(0691) On Oral Cavity Carcinoma: Dentists Provide the Best Detection of Early Disease

Introduction: Oral cavity squamous cell carcinoma (OSCC) typically presents with dental symptoms. The purpose of this study was to investigate whether dental providers were able to identify early staged OSCC and appropriately refer to head and neck surgeons.

Methods: This is a cross-sectional study of newly diagnosed OSCC patients treated with surgical resection from 2014 to 2023 at Roswell Park Comprehensive Cancer Center. For patients with recurrent disease or second OSCC primaries, only the initial diagnosis of OSCC was included. The primary predictor was the practicing specialty of the referrer, classified as either OMFS, ENT, other dental specialty, or other specialty. Outcomes encompassed pathological characteristics: pT stage, pN stage, lymphovascular invasion (LVI), and perineural invasion (PNI).

Results: In total, 215 patients were included, and most were referred by a dental provider (n = 132, 62.3%). Compared to other specialists, a larger proportion of dental referrals were for gingival primaries (27.1 vs 7.4%, p < 0.01). Dental referrals presented with earlier T stage disease (pTis/T1/T2: 61.1 vs 40%; p < 0.01) and had lower rates of cervical nodal positivity (pN0: 70.5 vs 52.1%; p = 0.01). Further, dental referrals were associated with lower rates of oral pain symptoms (61.7 vs 77.5% p = 0.02), LVI (10.9 vs 21.8%, p = 0.04), and PNI (22.3 vs 35.4%, p = 0.04). Referrals from OMFS or ENT providers were more likely to have biopsy proven disease at the initial consult (p < 0.01). However, the lack of a tissue diagnosis at presentation was not significantly associated with worse T stage (p = 0.46) or N stage (p = 0.21) on final pathology.

Conclusions: Among patients with similar risk factors and characteristics, dental referral for OSCC was found to be associated with earlier disease. OMFS/ENT providers were more likely to obtain a diagnosis of OSCC prior to referral, however a preexisting diagnosis was not associated with a more favorable final pathology. Future studies should explore whether dental detection of OSCC is more likely to arise from an asymptotic screen or a problem directed exam, as this will help efforts for earlier detection.