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> Research > Oral Cancer Research
Oral Cancer Research
oral-cancer.org:
A Web Site, With Foresight, to Incite
by Michael C. Alfano, D.M.D., Ph.D.
What is in the
public interest, in the highest of dental practice standards,
and has the best potential for the growth of your dental practice?
Answer: the oral cancer examination. This simple, quick, painless
examination is the gateway to saving lives through dental
practice, adding prestige to the profession and providing
one more compelling reason for patients to visit the dental
office. Yet fewer than 7% of Americans report getting an oral
cancer exam, even though more than 60% of us visit a dentist
each year. Why is there such a huge discrepancy? Do dentists
believe that they are not properly compensated for the exam?
Are they afraid of scaring their patients? Is it because the
only perceived option for confirming a lesion is an incisional
biopsy?
Whatever the reason,
it is time for a change! New diagnostic approaches are becoming
available, and several forces operating at the national level
are soon to create a groundswell of demand from the consumer.
These approaches include the following: a national goal for
"Healthy People 2010" to increase the number of Americans
reporting an oral cancer exam from 7% to 35% each year; the
forthcoming, first-ever, Surgeon General's Report on Oral
Health, which is certain to focus public attention on oral
cancer; the continuing incisive editorials on the subject
by Journal of the American Dental Association editor,
Dr. Lawrence Meskin; the expected productivity of several
new oral cancer research centers funded by the National Institute
of Dental and Craniofacial Research; and the grassroots efforts
of oral cancer patients and several regional initiatives.
One such regional
initiative that is beginning to have an impact is the Consortium
for the Prevention and Early Detection of Oral Cancer. This
consortium consists of four dental schools (Columbia University,
New York University, the State University of New York at Stony
Brook, and the University of Medicine and Dentistry of New
Jersey) in concert with the New York City Health and Hospitals
Corporation. Partnering with WABC-TV, Zila Pharmaccuticals,
the NYU/Forsyth Center for Minority Oral Health,and local
media companies, this consortium established a Web site (oral-cancer.org),
a consumer hotline, an oral cancer awareness survey, and free
continuing education courses in oral cancer examination for
area dentists. It also conducted a massive regional cancer
screening exercise after only a few months of existence. However,
the most important aspect of this public outreach program
is not the unusual combination of the talents of four dental
schools and a large city agency, nor is it even the fact that
several cancerous lesions were identified, thereby saving
lives. It is the fact that the advertising for the program
sparked not only the public to action, but many area dentists
as well.
| Pivotal
to the success of the advertisement (reproduced here)
that ran in the New York/New Jersey area newspapers was
not only the shock value in learning how deadly oral cancer
can be, but the inclusion of the simple phrase, "Ask your
dentist." It was this phrase, embracing the practicing
dentist, that made it clear that oral cancer awareness
and diagnosis was everyone's job, not simply the area
clinics. Moreover, instead of the rancor that sometimes
arises among dental practitioners when a dental clinic
presents its services to the public, many area dentists
said that they were going to offer free cancer screenings
to their patients. Indeed, it is hoped that future screenings
will be done in cooperation with local dental societies
so that hundreds of area dentists will open their doors
for free screenings in the future. |
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So that's
the "Web site with foresight." But what about the "incite"
part? Clearly the goal here is to incite the dental profession
to change its average practices with respect to oral cancer
diagnosis. But perhaps a more far-reaching goal can be achieved
by the involvement of the dental "org," or organized
dentistry. Because oral cancer kills more Americans than melanoma
or cervical cancer; because Americans embrace periodic Pap
smears, mammograms, and prostate specific antigen (PSA) tests;
and because the recent ADA advertising proposal was rejected
by the membership-why not initiate a national campaign for
an annual oral cancer exam? Lives will be saved, and the profession
will be promoted very effectively as patients realize that
a trip to the dentist is not only about a postponable prophylaxis,
but about a nonnegotiable, must-have, life-saving procedure.
Women do not enjoy mammograms or Pap smears, but they consistently
go for these procedures for the peace of mind that they bring.
Perhaps organized
dentistry can partner with the private sector the way sunscreen
manufacturers have partnered with dermatology. This informal
partnership underscored the damaging effects of the sun, the
deadliness of melanoma, and the importance of sunscreens.
Self-serving? Yes. But it has also created a generation of
children whose parents slather them with sunscreens and further
the likely reduction of skin cancer for generations to come.
The corollary for dentistry would be to partner with the media,
federal agencies, consumer oral health companies, and dental
supply manufacturers to promote the need for an annual oral
cancer exam. Such a campaign would be on the high ground relative
to the picket-fence approach that emphasized appearance-an
important benefit of dental care, but not necessarily a compelling
one.
The time is right
for a major oral cancer screening initiative, not only for
all the reasons listed in the second paragraph, but also because
new tools are now available to the dentist. These tools include
brush biopsies enhanced by computer scanning, and soon, perhaps,
new visualization and imaging techniques. The brush biopsy
is particularly interesting because it is reported to have
extremely high sensitivity and specificity, yet it can be
accomplished quickly, without anesthesia and with virtually
no bleeding. Perhaps it has been the absence of such a technique
that has reduced the enthusiasm of dentists for oral cancer
exams. Because most oral lesions are benign, it may be difficult
for dentists to justify a conventional incisional biopsy.
As a result, the cancer examination is not performed with
the requisite regularity.
Let's skip the
cliché usually inserted at this stage of an editorial: that
we dentists need to begin widespread oral cancer screening
now to get ready for that year with three zeros in it. Let's
do it because we have always had the ethical obligation to
do it. Let's do it for our enlightened self-interest in building
our practices. But most of all, let's do it because it serves
the public good.
Michael C. Alfano is Dean of the New York University
College of Dentistry
This commentary originally appeared in
Dental Abstracts Vol. 44 Issue 5 1999 p. 194-196
Reprinted with permission of the publisher
This copyrighted material may only be used personally
and may not be distributed further. All rights reserved.
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