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Harmony Family Dental
Harmony Family Dental
10103 N. DIVISION SUITE 201
SPOKANE, WA 99218
509-467-1562
Oral Cancer Screening Form
Our dental practice continually looks for advances to ensure that we are providing the optimum level of
oral healthcare to our patients. We are concerned about oral cancer and look for it in every patient.
One American dies every hour from oral cancer. Late detection of oral cancer is the primary cause of
increasing incidence and mortality rates of oral cancer. As with most cancers, age is the primary risk factor
for oral cancer. Tobacco and alcohol use are other major predisposing risk factors, but more than 25% of
oral cancer victims have no such lifestyle risk factors. Studies also suggest that human papillomavirus
(HPV 16/18) plays a role in more than 20% of oral cancer cases. Oral cancer risk by patient profile is as
follows:
INCREASED RISK: Patients age 18-39, sexually active patients (HPV 16/18)
HIGH RISK: Patients age 40 and older, tobacco users (ages 18-39, any type within 10 years)
HIGHEST RISK: Patients age 40 and older with lifestyle risk factors (tobacco and/or alcohol use);
previous history of oral cancer
Please select one:
YES - I would like to have the oral cancer exam.
NO - I would prefer not to have the oral cancer exam at this time.
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