Oral squamous cell carcinoma (OSCC) accounts for 90% of all head and neck cancers, posing a significant public health concern worldwide (Shafiq et al., 2023). Despite increasing awareness, OSCC is frequently diagnosed at advanced stages, leading to poor prognoses and lower survival rates (Roi et al., 2019). If untreated, this type of cancer can metastasize, spreading to other regions of the body. According to the National Cancer Institute, 53% of cancers in the oral cavity and pharynx are identified only after they have spread to neighboring lymph nodes, of which some sources report a 50% decrease in patient survival rates (The Surveillance, Epidemiology, and End Results (SEER) Program, 2024; Bugshan & Farooq, 2020). Given these alarming statistics, early detection and heightened clinical awareness has become crucial, as timely intervention can significantly improve patient outcomes and save lives. In response to these challenges, advancements in salivary diagnostics are transforming the way dental professionals can detect and monitor oral cancer, promising earlier diagnosis through non-invasive measures that utilize salivary biomarkers. OraRisk® HPV, developed by OralDNA® Labs, is a powerful tool enabling clinicians to assess risk for oral cancer by detecting the presence of 51 types of oral human papillomavirus (HPV) infections, including 24 high-risk genotypes linked to oral cancer development.
Saliva contains a vast array of molecules that reflect our systemic health. Extensive research has identified several proteins and enzymes as potential indicators of oral squamous cell carcinoma (OSCC). One notable example is CYFRA-21, a protein fragment that is elevated in malignant tissue (Adusumilli et al., 2023). The high turnover rate of epithelial cells associated with OSCC releases cytokeratin proteins into the bloodstream. Of those proteins, CYFRA-21 is a soluble portion that can be detected in salivary samples, making it a valuable biomarker for cancer detection. Another significant biomarker is lactate dehydrogenase (LDH), an enzyme found in the cytoplasm of cells (Shafiq et al., 2023). Unlike healthy cells, cancer cells rely heavily on glycolysis for energy production, which requires a consistent supply of LDH. As a result, patients with cancer typically have higher levels of LDH in their blood and saliva due to the abnormally high rate of glycolysis and cell growth. Knowing this, LDH can prove to be a reliable source to identify and track the progression of OSCC.
Salivary diagnostics not only shows promise in scientific research, but also offers social and clinical advantages. The late detection of oral cancer stems from a range of factors. Many individuals struggle to recognize the early signs or risk factors of oral cancer and may not prioritize regular dental check-ups, delaying the possibility of treatment. Current testing methods, such as visual exams and biopsies can be invasive and time-consuming, which can affect the patient’s willingness to undergo preventative screenings (Roi et al., 2019). Additionally, dental professionals may sometimes overlook early symptoms or even misdiagnose them. These barriers have prompted researchers to explore the possibilities of salivary testing. The convenience and speed of salivary diagnostics could significantly increase the number of patients being tested and treated at earlier stages, all while bypassing much of the discomfort associated with traditional methods.
While salivary diagnostics is still an evolving field, its potential impact is undeniable. Ongoing research is still essential to validate the specificity and sensitivity of other biomarkers, like the ones discussed, to hopefully establish a standard for OSCC testing. In a future where salivary diagnostics becomes a routine part of dental practices, healthcare professionals can ensure that patients receive the highest quality of preventative care. The integration of these innovative diagnostic tools into dental care will undoubtedly transform the landscape of oral cancer screening and prevention, transforming the approach against oral cancer and improving lives in the process.
References:
Adusumilli, P., Babburi, S., Venigalla, A., Benarji, K. A., Sai, S. K., & Soujanya, P. (2023). Estimation of salivary and serum CYFRA 21-1 levels in patients with oral squamous cell carcinoma. Journal of oral and maxillofacial pathology : JOMFP, 27(1), 98–102. View Here
Bugshan, A., & Farooq, I. (2020). Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis. F1000Research, 9, 229. View Here
Roi, A., Rusu, L. C., Roi, C. I., Luca, R. E., Boia, S., & Munteanu, R. I. (2019). A new approach for the diagnosis of systemic and oral diseases based on salivary biomolecules, Disease Markers, 2019(1). View Here
Shafiq, S., Ali, M., Tariq, U., Hassan, S., Soomro, S. P., & Amjad, A. (2023). Evaluation of salivary biomarkers for early detection of oral cell carcinoma. The Professional Medical Journal, 30 (11), 1475-1479. View Here
The Surveillance, Epidemiology, and End Results (SEER) Program. (2024). Cancer stat facts: Oral cavity and pharynx cancer. National Cancer Institute. View Here
