Finally, it’s Spring!  Thank God the winter is over!  Bring on … well, whatever outdoor activities we can safely practice these days!

But first…let’s talk a little about two important medical topics that are related to April and one another.  Of course, I am talking about oral cancer and immunizations.

That’s what you were going to guess, right?

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April is Head and Neck Cancer Month, which is a good time to talk about oral cancers. Oral cancers encompass cancers of the mouth and throat.  As a pediatrician, this doesn’t often come up in terms of treatment, (though I have seen one case in a child in residency, where most doctors see “the one case ever” of almost every disease).

 However, as a pediatrician, we do have an important role to play in prevention of diseases like these, so the patient does not have to deal with the pain and suffering later.  It is not glamorous, but it is a heck of lot cheaper (and more rewarding) than treating disease.  Some things are not preventable and not all preventable things can be stopped in everyone as we humans are tricky like that and do not always do the right thing.

So, guess what? Oral cancer IS preventable!  How, might you ask?  It is because the main causes are mostly under our control. Let’s start with the lesser-major cause and work our way up to the big one.

First up is smoking, especially when drinking is added on.  Smoking is a major cause of oral cancer.  Though rates of smoking have dropped significantly, kids still find cigarettes and get addicted to them.  Add drinking to the mix and you have a recipe for disaster, not just in the mouth, but elsewhere in the body as well (including the lungs, stomach and kidneys to name a few).  Tobacco, with or without alcohol, damages the cells that line the mouth and throat, causing these cells to divide more than needed, increasing the chances of mutations that can cause cancer.  Also, chemicals in tobacco by themselves damage the DNA of our cells, further leading to mutations that can cause cancer.    

By now it should go without saying that smoking cigarettes is a TERRIBLE habit that should be avoided at all costs.  This goes for e-cigarettes as well, as they contain many chemicals including formaldehyde, a known carcinogen.  As of now, the American Dental Association notes that there is no consensus as to whether smoking marijuana causes oral cancer.  There is a theoretical possibility due to the immunosuppressive effects of cannabis (along with other risk factors such as also smoking tobacco, and oral papillomavirus), but many studies have found no association.

Which leads me to the biggest cause of oral cancer, and another big April medical topic.  World Immunization week is the 23rd-30th, and therefore a perfect time to remind parents (and young adults) to get the Human Papillomavirus (HPV) vaccine since HPV is the major cause of oral cancer.  Thankfully, there’s an easy way to prevent this: you can have your child, get the HPV vaccine, known as Gardasil, starting at age 9  Gardasil protects against several cancer-causing forms of HPV, but especially types 16 and 18, which are the main ones associated with oral cancers.  HPV DNA is found in many of the tumor cells of these cancers, especially (according to the American Cancer Society), in non-smokers who drink little or no alcohol.  And as of July 2020, Gardasil has FDA approval for the prevention of oral cancers.

I’m not going to wade into debates about vaccine here; the science supports the enormous benefits this vaccine has already produced, I recommend it wholeheartedly to all my patients, it has been around for over 20 years now, I wish it were available when I was a teenager, and my kids will be getting it as soon as they are the correct age. The recommended age is 9-26, though adults as old as 45 may also get it.

Lastly, I need to state that some oral cancers have no clear cause, and may be linked to other, as yet unknown, factors.  That is how medicine works.  We do not have all the answers, all the time.  But we know the answers to these two major causes, and they are preventable.

 No one wants cancer.  No one wants to have to care for or lose a loved one to a disease, let alone one that can be prevented.  For parents, do your best to talk honestly, and not aggressively or fearfully, to your kids about the dangers of smoking and drinking.  And do the same thing for sex and intimacy.  Don’t be scared to be open about what you know and feel.  Our kids know more than we think, but not always the facts.  They want that information from us, and we owe it to them to provide it. 

If you need help, call your pediatrician.  That is what we are here for.

David B. Levine, MD, is a board-certified pediatrician with Atlantic Medical Group Pediatrics at Florham Park. He will soon be practicing at Atlantic Medical Group Pediatrics at Scotch Plains.