Claims Related to Oral Cancer Diagnoses Rise 61 Percent since 2007

Posted on October 20, 2016

Privately billed insurance claim lines related to oral cancer diagnoses rose 61 percent from 2007 to 2015, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As shown in the infographic below, the greatest increase occurred in throat cancer (malignant neoplasm of the nasopharynx, hypopharynx and oropharynx) and the second greatest in tongue cancer (malignant neoplasm of the tongue).

Oral cancer claims occurred nearly three times as often in males (74 percent) as in females (26 percent) in the period 2011-2015, according to data from FAIR Health’s repository of over 21 billion privately billed medical and dental claims. Tongue and throat cancers in particular were more likely to occur in men than women. However, men and women had similar chances of developing gum cancer (malignant neoplasm of the gums) and an oral tumor that was benign but could become cancerous (neoplasm of uncertain behavior—oral).

In the period 2011 to 2015, oral cancer claims occurred much more frequently in individuals who were age 46 years and older than in younger individuals, according to FAIR Health data. From 2011 to 2015, oral cancer claims increased in the 56-to-65-year-old age group, and decreased in people over 65 years old.

Oral cancer is the eighth most commonly occurring cancer in males and has a high death rate. The American Cancer Society (ACS) estimates that approximately 48,330 Americans will get cancer of the oral cavity or pharynx (throat) in 2016, and that approximately 9,570 people will die of the disease. Tobacco use in any form is a principal risk factor for oral cancer, according to the ACS. Such use includes smoked tobacco in the form of cigarettes, cigars and pipes, and smokeless tobacco in the form of chewing tobacco and snuff. Excessive alcohol use and human papillomavirus (HPV) infection also are risk factors.

The Importance of Early Detection

Patients who are diagnosed with oral cancer at the early, local stage, before the cancer has spread elsewhere in the body, are much more likely to be alive five years later than patients whose cancer has spread, according to the ACS. Because of the importance of early detection, the American Dental Association (ADA) suggests that dentists perform oral cancer screenings during routine dental checkups, particularly in patients who use tobacco or consume alcohol heavily. But, FAIR Health data in the period 2007-2015 show that adult males, despite their higher risk for oral cancer, were much less likely than adult females to seek preventive dental examinations and cleanings.

According to FAIR Health data, two dental procedures associated with oral cancer screenings have been increasingly performed in recent years: CDT codes D0431, an adjunctive pre-diagnostic test, and D7287, exfoliative cytological sample collection (obtaining cells for microscopic study).1 The chart below shows the distribution by age group for those codes in the period 2007-2015.

FAIR Health President Robin Gelburd stated, “Oral cancer is a serious and growing public health problem. We hope that our data help inform the national conversation on this topic.”

1The code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), American Dental Association (ADA). All rights reserved.

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