Current Trends Examinations for Oral Cancer -- United States, 1992

During 1992, oral cancer (i.e., cancers of the oral cavity and pharynx) was diagnosed in approximately 30,000 persons in the United States and caused nearly 8000 deaths (1); approximately 70% of deaths from oral cancer are associated with smoking (2) and other forms of tobacco use (3). Although the 5-year survival rate (53%) for persons with oral cancer remains low, survival varies by stage at diagnosis (4). Detection of oral cancers by oral examination can reduce morbidity and death associated with this problem (5). To characterize examinations for oral cancer among U.S. adults, CDC analyzed data from the 1992 National Health Interview Survey-Cancer Control (NHIS-CC) supplement. This report summarizes findings from that analysis.

The NHIS-CC supplement collected self-reported information from a representative sample (n=12,035) of the U.S. civilian, noninstitutionalized population aged greater than or equal to 18 years regarding cancer screening and cancer-risk behaviors. The response rate was 87.0%. Participants were asked, "Have you ever had a test for oral cancer," and were provided a description of the examination (i.e., "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?") and were asked about cigarette smoking and other tobacco use. Persons reporting that they had had an examination were asked the length of time since the most recent one and the reason for and the type of health professional who performed the examination. Data were weighted to adjust for nonresponse and sample design to provide national estimates. Confidence intervals (CIs) were calculated using standard errors generated by SUDAAN (6).

Overall, 14.3% (95% CI= plus or minus 0.8%) of respondents reported that they had ever been examined for oral cancer. Having ever received an oral cancer examination varied by demographic characteristics, education, and smoking status (Table_1). Blacks were less likely than whites and Hispanics were less likely than non-Hispanics to report an oral cancer examination. The percentage of adults reporting an examination for oral cancer increased with level of education and with age but was lower for persons aged greater than or equal to 65 years. Current smokers were less likely to report an examination than were former smokers.

Of persons ever examined for oral cancer, 48.7% (95% CI= plus or minus 3.0%) reported their most recent examination had occurred during the preceding year (Table_1). More than half (54.4%; 95% CI= plus or minus 3.3%) of respondents who had received oral cancer examinations reported that the most recent one was part of a routine dental examination and more than one third (35.0%; 95% CI= plus or minus 3.2%) as part of a routine physical examination; small proportions reported that the primary reason was because of a specific oral problem (6.3%; 95% CI= plus or minus 1.5%) or for other reasons (4.3%; 95% CI= plus or minus 1.3%).

Among respondents who reported examinations, 67.4% (95% CI= plus or minus 3.1%) reported that the most recent one had been performed by a dentist, followed by a physician (23.5%; 95% CI= plus or minus 2.9%), a dental hygienist (6.6%; 95% CI= plus or minus 1.5%), and another health-care provider (2.5%; 95% CI= plus or minus 0.8%).

Reported by: Office on Smoking and Health, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion; Div of Oral Health, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: More than three fourths of oral cancers occur in sites that can be readily visualized or palpated (e.g., tongue, 20% of oral cancers; lip, 12%; oropharynx or tonsils, 13%; floor of mouth, 11%; and other sites within the oral cavity, 26% {7}) during an oral examination. One of the national health objectives for the year 2000 is to increase to at least 40% the proportion of persons aged greater than or equal to 50 years who have received an oral examination while visiting a primary-care provider during the preceding year (objective 16.14) (5).

The findings in this report indicate that a low proportion of persons reported having had an examination for oral cancer, ever or during the preceding year. At least two explanations may account for these findings. First, clinical health-care providers may not conduct oral examinations routinely or when patients' medical histories indicate the need for an examination. In addition, some clinical health-care providers may not have received appropriate training beyond that needed to conduct a simple oral inspection and thus do not examine or palpate for early clinical signs of oral cancer. Second, the prevalence of oral cancer examinations may be underestimated because some persons made primary-care visits for reasons unlikely to prompt an examination for oral cancer and because some patients may not recall receiving an oral cancer examination, despite a prompting question.

