November is an interesting month. The clear end of summer, often bright but becoming increasingly a period of darkness with nights closing in early; however there is, if we can just go with that darkness, the promise of renewal, of spring and the following summer.
When we set up The Ben Walton Trust, twenty years ago now, mouth cancer was in darkness, the province of no one profession; poor public and professional knowledge and poor outcomes; long waiting times; delayed referrals; a Cinderella disease. From an outsider’s point of view (I am neither doctor nor dentist), this lack of awareness was surprising, especially given that survival rates were not good and what appeared to be a simple mouth ulcer could become fatal.
A number of initiatives since that time have improved matters. There are now more rapid referrals and increased awareness; NICE and SIGN guidelines; the formation of managed clinical networks (the disease becoming the specialism of head and neck teams); the start and development of Awareness / Action month (importantly held annually); and significantly improved target waiting times for treatment. The dental profession has been at the forefront of embracing the problems and being aware of the need for vigilance.
If we look at some key facts about mouth cancer, we can see both why these improvements were necessary and in them perhaps the key to really improving problems long-term.
Six out of ten mouth cancers are found at a late stage – early detection and treatment significantly improves survival (potentially from 50% - 90% five year survival). It is critical that target waiting times are not eroded to suit economic or political ends or we will revert to that dark past.
The most common traditional risk factors, we know, are still heavy alcohol and tobacco consumption (together they increase risk significantly) but we also know that around 25% of the younger age group, which are increasing, cannot be explained by these traditional risk factors – so we have to be clear that almost anyone can contract mouth cancer, young/old, male/female, non-smokers/heavy smokers, drinkers and non-drinkers.
Delays in referral from primary to secondary care are associated with a threefold increase in mortality. Therefore accurate detection, and rapid referral onwards for treatment to a specialist unit, can be critical. There is no room for misdiagnosis or missed diagnosis. We have to remember that however ‘gold standard’ treatment plans become (and there are improvements), until the patient is referred and treated, precious time is lost.
Mouth cancers can kill. Whilst most unusual mouth conditions are not cancer, more people now die annually of mouth cancer than are killed in road traffic accidents – so what can you do?
The Trust has very good reasons to be grateful to dentists, hygienists, therapists and dental students: they have understood the problems and are well placed, in the front line, to detect problem conditions in the mouth and encourage good oral health. They help even more by carrying out a full oral mucosa examination on all patients. In the event of being unable to come up with a definitive answer to an unusual mouth condition, seek a second opinion and refer where appropriate.
Always remember, most specialists would rather see and reject an unusual mouth condition than have to treat it at a later stage.
If all individuals and health professionals remain vigilant and monitor unusual conditions, more light will become shed on this disease and we may begin to fully understand the causes and potentially save needless suffering or indeed a life.
The Key Signs of Mouth Cancer are
Remember: this disease can affect young people too.
“If in doubt, check it out”
Thank you for helping.
Michael Walton MBE
The Ben Walton Trust