Oral cancer screening is an important part of routine dental care. This process involves looking at the lips, mouth and tongue for any sores or color changes that may be a sign of cancer.
Several studies have demonstrated that visual inspection by trained public health workers (PHCWs) reduces oral cancer mortality. However, sensitivity varies across studies and is dependent on the model-predicted risk of disease.
Oral Cancer Risk Factors
In general, the more risk factors a person has for cancer, the greater their chance of developing it. However, many people who have multiple risk factors never develop cancer. This is because most cancers develop over a long period of time and often don’t cause symptoms in the early stages.
Smoking tobacco or using other forms of tobacco (such as chew or snuff) and heavy alcohol consumption are major risk factors for oral cancer. In addition, a weakened immune system due to illness or medication increases the chances of getting oral cancer. Additionally, certain types of the human papillomavirus are etiologic agents for oropharyngeal squamous cell carcinoma (OSCC).
During health checkups, healthcare professionals may use various methods to look for any signs of cancer in your mouth and throat. They will examine your mouth, throat, and neck and may feel under your tongue or inside your cheeks. They will also review your medical history and ask about any habits you have that might increase your risk for cancer.
When looking for potential cancerous lesions, healthcare professionals may shine a light in your mouth to see if any tissues reflect differently under fluorescent light. This technique is called exfoliative cytology and can detect precancerous or cancerous cells. A 2021 study found that a device called VELscope is effective for detecting changes in cellular structure that may indicate cancer, and can complement the traditional method of examining tissue under a microscope.
Oral Cancer Symptoms
In most cases, mouth cancers develop in the squamous cells that line the lining of your throat and mouth. These cancers are most common in people who use tobacco products (including e-cigarettes) and those with human papillomavirus infection. However, even non-smokers can get these cancers, especially if they have other risk factors such as older age, genetics and sun exposure.
Most mouth cancers are not painful and many go away on their own, especially if they are caught early. However, they can spread quickly, and may cause numbness, pain, bleeding or other symptoms. That’s why it’s important to have a dental professional check for signs of mouth cancer. An oral cancer screening usually takes only a few minutes and can be done during your regular dental visit.
Your dentist or hygienist will look at your neck, lips, tongue, jaw and the back of your throat for any unusual tissue. They will also feel around your neck and jaw for lumps. They may also use a special light to help them see any areas of concern. They may also apply a blue dye (toluidine blue) to your tongue and throat to help identify any abnormal tissue.
If they find something that worries them, the healthcare provider will ask you questions about your health history and check for other symptoms. They may also order imaging tests such as CT scans or MRI to get more detailed images of your throat, neck and jaw area.
Oral Cancer Diagnosis
When head and neck cancers such as oral cavity or oropharyngeal cancer are diagnosed in their early stages, they may be easier to treat. Early detection increases survival rates dramatically. During an oral cancer screening, your healthcare provider will look for asymmetries, swellings or lumps in the mouth and throat area. They will also examine your lips, cheeks, neck, jaw and inside of your nose. Your provider may ask you to remove your dentures and other removable dental appliances, so they can better see the whole mouth. Many providers use a special light and/or blue dye during a screening, which helps them see abnormal tissues. You might swish the dye around in your mouth for several seconds before you spit it out, so it can coat any tissues that are not healthy. Your healthcare provider can also use an app that can send images of your mouth to a specialist for further evaluation.
Researchers have been working on new methods to detect early signs of oral cancer, such as a simple saliva test (Downer et al., 2023). However, PHCWs may need additional training to make the most of these new methods.
Oral Cancer Treatment
Oral cancer can be treated effectively, especially when it is caught early. Regular screening with a healthcare professional, such as a dentist or other oral health care provider, can help detect abnormal cells and precancerous lesions before they become cancerous.
If a healthcare professional suspects that an area of the mouth is suspicious, they may perform a biopsy to test the tissue for cancer or precancerous cells. This usually involves gently scraping the surface of the area with a tool and sending the sample to a lab to be analyzed by a pathologist. Alternatively, a healthcare professional may use an imaging test to get a closer look at the area. Examples of imaging tests include a CT scan, an MRI, or a PET/CT scan.
Other testing methods used to check for cancerous or precancerous cells include a toluidine blue dye test, in which you swish a solution containing the dye around your mouth for several seconds before spitting it out. A health care professional then examines your lips, cheeks, tongue, gums, roof of the mouth, and floor of the mouth for asymmetries, bumps, or changes in color. They will also feel your jaw and neck for lumps and check the lymph nodes in your throat for any signs of cancer spreading to them.