While the public and media focus their attention on stalled health care reform at the public policy level, they overlook real health care reforms that could significantly improve public health, increase access and lower costs.
Consider the recent major breakthrough in early cancer detection using saliva.
With the exception of advancements for certain cancers, including breast, cervical and prostate, cancer diagnoses generally rely on the invasive, expensive and time-consuming process of tissue biopsy. This means they have been reserved for the small subset of the population already exhibiting symptoms. But by this stage cancer has often progressed to the point where it is too advanced to successfully treat.
A team of UCLA scientists is poised to upend this status quo. They’ve revolutionized the cancer detection technology of so-called liquid biopsies that detect cancer mutations not only in affected tissue but also in biomarkers throughout the body. This allows doctors to test for cancer by examining drops of saliva or other body fluids.
The importance of this development is difficult to overstate. A liquid biopsy — the easiest of which uses saliva — democratizes cancer detection from those exhibiting symptoms to all patients as part of their routine medical or dental care. It is also less invasive, faster and cheaper — especially when performed in lower-cost settings such as the dental office.
Whereas tissue biopsies take several weeks and several thousand dollars to process, new technology called electric field-induced release and measurement allows salivary diagnostics to be performed on the spot. All the patient must do is spit into a vile.
The kicker: Salivary biopsies are more reliable than existing liquid biopsies. Blind tests show salivary diagnostics are 100 percent effective in detecting cancer. On the other hand, currently liquid biopsy technologies only have an 80 percent effectiveness rate. “[EFIRM] is the holy grail of liquid biopsy,” says Dr. David Wong, associate dean for research at the UCLA School of Dentistry.
Consider salivary diagnostics’ potential impact on lung cancer, the number one cancer killer accounting for over one-quarter of all American cancer deaths. The overall five year lung cancer survival rate is very low largely because it is difficult to detect early. But if detected early enough through salivary diagnostics, existing pharmaceutical drugs can target the mutated genes before they spread.
Access and cost savings could be especially big if dentists are allowed to offer initial screenings as part of customary dental examinations and are not blocked by regulators and special interests. Given their existing familiarity with saliva, dentists should lead this effort by making initial screening assessments and working with medical professionals to make specialist referrals. This creative health care reform would improve patient care, increase access and cut into the $88.7 billion spent each year on cancer screening and treatment. Dr. Wong expects EFIRM technology could be in dentists’ offices within three years.
Federal and state governments can help accelerate this breakthrough. The National Institute of Health’s Dental and Craniofacial Research Council — the Health and Human Services body responsible for dental grant allocation — should prioritize more funding for salivary diagnostics. More post-doctoral programs should be created to encourage dentists, who have long operated in silos, to coordinate with physicians. And universal diagnostic codes must be standardized to allow dentists to be reimbursed for this service in the same manner as physicians. But ultimately, dentists must be the ones who proactively seek out this exciting opportunity to bridge the current gap with their fellow medical doctors.
Health care policy reform will continue to generate headlines. But salivary diagnostics suggests the real improvements in patient outcomes, cost and access will come from health care professionals themselves.
Dr. Joel Strom, DDS, MS, is a fellow at the Unruh Institute of Politics at the University of Southern California.