Feasibility and challenges of oral cancer screening in a large healthcare system
Presenter: Frank Ondrey, MD;PhD Session: Early Detection and Interception Time: 4/21/2026 9:00:00 AM → 4/21/2026 12:00:00 PM
Authors
Emily Becker 1 , David Hamlar 1 , Frank G. Ondrey 2 1 Otolaryngology, Healthpartners, St Paul, MN, 2 Otolaryngology, University of Minnesota Medical School, Minneapolis, MN
Abstract
Introduction: In the US oral and oral pharyngeal cancers are increasing in incidence over the past 25 years- primarily due to the increased numbers of HPV oropharyngeal associated malignancies. Although smoking has been decreasing over the past several decades the incidence of oral cavity malignancies is stable. Problematically, similar percentages of patients present with advanced (Stage III/IV) oral cancer over several decades. This is despite adopted efforts in professional organizations to promote screening (e.g. American Dental Association, American Academy Otolaryngology) as well as national awareness campaigns on mouth cancer. We decided to examine the feasibility of instituting an oral cancer screening system in a large health care system that includes dental physicians and significant numbers of head and neck cancer surgeons and staff. Methods: The HealthPartners/Park Nicollet health care system in Minnesota services approximately 1.36 million patients regionally and a large comprehensive dental practice has been part of this system for several decades. We examined numbers of patients at high risk for oral cancer based on publicly available statistics on smoking and potentially malignant disorders based on current ADA recommendations. The healthcare system is serviced by approximately 37 otolaryngologists and mid level providers with extensive training in the identification of oral cavity lesions and head and neck cancer treatment as well as dental clinics. This is an integrated system whereby rapid referrals occur based on our prior training and outreach efforts to practitioners. Results: For 2 High risk Oral potentially malignant disorders (OPMD), the reference published incidence of leukoplakia is between .44% -3.4%. For oral lichen planus published incidence is 0.48-1.0%. The percentage of adult smokers in MN is 12.2%. Using these assumptions, we would need to conduct between 12,512 and 59,840 visits a year for leukoplakia and oral lichen planus patients, as judged by OL and OLP incidence statistics. If we included regular smokers this would become over 200,000 patient visits a year. For these conditions alone, we would need to potentially add between 6 and 100 practitioners dedicated to oral cancer screening for yearly visits. Discussion/Conclusions: To service projected oral cancer screening visits to the number of overt cancer patients each of the current otolaryngologic practitioners would have to increase their visits by 50% a week to their current schedules or add minimally 6 practitioners for the singular purpose of oral cancer screening under our proposed hypothesis. We conclude that although the examination and referral of oral lesions patients is feasible the sheer numbers of OPMD patients in the system (excluding smokers) would overwhelm the system in a universal screening scenario.
Disclosure
E. Becker, None.. D. Hamlar, None.. F. G. Ondrey, None.
Cited in
Control: 3226 · Presentation Id: 896 · Meeting 21436