A. Gupta1, R. Bergmark5,6,7, E. Schneider8,9, A. Villa2,3,4 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Brigham And Women’s Hospital,Oral Medicine And Dentisry,Boston, MA, USA 3Harvard School of Dental Medicine,Oral Medicine Infection And Immunity,Boston, MA, USA 4Dana Farber Cancer Insititute,Oral Medicine And Oncology,Boston, MA, USA 5Brigham And Women’s Hospital,Otolaryngology-Head And Neck Surgery,Boston, MA, USA 6Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 7Harvard School Of Medicine,Otolaryngology,Brookline, MA, USA 8The Johns Hopkins University School Of Medicine,Baltimore, MD, USA 9University Of Virginia,Surgery,Charlottesville, VA, Virgin Islands, U.S.
Introduction:
According to the American Cancer Society there will be an estimated 51,540 new cases of oral cavity and pharyngeal cancers in 2018 in the United States, with nearly 33,950 in the oral cavity. Racial-ethnic disparities have been reported in oral cancer stage at diagnosis, mortality, and dentist-patient communications about oral cancer. The national guidelines recommend that all adult patients should receive an extra-oral and intra-oral examination when visiting dentists to identify potentially malignant lesions or early-stage cancers. We examined the likelihood of receiving an oral cancer screening exam among different racial-ethnic groups in the US.
Methods:
National Health and Nutrition Examination Survey (NHANES), a series of ongoing cross-sectional surveys was inquired from years 2011 to 2016. NHANES uses a complex, multistage, probability sampling design, which when weighted is representative of the US non-institutionalized population. We included all individuals older than 30 years who responded to the screening question- “Have you ever had an exam for oral cancer in which the doctor or dentist pulls on your tongue, sometimes with gauze wrapped around it, and feels under the tongue and inside the cheeks?”. Response to this question as ‘yes’ or ‘no’ was the primary outcome. The primary exposure variable was race-ethnicity. Weighted multivariable logistic regression models were computed to control for age, gender, poverty income ratio, education level, health insurance, tobacco smoking status, alcohol consumption and the consumption of abuse potential recreational drugs.
Results:
A total of 14,027 individuals representing 185,196,253 individuals nationally were included in this analysis. 29.7% reported receiving an oral cancer exam. 74.5% of these were performed by a dentist/oral surgeon, 10.3% by a doctor/physician, and 0.3% by a nurse/nurse practitioner. Weighted multivariable logistic regression models demonstrated that, Mexican-Americans (RR: 0.31; 95% CI: 0.22-0.44; p<0.001), Non-Hispanic Blacks (RR: 0.34; 95% CI: 0.26-0.45; p<0.001), Non-Hispanic Asians (RR: 0.33; 95% CI: 0.23-0.48; p<0.001), other Hispanics (RR: 0.27; 95% CI: 0.19-0.37; p<0.001) and other minority races (RR: 0.42; 95% CI: 0.27-0.66; p<0.001) were less likely to have received an oral cancer screening exam, as compared to Non-Hispanic Whites.
Conclusion:
Racial minorities are less likely to receive an oral cancer screening exam either during a dental or medical visit, as compared to non-Hispanic Whites, regardless of their insurance status, income, education, age group or the presence of high-risk behaviors such as smoking, alcohol or drug use. Further studies examining the underlying reasons for lower rates of screening among racial-ethnic minorities are needed in order to support the development of interventions to address the existing racial-ethnic disparities in the incidence and outcome of oral cancer.