Oral Cancer Diagnoses Jump 61% From 2011 to 2015



Privately billed insurance claims related to oral cancer diagnoses rose 61% from 2011 to 2015, according to data on 21 million privately billed medical and dental claims examined by FAIR Health. The greatest increase involved throat cancer (malignant neoplasm of the nasopharynx, hypopharynx, and oropharynx). The second greatest was in tongue cancer (malignant neoplasm of the tongue).

“Oral cancer is a serious and growing public health problem,” said FAIR Health president Robin Gelburd. “We hope that our data help inform the national conversation on this topic.”

Also, 74% of oral cancer claims were for males while 26% were for females. Tongue and throat cancers in particular were more likely to occur in men than women. However, men and women had similar chances of developing gum cancer (malignant neoplasm of the gums) and an oral tumor that was benign but could become cancerous (neoplasm of uncertain behavior—oral). Tobacco use, excessive alcohol use, and human papillomavirus (HPV) are the chief risk factors.

Oral cancer claims occurred much more frequently among individuals age 46 years and older than in younger individuals, with increases among those age 56 to 65 years and decreases for those age 65 years and older. The American Cancer Society estimates that approximately 48,330 Americans will get cancer of the oral cavity or pharynx in 2016 and about 9,570 will die of the disease.

However, patients who are diagnosed in the early stages of the disease see 5-year survival rates between 80% and 90%. That’s why the ADA recommends oral cancer screenings during routine dental checkups, particularly among patients who use tobacco or consume alcohol heavily. Still, FAIR Health reports, adult males were much less likely than adult females to seek preventive dental examinations and cleanings despite their greater risk for oral cancer.

According to FAIR Health, 2 dental procedures associated with oral cancer screenings have been increasingly performed from 2007 to 2015: CDT codes D0431, an adjunctive prediagnostic test, and D7287, an exfoliative cytological sample collection, or obtaining cells for microscopic study. Approximately 65% of these codes were filed for patients between the ages of 31 and 60 years, with the 41- to 50-year-old segment seeing the most codes at about 24%.    

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