Remain Vigilant for Signs of Oral Cancer

PHILADELPHIA - Clinicians need to remain vigilant for the signs of oral cancer to assist with early diagnosis, according to a speaker here.

“We need to look our patients in the eye and tell them we are doing the best we can for them, but the problem I see is that a lot of clinicians don’t look,” Martin Jablow, DMD, a New Jersey clinician, told an audience of more than 200 at the Updates in Contemporary Dentistry Meeting.

Dr. Jablow said that the mortality rate for oral cancer has not changed in 30 years, and that is unacceptable in this day of better diagnostic options. He said that there are newer tools that may assist clinicians in the diagnosis of the early stages of oral cancer.

“HPV types 16 and 18 may be contributing factors in oralpharyngal cancers. Oralpharyngal cancers can be difficult to find,” Dr. Jablow said.

The bad news is that  HPV is very common, with about 75% of the sexually active population having been infected at one time. The good news, he noted, is that most people with HPV related oral cancers have a better outcome than those with other types of oral cancer. The problem is 50% of those diagnosed with oral cancers die within 5 years due to late diagnosis. So, Dr. Jablow said, early diagnosis is key.

In Dr. Jablow’s office, “I assume everyone is HPV positive, and everyone in my office from age 14 and up gets screened for oral cancer, 100% of the time.” Although Dr. Jablow does not charge for this screening, he notes there is a reimbursement code, which is D0431, if a clinician chooses to charge for the screening.

 Although Dr. Jablow admits that finding even one lesion is rare, “when you find that one, it’s a very big deal for that patient.”

In addition to looking for the oral pathology using tools like the Identafi from DentalEZ Group or other similar tools, Dr. Jablow said it is also important to do a thorough tactile examination. He encouraged clinicians in attendance to visit the website, sixstepscreening.org for tips on the tactile examination techniques. Many of the HPV related oral pharyngeal cancers are first identified from a lump in the neck.

Using the Identafi 3000, Dr. Jablow first uses the white light, and “when I do this, I am looking for all those things that we were taught in dental school. You are searching for anything from white to red in color that doesn’t look like it belongs. Then I switch the [light] to the violet color, because it makes it easier to see possible pathologic areas that appear darker. Then I switch to the green light, which shows abnormalities in blood vessels, abnormal tissue and diffuse vasculature.”

Dr. Jablow notes that this entire process only takes approximately 2 minutes but has the potential to save a life.

“If you are already looking for the signs of oral cancer, thank you, if you are not, please start. It’s not only for your benefit; it’s also for your patients’ benefit. If you find that one needle in a haystack, it is going to make you feel good to know that you may have saved a  life.”