"This is not a disease that strikes just old men anymore," said Arnold Rosenheck, assistant dean at UMDNJ's dental school, before he was to speak to health care professionals about oral cancer at the American Public Health Association's annual meeting here. Oral cancer can strike anyone, even people who don't smoke or drink, which are two of the risk factors, Rosenheck said, adding that his goal is to educate Americans and health care professionals on how to prevent the disease. Oral cancer once struck mainly men in their 60s, but the largest increase in cases now is seen in people under 40 years of age, and in women. The survival rate remains unchanged from 50 years ago _ about 50 percent for someone diagnosed with the disease in its later stages. Women began developing oral cancer when smoking became chic, said Rosenheck, referring to the well-known Virginia Slims ad campaign, "You've Come a Long Way, Baby," that ran from 1968 to 1986. "As a result, women have taken their place alongside their male counterparts in developing the diseases that are prevalent to tobacco use," Rosenheck said. "And I think women are drinking more openly now, going out with the girls, so to speak, like the guys do." As for cases in people younger than 60, the causes remain a mystery, but some cases may be due to a sexual transmission of a virus, Rosenheck added. Drore Eisen, a dentist who is considered an oral cancer expert _ he has written two books and more than 40 articles on the subject _ said no one knows for certain what makes people at risk for the disease, other than excessive use of tobacco and alcohol. "It can really strike at any age," said Eisen, also vice president and medical director of CDx Laboratories, based in Suffern, N.Y. Five years ago, the lab developed a brush biopsy that enables dentists to scrape cells from a person's mouth, allowing them to catch oral cancer in its early stages. The procedure takes about one minute to complete and requires no local anesthetic or sutures. Before that, patients had to undergo an invasive biopsy procedure done when the cancer was already in its later stages, Rosenheck said. In its early stages, oral cancer is hard to detect. A person doesn't feel any pain and red and white bumps in a mouth that can be a precursor to oral cancer are commonplace. Eisen said that 5 to 10 percent of all Americans have spots in their mouths, and the overwhelming majority are harmless. "There's no symptoms, no pain. They look like an ordinary-looking sore that you might get from a pizza burn or biting your lip," he said. Treating oral cancer is expensive, costing more than $100,000 per person, Eisen said, citing surgery and chemotherapy as the big expenses. Nationally, the cost of treating people who have oral cancer runs nearly $2 billion a year, Rosenheck added. Reducing those costs for patients and the nation's health care system is just one reason why Rosenheck and Eisen are engaged in their crusade for greater public awareness. People should go to their dentists at least once a year for a screening, they said. "They don't think about oral cancer because there really hasn't been a big breakthrough yet, although oral cancer now kills as many Americans as melanoma," Eisen said. "You can't pick up a newspaper, you can't watch TV without hearing about malignant melanoma. Because patients are aware of it now, they're screening for it now. The same is going to come true with oral cancer."

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