Monthly Archives: April 2011

Mayo Clinic finds robotic surgery effective for removing hard-to-reach throat cancer

Author: press release

Robotic surgery has become a mainstream tool for removing an ever-increasing variety of head and neck tumors. Now, a team of head and neck surgeons from Mayo Clinic has found robotic surgery can treat cancer in the narrow, hard-to-reach area beyond the tongue at the top of the voice box. Some patients were able to avoid further treatment with chemotherapy or radiation, and most could resume normal eating and speaking.

“We’ve known it’s useful for tongue base and tonsil cancers, but we wanted to assess its effectiveness in the larynx,” says Kerry Olsen, M.D., Mayo Clinic otolaryngologist and senior author of the study that was presented April 29 at the Combined Otolaryngological Spring Meetings in Chicago.

The investigation of transoral robotic surgery (TORS) followed nine patients for up to three years following removal of supraglottic squamous cell carcinoma, which affects the area of the larynx above the vocal cords. Most of the patients had advanced-stage disease. The results showed TORS effectively removed cancer, with “clean,” disease-free margins, and was easier to perform than the approach of transoral laser microsurgery via a laryngoscope. The patients also underwent the surgical removal of their adjacent neck nodes at the same operation.

“We were pleased with the cancer outcomes,” Dr. Olsen says. “We also found patients had minimal trouble after surgery, in most cases resuming normal eating, swallowing and speaking.”

With TORS, the robotic arms that enter the mouth include a thin camera, an arm with a cautery or laser, and an arm with a gripping tool to retract and grasp tissue. The surgeon sits at a console, controlling the instruments and viewing the three-dimensional surgical field on a screen. “The camera improves visibility,” Dr. Olsen says. “We also gain the ability to maneuver and see around corners and into tight spaces, and we believe we’ll now be able to take out more throat tumors than with traditional approaches of the past.”

The new application of TORS comes at the right time, Dr. Olsen notes. Cancers of the tongue and throat are on the rise. Not all patients will be candidates for robotic surgery; its use will depend on the architecture of a patient’s throat and neck, along with the type and extent of the tumor. “What we know from this study is that for larynx cancer, we have another effective surgical tool available to us,” he says. “We can further tailor the cancer treatment for each patient and provide individualized care.”

April, 2011|Oral Cancer News|

Combined CT, FDG-PET improves head/neck cancer treatments

Author: staff

Combining CT with fluorodeoxyglucose positron emission tomography (FDG-PET) imaging results in significantly more defined tumor outlines and potentially different treatment options in head and neck cancer patients compared with using CT alone, according to research presented April 29 at the Cancer Imaging and Radiation Therapy Symposium in Atlanta.

In this trial, conducted at Utrecht University Medical Center, 327 patients were treated with intensity-modulated radiation therapy for head and neck cancer. Based on the combined approach of the CT scan and FDG-PET, the researchers noticed a change in the delineation of the tumor in one out of three patients, resulting in 10% of patients’ treatment being changed and 33% of patients having their treatment adjusted.

In 17% of the patients, the primary tumor was not visible on the CT scan alone, mostly due to dental inlays.

“We expected there to be an improved delineation of the tumor,” said Homan Dehnad, MD, study author and radiation oncologist at Utrecht University Medical Center. “However, we never expected it to have such an influence on the treatment options for patients. Each dedicated institute dealing with head and neck cancer should be equipped with multi-imaged facilities.”

April, 2011|Oral Cancer News|

VEGF expression tied to poor psychological function

Author: press release

Patients with newly diagnosed head and neck squamous cell carcinoma who have increased levels of perceived stress and depressive symptoms may have higher levels of vascular endothelial growth factor expression, which is associated with shorter disease-free survival, according to a study presented at the 32nd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine, held April 27 to 30 in Washington, D.C.

