Oral Cancer: Updates from AGD and Around the World
2022: The AGD Foundation’s Golden Anniversary
By Gary E. Heyamoto, DDS, MAGD
This year marks the 50th anniversary of the AGD Foundation. For half a century, the Foundation has been serving the dental community by assisting dentists with charitable initiatives such as oral health literacy, dental care for fragile populations, oral and oropharyngeal cancer awareness programs, educational opportunities and recognition of cancer risk factors, while enabling diagnostic training opportunities and providing grants.The AGD Foundation grant program offers financial support for groups that promote oral and oropharyngeal cancer awareness, education and/or screening that is independent of standard dental practice. In 2021, the Foundation awarded over $16,600 between four recipients: Florida Dental Association Foundation; West Virginia University Foundation, Inc.; Chatham County Safety Net Planning Council and Team Maureen. In 2022, over $14,200 will be shared among Family Health Centers of Southwest Florida; Home Smiles, Inc.; Michael Yuan Student Run Free Clinic at Columbia University College of Dental Medicine and Pennsylvania Coalition for Oral Health.
In addition, the Foundation is developing an oral/oropharyngeal cancer toolkit, which will be a one-stop electronic resource for dentists, physicians and patients to educate themselves about oral and oropharyngeal cancer.
Also, since 2014, the Foundation has been hosting oral cancer screening programs at the AGD scientific sessions and will again this year at AGD2022 in Orlando.
Oral and Oropharyngeal Cancers
Oral cancers are found in the mouth, and oropharyngeal cancer in the oropharynx. In terms of cancers that affect the head and neck, HPV is mostly related to oropharyngeal cancers and less so to oral cancers.
HPV-related oropharyngeal cancers are difficult to detect because they often cannot be diagnosed until a metastasized neck mass presents. Oral cancer, however, can be seen with the naked eye, and general dentists and hygienists often can serve as the first line of defense in early detection.
When screening for oral cancers, the provider typically is looking for any lesions, swellings, rashes and/or abnormalities. Remember, this is visual in detection, so a mouth mirror, proper lighting and clean gloves are needed.
When doing an oropharyngeal cancer screening, the area to inspect is down the throat. Without a pharyngeal scope, we dentists cannot see this area clearly, and, unless the lesion shows on the base of the tongue or in the adenoids, it goes undetected. What we need is a tool to help us “see” this area.
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One useful tool is a questionnaire developed by the Washington AGD, a 2019 AGD Foundation grant awardee. The “11 Critical Questions” dentists should ask their patients when screening for oropharyngeal cancer can help “illuminate” what we can’t see. (See “Eleven Critical Questions.”) Though the Foundation is proud of its accomplishments, there is still much work to be done. Oral and oropharyngeal cancer cases continue to rise each year.
The Centers for Disease Control and Prevention has stated that HPV vaccination has the potential to prevent more than 90% of these cancers. Furthermore, it is more effective to vaccinate children before they become exposed to HPV.
We as general dentists can:
- Add a question to our health history questionnaires asking about HPV vaccine status.
- Begin talks with parents of young children to make them aware of the HPV vaccine. Recommendation of the HPV vaccine should be routinely made for all preadolescents.
- Provide literature in our offices on oropharyngeal cancer and the vaccine.
- Establish a working relationship with an ENT (with referral pads) so we can make immediate referrals.
Knowledge of how to examine and when to refer is our responsibility. Dentists no longer can be inactive in the oral/oropharyngeal cancer fight.
Help us celebrate the Foundation’s 50th anniversary by becoming involved in oral/oropharyngeal cancer awareness programs by visiting agd.org/agd-foundation and/or by donating to the AGD Foundation at agd.org/agd-foundation/50th-anniversary-2022.
A special thank-you goes to our 2021 corporate donors: 3M, Ivoclar Vivadent, Procter & Gamble, Henry Schein One and Dentist’s Advantage. They are the true heroes of your Foundation.
Oral Cancer Research Around the Globe
The battle against oral cancer is a long and gradual one. While major breakthroughs may be years away, scientists around the world are still making progress learning about the disease and the best treatments to recommend. AGD Impact has compiled some of these developments so that general dentists can stay abreast of developments around the globe.
