Medical Minute 8-3: Brushing Away Oral Cancer

By: Vanessa Welch Email
By: Vanessa Welch Email

Robert Levine is one happy guy.

He avoided disaster just by going to the dentist. During a routine cleaning, Robert's dentist found something on the bottom of his tongue.

"He saw a white spot on one side."

The almost undetectable spot was dysplasia -- a pre-cancerous cell.

"One of the biggest problems, once we find it and diagnosis, survival is less than a year," said David Godin, M.D., Head & Neck Surgeon at
Beth Israel Hospital.

Head and neck surgeon David Godin says the key is to find it early before a pre-cancerous cell turns into a carcinoma. 95-percent of all cancers are carcinomas.

"This lining we're talking about is the thickness of a piece of paper," said Mark Rutenberg, CEO & Co-Founder of OralCDx Laboratories.

Mark Rutenberg used the same technology he created in the military to determine nuclear warheads from decoys to create oral CDX. It's used to detect abnormal cells among normal cells. It's a brush test that sweeps across the inside of the mouth.

"We check the mouth for white spots and red spots," said Dr. Samuel Horowitz, Dentist.

Traditionally, cancerous cells were found after lesions or other symptoms appear. Then doctors performed a biopsy, which could miss cancerous cells.

There's a tiny little white spot on the right side of your cheek."

There's no anesthesia and takes just a few minutes.

The brush biopsy is sent to a lab where 200 of the most suspicious cells are analyzed by specially-trained pathologists. A cancerous cell has six to eight genetic mutations. A precancerous cell has four

"If you can find those cells and remove them, you can prevent cancer before it starts."

Gastroenterologist Elliot Heller took part in a clinical trial using a similar brush test plus the traditional biopsy to detect esophageal cancer.

"We had a 40 percent increase of finding Barrett's," said Elliot Heller, M.D., Gastroenterologist.

"I'd go for that test every day."

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500,


BACKGROUND: Oral cancer is cancer of the mouth. An estimated 350,000 to 400,000 new cases are diagnosed each year. Approximately half of people with oral cancer will live more than five years after they are diagnosed and treated. If the cancer is found early, before it has spread to other tissues, the cure rate is nearly 90 percent. However, more than half of oral cancers have already spread when the cancer is detected. Most have spread to the throat or neck. About 1 in 4 people with oral cancer die because of delayed diagnosis and treatment. (SOURCE: PubMed Health)

CARCINOMA: Carcinomas are malignancies that originate in the epithelial tissues. Epithelial cells cover the external surface of the body, line the internal cavities, and form the lining of glandular tissues. The incidence of oral tongue squamous cell carcinoma has been rising in young white American women, according to a new report. For the past three decades, the incidence has been increasing in white men and white women 18 to 44 years of age, but the trend is most pronounced in young white women.

EARLY TESTING: The OralCDx BrushTest is an easy, painless and definitive way for doctors to test the common small white and red oral spots that most people have in their mouth at one time or another. The BrushTest is used to determine if a common oral spot contains abnormal cells (known as dysplasia) that, if left alone for several years, may develop into oral cancer.

It typically takes several years before a dysplastic oral spot can turn into an oral cancer, and during this time, the spot can be removed, and oral cancer can potentially be prevented from even starting. OralCDx consists of a specially-designed brush that is used to painlessly obtain a sample of an oral lesion. In contrast to a typical cytologic smear, like a Pap smear, which samples cells only from the superficial layer, the OralCDx brush obtains a complete transepithelial biopsy specimen by collecting cells from all three layers of the epithelium: the superficial, intermediate and the basal layer. OralCDx requires no anesthesia, causes no pain and is associated with minimal or no bleeding. (SOURCE: OralCDx)

