A life-saving exam

Annette Ashley Linder, BS, RDH

According to the NIH, oral cancer accounts for two- to-four percent of all cancers diagnosed annually in the U.S. However, survival rates are among the lowest of major cancers. Only half the people diagnosed with oral cancer are alive five years after the diagnosis. In contrast to other cancers (e.g., breast, colorectal, and prostate cancers), the overall U.S. survival rate from oral and pharyngeal cancer has not improved during the past 16 years.

Ninety percent of oral cancers are found after the age of 45. Oral cancer today occurs twice as often in males as in females. This is considerably different from the 5:1 male-to-female ratio of 40 years ago. Increased tobacco use among women is the main reason for the change in cancer rates compared with rates in the 1950s.

Cancer of the oral cavity occurs in 30,000 new patients every year. Most often detected in late stages, 8,000 to 10,000 people die each year of oral cancer. That equates to one person every hour. Oral cancer kills more people nationwide than melanoma, but the public is more aware of the risks for skin cancer than they are about lesions or abnormalities in their mouth. The medical community has done a much better job of informing the public about the risks of melanoma than we have in informing and educating our patients about the importance of early detection of oral cancer.

The dental hygienist, as preventive-care specialist and educator, has a pivotal role in evaluating the patient and providing necessary information. One survey reported that less than 14 percent of patients remember receiving an oral cancer exam at their dental visit. In my consulting work throughout the country, I observe that, quite often, patients are not told that an oral cancer exam is being performed. In fact, we often tend to minimize the procedure with comments such as, "I'm just going to take a quick look around." Some hygienists and doctors tell me that they do not want to "scare or alarm" the patient.

So why should we be surprised by the high cancellation and failure rates at the recall appointment? Patients view the appointment as nothing more than just a cleaning (no big deal; basically a cosmetic appointment!), and we contribute to the misperception when we minimize the services we perform.

Providing professional verbal and written information regarding oral-disease prevention enhances perception and helps to move the patient out of the "just a cleaning" mentality. Routine screening for precancerous lesions such as leukoplakia and changes in the color or texture of the tongue and oral mucosa should be noted and discussed. Simple and cost-effective tests to evaluate and monitor any abnormalities are available.

Professional brochures are available to the dental office and should be distributed to patients. Consider including one of these brochures as a "Statement Stuffer." Include it in your monthly statement with a note that says something such as, "Because we care about you, here is the latest research information." Additional ways to increase patient awareness include creating an "Oral Hygiene Fitness Report" for each hygiene patient as part of his or her take-home materials. Include all of the examinations, procedures, freebie home-care products, etc. (visit www.Annette Linder.com for a sample).

The National Institutes of Health recommends a thorough oral evaluation by the dental team. Develop office protocols for a routine oral-cancer screening for every patient, and make sure that everyone on the team understands the benefit of this service. Educating patients, coupled with early detection through regular examinations, will create a more aware public and, hopefully, reduce the morbidity rate.