Smokers are 2 to 3 times more likely to develop oral cancer than nonsmokers.1 This risk increases with amount and duration of smoking.1 The combination of smoking and alcohol use has a synergistic effect, increasing the likelihood of developing oral cancer 15 fold.1,3
Alcohol use. Among male patients with oral cancer, one-third are heavy alcohol users.1 In fact, one study found that 20% of these patients have cirrhosis of the liver.1 Thus, it makes good clinical sense to routinely examine the soft tissue of the oral cavity for abnormalities in patients with alcohol-induced cirrhosis of the liver.
Our patient. We placed our patient on a 3-month recall and stressed the importance of not smoking. The patient had surgery and a good outcome was documented. The patient indicated at follow-up that he’d started drinking again and was referred for counseling.
TAKEAWAY
It’s important to pay attention to color differences in the oral cavity on routine visits, particularly in patients with known risk factors for SCC. Patients with a lesion in the oral cavity should be seen again within 2 weeks. If the lesion is unresolved, the patient should be referred for further examination and/or biopsy. The possibility of recurrent oral cancer or cancer in the surrounding areas makes these patients good candidates for frequent follow-up examinations.
We strongly suggest that primary care physicians encourage their patients with the known predisposing risk factors of tobacco use and chronic alcohol misuse to quit these habits, visit their dentists for annual oral cancer screenings, and report any oral symptoms promptly to their medical and/or dental care providers. The asymptomatic nature of many of these lesions underscores the importance of following this advice. As is the case with most other cancers, survival rate is dependent on the stage of the disease at diagnosis.