Thursday, October 3, 2019

American Dental Association Expands Policy on Oral Cancer Detection to Include Oropharyngeal Cancer


As regular readers of the blog know, I’m extremely passionate about the detection of cancers of the head and neck.  Not only are these diseases life threatening, survivors are often left to deal with permanent disfigurement from surgeries.  For that reason, in my office every patient receives an oral cancer screening at every recare appointment.

The numbers dealing with these diseases are staggering.  Over 35,000 cases are diagnosed each year.  Of those diagnosed only 50% survive over 5 years.  More people in the United States die of oral and pharyngeal cancer than of cervical cancer.  Due to causation by the HPV 16 virus, those being diagnosed are young… many in their 20’s.  I could go on further, but I think you get the idea.  Dentistry needs to do all it can to help detect this threat at its earliest stages.

I’m a proud member of the American Dental Association and I am *really* proud of the organization’s stance and position on oral cancer.  At the most recent ADA meeting in San Francisco a few weeks ago the organization expanded its policy on the disease.  Here is the latest:

The American Dental Association recommends dentists conduct routine visual and tactile examinations for oral and oropharyngeal cancer for all patients, according to a resolution passed by the ADA House of Delegates on Sept. 9.

Resolution 65H-2019 amended the ADA policy on early detection and prevention of oral cancer to include oropharyngeal cancer and cover all patients, not just those previously thought to be at an increased risk because of tobacco and alcohol use.

"The revised policy aligns our statement with Centers for Disease Control and Prevention guidelines on visual and tactile examination and screening for oral and oropharyngeal cancers and highlights dentists' critical role in cancer screening and prevention," said Dr. Maria Geisinger, chair of the ADA Council on Scientific Affairs, which was charged with reviewing the policy and recommending changes.

The amendments also align with the ADA policy approved by the House of Delegates in October 2018 that supports the use and administration of the human papillomavirus vaccine. The CDC estimates 70% of oropharyngeal cancers in the United States are associated with HPV.

A research article published in August by the American Journal of Preventive Medicine found that in the 2011-16 National Health and Nutrition Examination Survey, only about one-third of U.S. adults 30 and older who had visited a dental practice within the last two years reported receiving an oral cancer screening exam.

In addition, survey data showed disparities based on demographics, with individuals who were a racial/ethnic minority, low income, less educated and uninsured or publicly insured less likely to be screened for oral cancer than those who were white and non-Hispanic, high income, more educated and privately insured.

"These patients are at a higher risk of developing oral cancer. The lower probability of dental professionals to screen these individuals represents a missed opportunity for early detection and improved outcomes of oral cancer," said Dr. Alessandro Villa, an assistant professor at the Harvard School of Dental Medicine and associate surgeon at Brigham and Women's Hospital, who co-authored the article and has worked with the ADA on HPV and oral cancer initiatives.

The disparities could indicate poor compliance with the current oral cancer screening guidelines and highlight possible selection of patients by dentists based on their socioeconomic status, but the findings also could be explained by some patient groups' lack of access to dental professionals with the time and training to provide oral cancer screenings, Dr. Villa said, adding more research is needed to understand the factors that limit an equitable delivery of the recommended screening.

"Every patient should be screened by their dentist and dental hygienist for possible early signs and symptoms of oral cancer, including the HPV-associated oropharyngeal ones," he said. "Efforts should be directed towards the education of patients about requesting an oral cancer screening in the dental office, and adequate training of the dental professionals on culturally sensitive communications might be an effective means to increase oral cancer screening exams among minorities and high-risk patients."

The full resolution will be available to members by the end of the year in the ADA Current Policies document at

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