Mouthing Off: Oral Cancer Prevention


“Here’s looking at you, kid!”— Rick’s famous toast to Ilsa in “Casablanca”— will be forever etched in our memories, thanks to the genius of Humphrey Bogart. Not long after this famed Hollywood moment, however, Bogart— who was a heavy smoker and drinker— developed esophageal cancer. It was only six months from the time his symptoms presented to when he was finally admitted to a hospital, but it was also six months too late. Despite complete removal of the tumor, adjacent lymph nodes, a rib, and radiation and chemotherapy to stop the spreading cancer, the inimitable Bogart succumbed to this lethal disease. He was only 57. 

But oral cancer doesn’t only affect Hollywood heroes; many times it can also hit close to home.

A 42 year-old former patient of mine, who we will call John in respect for his privacy, had no risk factors. He was young and did not smoke or drink alcohol. A month after John got married, he experienced a sore throat. Right around this time, he also noticed a persistent white spot on his tongue. John called his dentist right away.

After initial screening, his dentist referred him to an oral surgeon who, after detailed tests, detected that John had cancer of the tongue. John underwent painful radical surgery, which involved removal of a large portion of his tongue, followed by years of therapy and reconstructive surgery. When I met John, he was 12 years, ecstatically cancer-free and living life to the fullest. Even now, John attributes his survival mainly to the early detection of this deadly disease. Its stories like John’s that inspire me to spread the word about the importance of early detection.

Oral cancers comprise of 85% of all head and neck cancers. Historically, the high death rate associated with oral cancer was not because it was hard to diagnose, but due to the fact that discovery came too late, when the disease had progressed and metastasized.

The good news is that the rates of oral cancer have dropped in the last 20 years. There is now greater opportunity for treatment and cure because of early detection. This has led to an improved quality of life and increased chances of survival.

Prevention is always better than cure. If you are able to identify the risk factors and then modify your lifestyle, you’ll have a greater chance of living a healthier and longer life.


Early Detection

Take a few minutes out of your day to examine your lips, gums, cheek lining, tongue and the floor and roof of your mouth. Make a note of any color changes, whitish or reddish spots, ulcers or sores that bleed easily or do not heal, and any lump, thickening, rough spot or crust.

Pain, tenderness and numbness anywhere in the mouth or lips may appear progressively. Notice if you have any difficulty chewing, swallowing, speaking or moving your jaw and tongue. Also take note if there is any change in the way your teeth fit together, or any changes in your voice or to your speech. Apart from these changes, observe any drastic weight loss, or a lump or mass in your neck. If any of these changes do not resolve on their own in 14 days, you should make an appointment be looked at by a professional.


Best Practices for Prevention

The human papillomavirus (HPV), one of the viruses responsible for majority of cervical

cancers in women, has replaced tobacco as the number one risk factor for oral cancer in the US in 2011. Ask your physician for details about its risks, prevention and the vaccines available.

-          You should also avoid tobacco and alcohol use. Tobacco is still very high on the offender list; chemicals associated with the development of cancer have been found in all types of tobacco such as cigarettes, pipe tobacco, cigars or smokeless varieties like snuff and chewing tobacco. Tobacco usage, combined with heavy alcohol consumption synergistically increases the risk for oral cancer. Cirrhosis of the liver from alcohol abuse is also a known risk factor.

-          If your profession or hobbies require you to spend a great deal of time under the sun, take precautions to protect you skin AND your lips. Prolonged and repeated exposure to the sun greatly increases the risk of lip and skin cancers.

-          A healthy diet rich in fruits, nuts, vegetables and dairy may slow or possibly prevent the development of potentially cancerous lesions. Some examples of such food sources include sweet potatoes, carrots, cantaloupe, squash, apricots, pumpkin, mangoes, collard greens, spinach, kale, tomatoes, watermelon, guava, papaya, pink grapefruit, blood oranges, milk, egg yolks, mozzarella, almonds, wheat germ oil, safflower oil, corn oil and soybean oil.

-          Genetics, prolonged and untreated acid reflux disease, lowered immune system and areca (betel) nut chewing are also considered risk factors.

-          Dental check-ups are extremely important. Have your dental problems corrected and practice good oral hygiene. Oral Cancer can go unnoticed in the early stages because it can be painless and present with little or no physical changes. Your health care provider’s trained eye and preliminary oral cancer screening can detect any precursor changes to the tissue that may be potentially dangerous. If you notice any abnormality in your head and neck area, please call your health care provider for an appointment right away.

For the 13th year in a row, April has been recognized as the official oral cancer awareness month in the US. This deadly disease is not to be taken lightly.

As a part of preliminary oral cancer test for my patients, I have performed many brush biopsies—a quick, minimally invasive, and inexpensive procedure that can provide an answer to whether or not a risk exists. I am overjoyed that to date, every single one of those biopsies has come back negative. Each of these patients’ initiative for early detection and survival is very commendable.

Every human life is invaluable and irreplaceable. Just think: had Bogart gone to a doctor much sooner, just like John did, we would have enjoyed his dramatic genius for many more years.


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