BRACKEN VERNON-JELIER Western Morning News (Plymouth, UK) November 22, 2011

Mouth cancer rates have risen by more than 20 per cent in the last 30 years and there are more than 4,000 new cases a year in England. but with a disease that is so prevalent why are so many cases being detected too late? Keith Francis, from Ivybridge in Devon, was 58 when a change to a simple action that he performed every day changed the course of his life. Whilst brushing his teeth one evening he noticed he had begun to spit blood. Assuming it was due to small graze on his tongue; he ignored it and went to bed. Little did he know that he had late stage aggressive mouth cancer and the disease was just weeks away from becoming inoperable.

November is Mouth Cancer Awareness Month and cases like Keith’s are being used to highlight the warning signs of a disease which, without early detection, could claim 30,000 lives over the next decade.

Keith, a retired architectural engineer, said: “I just wasn’t aware that mouth cancer was something you could get. it had never crossed my mind and even when they performed a biopsy I was confident that everything was OK. I couldn’t have been more wrong.”

His dentist, John Gittins, owner and principal dentist of Highland Dental Care in Ivybridge, says there is a worrying lack of public awareness into the often fatal disease. “It is the results of surveys and campaigns like this that really highlight the lack of knowledge on this serious subject. Dental professionals are always on the lookout for signs of anything unusual, but without regular check-ups the six to 12 months inbetween can see a lot of change and we need to make sure that our patients are aware of the symptoms to look out for.”

A study commissioned by the British Dental Health Foundation discovered that more than four in five people failed to know any symptoms of the disease. The survey, which questioned more than 800 people, looked particularly into the behaviours and attitudes of children aged 12-16 and their parents, in a bid to discover their level of understanding in a disease which is rapidly and progressively affecting a greater number of younger people.

It found that more than three in every four parents failed to recognise any early warning signs of the disease which is diagnosed in 6,000 people in the UK every year.

The surgery that followed Keith’s diagnosis was intensive and invasive and confirmed that the cancer was only 3mm away from spreading beyond medical control.

“Getting it checked out saved my life. it was a progressive tumour. The surgeon that treated me at the time told me that it was one of the fastest growing cancers and that amongst the top ten causes were hard drinking, like brandy and whisky – which I didn’t do – and smoking, which I didn’t do either.”

Surgery involved cutting away the tumour, which affected 40 per cent of the left side of his tongue, and replacing the tissue with skin taken from other areas of his body. He underwent five operations with three surgical teams working on him at once. He was off work for six months and for two months he could only breathe through a tube in his throat and be fed through a tube directly into his stomach. He was only able to communicate with his wife and family through writing notes until his mouth was healed enough.

Work with a therapist has meant that Keith’s speech is as clear as it ever was, but he is one of the lucky ones. six years of checkups means that Keith has now been given the all clear. Alec Cross in Modbury is in the early stages of treatment following diagnosis only weeks ago.

“I had a problem on my gum that I put down to rubbing from a clasp that went around my top teeth. but when the problem got worse and I had it checked out, a biopsy confirmed it was cancer. I was very alarmed when they said that they may have to remove all my teeth. Fortunately that has not had to happen, but they have had to remove a large slice of my tongue and my treatment continues.”

His dentist, John, said; “As well over half the population received a dental exam in the last two years dental teams are in the ideal position to share information about the risks and symptoms of mouth cancer with their patients. both Alec and Keith are examples of how a dentist can help to diagnose these problems – we wish Alec all our very best wishes for his continuing treatment and for a very speedy recovery.”

According to BUPA, symptoms of mouth cancer may include an ulcer in the mouth or lip that won’t heal; constant pain or soreness; red or white patches in the mouth; a lump on the lip, tongue or in the neck; bad breath; unexplained bleeding in the mouth, numbness or loose teeth.

Highland Dental Care is based in Ivybridge and will welcome anyone interested for a free mouth check-up during November. to make an appointment please call the reception team: 01752 893152.

Copyright 2011 Western Morning News (Plymouth)All Rights Reserved Western Morning News (Plymouth, UK)

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DID you know that a visit to the dentist could save your life? the Telegraph finds out more …

MANY of us may see a trip to the dentist as a chance to get a quick scale and polish, perhaps a filling or two, maybe even some light cosmetic work.

