In reading the March JADA letter to the editor from Dr. Tyler Potter and colleagues regarding the ADA’s recent oral cancer campaign, it becomes clear that they "just don’t get it."
While the entire profession would agree with the final statement in their letter advocating earlier diagnosis of oral mucosal abnormalities using improved methodologies, they fail to acknowledge the well-known fact that techniques exist to accomplish exactly that, including the scalpel biopsy. Historically, dental and medical practitioners have been encouraged and admonished relative to performance of a thorough oral examination on all patients with any follow-up care or treatment as needed. In spite of these efforts, the large number of undetected early oral cancer cases persists, ultimately presenting as late-stage disease.
Their letter, on the other hand, fails to recognize that many early-stage cancers we seek to identify are often mistaken for or considered as benign lesions1,2 and thus go undefined. Their criticism of the billboard featuring a young attractive woman with a "photographically superimposed" tongue cancer seems unwarranted. The message, which Dr. Potter and colleagues apparently missed, relates, in part, to the documented sharp upward trend in tongue cancer in young Americans3 and that attention be directed to all patients relative to oral cancer.
Furthermore, the statement that the original study design4 was flawed reflects a lack of comprehension of the statistical analysis. A review of the protocol at institutional review boards before performance of the study and the data generated afterward by independent statisticians did not indicate such "flaws." The letter writers seem to dismiss the grassroots acceptance, utilization and impact of this diagnostic approach within the dental community, in particular with reference to identifying oral mucosal alterations of uncertain potential.
While a substantial proportion of lesions evaluated will be of a benign nature, as noted in the multicenter trial, the significant number of unexpected dysplastic lesions identified and verified (by scalpel biopsy) speaks directly to early diagnosis. As clinicians, we are all too aware of the large number of mucosal alterations that are observed only with no sense of their biological nature. The brush biopsy is such a modality that bridges the gap between visual acknowledgment and scalpel biopsy, the latter being arguably the "gold standard."
Finally, the statement that nine authors who have previously published in peer-reviewed journals, including JADA, are "associated with the company that offers the service" is patently untrue. Blatantly implied is a relationship in which there was financial incentive in place in the form of an honorarium for authoring these publications.
Lectures across the country have been given by many of my esteemed and respected colleagues in which the rationale and basis for the use of the brush biopsy as a clinical tool has been explained in updates on mucosal diseases/leukoplakia. This hardly constitutes "an association," does not suggest impropriety, is outrageous and demands an apology to all individuals so named.
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