• 10/25/2001
  • Jennifer Huget
  • The Washington Post

It’s not every day a dentist gets to play Star Wars. But that’s not why more than 30,000 dentists in the United States are deploying OralCDx, a new diagnostic tool that incorporates technology developed as part of the Strategic Defense Initiative. OralCDx, launched nationwide last year, offers dentists a better shot at catching oral cancer lesions while there’s time to treat them.

About 8,000 Americans die of oral cancer each year. Nearly 30,000 new cases are diagnosed annually, and only 53 percent of all oral cancer victims are still alive five years after diagnosis. But among those in whom the disease — which is most common among tobacco users and heavy drinkers and is more common among men, people over 40 and African Americans — is caught early, five-year survival rates soar to 88 percent.

The problem has been that early stage oral cancer lesions look like benign mouth lesions, even to vigilant dentists. By the time a lesion becomes obviously, visibly cancerous, successful treatment is difficult.

In the past, dentists have had to make tough choices: Should they perform traditional scalpel biopsies (or refer patients to oral surgeons for the procedure) on all of the estimated 5 percent to 15 percent of their patients who have oral lesions? At up to $300 per procedure, plus lab analysis fees of up to several hundred dollars, scalpel biopsy is costly. Plus, the procedure requires the uncomfortable surgical removal of chunks of tissue, and only a small number of the lesions caught in this net turn out to be cancerous.

OralCDx, produced by New York-based OralScan Laboratories Inc., helps dentists determine which lesions warrant a biopsy. When faced with a lesion that is even remotely suspicious, the dentist gathers three layers of tissue with a device that looks a bit like a tiny toilet brush. Having completed this painless procedure, he swabs a slide and mails it off to OralCDx.

The software at the heart of the OralCDx system is adapted from a program designed for the Strategic Defense Initiative, the ambitious missile defense system championed by President Reagan in the 1980s. With it, OralCDx can spot a cancerous cell even if it is partially obscured by other cells, much in the way that the SDI system is supposed to sort decoys from real missiles. Having identified, with the computer’s help, any suspicious cells, the OralCDx pathologist faxes a report to the dentist, who can either proceed with a scalpel biopsy or tell the patient to rest easy.

At $65 for the lab work plus the typical procedure fee of $100 to $150 charged by the dentist (who gets the test kits for free from OralScan), the new system might be pricey for the 108 million Americans without dental insurance. OralScan points out, though, that many medical insurance plans cover the cost.

While the SDI’s ability to distinguish real targets from decoys remains unproven, OralCDx, which received an American Dental Association Seal of Acceptance in October, is backed by a study published in the Journal of the American Dental Association in 1999. In that study, the system accurately detected 100 percent of the cancerous and precancerous lesions included in the trial and even picked up signs of cancer lesions that clinicians hadn’t considered suspicious.

No word so far, though, as to whether OralCDx can be fooled by Mylar balloons.