INDIA
Indian University Working on Smartphone Detection of Oral Cancer
Two cancer foundations in India, Grace Cancer Foundation and BioCon Foundation, have teamed up with the International Institute of Information Technology, Hyderabad, a private university in Hyderabad, Telangana, India, to develop a smartphone app that uses AI to detect oral cancer in user-generated pictures. The impetus for the project was the realization that most patients at one of the Grace Foundation’s rural screening camps were diagnosed at an advanced stage. In addition to images of potentially cancerous oral lesions, the app will store demographic details of the patient and follow-up reports.
Source: “IIIT Hyderabad Working on Smartphone Detection of Oral Cancer.” Telangana Today, 7 Jan. 2022, telanganatoday.com/iiit-hyderabad-working-on-smartphone-detection-of-oral-cancer. Accessed 4 Feb. 2022.
UNITED STATES
80% HPV Vaccination Rate Could Rid U.S. of Most Oral Cancers in Men
A recent study predicts that if the United States can reach an 80% HPV vaccination rate among adolescents by 2025, 934,000 cases of oropharyngeal cancer could be prevented, leading to its elimination by the late 2070s. The study authors, led by Haluk Damgaciolglu, a postdoctoral research fellow at the University of Texas Health Science Center at Houston, created a computer simulation to see how vaccination rates would affect male mouth and throat cancer numbers. The authors noted that hitting the 80% goal will be difficult — HPV vaccination rates fell drastically during the COVID-19 pandemic and have remained lower than prior years.
Source: Preidt, Robert. “HPV Vaccination Could Rid U.S. of Most Mouth, Throat Cancers in Men.” U.S. News & World Report, 23 Dec. 2021, usnews.com/news/health-news/articles/2021-12-23/hpv-vaccination-could-rid-u-s-of-most-mouth-throat-cancers-in-men. Accessed 4 Feb. 2022.
AI Is Helping Reduce Excessive Radiation
Researchers have developed an AI algorithm that can “identify cancer patients who are not only at minimal risk of recurrence and death but also whose treatment could be decreased without impacting the cure rates.” The AI algorithm, named OP-TIL, identifies biomarkers called tumor-infiltrating lymphocytes (TILs). According to the researchers, “an increased density of TILs is associated with low risk of recurrence in low-stage HPV-associated oropharyngeal cancers.” The patients whom OP-TIL selects could then be candidates for de-escalation therapy, and the patients who are more likely to have cancer reoccur would not be selected for de-escalation.
Source: Rosso, Cami. “AI Helps Reduce Excessive Radiation for Cancer Patients.” Psychology Today, 11 Jan. 2022, psychologytoday.com/us/blog/the-future-brain/202201/ai-helps-reduce-excessive-radiation-cancer-patients. Accessed 4 Feb. 2022.
Researchers Find Shorter Treatment for HPV-Associated Oral Cancer
Researchers at the Mayo Clinic have found that a new, shorter treatment for HPV-associated oropharynx cancer leads to excellent disease control and fewer side effects compared to standard treatment. The shorter treatment utilizes minimally invasive surgery and half the standard dose of radiation therapy. It lasts for two weeks rather than the standard six weeks, and it may reduce the incidence of side effects related to the standard dose of radiation such as dry mouth and swallowing problems.
Source: “Mayo Clinic Researchers Find New Treatment for HPVAssociated Oral Cancer.” Newswise, 25 Oct. 2021, newswise.com/articles/mayo-clinic-researchers-find-new-treatment-for-hpv-associated-oral-cancer. Accessed 4 Feb. 2022.
Viome Receives FDA Approval for Salivary Oral Cancer Diagnostic Tool
Bioscience company Viome has developed technology that utilizes AI to analyze saliva samples to detect oral cancer. The technology was designated a breakthrough device by the Food and Drug Administration in 2021. “The diagnostic method, which improves significantly upon the standard of care, is the first salivary metatranscriptome-based oral cancer diagnostic,” the company said in a press release. “Viome has employed unique mRNA analysis technology and breakthrough machine learning techniques to accurately discover the interactions between microbial activities and human gene expression in the progression of these cancers.”
Source: “Viome Life Sciences Announces Discovery of Signature for Detecting Early Stage Cancer and Launch of its Grants Program.” Cision PR Newswire, 6 May 2021, prnewswire.com/news-releases/viome-receives-fda-approval-for-its-unique-mrna-technology-and-ai-platform-to-detect-cancers-301285629.html. Accessed 4 Feb. 2022.