Carolyn Y. Fang, Ph.D., from the Fox Chase Cancer Center in Philadelphia, and colleagues analyzed the association between psychosocial functioning and biological pathways related to tumor growth (VEGF expression) in 37 newly diagnosed, predominantly male HNSCC patients with an average age of 56.7 years. The primary tumor sites were oral cavity, larynx, and oropharynx, and more than 40 percent of patients were categorized as having early-stage disease. Prior to treatment, patients completed psychosocial questionnaires, and VEGF expression was evaluated by immunohistochemical analysis of the tumor tissue obtained during surgery.

The investigators found that, after controlling for disease stage, higher levels of perceived stress and depressive symptoms were significantly correlated with greater expression of VEGF in tumor tissue. After controlling for disease stage and other variables, increased VEGF expression was correlated with shorter disease-free survival (hazard ratio, 3.97).

“Poorer psychosocial functioning was associated with greater expression of VEGF in tumor tissue. Greater VEGF expression was, in turn, associated with shorter disease-free survival in HNSCC patients,” the authors write.

April, 2011|Oral Cancer News|

E-Cigarettes: the facts



Right now, there are 1.2 billion smokers worldwide, and 5 million of them die each year. Some experts say that death rate could double by the year 2030. While 1 million smokers now hope E-cigarettes cure their addiction, one academic says the data doesn’t add-up.

Hollywood got Freda Souligny smoking at just 13.

“It was a killer,” Souligny told Ivanhoe.

Now 81, she had a pack-a-day habit for 61 years. She stopped when emphysema led her to electric cigarettes two months ago.

“I didn’t feel this horrible withdrawal,” Souligny said.

Battery-operated, they deliver nicotine vapor through an adjustable cartridge and cost about 60 bucks to start. Souligny kicked her habit by slowly cutting the nicotine dose over several weeks. However, Professor Tom Eissenberg says E-cigs are misleading.

“We wanted to know if they really delivered nicotine — one of the things they’re supposed to do — if they really produce some of the same effects as a tobacco cigarette,” Eissenberg, Ph.D., from Virginia Commonwealth University, told Ivanhoe.




A pair of studies found while real cigarettes deliver nicotine, E-cigs do not — despite claiming to do so.

“Neither of them delivered nicotine, which was surprising, because that is, in fact, exactly what they are supposed to do,” Eissenberg said.

He says smoking an E-cig is just like puffing on an unlit cigarette. There’s no nicotine, no tobacco … nothing.

Souligny doesn’t agree.

“Well, you have to tell me what changed my life,” Souligny said. “It wasn’t medication, because I didn’t take medication.”

The studies do say E-cigs can cut the urge to smoke by nearly half, so Souligny’s mind may be tricking her body, but she doesn’t care.

“To me, it’s just been miraculous,” Souligny said.

Professor Eissenberg says E-cigs may indeed be a key tool in helping people quit standard cigarettes. Still, he’s calling for tighter government control of the products. The reason: if they don’t do what they claim to do, consumers have the right to know.

For additional research on this article, click here.



April, 2011|Oral Cancer News|

Soy increases radiation’s ability to kill lung cancer cells, study shows

Author: press release

Soy isoflavones block cancer cells’ DNA repair mechanisms while protecting normal tissue

A component in soybeans increases radiation’s ability to kill lung cancer cells, according to a study published in the April issue of the Journal of Thoracic Oncology, the official monthly journal of the International Association for the Study of Lung Cancer.

“To improve radiotherapy for lung cancer cells, we are studying the potential of natural non-toxic components of soybeans, called soy isoflavones, to augment the effect of radiation against the tumor cells and at the same time protect normal lung against radiation injury,” said Dr. Gilda Hillman, an associate professor in the Department of Radiation Oncology at Wayne State University’s School of Medicine and the Karmanos Cancer Institute in Detroit.

“These natural soy isoflavones can sensitize cancer cells to the effects of radiotherapy, by inhibiting survival mechanisms which cancer cells activate to protect themselves,” Hillman said. “At the same time, soy isoflavones can also act as antioxidants in normal tissues, which protect them against unintended damage from the radiotherapy. In a recent study, published in the Journal of Thoracic Oncology, we demonstrated that soy isoflavones increase killing of cancer cells by radiation via blocking DNA repair mechanisms, which are turned on by the cancer cells to survive the damage caused by radiation.”

