Dental screening for oral cancer

[Cooper]

On my last visit to the dentist he asked me if I were interested in being screened for oral cancer. He explained how important early detection is and how simple the test is. I was relieved to know I had no signs of oral cancer... Yesterday, on CBS news, I heard a report linking the rise of oral cancer to oral sex... As gay men, we should always look out for each other, so, on your next visit to the dentist, request an oral screening cancer detection test.

 

http://www.cbsnews.com/8301-504763_162-20035363-10391704.html

[+ Travis69]

My dentist offers this also. Started doing it one year ago. I also had a clean bill of health.

[Guest]

In case others are interested in what the independent experts are saying:

The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routinely screening adults for oral cancer.

Rating: I Recommendation.

Rationale: The USPSTF found no new good-quality evidence that screening for oral cancer leads to improved health outcomes for either high-risk adults (i.e., those over the age of 50 who use tobacco) or for average-risk adults in the general population. It is unlikely that controlled trials of screening for oral cancer will ever be conducted in the general population because of the very low incidence of oral cancer in the United States. There is also no new evidence for the harms of screening. As a result, the USPSTF could not determine the balance between benefits and harms of screening for oral cancer.

 

http://www.uspreventiveservicestaskforce.org/3rduspstf/oralcan/oralcanrs.htm

 

I would also like to point out that oral cancers associated with HPV are usually found at the base of the tongue, so one would need to use those tiny mirrors or a laryngoscope to screen for those.

[Rick Munroe]

As gay men, we should always look out for each other

 

Well, I hope you would tell your straight friends/family, too.

[Cooper]

Let's look at other organizations and see what they say:

 

"Not all medical organizations agree about the benefits of an oral exam for oral cancer screening. For instance, the American Dental Association recommends all adults undergo periodic oral exams when they visit the dentist. The American Cancer Society recommends discussing oral cancer screening when you visit your dentist. But the U.S. Preventive Services Task Force (USPSTF) concludes that there is insufficient evidence either for or against routine oral cancer screening in adults. The USPSTF also says that techniques other than the standard oral exam are being evaluated but are still experimental."

 

http://www.mayoclinic.com/health/oral-cancer/AN01704

[tyro]

Thanks for this, Cooper. I go to the dentist Thursday. Timing is everything.

T

[Guest]

Let's look at other organizations and see what they say:

 

"Not all medical organizations agree about the benefits of an oral exam for oral cancer screening. For instance, the American Dental Association recommends all adults undergo periodic oral exams when they visit the dentist. The American Cancer Society recommends discussing oral cancer screening when you visit your dentist. But the U.S. Preventive Services Task Force (USPSTF) concludes that there is insufficient evidence either for or against routine oral cancer screening in adults. The USPSTF also says that techniques other than the standard oral exam are being evaluated but are still experimental."

 

It's interesting that neither the ADA nor the ACS specifically recommend oral cancer screening either, although both have a financial interest to encourage it. It's interesting to see that the Canadian Task Force specifically discourages it:

 

For population screening, there is fair evidence to specifically exclude screening for oral cancer (grade D recommendation). For opportunistic screening during periodic examinations, there is insufficient evidence to recommend inclusion or exclusion of screening for oral cancer (grade C recommendation).

http://www.cda-adc.ca/jcda/vol-65/issue-11/617.html

[+ Travis69]

We are talking about the machine they shine in our mouths, right? Not just them looking in and feeling around.

[Cooper]

We are talking about the machine they shine in our mouths, right? Not just them looking in and feeling around.

 

Yes Travis, it's called Velscope: http://www.bizjournals.com/louisville/print-edition/2012/06/22/bright-lights-big-difference-dental.html

 

http://www.velscope.com/

[Guest]

Yes Travis, it's called Velscope: http://www.bizjournals.com/louisville/print-edition/2012/06/22/bright-lights-big-difference-dental.html

 

For existing patients, the charge for the two-minute exam is $25.

 

A quick $25 for something that has never been shown to save lives.

[Cooper]

 

A quick $25 for something that has never been shown to save lives.

 

Thanks for sharing your opinion, however, were talking about detection not a solution. The research that both of us shared on this topic indicate that these methods are still being evaluated.

[Guest]

Thanks for sharing your opinion, however, were talking about detection not a solution. The research that both of us shared on this topic indicate that these methods are still being evaluated.

It's simply a factual statement, not an opinion. If you can reference any research that contradicts my statement, I'll be happy to retract it.

[Cooper]

Research says "Dental Screening Saves Lives"

 

It's simply a factual statement, not an opinion. If you can reference any research that contradicts my statement, I'll be happy to retract it.

 

The research that both of us shared states it's still being "evaluated", I found nothing in my research that supports your opinion "that it doesn't save lives." Are you a dentist?

