Oral cancer screening in the elderly

Oral cancer screening in the elderly – Editorial

Jay R. Varma

Oral cancers represent 4 percent of all cancers diagnosed in men and 2 percent of all cancers diagnosed in women each year in the United States. Epidemiologic data point to alcohol and tobacco as major risk factors, and some reports[1] have linked the increased incidence of oral cancer with regular use of mouthwash.

About 7,700 Americans will die of oral cancer this year, and another 29,800 new cases will be diagnosed.[2] Of all the major cancers, oral and pharyngeal cancer rank among those with the lowest survival rates. The five-year survival rate is only 52 percent.[2-4]

The vast majority (90 percent) of oral cancers are squamous cell carcinoma.[5,6] Oral squamous cell cancer accounts for 5 percent of all cancers detected annually.[2] The most important prognostic factor is the status of the cervical lymph nodes at the time of diagnosis. The cure rate drops to 50 percent if the lymph nodes are involved.[2,7]

More than 95 percent of oral cancers occur in adults over the age of 40; the median age of patients with oral cancer is 63.[5] As the U.S. population ages, an increasing number of Americans will be diagnosed with oral cancer. One study[6] has already documented a rising incidence in oral cancer.

Survival rates following the diagnosis of oral cancer depend on several factors, including the size of the primary lesion, local extension, lymph node involvement, metastases, the patient’s ability to cope and the histologic differentiation of the malignancy.[5] As with many other cancers, the key to controlling this disease is early detection. Mortality remains high because of the advanced stages at which the disease is often first detected, and morbidity remains high due to aggressive therapy in an attempt to cure advanced disease.[5] Because elderly patients visit their physicians more often than they visit their dentists, physicians have an important opportunity to detect oral cancer at an early stage. Physicians need to be vigilant about oral health problems, which are among the most prevalent chronic conditions in the elderly. When oral cancer is detected early–when lesions are smaller than 3 cm and there is no evidence of metastases–the survival rate increases dramatically. The five-year survival rate is only 17 percent for patients with distant metastases and 30 percent for those with local extension, but 63 percent for those with local disease.[1-7]

The key to combating oral cancer is a concerted effort by all primary care physicians to regularly evaluate elderly patients for oral pathology. Oral cancer screening is a simple, noninvasive procedure that can be easily incorporated into any type of visit to a physician. Early detection of localized lesions will ensure a better prognosis.

REFERENCES

[1.] Winn DM, Blot WJ, McLaughlin JK, Austin DF, Greenberg RS, Preston-Martin S, et al. Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer. Cancer Res 1991;51:3044-7. [2.] Boring CC, Squires TS, Tong T. Cancer statistics, 1993. CA Cancer J Clin 1993;43:7-26. [3.] From the Centers for Disease Control. Current trends: deaths from oral cavity and pharyngeal cancer–United States, 1987. JAMA 1990;264:678. [4.] Skolnick A. CDC expands dental disease prevention role [News]. JAMA 1990;263:2609. [5.] Silverman S Jr, Gorsky M. Epidemiologic and demographic update in oral cancer: California and national data–1973 to 1985. J Am Dent Assoc 1990;120:495-9. [6.] Chen JK, Katz RV, Krutchkoff DJ. Intraoral squamous cell carcinoma. Epidemiologic patterns in Connecticut from 1935 to 1985. Cancer 1990;66:1288-96. [7.] Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 1990; 160:405-9.

COPYRIGHT 1993 American Academy of Family Physicians

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