Chew On This - Oral Cancer is a Continual Concern

Story Number: NNS150604-01Release Date: 6/4/2015 7:54:00 AM
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By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- The use of smokeless tobacco has become - a chew at a time - one of the leading causes of cancer statistics in the military.

With Navy Medicine's designated theme for June focusing on 'Men's Health,' Naval Hospital Bremerton's Tobacco Cessation Coordinator and Oral Surgery department are trying to lessen the associated impact for those who use such a product.

"Our Oral Surgery and Dental departments are on the forefront of detection, prevention and education about the potential dangers to our population that is nearly five times more likely to use smokeless tobacco than the general population. But smokeless tobacco is not the only culprit. Smokers are equally at risk. Smoking rates in the Navy are twice those of the general population. Often times Dental are the first to detect potential problems before the user has developed any awareness," said Pat Grave NHB Tobacco Cessation coordinator.

According to Lt. Cmdr. Sarah Lawson, NHB Oral Surgery Department head and oral and maxillofacial surgeon, it's vital for everyone who uses any type of tobacco product to get their regular oral cancer examination.

"Dipping can be very destructive to the dentition functionally and esthetically. It can erode gum tissue and bone that may never grow back. Early detection leads to a better chance of surviving," said Lawson, noting that when conducting an exam, a tobacco product habit can be detected by such indications as right handed smokers tending to develop cancers near or in the right tonsil and left-handed smokers on the left.

Oral squamous cell carcinoma has a 50 percent, five-year death rate and thousands continue to die in the U.S. from this cancer every year despite recent advances in detection and treatment.

"An active duty person diagnosed with oral cancer may be in cancer treatment for over a year even if removal of facial and neck structures is not required. If they survive, they may continue in fully deployable status but are then monitored closely for recurrence of the cancer," Lawson said.

Graves advocates that for anyone using tobacco in any form, it's important to get their dental checkups and cleaning, which provides a good visual inspection, and also practice good oral hygiene maintenance on a daily basis.

"It's kind of like putting gas in your car is the daily maintenance to make things go, getting your oil changed to make sure things are running well and tune ups to prevent engine failure," explained Graves.

Along with visits to Oral Surgery and/or Dental, it is important for patients to be aware of the following signs and symptoms, and to see their dental provider if they do not disappear after two weeks.

*A sore or irritation that doesn't go away

*Red or white patches

*Pain, tenderness or numbness in mouth or lips

*A lump, thickening, rough spot, crust or small eroded area

*Difficulty chewing, swallowing, speaking, or moving your jaw or tongue

*A change in the way your teeth fit together when you close your mouth

Why is the Navy so focused on oral cancer awareness and prevention? Graves sites statistical evidence that there are significant differences in smokeless tobacco use rates between the military and civilian populations. In 2008, the overall prevalence of smokeless tobacco use among active duty personnel was 14 percent (Bray et al., 2009). By comparison, 3.5 percent of civilians greater than18 years old used smokeless tobacco (Substance Abuse and Mental Health Services Administration, 2010; "Smokeless Tobacco Use in the United States Military: A Systematic Review" from: Nicotine Tob Res. 2012 May; 14(5): 507-515. Published online 2011 Nov 28. doi: 10.1093/ntr/ntr216).

There's even more statistics to consider. The U.S. Centers for Disease Control and Prevention shows that each year there are more than 30,000 new cases of cancer of the oral cavity and pharynx diagnosed. On top of that, there are also approximately 8,000 deaths due to oral cancer. The five-year survival rate for these cancers is approximately 50 percent. Mortality from oral cancer is nearly twice as high in some minorities - especially black males - as it is in whites. Methods used to treat oral cancers - surgery, radiation, and chemotherapy - can be disfiguring and costly.

Preventing high risk behaviors, that include cigarette, cigar or pipe smoking, use of smokeless tobacco, and excessive use of alcohol are critical in preventing oral cancers. Research has identified that those at an especially high risk of developing oral cancer are heavy drinkers and smokers older than 50.

"Alcohol and tobacco have a synergistic effect with nine percent of oral carcinomas occurring in nonsmokers. Avoid alcohol and cigarettes, especially together. Especially if you are female. Smokers in general have an eight-fold higher risk for oral cancer, with cancer incidence in women smokers twice that of men who smoke the same amount. High intake of alcohol raises the risk of oral cancer six-fold. Those who both drink and smoke are 22 times more likely to develop oral cancer," said Lawson.

The human papilloma virus version 16, which is sexually transmitted, is related to the increasing incidence of mouth cancer in non-smoking patients. It is likely that there is a complex interaction of many external and internal factors that play a role in the development of oral cancer.

Lawson cited the Oral Cancer Foundation report that stated, "HPV is the most common sexually transmitted virus and infection in the US. The fastest growing segment of the oral and oropharyngeal cancer population are otherwise healthy, non-smokers in the 25-50 age range. When you consider both anatomical sites, HPV is driving the growth in numbers of oral cancers.
Every day in the US, about 12,000 people ages 15 to 24 are infected with HPV. The vast majority of them will clear the virus naturally and never know that they were exposed or had it. If you test positive for HPV, there is no sure way to know when you were infected with HPV, or who gave it to you. A person can have HPV for many years, even decades, before it is detected or it develops into something serious like a cancer."

NHB's Tobacco Cessation Coordinator and Oral Surgery department attention to oral cancer mirrors that of the Oral Cancer Foundation (OCF), American Academy of Oral & Maxillofacial Pathology (AAOMP), American Academy of Periodontology (AAP), American Association of Oral and Maxillofacial Surgeons (AAOMS), and the American Dental Association (ADA).

All recommend that everyone - especially those who use any type of tobacco products - have regular oral cancer examinations from dental professionals to help detect oral cancer in its early stages.

Not just for the month of June, but on a continual basis.

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