Sir, it used to be an anecdote that a dentist might only see two cases of oral cancer in their entire career. But was, or is, that true? Recalculation may be needed because, although there are many more dentists (40,000), the incidence of oral cancer has risen sharply (three-fold) in the last 30 years without a marked increase in population size. Factoring in potentially malignant, possibly pre-cancerous lesions, we will all be seeing clinically significant cases each year.
Approximately 60% of the population attend the dentist regularly (38.4 million people).1 If we reflect this attendance pattern in the 6,767 cases of mouth cancer per year, then 4,060 patients would have attended their dentist; approximately one oral cancer per ten dentists or conversely, one case per 9,500 patients seen. If we then add in potentially malignant lesions (erythroplakia, leukoplakia, submucous fibrosis, lichenoid lesions) at a population rate of 2.5%,2,3 then we might expect to see 24 premalignant lesions per year (960,000 amongst 40,000 dentists), which is two a month.
Where cancer is suspected, the patient should be urgently referred to be seen within two weeks.4 Furthermore, with an increase in oropharyngeal lesions that may spread to cervical lymph nodes, dentists should carefully check for swellings in the neck every time a patient attends, as well as a careful clinical examination of the entire oral mucosa. This may be particularly important in irregular attenders, as that may be the one chance for early detection, which could quite literally save that person's life.
References
Health and Social Care Information. Adult Dental Health Survey 2009 - Summary report and thematic series [NS]. 2011, Available online at: http://www.hscic.gov.uk/pubs/dentalsurveyfullreport09 (accessed April 2015).
Lim K, Moles D R, Speight P M . Opportunistic screening for oral cancer and precancer in general dental practice: results of a demonstration study. Br Dent J 2003; 194: 497–502.
Warnakulasuriya S, Kovacevic T, Madden P et al. Factors predicting malignant transformation in oral potentially malignant disorders among patients accrued over a 10-year period in South East England. J Oral Pathol Med 2011; 40: 677–683.
National Institute for Health and Care Excellence (NICE). Referral guidelines for suspected cancer. 2005. Available online at: https://www.nice.org.uk/guidance/cg27/chapter/referral-timelines (accessed April 2015).
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Ogden, G., Scully, C., Warnakulasuriya, S. et al. Oral cancer: Two cancer cases in a career?. Br Dent J 218, 439 (2015). https://doi.org/10.1038/sj.bdj.2015.302
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DOI: https://doi.org/10.1038/sj.bdj.2015.302