The South African Dental Association (SADA) today announced its oral health theme for the year. Ms Maretha Smit, CEO of SADA says that Oral Cancer (OC) and Oro-pharyngeal Cancer (OPC) will be the association’s theme of its public awareness programme for the next twelve months. “SADA will focus the attention on all the different causes and relevant aspects pertaining to this subject and, our first briefing session to the media, therefore, deals specifically with the alarming increase in Oro-pharyngeal Cancer (OPC) as a result of oral sex.”
The causal link between OPC and oral sex in the younger generation, especially young males, is menacing as Oro-pharyngeal cancer can be caused through the invisible presence of the Human Papilloma Virus (HPV). This virus, with its more than a hundred sub-types, is relatively prevalent. The high-risk variants of the HPV virus cause cervical cancer in women and, consequently, through the practice of oral sex, can be transmitted to the oral cavity where it can be one of the causes of Oro-pharyngeal cancer.
Professor André van Zyl, together with Professor Willie van Heerden, both of the School of Dentistry, Faculty of Health Sciences, University of Pretoria - and active members of SADA - will be the programme leaders for the association’s awareness campaign regarding OC and OPC. They are of the opinion that the younger generation, while avoiding infection with HIV by practising oral sex, may be exposing themselves to the possibility of HPV infection.
“Oral sex is perceived to be a safer sexual behaviour in an AIDS dominated world”, says Van Zyl. “However, while it is true that the spread of HIV infection is lowered through the practice of non-genital sex, the spread of HPV has become more prevalent and, in turn, the cases of HPV-related Oro-pharyngeal cancer have increased dramatically over the past decade.”
HPV-related cancer occurs mostly in young adults. Van Zyl continues: “These young people could never imagine that they might develop Oro-pharyngeal cancer, and, it therefore is imperative that regular dental check-ups are conducted to ensure an early diagnosis of cancer in either the oral cavity or in the Oro-pharyngeal area.”
According to statistics, multiple oral sex partners significantly increase the risk for becoming infected by the Human Papilloma Virus (HPV), which may then lead to the development of Oro-pharyngeal Cancer (OPC). “While this type of cancer, if detected in the early stages, responds very well to chemo-radiation therapy and can be cured by such modern treatment, the tragedy is that in most cases the diagnosis is made too late and the patient often succumbs to the disease.”
Maretha says that the dental community is aware of the dangers that oral sex poses for the younger generation in particular and, that dentists have been made vigilant to a possible spike in the incidence of this type of Oro-pharyngeal Cancer in the years to come.
“Today a range of new diagnostic technologies are available that can be utilized to assist the dentist in ensuring that all suspicious oral lesions are properly evaluated. A dentist is the most appropriate health care professional to perform these examinations and be responsible for patient management, which may include referral for appropriate cancer treatment”
Maretha further states that OC/ OPC are diseases that globally affect up to 400 000 new patients per year. “While this statistic in itself is disturbing, the shocking fact is that 50% of people affected by OC/ OPC will die within five years of diagnosis.”
“These relatively poor survival rates have not changed significantly over the last 50 years and are in stark contrast to several other types of cancers where improvements in diagnosis and treatments have led to many types of cancer being regarded as curable diseases today.”
Professor van Zyl adds: “Should OC/ OPC be identified by the dentist at an early stage, then there is every possibility to stop the process and achieve a cure. It is for this reason, and the fact that dentists are trained particularly to detect early OC/ OPC - in that they are the healthcare professionals who routinely examine the oral cavity – that all efforts should be focused on raising public awareness and on encouraging people to visit the dentist strictly on a half-yearly basis.”
It is one of SADA’s stated objectives to ensure that its members are encouraged to utilise all knowledge and cutting-edge technology available to dental practitioners to protect patients and to ensure that OC/ OPC, which may be deadly, are identified in the very early stages. Maretha says, “This emphasises the need for regular dental check-ups. In excess of 90% of people who are diagnosed in the early stages of OC/ OPC survive as opposed to as low as 12% when these cancers are detected in the very late stages.”
Maretha Smit also announced a list of the other causes of Oral and Oro-pharyngeal cancer, each of which will be highlighted and discussed as separate subjects during the course of the “SADA Oral Cancer Awareness Year”.