 

If you do a quick google search you'll find dentists who disagree with your opinion:

 

http://littlesilver.patch.com/blog_posts/the-daily-floss-8-oral-cancer-screening-saves-lives

 

http://www.dentaleconomics.com/articles/print/volume-98/issue-7/columns/quality-care-for-oral-cancer/oral-cancer-mdash-early-detection-can-save-lives.html

 

http://www.utmbhealth.com/wtn/Page.asp?PageID=WTN000731

 

http://pearlcosmeticdds.com/oral-cancer-screening/

 

http://www.iarc.fr/en/media-centre/pr/2005/pr164.html

 

http://www.iarc.fr/en/media-centre/pr/2005/pr164.html

[whipped guy]

While not questioning the products effectiveness for what it does... it is interesting to note that the company chosen for the world-wide distribution of the product has a reputation for its effective and high-power marketing skills. Just something to consider as being part of the equation when contemplating the grand scheme of things...

[Steven_Draker]

It's simply a factual statement, not an opinion. If you can reference any research that contradicts my statement, I'll be happy to retract it.

 

http://www.elkgrove-laguna.net/forums/images/smilies/2/whip.gif

 

Take that, my friend ... ;-)

 

(just teasing you)

[Justice]

My dentist has been examining me for oral cancer for the last year or so. I think that it's a great idea. It's better to be safe than sorry and early detection is always a good thing.

[Toulouse]

Thanks for the useful information Coop. "An ounce of prevention is worth a pound of cure."

[Guest]

The research that both of us shared states it's still being "evaluated", I found nothing in my research that supports your opinion "that it doesn't save lives."

 

You're misquoting me. What I said was that it has never been shown to save lives. That is a simple factual statement that cannot be disputed (unless you have evidence to the contrary--in which case you should notify the USPSTF as well as the Canadian Task Force, because in that case you know better than they do). Of course, opinions are like a-holes. Everyone has one. Some people are firmly convinced that Hinduism, Islam, Catholicism, or Christian Science constitute the one and only true religion. However, it would be a factual statement to state that no evidence exists proving one religion to be the correct one (or that any god, in fact, exists). There's nothing wrong with believing that oral cancer screening saves lives. There's nothing to prove it or disprove it. It is simply a fact, however, that at this time no evidence exists to back up that belief.

[Cooper]

In case others are interested in what the independent experts are saying:

The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routinely screening adults for oral cancer.

Rating: I Recommendation.

Rationale: The USPSTF found no new good-quality evidence that screening for oral cancer leads to improved health outcomes for either high-risk adults (i.e., those over the age of 50 who use tobacco) or for average-risk adults in the general population. It is unlikely that controlled trials of screening for oral cancer will ever be conducted in the general population because of the very low incidence of oral cancer in the United States. There is also no new evidence for the harms of screening. As a result, the USPSTF could not determine the balance between benefits and harms of screening for oral cancer.

 

http://www.uspreventiveservicestaskforce.org/3rduspstf/oralcan/oralcanrs.htm

 

This research was published in 2004, long before the use of VELscope. It also concludes that "oral exams are experimental but still being evaluated". I can't find in that research anything that comes to your conclusion of not saving lives... The articles that I provided on "how oral screening can save your life" are current... I will rely on my dentist's advice and not some outdated research as to whether or not this simple, inexpensive, and painless VELscope test is in my best interest.

[Guest verymarried]

I think that the abilities of the average dentist in cancer detection may be exaggerated and may just be one more way to increase our check-up fees. I was examined by a small town dentist who actually saw something in my mouth which he said concerned him. He charged me then wanted to refer me to another dentist who supposedly was an expert. Instead I went to another dentist - a friend, who said he honestly did not see anything. Still wanting to put it to bed, I got in to see an oncologist who specialized in head and neck cancer at a med center and they confirmed that there was nothing there. I am thrilled of course, but am left with questions. Dentists have sort of claimed this area as their turf regarding cancer, but I wonder just how much cancer training they really have. Some have seen enough to feel qualified I assume. Others - perhaps may be taking our money but remain questionably skilled in that area.

[Guest]

I think that the abilities of the average dentist in cancer detection may be exaggerated and may just be one more way to increase our check-up fees. I was examined by a small town dentist who actually saw something in my mouth which he said concerned him. He charged me then wanted to refer me to another dentist who supposedly was an expert. Instead I went to another dentist - a friend, who said he honestly did not see anything. Still wanting to put it to bed, I got in to see an oncologist who specialized in head and neck cancer at a med center and they confirmed that there was nothing there. I am thrilled of course, but am left with questions. Dentists have sort of claimed this area as their turf regarding cancer, but I wonder just how much cancer training they really have. Some have seen enough to feel qualified I assume. Others - perhaps may be taking our money but remain questionably skilled in that area.

 

This is a good example of a "false positive" in a screening test. Many factors are involved in determining whether a screening test is helpful. The only cancers for which screening has been found to be helpful so far are colon, cervix, and breast. A large number of factors is involved in determining whether a screening test is helpful, harmful, or neutral. Among the many factors involved include the incidence and prevalence of the disease being screened, the sensitivity of the test (i.e. the ability of the test to find the disease when it's present), the specificity of the test (i.e. the ability of the test to identify those without disease), the positive predictive value (i.e. the chance that a positive screen indicates disease), the negative predictive value (i.e. the chance that a negative screen indicates the absence of disease), the amount of benefit received from a disease found early due to the screening (related to the Number Needed to Screen, or NNS), the amount of harm which results from the screening (related to the Number Needed to Harm, or NNH), among other factors. The less common a disease is, the less likely screening is likely to help, because in that case one needs incredibly high sensitivity and specificity in order to have favorable positive predictive values, negative predictive values, NNS, and NNH.

