The incidence of tongue cancer is on the rise, with a surprising spike in cases among Aussie women under 45 who are witnessing a staggering 4% annual increase – the tricky part? They’re not smokers, they’re not heavy drinkers. So, with the major risk factors ruled out, what’s causing this jump in numbers? That’s the question that’s got doctors stumped. 

Last year alone, 1336 cases were reported, a significant jump from 283 cases forty years ago, and doctors want to know why. While tongue cancer remains relatively rare in the country, the consistent rise prompts vigilance among healthcare professionals. The latest data from the Australian Health and Welfare reveals a 3% yearly increase in diagnoses, escalating to 4% for women under 45. The surge underscores the importance of identifying potential risk factors and encouraging early detection. Here's where things get a little perplexing – traditionally, tobacco use and alcohol consumption have been primary risk factors for tongue and mouth cancers. However, emerging factors, including increased transmission of the human papillomavirus, Epstein-Barr virus, poor oral hygiene, and gum disease, are increasingly recognised as contributors to the escalating cases.   

Associate Professor Michael Clements, Vice President of the Royal Australian College of GPs, emphasises the need for heightened awareness , especially considering the tendency to overlook oral cancer, associating it predominantly with older individuals or smokers. This oversight may lead to delayed diagnoses, echoing the broader issue of women often missing early diagnoses for various conditions.

“Patients shouldn’t ignore any lesions in the mouth, and if they’ve had an ulcer or a sore for more than three weeks, or a lump in their face, throat, or neck, then they should be seeing either the dentist or their GP,” he said.

What are the risk factors for tongue cancer? Let’s take a look – plus some of the specific factors relating to women:

• Dietary Choices: Shifts in dietary habits, including increased consumption of processed foods, sugary snacks, and high-calorie diets, may contribute to the rise in tongue cancer.
• Alcohol and Tobacco Trends: While traditional risk factors for oral cancers include tobacco and alcohol use, changing trends in the consumption of these substances may still play a role.
• Viral Infections: The prevalence of HPV, a group of sexually transmitted viruses, has been linked to the development of oral cancers. Changes in sexual behaviour and an increase in HPV infections may be a contributing factor.
• Lack of Dental Care: Insufficient attention to oral health, including poor dental hygiene practices and infrequent dental check-ups, may contribute to the development of oral cancers.
• Exposure to Environmental Carcinogens: Increased exposure to environmental factors, such as pollution and other carcinogens, may contribute to the development of oral cancers.
• Awareness and Healthcare Access: Delayed diagnosis may occur due to limited awareness of oral cancer risks among young individuals and barriers to healthcare access, leading to a higher incidence rate.
• Hormonal Changes: Hormonal fluctuations in women, possibly related to factors such as contraceptive use or hormonal therapies, could play a role in the development of tongue cancer.
• Genetic Factors: Some individuals may have a genetic predisposition to developing oral cancers, and genetic factors could be interacting with environmental and lifestyle elements.

The rise in tongue cancer rates coincides with challenges in accessing timely oral healthcare, particularly in remote and regional communities. With over 142,000 people lacking access to dental services within a 60-minute drive, the Australian Dental Association emphasises the consistent higher rates of potentially preventable hospitalisations for dental conditions in very remote areas. Addressing the knowledge gap and limited training among GPs, the RACGP has launched an online learning activity, 'Oral cancer screening and prevention.' This initiative aims to equip GPs with the necessary tools to navigate optimal referral and treatment pathways for tongue cancer. Despite being the primary point of contact for potential tongue cancer cases, GPs face challenges in education and training. Dr. Clements stresses the importance of the generalist role of GPs, emphasising the need to stay informed about a broad range of medical information and best practices in healthcare. He underscores the significance of a comprehensive approach, urging against fragmenting GP responsibilities and highlighting the need for continuous oral health education and vigilant monitoring of unusual symptoms or lesions. The spike in tongue cancer cases serves as a poignant reminder of the critical role GPs play in connecting the dots across various health domains for the well-being of their patients.

“We also need to ensure we have a good follow up plan for people with unusual symptoms or unusual lesions that don’t seem to be getting better,” Dr Clements said.

Failure to follow up on red flag symptoms, which are indicative of serious health concerns, can result in delayed diagnoses, progression of diseases, and compromised patient wellbeing. In some cases, this negligence can even lead to severe consequences or fatal outcomes.

Statistics highlight the prevalence of these issues within the healthcare system. Instances of missed or delayed diagnoses contribute significantly to medical malpractice claims. According to studies, diagnostic errors, often linked to inadequate follow-up on symptoms, account for a substantial portion of malpractice claims and adverse events.

So, what can you do if you’re not being heard? Keep pushing for a referral, or find another doctor who will follow up on your concerns – it’s vital to advocate for your health, as Clara Mearns discovered in her endometriosis battle.

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