Human A549 non-small cell lung cancer (NSCLC) cells that were treated with soy isoflavones before radiation showed more DNA damage and less repair activity than cells that received only radiation.

Researchers used a formulation consisting of the three main isoflavones found in soybeans, including genistein, daidzein and glycitein.

Previously, researchers had found that pure genistein demonstrated antitumor activity in human NSCLC cell lines and enhanced the effects of EGFR-tyrosine kinase inhibitors. This study showed that the soy mixture had an even greater antitumor effect than pure genistein. The soy mixture also is consistent with the soy isoflavone pills used in clinical studies, which have been proven to be safe, researchers said.

1. The study was supported by the American Institute for Cancer Research.
2. The Journal of Thoracic Oncology (JTO) is the official monthly journal of the International Association for the Study of Lung Cancer (IASLC). It is a prized resource for medical specialists and scientists who focus on the detection, prevention, diagnosis and treatment of lung cancer. It emphasizes a multidisciplinary approach, including original research (clinical trials and translational or basic research), reviews and opinion pieces.

April, 2011|Oral Cancer News|

More than 100 people receive free oral exams, courtesy of the City of Gulfport.


The Walgreen’s parking lot in Gulfport became a dentist office for a day. And instead of paying a fee for a clinical exam, patients were seen for free.

“I was very surprised because screenings of any kind are minimum of $35 to $50 dollars, so that was very nice. They advertised it very well,” St. Petersburg resident Rosalind Dunlop said.

This is the second year the City of Gulfport’s sponsored a free oral cancer screening The goal: to inform, educate and refer people to seek additional medical help if any signs are detected.

“We have volunteer dentists, it takes a couple of minutes, there’s no pain involved and it may save your life,” Gulfport Vice Mayor David Hastings said.

“It’s a free exam, basically we’ve had all sorts of people come in. Some people regularly go to the dentist, I had one person, it had been 17 years since they had been to the dentist. So, all sorts of people that have come in and I think we found, two that I’ve found that just need to be referred,” Dentist Lawrence N. Klein said.

“Last year, we screened over 200 and we referred nine people out. This year, I’ve already seen about five referral sheets going out. It’s not good to get the referral sheet, but on the same hand, it may be the thing that saves your life,” Hastings said.

“It’s your responsibility to take care of your own health. If you don’t want to know, I’m not saying anything about who doesn’t, but you can’t take care of anything if you don’t know,” Dunlop said.

“Sometimes the scary part is there’s no symptoms. Sometimes there’s swelling, sometimes there’s a growth or something that somebody will notice. But, sometimes we’ll pick up something, whether it be a clinical exam by feeling or looking or by actually taking some X-rays,” Klein said.

That’s why organizers and cancer survivors say the screening is vital.

“I was diagnosed with stage four oral cancer and I my symptoms were totally painless. I just had a little lump in my neck. Totally painless. Actually if it weren’t for my wife, I’d probably be dead today because I wouldn’t have ignored it beyond the point that it was treatable,” Hastings said.

“We came out to have it looked at. But I’ve learned. Anything I see that’s health oriented, I come out and do it. I just want to know and at least try to be proactive,” Dunlop said.

To view the full video, click here:


Protein inhibitor may supply contemporary HPV treatment


Researchers from Tufts University School of Medicine have developed a protein-based inhibitor that could provide a topical treatment for HPV as an alternative to surgical and harsh chemical treatments (FASEB Journal, April 11, 2011).

HPV affects about 20 million people in the U.S., making it the most common sexually transmitted infection. There are more than 100 types of HPV, of which more than 40 are sexually transmitted. These include two high-risk types, HPV-16 and HPV-18, which cause the majority of cervical and anogenital cancers, and some portion of head and neck cancers, particularly oral cavity and oropharynx cancers.

“Currently, there is no cure for HPV, and the available treatment options involve destroying the affected tissue. We have developed a protein inhibitor that blocks HPV protein expression in cell culture, a first step toward a topically applied treatment for this cancer-causing virus,” said senior author James Baleja, PhD, an associate professor of biochemistry at Tufts University School of Medicine.