Eric Hirsch, Public Relations
OralCDx Laboratories


Mark Rutenberg, CEO & Co-Founder of OralCDx Laboratories talks about a new brush test for detecting oral cancer.
Talk about where this came from and also about the American Dental Association.
Mark Rutenberg: Let me explain what all of this is about. Ninety five percent of cancers in adults are what we call carcinomas. What does that mean? They come from the lining of your body. So bladder cancer originates in the lining of the bladder, cervical cancer starts in the lining of the cervix, breast cancer in the lining of a duct in the breast, oral cancers start in the lining of the mouth, and esophageal cancers start in the lining of the esophagus. This lining we’re talking about is approximately a half a millimeter thick. All of these cancers come from something about the thickness of a piece of paper. In a way one way to think about it is they’re all skin cancers. There are certainly other types of cancers that strike adults such as lymphomas and sarcomas but ninety five percent of adult cancers are carcinomas. They come from your epithelium, the ”skin” that lines of your insides and outsides. Now years before there is a carcinoma , there’s something called a dysplasia. Which means there’s something wrong with the cells in the epithelium but they’re not bad enough to be cancerous yet, they’re still harmless. In general we believe that a cell needs to accumulate about six to eight genetic mutations to become cancerous. A dysplastic cell, a precancerous cell, has about four mutations. Not enough to be harmful but enough to look a little different under the microscope. Now if you can find those still-harmless precancers cells and remove them you can prevent cancer before it starts. We certainly always want to find cancer early but finding still-harmless pre-cancer is certainly better. This is really like preventing the bomb from going off.
This has happened before. The number one cause of cancer death in America, in American women in 1950 was cervical cancer, people have forgotten that. Cervical cancer was the number one cause of women’s cancer death in 1950. Almost everyone in 1950 had a mother, a granddaughter or a sister who died of cervical cancer. By 1992 cervical cancer had dropped from first place to fourteenth largest Cervical cancer basically disappeared. It did not disappear because we found cervical cancer early or that we got much better at treating it. In fact when women get cervical cancer today their five year survival rate isn’t much better than it was back then. So how do you make a major cancer disappear? Cervical cancer disappeared because we figured out a way of finding still-harmless pre-cancerous cervical cells when they only had a few mutations, we found them when they were dysplastic. How did we do that? The Pap smear. A pap smear allows doctors to find precancerous cells in the cervix, cells that are still harmless but could be on the road to cancer. We remove them so the patient never gets sick. It’s saved, tens of millions of lives, no question.
So you kind of created that?
Mark Rutenberg: Basically, that’s what we’re doing, CDx testing is in a sense, a pap smear of the mouth, of throat and of the esophagus. These three tests can be done by different doctors perhaps, and they detect precancer in different parts of the aero-digestive tract but basically what this is, is a way of preventing all of these cancers. Doctors can now detect precancerous cells in your mouth, your larynx and your esophagus and remove those cells years before they can harm you. That’s a major advance.
You’re getting some big endorsements right now, talk about the dental association.
Mark Rutenberg: The American Dental Association had a three year program informing the American public on billboards and ads on buses that if they have a tiny spot in their mouth they should ask their dentist about a brush test. Oral cancer starts as a tiny white or red spot in your mouth. The dentists know this, ENT’s know this. They’re all are trained that if you see a tiny spot in a patient’s mouth and if there’s no clear reason why the spot is s there you should do a biopsy of it because it could be pre-cancerous. But before the brush test physicians and dentists generally didn’t’ biopsy these small spots. The reason for that is that we all have small spots in our mouth at one time or another. There have been many studies that show that at least ten percent of the population has a spot in their mouth at one time or another. And taking a biopsy in your mouth with a scalpel is pretty invasive. So doctors aren’t going to do that until it looks quite suspicious. The problem is by the time an area in your mouth looks suspicious enough to test it with a scalpel it’s already often a cancer. So that’s why oral cancer has not improved in mortality in 40 years. It’s more important now than it used to be because oral cancer is rapidly growing in women, young people and nonsmokers. We’re not sure why. Some oral cancer in the back of the throat is associated with human papillomavirus (IHPV) but the majority of oral cancers occur in the front of the mouth and there doesn’t seem to be any association with HPV with them so we’re not sure what’s going on. But we’ve performed a half a million of these tests in our laboratory and I can tell you our typical patient with precancerous cells that are about to become cancerous is a forty year old nonsmoker. So this is becoming more important. The good news is that it's preventable now because if you see a spot in your mouth or your physician or dentist sees a spot in your mouth he or she can easily test it and rule out the small chance it’s precancerous. Basically because of the oral brush biopsy oral cancer this is now a preventable disease. If you see a spot in your mouth go to your ENT or dentist and they can do an easy, painless test, to rule out the small chance there’s some unhealthy cells years before those cells are a problem.

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