All cancers, including oral cancers, are life threatening. Oral squamous cell carcinoma in particular is recognized to have a 50% five-year death rate. The American Cancer Society estimates the prevalence of oral cancer as 60,000 new cases each year. This means that 30,000 individuals will succumb to oral cancer despite our best efforts to treat them.

Seventy-five percent of all head and neck cancers begin in the oral cavity. According to the National Cancer Institute's Surveillance, Epidemiology, and Ends Results (SEER) program, 30 percent of oral cancers originate in the tongue, 17 percent in the lip, and 14 percent in the floor of the mouth.

Unfortunately, the diagnosis continues to rely on patient presentation and physical examination with biopsy confirmation. This may result in delay in diagnosis accounting for the fact that the majority of these cancers are diagnosed at a late stage. Studies confirm that survival does correlate with stage making early diagnosis and treatment optimal for this disease. Despite advances in surgical techniques, radiation therapy technology, and the addition of combined chemotherapy and radiation therapy to the treatment regimen, the five-year survival rate continues to be less than 60%. In addition, those that do survive often endure major functional, cosmetic, and psychological burdens due to dysfunction of the ability to speak, swallow, breathe, and chew. A thorough, systematic examination of the head and neck need only take a few minutes and can detect these cancers at an early, and curable, stage. Our goal is to discover oral, head and neck cancers early, before patients present complaining of pain, a mass, bleeding, otalgia, or dysphagia. Errors in diagnosis are most often ones of omission, and therefore the importance of a systematic approach to the oral, head and neck cancer examination cannot be overstated.

It is critical to remember that any person with a history of tobacco smoking and alcohol use or prior head and neck malignancy has a significant risk of developing an oral, head and neck cancer. 90% of patients who have oral squamous cell carcinoma have some history of smoking tobacco. The University of Miami has also identified that 9% of patients that have oral squamous cell carcinoma have no tobacco history at all. These same studies have demonstrated a lack of association between smokeless tobacco and oral squamous cell carcinoma.

The following instruments and supplies are necessary to conduct a thorough and time efficient examination: an adequate light source, a dental mirror, tongue blades, 2x2 gauze pads and anesthetic spray (to diminish gagging).

You and your clinical staff make a difference. In general practice, you have the advantage at detecting head and neck cancer early because you see your patients more regularly. A thorough oral, head and neck cancer examination can easily be completed in less than 5 minutes and can be part of a hygiene check. It primarily consists of inspection and palpation. It is important to explain to the patient exactly what you are doing before doing it. Not only will this help put the patient at ease, but it also gives you the opportunity to educate your patient about the signs and symptoms of oral, head and neck cancer and how to detect it at an early stage. The order of exam is typically face, eyes, nose, ears, oral cavity, lips, buccal mucosa, tongue, floor of the mouth, hard and soft palate, oropharynx, tonsils and neck.

"Don't defer- refer!" Remember that the only definitive way to diagnose a malignancy is with a biopsy. It is always better to have a negative biopsy of a suspicious area than to observe something that is a looming threat. The key is not necessarily knowing what it is that you are looking at, but rather knowing that it is unusual and not normal in and of itself.