Sir, we are writing to share our concerns about the delayed diagnosis of oral cancer among non-smoking women in Jordan which we think may have wider implications.
Over the last year, we have seen four female patients with tongue cancer (Fig. 1). They were aged over 40 except one who was 38 years old. None of them had the classical risk factors for oral cancer; they were non-smokers and non-alcohol drinkers. They were seen by a substantial number of physicians and dentists mainly for the same complaint of a non-healing ulcer on the right aspect of the tongue posteriorly. No-one suspected that this was oral cancer because the patients were female and non-smokers. In each case biopsy was delayed and eventually diagnosis was reached at a late stage when the cancer became advanced, worsening the prognosis.
A recent Australian study pointed to a growing subgroup of oral cancer patients who are non-smokers and non-drinkers. According to Koo et al.,1 suggest that high-risk HPV infection is a predominant factor in the development of oral squamous cell carcinoma (OSCC) in patients who do not smoke or drink. On the other hand, Koo et al.1 suggest that HPV may confer a worse prognosis in tumours of the tongue, and as tobacco use decreases, they predict that the proportion of this group among OSCC patients will increase.
Dentists and physicians alike should be aware that female non-smokers can get oral cancer, and that of those diagnosed, the prognosis can be poor. Diagnosis should be established as early as possible by not neglecting any persistent lesion, particularly if it is an ulcer affecting the tongue. Patients would probably go to their physicians or dentists for reassurance regarding such lesions. Appropriate procedures like early referral and histopathological examination could save a patient's life or at least improve treatment outcomes and quality of life.
Koo K, Barrowman R, McCullough M, Iseli T, Wiesenfeld D . Non-smoking non-drinking elderly females: a clinically distinct subgroup of oral squamous cell carcinoma patients. Int J Oral Maxillofac Surg 2013; 42: 929–933.
Kansy K, Thiele O, Freier K . The role of human papillomavirus in oral squamous cell carcinoma: myth and reality. Oral Maxillofac Surg 2012; DOI: 10.1007/s10006-012-0383-0.
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Dar-Odeh, N., Abu-Hammad, O. Tongue cancer subgroup. Br Dent J 215, 154 (2013). https://doi.org/10.1038/sj.bdj.2013.796