Why oral cancer remains one of South Africa’s most overlooked health threats
By Dr Jameo Calvert, SC-THP(SA)
IHKS Scientist-Clinician | President, Traditional Health Practice Association of Southern Africa (THPASA NPC)
There are some cancers that hide deep within the body, revealing themselves only when the disease has already advanced.
Oral cancer is not one of them.
It develops in one of the most visible and accessible parts of the human body — the mouth. It can often be seen with the naked eye. It can be felt with a fingertip. In many cases, it announces its presence weeks, months and sometimes years before it becomes life-threatening.
Yet despite this advantage, thousands of South Africans continue to arrive at hospitals and specialist clinics only after the disease has reached an advanced stage.
The problem is not that oral cancer is invisible.
The problem is that too few people recognise what they are seeing. Even more concerning, too many warning signs are overlooked, dismissed, or treated symptomatically without adequate investigation.
Across South Africa, oral squamous cell carcinoma (OSCC) remains a significant public health concern. By the time many patients receive a diagnosis, the disease has already progressed to Stage III or Stage IV, limiting treatment options and significantly reducing survival outcomes.
As clinicians, researchers and Traditional Health Practitioners, we encounter a recurring pattern. A patient notices a sore inside the mouth. It does not hurt much. It seems minor. Weeks pass. The sore remains. Sometimes it grows. Sometimes it changes colour. Sometimes it begins to interfere with eating, swallowing or speaking.
The patient eventually seeks help.
Medication is prescribed.
The symptoms persist.
More medication follows.
The symptoms persist.
Months later, the patient is finally referred for further investigation and receives a diagnosis that should have been considered much earlier.
By then, valuable time has already been lost.
The Mouth Has a Remarkable Ability to Heal
One of the most important principles in oral health is deceptively simple.
Healthy oral tissue heals quickly.
The lining of the mouth constantly renews itself. Small injuries, accidental bites, irritation from food, or minor infections generally resolve within days. When a lesion remains unchanged for weeks, the body is signalling that something is wrong.
This is why healthcare professionals around the world recognise what is commonly known as the 14-Day Rule.
Any ulcer, lump, swelling, patch, unexplained pain, or abnormal change within the mouth that fails to resolve within two weeks requires further clinical assessment.
Not next month.
Not after another course of medication.
Not when it becomes unbearable.
Within two weeks.
The purpose of the rule is not to diagnose cancer after fourteen days. The purpose is to identify lesions and symptoms that warrant further investigation before opportunities for early diagnosis are lost.
The tragedy is that many patients are unaware of this principle. Equally troubling, some healthcare encounters fail to trigger the necessary escalation when symptoms persist beyond this critical period.
Cancer Does Not Always Look Like Cancer
One of the greatest misconceptions about oral cancer is that it always presents as an obvious tumour.
In reality, early disease is often subtle.
A white patch that cannot be rubbed away.
A persistent red area.
A roughened patch of tissue.
A thickening along the side of the tongue.
A recurring ulcer.
A small lump beneath the jaw.
Sometimes the earliest warning signs are not visible at all.
Patients may report difficulty swallowing, unexplained oral discomfort, numbness, altered sensation, persistent bleeding, speech changes, chronic sore throat, ear pain or the feeling that something simply does not feel right.
Many clinicians have encountered patients whose symptoms were initially dismissed because no obvious lesion was visible during examination.
This is where careful listening becomes just as important as careful observation.
A patient does not need to present with a dramatic lesion before their concerns deserve attention.
Persistent symptoms are clinical information.
They should never be ignored simply because they are difficult to explain.
Looking Beyond Risk and Towards Awareness
The science regarding oral cancer risk factors is well established.
Tobacco remains one of the most significant contributors to oral cancer development. Whether smoked, chewed or inhaled as snuff, tobacco exposes oral tissues to carcinogenic compounds capable of triggering malignant transformation.
Alcohol further compounds this risk by damaging tissues and facilitating the penetration of carcinogens into cells. When tobacco and alcohol are used together, their harmful effects multiply dramatically.
Human Papillomavirus (HPV), particularly HPV-16, has also emerged as an important contributor to cancers affecting the oral cavity, throat and surrounding structures, including among younger adults who may not fit traditional risk profiles.
Long-term irritation caused by poorly fitting dentures, sharp teeth, chronic inflammation and unresolved oral disease may also contribute to an environment that favours abnormal cellular change.
Yet risk factors alone do not determine outcomes.
Awareness does.
Early recognition does.
Prompt referral does.
Timely investigation does.
A Mirror Can Become a Screening Tool
One of the most powerful cancer detection tools available to the public costs almost nothing.
A mirror.
Every month, individuals should take a few minutes to familiarise themselves with the normal appearance of their mouth.
Look at the lips.
Inspect the cheeks.
Examine the tongue from every angle.
