SAN DIEGO -- Dentists don't want to spend time screening patients for oral cancer because they're not sure how to do it properly -- or how to make money from it, researchers said at the American Association for Cancer Research annual meeting here.
The researchers, from Simon Fraser University and the British Columbia Oral Cancer Prevention Program in Canada, collected four months of data from pilot cancer screening projects at 10 dental offices in Vancouver, then queried dental staff in focus groups.
"The idea was to raise public awareness, and remind dentists and their staff about how easy an oral cancer exam can be," said study author Denise Laronde, a dental hygienist and doctoral candidate at Simon Fraser University.
Earlier research has suggested that dentists could save lives with oral cancer screenings. In a British Columbia study, 70 percent of oral cancer patients who had regular dental office visits were diagnosed at an early stage (stage I or II), while only 40 percent of those who did not have regular dental visits were diagnosed at an early stage, the researchers said.
Oral cancer screening is a quick and painless procedure, yet fewer than 30 percent of people surveyed report being screened, the researchers added.
In the current study, dental personnel were taught to use a novel screening device that uses loss of autofluorescence to identify potential areas of concern in the oral mucosa. Dentists, dental hygienists, and dental assistants participated in a one-day workshop on the procedure with didactic sessions and hands-on assessments of patients with high grade dysplasia or squamous cell cancer lesions.
For the following four months, the dental offices screened all patients over age 21 for oral cancer, collected risk information, completed extraoral and intraoral exams, and performed autofluorescence visualization of the oral mucosa with a handheld device.
"With the autofluorescence device, the exams took less than two minutes," said Laronde. "Although dentists are taught this skill, many of them had questions about the details of oral cancer screening, including how to talk to patients about screening and how to do biopsies."
Some of the participants themselves suggested a way to communicate with patients: Information sheets for patients in different languages, and prep sheets for dental staff with simple responses to common questions, Laronde said. One dentist put together a one page script about oral cancer screening, including why screenings are important, and included statistics about oral cancer. "This raised patients’ awareness, and they started to ask questions about oral cancer that they hadn’t asked before," the dentist said.
Some participants told the researchers that oral cancer just wasn't at the top of their list. "You tend to forget oral cancer screening because you’re focusing on the crowns and bridges and fillings and implants," one dentist said. "You kind of leave all that (screening) education behind."
Others pointed out that they couldn't make money from cancer screenings. "The dentists felt they needed extra time not only for the exam, but for explaining the screening process to patients,"Laronde said.
In general, patient responses were very positive to the screenings. However many were surprised because they hadn’t been screened before, dental personnel reported.
The dentists and other dental personnel called for mandatory continuing education for all dental personnel to maintain the skills needed for oral cancer screenings. They suggested that a certification course for new technology (including fluorescence visualization) be available at conferences and workshops. They also noted that there was a need for guidelines, protocols and referral pathways, regarding who should be screened, at what intervals, what cases to refer forward, and who to refer patients to for follow-up and possible treatment.
In an editorial in a special issue on oral cancer published by the Journal of the Canadian Dental Association in April 2008, the Canadian researchers noted that dentists can prioritize patients for screening. Dentists should especially screen patients over 40, smokers, and those who use alcohol regularly, since these patients are at higher risk, the researchers said. But they recommended that screenings should be performed at every dental visit. "It’s important for us to integrate these screenings into our daily practice," Laronde said.