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 The American Dental Association says dentists should routinely look
for oral cancer. But the study, published in the American Journal of
Preventive Medicine, found that screening rates were low overall and
that racial and ethnic minorities, and people with lower income and
education, were less likely to report receiving oral cancer
screening during a clinic visit.
"We promise health care to all, but some sections report not getting
the quality others do," lead author Avni Gupta from the Center for
Surgery and Public Health at Brigham and Women's Hospital in Boston
told Reuters Health by telephone.
Gupta and colleagues analyzed data collected in 2011-2016 as part of
the National Health and Nutrition Examination Survey, from
participants who said they had visited a dental clinic in the
previous two years. Overall, the researchers had survey responses
from more than 9,000 adults, representing more than 133 million
civilians.
Participants were asked whether they had ever had an intraoral exam
for cancer, in which the dentist pulls out their tongue and checks
the insides of the cheeks, or an extraoral exam in which the dentist
checks the neck.
Only 37.6% of participants recalled being screened with an intraoral
exam. Of this group, 70.6% were non-Hispanic whites, 9.9% were
non-Hispanic blacks, 5.6% were Asians, 6% were Mexican-Americans and
5.2% were "other Hispanics."
Only 31.3% remembered receiving an extraoral exam. Again,
non-Hispanic whites accounted for the majority (71.6%), followed by
non-Hispanic blacks (9.8%), Mexican-Americans (5.9%), Asians (5.4%)
and other Hispanics (5.1%).
Within each minority group, being poor, less educated and uninsured
placed an individual at the highest risk of not being screened, the
researchers said.
After accounting for things like age, education, insurance status,
tobacco use and other lifestyle factors, the researchers calculated
that compared to non-Hispanic whites in the U.S., members of
minority groups were 53% to 73% less likely to report that a dentist
had examined them for oral cancer.
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"The groups less likely to be screened were also more likely to
present with advanced stages of oral cancer, perhaps because they
were not checked early," said Gupta.
The findings, however, could be affected by a recall bias, because
the findings depended on individuals' memories, said Dr. Len
Lichtenfeld, interim chief medical and scientific officer for the
American Cancer Society (ACS), who was not involved in the study.
"People may not have been aware they were being checked. Or, their
dentist may not have pulled out the tongue or checked in the way the
study describes," Lichtenfeld told Reuters Health over the phone.
Lichtenfeld noted that ACS guidelines don't include formal
recommendations for oral cancer screening.
The authors of the current study acknowledge that recall bias and
poor awareness may be limitations.
"The results were analyzed with an understanding that if the
self-report is incorrect, the findings might change. But it brings
up an important issue - why are some groups of people less likely to
say they were screened?" Gupta said.
One reason could be that dental professionals are not communicating
well with patients, particularly in the groups that reported the
lowest screening rates, the authors said.
They conclude, "Efforts to both educate patients about requesting
oral cancer screening in dental offices and (to) adequately train
dental professionals on culturally sensitive communications might
(help) increase oral cancer screening exams among minority high-risk
populations."
SOURCE: http://bit.ly/2UR0ACm American Journal of Preventive
Medicine, online August 13, 2019.
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