In their efforts to inhibit HPV, Baleja and his team zeroed in on the viral protein E2, which controls viral activities including DNA replication and the activation of cancer-causing genes. Using structure-guided design, the team developed a protein called E2R that prevents E2 from functioning normally. When the researchers applied E2R to a cell model of HPV biology, viral gene transcription was halted. Because HPV infects epithelial cells, the outermost layer of the skin, and the mucous membranes, protein inhibitors such as E2R could be applied in a topical form.

Baleja and colleagues used biophysical tools including circular dichroism spectroscopy and x-ray crystallography to test the structure and stability of different inhibitors. The most stable inhibitor was then tested in mammalian cells and was found to inhibit the E2 protein of HPV-16, the high-risk strain that is most commonly associated with cancers. The data in this study suggest that the inhibitor may also be effective against another high-risk virus, HPV-18, as well as a low-risk virus, HPV-6a, which causes warts.

“Vaccines are helping to lower the incidence of HPV, but vaccines will not help the millions of women and men who currently have an infection, especially those who have high-risk and persistent infections,” Baleja said. “Social and economic challenges make widespread administration of a vaccine difficult, particularly in developing countries. A topical treatment for HPV could provide an economical option,” he added.


April, 2011|Oral Cancer News|

Modest Drinking can Heighten your Risk for Cancer



April 14, 2011 — “A considerable proportion of the most common and most lethal cancers is attributable to former and current alcohol consumption,” concludes a large European study published online April 8 in BMJ.

The researchers attribute about 10% of all cancers in men and about 3% of all cancers in women to previous and current alcohol consumption.

The estimates come from an analysis of data from the huge ongoing European Prospective Investigation Into Cancer (EPIC) and from representative data on alcohol consumption compiled by the World Health Organization (WHO).

The risk increases even with drinking moderate amounts.

“This research supports existing evidence that alcohol causes cancer and that the risk increases even with drinking moderate amounts,” coauthor Naomi Allen, DPhil, an epidemiologist at Oxford University, United Kingdom, said in a statement.

The original data in the EPIC study were collected from 1992 to 2000, so “the results from this study reflect the impact of people’s drinking habits about 10 years ago,” Dr. Allen noted.

“People are drinking even more now than they were then, and this could lead to more people developing cancer because of alcohol in the future,” she added.

Data From 8 Countries

The EPIC study, which is still ongoing, is one of the largest studies of diet and cancer ever conducted. It involved more than half a million people in Europe.

For this analysis of alcohol and cancer, the researchers used EPIC data from 363,988 participants from 8 European countries — France, Italy, Spain, the Netherlands, United Kingdom, Greece, Germany, and Denmark. Two of these centers (France and the Netherlands) recruited only women, so the total cohort was about two thirds female (254,870 women; 109,118 men).

Data on the incidence of cancer was obtained through record linkage with national cancer centers and from sources such as death certificates, health insurance records, and pathology reports.

Information on alcohol consumption was collected using a detailed questionnaire about the frequency and amount of drinking and the type of beverages consumed during the previous year. The researchers also computed data on alcohol exposure in the general population using data from a WHO survey.

Cancer Attributable to Alcohol

The researchers assumed a causal association between alcohol and cancer of the upper aerodigestive tract (which includes the oral cavity, pharynx, larynx, and esophagus), liver cancer, female breast cancer, and colorectal cancer (as decreed by the WHO’s International Agency for Research on Cancer).

The team then calculated the proportion of these specific cancers that could be attributable to previous and current alcohol consumption. They estimated that, in 2008, alcohol was responsible for 44% of the upper aerodigestive tract cancers in men and 25% in women, 33% of liver cancer in men and 18% in women, 17% of colorectal cancer in men and 4% in women, and 5% of breast cancer in women.

A substantial portion of these cancers attributable to alcohol consumption was linked to drinking more than the currently recommended upper limit, the researchers note.

The World Cancer Research Fund and the American Institute for Cancer Research recommend a maximum of 2 drinks per day (about 24 g of alcohol) for men and 1 drink (about 12 g) for women.

