Late-stage head and neck cancer has increased by approximately 26% in the last decade. According to the National Institute of Dental and Craniofacial Research, there are approximately 53,000 new cases of oral cancer per year. Males are more than 75% more likely to be diagnosed with these cancers than women, and nearly 67,000 of these, are specifically oropharyngeal cancer.
Oral cancer occurs more frequently in persons over 40 years of age, but risks remain high for younger persons due to alcohol and tobacco use and the human papillomavirus (HPV).
With numbers this high, it is imperative that dental professionals are diligent in performing regular oral cancer screenings. Every patient, regardless of the reason for their visit, should be thoroughly examined. As with all cancers, early diagnosis and prevention are key and dental professionals are positioned to save lives by performing regular, thorough oral cancer screenings.
There are no head and neck squamous cell carcinoma guidelines currently recognized by the American Cancer Society, the National Cancer Institute, or the National Comprehensive Cancer Network. In 2019, and in response to the increase in head and neck cancer, the American Dental Association expanded its cancer policy to include recommendations of routine head and neck cancer screenings. Previously, their recommendation was to screen those patients known to be at increased risk. The policy has been expanded to recommend thorough oral cancer screenings for all patients, regardless of known susceptibility.
Dr. Allesandro Villa, then assistant professor at Harvard School of Dental Medicine stated, “Every patient should be screened by their dentist and dental hygienist for possible early signs and symptoms of oral cancer. Efforts should be directed towards the education of patients about requesting an oral cancer screening in the dental office, and adequate training of the dental professionals on culturally sensitive communications might be an effective means to increases oral cancer screening exams among minorities and high-risk patients.“
Basal cell carcinoma is the most common type of skin cancer, accounting for 80% of all skin cancers. These appear as pink patches or flesh-colored bumps on the skin’s surface. While these are not the most aggressive form of skin cancer, they can still metastasize and have deep effects on tissues including the bones and nerves, resulting in significant harmful effects, scarring, and disfigurement.
Squamous cell carcinoma is the second most common form of skin cancer. It frequently appears in areas most exposed to the sun and its harmful rays. Often presenting on the nose, forehead, and ears, it usually appears as red, scaly patches that seem to heal and reoccur. Like basal cell carcinoma, it rarely metastasizes, but can still have serious, deep, internal effects.
Melanoma is the most aggressive and deadly form of skin cancer. Highly pigmented melanocytes mutate and divide, becoming cancerous. This can occur anywhere, however, areas frequently exposed to the sun are most at risk. The mutation may occur within an existing mole, or as a new lesion.
The A, B, C, D, E’s of skin cancer examination presented by the CDC are:
- Asymmetry– Evaluate the lesion for symmetry. If part of the lesion is irregular in shape, it may be cause for concern.
- Borders– Evaluate the borders of the lesion. Are they clean, or craggy and jagged?
- Color-Does the color of the lesion appear even or blotchy?
- Evolving– Has the lesion changed in recent months or weeks from its prior appearance?
An intraoral examination should be performed noting any visible or palpated irregularities, and/or anomalies. To perform an intraoral cancer screening, the following procedure should be used as a guideline:
Buccal mucosa– perform a visual examination followed by palpation. Thoroughly examine the Stenson’s duct region.
Tongue– Have the patient stick out their tongue and move it laterally, right, and then shifting to the left. Next have the patient raise tongue, placing the tip on the palate to allow for examination of the ventral region. Palpate the tongue and the floor of the mouth.
Say Ahhh- have the patient open wide and say “ahhh” using the mirror as a tongue depressor. Examine the opening to the oropharynx and the palatine tonsils.
The best way to combat cancer is through early detection and treatment. We are key components in the early stages of interdisciplinary screening and referral for patients suspected of head and neck cancer. As professionals, our responsibility lies in properly educating ourselves, and our team members to feel competent in the identification of suspicious lesions that warrant referral for more thorough examination and diagnosis.
Her clinical and support team experiences are the inspiration for her writing and the motivation for coaching clients to success. She is a regular contributor to various publications within dentistry and beyond. In addition to feeding the homeless, starting a non-profit, and being involved in her church and other community organizations, she sings professionally and enjoys several creative outlets. She resides in Florida where she enjoys the company of her husband, three children, and four beautiful grandchildren.