Doctor's In-Depth: Early Detection of Oral Cancer

Here's the 6 On Health report from Monday, March 31, 2008. KFDM.com wants to continue to bring you the most complete health news online. Watch KFDM News each night at 10 to get the latest health story. If you miss the show make, remember you can always check right here for the latest story.

Steven Brattesani, D.D.S., explains the new VELscope device used to detect oral cancer.

How common is oral cancer and is it an increasing problem?

Dr. Brattesani: Oral cancer is a common malady in the oral cavity and has become more prevalent in the last few years. Some attribute this to the better diagnostic capabilities and some attribute it to more abusive behaviors. As a dentist, I would prefer to believe that my colleagues and I are doing a better job at diagnosing the disease much earlier.

What is the prognosis for oral cancer? Is it slow growing, or does it progress rapidly?

Dr. Brattesani: Until this new product, VELscope, was developed, oral cancer has had a very bad prognosis. If you don't catch oral cancer early enough it's usually fatal. We've been working to get better at diagnostic capabilities. In the last few years, new processes have been developed for oral cancer screening which before involved a visual test to spot anything out of the ordinary. Usually, if what we spot is bilateral, something that's on both sides, it's not a bad thing. But if we see something in one area and it is changing and looks different, it's usually questionable and requires secondary tests. Before we had VELscope, in cases like that we would send the patient to an oral surgeon or we would use toluidine blue to highlight that tissue and send it for biopsies.

What is toluidine blue?

Within the last few years, we've developed a technology more convenient for the dentist and patient. It's an acidic acid rinse that patients use in their mouth for about a minute to highlight questionable tissue. You would then wave something similar to a calcium light stick in the mouth to see any fluoroscopic events. If there was a change in the tissue, it would show up different than normal, healthy tissue. The problem with Toluidine blue is that it only detects the top surfaces of your cells. We really wanted to get to a place where we could diagnose it early on, before it manifests itself in the upper stages of tissue.

What is VELscope and how has it advanced oral cancer detection technology?

The great guys at VELscope and the team at LED worked on a technology similar to something used in Asia and Japan primarily for Tuberculosis biopsy and gynecological and proctological tissue. It uses a fluoroscopic light that shines a harmless blue light into the tissue and hits the basal cells. The VELscope filters out blue light. Anything that's healthy shows up apple-ish green and anything that's not healthy shows up as a dark color. It has allowed us to see things, non-invasively, deep down into the tissue.

Why does oral cancer show up as a different color?

Dr. Brattesani: The color indicates cellular change -- blood flow changes. Those cells don't have the same blood flow that normal tissue has and so it refracts at a different angle. The fluoroscopic sends in a blue light which is absorbed and then refracted in a specific spectrum. It's patented technology filters out the blue light and only allows the good stuff to show and the bad stuff is darkened. It's pretty interesting.  What's nice about it is it's very easy to use. The learning curve is very simple for most dentists.  Because it's not an invasive procedure, patients feel confident and a little more secure.  Is it 100% accurate? There's nothing that's 100% because tissues continue to change, but it is the earliest detection method available.

How much earlier can the VELscope detect oral cancer?

Dr. Brattesani: Every case is different and everybody develops disease differently. I don't have a statistic, but I can tell you that if we catch the basal cell at the bottom of the tissues before it actually manifests, it's 80 percent treatable and you have a higher chance of survival. If you catch it after it's begun to manifest, it's usually not a good long-term diagnosis.

Before the VELscope device was created, was there a way to detect oral cancer at an early stage?

Dr. Brattesani:  First of all, the device helps detect it but it doesn't say that it is oral cancer. The only way to tell if it's oral cancer is with a physical biopsy. A biopsy is a much better way of diagnosing the area of concern and of identifying the right border.

For example, in the old days when you have a questionable area, you would biopsy the area and also take a little good tissue surrounding it to differentiate between the two. The problem with all cancer is that it tends to be volcanic. There's a little peak of cancer but underneath is an underlying structure. Using the new VELscope method, researchers are finding that the cancerous area is quite large compared to what they found using the old method. If we can get that whole base early on, we can stop it in its tracks.

Does the VELscope effect oral cancer treatment?

