Making Oral Cancer Screening the Standard of Care
When numbers speak louder than words
Sixty-three percent of those polled...4 out of 5 dentists recommend...an acceptance rate of only 9%...”
We are bombarded with statistics like these everyday, but rarely do we slow down to really consider their meaning. So, stop. Take a moment and consider the following: 1 in every 93 people will be diagnosed with cancer of the oral cavity and pharynx in their lifetimes.1 One in 93. Think about how many friends you have on Facebook, how many patients you see in a week, or how many people were in your high school graduating class. Chances are, oral cancer will touch your life sometime, somewhere.
Unfortunately, most oral cancers are not detected early. The majority of cancerous lesions are found after metastasis has occurred when the 5-year relative survival rate is less than 35%.1 Early detection, however, significantly improves the chances of a successful outcome. When oral cancer is detected and treated early, the 5-year relative survival rate increases to more than 82%.1 These statistics send the message loud and clear: Early detection saves lives. The fact is, most people who present with advanced oral cancer were not screened. Screening is looking for cancer before a person has symptoms.2
By the time symptoms appear, it is likely the cancer has begun to spread. Dental professionals are on the frontline in the battle against oral cancer. Although an oral cancer screening is not required by most state dental boards, the American Dental Association3 and the American Cancer Society4 recommend an oral cancer screening as part of every periodic dental examination. Sadly, published studies state that less than 15% of those who have visited a dentist report having had an oral cancer screening.5
The association of the human papilloma virus (HPV) with oropharyngeal cancers has changed the demographics of the at-risk population. Oral cancer is no longer just a disease that affects older men who smoke and drink, although age, gender, and alcohol and tobacco use continue to be risk factors. The HPV-positive group is the fastest-growing segment of the oral cancer population,6 and this new etiology broadens the scope of the population that should receive regular, annual oropharyngeal cancer screenings.
The truth is that dentists and assistants are in a position to make a difference in the oral cancer mortality rate in the United States by making an oral cancer screening part of each periodic examination. Patients should be told that they are being screened for oral cancer. Doing so lets the patients know that the dental team members sincerely care about their health and increases awareness for patients to self-monitor at home in between visits to the dental office.
An effective oral cancer examination can be completed with a piece of gauze, a tongue depressor, a good light, and a few minutes. A great resource for conducting an effective screening can be found at the Oral Cancer Foundation’s website (http://oralcancerfoundation.org/dental/screening.htm). There are many adjunctive screening tools on the market today to help the dental professional differentiate between normal and abnormal tissue using a variety of advanced technologies, but these alone cannot substitute for the visual and tactile examination. These tools aid in the discovery of the atypical. Diagnosis comes after analysis under a microscope.
Suspicious lesions should not be “watched.” Suspected oropharyngeal cancer or an abnormality that does not resolve within 2 weeks should be biopsied for histologic evaluation. Early detection increases the likelihood of a successful outcome. Oral cancer screening can be a part of the standard of care in the dental office. Patients should be told they are receiving oral cancer screenings and educated about oral cancer. Dental professionals can make a difference in the fight against oral cancer.
1. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). In: Howlader N, Noone AM, Krapcho M, et al, eds. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2009_pops09/index.html.
2. Oral cancer screening (PDQ). National Cancer Institute. Bethesda, MD. July 2011. Available at: http://www.cancer.gov/cancertopics/pdq/screening/oral/Patient/page1. Accessed May 15, 2012.
3. Oral health topics: cancer, oral: regular dental check-ups important. American Dental Association. Available at: http://www.ada.org/3016.aspx. Accessed May 15, 2012.
4. Oral cancer. American Cancer Society. Available at: http://www.cancer.org/acs/groups/content/@nho/documents/document/oralcancerpdf.pdf. Accessed May 15, 2012.
5. The role of dental and medical professionals. Oral Cancer Foundation. Available at: http://oralcancerfoundation.org/ dental/role_of_dentists.htm. Accessed May 15, 2012.
6. The HPV connection. Oral Cancer Foundation. Available at: http://oralcancerfoundation.org/hpv/index.htm. Accessed May 15, 2012.