Oral Health Topics

To find information about the topic listed on this page, please visit the MouthHealthy.org page about Oral Cancer.

Overview

Routine, careful examination of patients for oral and pharyngeal cancer, in addition to an updated health history, can easily be achieved during a regular dental visit. The National Institute of Dental and Craniofacial Research describes one method.¹ The stage at which an oral or pharyngeal cancer is diagnosed is critical to the course of the disease. When detected at its earliest stage, these cancers are more easily treated.

Facts About Oral Cancer

Incidence and Mortality

According to statistics available through the National Cancer Institute²:

• Oral and pharyngeal cancer strikes an estimated 39,000 Americans each year.  An estimated 8,000 people die of these cancers annually.
• The disease occurs twice as often in men as in women.
• Although the difference between races in oral and pharyngeal cancer is negligible, the 5-year survival rate doubles for white men over African American men (the difference in survival rates between women is not significant).
• An estimated 1 in 95 adults will be diagnosed with oral or pharyngeal cancer in their lifetime.
• The median age at diagnosis is 62 years (that figure may drop to 52 to 56 years for people who have oral or pharyngeal cancer associated with human papillomavirus (HPV) infection.^3-7)

Risk Factors

• Tobacco use^8,9
• Alcohol consumption^9,10
• Heavy use of tobacco and alcohol together greatly increases the risk of developing oral and pharyngeal cancer^11,12
• HPV infection is associated with pharyngeal cancer^13,14
• Age: the risk greatly increases after 44 years²
• Gender: men are twice as likely to develop oral and pharyngeal cancer²
• Ultraviolet (UV) light exposure is a particular risk factor for lip cancer¹⁵ 
• Nutrition: a diet rich in vegetables and fruits is associated with a lower incidence of oral and pharyngeal cancer¹⁶

 Signs and Symptoms

• Leukoplakia or erythroplakia

• A lump or thickening of the oral soft tissues, or swelling that affects the fit and comfort of dentures

• Patients may complain of: difficulty chewing or swallowing, or moving the jaw or tongue; a sore throat or feeling that something is caught in the throat; numbness; hoarseness or a change in the voice.

Signs and symptoms that persist for two weeks or more merit further investigation, such as a biopsy or referral to a specialist.

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References

1. National Institutes of Health: National Institute of Dental and Craniofacial Research. Oral cancer exam. Accessed April 12, 2012.
2. SEER Fact Sheets: Oral cavity and pharynx. From data collected in: Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009. National Cancer Institute: Bethesda, MD. Based on November 2010 SEER data submission, posted to SEER website, 2011.  Accessed April 10, 2012.
3. Smith EM, Ritchie JM, Summersgill KF, et al. Age, sexual behavior and human papillomavirus infection in oral cavity and oropharyngeal cancers. Int J Cancer 2004;108:766-72. 
4. D'Souza G, Zhang HH, D'Souza WD, Meyer RR, Gillison ML. Moderate predictive value of demographic and behavioral characteristics for a diagnosis of HPV16-positive and HPV16-negative head and neck cancer. Oral Oncol 2010;46(2):100-9. (PDF) 
5. Fakhry C, Westra WH, Li S, et al. Improved survival in patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 2008;100:261-9. (PDF)  
6. Dayyani F, Etzel CJ, Liu M, et al. Meta-analysis of the impact of human papillomavirus (HPV) on cancer risk and overall survival in head and neck squamous cell carcinomas (HNSCC). Head Neck Oncol 2010;2:15-25. (PDF)  
7. Gillison ML, D'Souza G, Westra W, et al. Distinct risk factor profiles for human papillomavirus Type 16-positive and human papillomavirus Type 16-negative head and neck cancers. J Natl Cancer Inst 2008;100:407-20. (PDF)
8. The health consequences of smoking: a report of the Surgeon General . [Atlanta, Ga.]: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C.: For sale by the Supt. of Docs, U.S.G.P.O., 2004.  Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2004/complete_report/index.htm Accessed April 12, 2012.
9. Hashibe M, Brennan P, Benhamou S, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risks of head and neck cancer: Pooled analysis on the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst 2007;99:777-89. (PDF)  
10. Goldstein BY, Chang SC, Hashibe M, et al. Alcohol consumption and cancer of the oral cavity and pharynx from 1988 to 2009: An update. Eur J Cancer Prev 2010;19(6):431-65. (PDF)  
11. Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the rise in head and neck cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev 2009;18(2):541-50. (PDF)  
12. Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3283-7. (PDF) 
13. Cleveland JL, Junger ML, Saraiya M et al. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: Implications for dentistry. JADA 2011;142(8):915-24. (PDF)
14. Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: A systematic review. Cancer Epidemiol Biomarkers Prev 2005;14(2):467-75. (PDF)
15. Gallagher RP, Lee TK, Bajdik CD, Borugian M. Ultraviolet radiation. Chronic Dis Can 2010;29(Supplement 1):51-68. (PDF)
16. Edefonti V, Bravi F, La Vecchia C, et al. Nutrient-based dietary patterns and the risk of oral pharyngeal cancer. Oral Onc 2010;46:343-8. (PDF)

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The Journal of the American Dental Association

The Journal has published a number of articles related to oral cancer (ADA members and JADA subscribers may search the JADA archives for a complete list). A sampling of those articles appears below:

• Diet and prevention of oral cancer: Strategies for clinical practice (February 2011) (PDF)
• Evidence-Based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinomas (May 2010) (PDF)
• Adjunctive techniques for oral cancer examination and lesion diagnosis:A systematic review of the literature (July 2008) (PDF)
• Exploring reasons for delay in treatment of oral cancer (October 2008) (PDF)
• For the Dental Patient: Detecting oral cancer early (May 2010) (PDF)

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Additional Resources

• American Cancer Society 
• Fanconi Anemia and Oral Cancer
• National Cancer Institute 
  NCI's gateway for information about oral cancer (cancer of the lip or mouth)
• National Institute for Dental and Craniofacial Institute 
  Information on risk factors, examinations and treatment for oral cancer
• Support for People with Oral and Head and Neck Cancer (SPOHNC)
  Dedicated to raising awareness and meeting the needs of oral and head and neck cancer patients.

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