July 2020 • Jo-Anne Jones, RDH • ODHA Focus Magazine • Read the article on the ODHA site.
“Why do I need oral cancer screening?”
We often hear this statement from our clients although it may not be verbally articulated. However, body language may strongly suggest there is a lack of understanding as to why this is so imperative for someone who may not consume alcohol or use tobacco products. What are the facts surrounding the importance of oral cancer screening in today’s population and how we may impactfully communicate the importance of screening to our dental hygiene clients?
We are truly living in a ‘virally impacted’ world. The historical etiologic pathways of smoking and alcohol consumption which once were the predominant risk factors cited for oral cancer are now being challenged by a virus; a virus so common the Centers for Disease Control and Prevention (CDC) states almost every adult will have an infection in their lifetime.1 The virus is the human papillomavirus (HPV). Fortunately, most people will clear the infection and may not even be aware of its existence.2 However, a persistent infection with a high-risk strain of the virus can develop into an oncogenic presence.
The role of HPV in the development of oral and oropharyngeal cancer is no longer questionable. It is responsible for the escalation of oropharyngeal cancers. The profile of patients that develop HPV-positive squamous cell carcinoma are less likely to use tobacco products or consume alcohol. This escalating profile has re-emphasized the need to perform a comprehensive head and neck examination including an oral cancer screening using both visual and tactile techniques on all adult clients on an annual basis.
In 2015, HPV-related oropharyngeal cancer cases surpassed all other anatomical subsites for HPV-related cancers. Prior to oropharyngeal cancer taking the lead, HPV-related cervical cancer held the top position. Rates of head and neck cancer have set to grow further with an estimated seventy per cent attributed to HPV.3 At the same time, the rates of cervical cancer, nearly all caused by HPV, are declining due to increased screening and vaccination programs.
A distinct knowledge gap exists. Even those who have been diagnosed with HPV-related oropharyngeal cancer are often unaware it was caused by a virus. The researchers at MD Anderson in Houston, TX conducted an online survey with 200 HPV-related cancer patients (71% were HPV-positive oropharyngeal cancer patients). Only 33% of the sample group of 200 HPV-related cancer survivors, of which the majority were 61 years of age or older, white and male, reported knowing their cancer was HPV-related.4, 5 These findings suggest there is a clear need to increase knowledge amongst our population of all risk factors related to both oral and oropharyngeal cancer.
Is the importance of this screening procedure known to your dental hygiene clients? The following dialogue is critical to convey the importance of oral cancer screening for today’s dental client.
What has changed?
Seventy-five per cent of Canadians will have HPV in their lifetime.6, 7 The virus is fueling an escalation in sexually transmitted oral and oropharyngeal (back of throat) cancers. The symptoms are subtle and often overlooked. They include recurrent tonsil infections that are not responding to antibiotics, pain in one ear, feeling as though something is caught in the throat, change in speech, hoarseness and other subtle symptoms which should not be ignored.
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Acknowledgements: Article used with permission and thanks to ODHA - Focus Magazine. See more at ODHA.ON.CA