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Early detection of oral cancer
many for whom it has never been available.” The tone of the President’s letter was reassur ing. But his budget request to the Congress on January 29, 1968 was considerably less so. At that time he called for expanded programs for health care of mothers and children, for which the Congress on December 15, 1967 had author ized an expenditure of $100 million for the fiscal year commencing July 1, 1968. With one excep tion, the President agreed with the Congress’ $100 million authorization. The single exception was the dental program for poor children. The anticipated $5 million of support for the dental program suf fered an 80 percent cut in the Bureau of the Budget. The dental box score: $1 million for the chil dren’s program; $4 million worth of Presidential disinterest. His message to the dental profession is clear. But what is the President of the United States trying to tell those underprivileged children who will go through life Crippled by dental neglect? The Congress has the authority to restore the missing $4 million— and perhaps even more— to the budget, and it should be given the facts so that it can correct what we will charitably call admin istrative oversight.
Early detection o f ora / cancer April is Cancer Control Month and a good time for members of the health professions to make self-determinations as to whether they are applying to the fullest extent existing knowledge and skills to the problem of early cancer detection. The importance of early detection of oral cancer is brought out by the fact that currently about one of every three persons who develop intraoral can cer dies within a five-year period simply because the disease was not detected early enough. Each year public and private health agencies offer greater assistance to dentists and physicians in refining their cancer diagnostic capabilities. The National Center for Chronic Disease Control of the USPHS has an unusually comprehensive, interprofessional head and neck cancer program. The Center works closely with the American Den tal Association and the American Cancer Society. It supports continuing education programs at den tal schools and at the state and local levels. It sup 700 ■ JADA, Vol. 76, A pril 1968
ports casefinding programs in dental and medical schools and in hospitals. It supports specialty training programs in dental schools. And it funds the development of projects of a special nature in numerous institutions in all parts of the country. An important feature common to all of the Cen ter’s programs in the area of head and neck can cer is their interprofessional nature. Some of the projects are directed by physicians, some by den tists; but dentists and usually physicians are in volved in all o f them. As to the respective roles of physicians and dentists in the detection of can cer and other diseases of the head and neck, William L. Ross, MD, chief of the cancer control program at the Center says, “The problem is big enough for all of us to contribute toward a solu tion.” The National Center for Chronic Disease Con trol staff believes that dentists can detect oral can cer early if they will perform thorough examina tions routinely and if they will follow up the le sions they find. In the words of Doctor Ross, A careful examination will reveal apparently malignant lesions, potentially malignant le sions, apparently innocuous lesions and may reveal signs and symptoms of systemic diseases. Follow-up includes cytology of the apparently malignant or potentially malignant lesions, radiographs and other diagnostic tests as indi cated, referral, and close supervision of pa tients with persistent lesions until a final diag nosis is reached or the lesion has resolved.
The Center stresses the value of oral cytological studies, but it admits that false negatives do occur. It also points out, however, that a danger ous attitude has developed among diagnosticians that the biopsy technic is foolproof. Investigations of uterine cervix biopsies indicate that the biopsy technic may have a false negative rate at least as great as the cytological technic. Regardless of negative cytological or biopsy results, the oral le sion— which fortunately is a visible one— must, if persistent, be diligently followed up with fur ther studies. The Center’s key guidelines: “Examination. Follow-up.” are sound. So is the advice of Dr. Richard W. Tiecke, who heads the American Dental Association’s oral cancer detection pro gram: “Use all means available for detecting early oral cancer so that the patient may be treated at the earliest possible moment. It is only in this way that the low survival rate of intraoral car cinoma can be raised.”
Early detection o f ora / cancer April is Cancer Control Month and a good time for members of the health professions to make self-determinations as to whether they are applying to the fullest extent existing knowledge and skills to the problem of early cancer detection. The importance of early detection of oral cancer is brought out by the fact that currently about one of every three persons who develop intraoral can cer dies within a five-year period simply because the disease was not detected early enough. Each year public and private health agencies offer greater assistance to dentists and physicians in refining their cancer diagnostic capabilities. The National Center for Chronic Disease Control of the USPHS has an unusually comprehensive, interprofessional head and neck cancer program. The Center works closely with the American Den tal Association and the American Cancer Society. It supports continuing education programs at den tal schools and at the state and local levels. It sup 700 ■ JADA, Vol. 76, A pril 1968
ports casefinding programs in dental and medical schools and in hospitals. It supports specialty training programs in dental schools. And it funds the development of projects of a special nature in numerous institutions in all parts of the country. An important feature common to all of the Cen ter’s programs in the area of head and neck can cer is their interprofessional nature. Some of the projects are directed by physicians, some by den tists; but dentists and usually physicians are in volved in all o f them. As to the respective roles of physicians and dentists in the detection of can cer and other diseases of the head and neck, William L. Ross, MD, chief of the cancer control program at the Center says, “The problem is big enough for all of us to contribute toward a solu tion.” The National Center for Chronic Disease Con trol staff believes that dentists can detect oral can cer early if they will perform thorough examina tions routinely and if they will follow up the le sions they find. In the words of Doctor Ross, A careful examination will reveal apparently malignant lesions, potentially malignant le sions, apparently innocuous lesions and may reveal signs and symptoms of systemic diseases. Follow-up includes cytology of the apparently malignant or potentially malignant lesions, radiographs and other diagnostic tests as indi cated, referral, and close supervision of pa tients with persistent lesions until a final diag nosis is reached or the lesion has resolved.
The Center stresses the value of oral cytological studies, but it admits that false negatives do occur. It also points out, however, that a danger ous attitude has developed among diagnosticians that the biopsy technic is foolproof. Investigations of uterine cervix biopsies indicate that the biopsy technic may have a false negative rate at least as great as the cytological technic. Regardless of negative cytological or biopsy results, the oral le sion— which fortunately is a visible one— must, if persistent, be diligently followed up with fur ther studies. The Center’s key guidelines: “Examination. Follow-up.” are sound. So is the advice of Dr. Richard W. Tiecke, who heads the American Dental Association’s oral cancer detection pro gram: “Use all means available for detecting early oral cancer so that the patient may be treated at the earliest possible moment. It is only in this way that the low survival rate of intraoral car cinoma can be raised.”