Indian University Working on Smartphone Detection of Oral Cancer
Two cancer foundations in India, Grace Cancer Foundation and BioCon Foundation, have teamed up with the International Institute of Information Technology, Hyderabad, a private university in Hyderabad, Telangana, India, to develop a smartphone app that uses AI to detect oral cancer in user-generated pictures. The impetus for the project was the realization that most patients at one of the Grace Foundation’s rural screening camps were diagnosed at an advanced stage. In addition to images of potentially cancerous oral lesions, the app will store demographic details of the patient and follow-up reports.
Source: “IIIT Hyderabad Working on Smartphone Detection of Oral Cancer.” Telangana Today, 7 Jan. 2022, telanganatoday.com/iiit-hyderabad-working-on-smartphone-detection-of-oral-cancer. Accessed 4 Feb. 2022.
UNITED STATES
80% HPV Vaccination Rate Could Rid U.S. of Most Oral Cancers in Men
A recent study predicts that if the United States can reach an 80% HPV vaccination rate among adolescents by 2025, 934,000 cases of oropharyngeal cancer could be prevented, leading to its elimination by the late 2070s. The study authors, led by Haluk Damgaciolglu, a postdoctoral research fellow at the University of Texas Health Science Center at Houston, created a computer simulation to see how vaccination rates would affect male mouth and throat cancer numbers. The authors noted that hitting the 80% goal will be difficult — HPV vaccination rates fell drastically during the COVID-19 pandemic and have remained lower than prior years.
Source: Preidt, Robert. “HPV Vaccination Could Rid U.S. of Most Mouth, Throat Cancers in Men.” U.S. News & World Report, 23 Dec. 2021, usnews.com/news/health-news/articles/2021-12-23/hpv-vaccination-could-rid-u-s-of-most-mouth-throat-cancers-in-men. Accessed 4 Feb. 2022.
AI Is Helping Reduce Excessive Radiation
Researchers have developed an AI algorithm that can “identify cancer patients who are not only at minimal risk of recurrence and death but also whose treatment could be decreased without impacting the cure rates.” The AI algorithm, named OP-TIL, identifies biomarkers called tumor-infiltrating lymphocytes (TILs). According to the researchers, “an increased density of TILs is associated with low risk of recurrence in low-stage HPV-associated oropharyngeal cancers.” The patients whom OP-TIL selects could then be candidates for de-escalation therapy, and the patients who are more likely to have cancer reoccur would not be selected for de-escalation.
Source: Rosso, Cami. “AI Helps Reduce Excessive Radiation for Cancer Patients.” Psychology Today, 11 Jan. 2022, psychologytoday.com/us/blog/the-future-brain/202201/ai-helps-reduce-excessive-radiation-cancer-patients. Accessed 4 Feb. 2022.
Researchers Find Shorter Treatment for HPV-Associated Oral Cancer
Researchers at the Mayo Clinic have found that a new, shorter treatment for HPV-associated oropharynx cancer leads to excellent disease control and fewer side effects compared to standard treatment. The shorter treatment utilizes minimally invasive surgery and half the standard dose of radiation therapy. It lasts for two weeks rather than the standard six weeks, and it may reduce the incidence of side effects related to the standard dose of radiation such as dry mouth and swallowing problems.
Source: “Mayo Clinic Researchers Find New Treatment for HPVAssociated Oral Cancer.” Newswise, 25 Oct. 2021, newswise.com/articles/mayo-clinic-researchers-find-new-treatment-for-hpv-associated-oral-cancer. Accessed 4 Feb. 2022.
Viome Receives FDA Approval for Salivary Oral Cancer Diagnostic Tool
Bioscience company Viome has developed technology that utilizes AI to analyze saliva samples to detect oral cancer. The technology was designated a breakthrough device by the Food and Drug Administration in 2021. “The diagnostic method, which improves significantly upon the standard of care, is the first salivary metatranscriptome-based oral cancer diagnostic,” the company said in a press release. “Viome has employed unique mRNA analysis technology and breakthrough machine learning techniques to accurately discover the interactions between microbial activities and human gene expression in the progression of these cancers.”
Source: “Viome Life Sciences Announces Discovery of Signature for Detecting Early Stage Cancer and Launch of its Grants Program.” Cision PR Newswire, 6 May 2021, prnewswire.com/news-releases/viome-receives-fda-approval-for-its-unique-mrna-technology-and-ai-platform-to-detect-cancers-301285629.html. Accessed 4 Feb. 2022.