Tiresias: War on Oral Cancer

My friends

2021 is the fiftieth anniversary of the declaration of “War on Cancer”. April 2021 is the Oral Cancer Awareness Month. In this spirit Tiresias would like to share some figures with his friends.

Oral cancer is common. Oral cancer has a reported world incidence of 450,000 per year. This is undoubtedly an underestimate. Oral cancer is most common in South and Southeast Asia and parts of southern Europe. The incidence is almost certainly higher in other underdeveloped countries but the statistics are not available. Only 40% of those diagnosed with oral cancer will survive five years. Many that do survive have significant morbidity and disfigurement. It is estimated that 23 people die of oral cancer every hour of every day of every year. The average age of oral cancer is 60 but numbers start accelerating after the age of 40. This is not an end-of-life cancer. For a number of reasons, oral cancer is increasing worldwide, and increasing in the young. The key to reducing the death rate is screening.

The incidence of pre-cancerous lesions in the mouth is up to between 1 and 2%. The cancer has an insidious inobvious onset consisting of white patches, small ulcers, changing of gums or teeth or nothing at all. Cancer screening is inadequate even in the most developed countries. By the time the cancer is visible, say 1 mm in size, there are already 1,000,000 malignant cells present. Early cancer detection, when needed, when only a few malignant cells are present, is only feasible by repeated biopsy and repeated histopathological examination. This requires a highly developed medical and pathology infrastructure which is simply not available and will not be available in the foreseeable future, in underdeveloped countries where oral cancer is most common. Treatment of advanced lesions, many of which have already metastasised, is too late. Even a 99% efficacy in removal of the smallest lesion of 1mm (1,000,000 malignant cells), leaves behind 1% which is still 10,000 malignant cells, when one malignant cell is one too many, and leads to cancer recurrence or should we say persistence. Current surgical methods are blind, and do not visualise the cancer cells necessitating blind wide disfiguring excisions. It is not a surprise that metastasis and recurrence rates are so high, and mortality remains high. Optiscan Confocal Laser Endomicroscopy with the application of PARP1 molecular labelling combined with AI/machine learning and internet will enable real time digital pathology for anyone, anytime, anywhere in the world. This is about to revolutionise oral cancer screening and oral cancer surgery and treatment. And this is only one cancer, and only the beginning. Enjoy, my friends.