By Henrylito D. Tacio
The last study on oral cancer in the Philippines was conducted in 1995 yet. At that time, the study found that 6.8 per 100,000 people had mouth cancer.
Most of those who suffered from it were men, said Dr. Jesster Navarro, a diplomate of the Philippine Board of Otolaryngology and visiting consultant at Makati Medical Center, who was quoted in an article published in Philippine Daily Inquirer.
The above figure “does not include the HPV infection,” the doctor said, when in fact, 30-32% of mouth cancer incidence is attributed to it. HPV refers to human papillomavirus (HPV), which is transmitted during sexual intercourse.
A large majority of cervical cancer (more than 95%) is due to HPV. Most sexually active women and men will be infected at some point in their lives, and some may be repeatedly infected.
This is the reason why most people are embarrassed to have themselves checked. They are ashamed of the HPV link. In fact, they choose “to get examined only when the cancer is already in an advanced stage. Patients turn to doctors because by then, they could no longer swallow or open their mouths.”
Oral sex
HPV is transmitted to oral sex, a sexual act that involves the stimulation of the genitalia using the mouth. The more oral sex you have – and the more oral sex partners you have – the greater the risk of developing mouth cancer.
“An individual who has six or more lifetime partners – on whom they’ve performed oral sex –has an eightfold increase in risk compared to someone who has never performed oral sex,” explained Dr. Maura Gillison, an oncologist at Ohio State University.
Dr. Gillison headed a team of researchers who examined 271 throat-tumor samples collected over 20 years ending in 2004. They found that the percentage of oral cancer linked to HPV surged to 72% from about 16%.
The study, which was published in the Journal of Clinical Oncology, said that by 2020, the virus-linked throat tumors – which mostly affected men – will be more common than HPV-caused cervical cancer.
“The burden of cancer caused by HPV is going to shift from women to men in this decade,” observed Dr. Gillison. “What we believe is happening is that the number of sexual partners and exposure to HPV has risen over that same time period.”
In his weekly column in Philippine Daily Inquirer, Dr. Rafael D. Castillo noted: “Previously, it was well established that smoking (three-fold increase) and drinking alcohol (2.5 times) increased the risk for oral cancer, but even if you combine them, the risk is no match compared to that seen in those who frequently engage in oral sex.”
Widespread among young people
What alarms Dr. Castillo is that oral cancer might be rampant among young people. A study done by the University of the Philippines Population Institute showed that more than four million teenagers and young Filipinos are already engaged in sexual practices.
The findings of the third Young Adult Fertility Survey revealed that a total of 4.32 million Filipinos aged 15 to 24 are already sexually active. Another finding is that oral sex has become a common practice “among most sexually adventurous teens.”
“Doing simple math, if the expected prevalence of oral cancer in the general population is 1.5 percent, and with a nine-fold increase in risk, that means that we have approximately 583,000 young Filipinos aged 15-24 who are likely candidates to develop oral cancer,” Dr. Castillo surmised.
“Today’s teens consider oral sex to be casual, socially acceptable, inconsequential, and significantly less risky to their health than ‘real’ sex,” said Dr. Gillison.
Teens simply think oral sex is “not that a big a deal,” added Dr. Bonnie Halpern-Felsher, professor of pediatrics at the University of California, San Francisco. “Parents and health educators are not talking to teens about oral sex. Period.”
Members of the Philippine Medical Association (PMA) and the Philippine Dental Association (PDA) also noted that the practice of oral sex can lead to infections of the oral cavity, which may result in cancer of the tonsils, tongue or throat.
Controllable risk factors
Mouth cancer is also known as oral cancer. It is the ninth leading cause of cancer in the Philippines, according to Dr. Navarro.
Although not yet well-understood, there are some people who are susceptible to developing oral cancer. Aside from oral sex, the two greatest controllable risk factors, according to The Merck Manual of Medical Information, are tobacco and alcohol use.
“Tobacco use – including smoking cigarettes (particularly more than two packs per day), cigars, or pipes; chewing tobacco; and dipping snuff – accounts for 80-90% of all oral cancers,” the Merck manual notes.
“Chronic or heavy alcohol use (particularly more than 6 drinks per day) increases the risk of oral cancer,” the Merck manual says. “The combination of tobacco and alcohol is more likely to cause cancer than either one alone.”
Other factors that add to the risk of oral cancer include repeated irritation from the sharp edges of broken teeth, fillings, or dental prostheses (dentures).
Signs and symptoms
“Any lesion in the mouth should be seriously considered,” said Dr. Anne Camus, PDA’s Manila dental chapter president. “Not all can develop to cancer but malignancy must always be taken as an imminent possibility.”
A regular check-up with a dentist would help detect malignancies in the mouth. “The dentists are usually the first to see lesions in the mouth of our patients,” Dr. Camus said. “At this early point, if the lesion turns out to be malignant, then chances are it is still curable.”
“Oral cancers are usually painless for a considerable length of time but eventually do cause pain,” notes the Merck manual. “Pain usually starts when the cancer erodes into nearby nerves. When pain from cancer of the tongue or roof of the mouth begins, it usually occurs with swallowing as with a sore throat.”
The early growth of salivary gland tumors may or may not be painful. “When these tumors do become painful, the pain may be worsened by food, which stimulates the secretion of saliva,” the Merck manual informs. “Cancer of the jawbone often causes pain and a numb or pins-and-needles sensation, somewhat like the feeling of a dental anesthetic wearing off. Cancer of the lip or check may first become painful when the enlarged tissue is inadvertently bitten.”
Discolored areas on the gums, tongue, or lining of the mouth may be signs of cancer. “An area in the mouth that has recently become brown or darkly discolored may be a melanoma (malignant tumor),” the Merck manual states. “Sometimes, a brown, flat, freckle-like area (smoker’s patch) develops at the site where a cigarette or pipe is habitually held in the lips.”
“Keep in mind that your mouth is one of your body’s most important early warning systems,” reminds the Oral Cancer Foundation. “Don’t ignore any suspicious lumps or sores. Should you discover something, make an appointment for a prompt examination. Early treatment may well be the key to complete recovery.”
According to the US National Cancer Institute, oral cancer treatments may include surgery, radiation therapy or chemotherapy. Some patients have a combination of these treatments.
Famous victims
What do the following famous personalities had one thing in common: American actor Burl Ives, American television director and producer Bruce Paltrow, English actor Jack Wild, Susan Buffet (the first wife of investor Warren Buffet), American singer and actor Gordon McRae, English potter Josiah Wedgwood, Japanese sumo wrestler Takanohana Toshiaki and Indian politician Ajit Kumar Panja?
They all died of mouth cancer, that’s what! – ###
Photo captions:
1) One common sign of oral cancer (source: medicalnewstoday.com)
2) Oral cancer (source: medicalnewstoday.com)
3) Understanding oral cancer (source: verywellhealth.com)
