Prevalence of patients at risk for oropharyngeal cancer in veterans affairs dental clinic

Screening for oropharyngeal cancer is recommended for patients considered at risk (patients over 40, and users of tobacco or alcohol). Previous studies also indicate that the presence of an oral symptom predicts malignancy. We surveyed 389 consecutive patients in Dental clinic to determine the prevalence of patients considered high risk for oropharyngeal cancer. Using a self-administered questionnaire, patients were asked for their presence of oral symptoms, use of tobacco and alcohol, past visits to a physician, dentist, or otolaryngologist, and history of oropharyngeal carcinoma. Symptoms elicited were a change in voice, ear pain and/or cough lasting more than 4 weeks, mouth sores, red/white spots in the mouth, and difficulty/pain with swallowing. Of the 389 patients, 261(67%) were over the age of 40. Twenty-eight percent of all patients stated at least the presence of one oral symptom. Seventy-six percent had used tobacco: 32.6% were current tobacco users and 43% were former users. Fifty percent currently drank alcohol but only 6% drank on a daily basis [8% former daily drinkers, 30% total former drinkers]. Most patients over the age of 40 had over the past year visited a physician (79%) than a dentist (64%) or otolaryngologist (32%); only 7% patients had not seen any healthcare provider over the past year. Twenty-five patients were previously diagnosed with oropharyngeal carcinoma (only 2 patients were under the age of 40): 10 had oral cancer, 15 had laryngeal cancer. Fifty-seven percent had at least one risk factor for oropharyngeal cancer (62% of patients over the age of 40). The prevalence of patients over 40 at risk for oropharyngeal cancer in our clinic population was 38%. Including former smokers and drinkers increased the prevalance to 61 %. The prevalance of oral/throat cancer was 6%. Given the high prevalance of patients at risk for oropharyngeal cancer in this veteran population, screening for oropharyngeal cancer should be part of the routine dental visit. In addition, high risk patients were seen more frequently by physicians than dentists, therefore these patients should have an oropharyngeal examination by their primary physician or be referred for an annual dental examination.

Duke Scholars

Author Rowena Joy Dolor Medicine, General Internal Medicine

Author David Lee Simel Medicine, General Internal Medicine