Mouth cancer (written as ‘Oral Cancer’ in many scientific publications) is a major global health concern, with about 377,713 new cases and 177,757 deaths each year. Government initiatives have increased awareness among both public and dental fraternity.

One such measure to increase awareness among practitioners is  integrating early detection training into dentistry curriculum. Still, many people miss early, painless warning signs, causing late diagnoses which lead to poor outcomes. Improving public awareness is urgent, as early detection significantly boosts survival rates. 

Regional trends: Asia-Pacific and Southeast Asia 

In the Asia-Pacific region, oral cancer constitutes a notable portion of cancer incidence and mortality. Southeast Asia experiences higher rates of occurrence, which have been associated with the prevalent use of tobacco—both in smoked and smokeless forms—as well as areca-nut chewing (often combined with betel leaf, known as betel quid chewing) and alcohol consumption. These habits are present in the population as cultural practices, while access to oral health education may be limited for some groups. Nonetheless, cases of oral cancer have been identified in individuals who do not engage in tobacco, areca nut, betel-quid, or alcohol use.

Additionally, there is growing occurrence of cases  among younger populations. Globally, there has been an expansion of awareness initiatives, such as outreach campaigns and screening programs aimed at early detection. Despite these efforts, further coordinated actions are necessary to inform the public about risk factors and encourage timely medical evaluation if any unusual changes in the mouth are detected. 

Trends in Malaysia 

Malaysia records about 1,500 new mouth cancer cases  each year. Although older adults are most commonly affected, younger groups are facing increased risk due to shifting lifestyle habits. This disease has a high mortality rate, often because it is diagnosed at late stages. Government agencies, non-profit organisations, and all 13 Malaysian dental schools promote awareness through education, free screenings, and survivor support.  However, many of the Malaysian public remain unaware that oral cancer typically starts as a painless sore, leading to delayed treatment, which translated to worse outcomes. 

Early detection of mouth cancer – Knowing the early signs and symptoms  

Late-stage mouth cancer usually presents as swelling with ulcerations that have raised, firm edges and areas of whiteness and/or redness. Firm neck nodes may also be present and detectable by touch. Growths in the oral cavity can interfere with important daily functions such as eating and speaking.  

Individuals who observe these signs and symptoms need to consult a dental specialist, even if no pain is present. Mouth cancers often remain painless, even in advanced stages. 

Early mouth cancers and precancerous lesions [(oral potentially malignant disorders (OPMD)] are often painless and subtle, usually presenting as changes from the normal pinkish colour with no break in the surface of the mouth mucosa to signs which include: 

• White and/or red patches 

• Persistent ulcers or sores that do not heal 

• Thickened areas of the oral mucosa 

If abnormalities of the mouth mucosa are observed, it is vital to consult a dentist, dental specialist, or physician promptly. Most dental clinics and government health centres offer oral examinations which will include screening for mouth cancers, whereby patients will be referred for further assessment and management, if necessary. 

What you need to know about management and prognosis of mouth cancer? 

Early lesions of mouth cancer are typically managed by oral and maxillofacial surgeons through complete excision, followed by lifelong monitoring by dental specialists to detect any potential recurrence or new lesions, which would then be addressed promptly. When treated in early stages, the survival rate is approximately 80% and higher. 

In contrast, advanced-stage oral cancers may invade adjacent tissues and jawbone, or metastasize to cervical lymph nodes and distant organs. Management at this stage generally involves an oncology multidisciplinary team that evaluates and plans for optimal treatment options. Most studies indicate that late-stage oral cancer is associated with a survival rate of approximately 50% and lower. 

Screening for oral cancers facilitates the early detection of OPMDs. Early detection allows for timely intervention—such as complete excision or other therapeutic modalities—and consistent follow-up by dental professionals, which can either prevent malignant transformation or enable prompt management of early-stage cancer. In recent years, mouth cancer screening has become a standard component of routine dental care, often referred to as opportunistic screening. 

The Do’s and Dont’s for self-detection of abnormalities in the mouth mucosa:  

The Do’s: 

• Practise consistent oral hygiene and schedule regular dental check-ups. 

• Seek prompt consultation with a dentist for early screening of OPMDs and mouth cancers. 

• Recognise risk factors that may contribute to the development of mouth cancer, including: 

• Tobacco smoking/ inhalation? (cigarette use/ vaping) 

• Habitual tobacco chewing 

• Habitual Betel-quid (areca-nut) chewing 

• Excessive alcohol intake 

Note: Oral cancer shares several risk factors with other chronic diseases such as heart disease, diabetes, and lung cancer. Additional considerations include: 

• Poor nutrition and limited fruit and vegetable consumption 

• Human papillomavirus (HPV) infection 

• Persistent oral trauma or irritation 

• Mouth cancers can also occur in individuals with no identifiable risk habits. 

The Dont’s: 

• Do not dismiss any abnormality in the mouth, therefore, do not  wait for it to heal naturally. 

• Do not assume it is a simple ulcer/ white-red areas due to trauma or inflammation, hoping for a natural healing.  

• Do not apply any over-the-counter remedies despite its claims, unless prescribed by a dentist, dental specialists or medical professionals 

• While digital apps for early detection are increasingly becoming available, use these apps cautiously. Consultation with dental or medical professionals remains essential. 

Note: There can be a multitude of changes of the normal mouth mucosa. There are training programs on early detection of mouth cancers which ensures dental professionals are competent in differentiating between the changes that are normal variants (thus do not need referral) from those that are early cancers and OPMDs requiring urgent referral for definitive diagnosis and management. 

Current and future research directions 

Ongoing research explores innovative ways to tackle common risk factors and develop targeted interventions. Efforts include studying genetic susceptibilities, improving early detection technologies, and understanding the socioeconomic determinants that influence oral cancer risk. 

Collaboration between researchers, clinicians, and policymakers is essential for the implementation of effective preventive measures and for mitigating the individual and economic costs of oral cancer.  

Future Threats: Vaping and Emerging Risks 

The rise of vaping and novel tobacco products poses new threats to oral health. While long-term research is ongoing, early studies suggest that e-cigarettes and vaping may increase the risk of oral lesions and potentially oral cancer. Public awareness efforts must adapt to these evolving trends, with future prevention campaigns addressing both conventional tobacco products as well as emerging risk factors.  

Oral cancer remains a serious public health challenge, but through increased awareness, early detection, healthy living, and robust research, its incidence and impact can be minimized. Every individual, community, and policy maker have a role to play in reducing the burden of mouth cancer—starting with recognizing that a painless lesion in the mouth could be the first sign of something serious, thus seeking prompt advice from healthcare professionals is of paramount importance.