What specialist do I refer to for oral cancer screening?

From the Guidelines

For oral cancer screening, you should primarily consult with a dentist or an oral and maxillofacial specialist. According to the U.S. Preventive Services Task Force recommendation statement published in the Annals of Internal Medicine in 2014 1, an oral cancer screening examination should include a visual inspection of the face, neck, lips, labial mucosa, buccal mucosa, gingiva, floor of the mouth, tongue, and palate.

Key Points to Consider

• Dentists are trained to perform routine oral cancer screenings during regular dental checkups, looking for abnormal tissues, sores, or lesions in your mouth, lips, tongue, and throat.
• If your dentist identifies any suspicious areas, they may refer you to an oral and maxillofacial surgeon, an otolaryngologist (ear, nose, and throat doctor), or an oral pathologist for further evaluation and possible biopsy.
• These specialists have advanced training in diagnosing and treating oral cancers.
• It's recommended to have oral cancer screenings at least once a year during your regular dental visits, especially if you have risk factors such as tobacco use, heavy alcohol consumption, previous oral cancer diagnosis, or significant sun exposure to your lips.
• Early detection significantly improves treatment outcomes for oral cancer, as cancerous cells identified in earlier stages are more responsive to treatment and have better survival rates, with up to 75% of cases of oral cancer attributed to tobacco and alcohol use 1.

From the Research

Oral Cancer Screening Specialists

To determine the specialist to refer to for oral cancer screening, consider the following points:

• Both general practitioners (GPs) and dentists can refer oral cancer, with varying proportions reported in different studies 2
• Dentists may refer oral cancer at an earlier stage, especially in the absence of patient-perceived symptoms 2
• Regular dental attenders are a select group that is regularly screened for oral cancer, and it is likely that screening is not delivered to those with the highest risk 2

Recommendations for Oral Cancer Screening

The following recommendations are based on available evidence:

• Clinicians should remain alert for signs of potentially malignant lesions or early-stage cancers in all patients while performing routine visual and tactile examinations 3
• For seemingly innocuous lesions, clinicians should follow up in seven to 14 days to confirm persistence after removing any possible cause 3
• For lesions that raise suspicion of cancer or for lesions that persist after removal of a possible cause, clinicians should communicate the potential benefits and risks of early diagnosis 3

Specialist Referral

Based on the evidence, it is recommended to refer to:

• Dentists, as they are more likely to refer oral cancer at an earlier stage and have regular contact with patients for screening 2, 4
• Oral surgeons or specialists in oral medicine, as they have advanced training and experience in the diagnosis of oral mucosal disease 3