The team calculated that drinking more than this was responsible for 57% to 87% of the cancers attributable to alcohol (i.e., upper aerodigestive tract, liver, colorectal, and female breast cancer) in men and from 40% to 98% in women.

“Our data show that many cancer cases could have been avoided if alcohol consumption is limited to 2 alcoholic drinks per day in men and 1 alcoholic drink per day in women, which are the recommendations of many health organizations,” said lead author Madlen Schütze, PhD student and epidemiologist at the German Institute of Human Nutrition in Potsdam-Rehbrücke, Nuthetal, Germany.

“Even more cancer cases could be prevented if people reduced their alcohol intake to below recommended guidelines or stopped drinking alcohol altogether,” she said in a statement.

Although a substantial portion of the cancers were attributable to high alcohol intake, the remaining cancers were attributable to drinking alcohol at or under the currently recommended levels.

Risk Increases With Every Drink

“The cancer risk increases with every drink, so even moderate amounts of alcohol — such as a small drink each day — increases the risk of these cancers,” according to a press release from Cancer Research UK, which cosponsors the ongoing EPIC study, along with several European agencies.

“Many people just don’t know that drinking alcohol can increase their cancer risk,” said Sara Hiom, director of health information at Cancer Research UK.

“Cutting back on alcohol is one of the most important ways of lowering your cancer risk,” along with not smoking and maintaining a healthy bodyweight, she said.

The researchers touch on this point in their discussion. They refer back to studies that have shown a beneficial effect of alcohol on death from cardiovascular disease, especially coronary heart disease and ischemic stroke, which have in the past led to recommendations to enjoy a drink to benefit the heart.

But they point out that “even though light to moderate alcohol consumption might decrease the risk for cardiovascular disease, and mortality, the net effect is harmful.”

“Thus, alcohol consumption should not be recommended to prevent cardiovascular disease or all-cause mortality,” they write.

No Sensible Limit

The researchers also emphasize that this latest study, in addition to several others, shows that “there is no sensible limit below which the risk of cancer is decreased.”

This point was also made recently in an editorial in the Journal of the National Cancer Institute (2009;101:282-283), which accompanied findings from the British Million Women Study showing that even 1 drink a day significantly increased the risk for cancer (J Natl Cancer Inst. 2009;101:296-305).

There is no level of alcohol than can be considered safe.

At that time, editorialists Michael Lauer, MD, and Paul Sorlie, PhD, from the division of prevention and population sciences at the National Heart, Lung and Blood Institute in Bethesda, Maryland, wrote: “From a standpoint of cancer risk, the message of this report could not be clearer. There is no level of alcohol that can be considered safe.”

Clinical Context


Alcohol consumption accounts for a substantial number of deaths worldwide, and Europe is among the regions with highest alcohol consumption per capita. Chronic diseases, especially cancer, are among the disease burdens of alcohol consumption, but past studies have not examined the role of past consumption on future risk.

This is an analysis of a longitudinal European cohort study, EPIC, to examine the role of past and current alcohol consumption on cancer risk among men and women.