Look beneath the tongue.
Observe the roof of the mouth.
Check the gums.
Feel the neck and jawline for unusual lumps or swelling.
The purpose is not self-diagnosis.
The purpose is familiarity.
People who know what is normal for their bodies are far more likely to recognise when something changes.
And in cancer detection, change matters.
When the System Does Not Listen
There is another difficult conversation that South Africa needs to have.
Not every delayed diagnosis occurs because a patient ignored symptoms.
Sometimes patients do exactly what public health messaging encourages them to do.
They seek help.
They attend a clinic.
They report their concerns.
They return when symptoms persist.
They return again.
And again.
Yet the underlying disease remains undiagnosed.
Patients frequently describe months of symptomatic treatment without meaningful investigation. Repeated courses of medication may be prescribed despite persistent symptoms. Concerns may be attributed to minor infections, inflammation, stress or non-specific causes.
Meanwhile, the disease continues to progress.
The healthcare system must recognise that persistence itself is a warning sign.
A symptom that survives multiple treatment attempts deserves re-evaluation.
A patient who keeps returning deserves to be heard.
A lesion that fails to heal deserves further investigation.
A clinician’s inability to visualise a lesion does not automatically mean that pathology is absent.
The patient’s experience remains part of the clinical picture.
Listening remains one of the most important diagnostic tools in healthcare.
What Rights Do Patients Have?
South African patients are not passive recipients of healthcare.
They are rights-holders.
The Constitution guarantees the right of access to healthcare services. The National Health Act, Patients’ Rights Charter, administrative justice principles and professional ethical standards further establish important protections.
Patients have the right to:
• Receive respectful and appropriate healthcare.
• Seek a second opinion.
• Request reassessment when symptoms persist.
• Request referral to an appropriate healthcare professional or facility.
• Ask questions regarding their diagnosis and treatment.
• Access their medical records.
• Participate in decisions affecting their healthcare.
• Lodge complaints where concerns arise regarding the quality of care provided.
Complaints may be escalated through facility management, district and provincial health authorities, professional regulatory bodies, patient advocacy structures, or the Office of the Health Ombud where appropriate.
Patients should never feel intimidated into silence because symptoms continue despite treatment.
Persistence is not being difficult.
Persistence may save a life.
The Role of the Traditional Health Practitioner
Traditional Health Practitioners occupy a unique and often trusted position within South African communities.
For many individuals, the Traditional Health Practitioner is the first person consulted when illness emerges.
This creates both an opportunity and a responsibility.
Traditional Health Practitioners are well positioned to contribute meaningfully to oral cancer prevention, early recognition and patient advocacy.
This includes:
• Promoting public awareness regarding oral cancer warning signs.
• Encouraging routine self-examination.
• Identifying individuals with significant risk factors.
• Recognising suspicious symptoms and lesions.
• Encouraging timely medical and dental assessment.
• Supporting referral pathways.
• Promoting treatment adherence.
• Providing psychosocial support.
• Supporting families during treatment.
• Participating in palliative and supportive care.
• Promoting community-based prevention initiatives.
Importantly, the role of the Traditional Health Practitioner is not to replace oncologists, oral health practitioners, pathologists or other healthcare professionals involved in cancer diagnosis and treatment.
Rather, it is to strengthen the patient’s journey through the healthcare system by ensuring that warning signs are recognised, concerns are not ignored, and opportunities for early intervention are not missed.
In many cases, the most important intervention a Traditional Health Practitioner can make is a timely referral.
The Difference Between Suspicion and Diagnosis
A common misconception is that cancer can be diagnosed simply by looking at a lesion.
It cannot.
Even the most experienced clinician cannot confirm oral cancer through appearance alone.
Suspicion and diagnosis are not the same thing.
Definitive diagnosis requires histopathological examination of tissue obtained through a biopsy.
Not every suspicious lesion is cancer.
But every suspicious lesion deserves investigation.
Early assessment provides answers.
Delayed assessment creates uncertainty, progression and avoidable harm.
The Most Important Referral May Be the One Made Early
Healthcare often celebrates successful treatment.
Yet some of the most important interventions occur before treatment even begins.
A referral.
A second opinion.
A biopsy.
A practitioner who listens.
A patient who refuses to ignore persistent symptoms.
Oral cancer is frequently described as a disease that can be seen.
Perhaps it should also be described as a disease that must be heard.
Because long before cancer appears on a pathology report, it often appears in a patient’s story.
A sore that refuses to heal is never “just a sore.”
A patch that persists is never “just a patch.”
And two weeks can make the difference between early intervention and late-stage disease.
The mouth speaks.
The question is whether we are listening.
Dr Jameo Calvert, SC-THP(SA)
IHKS Scientist-Clinician | President, Traditional Health Practice Association of Southern Africa (THPASA NPC)