But according to a new nationwide survey, arguably their most important job goes unnoticed.

With mouth cancer rates increasing by more than 40 percent in the last decade, it has become one of the UK’s fastest growing cancers and it is up to our dentist to check for the early warning signs.

Yet, results from the survey reveal only 15 per cent of us believe the dentist to be checking our mouths for the early symptoms of a disease which kills someone every five hours in the UK.

Almost two-thirds of us didn’t know whether our dentist looks for any symptoms of mouth cancer during a routine check-up while the remaining quarter did not think they were being examined at all.

Peter, from northern Lincolnshire, was diagnosed with tongue cancer aged 59.

“It started with a sore spot on my tongue,” he said. “I just assumed I had bitten it and it would go away, but it didn’t.

“My doctor had a look and sent away for some blood tests, which did not reveal much.

“Luckily, I had a routine dental appointment coming up. my dentist was not very worried but referred me to hospital, where it was soon diagnosed as cancer.

“Thankfully it wasn’t advanced. all they did to diagnose it was take a tiny bit from my tongue, which didn’t hurt at all.

“The worst thing was the uncertainty. I ended up having most of the right side of my tongue taken out by laser.

“The thought is awful but it wasn’t nearly as bad as it sounds. At first I was bruised and swollen, and I had little control over it. I had to eat soft, even liquidised food, for a bit but I adjusted quickly. And my speech recovered in about three days.

“I’ve lost teeth after subsequent radiation sessions, and now I do without dentures because I find it better that way. I do have eating problems, but I’m just thankful I’m alive.

“A lesson from all of this is, if you have a mouth problem, consult your dentist as well as your doctor.”

The chief executive of the British Dental Health Foundation, Dr Nigel Carter, pictured, said: “During your routine dental check-up your dentist or hygienist performs a full examination of not only the teeth and gums, but the cheeks, tongue and floor of the mouth, too.

“They look for anything unusual in the mouth. With the number of new mouth cancer cases increasing greatly each year, everyone throughout the profession understands how important it is to check for any symptoms.”

“The importance of early detection speaks for itself – nine in 10 people survive mouth cancers that are caught early yet as most people are only diagnosed late in the disease, the five year survival rate remains as low as 50 per cent.”

The survey was carried out by the British Dental Health Foundation and quizzed more than 1,000 UK people.

It highlighted the importance of checking our mouths for any unusual red or white patches, unusual swellings in the mouth or neck or an ulcer that does not heal within three weeks.

All these are potentially signs of something being wrong and you should go along to your dentist or doctor.

Previously, the disease has been five times more common in men than women, however, recently, more women than ever are being diagnosed and it is now only twice as common in men as women.

Age is another factor, with people over the age of 40 more likely to be sufferers, though more young people are now being affected than previously.

Dr Carter added: “The main risk factor for mouth cancer is tobacco use, with alcohol the second most common and people who smoke and drink to excess are 30 times more likely to develop the disease.

Recently, HPV, the human papilloma virus, also responsible for cervical cancer, has also been discovered to be a cause. Spread by oral sex, over three-quarters of women will be affected at some time in their lives and as a result we are seeing more younger people affected.

“Next time you visit your dentist, ask about the disease, its symptoms and how to check for them at home – you might be surprised about how much knowledge you go away with.”

For further information, visit the dedicated campaign website mouthcancer.org. Alternatively, the National Dental Helpline is available Monday to Friday for free and impartial expert advice on 0845 063 1188.

Every 5 hours how often mouth cancer kills someone in the UK.

Last night’s BBC three documentary, presented by actress Jaime Winstone, discusses the newest potential cause of cancer – oral sex.

But before you declare a life of celibacy or start railing against those fun-killing scientists, we want to clarify exactly what we do and don’t know on this topic.

The reality is that there are still many pieces missing from the puzzle.

HPV and oral cancer

Oral cancer (also known as mouth cancer) rarely hits the headlines. People traditionally think of it as a disease that affects smokers and heavy drinkers in later life. but over recent years, as oral cancer rates have been increasing , so too has evidence for a new cause of the disease.

We now know that certain strains of a common virus called human papillomavirus (HPV) can also cause oral cancer, alongside tobacco, alcohol, betel quid and a poor diet.

