Experts explore evidence on oral cancer detection, diagnosis

In an effort to arm dentists with the best evidence on oral cancer screening, the ADA and Centers for Disease Control and Prevention hosted an expert panel April 13-15 at Association headquarters to develop evidence-based clinical recommendations for health care practitioners.

The panel was moderated by Dr. Michael Rethman, chair, ADA Council on Scientific Affairs.

Dr. William Kohn, CDC associate director for science, represented that organization’s Division of Oral Health, and the panel included many of the nation’s top experts in oral cancer as well as representatives from ADA councils, stakeholders, physicians, dentists from the public health sector and academia. The panel hopes to complete the evidence-based recommendations by the end of the year and the results will be published in the ADA News.

“There’s been a lot of interest and publicity around oral cancer because the mortality rate and incidence don’t seem to be decreasing,” said Dr. Rethman. “It is important to let dentists know what they ought to consider, based on the most current science, to screen for oral cancer.”

Echoed Dr. Kohn, “Unfortunately too many oral cancers are not diagnosed until the more advanced stages. We’d like to produce evidence-based recommendations so that oral cancers may be detected and treated earlier.”

Each year about 34,000 Americans are diagnosed with oral cancer, according to a statistic from the American Cancer Society. Through the evidence-based recommendations, the panel aims to help health practitioners in both dentistry and medicine diagnose cases earlier.

Other clinical questions addressed were:

• Does screening through visual and tactile exam performed by a dentist reduce morbidity or mortality from premalignant or early malignant oral and oropharyngeal cancer?
• Do the current oral cancer screening devices increase the diagnostic properties (for example, sensitivity, specificity and positive protective value) in detection of premalignant or early malignant oral and oropharyngeal lesions compared to visual and tactile examination alone?
• Are there specific population subgroups in the United States defined by age, sex, ethnicity, risk factors, or other characteristics in which oral cancer screenings have relatively high positive and negative predictive values resulting in detection of premalignant or early malignant oral and oropharyngeal lesions?

In addition to Drs. Rethman and Kohn, the panel included: Dr. Mark Lingen, CSA, University of Chicago Pritzker School of Medicine; Dr. Philippe Hujoel, CSA, University of Washington -Health Sciences School of Dentistry; Dr. William Carpenter, consultant to the ADA Council on Access, Prevention and Interprofessional Relations, University of the Pacific, Arthur A. Dugoni School of Dentistry; Dr. Frank Graham, chair, ADA Council on Dental Practice, Teaneck, N.J.; Dr. Bert Oettmeier, ADA Council on Dental Benefits Programs, Stilwell, Kan.; and Dr. David Perkins, ADA Council on Education and Licensure, West Hartford, Conn.

Also on the panel were Dr. Britt C. Reid, National Cancer Institute; Dr. John Kalmar, Academy of Oral and Maxillofacial Pathology, Ohio State University College of Dentistry; Dr. Paul M. Lambert, American Association of Oral and Maxillofacial Surgeons; Dr. Alfred Wyatt, National Dental Association; Ezra Cohen, M.D., University of Chicago Medical Center; Dr. Joel Epstein, University of Illinois at Chicago College of Dentistry; Dr. Caswell Evans Jr., University of Illinois at Chicago College of Dentistry; Dr. Catherine Flaitz, University of Texas Dental Branch at Houston; Dr. Lauren Patton, University of North Carolina School of Dentistry; Dr. Scott Tomar, University of Florida College of Dentistry; Dr. James J. Sciubba, Milton J. Dance Head & Neck Center at the Greater Baltimore Medical Center; Wayne Koch, M.D., John Hopkins Medical Institute.