FYI

Dr. Allen Edwards, fondly known as Dr. Al, is the Principal Advisor for Government Programs at Delta Dental and the author of this article. He is a seasoned health care professional with expert knowledge of the U.S. Congress, the Department of Defense (DOD) and Federal health care laws and policy. Senior members of Congress and the Executive Branch have trusted him to craft and oversee complex health care, education and commercial resale legislation for the largest Federal agency, the DOD.

Each of you practicing dentistry today is an oral medicine specialist. Through dental education and training, you learned the importance of conducting a head and neck exam to identify suspicious lesions of the oral cavity and oropharynx. I can recall my Oral Path professors demanding that every patient deserves a thorough screening exam because early diagnosis of cancer of the oral cavity and the oropharynx is the key to survival. That message has stuck with me all these years.

Despite our best efforts to spot these cancers early, malignancies of the lips, tongue, cheeks, gums and throat remain a significant public health concern. Although oral cancer is one of the most accessible cancers to spot, we often diagnose it late, making early screening essential for improving treatment outcomes. In the U.S., the National Cancer Institute expects over 59,000 new cases of oral and pharyngeal cancer in 2025 and over 12,000 deaths.¹

Oral cancer screening matters because early detection dramatically improves survival rates. When diagnosed at a localized stage, the five-year survival rate is 86.3%, compared to 69% for regional spread and just 40.4% for distant metastasis.² In the U.S., oral cancer accounts for about 3% of all new cancer cases, and most cases (78%) occur in persons over 55 years old.¹ Men are three times more likely than women to develop oral cancer.¹

Patients who use tobacco of any kind result in 60% of cases — smokers have ten times higher risk.³ Alcohol use contributes to nearly one-third of cases and patients who use both tobacco and alcohol increase their risk by up to thirty times.⁴^,⁵ Disturbingly, oropharyngeal cancers caused by the human papilloma virus (HPV), a sexually transmitted disease, are increasing especially in young, non-smoking persons. HPV causes about 60% of all oropharyngeal cancers.⁶

As an oral medicine specialist, what can you do to improve oral cancer survival rates?

• During routine patient visits, do a thorough examination of the oral cavity and surrounding tissues of the head and neck. My dentist does two screening exams on every patient; his hygienist does an exam and then he follows with another one.
• As an adjunct to the clinical exam, an FDA-approved tissue fluorescence device can help to detect potential oral cancers and precancerous lesions. Studies have shown that sensitivity and specificity of these devices are relatively good, demonstrating their value as adjunctive screening tools.
• Screen patients with high-risk profiles — smokers, heavy drinkers, or those positive for HPV — more frequently.
• For a suspicious tissue area, biopsy the area or refer the patient to an oral surgeon or ENT for biopsy.
• Since HPV causes a high percentage of oropharyngeal cancers, advise parents of young patients to get their children vaccinated.
• Make your patients aware of symptoms like persistent sores, difficulty swallowing, or unexplained bleeding in the oral cavity and encourage them to see you immediately for an evaluation.
   

Oral cancer screening is a simple yet powerful tool in reducing mortality and improving quality of life. With rising incidence rates and disparities in outcomes, proactive screening and patient education are more important than ever.