How to Detect Oral Cancer, and Why Sleep Apnea Plays a Large Role in Detection

August 24, 2021

Although oral cavity and oropharyngeal cancers don’t get the same media exposure as other forms of cancer, studies show that over 54,000 Americans are diagnosed with oral or oropharyngeal cancer every year. Men account for around 38,000 cases, compared to women, who total about 15,000 cases.

The Oral Cancer Foundation says oral cancer causes “over 9,750 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 54,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years”

As with most cancers, catching it early is critical, and dentists are essential for early detection. Understanding the higher risk factors will help dentists conduct more meaningful and targeted screening for those patients who are more susceptible to oral cancer. In this article, we’ll briefly discuss what a regular screening entails and the most common factors of heightened risk for oral cancer—including sleep apnea.

A Regular Screening

Regular screening should include the following areas:

  • The tongue
  • The roof of the mouth and under the tongue
  • The inside of the cheeks
  • The oropharynx (the part behind the soft palate)
  • The salivary glands
  • The lips

Common Oral Cancer Risk Factors

Once the physical exam is complete, a brief screening of a patient’s profile and lifestyle habits can uncover potential risks: Namely, age, lifestyle habits, gender, and sleep patterns.

Age

Studies show that the risk of oral cancer increases in patients over the age of 40. Since this type of cancer takes many years to develop, most cases appear in patients aged 55 and older. The average age for an oral cancer patient is 62.

Tobacco Use

About 80 percent of patients with oral cancers use tobacco via cigarettes, pipes, or chewing tobacco. Any tobacco use carries risks, but the duration and amount of use impact the likelihood of oral cancer. “Smokers are also at a 10 times higher risk for oral cancer compared to non-smokers,” say experts at Johns Hopkins Medicine, adding that there are 28 cancer-causing compounds in smokeless tobacco. 

“Cancer caused by smokeless tobacco often begins as leukoplakia, with a whitish patch that develops inside the mouth or throat,” they explain. “Or the cancer may [be] erythroplakia. With this condition, a red, raised patch develops inside the mouth. It’s also linked to esophageal and pancreatic cancers.”

Alcohol

An estimated 70 percent of people diagnosed with oral cancer are heavy drinkers. As with tobacco use, research from the Centers for Disease Control shows that alcohol turns into a DNA-damaging chemical called acetaldehyde, preventing DNA from repairing damaged cells and encouraging normal cell growth. “When DNA is damaged, a cell can begin growing out of control and create a cancer tumor,” says the CDC.

For people who smoke and drink heavily, the risk of oral cancer may be as high as 100 percent more than the risk for people who do not smoke or drink.

Gender

Based on lifestyle risk factors, it’s no surprise that men are twice as likely to have oral cancer than women. The National Institute of Health found that 16.7 percent of men use tobacco products versus 13.6 percent of women.

Men also lead the way in alcohol use, with the CDC reporting men are “almost two times more likely to binge drink than women.” Further, “Alcohol use is one of the most important preventable risk factors for cancer,” say researchers at the CDC. “Alcohol use increases the risk of cancer of the mouth, throat, esophagus, liver, and colon, which are more common among men. Drinking alcohol also increases the risk of prostate cancer.”

Sleeping Patterns

There are two reasons why addressing severe sleep disorders with your patient is important: 

First, while dentists don’t treat cancer, they are the first defense for identifying early signs or heightened risk factors exacerbated by chronically interrupted sleep or sleep disorders.

While research remains in the preliminary stages, several studies show an increased risk of cancer development in people suffering from sleep apnea. “The theory backed by many researchers is that blockage of someone’s airway may promote a process called neovascularization, which is the growth of new blood vessels,” explains Lana Barhum at Verywell Health. “This process may end up encouraging tumor growth.” 

Barhum referred to a 20-year study published in the Journal of Sleep Medicine, which concluded that people with moderate to severe cases of sleep apnea are two and a half times more likely to develop a form of cancer and three times more likely to die from it. 

Second, if your patient was treated for oral cancer, OSA is likely to occur. A recent study concluded that “surgery and chemo/radiotherapy for head and neck cancer may lead to several alterations of the anatomical structure and functionality of the upper airways.” It also identified radiotherapy as being responsible for edema within the soft tissues, while partial laryngectomy and tongue reconstruction can change the main supporting structures of the pharynx and larynx. 

Research continues to understand better the connection between sleep apnea and its impact on cancer risks and treatments. However, research can confirm the importance of screening for it and other patient profile factors during a patient’s checkup.

Your patients trust you to provide the best care possible. With thoughtful, comprehensive screening, you can improve the chances of early detection for oral cancer and prepare your patients for better sleep and a healthy quality of life for many years to come.