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In the ranks of public health threats, it is among the most stubborn - and the most deadly. MED discovers why both dentist are still struggling to improve oral cancer detection.
In 2007, it is estimated that as many as 400,000 cases of oral cancer were diagnosed worldwide. When you consider that the five-year survival rate for those afflicted by oral cancer has hovered on the lower side of the 50% mark for almost 50 years, the figure makes for dismal reading.
Yet considering it is the sixth most common malignancy in the world, oral cancer has a relatively low profile among the general public. Indeed, dentists are now encouraged to refer to the disease as mouth cancer - supposedly a more recognisable term for patients.
But as the competitive nature of modern dentistry places more and more emphasis on aesthetics, are dentists themselves doing enough to screen patients for oral cancer? When chair-time equals revenue, how can dentists afford the time to screen for its symptoms? MED hears from the dentists on the front line in the fight against oral cancer.
Pitching an idea
While most dentists are more than willing to screen patients for oral cancer, there are others who are ready to go that extra mile. At a recent baseball game in New York's Queens County, Dr Stuart Kessner, a general dentist with his own practice, led a team of dentists that offered free, two-minute oral cancer screenings to spectators before and during the action.
"The idea with the baseball game is that you can reach these sort of people in a painless, friendly atmosphere," explains Kessner. "Obviously there are no results given there, that's not exactly what people go to watch baseball for, but we can refer cases on to local hospitals."
Kessner and his colleagues also struck a deal with the New York Mets to try and reach every member of the crowd, not just the ones that they had the time to examine. "We distributed a brochure at the game in an attempt to educate people about the risks," he says.
Dr Kessner believes those most at risk from oral cancer are also least likely to visit a dentist. But just because someone doesn't take a proactive approach to oral health doesn't mean they deserve to fall off the healthcare radar, he argues. If dentists, and dental associations, really want to make a difference then they need to target the members of their community at most risk to oral cancer.
"The absolute key to catching oral cancer is to get it early - and you can do that with a simple two minute test that looks at the floor of the mouth, the inside cheek and the roof," he explains. "The problem is that many of the people that are at risk to these symptoms, whether its through tobacco or alcohol, typically don't go to vsit the dentist that often."
What is vital, argues Kessner, is that when any dentist receives a new patient that the first thing that they do is conduct a thorough screening for oral cancer - and not just for high-risk patients, either.
"I would hope that every dentist is screening for oral cancer with each new patient - the way I was taught at Columbia was that you had to try and treat the whole of the patient," he says. "Even if it is an emergency procedure you should be obligated to test for oral cancer - it should be the first thing that any dentist does."
Screen time
The problem is not one of knowledge, but of time constraints, argues Dr Louis Malcmacher. A practising general dentist, Malcmacher also acts as a consultant to the Council on Dental Practice of the American Dental Association.
"The average dentist is very aware of the symptoms of oral cancer but most dentists only do an examination, not a screening," he points out. "They look...and feel with their hands for anything unusual."
