The Role of Dentists in Oral Cancer Detection

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Worldwide there are approximately 369,000 new cases of oral cancer each year that account for 145,000 deaths. In the US in the year 2021, there are over 54,000 expected new cases of cancers of the oral cavity and pharynx leading to nearly 11,000 deaths according to the National Cancer Institute. This makes oral cancer the sixth most common cancer worldwide accounting for 1.8% of all cancer deaths. It is important to note that death rates for oral cancer are higher than for cervical cancer, laryngeal cancer, skin cancer, cancer of the testes, and endocrine system cancers such as thyroid cancer. The 5-year survival rate is between 50% and 60%. Unfortunately, there has not been much improvement in these rates for many decades, with current survival rates are only slightly better than during the 1970s despite all the advances in surgical techniques, diagnostic techniques, and adjuvant treatments such as radiation and chemotherapy. There also remains a race gap in oral cancer survival, with black men having a lower 5-year survival rate.

The major risk factors for oral cancer are smoking, which increases one’s risk threefold; exposure to second hand smoke; the use of smokeless tobacco; alcohol misuse; and human papillomavirus for cancers of the oropharynx. Quitting smoking helps decrease the risk; smokers who quit 20 years ago have the same risk as nonsmokers.

Despite the prevalence of the disease and relative lack of improved survival compared with other cancers, awareness of oral cancers remains problematic. By comparison, cervical cancer, which is associated with a significantly lower incidence and mortality rates, has a greater awareness among health care providers and the public. Primary care providers routinely instruct their patients on the role of screening the PAP smears and HPV testing. Oral cavity cancers do not enjoy the same level of awareness partly because the dental profession, considered the expert body on this anatomic subsite, has not taken ownership of this disease entity.

Oral health care providers can take a role in increasing awareness of these types of cancers by educating their patients on the disease and helping promote the dental profession as the first line of defense against oral cancer. Dentists should not assume that physicians will pick up on signs of oral cancer. When other health care providers do identify problems in the mouth, for example in an emergency department setting, they are often caught at a much more advanced stage significantly affecting survival.

Early detection remains the best tool for improving patient outcomes, and this where the critical role of oral health care providers comes into play. Dentists are experts in the early detection of oral cancer, putting them at the forefront of recognizing this disease and initiating treatment. Stage I 5 year survival rates are 80-90%. The survival rate drops to 30% at Stage IV. Therefore, simply put, early detection equals cure. The role of the general dentist in detecting oral cancer cannot be over-emphasized. If dentists don’t look for the signs, nobody else will until the cancers are more obvious and advanced.

The dental profession needs to take ownership of this disease entity and feel empowered to do so. Dentists should emphasize to patients the effects of oral health on the overall health of the patient. Head, neck, and oral cavity exams done by dentists save lives. Getting the word out to the public and specific messaging from the dental profession regarding their expertise in oral cancer detection is paramount.

In addition to detection, dental providers should be aware that this disease entity is treated by members of the dental profession. There are numerous fellowship-trained oral and maxillofacial surgeons that treat head and neck cancers providing superb patient care and unparalleled reconstructive techniques taking occlusion and dental rehabilitation into consideration. This is where oral and maxillofacial/head and neck surgeons shine, thanks to their dental background.

Mohammed Qaisi, DMD, MD FACS Illinois Dental News