Screening for Oral Cancer

Dental hygienists are key to changing the dynamics

Catherine Paulhamus, MA

ach April, oral cancer awareness is promoted throughout the healthcare industry and the general population. As with other cancers, such as breast and prostate, a concerted push for early and effective screening is urged to improve prognosis and survival rates. However, as Debbie Zafiropoulos, Principle of OralED Institute and Founder of the NationalCancerNetwork.org 501(c)(3), notes, oral cancer is everywhere, unfortunately. "Screening and education throughout the year should be routine, proactive care for the community, versus reactionary care or no care at all, which is not what the community deserves," she says.

Unfortunately, as many stakeholders and organizations have noted, a lack of persistent, effective screening, in conjunction with financial or insurance issues in obtaining diagnostic tests and biopsies, contribute to delayed diagnosis.¹

According to the Oral Cancer Foundation, "the dental community is the first line of defense in early detection of the disease."²There are over 100,000 dentists in the United States (generalists and specialists) examining eight to 15 patients daily. The Foundation adds, "If you include those patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher."²

Putting the Protocols into Place

While there may be agreement on the necessity for screening, how and when to implement examinations varies among practices. In an Inside Dentistryroundtable discussion, Emily Boge, RDH, BS, MPAc, urged universal screening, saying, "In the past, other providers have shared with me that an oral cancer screening is only to be completed on ‘high-risk' patients. Although I understand this thought process, I respectfully disagree. By screening all patients-young and old, smokers and nonsmokers, snuff chewers and non-tobacco users, alcohol users and those who refrain from alcohol, those having a family history of oral cancer and those that do not-the clinician not only gets accustomed to the process, but incorporates that process into the sequence of that day's appointment."³

Practices that have not determined a consistent protocol likely conduct fewer tests and have less experience. "Every day is a learning opportunity," Zafiropoulos explains. "The dental team that practices consistently becomes more comfortable and confident in providing the examination and educating the patient." For example, she explains that using the term "cancer" might not be effective in communicating with the patient. She recommends explaining the procedure as a screening for oral and skin abnormalities to alleviate patients' fear and improve the chance that they'll understand the importance and value of the  examination.

How confident are dental hygienists? In a recent article, Walsh et al discussed the influence of continuing education on dental hygienists' knowledge and behavior related to oral cancer screening.⁴ The authors determined that almost all the dental hygienists in the study thought they were performing oral and pharyngeal cancers (OPC) screening, although only about half were performing neck palpations. At a 6-month follow-up, continuing education (CE) participants reported a significant improvement in understanding thorough OPC screening, and there was also a significant improvement in the percentage of dental hygienists who informed patients of the screening procedure.⁴

In her continuing education article on screening for oral cancer, JoAnn R. Gurenlian, RDH, PhD, identified how, as prevention specialists, dental hygienists are key to actively engaging patients: "Reviewing perceptions of risk factors with the patient opens the door to discussing signs and symptoms of oral cancer and prevention strategies."⁵

Empowering the Dental Hygienist

Dental hygienists spend more time with patients-time to communicate and build relationships and trust. Ultimately, though, they cannot diagnose oral cancer, but they can impact early diagnosis. As Zafiropoulos explains, "Can you diagnose oral cancer with a clinical oral exam? The responsible answer is no, not all spots or abnormalities are cancer. There is no differential diagnosis in a palpation or visual exam. However, abnormality detection is extremely important in gaining a definitive diagnosis from an oral pathologist, specialty group, or reputable hospital vetted for cancer diagnosis protocols."⁶

As she explains, it is critical to build a matrix of adjunctive medical professionals and to get comfortable asking questions, sharing patients, and following up with a diverse group of clinicians, labs, specialists, and educators.⁶ "Small changes make big differences, and it's cumulative both in preventive and non-preventive ways," Zafiropoulos affirms. "This is a great opportunity for dental teams and organizations to really understand our ability to affect change in the mortality and morbidity rates related to oral cancer."

References

1. Goldstein LB, Duong ML, Levine R, Dillenberg J. The future of oral cancer diagnosis: merging provider awareness, patient education, and technology to achieve early detection. Compend Contin Educ Dent. 2019;40(4):208-213.

2. The role of dental and medical professionals. Oral Cancer Foundation Web site. https://oralcancerfoundation.org/dental/role-dental-medical-professionals/. Accessed March 22, 2020.

3. Boge E, Kalmar JR. Question: should dental practitioners perform a cancer exam on every patient? Inside Dentistry. 2014;12(2):42-43.

4. Walsh MM, Rankin KV, DDS; Silverman S. Influence of continuing education on dental hygienists' knowledge and behavior related to oral cancer screening and tobacco cessation. https://adha.cdeworld.com/courses/20057-influence-of-continuing-education-on-dental-hygienists-knowledge-and-behavior-related-to-oral-cancer-screening-and-tobacco-cessation. Accessed March 23, 2020.

5. Gurenlian JR. Screening for oral cancer. https://adha.cdeworld.com/courses/20338-screening-for-oral-cancer. Accessed March 23, 2020.

6. Zafiropoulos D. We can do better. Inside Dental Hygiene. 2019;15(4):6-7.