JOMS study: Study emphasizes the value of discussing oral cancer risk factors with patients needing oral biopsies

ROSEMONT, Ill. – A new study suggests a doctor-patient discussion of risk factors at the time of oral cancer biopsies could be “an important initial step” toward behavior changes of at-risk patients.

The study, published in the October issue of the Journal of Oral and Maxillofacial Surgery, encourages doctors to advise their oral cancer biopsy patients of the risk factors associated with continued tobacco and alcohol use.

“Knowledge of the relation between oral biopsy and behavior change can be very important for oral and maxillofacial surgeons and other clinicians who deliver diagnoses and arrange for disease treatment because these providers are in a unique position to influence at-risk patients and lower the overall use of the chief etiologic agents responsible for oral cancer,” the authors said.

The study, published in the official journal of the American Association of Oral and Maxillofacial Surgeons, looked at the behavior changes of 605 patients to determine the association between changes in alcohol or tobacco use and an oral biopsy (an examination of cells or tissues removed from a body to check for the presence of a disease). Adults diagnosed with hyperkeratosis (a thickening of the skin’s outer layer), dysplasia (abnormal precancerous tissue), or carcinoma (a type of cancer) were included in the study. 

Larger percentages of patients with more severe clinical diagnoses quit smoking and stopped drinking alcohol following their biopsies, the study found. A higher percentage of patients with dysplasia quit than those with hyperkeratosis, a promising finding because dysplasia has shown to be potentially reversible, researchers wrote.

Nearly 36 percent of tobacco users at the time of their biopsy quit smoking after the exam, and almost 9 percent who were using alcohol stopped drinking after undergoing a biopsy.

Age and race were connected to behavior changes, emphasizing “the need for clinicians to address cessation with all types of patients,” the researchers concluded. The youngest respondents ­– ages 21 to 52 – were 3.7 times more likely to continue to smoke before or after a biopsy. White non-Hispanics were less likely to quit drinking alcohol before and after biopsy than other races.

During diagnosis, doctors can provide “objective, personal and tangible evidence of physical harm resulting from” tobacco and alcohol use to potentially change patient behavior, researchers wrote.

“Informing a patient that surgical removal of a suspicious lesion is recommended enlightens the patient to the fact that the patient’s health could be in jeopardy and that a painful procedure is recommended to determine this possibility,” authors wrote. “Also, delivery of the biopsy diagnosis serves as an opportunity to highlight unequivocally how the patient’s tissues are being affected and how cessation would be directly beneficial.”

The authors of “Is Oral Biopsy Associated With Change in Tobacco or Alcohol Use?” – all from the University of North Carolina in Chapel Hill, N.C. – are: Tiffany M. Peters, DDS, MS, Adjunct Assistant Professor, Department of Diagnostic Sciences; Ceib Phillips, PhD, MPH, Assistant Dean for Graduate/Advanced Education, Department of Orthodontics; and Valerie A. Murrah, DMD, MS, Professor and Chair, Department of Diagnostic Sciences; Director, Division of Oral and Maxillofacial Pathology.

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