We normally talk about HPV in the context of cervical cancer, and it is the main cause of this disease. but the virus can infect other areas of our body. Spread by skin-to-skin contact, not just by sex, HPV affects almost everyone at some stage in their life.

But there’s no need for undue alarm. in most of us, our immune system fights it off and it doesn’t do any harm. but on rare occasions, the virus takes hold, leading to a chain of events that ends in cancer of the cervix, penis, anus, vagina or mouth.

We know that around fifteen strains of HPV can cause cervical cancer, and that the most common of these – HPV-16 – can also cause oral cancer. but we don’t know how often HPV infections lead to oral cancer, nor how the virus ends up in the mouth.

Oral cancer on the increase

Oral cancer – which includes cancers of the lip, tongue, gums, tonsils and parts of the throat – has been on the increase for about thirty years. in 2009, we highlighted oral cancer as one of the fastest rising cancers in the UK, now affecting around  5000 people each year.

Rates of a certain type of oral cancer – cancer of the tonsil – seem to have been rising especially rapidly. according to the latest statistics, there are around 1,100 cases of these cancers every year in the UK.

Scientists agree that many of these tonsil cancers are linked with HPV. but they aren’t sure exactly how many are related to the virus, and estimates vary from 15 to 85%, depending on the smoking rates in the study population.

This isn’t all bad news. for some reason, oral cancer patients tend to have better outcomes when their tumours test positive for HPV. at the moment, we don’t know why this is.

How does HPV end up in the mouth?

A few case-control studies have suggested that oral sex may be the main way that HPV ends up in the mouth. One of the largest and best of these studies found that people who had more than six oral sex partners, or more than 26 vaginal sex partners in their lifetime had an increased risk of oral cancer.

But the authors of the this US study themselves concluded

Our data suggest that oral HPV is sexually acquired… but we cannot rule out transmission through direct mouth-to-mouth contact, or through other means.

Indeed one study of around 200 college-age men found that those who had more ‘open-mouth kissing partners’ had a higher risk of getting an oral HPV infection.

But these studies about oral sex or kissing have been small, and their results are not conclusive. up to now, all of the studies on this topic have been ‘case-control studies’. this means that they asked people who had already been diagnosed with oral cancer about their sexual behaviour, often many years ago. this could mean that their responses aren’t entirely reliable. where possible scientists prefer to ask about behaviours in a large group of healthy people, and then look at cancer rates in this group years later (these are known as ‘prospective studies’).

The HPV vaccine and oral cancer

The BBC’s documentary raised the issue of the HPV vaccination and oral cancer. The HPV vaccine protects against two high-risk strains of HPV (16 and 18). it is very effective at preventing cervical cancer and it is already being offered to teenage girls at school.

Some scientists argue that boys should be vaccinated too. High-risk strains of HPV do indeed cause penile and anal cancers in men as well as cervical cancer in women. but studies suggest that, overall, vaccinating males wouldn’t be an effective use of NHS resources, as long as enough women agree to have the vaccine.

If the vaccine also protects against oral cancer, that could change things. but it’s too early to jump to that conclusion because scientists don’t know yet whether the vaccine could prevent HPV infection in the mouth.

So where does that leave us?

Certainly oral cancer is on the increase, and HPV appears to be playing a role. but there are still a lot of unanswered questions about oral sex, human papillomavirus and oral cancer.  for example, we still need to find out:

• How exactly do people contract HPV infections in their mouths, and how does that affect their risk of mouth cancer? we need large studies to answer this question.
• How common are oral HPV infections in the UK? what happens to these infections? how many of them clear up by themselves and how many persist?
• How long does it take for an infection to lead to oral cancer? and in the meantime, are these signs that doctors and dentists could look for to help screen for the disease?
• Is the HPV vaccine effective against oral HPV infections? does this affect decisions about the age at which girls are vaccinated and whether boys should be vaccinated too?

Scientists from across the world, including many funded by Cancer Research UK, are working hard to answer them.

Hazel Nunn is a senior health information manager at Cancer Research UK

this entry was posted on Monday, January 10th, 2011 at 9:00 pm and is filed under Cancer in the news, HPV, Mouth, Risks & Causes. you can follow any responses to this entry through the RSS 2.0 feed. you can skip to the end and leave a response. Pinging is currently not allowed.