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Oral cancer, also called mouth cancer, can affect the lips, gums, roof or floor of the mouth, gums, or tongue. There are many types, but early detection is key to improving survival rates, especially in Black men who are at the highest risk of developing oral cancers. April is Oral Cancer Awareness Month, so let’s take a closer look at various mouth cancers and how it affects ethnic groups like African Americans.
Types of Oral Cancers
As with most conditions, there are several types of mouth cancer. It may be in a specific place initially, and possibly spread to other locations within the mouth, to the lymph nodes, and throughout the body. Much like breast cancer and other forms, the risk of spreading is abundant and should be monitored.
Most oral cancers are squamous cells that line the tissues of the mouth. Other common types of mouth cancer include lymphoma, which typically affects the lymph nodes and the tonsils, while minor salivary gland carcinomas affect the salivary glands of the mouth and throat.
Common locations for oral cancers include:
- Lip Cancer: This is the most common type of mouth cancer and typically has a positive prognosis when caught early.
- Gum Cancer: Typically linked to chewing tobacco and alcohol use, this cancer can quickly spread to the jaw.
- Tongue Cancer: When in the front two-thirds of the tongue, it can quickly spread to the lymph nodes.
- Doctors classify cancer at the back of the tongue, tonsils, and back of the mouth as throat cancer.
Cancer Research UK breaks down the stages and grades of oral cancers. Determining the severity of the cancer is an essential first step for diagnosis before treatment can begin. It helps to ensure that treatment is as effective as possible.
Oral Cancer Staging
Doctors can use two methods for determining the stage of your oral cancer. The first is clinical staging, using results from tests and scans. They typically perform pathological staging if you will have surgery to remove the cancer and they will send part of the removed tissue to the lab for testing. It is more precise and can help determine the type of cancer as well as the cancer’s location if it has spread.
There are two ways to stage mouth cancer:
- TNM: Your doctor will consider the size and depth of the tumor, whether it has spread to the lymph nodes, and whether it has spread to another part of the body.
- Number Stages: Your doctor will assign a number zero (pre-cancer) through 4 A, B, or C based on how invasive the cancer has become.
Mouth Cancer Grades
Oral cancer grading differs from staging. This step involves the appearance of cancer cells, from looking like typical, healthy cells to abnormal cells well differentiated from the healthy cells around the tumor. Your doctor will assess them and assign a grade 1, 2 or 3. A “Gx” grade means it can’t be determined.
Oral Cancer Risk Factors
There are many lifestyle choices, health conditions, and other variables that may increase your chances of developing oral cancer. Remember that you have some control over several factors, like smoking cigarettes, that could improve your health and risk, while not others.
- Nicotine Products: The most common cause of mouth cancer is tobacco use, especially smoking or chewing tobacco. While those who use nicotine themselves are at highest risk, even secondhand exposure can lead to cancer.
- Alcohol Use: Drinking alcohol is one of the top risk factors for mouth cancer and heavy drinkers or those who drink and use nicotine products are most susceptible.
- Human papillomavirus (HPV): Not all types of HPV cause cancer, but some are high risk. For example, HPV16 causes approximately 70% of all cases of oral cancers.
- Gender: Oral cancer is twice as common in men than women. Researchers believe smoking causes the higher rates of oral cancer in men.
- Age: Most cases of mouth cancer occur in those over the age of 50 unless caused by an HPV-related infection. This is because it takes time for cells to mutate and develop.
- Weight: Based on statistical research, weight has some effect on your likelihood of developing oral cancer.
- Diet: People who eat a diet low in vegetables and fruits seem to be at a much higher risk. Eating a well-balanced diet may help improve risk factors for many health conditions like diabetes.
- UV Light: Sunlight contributes to skin cancer and may also affect rates of lip cancer, a form of mouth cancer.
- Co-Existing Health Conditions: Those who have Fanconi anemia or Dyskeratosis congenita are also at higher risk of developing oral cancer because of their predisposition to blood diseases.
