Q: What is the “BrushTest” and when is it used?

A: The BrushTest consists of 2 components: a specially designed brush that a dentist uses to obtain a tissue sample of a common oral  spot, and the analysis of that sample using computers that help identify abnormal cells for review by a specially trained pathologist. The BrushTest requires no anesthesia, causes no pain and minimal or no bleeding.

The BrushTest is used to test the common, harmless-appearing, small white and red spots that dentists and dental hygienists see several times each week, to determine if they contain abnormal cells. These small, subtle tissue changes can be seen in up to 10% of carefully examined adults. Over 96% of these spots will not contain any abnormal cells. When an oral spot is found by the BrushTest to contain precancerous cells they are typically still harmless for several more years.  During this time the precancerous spot can be removed and oral cancer prevented.  

The BrushTest is not intended to test the highly suspicious oral lesion which should receive an immediate scalpel biopsy. 

Q: What should a dentist say to a patient who needs a BrushTest?

A: Communication with patients regarding the BrushTest needs to be focused on the fact that it is not a test for oral cancer but for oral precancer that is still harmless at the time of diagnosis. Patients should be informed that the vast majority of small, harmless-appearing oral spots that are evaluated by the BrushTest will not be found to contain any abnormal cells. It is particularly important to stress to patients that if abnormal cells are found by this test, it typically takes several years before they can cause any harm. During this time, the abnormal spot can usually be easily and completely removed.

Q: How can the BrushTest help to prevent oral cancer?

A: Consider the role of the cervical Pap smear in gynecology: In 1950, cervical cancer was the leading cause of cancer death in American women. Between 1955 and 1992, the incidence of cervical cancer in the US declined by 74%, and it now ranks 14th in frequency.  The reason for this precipitous drop was the use of the Pap smear. Gynecologists used the Pap smear to detect abnormal cells years before they could turn into cancer.

Dentistry now has a similarly effective tool to detect precancer, years before it can turn into cancer. The BrushTest is a test that identifies abnormal precancerous cells in common oral spots that do not have suspicious clinical features – spots that dentists may not suspect contain abnormal cells. This is why every unexplained oral spot needs to be tested.  Just like the Pap smear helps to prevent cervical cancer by detecting cervical precancer, the BrushTest can now help to prevent oral cancer by detecting oral precancer.

Q: Is the BrushTest accurate?

A: Yes. The computer-assisted transepithelial oral brush biopsy was recently referenced by the National Cancer Institute. The BrushTest has been the subject of well controlled, randomized, double-blind, clinical studies published in peer reviewed journals. This includes one of the largest studies ever conducted in dentistry performed at 35 dental schools and published as the cover story of the Journal of the American Dental Association.  In published studies, the accuracy of the BrushTest has been shown to be substantially greater than other accepted life-saving tests such as the Pap smear, mammogram, or prostate PSA test.

Q: Is the BrushTest similar to “adjunctive oral cancer visualization aids” that are currently being marketed? 

A: No. The BrushTest is a “test.” There are only two “tests” for oral precancer and cancer, the BrushTest and the scalpel biopsy. This is because these are the only two methods that have been demonstrated in clinical trials to have high sensitivity and specificity for the detection of these abnormalities.

Several examination devices that use non-white light are now being marketed with the objective of helping dentists to visualize tissue changes that they may not have noticed using a standard white examination light. These devices are not “tests” and are not marketed as such. Thus the patient may have a precancerous or cancerous abnormality and it will not be seen with the colored light, and conversely the observation of a tissue change using the colored light does not provide information regarding its clinical significance.