GENETIC ORAL CANCER SCREENING

A representative from a genetic oral cancer screening company recently came to my office to sell the idea of using their company for testing of my patients.

False Positives

Several years ago I introduced a cancer screening device where a special light and dye were used for early detection. The idea is great, but several problems were inherent in the procedure. The biggest problem is that the technique can have false positives – lots of them.   So the patient pays for this exam, is sent to an oral surgeon, and biopsy is done, and all is OK. Great that it’s OK, but in the meantime the patient has lots of worries and has to go through the pain and expense of a procedure. If this is an isolated instance or if there is evidence of abnormal cells, this is totally worthwhile. However, the oral surgeons I work with were not impressed with the results and recommended that I discontinue usage.

Oral Exams

Oral cancer screening is considered a normal part of any oral examination.  Dentists are trained to spot unusual features in the oral tissues which may be cancer or a pre-cancer.  The lesions are usually white or red, can be raised or ulcerated.  A major concern is that the lesion may start under the surface of the tissue and won’t be diagnosed until it surfaces.  By this time, the lesion may have broken through the surface tissue to the underlying tissue at which point it can metastasize to other points of the body.  At this stage the cancer is difficult to treat and is in fact life threatening.  (See note with ***at bottom.)

New Testing Available

This company advocates that every patient 18 and older take their test every year because of the quick spread of oral cancer. I personally will have a difficult time convincing my patients to do this.

For simplicity, the patient will swish and gargle for 30 seconds and spit it back into a test cup which is then mailed to the company. That’s pretty simple. The results come back as positive, negative, or “high risk” for genetic predisposition for oral cancer (this is for the HPV, or Human Papillovirus).

I am personally not on board with this. In 35 years I have seen very few patients with oral cancer. Yes, it is possible that someone has cancer and I can’t see it, and I do look carefully on all patients. But this puts the fear factor into each patient every time we address this, with false positives still abounding. I will continue to do research in this area to see if this is worth the expense to my patients.