By Vishwadha Chander

Only about 1 in 3 U.S. adults say a dentist has ever examined them for oral cancer – and most of those who remember getting such exams are non-Hispanic whites, a new study suggests.

The American Dental Association says dentists should routinely look for oral cancer. But the study, published in the American Journal of Preventive Medicine, found that screening rates were low overall and that racial and ethnic minorities, and people with lower income and education, were less likely to report receiving oral cancer screening during a clinic visit.

“We promise health care to all, but some sections report not getting the quality others do,” lead author Avni Gupta from the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston told Reuters Health by telephone.

Gupta and colleagues analyzed data collected in 2011-2016 as part of the National Health and Nutrition Examination Survey, from participants who said they had visited a dental clinic in the previous two years. Overall, the researchers had survey responses from more than 9,000 adults, representing more than 133 million civilians.

Participants were asked whether they had ever had an intraoral exam for cancer, in which the dentist pulls out their tongue and checks the insides of the cheeks, or an extraoral exam in which the dentist checks the neck.

Only 37.6% of participants recalled being screened with an intraoral exam. Of this group, 70.6% were non-Hispanic whites, 9.9% were non-Hispanic blacks, 5.6% were Asians, 6% were Mexican-Americans and 5.2% were “other Hispanics.”

Only 31.3% remembered receiving an extraoral exam. Again, non-Hispanic whites accounted for the majority (71.6%), followed by non-Hispanic blacks (9.8%), Mexican-Americans (5.9%), Asians (5.4%) and other Hispanics (5.1%).

Within each minority group, being poor, less educated and uninsured placed an individual at the highest risk of not being screened, the researchers said.

After accounting for things like age, education, insurance status, tobacco use and other lifestyle factors, the researchers calculated that compared to non-Hispanic whites in the U.S., members of minority groups were 53% to 73% less likely to report that a dentist had examined them for oral cancer.

“The groups less likely to be screened were also more likely to present with advanced stages of oral cancer, perhaps because they were not checked early,” said Gupta.

The findings, however, could be affected by a recall bias, because the findings depended on individuals’ memories, said Dr. Len Lichtenfeld, interim chief medical and scientific officer for the American Cancer Society (ACS), who was not involved in the study.

“People may not have been aware they were being checked. Or, their dentist may not have pulled out the tongue or checked in the way the study describes,” Lichtenfeld told Reuters Health over the phone.

Lichtenfeld noted that ACS guidelines don’t include formal recommendations for oral cancer screening.

The authors of the current study acknowledge that recall bias and poor awareness may be limitations.

“The results were analyzed with an understanding that if the self-report is incorrect, the findings might change. But it brings up an important issue – why are some groups of people less likely to say they were screened?” Gupta said.

One reason could be that dental professionals are not communicating well with patients, particularly in the groups that reported the lowest screening rates, the authors said.

They conclude, “Efforts to both educate patients about requesting oral cancer screening in dental offices and (to) adequately train dental professionals on culturally sensitive communications might (help) increase oral cancer screening exams among minority high-risk populations.”

SOURCE: American Journal of Preventive Medicine, online August 13, 2019.