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 first-ever Surgeon General's Report on Oral Health, which focuses 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 Prevention and Early Detection of Oral Cancer. This consortium consists of NYU College of Dentistry · UMDNJ New Jersey Dental School · SUNY Stony Brook, School of Dentistry Columbia University, School of Dental & Oral Surgery · NYC Health and Hospitals Corporation-Oral Health, Programs & Policy New Jersey Dental Association ·Atlantic Health Systems · Morristown Mountainside Overlook · St. Joseph Hospital Essex County Dept. Dental Service · New York County Dental Society. Partnering with WABC-TV, 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 conducts massive regional cancers screening annually. However, the most important aspect of this public outreach program is 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 that runs in the New York/New Jersey area newspapers is not only the shock value in learning how deadly oral cancer can be, but the inclusion of the simple phrase, "Ask your dentist." It is 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. It is hoped that future screenings will be done in cooperation with local dental societies so that hundreds of area dentists will become involved.
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