office to do free oral cancer screenings and provide literature about oral cancer for participants in the American Cancer Society's Relay for Life. We did it again this June.
Within the past year I have done two TV interviews with the Philadelphia affiliates of ABC and CBS with the hope that they will raise public awareness of oral cancer and the importance of thorough oral cancer screening exams. The CBS spot was recently picked up and shown in Los Angeles and New York City.
In an attempt to get more dentists and hygienists involved in screenings, I recently spent three days at the Valley Forge Dental Conference doing oral cancer screenings of the attendees.
I recently passed my three-year survival anniversary, and it's remarkable that only some minor effects remain. Considering that a 2 cm radius section was removed from my tongue, only a small divot remains on the left lateral border.
There is some numbness and loss of taste in that area. The scar on my neck from the removal of the lymph nodes has faded. My cheek and neck are still numb along the incision area and will remain that way. This is surely a small price to pay for becoming a survivor.
There is never a day that goes by that I don't think about my experience with oral cancer. Being a dentist and an oral cancer survivor puts me in a unique position. After spending three years participating in the OCF online forum, I have found that there are too many people with late-stage squamous cell carcinomas that should have been caught much earlier.
During these years, I have made and unfortunately lost several new friends. Many members say that their dentist never did a head and neck cancer screening. I am shocked every time I read that some of these patients' dentists told them, "We'll watch this and look at it again at your next checkup," or "It's nothing; don't worry about it."
What is your responsibility?
How many times have we been told that any sore that doesn't go away in two weeks should have a biopsy? Why are so many in our profession not doing thorough oral cancer screenings? Why has there been no decrease in the number of deaths from oral cancer in decades?
Please read the quote in the box below from the Oral Cancer Foundation Web site and decide what you want to do about this.
Dr. Jerold B. Wilck practices general dentistry in Langhorne, Pa. He graduated from Temple Dental School in 1970, and spent two years in the United States Air Force. He is married, has two married children, and four grandchildren. Dr. Wilck can be reached at email@example.com.
For more information about the profession's efforts with oral cancer prevention and diagnosis, visit www.dentaleconomics.com/oralcdx.
"More than 34,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly one person per hour, 24 hours per day. Of those 34,000 newly diagnosed individuals, only half will be alive in five years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, endocrine system cancers such as thyroid, or skin cancer (malignant melanoma). The death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intraoral area. Besides the metastasis, at these later stages, the primary tumor has had time to invade deep into local structures. Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for five to 10 years after the first occurrence. There are several types of oral cancers, but around 90% are squamous cell carcinomas."
To learn more about what you can do as well as the relationship between the human papillomavirus (HPV) and oral cancer, please do yourself and your patients a favor. Check out: www.oralcancerfoundation.org or call (949) 646-8000.