Oral cancer cases on the rise

After reading this feature, you should be able to: 

• Understand the risk factors and major signs/symptoms of mouth cancer
• Recognise the role that pharmacy teams can play in aiding the early detection of oral cancers in the community 
• Provide customers with treatment and management advice for everyday oral health issues.

According to the latest figures, over 8,000 people are diagnosed with mouth cancer each year in the UK — equating to around one in every 50 cancer cases.^1,2 

Figures compiled by the Oral Health Foundation show that the number of diagnosed cases of oral cancer in the UK has risen by 103 per cent over the past 20 years, with increases seen every consecutive year of the past decade.^2,3

The soaring cases of mouth cancer highlight the critical need to raise awareness of this disease, says Dr Nigel Carter, chief executive of the Oral Health Foundation. “While many cancers are seeing a reduction in the number of people affected, mouth cancer is one of very few that is sadly going the other way.” 

Established risk factors like smoking and excessive alcohol have been joined by emerging causes like the human papillomavirus (HPV). This has changed the profile of the disease quite considerably over recent years – and mouth cancer can now affect anybody, says Dr Carter.

Spotting the danger signs

“One of the biggest challenges we face regarding mouth cancer is how little educational support it receives from Government and public health bodies…we will be working with thousands of organisations to improve awareness of the disease so that more people are able to recognise the early warning signs,” he says. 

As part of this national drive to improve mouth cancer detection and diagnosis, pharmacy teams can play an important role in picking up on potential danger signs. “Although dental professionals remain the front-line of oral healthcare provision, pharmacy teams can play a key supportive role in helping to spot signs and symptoms of potential mouth cancers in the community setting,” says Miranda Steeples, current president of the British Society of Dental Hygiene and Therapy, and a qualified dental hygienist and dental therapist working in general practice. “This role is particularly important given the number of people who are currently experiencing difficulty in accessing a NHS dentist.” 

The fact that nine in 10 cases of mouth cancer are completely curable with surgery if diagnosed early enough highlights the importance of efforts to expedite timely detection.¹

Spotting signs and symptoms

Oral cancers fall under the broader umbrella of head and neck cancers and may present in different ways and in different locations in the mouth. The most common places to be aware of are on the floor of the mouth, the lateral borders (sides) of the tongue and at the back of the mouth, “but that is not to say that lesions cannot be found anywhere else”, says Steeples. 

Oral cancers can also appear on the junction of the hard and soft palate, the cheeks, the tonsils at the back of the throat, and even outside on the lips. “Ulcers that take longer than three weeks to heal, and white, red or pinky speckled patches that may or may not look like an ulcer, or appear similar to a blood blister, should all be monitored carefully,” advises Steeples. “Anything that is ‘new to you’ is what I tell my patients,” she adds. 

Other signs and symptoms that may raise a red flag for potential oral cancer include unexplained loose teeth or sockets that fail to heal after extractions, numbness or unusual sensations affecting the lips or tongue, or pronounced changes in speech, such as a lisp. 

“The unusual patches that can indicate oral cancers are not always painful but if any ulcer or mouth abnormality does not resolve within three weeks, then the customer needs to see a dentist, dental hygienist or dental therapist, all of whom can make an appropriate onwards referral if needed,” advises Steeples. 

Recognising risk factors

Unsurprisingly, the two major risk factors for mouth cancer are tobacco and alcohol. Estimates suggest that around 25 per cent of cases of oral cancer in the UK are caused directly by smoking and 35 per cent are attributable to excess alcohol intake.⁴ 

“It is well known that those who use tobacco, either in cigarette form, or by chewing it or using a shisha pipe, are all at heightened risk of oral cancers and tooth loss,” says Miranda Steeples. “Excessive alcohol consumption, especially at the same time as tobacco, can lead to a 30-fold increased risk of mouth cancer.

“Some brief advice around reducing the amount and frequency of alcohol consumption, plus referral to alcohol counselling services, alongside a recommendation to seek smoking cessation advice, or at least signposting for when the individual is ready, can be useful,” she suggests.

Another increasingly important risk factor for mouth cancer is infection with HPV, specifically the HPV16 variant, which can cause malignant changes in the mouth and throat. The link between HPV and oral cancer is particularly strong for oropharyngeal tumours. 

Other customers who may be at heightened risk of oral cancer include those with a family history in a close relative and people with a weakened immune system. 

Age also plays an important part in overall disease aetiology and consequently around two-thirds of mouth cancers develop in adults over the age of 55 years.¹ Cases in younger adults are less common and usually linked to HPV infection. Men are affected more frequently than women but this is thought to be related to increased alcohol consumption rather than a gender-specific effect. 

Another important cohort of customers not to overlook are those who spend a large proportion of their time outside and may therefore be at increased risk for a cancer of the lip. “These are often people who ‘don’t sunbathe’ and so don’t perceive their daily dog walk or time in the garden as exposure to the sun,” explains Steeples. 

“They could be recommended to purchase a sun block of at least SPF30 for their lips. Someone coming in for travel advice, for example, or who is buying sunscreen for the rest of their body, should be encouraged to protect their lips as well.”

Also worth considering for onward referral is any customer with a persistent sore throat, lumps in the neck, hoarse voice, difficulty swallowing, or a cough that won’t clear. These are warning signs of potential cancer of the throat or lungs and customers should be signposted to their GP.