This is the first draft of an editorial I have been asked to write about why we do not have a national screening policy. When the final version is ready, I wil repost it here.

What does it take?
One person's opinion.
By Brian Hill

This year cancer replaced heart disease as the number one killer of Americans. Since the official war on cancer was declared by President Nixon in 1972, progress has been made, but clearly not enough. Huge leaps in knowledge such as the mapping of the human genome, which we thought would yield the clues to scientific breakthroughs, have instead left us with the knowledge that cancer is not just a couple of pathology types, but literally hundreds of unique diseases. The more we find out, it is clearer the less we know. That does not mean that progress has not been made, just not progress that has yielded the breakthrough that will finally label cancer a manageable and survivable disease. To put this in perspective, the annual budget for cancer research in the US alone is over 5 billion dollars per year (requests of an additional 4.2 billion over the next 5 years were made this year by the NCI), in spite of this enormous expenditure and effort, one person dies of cancer every minute of every day in the US

That's a great (though discouraging in many ways) editorial. I hope it helps you find people willing to move a whole lot of pebbles...

Nelie

Bravo, Brian. Those of us who have benefited from early detection need to have our dentists and oral surgeons added to the list of dental heroes on this site, and recognized. My dentist was very emotional when I nominated him and added a link to this site on his practice web site.

Sincerely,
Lisa

Brian,

You raise many interesting issues with respect to oral cancers.

I believe that what is so direly needed at this time is public awareness and general education with respect to oral cancers.

I am a college graduate and professional and I did not know nor I had ever heard of tongue cancer until my family member was diagnosed with SCC oral tongue early this year.

I fully concur with your assessment of the dentistry community in what has been subpar performance in both the carrying out of oral screenings and cancer identification in conjunction with visists for dental exams or other denatl work.

My family member had visited with the same dentist three times within a few months of diagnosis and during each of the visits the dentist failed to detect or identify the tumor.

When the diagnosis was finally made by another medical doctor the cancer was advanced.

I believe that in many cases we may also be the culprits. Because we tend to dismiss conditions in our oral cavity as inconsequential since they may be asymptomatic and we have no knowledge or awareness of these cancers which otherwise would prompt us to act.

Generally, us at large know about breast cancer, colon cancer or lung cancer but whose ever heard of throat cancer or tongue cancer?

If ignorance is a blessing in oral cancers is deadly.

I'll tell you one thing that may motivate dentists. My dental insurance pays $37 for the oral cancer screening. Not bad for 3 minutes work x's how many patients? My prosthodontis charges for it, my periodontist does not, but does it anyway.

I for one had never heard of oral cancer before I had it, other than lip cancer from smoking a pipe. I think one of the reasons this disease is so ignored is that it, like alcoholism, is associated with negative behavior. I even had the guy in the next cube state 'anyone who smokes or drinks deserves to get cancer'. That was after the second time I had cancer. I asked him if that applied only to me or his best buddies on the staff who were still smoking. I think pointing out that 25% of these cancers are not caused by these controllable behaviors might help our cause at least in research. There is certainly no reaon why the dental community shouldn't be looking for this disease at least once a year.

I'm curious as to what journal/magazine this is going in. Keep up the good work and keep tossing those rocks. Maybe some of those dense heads will finally listen.

Eileen

Brian,

Great editorial!

I too, was wondering which Journal this will be in.

I have a question. One which has been bothering me since my cancer and since I joined this foundation. What is the percentage of oral cancers that are "base of tongue" and Tonsilar?

As you and many members know from my previous posts, my dental office has overhauled our Oral Cancer Screenings since my scc. What keeps nagging at me is that I wonder if it should be routine for me to suggest that my patients see an ENT in order to have the base of their tongue and tonsils checked?

I am convinced that the doctors and the hygienists in my practice will be able to spot any lesions on the dorsal, lateral or lingual borders of the tongue. We can easily vizualise the palate, cheeks, lips, face and neck. We can palpate the floor of the mouth, the lymph nodes and tongue, but we CANNOT see the base of the tongue and in most people, we CANNOT see the tonsils well.

Any thoughts on this would be greatly appreciated.

Jerry

Jerry, call Schein and buy a small exam mirror with a long shaft normally found in ENT offices. The mirror size is about 2/3rds as big as a conventional dental mirror. When using it (as you clearly understand) be careful not to touch the back of the patient's throat and initiate a gag reflex. With practive, a QUICK pass of a finger across the base of the tongue will also reveal hard areas or lumps. My doc does this so fast I barely have an issue with gaging, and he says the feeling of a begining cratered lesion or hard indurated tumor is unmistakable once you have felt the first one. Pulling the tongue forward with a 2X2 facilitates both of these things, getting things further away from a relfex area, and also into a more visible one at the same time.

I will have to scan the databases to get you the actual numbers on tonsillar and BOT's.

The article is going to be in Nexus which is a publication of NYU School of Dentistry. The entire issue is devoted to Oral Cancer.

I have taken this issue up with many others in government, and it will take public pressure to get past the roadblocks that exist. We have talked before about a letter writting /email campaign to decision makers, and I hope in the near future we will be able to get a significant number of OCF involved people on the task.

I'm ready! Just let me know where to send the letter.......

Brian,

Count me as one of the people who is willing to get involved.

John

Brian,

A couple of things about the examination of the BOT and tonsils. I guess you have to start somewhere, but I would be worried that in a quick pass over the BOT, I might miss something. The gagging reflex is another problem for me. I can tell you that most of my patients gag when I pull their tongues out with a 2x2 gauze and examine the tongue. Also, I know how I gag when I'm examined with one of those mirrors. I honestly feel that the only way to be sure that there is nothing in those areas, is with an endoscope.

As far as letter writing is concerned, that's one of my favorite passtimes. Count me in.

Please let us know when the magazine comes out. Perhaps I can get a copy from Ross Kerr. I would be very interested in the whole publication, of course.

Brian, count me in also. If I can be of some help, do not hesitate to ask. Thanks, Carol

Doc W - Ross also has an article in the same magazine. I'd give him a call and ask him to send you one. I expect they will send me one as a contributor.

Brian,

I've been in touch with Ross via email and he is going to send me a copy. It comes out in mid January.

Thanks