Vol. 111 No. 3 March 2011

EDITORIAL

Assuring dental student head and neck cancer screening

competency

With an annual incidence worldwide of �500,000cases, head and neck squamous cell carcinoma (HN-SCC) is the sixth most common malignancy.1 Despiterecent advances in detection, prevention, and treatment,the overall 5-year survival for HNSCC continues to bemodest. To improve long-term outcomes, effectivescreening, in conjunction with primary and secondaryprevention strategies, is critical.

Screening for HNSCC is thought to decrease bothmorbidity and mortality, because, unlike most anatomicsites, oral cavity premalignant lesions are often visibleduring a conventional visual and tactile examination.However, evidence has repeatedly demonstrated thatdentists possess a poor working knowledge of HNSCCand often do an inadequate job of screening for thedisease.2-4 Studies have also found that the majority ofsenior dental students expressed uncertainty or lackedthe ability to adequately recognize premalignant and/ormalignant lesions of the oral cavity.5,6 These data sug-gest that the challenge of ensuring adequate HNSCCscreening examinations may be multifactorial. Part ofthe issue may be related to the development of com-placency among dentists as they move further awayfrom their dental school education. In addition, newdentists may be unprepared to adequately perform thor-ough HNSCC screening examinations when they enterthe workforce.

How can the latter be true? I am not intimatelyfamiliar with the curricula for each of the United Statesdental schools. However, I am certain that the preclin-ical training provided at these institutions has extensivedidactic instruction regarding the pathobiology, diag-nosis, and treatment of diseases of the oral and maxil-lofacial region, including HNSCC. Despite this, itwould seem that the lessons learned in these classes arequickly forgotten and/or not reinforced during the sec-ond half of dental school when the focus of trainingshifts to the development of restorative skills. Some

have also suggested that complacency among the clin-

ical faculty regarding the performance of HNSCCscreening has reinforced the perception among dentalstudents that the development of excellent oral exami-nation skills is of secondary importance. The lack ofcontinuity between what is taught in the preclinicalyears and what is emphasized during the clinical yearshas been a longstanding issue in dental education.However, until now, the dichotomy between thesephases of training has not been formally addressedregarding HNSCC screening.

Therefore, it is gratifying to see that the Commissionof Dental Accreditation (CODA), the accrediting bodychartered by the United States Department of Educa-tion, recently approved the establishment of an aca-demic standard requiring all USA dental students to becompetent in the performance of a HNSCC screeningexamination and risk assessment. The hope is that therequirement for dental students to demonstrate compe-tency will result in the HNSCC screening examinationbecoming a routine component of patient management.

Though it represents an excellent opportunity to in-crease the competency of graduating dentists, there arestill several questions regarding the implementation ofthis standard. How will each school define competency,and how will it be determined? How often will com-petency be tested, and how will schools remediatestudents? How will dental schools ensure that theirclinical faculty are competent in HNSCC screening andthat the faculty consistently assess the competency ofdental students? Each of these critical issues must beaddressed if this CODA standard is to have its intendedeffect.

Finally, it should be noted that this effort was spear-headed by Drs. Michael Siegel (American Academy ofOral Medicine [AAOM]), Wayne Herman (AAOM),and Valerie Murrah (American Academy of Oral andMaxillofacial Pathology [AAOMP]). Our colleaguesshould be congratulated for taking the lead on an issue

that is near and dear to our professional hearts. It is also

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an excellent example of how our respective Academiescan find an area of common ground and work togetherin a collegial fashion. I sincerely hope that similarfuture collaborations of this nature can be forged be-tween our respective Academies. We may not see eyeto eye on all matters. However, both Academies aremodest in size, and the old adage of there being “powerin numbers” is certainly valid, especially in today’sever-changing health care landscape.

Mark W. Lingen, DDS, PhDEditor in Chief

doi:10.1016/j.tripleo.2010.11.024

REFERENCES1. Jemal A, Siegel R, Ward D, Hao Y, Xu J, Thun MJ. Cancer

statistics. CA Cancer J Clin 2009;59:225-49.2. Burzynski NJ, Rankin KV, Silverman S Jr, Scheetz JP, Jones DL.

Graduating dental students’ perceptions of oral cancer education:results of an exit survey of seven dental schools. J Cancer Educ2002;17:83-4.

3. Cannick GF, Horowitz AM, Drury TF, Reed SG, Day TA. As-sessing oral cancer awareness among dental students in SouthCarolina. J Am Dent Assoc 2005;136:373-8.

4. Horowitz AM, Drury TF, Goodman HS, Yellowitz JA. Oralcancer prevention and early detection. Dentists’ opinions andpractices. J Am Dent Assoc 2000;131:453-62.

5. Yellowitz JA, Horowitz AM, Drury TF, Goodman HS. Survey ofU.S. dentists’ knowledge and opinions about oral pharyngealcancer. J Am Dent Assoc 2000;131:653-61.

6. Horowitz AM, Siriphant P, Sheikh A, Child WL. Perspectives ofMaryland dentists on oral cancer. J Am Dent Assoc 2001;132:65-72.