Johannesburg, 4th October 2011
NOTES TO EDITORS:
1. Please note that Oral Cancer (OC) can be divided into two anatomically different areas, namely Oral Cancer (cancer of the mouth) and Oro-pharyngeal Cancer (cancer of the throat or OPC), each with distinctly different challenges and often different causes. Throat Cancer (OPC) simply is a term used for Oral Cancer (OC) which manifests further back in the mouth. The mouth and throat are two interconnected areas and covers a relatively large area.
2. OC is a cancer that starts in the lining mucosa of the oral cavity and is often associated with a visible alteration of the mucosa, called a potentially cancerous lesion.
3. In developing countries the incidence of OC is still on the increase whereas it is on the decline in some western countries.
4. An additional factor which clouds the whole issue of OC in South Africa is the fact that not all OC cases are taken up in the official cancer statistics of the country. This is owing to the fact that often it is picked up too late and patients receive no formal diagnosis and palliative care only is given to make their last days more comfortable. (We owe our patients more than this in a civilized country!) There is thus an under-estimation of the true burden of OC in this country.
Causal Factors and other Facts regarding Oral Cancer
1. Oro-pharyngeal cancer: A sexually transmitted disease
Over the last 30 years an increase has been seen in cancer of the head and neck areas. This is mainly because of an increase in Oro-pharyngeal cancer, a subset of head and neck cancer. The Human Papilloma Virus (HPV) is linked to Oro-pharyngeal cancer (OPC) and HPV is sexually transmitted, with the odds of infection linked to the number of oral sex partners. HPV Oro-pharyngeal cancer seems to affect mostly young males between 20-40 years of age, whereas traditional tobacco-alcohol associated OC’s and OPC’s are usually seen later in life.
2. Hubbly-Bubbly and Oral Cancer
All forms of tobacco are carcinogenic – meaning they put the user at risk of developing oral and Oro-pharyngeal cancer. Hookah-pipe smoking (called Hubbly Bubbly in South Africa) is becoming more popular internationally and, especially in our country, Hookah cafés are gaining in popularity. Research has shown that a one-hour Hookah session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
3. Alcohol
The role of ethanol in alcoholic beverages holds the same risk for causing oral cancer as the nicotine in tobacco. When used in conjunction with tobacco, it accounts for up to 75% of oral cancers. The role of alcohol is complex and especially young people need to be educated about the dangers of alcohol as a cause of oral cancer.
4. Areca nut chewing
Worldwide 600 million people chew the Areca nut. Almost 60% of all oral cancers occur in South-East Asia, mainly because of Areca nut chewing, alone and in combination with other products. In KwaZulu- Natal, Areca nut chewing is still very prevalent amongst the Indian community and most users are unaware of the dangers involved. There is a need to develop a programme to educate these communities about this dangerous pastime and, especially the younger generation needs to be made aware of this menace.
5. Warning signs of Oral Cancer
The abysmal 5-year survival rate of people with oral cancer has remained largely unchanged over the last 50 years. This is partly owing to the late diagnosis of oral cancer in most patients. Patients need to be educated about the danger signs and how they themselves may play a role in ensuring earlier diagnosis and, consequently better survival rates. This is one of the most important aspects of working towards a better quality of life for oral cancer patients.
6. If worried – who should you see?
Oral Cancer (OC) and especially Oro-pharyngeal Cancer (OPC) straddles many specialities and professions. The importance is that all need to work together towards the common goal – improving the survival rate of oral cancer – especially amongst the poorest of the poor. The dentist remains the only trained health care worker who will screen oral health routinely, and has to be an important front person for diagnosing this increasing disease. Getting the dentist to diagnose cancer early and to liaise with the other health care workers for successful management of oral cancer – is the challenge. Most oral cancers go through a phase of early changes that have not become cancerous yet. These can easily be spotted by the dentist, using special screening tools. Early diagnosis can lead to a cure of the oral cancer. There have been major advances in cancer screening over the last 3 years and patients and dentists should both be aware of these. It, therefore, also is of crucial importance to incorporate South Africa’s primary health care workers into this team of professionals.
