Sociodemographic Disparities in Oral Cancer Screening Rates

Dental professionals play an important role in identifying oral and oropharyngeal cancer through oral cancer screenings, as early detection significantly improves patient survival rates. But not all patients are screened for oral cancer during dental visits, particularly minority and lower-income individuals, according to findings from the study, “Disparities in Oral Cancer Screening Among Dental Professionals: NHANES 2011–2016,” published in the American Journal of Preventive Medicine.

The disparities were independent of two major risk factors for oral cancer: smoking and alcohol consumption. This indicates patients are not necessarily being screened based on their high-risk profile for oral cancer, but rather on sociodemographic characteristics.

This study reveals access to oral health care is not enough, says first author Avni Gupta, BDS, MPH, a research scientist at the Boston-based Brigham and Women’s Center for Surgery and Public Health. Not screening certain patient subgroups is a missed opportunity for oral health professionals to detect oral cancer and quickly refer these patients for treatment.

“We need to look beyond access,” says Gupta. “We talk a lot about disparities in medical care, but the quality of dental care services is important, too. We need to better understand the barriers that dental providers face in order to ensure that patients get the same level and quality of care, regardless of sociodemographic factors.”

Led by Gupta, researchers at Brigham and Women’s Hospital in Boston looked at a nationally representative sample of civilian, non-institutionalized individuals in the US from 2011 to 2016 that had visited a dentist in the last two years. Patients aged 30 and over self-reported if they had ever had an intraoral or extraoral exam, which are noninvasive procedures performed in an outpatient setting.

Of these individuals, 37.6 % reported receiving an intraoral cancer screening, while 31.3% reported receiving an extraoral exam. The team then adjusted for various risk factors (race/ethnicity, sex, age, marital status, education, health insurance status, smoking status, number of alcoholic drinks per week, and poverty income ratio) and found oral cancer screening rates were much lower among racial minorities, lower-income groups, and those who were uninsured or publicly insured.

Clinicians should be prepared to provide routine oral cancer screenings, and educate patients about self-exams and risk factors. Additionally, oral health professionals must be able to recognize precancerous or cancerous lesions and be trained on culturally sensitive topics.

Gupta notes the report underscores the need for health care professionals to evaluate how and why the quality of care being delivered is different between these patient subgroups.

Researchers suggest patient- and dental professional-related factors may be the reason patients are not receiving recommended services. In addition, a low level of oral cancer awareness may prevent patients from understanding or asking for screenings, or they may visit dental clinics that are overburdened to the point clinicians do not have time to provide all recommended screening and preventive services.