April 15, 2022

WSU study links dental insurance access to oral cancer outcomes

The first study to directly link dental insurance to cancer outcomes is the work of a Wayne State University School of Medicine-based team that includes Assistant Professor of Otolaryngology – Head and Neck Surgery John Cramer, M.D., FACS.

The team explored how changes in public support for dental insurance have impacted detection of early-stage oral cancer. They found that cuts to Medicaid dental insurance were associated with a 6.9% decrease in detection of early-stage oral cancer.

John Cramer, M.D., FACS

“Survival for oral cancer is dramatically higher with early detection – 70% five-year overall survival for stage I versus 35% with stage IVA,” Dr. Cramer said.

He is the principal investigator and senior author on “Association of Changes in Medicaid Dental Benefits with Localized Diagnosis of Oral Cavity Cancer,” published in JAMA Oncology.

Dr. Cramer cares for patients at the Barbara Ann Karmanos Cancer Institute. His primary clinical focus is head and neck surgical oncology.

“I treat patients with oral cancer every week and I often wonder about all of the factors that go into early presentation for some patients and advanced presentation for others,” he said.

He became interested in the potential impact of dental insurance on early detection of oral cancer last summer, when the United States Congress considered expanding dental insurance to people with Medicare.

“Disparities in oral health pale those in other medical care. For example, 62% of older adults lack dental insurance. Similarly, oral cancer has one of the greatest survival disparities of any type of cancer,” Dr. Cramer said. “These results are particularly relevant for Detroit as we have one of the widest racial disparities in survival of oral cancer of any city in the country. As states consider support for dental insurance in Medicaid and Congress considers expanding dental insurance in Medicare, one important consideration is the potential for oral cancer detection.”

The study team included WSU Otolaryngology – Head and Neck Surgery first-year residents Lulia Kana, M.D., and Daniel Quan, M.D.; and Jordan Grauer, M.D., a research fellow at WSU and an incoming resident into the same program.

The Affordable Care Act made many cancer screening examinations like colonoscopies and mammograms free, with no out-of-pocket costs for patients.

“Dental care also has an important cancer screening role, but many people don't consider this. Many people view dental insurance as an optional type of coverage, but I think this helps to bolster the case that dental insurance is not just about clean teeth but is important to the role of cancer screening,” Dr. Cramer said.

The team is planning a follow-up study focused on how cuts to dental insurance for Medicaid patients impacted racial disparities in oral cancer.

“We are trying to continue to investigate this relationship between dental insurance and oral cancer, and would like to advocate for policy change on a state and national level,” he added.

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