Bill Klaproth (Host): This is an AAOMS On the Go podcast. I'm Bill Klaproth and I'm pleased to welcome Dr. Deepak Kademani. He is a Board Certified Oral and Maxillofacial Surgeon with an ABOMS Certificate of Added Qualifications in head and neck cancer, as we talk about how to host an oral cancer screening event.

Dr.  Kademani, welcome.

Deepak Kademani, DMD, MD, FACS: Well, thank you very much, Bill.

Host: Yes, great to talk with you again. Always a pleasure. So let's start with this, Dr. Kademani, could you please tell us a bit about yourself and your focus area of practice?

Deepak Kademani, DMD, MD, FACS: So I'm an oral and maxillofacial surgeon practicing in Minneapolis. I've been fortunate to have a pretty diverse career, both in academic practice and also in private practice. My main clinical area of interest is in head and neck surgery, but I do practice all aspects of oral and maxillofacial surgery from the removal of teeth and placement of dental implants to orthognathic surgery, TMJ, and also reconstructive head and neck surgery as well.

Host: How did you become interested in head and neck cancer, your focus area?

Deepak Kademani, DMD, MD, FACS: It really came from my residency training. I really felt that management of the pathology and cancer patient was the most significant aspect of clinical practice for an oral and maxillofacial surgeon. I felt it really relied on the art and skill, relying on our roots in dentistry and also in medicine and certain surgery.

So it was a very natural pull for me to practice the major aspects of our specialty.

Host: So it's fair to say you've pretty much have seen it all when it comes to head and neck cancers.

Deepak Kademani, DMD, MD, FACS: Yes, I've been practicing for 20 years and I practice a full scope of head and neck surgery. So everything from endocrine surgery with the thyroid to skull-based surgery in all aspects of oral cavity cancer surgery and skin cancer surgery as well. And also Mohs reconstruction as well.

Host: So you would be the perfect person to ask this question. You would certainly know the value of hosting free oral cancer screening events to raise awareness. Could you tell us more about that and why that is so important?

Deepak Kademani, DMD, MD, FACS: I think as oral and maxillofacial surgeons, we are really the best professional discipline – both in medicine and dentistry – to perform these types of examinations. Having gone through both medical and also dental school, there's no question that reliance on a dental education and training to be able to offer patients full and comprehensive oral examinations is going to be key, to be able to identify the types of lesions that we get concerned about and are important to be able to pick up with these types of oral screening examinations. You may or may not be aware Bill, but over 50% of head and neck cancers now are still diagnosed at advanced stage. And so the patients that get diagnosed with advanced stage cancers really struggle with the complexity of surgical treatment that they have, but also often need radiation and chemotherapy.

And all of these things tends to add to a detriment in their overall quality of life. So if we're able to diagnose patients with earlier stage disease, the complexity of treatment is much better and these patients do significantly better.

Host: So you said early detection is the key. Unfortunately, most of the time you see it when it's in an advanced state. Why is that? Do most people not know what the potential symptoms and signs are?

Deepak Kademani, DMD, MD, FACS: In the very early stages or the pre-cancerous conditions, many of these patients don't have any symptoms. As lesions continue to grow and evolve, it can take some time, and patients can often get used to those symptoms. So it can take a little bit of time for lesions to progress.

And usually when we think about symptoms when they do occur, we are looking for lumps or masses inside the mouth or the neck. We are looking for things like canker sores that don't heal for a prolonged period of time. Feelings of dysphasia or difficulty or painful swallowing. Ear pain is also a common symptom. And then we can have more subtle things like changes in bite or facial numbness or those types of things.

Host: So since people don't just normally recognize these things, that's why it's really important for a professional like you who knows what they're looking for to do these oral cancer screenings. Would that be right?

Deepak Kademani, DMD, MD, FACS: Yes. I mean, at the present time we have just around 50% of the U.S. population sees the dentist regularly. So, doing these screenings allows accessibility to patients that perhaps don't have access to care or don't go to the dentist regularly to get these types of screenings done.

Host: So is this what led you to providing these screenings? Where did you begin and when did you first host an oral cancer screening event?

Deepak Kademani, DMD, MD, FACS: This is our fifth year now of doing this and we started just in our practice and offering this to our local community. And over the years it really grew into more of a statewide event. And this year we have nine who are dental and oral maxillofacial surgery practices in our state.

But we were also fortunate to partner with U.S. Oral Surgery this year. And so we have seven states and 31 practices that are participating in our screening events. So it's been really great to see this grow.