7. How is oral cancer managed?
If oral cancer is diagnosed early, the management and survival is significantly better and more successful than if diagnosed late (90% versus 20%). As management of the cancer still largely relies on surgical excision, the focus on early intervention is of critical importance. Radiation and chemotherapy is as successful as surgery in some cancers. Knowing the HPV status of Oro-pharyngeal cancer (OPC) is of critical importance, as it carries a much better survival rate than HPV-negative Oro-pharyngeal cancer (OPC).
8. What can the patient contribute to lowering the risk of oral cancer?
Aside from abstaining from the use of risk factors such as tobacco and alcohol abuse, patients can lower the actual risk of developing Oral Cancer (OC) – by eating themselves healthy! Certain foodstuffs such as fruit and non-starch vegetables can lower the risk of oral cancer substantially. Patients need to be made aware of the exact role of foodstuffs that are beneficial.
9. Benefits of coffee
Over the past few years it has emerged that coffee with its potent anti-oxidants, can actually lower the risk of developing oral cancer. Coffee has other benefits too, and if used in moderation, can promote health. Current research has not found any other beverage with these protective properties.
10. Are certain sections of the South African population more at risk of oral cancer development?
Yes! Certain sections of the population are more at risk, especially the poor, the malnourished and those far from health care services. As poverty is a serious problem in South Africa, we need to formulate strategies to combat the role poverty may play in adverse oral cancer outcomes. Information regarding oral cancer lowering diets, information about diagnosing oral cancer, risk factors and such – need to be incorporated in school curricula, especially at primary school level. This message needs to be taken to every person in South Africa.
11. CAN HPV VACCINE PROTECT AGAINST ORO-PHARYNGEAL CANCER?
Vaccination against the Human Papilloma Virus (HPV) is now regarded as standard procedure in the prevention of cervical cancer in females and provides protection against a range of disease caused by the specific HPV variants targeted by the vaccine. The past two years there has been increased support for the vaccination of males. The USA’s Centers for Disease Control and Prevention (CDC) now recommends routine vaccination for males from as young as nine to the age of 26 years old. The vaccine protects males against genital warts, anal cancer and Oro-pharyngeal Cancer (OPC). More research is expected to emerge during the coming 12 months and, hopefully, the costs of the vaccines will decrease concomitantly.
The causal link between OPC and oral sex in the younger generation, especially young males, is menacing as Oro-pharyngeal cancer can be caused through the invisible presence of the Human Papilloma Virus (HPV). This virus, with its more than a hundred sub-types, is relatively prevalent. The high-risk variants of the HPV virus cause cervical cancer in women and, consequently, through the practice of oral sex, can be transmitted to the oral cavity where it can be one of the causes of Oro-pharyngeal cancer.
Professor André van Zyl, together with Professor Willie van Heerden, both of the School of Dentistry, Faculty of Health Sciences, University of Pretoria - and active members of SADA - will be the programme leaders for the association’s awareness campaign regarding OC and OPC. They are of the opinion that the younger generation, while avoiding infection with HIV by practising oral sex, may be exposing themselves to the possibility of HPV infection.
“Oral sex is perceived to be a safer sexual behaviour in an AIDS dominated world”, says Van Zyl. “However, while it is true that the spread of HIV infection is lowered through the practice of non-genital sex, the spread of HPV has become more prevalent and, in turn, the cases of HPV-related Oro-pharyngeal cancer have increased dramatically over the past decade.”
HPV-related cancer occurs mostly in young adults. Van Zyl continues: “These young people could never imagine that they might develop Oro-pharyngeal cancer, and, it therefore is imperative that regular dental check-ups are conducted to ensure an early diagnosis of cancer in either the oral cavity or in the Oro-pharyngeal area.”
According to statistics, multiple oral sex partners significantly increase the risk for becoming infected by the Human Papilloma Virus (HPV), which may then lead to the development of Oro-pharyngeal Cancer (OPC). “While this type of cancer, if detected in the early stages, responds very well to chemo-radiation therapy and can be cured by such modern treatment, the tragedy is that in most cases the diagnosis is made too late and the patient often succumbs to the disease.”
