Awareness transcends time…Interview: Dr. Jack Martin
Beyond Cancer Awareness Months: Continuing Focus on Oral Cancer
Well…it’s summer. The longest day of the year is behind us, and we’re headed for that time of year when we want to focus on travel, relaxation, good times with family and friends…anything but cancer.
Oral Cancer Awareness Month (April) is over.
So is May…and with it, ‘awareness (whatever that means…)’ of all other types of cancer, at least from a public perspective. It’s June…and as I think I mentioned…it’s summer.
What’s my point?
You’ll recall from my last post that awareness and its relevance are–literally–what we, as individuals–make of them. For what it’s worth, I’m still wearing the burgundy wristband…see that post for a pic. It’s had some damages and repairs in the past few months, though (more on that later). And, thanks to all who checked out the related post on my Facebook page–it was a record reach for DSS!
Awareness transcends time
Trying to confine cancer–and how we approach it–to a symbol–or a specific time period–carries the risk of diminishing its importance–our awareness of it…and, of greatest relevance, our control over it.
So, since May was ‘REGULAR’ Cancer Awareness Month, I’d like to continue our focus, in June’s waning days, on keeping oral cancer on our radar during months to come, along with all the other more well-known cancers (cancer POPULARITY? Is that a real thing? YIKES!!!)–and maybe work toward a certain mindfulness that cancer’s presence in nearly everyone’s life warrants a change in perspective.
How early is EARLY?
For some, early detection of any kind of cancer is the best treatment, because let’s face it–once most cancers are well established in the human body–despite the hype that sucks in so many well-intentioned folks who ‘race for the cure’, wear the colors of the particular cancer day–AND donate huge sums of money, sometimes with questionable accountability…medicine just isn’t very good at treating them effectively. In the specific example of oral cancer, the traditional cancer treatment paradigm just isn’t getting any better, and it is not doing right by patients.
The old definition of ‘early detection’ usually involves finding a small lump (often by using radiation, like an x-ray…), or a suspicious lesion somewhere else (like the oral cancer screening you got–I hope–at your last dental checkup). Oral cancer and its detection paradigm are a particularly good example of how true early detection seldom happens. But: that may be changing. Read on…
Here’s the thing: bizarre as this may sound, cancer isn’t normal. BUT–because it’s so commonplace, we sometimes slip into thinking it is. It’s not a random event. It doesn’t happen for no reason. Fact is, cancer doesn’t just show up. What most people don’t stop to realize is this: development of cancer is a fairly long-term process, and once there’s a lump or a visible lesion, chances are it’s already been in the body for YEARS. That’s one of the reasons cancer is so hard to treat, even with so-called ‘early detection.’
The human immune system is fending off cancer and pre-cancer every second we’re alive. And, it’s REALLY good at it, too! SO MANY THINGS have to be SO WRONG with the human body–on so many levels–before cancer can even get a toehold.
Would it be useful to be able to see the very beginnings of what could be–or might someday become–cancer…while it’s still just cells, not a lump, or a suspicious lesion?
You’ve probably heard about salivary DNA testing, which is becoming increasingly routine for things like identifying periodontal bacteria–and oral cancer. We’ll explore more of the redefinition of ‘early detection’…courtesy of your DNA…now.
Part 1: Interview with Dr. Jack Martin of PeriRx, LLC
A while back, I spoke with Jack L. Martin, MD, an interventional cardiologist in the Philadelphia area who is also Chief Medical Officer of PeriRx, LLC of Broomall, PA. PeriRx developed SaliMark™ OSCC, an ultra-sensitive, ultra-specific salivary DNA test that can signal the very earliest of changes that occur with–or precede–oral cancer. The early warning details such a test can provide go a long way toward taking the next definitive step in actually diagnosing what that suspicious area in someone’s mouth is.
In Part 1 of our interview, Dr. Martin provides some insights from the medical side that physicians and dentists alike can use to add a personalized, specific dimension to what’s probably still the single best cancer management strategy: PREVENTION.
DSS: What issues and questions come to mind when you think of the most significant challenges in medicine and health care?
JM: We are in the era of personalized medicine. There is a focus on value, cost-effectiveness—the challenge is how to tailor the right therapy to the right patient. This will depend on molecular and genomic testing.