Possible Treatment Options
Your primary care physician will refer you to a specialist who will evaluate your condition and recommend the best treatment plan. It could include surgery, chemotherapy, or radiation therapy, depending on the type, location and severity of the cancer. You will probably work with a team of providers, including one or more of those listed here.
- Oral and Maxillofacial Surgeon
- Radiation Oncologist
- Medical Oncologist
- Plastic Surgeon
Detecting Oral Cancer Early
An early diagnosis is important for improving survival rates. Healthcare professionals can easily spot signs of mouth cancer by looking for lesions within the oral cavity, feeling for enlarged lymph nodes, asking about family history, and referring a patient to a specialist for any suspect symptoms.
Symptoms of oral cancer may include:
- Changes in the skin
- Pain or tenderness
- Change in bite
- Problems swallowing
- Difficulty chewing
- Feeling like something is caught in the throat
- Sore throat
- Ringing in the ears or ear pain
Mouth Cancer in African Americans
There are many barriers for Black men and women with mouth cancer, from biological differences affecting successful treatment to the number of people who use nicotine products to access to health care resources ensuring early detection and proper cancer treatment.
Two recent studies have shown that a Black person with oral cancer will likely respond differently to treatment. The first, published in 2021 in JCO Oncology Practice, showed that African Americans have fewer immune cells within oral cancer tumors and they don’t respond as effectively to the same treatments as Caucasian patients. Tumors may also show more instances of mutations. The second, published in 2022 in the Journal of the National Cancer Institute, reviewed the treatment outcomes of both the Black population and white people enrolled in clinical trials. In clinical trials, all patients receive the same cancer treatment, so socioeconomic factors are minimized. The results showed that biological factors still play a large role in survival rates.
The Oral Cancer Foundation reports that those living below the poverty line are more likely to smoke than those that don’t. Given that many African Americans live in poorer neighborhoods and are more likely to suffer from un- or underemployment, this puts them at higher risk of smoking, using chewing tobacco, or using other forms of nicotine-based products. Some states within the US also have higher rates of smoking than others. The states with the highest rates of smokers are Nevada, Kentucky, and Ohio, while those with the lowest rates are Utah, Hawaii, and California. Compared to others, Blacks or multiracial people self-identifying as African American are more likely to smoke than Caucasians or Hispanics.
There are more than 100 types of human papillomavirus (HPV). While not all of them cause cancer, some strains are more common within the Black community may explain why mouth cancer is so much more prevalent. Some types of HPV infections were more common in Caucasians, like types 16 and 51, while others were more common in Blacks. Type 35 is one of the highest risk factors for mouth cancer.
Access to Resources
Why is access to resources so important? Researchers have well documented that early detection is less likely with minimal access to resources, such as adequate health insurance and local medical providers. Studies show that if cases are discovered early, the 5-year survival rate can reach 85%, but only 28% of all cases are found early. However, more than half of all oral cancers are diagnosed after having spread to local tissues such as the lymph nodes. The survival rate at this point drops to 68%. If the cancer has spread further, it drops to just 40%.
According to the Kaiser Family Foundation, Black people are less likely to have health insurance because of a financial barrier. They are also more likely to live below the poverty line but not qualify for state financial aid or not be able to utilize those resources if they do because of lack of transportation. Food insecurity may lead families to focus more on day-to-day needs and not long-term care like their health. This reduces the chance they will receive a routine dental exam with an accompanied oral cancer exam.
It’s also clear that Blacks do not receive the same level of care that white Americans do. Brigham and Women’s Hospital recently found that race, among other factors, played a role in whether a dentist even screened for mouth cancer during a routine dental exam. Dentists may also not provide education about the risk factors and the steps they can take to help prevent oral cancer, especially smoking and human papillomavirus.
Oral Cancer Awareness Month: Recognizing Black Americans
The first step in improving oral health and bettering the survival rates of mouth cancer, especially for Black Americans, is to acknowledge the problem. The American Cancer Society reports that cancer rates for Black people have decreased since the 1990s and this is a trend we wish to see continue. Black Health Matters will do our part by raising awareness of the effects of mouth cancer on the African American population.