Early detection of oral cancer by application of four methods.

Abstract During the past several years all members and restorees were examined by the chief of the Dental Service. In order to stimulate interest throughout the staff, the assignment for examination diagnosis and treatment planning was rotated. In the early period of this study the finding of a small asymptomatic lesion brought up the question of whether a further check or biopsy was necessary. The staff was conditioned to the fact that in many instances the older members should not be subjected to a biopsy. It appears that it would be relatively easy to discover cancer of the mouth, but probably the delay in diagnosis of early oral neoplasms was due to the fact that the lesion was asymptomatic and many patients declined treatment. In the elderly or geriatric members and patients, who may be unaware of changes, a systematic and thorough clinical examination is of prime importance. If cancer is suspected, a biopsy specimen should be obtained immediately. In the period from September 1960, to July 1961, two cases of oral cancer were detected and verified. In an effort to improve dental health care, the Papanicolaou smear technique for cytologic study was initiated in the Domiciliary Dental Service in 1961. Smears were taken of all suspicious or abnormal tissue lesions discovered during the routine dental examination. This procedure was carried out routinely in every oral examination. Later those members of the staff who were not familiar with the technique were instructed and, when assigned to examinations, they also took smears. The staff more closely examined the patients they were treating and, on finding a suspicious lesion, took smears during the routine treatment course. In the period from July 1961, to July 1962, the staff detected three cases of oral cancer. In each of the one-year periods from July 1962, to July 1963, and from July 1963, to July 1964, one case of oral cancer was detected and verified. In May 1964, the toluidine blue staining test for delineation of oral neoplasms was initiated as an additional tool to improve patient care in the Domiciliary Dental Service. During the year from July 1964, to July 1965, eleven very early cases of oral cancer were detected and verified. This diagnostic staining technique applies only to changes in the epithelial layers, and the biopsy site can be more critically defined. During the previous years, it was thought that in this population, which consists mainly of the older members and patients, we were probably not detecting as many early neoplasms as possibly should be found in this age group. A more thorough and intensive examination procedure was initiated, along with the use of the Papanicolaou smear, the toluidine blue test, and the biopsy. Our dental staff readily accepted these additional responsibilities, and their enthusiastic efforts and attention were instrumental in achieving these results. This concerted effort was employed to improve the dental health care of the members, restorees, and patients. During the year from July 1965, to July 1966, a total of twenty-six cases of cancer were detected; these included eighteen cases of oral cancer and eight of skin cancer. The Papanicoloau smear and the toluidine blue test have been definite aids in the case of elderly patients who, because of fears or other reasons, refuse biopsy. The tools are of value for checking possible recurrence in patients who have had surgical or irradiation treatment. They are also useful in certain patients with cardiovascular problems, for whom biopsy may not be advisable. The oral cavity is readily accessible to routine dental examination, and it has been estimated with early detection some 90 per cent of these patients could be cured. The dentist is in an unparalleled position to detect oral cancer, and every dental office could be an oral cancer detection center.