Screening for oral cancer

Cancers of the oral cavity and pharynx are a major cause of death from cancer in the U.S. An estimated 30,750 new cases of oral cancer are expected to be diagnosed in the U.S. in 1997 and approximately 8,440 people will die of the disease.[1] This form of cancer accounts for about 3% of cancers in men and 2% in women.[1] It occurs more frequently in blacks than in whites.[2]

More than 90% of oral cancers occur in patients over the age of 45. The incidence increases steadily with age until 65, when the rate levels off. Over the past 11 years, there has been no change in incidence, but there has been a slight decrease in mortality rate.

The primary risk factors for oral cancer in American men and women are tobacco (including smokeless tobacco) and alcohol use; lower socioeconomic status, poor oral hygiene, and decayed teeth have also been implicated.[3]

Oral cancer occurs in a region of the body that is generally accessible to physical examination by the patient, the dentist, and the physician. Screening can be made more efficient by inspecting the high-risk sites where 90% of all squamous cell cancers arise: the floor of the mouth, the ventrolateral aspect of the tongue, and the soft palate complex.[4] It has been pointed out that high-risk individuals visit their medical doctors more frequently than they visit their dentists. An inspection of the oral cavity should be part of every physical examination in a dentist's or physician's office.

Although easily detected and often cured in its early stages, most oral cancers are moderately advanced (regional stage) at the time of diagnosis. Unfortunately, this trend has not changed. An oral examination should also look for leukoplakia and erythroplastic lesions, the earliest and most serious signs of squamous cell carcinoma.[5] The overall survival rate also has not changed over the past few years.


  1. Parker SL, Tong T, Bolden S, et al.: Cancer statistics, 1997. Ca-A Cancer Journal for Clinicians 47(1): 5-27, 1997.
  2. National Cancer Institute: Cancer Statistics Review 1973-1987. Bethesda, NCI Publication No. (NIH)90-2789, 1990.
  3. Elwood JM, Gallagher RP: Factors influencing early diagnosis of cancer of the oral cavity. Canadian Medical Association Journal 133(7): 651-565, 1985.
  4. Mashberg A, Barsa P: Screening for oral and oropharyngeal squamous carcinomas. Ca-A Cancer Journal for Clinicians 34(5): 262-268, 1984.
  5. Chiodo GT, Eigner T, Rosenstein DI: Oral cancer detection: the importance of routine screening for prolongation of survival. Postgraduate Medicine 80(2): 231-236, 1986.


The routine examination of asymptomatic and symptomatic patients results in the detection of earlier stage cancers as well as premalignant lesions. In 1982, routine oral examinations were performed on 672,000 initial exam veteran patients with the detection of 814 oral squamous cell cancers. In high-risk heavy smokers and drinkers over 40 years of age, the detection rate can be as high as one cancer in every 200-250 individuals examined.[1] In a regional oral cancer detection program in the Boston area, early stage disease increased from 20% to 33% over a 3-year period by stressing the importance of the routine oral examination.[2] It did not require an intricate time-consuming examination, just an examination. In Sri Lanka, primary health care workers were trained in the oral examination, and they sent to a referral center 660 suspected cancers, of which only 10% had no lesion, and 58% were confirmed as having oral cancer.[3]

When monitored in an entire population, white males have a higher percentage of oral cancer diagnosed and treated for early cancer than black males. White males with localized cancer have a better survival than black males. This indicates either more advanced localized disease in black males or a difference in treatment. Unfortunately, when detected, most oral cancers are advanced in both races.


  1. Mashberg A, Barsa P: Screening for oral and oropharyngeal squamous carcinomas. Ca-A Cancer Journal for Clinicians 34(5): 262-268, 1984.
  2. Prout M: Follow-up studies on head and neck screening. unpublished, 1990.
  3. Warnakulasuriya S, Pindborg JJ: Reliability of oral precancer screening by primary health care workers in Sri Lanka. Community Dental Health 7(1): 73-79, 1990.

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Stuart A. Greene, DDS-FAGD
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