Study Highlights


  • The EPIC is a multicenter prospective cohort study from 1992 to 2000 that recruited more than 500,000 men and women aged 37 to 70 years from 10 European countries.
  • Participants were selected from the general population, except in France and the Netherlands. This analysis included participants without cancer at recruitment who were not in the top or bottom 1% of the ratio of energy requirement to energy expenditure.
  • The investigators determined alcohol consumption using a validated dietary questionnaire assessing frequency and portion size of beer/cider, wine, spirits, and fortified wine covering the 12 months before recruitment.
  • Past alcohol consumption was assessed as self-reported consumption at the ages of 20, 30, 40, and 50 years.
  • Participants were differentiated by never-consumption, former consumption (past consumption but no current consumption), and lifetime consumption (current and past consumption).
  • The incidence of cancer was determined with use of regional cancer registries, self-report, next-of-kin report, pathology registers, health records, or death certificates.
  • Loss to follow-up was less than 2% in all countries.
  • Analysis was stratified by sex, age, education, body mass index, physical activity, menopause status in women, and other factors.
  • Alcohol-attributable fractions for cancer risk were calculated.
  • The recommended level of alcohol consumption was defined as 2 drinks a day (24 g) for men and 1 drink a day (12 g) for women.
  • Consumption over that level was considered higher than recommended.
  • Across the countries, there was a north-to-south gradient in alcohol consumption.
  • Consumption was highest in Germany and Denmark and lowest in Greece and Spain, with a similar pattern seen for consumption above the recommended level.
  • Among male and female lifetime alcohol consumers, the risk for all cancers increased with each additional drink a day.
  • Former alcohol consumption in men was also associated with an increased risk for all alcohol-related cancers.
  • 10% and 3% of the risk for total cancer were attributable to lifetime alcohol consumption in men and women, respectively.
  • The number of attributable cases varied by country because of different population sizes.
  • For selected cancers, the respective risks for men and women were 44% and 25% for upper aerodigestive tract cancers, 33% and 18% for liver cancer, 17% and 4% for colorectal cancer, and 5% for breast cancer in women.
  • The highest absolute number of alcohol-related cases in men was found for aerodigestive tract cancers and in women for breast cancer.
  • A substantial portion of attributable risk was due to consumption above the recommended level of alcohol for men and women.
  • The authors concluded that lifetime alcohol consumption in men and women, especially above recommended levels, was associated with increased cancer risk and that restricting consumption to recommended levels would reduce cancer risk.

Clinical Implications


  • Lifetime alcohol consumption, especially above recommended levels, in men and women is associated with an increased cancer risk.
  • The highest cancer risk with alcohol consumption is for aerodigestive tract cancers in men and breast cancer in women.


April, 2011|Oral Cancer News|

Voice analysis after cancer treatment with organ preservation

Author: staff

This cross-sectional study objects to measure, subjectively and objectively, the voice and life quality of patients with oral cavity, pharyngeal and laryngeal cancer, after organ-preservation treatment.

25 cases diagnosed and treated at a high complexity oncology center in southeastern Brazil. All had oral cavity, pharyngeal or laryngeal cancer, with a therapeutic proposal of radiotherapy alone or simultaneous radiochemotherapy.
Acoustic voice analysis and the Voice Handicap Index protocol were used to measure voice quality. The data were analyzed through the x2, Student`s t and Kruskal Wallis tests. Significance level was 5%.

After treatment, 40% complained of hoarseness, 56% complained of throat clearing, and no patient reported aphonia. On the voice quality auditory scale, 36% had moderate dysphonia.
Acoustic voice analysis ranged from 184 to 221Hz in females, and from 92 to 241Hz in males. As for quality of life, most patients had mild physical, functional and emotional handicaps.

Chemio-radiation organ preservation protocols in the patients studied may leave the organ but with reduced function which brings communication sequelae.
In such cases, voice assessment and quality of life protocols, as well as speech therapy rehabilitation, are important tools to preserve function, measure and treat alterations, and reintegrate patients into the community.

Authors: Renata Campos, Cristina Maciel, Marcelle Cesca, Isabel Leite
Source: Head &Neck Oncology 2011, 3:19

April, 2011|Oral Cancer News|

How do you conquer the main difficulties to accomplish a proper oral cancer screening?


From coast to coast the same answer complete

As I tour this country presenting programs on early oral cancer detection, I ask the same question of all my attendees: What do you think is the main reason that dentists give for not doing a complete oral cancer examination?

The unanimous response in more than 25 states and close to 50 locations is, “Time!” … Yes, time!

My next question is always the same: How much time does it take to do a complete extraoral and intraoral cancer examination?

The answer is always the same: “One to one-and-a-half minutes.”

Something changed somewhere along the way

Within this past year, I was made aware of a statewide study evaluating outcomes of dental school education at one particular state-supported dental school. Among the topic areas evaluated was the percent of graduates who are doing a complete extra-/intraoral cancer screening examination in their current practice setting. About 30% of respondents replied in the affirmative. Only one-third! And that was within the first five years out of dental school. Nationwide, the percent of dental offices doing a complete screening examination is only about 20%!