Host: So for people that may not ordinarily even go to a dentist or even an OMS, this is a chance for them to come in and get a free screening and for you to provide a really great benefit to the community. Would that be right?

Deepak Kademani, DMD, MD, FACS: Yes, that's the goal. You know, we’re very fortunate that in the oral cavity and within the head and neck, the screenings are relatively simple. They're painless, not particularly invasive. So it's a very quick exam and we get a wealth of information and can certainly provide guidance or reassurance to our patients.

Host: And then how did you coordinate this with your fellow surgeons to take part in these events?

Deepak Kademani, DMD, MD, FACS: Well, we have a foundation that's established and it's really coordinated through the efforts of our staff. We send out really a screening kit for all of our partner practices that has all of the information that they need. We were also fortunate to partner with the University of Minnesota Oral and Maxillofacial Pathology department. They were also very generous in being able to provide free pathology interpretations for any biopsies that were done during the Oral Cancer Screening Awareness program that we have. So it's very self-explanatory. We also provide a Zoom webinar for all of our partner practices to ask questions and talk about the logistics of the screening events.

And we're really just asking for an hour or two of the week, a little bit of staff time to be able to provide this type of support and community service for the patients that we serve.

Host: So then on the flip side, what tools or methods did you use to inform the public of these events?

Deepak Kademani, DMD, MD, FACS: So we really relied on our local media outlets. That's the traditional types of networks and also using social media as well. So certainly newspaper, print, radio and television were the typical networks that we used, and then we also use social media in all of our partner practices to kind of make the public aware that we were offering these events.

Host: So in the past five years, Dr. Kademani, is it safe to say that you've caught some cancers early?

Deepak Kademani, DMD, MD, FACS: We've certainly done that. We've certainly caught a lot of pre-cancers. We've certainly had the opportunity as well to counsel patients too about risk factors for the development of cancer. And we've also been able to reassure lots and lots of patients too, that there's absolutely nothing wrong and they're doing great and just to advocate that they continue and have routine dental care as well.

Host: This really is a benefit to the community and for people that might not ordinarily go to the dentist or OMS, maybe they're high risk of oral cancers – heavy smokers, people that chew tobacco, et cetera. For them to be able to come in for a free screening and get everything checked out is really amazing. Really great things you're doing for the community, Dr. Kademani.

Deepak Kademani, DMD, MD, FACS: Well, thank you very much, Bill. It's been a real privilege to be able to do this.

Host: And it's great that you're coordinating with fellow OMSs around the state as well to give them guidelines so you're all kind of speaking from the same page. Is that right?

Deepak Kademani, DMD, MD, FACS: Yes, it’s very standardized. We have all of the examination forms and it's all very much a standardized process. So our hope is that everyone around the country will have a very comparable experience when they come for a screening.

Host: Absolutely. And that experience, as you said, could lead them to making further appointments where then you can focus on preventative care. So this all works together. Would that be right?

Deepak Kademani, DMD, MD, FACS: Yeah, that's exactly right. The vast majority of oral and maxillofacial surgeons have specialty practices, and these types of examinations are very comparable to what's done in a routine dental office. So it's really the opportunity to kind of educate our patients and the general population about the importance of oral health, encourage them to see a dentist, encourage them to have those routine visits and certainly rely on their specialty oral and maxillofacial surgeon in the community if they need any subspecialty care.

Host: Yeah, it gets them familiar with their local OMS in the community, which I think is, uh, great as well. Dr. Kademani, thank you so much for your time. I really appreciate it. Before we go, do you have any final thoughts that you would like to share with your OMS colleagues that might be thinking about doing this?

Deepak Kademani, DMD, MD, FACS: I think that if any of our colleagues and members of the American Association of Oral and Maxillofacial Surgeons are interested in participating with us, feel free to reach out to me. All of the information is on my practice website, which is MNOFS.com under the Cancer Foundation tab. And we have staff there that will be able to help and coordinate. We would love to see practices in all 50 states next year participate.

Host: That would be wonderful, and thank you so much for sharing that. Dr. Kademani, thank you so much for your time today and sharing with us your process for all of these free oral cancer screening events that you hold. So thank you again.

Deepak Kademani, DMD, MD, FACS: Okay. Thank you very much, Bill.

Host: You bet. And once again, that is Dr. Deepak Kademani, and I also want to mention that AAOMS members have access to resources including an oral cancer screening toolkit. You can get that at AAOMS.org/OralCancerAwareness. Once again, AAOMS.org/OralCancerAwareness. Go there for more information and the oral cancer screening tool kit.

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