Uncle Emil died of oral cancer. He was an artist and my mother’s brother, the youngest of seven children. Conversely, I am the oldest of seven children, and even the oldest of all my cousins. So our ages weren’t all that far apart. I always called him “Uncle”, but in a lot of ways we were more like cousins.
Today he would be considered a tough customer. He would have liked that. Kensington, even then, wasn’t a neighborhood for the faint of heart. He brought me to my first pool hall above the Iris movie theater just off Allegheny Avenue. I can remember how fascinated I was with the bright-colored ivory balls on smooth green felt, the overhead lamp reflecting out into a milky sea of cigarette smoke and by the half-filled beer glasses scattered about the room.
Lying about his age he enlisted in the navy after Pearl Harbor and a photo of him with his two brothers, all in seaman’s attire, was enshrined for decades atop my grandmother’s TV set. In the Pacific he survived the sinking of two ships by Kamikaze attack. A blue anchor was tattooed on his right arm and “MOM” just above his wrist.
He never married and, at sixty-five, still lived at home with my grandmother. Beer and cigarettes were never renounced. An infected tooth was tolerated for a long while before he sought an oral surgeon. There was swelling and mobility and pain and a white lesion. The biopsy revealed squamous cell carcinoma. Before he died he lost his tongue and his mandible. He was so disfigured he refused visitors.
While gathering material for this issue I have had time to reflect upon the horrors of this disease. One of them concerns identity. What are You? What makes you YOU? The center of my being seems to rest just behind my eyes. Toward the front of my brain. Whether I call it a soul or my consciousness, I perceive it as something intangible and metaphysical. My fear of death is a fear of its loss. It is my identity.
The closest physical manifestation of my identity is my face. My voice is unique to me among all the people in the world. Dining with family and friends is one of the joys of life. The loss of these things for me would be almost a death before death. The final end would come as a relief.
It is truly a terrible disease, this oral and pharyngeal cancer. And as a profession we can do so much more than we have done. One American an hour dies of this affliction. Eighty thousand a year are diagnosed with it. 30,000 a year die from it. Even with improvements in radiation and chemotherapy, the five-year survival rate has hovered around fifty percent for decades.
Prevention and early detection are the keys to improving this poor record. Eighty to 90% of patients have a history of tobacco use including cigarette, cigar, pipe and smokeless products. The heavy use of alcohol enhances the carcinogenic effects of tobacco use. Educating patients about the dangers of tobacco and alcohol is essential in the dentist’s oral cancer screening program.
Although the five-year survival rate is only 50%, the survival rate among patients who have had early diagnosis rises to 80% while those with late diagnosis drop down to 20%. An oral cancer examination should become a standard part of a comprehensive dental examination beginning in the teenage years. It must be as routine as the Pap smear, prostate-specific antigen test or mammogram. You should also familiarize yourself with the new methods available to aid in diagnosis and consider if they would be of benefit in your practice.
Because of the public health implications of this topic, a copy of this issue of the Journal has been sent to all licensed Pennsylvania dentists. I would like to thank the members of the Pennsylvania Dental Association for providing the funding to make this possible. rjg
Published in the Pennsylvania Dental Journal. Authored by Dr. Richard Galeone, editor of the Pennsylvania Dental Association.