Oral Cancer Awareness Month (April) highlights the fact that more than 50,000 Americans will be diagnosed with oral cancers this year. In a Q&A, Dr. Brendan Gaylis, director of the head and neck cancer program at Scripps MD Anderson Cancer Center and a Scripps Clinic physician, discussed risk factors and signs people should be aware of.
The following has been lightly edited for clarity and conciseness.
Q: What is your background and how did you end up at Scripps?
Gaylis: I graduated from medical school in 1983, so I’ve been a physician for about 38 years. I originally came from South Africa. I did my medical school training in South Africa and then did some post graduate work there for about two years, doing internship type work. I came to the states in 1986 to do a general surgery and head and neck surgery residency. I spent a year at the University of Minnesota and then I spent four years at Washington University in St. Louis doing head and neck surgery there. And then in 1991, moved to San Diego. I spent 15 years working on staff at Kaiser, and in 2006 I moved over to Scripps and have been here for the last 16 years.
Q: With April being Oral Cancer Awareness Month, what are some things about oral cancer that people should be more aware of?
Gaylis: There are two types of cancers that affect the mouth and throat. One is HPV-related, where we have a definite cause. That is what is really right now very endemic in the population, the HPV virus. That cancer has increased at an incidence of about 2% a year for the last 15 years. This is a cancer that grows in the tonsil tissue of the mouth and the throat, the palatine and the lingual tonsils. So we have what’s called tonsils in the sides of our throat and the back of our tongue. This virus has a particular predilection to grow in that tissue. The virus is typically acquired in mid-adulthood when people become sexually active. It’s a very common virus and it tends to stay in the throat. It may take 20 years or 30 years before it forms cancers. We’re seeing a lot of cancers in people from 45 and up, to about 75.
Most of these cancers occur in healthy people. They are often extremely fit and they don’t necessarily have other health issues, but they probably acquired this virus when they were in college or if they’ve had multiple sex partners, and they acquired the virus before they could get the HPV vaccine.
We have a wonderfully effective vaccine for this disease and all children should routinely be given this vaccine when they’re between the ages of 9 and 12. For those who don’t get it from ages 9 to 12, they can still get it up to the age of 26.
Q: What about oral cancers caused by factors such as tobacco use?
Gaylis: The two main kinds of cancers in the mouth and throat, one is related to HPV and the other is non-HPV related. In the past, the most important risk factors for cancers in the mouth and throat were smoking, chewing tobacco and alcohol. Those are important risk factors, and they remain important risk factors for cancer of the tongue, cancer of the gums, even the tonsils can become malignant in smokers. The incidence of smoking, especially in California, has decreased substantially. We don’t see a lot of smoking-related cancers here at Scripps. We still see them, but it’s not as often that you find someone who has been smoking a pack of cigarettes a day for 35 years. But those are two important risk factors.
The last important thing I want to mention is cancer of the tongue. Because cancer of the tongue, especially the side of the tongue, is a disease that is potentially very aggressive and can often occur in people as young as 30, 35 years of age. There are no risk factors. It can happen when you’re not a smoker, not a drinker. There is a subset of patients, and it’s probably more women than men who fall into this category, who are predisposed to getting cancer of the tongue with no known risk factors. If you have a sore on the side of your tongue that is not healing and causes pain with eating certain foods, it’s got to be shown to your primary care doctor or the dentist, and you need to get an appropriate referral for a biopsy. If you do get a tongue cancer, you want to find it early.
Q: What can people do to ensure early detection of an oral cancer?
Gaylis: Unfortunately, there’s no screening method yet. We don’t have a way to screen the population the way we do with colonoscopies or mammograms. The only way we can help is early detection. The most important thing in early detection is when patients go to the dentist and get their teeth cleaned, they should ask their dentist to have a good look at the lining of the mouth and the throat to make sure they don’t see anything abnormal, like a tonsil on the one side that looks significantly more swollen than the other side. The other thing is a lump in the neck. That’s the first area these cancers spread to. Primary doctors should feel your neck every time you go to the doctor. If a patient has a lump in the neck that doesn’t go away after two to three weeks and is not painful, a painless lump in the neck needs to be seen ASAP by the primary care provider.
Q: Is there a reason why men are at greater risk for oral cancer?
Gaylis: We don’t know exactly why, but it does seem that men have a greater predilection for developing this kind of cancer than women. I think it’s probably some sort of genetic cause. Perhaps it’s got something to do with sexual activity, multiple partners, men being more exposed at a young age during the college years or whatever. Certain sexual practices such as oral sex will increase the likelihood of transmission. This is the same virus that causes cancer of the cervix in women. Cancer of the cervix in women was an extremely prevalent disease. The incidence of cervical cancer has gone down. Gynecologists see less cervical cancer from HPV. The reason is women go in to get pap smears routinely. So they can get picked up in the cervix earlier and treated. So HPV of the cervix can be treated at an earlier stage than mouth and throat cancer, because we don’t have that kind of screening for men.