Jarvie Journal - College of Dental Medicine - Columbia University

Volume 56, Spring 2013
Oral Cancer Risk Assessment: A Survey of Dental Schools
Michelle Castro 2 , Deepthi Shetty 1 , Athanasios Zavras 2 *
1 Postgraduate Dental Public Health Program, College of Dental Medicine, Columbia University, NY, NY
2 College of Dental Medicine, Columbia University, NY, NY * Faculty Mentor
Introduction: Though it account for just 2% (females)-3% (males) of all cancers, Oral Squamous Cell
Carcinoma (OSCC) has one of the lowest five-year survival rates as compared with other major cancers.
The odds of survival increase from a low 26% for patients with Stage 4 OSCC to 85% for patients with
Stage 1 OSCC. Current risk assessment practices have not been effective in detecting OSCC in its early
stages. Most early lesions are asymptomatic, contributing to why approximately 65% of patients are
diagnosed at stages III or IV of the disease.
Objective: Our long-term goal of this project is to introduce the science of risk assessment as a major
educational requirement of predoctoral dental students and to eventually lead to increased utilization
while in the Dental School environment to prepare students to more efficiently and effectively diagnose
OSCC at an earlier stage.
Materials and Methods: One of the major resources that we are using for this task is the knowledge of
the professors of oral pathology and oral medicine who are currently teaching the predoctoral students.
With their help, we have gone about collecting information in the form of a survey to begin to
understand the opportunities for improvement in current practices. The results of this survey helped us
to develop an algorithm that indicates risk assessment. We developed the first draft of a risk algorithm
that is currently being pilot tested in dental clinics at Columbia University. Patients will be evaluated on
a broad variety of risk factors including alcohol consumption and quantity, tobacco use and quantity,
quantity of partners on whom the patient has performed oral sex, consumption of various food such as
fruits, vegetables, dairy products, seafood, and meat products, and high-risk occupations. We will
continue to evaluate and adapt our processes accordingly.
Additionally, we included an open-answer section to our survey that encouraged faculty members to
opine on the strengths and weaknesses of their curriculum as well as to discuss different obstacles that
they feel are present in oral cancer assessment. This section also allows responders to further clarify
previous answers, which increases their value in modifying our algorithm.
Results and Conclusions: There were several areas for opportunity that were a source of focus for a
large percentage of the dentists polled. While a majority felt that each dental student did a routine check
for suspicious lesions as part of standard protocol, many felt that graduating students were not capable of
actually recognizing a malignant lesion. An even larger percentage felt that graduating students were not
capable of recognizing a pre-malignant lesion. Almost half of the polled dentists felt that graduating
students did not sufficiently discuss oral cancer prevention with “high-risk” patients. 50% of all polled
did not believe that graduating dentists had received sufficient education in smoking cessation and
47.5% felt that there was insufficient training in alcohol abuse cessation. 65% of dentists polled felt that
students graduated without a proper understanding of the cost versus benefit of oral cancer screening.
Discussion: It is our aim to approach improvements to pre-doctoral curricula from a scientific
perspective as opposed to simply a seemingly logical one. This is an ongoing process that will require
continued revision of the algorithm. Based on the continually revised results of our meta-analyses
identifying an expanded list of risk factors, our ongoing interactions with oral pathology and medicine
professors, and continued research to better understand the barriers to effective risk assessment, we will
continue to evaluate and adapt our processes accordingly.
Michelle Castro was supported by a College of Dental Medicine Pre-Doctoral Summer Research
Fellowship sponsored by the New York Academy of Dentistry.
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