DEAR DR. ROACH: I am a healthy 69-year-old female. I walk every day and belong to an exercise group that I attend twice a week. I’m writing because during a routine dental cleaning, my dentist noticed a spot on the left side of my tongue that turned out to be squamous cell carcinoma.

I’ve never smoked, and I drink less than one alcoholic drink per month. I’ve had my surgery, and my PET scan was negative for the cancer spreading into my lymph nodes. So, I was fortunate to catch it fairly early. My message to your readers is to please get your routine teeth cleanings; it just might save your life. — Anon.

ANSWER: This is a message worth publishing. I congratulate you on your apparent cure and appreciate your writing. My own dentist is diligent about doing a careful mouth exam for cancer every visit.

The traditional risk factors for squamous cell cancer (SCC) of the head and neck have been smoking and tobacco use, including chewing tobacco. However, human papilloma virus (HPV) has recently emerged as a major risk factor for SCC. The treatment is the same for HPV-related SCC as it is for non-HPV-related SCC, but the prognosis is better if the cancer is associated with HPV, which the pathologist normally tests for.

Since the HPV vaccine is effective at reducing the risk of head and neck cancer, it is critical that we continue to vaccinate our children. HPV isn’t just a sexually transmitted infection; it’s a preventable cause of cancer.

DEAR DR. ROACH: Can having a bunion cause a different problem on the same leg? I saw an orthopedist about a bunion eight to nine years ago and was told it could be fixed, but since the bunion doesn’t hurt, he recommend waiting until it does hurt. It mostly doesn’t bother me; I’ve never worn the type of shoes like high heels that make it worse.

But in the past year, I’ve developed arthritis on the inside part of my knee on the same leg. Rehab exercises and “arthritis strength” acetaminophen mostly keep the pain under control.

I’m wondering whether having a bunion can cause the knee to develop arthritis, perhaps affecting the way I walk and stressing the knee? Should I consider having the bunion fixed in order to prevent further damage to my knee? I’m a female, age 67, and I’m reluctant to have the bunion corrected as I understand it’s a very painful procedure. — B.J.S.

ANSWER: A bunion is an acquired malformation of the large toe at the metatarsophalyngeal joint, so the joint sticks out toward the outside of the foot while the toe points toward the inside.

You are right that problems in one joint (like your big toe) can affect another (like your knee or hip). When you are in pain, the body learns to walk in such a way as to minimize pain, but this abnormal gait can put stress on other joints. I often see people who don’t notice the pain in the original location as their body is so adept at changing pressures to avoid the pain.

On the other hand, one of many underlying conditions that can lead to a bunion deformity is arthritis. It is possible that you were destined to develop knee arthritis, and the bunion had nothing to do with it.

I’ve had many patients who have been treated for bunion deformities, but not all people need surgery. Conservative management including shoes with a wide-toe box, orthotics, and pain management are adequate for many. The success rate and tolerability of surgery has significantly improved, so many more of my patients are satisfied with their results than patients from 30 years ago. But I still don’t recommend rushing into a procedure.