Oral Cancer Screenings: Have We turned the Corner?

Abstract

Cancer is the second most cause of morbidity and mortality in the world today after cardiovascular diseases. Six million people die due to cancer each year. Detecting cancer in its early stages dramatically increases the survival rates as compared to its detection in later stages. 1 Most major cancers are tracked by their 5-year survival rate-the percentage of patients that are diagnosed with cancer and are still alive after 5 years. With advancements of technologies and screenings, most cancers have a survival rate greater than 50%, a number that is steadily increasing. On the contrary, there are some cancers that have a survival rate that is surprisingly low.When looking at the 5-year survival rates of the worst cancers (pancreas 7%, liver 17%, lung 17%, esophagus 18% and stomach 28%), there is a common trend: these are all internal organs with no accepted screening protocol, and symptoms only occurring until late stages and metastasis. Not that this is acceptable, but it is understandable given the complexities of regular screenings for these organs. What is not understandable is that the 5-year survival rate of oral cancer has not improved in decades. With easy to access tissue of the oral cavity, along with advancements in technology and protocols, there are no excuses for oral cancer to be discovered in late stages, regardless of what country it may be.Oral cancer, also called 'head and neck cancer', has a low 5-year survival rate of 63%, even in developed parts of the world. 2 The reason for the low survival rate is that the majority of oral cancers are discovered in the latter stages of the disease, often after it has metastasized. 3 In settings with low resources, a similar low survival rate exists. However, this author believes that the similarity in the mortality rates are due to different reasons depending on the resource setting.In the United States, e.g. the de facto medical professional to identify oral cancer is the dentist. For almost a decade, the advanced technology of fluorescence has been on the market as a general screening tool, but this technology occupies less than 10% of the American dental offices. At American dental schools there may be a few of instruction hours covering pathology and cancer, while the vast majority of time is dealing with teeth. As a general rule, American dentists are uncomfortable talking with their patients about the dreaded 'C' word; life and death discussions are outside their comfort zone. It is a difficult task introducing them to technology and protocols outside of their training and expertise. Lastly, the lack of insurance reimbursement is an impediment to implementing this technology. Dental insurance is an unpredictable creature which may not compensate the dental office for their time. This is why many offices have moved to a strict fee-for-service model. This also is problematic in that trying to amortize a multithousand dollar piece of equipment from a cash pay patient is difficult. Furthermore, an additional cost of $2.50 USD per patient in disposable ...