Oral cancer costly to Black American’s health – St. Louis American

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According to a 2021 study published by the American Cancer Society, African Americans have a higher risk of developing oral cancer and a higher likelihood of dying from it compared to white Americans.
Mortality rates for oral cancer were 85% higher for African American men than White men in 2000.
“Early diagnosis of oral cancer gives a person more than an 80% survival rate”
While the incidence rates of oral cavity and pharynx cancers from 2011 to 2015 were higher for white Americans than African Americans, Black patients had a death rate that was 20% higher than the death rate for white counterparts.
Oral Cancer Awareness Month was observed in April, and advocates for cancer awareness say they focus on educating people year-round about oral and oropharyngeal cancers, while promoting early detection and prevention.
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“The goal is to prevent the precursor — precancerous — oral lesions from progressing to cancer over time by catching them early and treating them accordingly,” said Dr. Richard J. Vargo, an assistant professor and the Director of Oral and Maxillofacial Pathology at A.T. Still University – Missouri School of Dentistry & Oral Health (ATSU-MOSDOH) and the St. Louis Dental Center.
Doctors encourage regular dental check-ups, ongoing public education about risk factors and symptoms, and emphasize the importance of early diagnosis.
Oral cancer comes in various forms. While 90% of oral cancers are oral squamous cell carcinoma, patients can also have salivary gland malignancies, melanomas, sarcomas, lymphomas, leukemias, and metastatic cancers from other sites present in the mouth.
Nearly 60,000 people in the U.S. were diagnosed with oral cancer in 2024, and the rate increases every year, according to the Oral Health Foundation.
Early diagnosis of oral cancer gives a person more than an 80% survival rate. Anyone experiencing persistent symptoms should seek medical attention. However, Dr. Vargo says for oral squamous cell carcinoma many cases have little to no pain early in the course of the disease.
“I have seen numerous patients in my clinical practice at SSM Health Saint Louis University Hospital who informed me that their lesion has been present for months to years and that they only sought care when they did because it hurt or was interfering with eating,” said Dr. Vargo.
He says the most common signs include a non-healing sore, a white, red, or black patch.
“If the lesion does not hurt, is not felt with the tongue, and does not interfere with function, then patients often overlook it,” he said.
But oropharyngeal squamous cell carcinoma presents in the soft palate, tonsillar region, or base of tongue. Early cases of oropharyngeal squamous cell carcinoma are generally asymptomatic.
Patients may present with asymmetry of the tonsils, difficulty swallowing, ear pain, or an enlarging neck lymph node, which is the most often presenting sign. The most common risk factors include tobacco use and alcohol consumption.
This may contribute to racial disparities, according to the Cancer Society.
Other factors are:
Late-Stage Diagnosis: African Americans are more likely to be diagnosed with oral cancer at later stages when the cancer has spread and is more difficult to treat effectively.
Access to Healthcare: Disparities in access to quality healthcare, including dental care and cancer screening, can contribute to late-stage diagnoses and poorer outcomes.
Social Determinants of Health: Social and economic factors, such as poverty, lack of access to education, and exposure to environmental toxins, can also play a role in oral cancer disparities.
HPV a haunting cause
Experts say 80% of squamous cell carcinomas in the oropharynx are associated with high-risk HPV infection; therefore, HPV infection has led to a significant rise in the number of oropharyngeal squamous cell carcinomas.
About 10% of oral cancers have no identified cause or risk factor and may be the result of a genetic predisposition, frailty, or another cause. The number of HPV-associated oropharyngeal squamous cell carcinomas has increased 1% to 2% annually in males in the United States in the past 30 years, and it is the most common HPV-related cancer in the U.S., Dr. Vargo said.
“I biopsy any suspected precancerous lesion and then completely remove these lesions if that is indicated. Other treatments include CO2 laser ablation and topical medications,” said Dr. Vargo.
At the St. Louis Dental Center, every patient gets a thorough head and neck soft tissue examination and oral cancer screening. Vargo will perform oral cancer screenings at the 2nd Annual Baden Community Coalition Men’s Health Fair in June.
“I hope that taking part in this event and events like it in the future will get the word out to vulnerable and at-risk populations across the St. Louis region,” he said.
Every new patient at the St. Louis Dental Center has an oral cancer risk assessment completed, and patients at high risk are put on more frequent recalls. Self-exams work well, too.
Dr. Vargo suggests using a bright light and mirror to look and feel the roof of the mouth, sides of the mouth, and back of the gums. Examine your tongue top and bottom and feel for any lumps or enlarged lymph nodes on both sides of the lower jaw and neck. If something is new or seems unusual, schedule an oral health exam.
About 43% of patients survived oral cancer for more than five years, but many of those patients suffer from difficulties with eating and speaking. Because diagnosis often occurs late in the development of the disease, surgical treatment for survivors may result in severe facial disfigurement.
Many oral health specialists encourage the creation of a national educational program to emphasize the importance of timely, regular oral health screenings, as well as the value of routine self-exams.
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