My question is what happened that stopped dental professionals from doing a complete extra-/intraoral cancer screening?

What are the barriers stopping us from doing what we all know we should be doing?

Brief overview of Parts 1 and 2

In Part 1, I discussed that, in my opinion, there is a four-part “system of early oral cancer detection” for any dental office to be maximally effective:

  1. The target population: Who do we examine and why?
  2. The basic examination: How do we perform and record it?
  3. The delivery of a difficult message: Verbal skills and seamless referrals
  4. The new tools available for screening: What are they, how do they work, and when are they used?

Part 1: the first resistance factor

  • Overall lack of confidence in doing the complete oral cancer screening examination. The rationale: “Not doing the exam at all puts me at less risk than doing it and missing something.”

Part 2: the second resistance factor

  • Being unclear about who to examine: The changing target population.

Now, in Part 3: the third resistance factor

  • Uncertainty about the complete extraoral and intraoral screening examination itself.

When every dental health-care provider had his or her respective training, the “parts and pieces” of the extraoral and intraoral oral cancer screening examination were:

  • Discussed at length in the classroom setting
  • Practiced (usually one student on another)
  • Required to be performed and recorded for every patient evaluated as a new patient
  • Required to be performed and recorded in the preventive recare clinical areas

The critical nature of this examination, the doing of it, and the recording of it were all stressed. So what happened?

It’s all there inside our heads

Besides our own books from our training, there are many books and online materials available that can serve as a refresher on how our cancer screening should be done. This “cancer screening exam” has not changed in more than 30 years.

As a prominent oral pathologist who attended a recent program of mine agreed, a squamous cell carcinoma looks the same now as it did 30, 40, or more years ago. So the majority of pathology has not changed either. To refresh what is already in our heads, we just need to take a few minutes, break out our books or our computer, and do a review. Simple, huh? So why is there resistance? Is it ego?What do you think?

Here are the facts:

  1. We were taught how to do an effective cancer screening examination.
  2. We have the tools at our fingertips to review what we were taught at any time we would like to do so.

If the barrier to doing a complete cancer screening examination is not being sure of what one should be doing, voila! Here is a way to easily get unstuck.

If your ego does not allow you to admit that you are rusty or unclear about what you need to be doing when performing the cancer screening exam, then you can quietly review what you need to know privately.

What about when the patient asks, “Why are you doing this cancer screening exam now when you did not do it before?”

Now that you are committed and have clarified and sharpened your skills about the complete cancer screening exam, what is your next step?

Involve the entire team!

  1. Have a discussion with your team about the mission of your office as it relates to the complete cancer screening exam (see Dental Economics article by this author, December 2008. Complete buy-in is critical.
  2. Write down the questions that might arise when patients experience this exam.
  3. Role-play and practice the communication skills with each other that will make it comfortable and effortless to answer these questions that we all know will arise.

I am often asked to provide a scripted reply to the patient question: “Why are you doing this now?” The process of working through a response for yourself is critical to the ownership and buy-in that is required for maximum team success. So I encourage you to create your own scripts in your own words.

Work through this challenge of what the “complete cancer exam” entails and how to reply to your patients’ questions about why you are doing it. Once accomplished, you will overcome another common barrier that stands in the way of performing the routine extra-/intraoral cancer screening exam that we all were taught to do and know we should be doing!

In Part 4, I will be discussing the critical aspect of recordkeeping that is a key adjunct to the cancer screening exam. The confusion/lack of clarity about what this recordkeeping must entail, as well as how it must be done medicolegally, is a barrier for many dentists that is directly connected with the uncertainty about exactly how the cancer screening exam should be performed.


Jonathan A. Bregman, DDS, FAGD, is a clinician, speaker, author, and trainer who led successful dental practices for more than 30 years. While dedicated to improving the dentist, team, and patient experience, he has a passion for educating dental professionals about early oral cancer detection and laser-assisted dentistry. You may contact Dr. Bregman by e-mail at or visit Also be sure to check out his blog at

April, 2011|Oral Cancer News|