Dentists and physicians who take advantage of routine checkups to screen their high-risk patients for oral cancer may be the most cost-effective guard against the disease, at least in the United Kingdom.
The new analysis suggests that screening of high-risk patients by dentists could save anywhere from 2,000 British pounds to 12,000 British pounds (roughly $3,600 to $21,700 in U.S. dollars) in health-care costs for each additional healthy year of a patient’s life.
The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment program of the National Health Service for the United Kingdom.
Dr. Paul Speight of the University of Sheffield in England and colleagues collected data on resources and costs in oral cancer treatment from two hospitals, as well as information from published studies and expert clinicians. They tested a variety of screening scenarios - from no screening at all to screening at all physician visits - on a hypothetical population of Britons age 40 and older.
Screening high-risk patients - those who smoke or who drink heavily - brought about the most significant results.
However, Speight said the estimate assumes that treating precancerous lesions in the mouth lessen the chance that the lesions will become malignant. The review of the medical literature “revealed that there is little evidence that this is the case,” Speight said.
But Dr. Michael Kahn, an oral pathologist with Tufts University and member of the Massachusetts Dental Society, said that there is an “excellent prognosis” for people who catch oral cancer in its earliest stages.
He acknowledged that “once you’ve had a premalignant spot, you’ve already identified yourself as someone more prone to get another one.” Most dental associations recommend extra checkups and self-exams at home for these patients, he said.
Speight and colleagues’ analysis also depends heavily on how much the government-run health service in the United Kingdom would be willing to pay for both screening and treatments for oral cancer, suggesting costs in the United States may not be the same.
The models suggest screening people ages 40 to 70 may be more cost-effective than screening older patients. Screening by doctors was only slightly more expensive than screening by dentists, despite the doctors’ lack of specific training to identify oral lesions, Speight and colleagues found. They suggest that doctors may catch more cancers because they see a bigger slice of the population than their dental colleagues.
Kahn said medical students in the United States do not receive the same intensive training in detecting oral cancers that dentists and dental hygienists undergo. Both dentists and dental hygienists “are absolutely more qualified and experienced in detecting oral cancer” than physicians, he said.
“They are very well aware that they are responsible for oral cancer screening and take this responsibility very seriously - they are the gatekeepers,” Kahn said. “For the 50 percent of Americans who regularly see their dentist, whether they know it or not, they are being screened for oral cancer during their cleaning and checkup examination.”
Most people do not realize they have oral cancer until the cancer is well advanced, Speight and colleagues found, which can make treatment long and costly. The outlook for oral cancer patients - surgery, radiation therapy and lengthy jaw reconstruction and counseling - can be grim, the researchers say.
“There has been no improvement in survival for decades, and recent studies show that the incidence is increasing,” Speight added. He said the only way to reverse the trend, beyond the push to prevent smoking and heavy drinking “is by improved detection of lesions while they are small.”
Kahn agreed but said, “for the most part, the average American isn’t going to catch [oral cancer] at that stage. If they come to dentists, there is a golden opportunity to catch it early.”
Speight and colleagues say researchers should take a closer look at whether early identification of oral lesions affects future treatment and survival. They also say that their review does not look at the potential negative and positive psychological effects of screening.
Speight PM, et al. The cost-effectiveness of screening for oral cancer in primary care. Health Technology Assessment, 10(14), 2006.
Health Behavior News Service
Revision date: July 7, 2011
Last revised: by Jorge P. Ribeiro, MD