May 9, 2018
by Jo-Anne Jones
At the time of writing this article, the Check Your Mouth™ campaign is growing exponentially. The North American launch of the public campaign in February of this year has been a long awaited aspiration of the Oral Cancer Foundation and specifically of the founder, Brian Hill, a stage IV oral cancer survivor himself. The emergence of Throat Scope, the world’s first all in one illuminated tongue depressor on the market, would become the ideal tool to facilitate an effective self-examination for the public campaign. The partnership of the Oral Cancer Foundation and Throat Scope supported strongly by the Canadian Dental Hygienists Association and the American Dental Hygienists Association has created an organically driven movement across North America.
Why is this campaign so necessary? The key to saving lives is earliest possible discovery of an abnormal finding. When an oral lesion is discovered in the early or localized stage, five-year survival rates are impacted significantly accompanied by an improved quality of life for survivors 1 (Table 1). Oral and oropharyngeal cancer are still found at the later stage primarily due to lack of public awareness and the lack of routine opportunistic screening programs being employed.
The concept of in home self-examination of the head and neck and inside the oral cavity follows other successful models such as ‘Do You Know Your ABCDE’s?’ initiated by the Skin Cancer Foundation. 2 The concept was to educate the public on examining their skin and taking note of any new moles or growths, and any existing growths that undergo change and/or symptoms. Public awareness and education are the key critical components to drive earlier discovery whether it be melanoma or oral cancer. This by no means detracts from the importance of a regular professional oral cancer screening. It in fact reinforces the importance of it.
The incidence of oral and oropharyngeal cancer continues to increase each year. The often optimistically and confounding statistic is the improved five-year survival rate; “the survival number at five years from diagnosis was for many decades about 50%” and presently 57% “so 57% is an improvement over the last ten years”. 3 The cause of this improved rate is not due to increased or improved screening techniques aiding in earlier discovery or medical discoveries leading to superior treatment outcomes. It is directly correlated to the increase in incidence of a different etiologic pathway causing an escalation of oral and oropharyngeal cancers that react more favorably to treatment modalities resulting in increased survival rates.
For the large part, the North American population is unaware of the risk factors the lead towards oral cancer. Historically smoking and alcohol have been the two most well-known etiologic pathways. Many feel that if they are non-smokers and non-drinkers, they will not possess an inherent risk for oral and/or oropharyngeal cancer. This new pathway and fastest growing profile is caused by a very common virus, the Human Papillomavirus (HPV). HPV is fueling an epidemic of oral and in particular oropharyngeal cancers in a much younger age group. Because of the prevalence of the virus, almost every sexually active person is exposed to the cancer-causing strains of the virus as they begin to engage in sexual activity. The greater the number of partners, the greater the risk, however it may be the first sexual partner that initiates contact with a high-risk strain. It is important to note that there are over 200 strains of the Human papillomavirus of which nine have been identified to be oncogenic or cancer causing. HPV-16, a high-risk strain, accounts for the vast majority of oral and oropharyngeal HPV-related cancers. It is through a persistent infection with a high-risk strain, such as HPV-16 that presents an increased risk for a transformation to malignancy. For most, the virus like the common cold, is dealt with and cleared by a functioning immune system. “There is no recommended clinical indication for oral human papillomavirus screening to evaluate the risk of developing oropharyngeal cancer.” 3 To this point, there is the possibility of elevating unnecessary anxiety through more testing over something that will likely resolve on its own in the vast majority of individuals.
The HPV etiologic pathway does present its challenges clinically. Typically occurring in posterior anatomical areas including the lingual and palatal tonsillar areas, posterior base of the tongue, soft palate and oropharyngeal area presenting a challenge in gaining visual access. A dedicated light source and magnification through the use of loupes are essential tools to visually evaluate soft tissues of the oral cavity and accessible oropharyngeal areas. Equally important is the employment of tactile palpation wherever anatomically possible for all extraoral and intraoral anatomical areas.
We are mandated by our professional Standards of Practice to perform an extraoral and intraoral soft tissue examination which includes an oral cancer screening. The oral cancer screening examination is not an option; it is our responsibility. Furthermore, educating our clients on the importance of doing a self-examination at home and initiating a self-referral is a supportive and strong step toward earlier discovery (Fig. 1). Through education provided on the Check Your Mouth™ website, our clients will have an elevated awareness of ‘what to look for’ and ‘what shouldn’t be ignored’ reinforcing the need for self-referral and examination by a dental professional (Fig. 2). This would then eliminate the long time period between regularly scheduled professional care and the opportunity for assessment of an abnormal finding.
The clear message of the Check Your Mouth™ campaign is the self-examination of the face, neck and inside the mouth on a monthly basis. It is through this familiarity that a new finding will be most readily recognizable. A persistent finding, being anything that does not resolve within two weeks, should be further examined by a dental professional. The Check Your Mouth™ website provides an educational video illustrating a step by step self-examination of the face, neck and inside the oral cavity and visually accessible areas of the oropharynx. An overview of what to look for complemented by a visual gallery of normal vs. abnormal findings is included on the site. The often subtle, life-saving symptoms are outlined along with risk factors. The recommended tools are made available for purchase through the website (Figs. 3 & 4). Professional postcards to provide to the dental hygiene client are available through the Oral Cancer Foundation store (Fig. 5) (http://www.ocfstore.org/check_your_mouth_info_postcard_p/cym-250.htm).
The information on the card provided at the dental hygiene recare appointment will direct the client to the website for further information. Additional information on oral and oropharyngeal cancer may also be found on the Oral Cancer Foundation’s comprehensive website www.oralcancer.org. Client educational materials and practice resources are available through the Oral Cancer Foundation, the CDHA professional and public site, Dental Hygiene Canada (resource listing at the end of the handout).
Often we feel powerless to positively impact the course of an abnormal finding. The Check Your Mouth™ campaign provides our professional community with a tangible resource to make positive inroads on earlier discovery of oral and oropharyngeal cancer. The support of our professional associations and each dental hygienist across our country will be the cornerstone of the success of this campaign. Thanking you in advance for your commitment.
Disclosure: Jo-Anne Jones is a contributor to the project management team for the Check Your Mouth™ campaign. Jo-Anne serves as an advisor to Throat Scope® and is involved in the North American launch of Throat Scope® into the dental community. There was no financial compensation received for writing this article.
Check Your Mouth™ Professional Postcards: http://www.ocfstore.org/check_your_mouth_info_postcard_p/cym-250.htm
Oral Cancer Foundation Info Sheets: www.oralcancerfoundation.org (Home>>Resources>>Screening Event Downloads; Oral Cancer Facts & HPV Sheet)
CDHA Professional and Public Resources
Online course and booklet for download: www.cdha.ca/oralcancer
Public information site and video: www.dentalhygienecanada.ca/oralcancer
Early Detection Flyer: www.dentalhygienecanada.ca/pdfs/DHCanada/OralCancerEarlyDetectionFlyer.pdf
Oral Cancer Fact Sheet: http://www.dentalhygienecanada.ca/pdfs/education/OCS_FactSheet_2015.pdf
About the Author
Jo-Anne Jones is an international award-winning speaker, and was named a Dentistry Today CE Leader in 2018 for the eighth consecutive year. While preparing to present her research on HPV-related oropharyngeal cancer to her national association, a family member received a diagnosis of late-stage HPV tonsillar cancer, succumbing to the disease 16 months later. Ms. Jones proudly partners with the Oral Cancer Foundation in conveying the urgent need for changing the way in which we screen for oral cancer to meet the needs of today’s population. She can be reached at via email at email@example.com or by visiting www.jo-annejones.com.