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Task force says it can't recommend for or against oral cancer screenings by physicians

December 12, 2013

By Jean Williams, ADA News staff

Dr. Edmond Truelove

Dr. Mark Lingen
Taking care to except dentists and otolaryngologists, the U.S. Preventive Services Task Force has concluded that current evidence is insufficient to recommend for or against routine oral cancer screenings by primary care providers.

USPSTF's Screening for Oral Cancer: U.S. Preventive Services Task Force Statement is an update to its 2004 recommendation on screening for oral cancer. The Annals of Internal Medicine published the updated guidelines online on Nov. 26.

Dr. Edmond Truelove, chair of the ADA Council on Scientific Affairs, indicated that the exception of dentists in the latest recommendations underscores the significance of dentists in helping patients protect the oral cavity from diseases and other serious conditions.

“The statement places even greater importance on regular periodic evaluation by the patients' dentists to improve early detection of oral and dental conditions of the teeth and soft tissues of the mouth, including soft tissue changes that may represent lesions associated with cancer and premalignant change,” Dr. Truelove said. “If primary care providers in medicine are not encouraged to assess oral tissues for potentially dangerous change during their annual physical examination appointment with patients, then the role of regular dental assessments becomes an even more important factor for patients at increased risk of oral cancer.

“Those individuals include people who use tobacco, significant amounts of alcohol, have immunologically-based disease, family history of oral cancer, have had organ or bone marrow transplants, have a prior history of oral cancer or head and neck cancer therapy, or are otherwise significantly medically compromised.”

While the USPSTF's statement may help to reinforce the primacy of dentists as caretakers of the oral cavity, Dr. Mark Lingen, Ph.D., a professor of pathology at the University of Chicago Pritzker School of Medicine and a former ADA CSA member, finds it problematic that oral cancer has been singled out for a screening guideline apart from other potential serious conditions in the oral cavity.

“What is relevant is that the screen for oral cancer is not a stand-alone exam,” Dr. Lingen said. “It's part of the overall evaluation of the oral cavity. In other words, when you're screening the oral cavity, you're screening for any mucosal abnormality, the overwhelming majority of which are not going to be oral cancer. But that doesn't make them unimportant, as some of those other lesions also require specific therapies.

“The bottom line is clinicians, whether they're physicians or dentists, need to continue to fully examine the oral mucosa for signs of any disease, one of which might be oral cancer.”

To view the USPSTF recommendations, visit the Annals of Internal Medicine.