Nigel Carter highlights the role of patient education in mouth cancer prevention through the Oral Health Foundation’s latest research.
Mouth cancer is one of the most life-changing cancers that can affect the body. Not only can the disease drastically change a patient’s appearance, it also often turns basic daily functions like eating, speaking and breathing into the most painstaking tasks.
Incidences of mouth cancer in the United Kingdom have increased by 34% in the last decade. The disease also claims more than 3,000 lives every year.
Spotting mouth cancer early is crucial for beating the disease and getting the best quality of life afterwards. Despite this, we remain in a position where most cases are only diagnosed in stages three or four.
The reality is that it is a trend that is likely to continue unless we take active steps to avoid it.
Signs of mouth cancer
Mouth cancer can be hard for patients to detect in its early stages. Its presentation differs vastly, is often hidden from plain sight and is not always painful for the patient.
In addition, we have severe challenges with education. The data from the Oral Health Foundation’s new State of Mouth Cancer UK Report 2022 shows public awareness of the major signs and symptoms of mouth cancer is as low as 17%.
If patients do not know what to look out for, it is little wonder why they are not seeking help earlier.
Mouth cancer is most likely to occur in the tongue, which contributes to more than one in three (34%) cases. The tonsils are statistically the next most likely area, although we all know that it can occur anywhere in the mouth, head or neck.
Patients need to be clearly informed about the early warning signs of the disease – including mouth ulcers that do not heal within three weeks, red or white patches in the mouth, or unusual lumps and swellings. Persistent hoarseness could also be a symptom as well as not being able to stick your tongue out straight.
Given the lack of awareness about the symptoms, it is not surprising that nearly two in three (62%) of patients have never checked their mouth for signs of cancer.
It is critical that patients understand what is normal for their mouths and look out for any changes. Even if it isn’t mouth cancer, they need to understand that it could be another underlying problem that needs attention.
We must be persistent with the message that, whether it is for a toothache or suspected mouth cancer, early detection is crucial in getting the best and most successful treatment.
A cause for concern
Increased recall intervals, NHS dental access problems and the cost of living have all contributed to patients spending less time in the chair. For some, this could have serious consequences, as mouth cancer is often first suspected during a dental visit.
We recently spoke to Robert Powell from Milton Keynes, who ended up in a dental practice by nothing other than chance. Thinking he had nothing but a recurring tonsillitis, he was shocked by what followed.
Robert said: ‘I was doing training at a dental practice and asked the dentist if they would mind taking a look at something. The dentist put me in the chair and took one look before bringing in a colleague. They immediately said: “You need to see somebody urgently”.
‘When I was told that I had mouth cancer, I was in disbelief,’ Robert said. ‘A feeling of denial that it can’t possibly happen to me. I lived healthily and didn’t think I was in a risk factor group.’
Dental access
The cost of living crisis and lack of NHS dental appointments has led to many patients delaying dental appointments. Our findings show that as many as one in five (23%) have avoided making an appointment because of the rise in cost of living. Many of these cite mounting food and utility bills as a reason why oral care has fallen down the priority list.
Combining this with increasing ‘dental deserts’ in some areas, it can take some patients months to be seen. In England alone, the number of NHS patients seen in the last 24 months declined by 26% compared to before the pandemic.
Since the start of the pandemic, there have been an estimated 40 million postponed or cancelled appointments. During this time, around one in five (18%) people have experienced at least one of the potential early warning signs of mouth cancer and have been unable to seek professional help.
Unfortunately, in many cases, this will mean that a late diagnosis is a high probability for these people.
Where do we go from here?
Improving access to NHS dentistry, tackling late diagnosis and protecting public health policies are some of the key challenges in confronting mouth cancer.
There is no overnight fix with government policy around the lack of dental professionals and the need for more training. The Oral Health Foundation believes that this should be a priority for the government.
We are relying quite heavily on patient and public education. During November, our charity is again running Mouth Cancer Action Month. It is an annual campaign with one very simple message – be mouthaware and, if in doubt, get checked out.
We are urging you to help us improve mouth cancer education amongst patients. This is not only a chairside conversation. We are also asking you to send information for patients while they are at home.
This means mouth cancer information on social media, uploaded to your website and even sent to patients on email. Make sure patients know how to carry out mouth cancer checks on themselves at home and what the signs and symptoms are.
Share information about the risk factors, too. Relaying the dangers of smoking, alcohol and HPV needs to be at the forefront of our discussions with patients.
We must also stress the importance of early detection – by spotting mouth cancer early, we can beat it. Importantly, people should be encouraged to come forward if they notice anything unusual during their regular mouth checks.
By supporting November’s Mouth Cancer Action Month, you can make a real difference improving mouth cancer education across your community. By boosting early diagnosis, we can not only increase a patient’s quality of life but also give them a longer life. This is a highly rewarding and worthwhile venture.
For downloadable patient materials, visit www.mouthcancer.org.