Maretha says that the dental community is aware of the dangers that oral sex poses for the younger generation in particular and, that dentists have been made vigilant to a possible spike in the incidence of this type of Oro-pharyngeal Cancer in the years to come.
“Today a range of new diagnostic technologies are available that can be utilized to assist the dentist in ensuring that all suspicious oral lesions are properly evaluated. A dentist is the most appropriate health care professional to perform these examinations and be responsible for patient management, which may include referral for appropriate cancer treatment”
Maretha further states that OC/ OPC are diseases that globally affect up to 400 000 new patients per year. “While this statistic in itself is disturbing, the shocking fact is that 50% of people affected by OC/ OPC will die within five years of diagnosis.”
“These relatively poor survival rates have not changed significantly over the last 50 years and are in stark contrast to several other types of cancers where improvements in diagnosis and treatments have led to many types of cancer being regarded as curable diseases today.”
Professor van Zyl adds: “Should OC/ OPC be identified by the dentist at an early stage, then there is every possibility to stop the process and achieve a cure. It is for this reason, and the fact that dentists are trained particularly to detect early OC/ OPC - in that they are the healthcare professionals who routinely examine the oral cavity – that all efforts should be focused on raising public awareness and on encouraging people to visit the dentist strictly on a half-yearly basis.”
It is one of SADA’s stated objectives to ensure that its members are encouraged to utilise all knowledge and cutting-edge technology available to dental practitioners to protect patients and to ensure that OC/ OPC, which may be deadly, are identified in the very early stages. Maretha says, “This emphasises the need for regular dental check-ups. In excess of 90% of people who are diagnosed in the early stages of OC/ OPC survive as opposed to as low as 12% when these cancers are detected in the very late stages.”
Maretha Smit also announced a list of the other causes of Oral and Oro-pharyngeal cancer, each of which will be highlighted and discussed as separate subjects during the course of the “SADA Oral Cancer Awareness Year”.
Johannesburg, 4th October 2011
NOTES TO EDITORS:
1. Please note that Oral Cancer (OC) can be divided into two anatomically different areas, namely Oral Cancer (cancer of the mouth) and Oro-pharyngeal Cancer (cancer of the throat or OPC), each with distinctly different challenges and often different causes. Throat Cancer (OPC) simply is a term used for Oral Cancer (OC) which manifests further back in the mouth. The mouth and throat are two interconnected areas and covers a relatively large area.
2. OC is a cancer that starts in the lining mucosa of the oral cavity and is often associated with a visible alteration of the mucosa, called a potentially cancerous lesion.
3. In developing countries the incidence of OC is still on the increase whereas it is on the decline in some western countries.
4. An additional factor which clouds the whole issue of OC in South Africa is the fact that not all OC cases are taken up in the official cancer statistics of the country. This is owing to the fact that often it is picked up too late and patients receive no formal diagnosis and palliative care only is given to make their last days more comfortable. (We owe our patients more than this in a civilized country!) There is thus an under-estimation of the true burden of OC in this country.
Causal Factors and other Facts regarding Oral Cancer
1. Oro-pharyngeal cancer: A sexually transmitted disease
Over the last 30 years an increase has been seen in cancer of the head and neck areas. This is mainly because of an increase in Oro-pharyngeal cancer, a subset of head and neck cancer. The Human Papilloma Virus (HPV) is linked to Oro-pharyngeal cancer (OPC) and HPV is sexually transmitted, with the odds of infection linked to the number of oral sex partners. HPV Oro-pharyngeal cancer seems to affect mostly young males between 20-40 years of age, whereas traditional tobacco-alcohol associated OC’s and OPC’s are usually seen later in life.
2. Hubbly-Bubbly and Oral Cancer
All forms of tobacco are carcinogenic – meaning they put the user at risk of developing oral and Oro-pharyngeal cancer. Hookah-pipe smoking (called Hubbly Bubbly in South Africa) is becoming more popular internationally and, especially in our country, Hookah cafés are gaining in popularity. Research has shown that a one-hour Hookah session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
3. Alcohol
The role of ethanol in alcoholic beverages holds the same risk for causing oral cancer as the nicotine in tobacco. When used in conjunction with tobacco, it accounts for up to 75% of oral cancers. The role of alcohol is complex and especially young people need to be educated about the dangers of alcohol as a cause of oral cancer.
