• 12/22/2004
  • Jennifer Barrett Ozols
  • Newsweek Health (msnbc.com)

New screening tools could help dentists save lives through the early detection of oral cancer. Should insurance companies be paying for the tests?

A couple weeks before he was scheduled to have his teeth cleaned, Gerald Zember felt a slight pain in the back of his mouth. The retired lawyer figured he had burnt his tongue sipping hot soup or developed an ulcer from one too many spicy meals. And at first glance, Zember’s Ft. Lauderdale, Fla., dentist, William Balanoff, didn’t notice anything unusual during a routine examination—until he pulled out a new oral-cancer screening tool called ViziLite.

After Zember rinsed with a raspberry-flavored acetic solution, Balanoff inserted a ViziLite light stick into his patient’s mouth. Suddenly, a tiny white lesion became visible on the side of Zember’s tongue. “It was tiny, but I couldn’t explain it away,” says Balanoff, since Zember had no history of canker sores that could have left such a mark. Zember, 78, did have a history of smoking, though, which put him at higher risk for oral cancer. So Balanoff referred him to an oral surgeon to have the lesion checked out. A biopsy revealed the cells were cancerous. “It was so tiny, I might not have noticed it until a year or a year and a half later [once it had grown],” says Balanoff. “By then, it would have been a stage-three cancer, and his chances wouldn’t have been that good.”

About 30,000 Americans will be diagnosed with oral or pharyngeal cancer this year, and more than 8,000 people will die from it. The death rate—about 50 percent over five years—hasn’t changed much in the past few decades, in part because the cancer often isn’t detected until it’s visible to the naked eye. “Probably about two thirds of the cases at the time of diagnosis and treatment are already at an advanced stage,” says Sol Silverman, a professor of oral medicine at the University of California, San Francisco, and an oral-cancer spokesman for the American Dental Association. “So what can we do today? Early detection.”

Over the past few years, the American Dental Association has made detecting oral cancer earlier a priority, launching an awareness campaign in 1999. But it’s taken a little while for the new screening tools to catch on. ViziLite, manufactured by Phoenix-based Zila Pharmaceuticals, was approved by the Food and Drug Administration in November 2001, but not widely marketed until this year. Another device, OralCDx’s oral-brush biopsy, which uses a specialized brush to collect several test cells from the tongue’s surface, has been available since 2000. But it was only this year that Delta Dental Plan of Michigan and its affiliated plans in Ohio and Indiana became one of the nation’s first dental benefits providers to include the diagnostic tool, distributed by Sullivan-Schein Dental, as part of its standard benefits (DaimlerChrysler was the first employer group to incorporate the benefit for it’s 400,000 union workers).

Soon there may be another option, too. Zila’s OraTest, a patented five-minute mouth rinse that uses a special dye, has already been approved for use in more than a dozen other countries, but still awaits approval from the FDA—something that both Zila and the ADA’s Silverman expect to happen soon.