Oral Cancer

Paul Beresford Excerpts

Monday 13th January 2014 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con)]

I am particularly delighted to see my hon. Friend the Minister on the Front Bench because she understands my unusual form of English, which is really quite helpful.

I must first declare a double interest as chairman of the all-party parliamentary group on dentistry and as a very part-time practising dentist. This means that I am a member of the profession that faces the detection and treatment of the appalling disease of oral cancer. Over the years I have detected perhaps seven cases among my patients. We picked them up at a very early stage, and I believe that as a result those involved were all successfully operated on and treated without disfigurement, and survived.

I recall being called in by a colleague for a second opinion on a patient who was very well known in the media. I confirmed my colleague’s opinion that the small growth behind the lower right wisdom tooth was cancer. My colleague referred him to a specialist oral surgeon. The patient then disappeared off our horizon. He did not return for regular check-ups or go to the oral surgeon. As I said, he was a famous media personality. About two years later, news reports stated that he had died in spite of late treatment involving massive oral surgery disfigurement. As we later discovered, he had not wanted to hear my advice or my colleague’s. He went to see his GP, who gave him a bottle of some green fluid to paint on the ulcer, thus allowing the cancer to grow. This sad example indicates the first problem of oral cancer—that there is insufficient awareness among the public, among general medical practitioners, and even, regrettably, within the dental profession.

Last November, there were two cancer campaigns. The campaign on prostate cancer—Movember—caught the public imagination thanks to the proliferation of sometimes quite hideous hairy growths just under the nose on predominately male faces. The other campaign was an oral cancer awareness campaign. It was very successful within the dental profession but did not catch the public awareness. This is deeply disturbing, first, because prevention and cure is possible if the disease is found easily and early, and secondly, because of the increasing prevalence of the disease.

The latest available reports and figures relating to oral cancer do not make encouraging reading. In short, the problem is worsening each year and is set to continue to do so unless decisive action is taken on a national level. Across the globe, oral cancer is now one of the 10 most common neoplasms. About 6,000 new cases of oral cancer are reported annually in the UK, with 1,800 deaths related to the disease each year. The total number of new cases per annum has been steadily rising for the past three decades, to the extent that there are now 35% more new cases a year than 30 years ago. The problem has become so acute that oropharyngeal cancer is the fastest growing cancer in Scotland and is a similar, significant problem in the rest of the UK. To quote the British Dental Association:

“No other cancers have shown such a significant increase in their incidence. Furthermore, treatment of many cancers is showing impressive improvement in survival, but oral cancer continues to have high death rates.”

As I alluded to earlier, a key factor is late diagnosis, which brings me to my first point. Public awareness would be a huge help. Yawning is really dangerous, Mr Speaker, from a dentist’s point of view. That lump—that ulcer—in the mouth, particularly if it is painless, needs to be seen by a dentist. More dentists should be aware and look at the soft tissue, not just the teeth.

The second and third factors are tobacco and excess alcohol, particularly when the two are combined. I will not dwell on them, because the Minister, the Government and previous Governments are well aware of the detrimental health factors relating to both. Dentists have a role to play, particularly in persuading their patients to give up tobacco smoking. I suspect that the Minister will enlighten us a little further on that in due course.

The fourth factor, and the one on which I believe decisive action can be taken, is tackling the human papillomavirus. It is a very large family of viruses that infect the skin and lining of the cervix, vagina, anus, mouth and throat. There are two groups. One group—HPV 6 and 11—is relatively low risk, causing laryngeal and genital warts, while the other group carries a high risk of causing cancer. They are key in causing 13 different types of cancers, but of these viruses perhaps HPV 16 is the most dangerous.

The last figures I have quickly managed to find on new cases of HPV-related cancers in the UK are from 2009, when 7,538 females and 6,484 males were affected. In 2010, 2,016 males and 2,253 females died in the UK as a result of HPV-associated cancers, namely cervical, penile, vaginal, vulval, laryngeal and oral. In UK males, the greatest proportion of those cancers involved new cases and deaths as a result of oral cancer. In females, oral cancer is a relatively close second to cervical cancer.

The number of annual cases of HPV-causing cancers in men is rising significantly. They are not just oral cancers; they cover other areas as well. Indeed, if recent incident trends continue, the annual number of HPV-positive oropharyngeal cancers may surpass the annual number of cervical cancers by 2020.

Obviously, that trend will be affected by the success of HPV vaccines, which are advocated in this country for women but not for men. That is a little odd, because it appears that fewer men than women produce an immune response to HPV infection. HPV vaccines protect against HPV infection and disease, including cancers, in men as well as women.

Australia’s policy of vaccinating both males and females is producing herd immunity. The effect on HPV diseases, including cancers, has been quite dramatic. The last chart I happened to see showed a 90% decline in the number of patients—both men and women—diagnosed with genital warts, caused by HPV, at a Melbourne sexual health centre between 1 July 2004 and 30 June 2011.

HPV plays a role in oral cancer and it is clear that gender-neutral vaccination would lead to a dramatic reduction, over time, in a number of cancers, including oral cancer. Immunising boys and girls would achieve real herd immunity for all such cancers.

The burden of HPV-associated cancers is now almost the same on men as it is on women. Men currently face a significant and rising risk of HPV-associated diseases. I therefore put it to the Minister that it is not fair, ethical or socially responsible to have a public health policy that leaves 50% of the population vulnerable to infection. Such vaccination, combined with early detection and action on smoking and heavy drinking of alcohol, could save a huge number of lives just as we face a dramatic increase in oral cancer. I repeat that the next procurement round is in the offing: the moment and the opportunity is here now.