Oral Cancer Screening: A Necessary Part of Any Exam

Oral screenings are easier to perform than prostate, colon, or even breast exams. Colonoscopies and mammograms are only performed by specialists, but the oral cavity is accessible to anyone. As 40% of head and neck cancers diagnosed in the United States are in the oral cavity, and 40% of those are on the lateral tongue, the oral cavity is a prime area for screening. Any physician, dentist, or physician extender should not only be able to perform the oral exam, but should also be able to detect the overwhelming majority of oral cavity-incident cancers. Yet up to 40% of some medical practitioners feel that they lack the skill to recognize a potentially malignant lesion. And even though a quick oral exam can take less than a minute, increasingly overstretched physicians do not feel that they have the time to perform an oral exam, especially in a health care setting that is increasingly demanding more office visits in less time with less compensation. In other words, being a thorough physician just doesn’t pay.

There has been some debate among head and neck cancer clinicians regarding the use of adjuvant tests for oral screening, such as dyes or cytological brushing specimens. Although these may be useful for the experienced examiner, they are not appropriate for the primary care provider. We need to first ensure that primary care providers and dentists are actually performing the screening and have the proper training to recognize lesions. The state of oral screening among primary care providers has not advanced enough to utilize adjuvant testing.

Components of an Effective Screening Program

What are the components of effective screening programs? First, the screening test must be easy, reliable, and cost-effective. The oral cavity exam is easy and inexpensive, but is it reliable? It is only as reliable as the strength of the training of the practitioner.

Second, intervention must be able to reduce the morbidity and mortality of the disease. Early stage disease can have as high as a 90% five-year survival with proper treatment.

Finally, the incidence of disease must be high enough that it is likely that a random sampling of the target population will identify patients with early asymptomatic (or minimally symptomatic) disease. This final criterion poses a difficulty for screening programs directed at oral and oropharyngeal cancer detection. The incidence of disease, while increasing in some populations, is not necessarily high enough to make oral and oropharyngeal cancer a common disease, at least in the United States.