Dr. Brattesani: The VELscope makes detecting cancer more definitive. I would rather remove all of the cancer rather than just pieces of it. There's an old argument that says if you cut into cancer you could rupture the cells and they will spread faster. Some tests show when you biopsy an area but do not remove it completely, the malignant cells multiply faster.

If we remove the cancerous tissue along with some of the surrounding healthy tissue, we know we've removed the entire thing. It's going to heal and scar but you know you've gotten the cancer and don't have to question if there is more and whether you have to do a second biopsy and remove more tissue.

That's why, as a general dentist I refer to oral surgeons. I want their expertise in oral- maxillofacial surgery. I feel more comfortable in my own practice to work with an oral surgeon as a team to treat patients.

General dentists are the front line of defense. People don't realize that their dentist is not just a tooth doctor and cleaning facility. It's a first line of defense for many diseases that show up in the mouth before they actually manifest themselves in the rest of the body.

What risk factors contribute to oral cancer?

Dr. Brattesani: Certain factors like smoking or chewing tobacco increase your risk of developing oral cancer, but 25 percent of all people that develop it have no predetermining factors. They could be young or old -- it's indiscriminate. Cancer doesn't judge by age -- it judges by humans.

Now that VELscope is offered, do all patients who come to your office get this procedure?

Dr. Brattesani: As of February, in honor of my mom, we're going to do this twice a year for all of our patients. It's going to become standard practice, straight across the board -- new and old. We will see what insurances pay and what insurances don't. If a patient doesn't want to cover the procedure from their own pocket, I would rather do it pro-bono than have to argue with insurance companies. I would rather be pro-active because one life saved is worth everything.

Why are you so passionate about oral cancer?

Dr. Brattesani: My mom passed away in February of 2005 from Multiple Myeloma. It is an aggressive form of cancer. She was never sick a day in her life. In 18 months she passed away, not from the cancer itself but from the treatments. If we can catch this disease early, before it progresses, we eliminate most of the treatments. If we can eliminate most of the treatments, we can increase productivity and improve quality of life. We can stop a disease in its tracks by 80 percent. That's a huge change. I was speaking earlier about HPV virus and cervical cancer, and yes, it's a serious disease. Women's groups and organizations have done a great job getting the message out, but unfortunately that's only one cancer that is affecting humanity and it's not as prevalent as oral cancer. Oral cancer is 3 times more prevalent. I'm not suggesting we don't deal with HPV. We should deal with all cancers. I call it the animal, and if we can get these animals under control and can kill these animals, we can really help humanity.

How often does someone die from oral cancer?

Dr. Brattesani: Every hour one person dies of oral cancer. There are about 360,000 cases a year worldwide. It doesn't sound like a lot, but it is. When it's your family member or you, it makes a difference, and everybody that I know has been touched by some disease, especially cancer. I think everybody can say they have a family member or a friend or co-worker that's had cancer. We all know the toll it takes, not just on the person, but on families, kids, mothers and fathers and uncles and aunts and friends. It's all about saving lives. Rather than going to war and trying to kill each other, we should be killing disease processes.

What does VELscop offer patients, including those that do not have any risk factors of oral cancer?

Dr. Brattesani:  VELscope allows a patient to have a non-invasive simple screening examination to rule out the possibility of questionable tissue at an early state. It allows the dentist and the health care worker -- the hygienist -- that works with this technology to screen patients and be pro-active in stopping the disease process that unfortunately, is all too often a death sentence.

Do you have any other comments about VELscope and its effect on the dentistry industry?

Dr. Brattesani:  Everybody usually has a little hesitation about going to the dentist, either because it's a scary prospect, or because they've had a bad experience. But in recent years, and especially in the past five years, dentistry has come one hundred years in technology. We have CAD/CAM technology, we have computers, we have intraoral cameras -- we have new technologies -- all kinds of new exciting technologies. Everyone should go to the dentist, but 50 percent of the population in the United States doesn't. People are walking around with pain and discomfort they shouldn't have. We're not a third world country. We are a first world country -- the United States of America -- and I find it hard to believe in the year 2007 we are still dealing with people not going to the dentist. This screening process gives one more reason for people to go. VELscope allows people to have a non-invasive procedure, with no pain and discomfort.

Steven Brattesani, DDS

Marina Pacific Heights Dental Care

San Francisco, CA

(415) 922-3220

http://www.drbrattesani.com