Behind the cancer smokescreen
When I was a child my father had a friend who smoked cigars, constantly. He said they were much healthier than cigarettes, you didn’t inhale the smoke, so there was much less chance of getting lung cancer. My mother explained that a) this wasn’t true and b) it was more than lung cancer that smokers had to beware of, primarily, for cigar smokers, oral cancer.
It was the first time I had heard of oral cancer, but there was much less awareness of it then. There is a lot more awareness now. Sadly, this is driven by the increase in incidences. The number of cases in the UK has grown by 49 per cent in the last 10 years and 135 per cent in the last 20 years. It is now the 11th most common cancer in UK men and the 16th most common in UK women, with 45 per cent of cases diagnosed in people 65 and over. But, the demographics are changing. More cases are being diagnosed in younger cohorts, and cases in women are increasing. However, data cited by the BDA for Scotland shows that 90 per cent of cases could be prevented and that survival could be improved from 50 per cent to 90 per cent with early detection. Focus on prevention and early detection then: easier to write than do perhaps.
Dentistry is unique as it provides a regular touchpoint for the public. The value of this for early detection is incredible. Yet, more than
40 per cent of cases present first to GMPs. Anecdotal evidence suggests there are two reasons for this: firstly, the public still don’t understand the breadth of dental training and expertise, so don’t think about going to their GDP with concerns about their oral (as opposed to dental) health; and, secondly, people are not attending their dental appointments regularly enough for issues to be spotted. Surely though, patients can be educated to take on some responsibility for early detection? It is important to raise awareness and encourage people to learn how to spot symptoms, but it can’t replace regular checking at dental appointments. Oral cancer diagnosis is difficult even for professionals who see cases regularly. The advice to the public must be: If you see anything suspicious, get it checked.
Two of the three main causes of oral cancer are alcohol and tobacco, and this where the public really can have an impact by stopping smoking, eating more healthily, and cutting down on alcohol. Except, it’s not as simple as that.
Change needs a significant public engagement and education campaign, and a public health and private sector infrastructure that supports individuals to live healthier lifestyles. It also needs investment in smoking cessation and alcohol advice programmes.
The third major cause is HPV. It seems incredible that it still hasn’t been confirmed that the HPV vaccine will be introduced for boys in Northern Ireland as it has in the rest of the UK and in Ireland. New powers have been legislated for now to help address the current political stagnation, so surely the vaccine should be agreed as early as possible. Particularly as it has just been announced that there will be no catch-up programme in England, and no commitment to one in Scotland. Governments are relying on herd immunity to protect people, but that simply won’t happen if not enough people, of both genders, are vaccinated. Put simply, oral cancer is preventable. My parents’ generation didn’t know the risks and thought cigars were ‘healthy’. I hope that people in my children’s generation will know what to look out for, who to see about their concerns, know the risks and how to mitigate them, and have the added protection of HPV vaccinations as standard.