4. Areca nut chewing
Worldwide 600 million people chew the Areca nut. Almost 60% of all oral cancers occur in South-East Asia, mainly because of Areca nut chewing, alone and in combination with other products. In KwaZulu- Natal, Areca nut chewing is still very prevalent amongst the Indian community and most users are unaware of the dangers involved. There is a need to develop a programme to educate these communities about this dangerous pastime and, especially the younger generation needs to be made aware of this menace.
5. Warning signs of Oral Cancer
The abysmal 5-year survival rate of people with oral cancer has remained largely unchanged over the last 50 years. This is partly owing to the late diagnosis of oral cancer in most patients. Patients need to be educated about the danger signs and how they themselves may play a role in ensuring earlier diagnosis and, consequently better survival rates. This is one of the most important aspects of working towards a better quality of life for oral cancer patients.
6. If worried – who should you see?
Oral Cancer (OC) and especially Oro-pharyngeal Cancer (OPC) straddles many specialities and professions. The importance is that all need to work together towards the common goal – improving the survival rate of oral cancer – especially amongst the poorest of the poor. The dentist remains the only trained health care worker who will screen oral health routinely, and has to be an important front person for diagnosing this increasing disease. Getting the dentist to diagnose cancer early and to liaise with the other health care workers for successful management of oral cancer – is the challenge. Most oral cancers go through a phase of early changes that have not become cancerous yet. These can easily be spotted by the dentist, using special screening tools. Early diagnosis can lead to a cure of the oral cancer. There have been major advances in cancer screening over the last 3 years and patients and dentists should both be aware of these. It, therefore, also is of crucial importance to incorporate South Africa’s primary health care workers into this team of professionals.
7. How is oral cancer managed?
If oral cancer is diagnosed early, the management and survival is significantly better and more successful than if diagnosed late (90% versus 20%). As management of the cancer still largely relies on surgical excision, the focus on early intervention is of critical importance. Radiation and chemotherapy is as successful as surgery in some cancers. Knowing the HPV status of Oro-pharyngeal cancer (OPC) is of critical importance, as it carries a much better survival rate than HPV-negative Oro-pharyngeal cancer (OPC).
8. What can the patient contribute to lowering the risk of oral cancer?
Aside from abstaining from the use of risk factors such as tobacco and alcohol abuse, patients can lower the actual risk of developing Oral Cancer (OC) – by eating themselves healthy! Certain foodstuffs such as fruit and non-starch vegetables can lower the risk of oral cancer substantially. Patients need to be made aware of the exact role of foodstuffs that are beneficial.
9. Benefits of coffee
Over the past few years it has emerged that coffee with its potent anti-oxidants, can actually lower the risk of developing oral cancer. Coffee has other benefits too, and if used in moderation, can promote health. Current research has not found any other beverage with these protective properties.
10. Are certain sections of the South African population more at risk of oral cancer development?
Yes! Certain sections of the population are more at risk, especially the poor, the malnourished and those far from health care services. As poverty is a serious problem in South Africa, we need to formulate strategies to combat the role poverty may play in adverse oral cancer outcomes. Information regarding oral cancer lowering diets, information about diagnosing oral cancer, risk factors and such – need to be incorporated in school curricula, especially at primary school level. This message needs to be taken to every person in South Africa.
11. CAN HPV VACCINE PROTECT AGAINST ORO-PHARYNGEAL CANCER?
Vaccination against the Human Papilloma Virus (HPV) is now regarded as standard procedure in the prevention of cervical cancer in females and provides protection against a range of disease caused by the specific HPV variants targeted by the vaccine. The past two years there has been increased support for the vaccination of males. The USA’s Centers for Disease Control and Prevention (CDC) now recommends routine vaccination for males from as young as nine to the age of 26 years old. The vaccine protects males against genital warts, anal cancer and Oro-pharyngeal Cancer (OPC). More research is expected to emerge during the coming 12 months and, hopefully, the costs of the vaccines will decrease concomitantly.
