Tongue cancer diagnoses on the rise

Michelle Wisbey

19/01/2024 2:50:04 PM

Rates have spiked in cohorts not traditionally at risk of the cancer, especially younger women with no history of smoking or heavy drinking.

Doctor checking woman with hands on neck.
More than 1300 cases of tongue cancer were reported in Australia last year.

It may be relatively rare in Australia, but cases of tongue cancer are skyrocketing and not in the patients you might expect.
GPs are being urged to look out for the condition’s symptoms as diagnoses continue to rise by around 3% each year.
For women under the age of 45, that rate jumps to a 4% increase; however, the cause of the spike remains unknown.
According to the latest Australian Health and Welfare data, 1336 cases of tongue cancer were reported across the country last year, compared to just 283 cases four decades ago.
The main risk factors for tongue and mouth cancers continue to be tobacco use and alcohol consumption, but can also include human papillomavirus, Epstein-Barr virus, poor oral hygiene, and gum disease.
RACGP Vice President Associate Professor Michael Clements said these rising numbers come at a time when female patients often miss out on an early diagnosis for many other conditions as well.
‘We know that we often miss cardiac disease or heart attacks in females because we’re often thinking of many things as male diseases,’ he told newsGP.
‘We’re often thinking of oral cancer as a smokers or an older person’s disease, so it’s a reminder for us as GPs to keep our differential list wide.
‘But it’s also a reminder for the community planners, the health planners, that for generalists like GPs, we keep these kinds of things in mind every time we see somebody.’
The rise in tongue cancer rates come as Australia’s remote and regional communities struggle to access timely oral healthcare.
According to the Australian Dental Association, 142,269 people currently do not have access to dental services within a 60-minute drive time.
‘The rate of potentially preventable hospitalisations due to dental conditions was consistently higher for those living in very remote areas than those living in major cities,’ it said.
Additionally, Associate Professor Clements said many patients remain unaware of tongue cancer and its symptoms.
‘Patients shouldn’t ignore any lesions in the mouth, and if they’ve had an ulcer or a sore for more than three weeks, or a lump in their face, throat, or neck, then they should be seeing either the dentist or their GP,’ he said.
‘Patients will come and see us for the painful sores and the ones that persist, but the problem is we’ve still got many vulnerable populations out there with very poor dental hygiene who don’t have access to public dental care.
‘This is a good nudge for the community to think about their oral health, and we may well see more people presenting to the GP with oral health lesions or dental concerns over the next few weeks as a response.’
Despite GPs often being the first point of contact for patients with a potential tongue cancer, training and education remains limited.
Recent research laid bare the gaps in GPs’ knowledge and clinical practice when it comes to oral health, as well as a lack of training to support them with prevention and diagnosis.
In a bid to combat this, the RACGP released a new gplearning online learning activity, ‘Oral cancer screening and prevention’, designed to provide optimal referral and treatment pathways for GPs.
Dr Clements said the tongue cancer spike highlights GPs’ generalist role, and the need to keep up to date with a broad range of medical information and best-practice healthcare.
‘If we try and break down that GP relationship and hive-off parts of what GPs do to small groups, nurse practitioners and pharmacists and so forth, then we miss out on somebody piecing the whole thing together,’ he said.
‘This is a reminder for us to keep on top of our oral health education and be on the lookout for these rare conditions with lesions and lumps that aren’t healing.
‘We also need to ensure we have a good follow up plan for people with unusual symptoms or unusual lesions that don’t seem to be getting better.’
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Dr Ruth Sophie Ratner   23/01/2024 9:59:32 AM

Are these HPV related?

Dr Andrew Robert Jackson   23/01/2024 7:47:14 PM

I saw a 71yo male ex-smoker last year on 3/3 with a 'firm' ulcer on the lateral tongue border.

He had an immediate punch biopsy at my surgery (I have a side interest and qualification in skin cancer medicine). The histology return four days later confirming SCC of the tongue.

ENT referral the next day.

Seen in a large Melbourne hospital centre interstate on 23/3.
Surgery 4/4 'excision complete'. Subsequent PET scan 'clear'.

A great story from life in general practice.

A.Prof Christopher David Hogan   24/01/2024 7:08:19 AM

Assumptions are dangerous especially to ignore the possibility of a condition because the patient is too young eg Ca of bowel, ca of tongue and heart disease but equally other diseases as well