Dr. Robert Miller Talks About Oral Cancer and Its Risk Factors
Oral cancer — and how people contact it through sexual activity — is traditionally associated with men over the age of 40 who smoke. However, as this May 2007 Time article points out, young men and women are at risk for oral cancer due to the transmission of HPV during sexual activity.
As part of my effort to educate consumers, I’ll be posting information about oral cancer through April as April 12 – 18 is Oral, Head and Neck Cancer Awareness Week. Over 140 medical offices across the U.S. are offering free oral cancer screenings — including my own (more details forthcoming!).
Today I’m happy to introduce Dr. Robert Miller, M.D. of WellSpring Oncology Cancer Center from Pinellas Park, Florida. He took some time to answer basic questions about oral cancer.
Dr. Miller, are you seeing more oral cancer patients and are these patients young, older, male or female?
Dr. Miller: Yes, we’re seeing more oral cancer patients who are a little bit younger –- due to smoking. The patients tend to be younger but are equal in male and female.
In the patients that you see with oral cancer, is the cancer advanced? What brought the patients in to see you? Had they seen a dentist first who performed an oral cancer screening?
Dr. Miller: In the patients that we’re seeing, they do tend to be more advanced because they were not screened. Unfortunately, a lot of patients who have oral cancer are heavy smokers and/or drinkers. They are socially disadvantaged because of this and are pretty advanced in the disease.
By the time they see us, an oral surgeon or an ENT (ear, nose and throat) physician has already made the diagnosis.
Of the patients that you’re seeing, do they know about oral cancer? Are they shocked when you tell them they have oral cancer — esp. if they’re young and don’t smoke?
Dr. Miller: Most patients are surprised. It didn’t occur to them that they had cancer in the mouth. They may have had concerns over lung cancer [due to smoking and such] but not oral cancer.
In addition to oral sex and HPV, what other risk factors exist and what can young women do to reduce their risk?
Dr. Miller: Mainly smoking and alcohol. Those are the two biggies. Obviously, to not smoke or drink excess amounts of alcohol. Having multiple sexual partners is a risk, so practicing safe sexual behavior by using condoms and protection would reduce the risk.
Do you think that getting screened annually by a dentist who uses tests such as ViziLite (or any other test) is one thing they can do?
Dr. Miller: Yes, if a person thought they were particularly at a high risk, they should be screened because dentists are trained to inspect the mouth for anything suspicious. Competent dentists will inspect for white lesions or leukoplakia.
Early signs of irritability or continuing to smoke are high risk factors, oral surgeons or dentist should be encouraged to perform a thorough screening in these cases.
The problem with oral cancer is that no standard or official screening is in place. What I mean is that when you go for your yearly physical, the doctor doesn’t look in your mouth and check for any signs of cancer. It’s not like breast cancer that can be screened with mammograms, prostrate cancer which can be caught with a prostate exam or colonoscopy which can catch colon cancer.
No oral cavity screening exists as a separate exam. A patient has to pay attention to changes on their own skin (skin cancer) or mouth — and then call a doctor or dentist if he/she notices anything unusual.
Have you found that your patients know about tests that exist for oral cancer?
Dr. Miller: In short: No.
I have found that the media is simply not addressing this issue. Why do you think that is?
Dr. Miller: The media has so many diseases to cover; if a disease is not on the radar because it’s not that common, then it won’t be discussed.
High volume diseases like breast cancer, colon cancer or prostate cancers are covered because of the amount of people those diseases affect. The media doesn’t pay attention to the others.
And too, topics about oral cancer that include oral sex may be uncomfortable to talk about and therefore the topic is avoided, although the media will cover it indirectly by discussing the dangers of smoking for example.
Some diseases that have began to get attention were due to celebrities that experienced it i.e. Farah Fawcett who succumbed to anal cancer. However, if it’s an “uncomfortable” cancer, you won’t see much about it in the media.
Another example is Katie Couric who lost her husband to colorectal cancer in 1998. Because of this, colorectal cancer was mentioned more in the media.
Dr. Miller, thank you for your time and insight!
Do you have a question about oral cancer and HPV that isn’t answered here? Please post it in the comments section below and if I don’t know the answer, I’ll find someone who does.