According to the NIH, http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/OralCancer/OralCancerPrevalence.htm , In 2004 approximately 157,000 (0.11% of) men and 87,000 (0.07% of) women had oral cancer in the U.S.. So even if one were to assume 100% sensitivity, 100% specificity, cures for all of those successfully screened, and death for all those who aren't, with no one harmed from screening, one would expect to benefit only about one out of every 1000 men screened. Since most oral cancers are associated with tobacco use, the NNS would be even higher for non-smokers (or women, of course). Of course, none of those assumptions is true, so if there is a benefit to oral cancer screening, it's going to be on the level of fewer than one in a thousand who benefit.

There are cancers which are far more common for which cancer screening has been found to be ineffective (lung, bladder), or even harmful (prostate). For these reasons, it's highly unlikely that oral cancer screening will help more than harm, and if it does, the benefit will be very small.

[Cooper]

Oral Cancer facts

 

In a 2013 report, 42,000 Americans will be diagnosed this year with oral cancer. The death rate is higher than with most cancers. I've attached a link to a current (2013) report that presents the facts including: early signs/symptoms, causes, treatment, statistics, risk factors, current research, and the importance of early detection.

 

"Historically the death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development."

 

"Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors."

 

"The good news is however, that your dentist or doctor can, in many cases, see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages."

 

I found this recent research on oral cancer to be most interesting and informative.

 

http://oralcancerfoundation.org/facts/index.htm

[whipped guy]

Dentists have been screening for oral cancer for decades... and lives have been saved. Unfortunately it is often caught in its later stages as very often it affects patients who are not very dentally oriented. Think alcohol and tobacco use and abuse. Plus, it is often human nature to ignore various signs and symptoms. With the increased use of non- smoking tobacco among the younger generation... a generation who thinks that they are invincible and thus ignores warnings and symptoms... there might be an even greater need for screening than in the past.

 

It is possible that the newer methods of detection will ultimately prove to be more effective... yet perhaps not. As an example, when the sophisticated echocardiogram was introduced many patients were diagnosed with "problems" that ultimately were shown to be simply variations of a normal situation. As a result much time, energy, and money was spent only to prove that the law of diminishing returns can often be the rule of the day. I am not saying that the same thing definitely applies to any newer diagnostic techniques, but it is surely something to consider. Still, the more information the better... as long as that information is used wisely.

 

I guess differing opinions are in order and even regarding something that saves lives!! Yet such discussion is healthy if it leads to greater awareness.

[Guest]

In a 2013 report, 42,000 Americans will be diagnosed this year with oral cancer. The death rate is higher than with most cancers. I've attached a link to a current (2013) report that presents the facts including: early signs/symptoms, causes, treatment, statistics, risk factors, current research, and the importance of early detection.

 

"Historically the death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development."

 

"Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors."

 

"The good news is however, that your dentist or doctor can, in many cases, see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages."

 

I found this recent research on oral cancer to be most interesting and informative.

 

http://oralcancerfoundation.org/facts/index.htm

 

It doesn't look like you don't know what the word "research" means. The link you provided goes to a patient support website and does not present any research, i.e. scientific study, of any kind, let alone any research on the benefits or harms of oral cancer screening. It does provide links to some sites with purely statistical data, some fairly old, 1988-1992, and one recent (to 2009), and those statistics show that oral cancer doesn't even hit the top 10 of cancer deaths even in men (let alone women, in which it's rarer):

Male

Lung & bronchus

88,900 (30%)

Prostate

27,360 (9%)

Colon & rectum

25,240 (9%)

Pancreas

18,030 (6%)

Leukemia

12,590 (4%)

Liver & intrahepatic bile duct

12,090 (4%)

Esophagus

11,490 (4%)

Urinary bladder

10,180 (3%)

Non-Hodgkin lymphoma

9,830 (3%)

Kidney & renal pelvis

8,160 (3%)

All sites

292,540 (100%)

 

Of course, you may believe anything you want. I seem to remember it was Richard Dawkins who said something along the lines of "I can't disprove that there are a bunch of fairies living at the bottom of the pond." But it's absurd to state that there are facts to back up your beliefs. There is simply no evidence at this time that screening for oral cancer is in any way helpful--and it is doubtful that such evidence will ever exist given current technology.

[Cooper]

It doesn't look like you don't know what the word "research" means. The link you provided goes to a patient support website and does not present any research, i.e. scientific study, of any kind, let alone any research on the benefits or harms of oral cancer screening.

 

If you have a concern over the definition of the word "research" that's cited in this article you might want to take it up with the Oral Cancer Foundation that provided the "research" mentioned in this article entitled: "What's new in oral cancer research". I'm only a messenger here, I didn't write this article.

 

http://oralcancerfoundation.org/facts/whats_new_in_oralcavity.htm