Routine examinations by primary-care providers offer opportunities for primary and secondary prevention. The U.S. Preventive Services Task Force has recommended that clinical health-care providers perform oral examinations for cancerous lesions in patients who use tobacco or excessive amounts of alcohol (8). Persons who may be at risk for oral cancer should be identified and counseled about risk behaviors (e.g., tobacco use) and encouraged to have regular oral examinations. The findings in this report may be used to target efforts to increase oral examinations in underserved groups and others (e.g., racial/ethnic minorities and persons with less than 12 years of education) and groups at increased risk for oral cancer (e.g., persons who smoke cigarettes or use other tobacco products).

References

1. Boring CC, Squires TS, Tong T. Cancer statistics, 1992. CA 1992;42:19-38.

2. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

3. Silverman S Jr, Shillitoe EJ. Etiology and predisposing factors. In: Silverman S Jr, ed. Oral cancer. 3rd ed. Atlanta: American Cancer Society, 1989:7-37.

4. National Cancer Institute. Cancer statistics review, 1973-1990. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1993; DHHS publication no. (NIH)93-2789.

5. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

6. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.30 {Software documentation}. Research Triangle Park, North Carolina: Research Triangle Institute, 1989.

7. CDC/National Institutes of Health. Cancers of the oral cavity and pharynx: a statistics review monograph, 1973-1987. Atlanta: US Department of Health and Human Services, Public Health Service, 1991.

8. US Preventive Services Task Force. Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions -- report of the U.S. Preventive Services Task Force. Baltimore: Williams and Wilkins, 1989.

Table_1
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TABLE 1. Percentage of respondents who reported having had an oral cancer
examination ever and during the preceding year, by selected characteristics --
United States, National Health Interview Survey-Cancer Control Supplement, 1992
==================================================================================
                                                Had most recent oral
                       Ever had examination      cancer examination
                          for oral cancer       within preceding year
                       --------------------     ---------------------
Characteristic           %      (95% CI *)         %        (95% CI)
---------------------------------------------------------------------
Sex
  Female                13.9     (+/-1.0)         50.5      (+/- 3.8)
  Male                  14.8     (+/-1.2)         46.8      (+/- 4.5)

Age group (yrs)
  18-24                  9.0     (+/-2.0)         37.2      (+/-10.7)
  25-44                 14.4     (+/-1.1)         50.4      (+/- 4.4)
  45-64                 17.5     (+/-1.8)         48.6      (+/- 5.4)
   >=65                 13.3     (+/-1.6)         50.1      (+/- 7.2)

Race/Ethnicity
  White                 15.2     (+/-0.9)         49.8      (+/- 3.2)
  Black                  9.0     (+/-1.8)         29.9      (+/- 9.0)
  Other +               10.7     (+/-4.2)          &

Hispanic origin
  Hispanic               9.3     (+/-1.9)          &
  Non-Hispanic          14.7     (+/-0.9)         49.5      (+/- 3.1)

Education (yrs)
    <12                  8.5     (+/-1.3)         39.4      (+/- 7.6)
     12                 11.4     (+/-1.1)         45.0      (+/- 5.2)
  13-15                 17.3     (+/-1.8)         50.4      (+/- 5.7)
   >=16                 22.7     (+/-2.0)         54.2      (+/- 4.9)

Smoking status
  Current @             13.0     (+/-1.5)         46.4      (+/- 6.0)
  Former **             16.7     (+/-1.6)         47.9      (+/- 5.4)
  Never                 13.9     (+/-1.1)         50.5      (+/- 4.3)

Smokeless tobacco use status
  Current ++            11.2     (+/-4.1)          &
  Former &&             13.8     (+/-3.4)          &
  Never                 14.5     (+/-0.9)         48.9      (+/- 3.1)

Total                   14.3     (+/-0.8)         48.7      (+/- 3.0)
---------------------------------------------------------------------
 * Confidence interval.
 + Includes American Indians/Alaskan Natives and Asians/Pacific Islanders.
 & Number too small for meaningful analysis.
 @ Respondents who reported having smoked at least 100 cigarettes and who were
   currently smoking every day or some days at the time of the interview.
** Respondents who reported having smoked at least 100 cigarettes but were not
   smoking at the time of the interview.
++ Respondents who reported using snuff and/or chewing tobacco at least 20 times
   and who were using these products at the time of the interview.
&& Respondents who reported using snuff and/or chewing tobacco at least 20 times
   and who were not using these products at the time of the interview.
==================================================================================

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