We know that not all patients respond to the same therapy the same way. The challenge will be how to apply that technology so that it pays for itself and we don’t waste resources applying therapies that are destined not to be of value. I’m not talking about the new technologies, but rather present therapies that we often apply indiscriminately, and we spend a lot of resources on therapies that aren’t going to work for that patient. That ties into salivary testing and SaliMark, via the risk stratification tool, to quantify the likelihood of cancer. We can get the RIGHT patients to have biopsies and consultations with specialists, as opposed to doing that in everybody.
DSS: So, fair to say that SaliMark targets this as a vanguard of personalized medicine, where we have a need for better diagnostic accuracy?
DSS: In regard to the conversation that is—or perhaps should be—going on between dentists and physicians…do you see a deficit in the degree to which dentists and physicians communicate?
JM: There is no doubt that it needs to be taken to higher level—position papers in the Journal of Periodontology1-4 as far back as 2009 cite lack of awareness on part of medical doctors re: oral inflammation—in regard to making diabetes harder to control—there is an association between periodontal disease and oral cancer (OC), even independent of the common denominator of smoking—even there’s some suggestive evidence that periodontal disease may involve a higher risk for other malignancies including lung cancer. The relationship of periodontal disease, its effect on systemic inflammation, how that affects diabetes control, and how that puts patients at further risk for cardiovascular events–I don’t think that’s well understood on the medical side.1, 2
When I’ve talked with dentists at meetings on the oral systemic connection, many of them comment on their frustration communicating with their colleagues, and what role they can play in helping to manage the patient’s general health.
Many patients see their dentist more frequently than their MD—dentists can play a role in getting patients to their MD for medical intervention—for example, there are large numbers of patients going into dentists’ offices with unrecognized diabetes and pre-diabetes, and that’s where the dentist can play a great role in getting them the medical attention they need. Salivary diagnostics could be the ‘glue’ that helps bring the 2 sides together—if the dentist is screening patients who otherwise wouldn’t be seeking medical care, that could cement this relationship more effectively.
[DSS comment: A 2011 survey paper published in the Journal of Dental Education documented that pharmacy, nursing and medical school curricula lack adequate oral-systemic training.5]
DSS: How would you characterize the role of American Academy for Oral Systemic Health (AAOSH) in fostering better awareness and communication among physicians and dentists?
JM: I think it’s great; it only enhances awareness of the connection of oral health with systemic health—it’s a great start and hopefully societies and national meetings such as this will help to raise awareness.
Even though 40% of patients. [in the United States] don’t see a dentist on a regular basis, among some groups it’s even higher, because we’re still dealing with the disparity in access to health care. The fact that oral cancer mortality rates are higher among blacks probably relates at least in part to access to health care, and the fact that they are diagnosed at later stages.
DSS: Keep following here and on the DSS Facebook page (Likes and Shares are greatly appreciated!) for our continuing discussion with Dr. Martin and other developments as they break. See you next time!
[Disclosure: DSS/Dr. Saunders has no financial relationship with any product or manufacturer mentioned in this post; any mention is based on Dr. Saunders’s opinion regarding and/or quality of scientific data supporting clinical utility of products or methods discussed].
- Al-Khabbaz AK, Al-Shammari KF, Al-Saleh NA. Knowledge about the association between periodontal diseases and diabetes mellitus: contrasting dentists and physicians. J Periodontol. 2011 Mar;82(3):360-6.
- Quijano A, Shah AJ, Schwarcz AI, Lalla E, Ostfeld RJ. Knowledge and orientations of internal medicine trainees toward periodontal disease. J Periodontol. 2010 Mar;81(3):359-63.
- Giddon DB. Re: primary health care assessment and intervention in the dental office. Lambster [sic] IB, Wolf DL. (J Periodontol 2008;79:1825-1832). Primary care provided by periodontists/oral physicians. J Periodontol. 2009 Feb;80(2):173-4.
- [No authors listed] Position paper: oral features of mucocutaneous disorders. J Periodontol. 2003 Oct;74(10):1545-56.
- Hein C, Schonwetter DJ, Iacopino AM. Inclusion of oral-systemic health in predoctoral/undergraduate curricula of pharmacy, nursing, and medical schools around the world: a preliminary study. J Dent Educ. 2011 Sep;75(9):1187-99.