Does the 'inverse screening law' apply to oral cancer screening and regular dental check-ups?

Early detection through regular screening is a measure used in certain cancer prevention strategies. This approach has been advocated for the prevention of oral cancers in the UK. The objective of this study was to assess whether people at higher risk of oral cancer in the UK visit dentists on a regular basis, and thereby afford opportunities for oral cancer screening.

Data from two large national surveys were used. Firstly, data from the Health Survey for England, 2001, were used to assess the relationship between dental attendance (the outcome measure) and recognized oral cancer risk factors; there were 13,784 participants with complete data. We used known risk factors for oral cancer (age >40 years, male sex, alcohol intake >28 units per week, cigarettes >20 per day, and fruit and vegetables <5 times a day) to generate a risk score for oral cancer. Logistic regression was used to compute the odds ratios for regular dental attendance according to risk score. All analyses used education and social class as covariates. We also used data from the British Household Panel Survey to assess whether dental attendance behaviour is sustained over a set period of time (5,547 participants with complete data).

In persons in the higher risk category (as defined above) of the five risk factors, age, sex, alcohol, smoking, and fruit/vegetables, 68%, 56%, 52%, 43% and 60%, respectively reported regular dental check-ups. In persons with 0, 1, 2, 3, 4 and 5 of these risk factors, the odds ratio for regular dental check-ups was 1.00, 0.93, 0.81, 0.64, 0.50 and 0.28, respectively. The probability of regular dental attendance was low in all groups with a higher risk of oral cancer. In the longitudinal sample, the low probability of visiting a dentist regularly was stable over time.

Opportunistic screening for oral cancer in general dental practice in the UK is unlikely to be an effective preventive strategy.