WHEN RACHEL Bourke got what she thought was a mouth ulcer under her tongue, she tried treating it the usual way, rubbing on soothing antibacterial gel.
It didn’t go away, but she wasn’t particularly concerned. She told herself that, as a busy single mother of three boys, she was just a little stressed and run down, and that was why the sore was taking so long to heal.
It wasn’t until eight weeks after she first noticed the lesion that Bourke, from Wexford, ended up in her doctor’s surgery. Anti-fungal tablets were prescribed, which also failed to clear the problem, so her doctor prescribed antibiotics and suggested a check-up by the dentist.
“Everything went so quickly after that,” she says. “My dentist took one look at the ulcer under my tongue and I knew by his reaction that there was something wrong. He told me he was going to refer me to the dental hospital and said he’d be in touch.
“That was a Thursday morning, and the same afternoon he phoned me to say an appointment had been made for the following Tuesday at St James’s dental hospital in Dublin. The fact that this degree of urgency was put on it was what frightened me and led me to believe it was sinister.”
Sure enough, the innocuous-looking ulcer under Rachel’s tongue turned out to be mouth cancer. “I felt really sorry for myself, but I was petrified for the boys. In my eyes I thought I’d brought it on myself by smoking, but the kids had done nothing to deserve this.”
The biopsy that she underwent was unpleasant – “it’s the most abnormal feeling, having your tongue stitched” – but Bourke’s deep fear was that she would never talk again.
“I wasn’t sure how much of my tongue they would have to remove,” she says. In addition to the surgery on her mouth, she had 27 lymph nodes removed from her neck.
Two years after the initial diagnosis, she considers herself fortunate. “I can’t lick my lips or teeth, and there are certain foods that are hard for me to eat. But I’m so lucky that I can speak.
“The muscle on one side of my tongue is completely gone, and I had to retrain the remaining muscle to function. It took a while, but I got there. Being articulate is very important to me.”
Mouth cancer is on the rise in Ireland, with about 400 cases reported each year. It’s a similar picture in Britain, where the incidence of the disease has increased faster than any other cancer in the past 25 years.
Two people die each week in Ireland from the disease, and it kills more people than cervical cancer and malignant melanomas. Yet public awareness of oral cancer remains surprisingly low, with little knowledge of the warning signs and symptoms.
It’s a dangerous state of affairs, because early detection is vital in this potentially disfiguring disease. There’s a good prognosis if it’s picked up early; if it’s detected late, the outlook is poor.
Novelist Lia Mills, who has written movingly about her own encounter with oral cancer, knows from painful experience just how vital it is to pick this disease up before it takes hold.
“My own diagnosis came late. I had no idea about cancer of the mouth; I just thought I had an outrageous mouth ulcer that wouldn’t go away. By the time it was detected, the cancer was advanced and had started to spread,” she says.
“So instead of a simple clean removal of the tumour, I spent more than nine weeks in hospital. And it’s not just about me – think of the money and time that could have been saved in the health service if I had acted sooner.”
While it was previously seen as a disease of older people, mainly older men, that pattern is changing too: younger women are increasingly falling victim to oral cancer.
The main risk factors are smoking and drinking, although there is a link between the human papilloma virus (HPV) and mouth cancer, which might indicate why younger people are getting the disease.
As Bourke discovered, your dentist may be more likely to diagnose it than your doctor: most patients with potentially malignant lesions are referred to hospital by a dentist.
Dr Conor McAlister, president of the Irish Dental Association, says dentists are “much better disposed to detect mouth cancer early. It’s the most serious disease that we encounter. But the examination for oral cancer is nothing to worry about: it only takes three minutes or so, part of the normal routine when you go for a check-up.”
McAlister says that oral cancer usually presents as an ulcer that doesn’t heal in the normal period, a white or red patch in the mouth, a lump in the mouth or neck, or hoarseness.
In a collective effort to raise public consciousness of the disease, more than 700 dentists around the country are to offer free oral examinations tomorrow to mark World Mouth Cancer Awareness Day.
As McAlister says, it’s quick, painless and could potentially save your life.
mouthcancerawareness.ie