Oral Cancer

Oral Cancer

Open Wide and Check
for Changes

You do all the right things to support an active, healthy life: You eat right, get plenty of sleep, exercise regularly and do a monthly breast self-exam, plus have an annual pelvic exam and Pap test. But did you ever think that your health might also depend on whether you pull out a hand mirror, open your mouth and look around?

Who would've thought?

Yet oral cancer, which is frequently preceded by an easily detectable precancerous red or white patch that can appear anywhere in the mouth, is expected to hit nearly 10,000 women this year alone--continuing an upward trend that has increased the number of oral cancer deaths among women by 9 percent over the past three decades.

What puts women at risk? "Cigarette smoking, smokeless tobacco, alcohol, alcohol-based mouthwash and--especially among young women--the human papillomavirus," says Waun Ki Hong, M.D., chairman of thoracic/head and neck medical oncology at the University of Texas M. D. Anderson Cancer Center in Houston.

Alcohol and tobacco are the most common causes of oral cancer, particularly when they're used in combination, says Dr. Hong. No one knows exactly how long you need to smoke or drink before cancer appears, but scientists estimate that the risk is just about doubled in someone who smokes one to two packs of cigarettes a day or drinks one or two drinks a day.

The risk is quadrupled when someone does both at that level, while smoking and drinking heavily--with heavily defined by experts as more than two packs and four drinks a day--increases the risk nearly 40 times.

It's difficult to calculate a woman's risk of oral cancer from the human papillomavirus, says Dr. Hong. The virus, which causes genital warts and is a first cousin to the virus associated with cervical cancer, has no symptoms and no known cause. It cannot be prevented or treated and is usually identified only under a microscope--when it's already set the stage for cancer.

Prevention: The Best Defense

Oral cancer is a formidable disease. Once the cancer has invaded the oral cavity, the survival rate after five years is only 52 percent even with today's technically advanced surgery, radiation and chemotherapy.

The problem is that the carcinogens causing the cancer have been bathing the entire oral cavity for years, says Dr. Hong. As a result, the proliferation of cancer cells is probably under way in several areas by the time any changes are detected. And that means that the premalignant or malignant changes that first appear in the mouth may be only the first of many.

In contrast to its gloomy prognosis, however, oral cancer is a highly preventable disease. Here's how experts suggest we do it.

Avoid the deadly duo. The most effective way to reduce your risk of oral cancer is to avoid alcohol and tobacco, says Dr. Hong. As men have modified their lifestyles over the past couple of decades, their rate of oral cancer has dropped a whopping 22 percent.

Use low-alcohol mouthwashes. A study by the National Cancer Institute (NCI) in Bethesda, Maryland, revealed that women who regularly used mouthwash with an alcohol content of 25 percent or higher were nearly twice as likely to develop oral cancer as those who didn't. That's why women should check the ingredient label on any mouthwash they use to make sure that it contains less than this amount of alcohol, says Dr. Hong.

Stuff snuff. Several years ago doctors from Memorial Sloan-Kettering Cancer Center in New York City estimated that 1.3 percent of all women in the United States were using smokeless tobacco.

Dipping snuff, as the habit is called, is just as harmful as smoking a cigarette or chewing tobacco, says Dr. Hong. A study of more than 600 North Carolina women found that long-term users--many of whom had started to use smokeless tobacco by the age of ten--increased their risk of cancer nearly 50 times.

Fit fruit into your life. A federal study of nearly 2,000 men and women from across the country found that those who regularly ate a variety of fresh fruits and vegetables containing a naturally occurring cancer-fighter called glutathione reduced their risk of oral and throat cancer.

"Consumption of raw fruits and vegetables looks protective, but we don't know if this effect was due to glutathione or to some other constituent in raw vegetables and fruit," says Gloria Gridley, one of the NCI researchers who conducted the study.

Researchers aren't sure whether the glutathione may have helped repair cells injured by cancer-causing agents, enhanced immune system function or simply grabbed cancer-causing free radicals and escorted them out of the body.

Top fruit sources of glutathione in the study were grapefruit, orange juice, cantaloupe, watermelon and oranges.

Adopt a soybean diet. A series of laboratory and animal studies at the University of Pennsylvania in Philadelphia may show that soybeans contain Bowman-Birk inhibitor (BBI), a substance that may help prevent cancer.

"BBI prevents the transformation of precancerous cells into cancer," explains Ann Kennedy, D.Sc., professor of research oncology at the university. And it may be the single biggest reason that the Japanese, who eat a diet rich in soybeans, have such a low rate of many different kinds of cancer.

Dr. Kennedy and her associates are studying whether a soybean-based mouthwash will prevent the transformation of precancerous patches into cancer in the mouths of 24 people. The mouthwash, which is swallowed after it's swirled around the mouth, contains the equivalent of less than an ounce of a soybean preparation.

Preliminary indications are that the mouthwash is likely to prevent oral cancer. But until it's commercially available, why not borrow a book on Japanese cooking from the library and figure out how to work more soy into your diet?

Think about vitamin E. In a study at the NCI, women who took vitamin E supplements in any amount had half the risk of oral cancer of those who didn't, says Gridley, the researcher who led the study. Although researchers are not yet recommending vitamin E, they note that studies indicate that vitamin E neutralizes cancer-causing free radicals, protects cell walls against carcinogenic changes and may even enhance the immune system's work.

Monitor your mouth. Get into the habit of checking your mouth for red or white patches whenever you brush your teeth, says Dr Hong. It only takes a second, and constant vigilance pays off.

Put your dentist on the alert. Also ask your dentist or hygienist to keep an eye out for precancerous patches and to give you an oral cancer check during your six-month checkup.

"Cancer of the oral cavity is a multistep process," says Dr. Hong. "So if we can catch a precancerous lesion, there's a possibility we can prevent the cancer."