As a disease entity, cancer involves a significant group within the Australian population and consumes a significant section of the health budget. In 2010, the Australian Institute of Health and Welfare statistics showed 114 000 new cases of malignancy (6000 more than in 2007) and 43 000 deaths (40 000 in 2007). What is even more alarming is the statistic showing 15 000 more deaths related to cancer than 30 years ago. In the 25 years from 1982 until 2007 there has been a 27% increase in the incidence of all cancers. There are many reasons for this, including increased lifespan. Currently one in two Australians will receive a diagnosis of cancer by the age of 85 years. These figures exclude non-melanoma skin cancer which adds a further 434 000 cases and accounts for 450 deaths.
Cancer Council of Australia statistics show the position of head and neck malignancies. These represent 2% of cancers (internationally 3–5%) with a risk estimate of 1 in 40 by 85 years of age for males and a fourfold lesser risk for females. Although this translates to some 2080 cases per year in Australia (5.7 cases per day), the mortality is 415 cases (1.1 cases per day). Small lesions still enjoy a 75% survival at five years but advanced lesions plummet to 15% at five years.
Based on these sobering statistics, the current issue of the Journal features six papers covering varying aspects and presentations of oral malignancy. The focus of oral malignancy is squamous cell carcinoma and the dental practitioner plays a critical role in the identification of early mucosal changes that may represent a premalignancy and the detection of established cancers. Early lesions are eminently treatable and an interceptive procedure provides the patient with an inestimable service. The position and evaluation of leukoplakic and erythroplakic lesions is addressed in the paper by Villa et al. and places these lesions in perspective. They are a dangerous group of lesions that should never be underestimated and never be given the opportunity to progress.
Neoplasms involving the lymphoid system (typically lymphomas) are not seen as frequent occurrences but the paper on plasmablastic lymphomas dispels this. Many patients with non-Hodgkins lymphoma have involvement of the cervical lymph nodes and the complete dental examination, which includes an examination of the submandibular and cervical lymph node chains, may be the first indication of pathology.
The essential question that inevitably arises in the professional forum on malignancy is where to allocate the limited available funds (usually provided by competitive grants including the Australian Dental Research Foundation) – what is the most important issue to address? From a patient perspective, treatment is paramount. An understanding of disease mechanisms, however, may lead to the development of enhanced detection systems and the development of specific treatment. Research is of enormous importance. A review of the literature shows a large volume of research, much of which is clinical, but, as seen from the figures above, survival has not improved at the anticipated rate. Basic research is pivotal and significant advances are being made from groups both here in Australia and internationally. This includes: basic science research (what causes cancer and who might be predisposed?); detection protocols (how can the clinician and pathologist detect/predict cancer development?); what is the best treatment to offer a particular patient with a particular malignancy; how do we rehabilitate and care for patients who have undergone both curative and palliative treatment? A focus on one area is unsupportable but the combined body of developing knowledge, including significant Australian contributions, is slowly allowing a progressive and optimistic approach to many previously undetected and often untreatable malignancies.
The Journal commends the papers in this issue. They represent a spectrum of positions and most importantly they reinforce the position of the general dental practitioner in early detection of possibly malignant and overtly malignant lesions. A single case detected in a practising lifetime is a single life saved. How can a value ever be placed on this?