By A. Ross Kerr, DDS, MSD Clinical Associate Professor of Oral & Maxillofacial Pathology, Radiology & Medicine;
Chairman, Oral Cancer Consortium
Until 1999, when the Oral Cancer Consortium was conceived in New
York and New Jersey, there was no formal dental-based organization in the
United States dedicated exclusively to raising awareness of the deadliness
of oral cancer and the importance of prevention and early detection. Originally
consisting of four dental schools in New York and New Jersey, the New York
City Health and Hospitals Corporation, and a local television station, ABC7,
the Consortium developed a media-driven strategy that was intended to galvanize
public awareness of this largely unknown disease, and to motivate people to “Ask Their Dentists” for an oral cancer exam. The premise was that if consumers began to ask for the exam, dentists who previously did not routinely screen for oral and pharyngeal cancer would feel compelled to do so.
The facts tell a powerful story:
- Each year approximately 29,000 Americans are diagnosed with oral cavity and pharyngeal cancers, and 7,300 of these people will likely die.
- While over 90% of those diagnosed are over age 40, in recent years there has been a significant increase in the under-40 population.
- Oral cancer is the 9th most common cancer in men, who are twice as much at risk as women. African-American men have the highest rates of oral cancer in the U.S.
- Less than 60% of oral cancer patients will survive for 5 years, and only 40% will survive for 10 years. This is because
two-thirds of patients are diagnosed late with advanced disease, which is less amenable to treatment. In contrast, if oral cancer is detected early, there is a greater than 80% 5-year survival rate.
- 75% of oral and pharyngeal cancers are attributed to tobacco and heavy alcohol use. The cause of the remaining 25% is not clear.
- The main treatments for oral cancer include surgery and radiotherapy, both of which carry significant long-term side effects and have a major impact on quality of life.
In spring 1999, the Oral Cancer Consortium held the first of what has become an annual free screening day sponsored by an ever-expanding group of partners, who now include 29 metropolitan-area healthcare institutions and professional societies, hospitals, and corporations not only in New York and New Jersey, but also in Pennsylvania. These events have become models for other states across the nation. Indeed, the Oral Cancer Consortium’s importance was recognized recently with a grade of “A” from Oral Health America for its efforts to reduce the incidence of oral and pharyngeal cancer and to promote early diagnosis. But while we can take pride in what has been accomplished to date, the statistics remain virtually unchanged. Accordingly, we in the Oral Cancer Consortium must face the fact that our message is not effective enough.
Where Do We Go from Here?
Why, after five years, are 88% and 99% of people diagnosed with breast cancer and prostate cancers, respectively, still alive, compared to only 59% percent of people diagnosed with oral and pharyngeal cancer? One important reason is the public’s awareness of these cancers. Simply put, more people get screened regularly for breast and prostate cancer because of phenomenal marketing efforts to “brand” these cancers. Oral cancer must do the same. It’s clear that oral cancer has a high cure rate when detected before the cancer has metastasized to the local lymph nodes or beyond. Unfortunately, “frontline” dental and medical healthcare providers do not do a good enough job of performing a thorough visual and tactile oral cancer examination on every patient. Why this is the case is a complex and multifactorial issue that is not likely to be resolved soon. Be that as it may, if we are to realize the potential that exists to reduce mortality from this disease by detecting cancers earlier and, better yet, intercepting them when they are in the precancerous stage, we must work harder at raising awareness among both the public and healthcare professionals.
Why must there be so much suffering? Oral cancer is one of the most devastating cancers — not only because it is so deadly, but also because it can have such major impact on one’s quality of life. Unlike breast cancer and prostate cancer, whose survivors can conceal their disease, oral cancer survivors typically undergo extensive disfiguring surgery and radiation therapy. And we live in a society where, for better or worse, appearance is very important. Moreover, the simple pleasures that we take for granted, like eating, drinking, talking or kissing, can be severely compromised forever as a result of oral cancer.
Accordingly, the Oral Cancer Consortium plans to add new initiatives that have the potential to take oral cancer awareness and action to the next level. Toward this end, Sam Champion and ABC7, who have been terrific partners in publicizing the free screenings since they began, will be invited to play an even larger role, both as consultants and on-camera. The new initiatives we are planning include:
- Developing a "brand."
One of the ideas that came out of an Oral Cancer Consortium “Think Tank” held last year at NYUCD was the need to look at the issue of oral and pharyngeal cancer from a marketing perspective and come up with an actual brand that will prompt instant recognition and therefore allow us to access our target audience more effectively.
Heightening professional awareness through our students. In April, in advance of the Oral Cancer Consortium’s annual free screening day, we hope to attract widespread attention by holding an Oral Cancer Walk-A-Thon in conjunction with the Student National Dental Association. The idea came from one of our senior students, Khadine Alston. Brian Hill, Founder of The Oral Cancer Foundation, which hosted a similar event last spring, has offered to help Khadine organize the event and recruit participants and sponsors. One of the wonderful things about this plan is its potential to motivate dental students at other schools to lobby their institutions to join in the effort to promote awareness and early detection. With a critical mass of dental students dedicated to early detection, it is reasonable to expect that it will be second nature for tomorrow’s dentists to perform an oral cancer examination for every patient.
Telling survivors’ stories and recruiting celebrity spokespersons. We plan to invite oral cancer survivors, including dentists and hygienists who have survived oral cancer, to tell their stories in print and on TV. We will also invite African-American and Hispanic celebrities to do public service announcements targeted to high-risk peer audiences, who bear a disproportionate oral cancer burden.
Enlisting other healthcare professions in conducting oral cancer exams and promoting prevention. NYUCD’s alliance with nursing provides a wonderful opportunity to involve other healthcare providers in promoting early detection and prevention. To that end, we are exploring the possibility of a collaborative project to develop and test a continuing nursing education program on oral cancer that can be presented at national and regional nursing meetings.
Forging new technologies that will make it easier to screen for oral cancer. Currently there is no separate ADA code for a standard visual and tactile oral cancer exam and therefore it is not reimbursed separately from a comprehensive dental/periodontal/soft tissue exam. As a consequence, while many dentists are charging for a comprehensive oral exam, they are not meeting their obligation to screen for oral cancer. The good news is that there is a growing field devoted to “predictive oncology” and important research is underway that will lead ultimately to new screening adjuncts to augment our standard visual examination and help us identify and characterize early cancers or precursor lesions with high potential for becoming cancers. Such adjuncts may include handheld detection devices coupled with cytological or salivary diagnostics. The introduction of such tests into the marketplace may very well facilitate further expansion of ADA reimbursement coding for oral cancer screening and, hopefully, motivate more private practitioners to screen for oral cancer. But that may be too long to wait.
Maybe it’s time to stop pulling our punches and start producing more aggressive marketing materials, as the cover of this issue of Global Health Nexus suggests, and to depict more vividly what the disease can do to a person’s face and quality of life.
Those of us who are involved in the campaign against oral cancer know that there are promising directions to follow that will ultimately allow us to downsize this disease. The only question is how bold we are prepared to be to reach our goal.