Training Undergraduates to Diagnose Oral Cancer

Performing a death-defying act

Oral cancer early detection: What will it take?

Aim Oral cancer poses a significant global health challenge, characterized by rising incidence rates and substantial morbidity and mortality. Given the pivotal role of dental professionals in early detection and prevention, it is imperative to ensure heightened awareness among dental students. This survey aims to assess the level of knowledge among Near East University Faculty of Dentistry students regarding oral cancers, determine their educational approach, and identify opportunities for enhancing oral cancer education. Material and method A structured questionnaire assessed students’ knowledge, perceptions, and preferences regarding oral cancer education. Data were collected electronically and analyzed descriptively. Results A total of 330 students attended to the survey, including 64 1st grade, 38 2nd grade, 65 3rd grade, 74 4th grade, and 89 5th grade students. 167 students stated that they are not well informed about oral cancers while 102 students stated that they are partially informed. 55 students said that they have no idea about oral cancers. While 257 of 330 students stated that there should be a new course under the name of oral cancers, 73 students stated that they did not need such a course. Conclusion The study highlights deficiencies in oral cancer awareness among dental students, emphasizing the urgent need for targeted educational interventions. By addressing these gaps, future dental professionals can effectively contribute to oral cancer prevention and management.

Oral Pharyngeal Cancer Prevention and Early Detection: Dentists' Opinions and Practices

Maryland adults’ perspectives on oral cancer prevention and early detection

Oral cancer has emerged as a significant cause of global public health concern in both developing and developed nations. Multiple socio-demographic and habit-related risk factors have been attributed to causing oral cancer. A diverse array of challenges exists in the global campaign to address the burden of oral cancer. Such challenges have served as barriers to the early diagnosis and treatment of oral cancer, thus impacting the scope of the public health benefit and chances for survival. Oral health screening services should be integrated into National Public Health Programs and the development of an evidence-base on strategies which focus on primary prevention and community health education will assist in efforts to detect and treat oral cancer at earlier stages in the epidemiology of the disease. References World Health Organization. Oral health - Fact sheet N°318, 2012. [ http://www.who.int/mediacentre/factsheets/fs318/en/ ] Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009; 45(4-5): 309-16. Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012; 2012: 701932. Zohoori FV, Shah K, Mason J, Shucksmith J. Identifying factors to improve oral cancer screening uptake: a qualitative study. PLoS One 2012; 7(10): e47410. Lin WJ, Jiang RS, Wu SH, Chen FJ, Liu SA. Smoking, alcohol, and betel quid and oral cancer: a prospective cohort study. J Oncol 2011; 2011: 525976. Stanko P, Kruzliak P, Labas P. Role of human papilloma virus infection and oral-genital contact in oral cancer etiopathogenesis. Bratisl Lek Listy 2013; 114(6): 345-8. Pakfetrat A, Falaki F, Esmaily HO, Shabestari S. Oral cancer knowledge among patients referred to Mashhad dental school, Iran. Arch Iran Med 2010; 13(6): 543-8. Rahman B, Hawas N, Rahman MM, Rabah AF, Al Kawas S. Assessing dental students' knowledge of oral cancer in the United Arab Emirates. Int Dent J 2013; 63(2): 80-4. Saleh A, Yang YH, Wan Abd Ghani WM, Abdullah N, Doss JG, Navonil R, et al. Promoting oral cancer awareness and early detection using a mass media approach. Asian Pac J Cancer Prev 2012; 13(4): 1217-24. Kujan O, Sloan P. Dilemmas of oral cancer screening: an update. Asian Pac J Cancer Prev 2013; 14(5): 3369-73.

Aim: Oral cancer (OC) is characterized by a high mortality rate because most cases are diagnosed at an advanced stage. The purpose of this study was to assess population knowledge at screening for OC, risk factors, prevention, and early detection, and to determine whether factors such as level of education and gender affect knowledge of the respondents. Material and Methods: The study was conducted at the School of Dental Medicine University of Zagreb and the Faculty of Dental Medicine University of Rijeka using the attached questionnaire. Participants were patients who arrived for free screening examinations during World Oral, Head and Neck Cancer Awareness Week from 22–28 April 2017, and answered survey questions on their knowledge of OC. Results: One hundred and eighty-five participants attended the screening event. Some participants did not answer certain questions, so the statistics with each question were made only for those respondents who answered that question. Screening event has included 99 (57.9%) females and 72 (42.1%) males (14 participants did not answer). The median age of participants was 67 years. The majority of participants (115; 80.4%) had heard about OC, but had not heard about nor previously attended OC screening examination (71 or 51.1% of females and 123 or 86.6% of males). No significant difference between genders and between participants with different levels of education was observed. The majority of participants (111;79.3%) knew that smoking was a risk factor for OC, and believed that their risk of getting OC was similar to other people in their age group and gender. Conclusions: Our results show that most participants have heard about OC, but have not heard about nor previously attend OC screenings. Future programs should be directed more to the high-risk population in order to achieve early detection and treatment of OC.

Purpose: The incidence of oral cavity and pharynx cancer is rising in the United States and South Dakota (SD) (2009-2018). In 2018, it was estimated that 396,937 of Americans were living with oral cavity and pharynx cancer. The 5-year relative survival rate for oral cancer is 66.2%, which is less than the survival rates for breast, colorectum, and prostate cancers. Tobacco and alcohol use and human papillomavirus (HPV16) exposure are some of the risk factors for oral cancer. Overall rural populations have higher cancer mortality than no rural population due to higher poverty, lower access to health services, and cigarette use. The purpose of this study is to investigate the prevalence of the oral cancer risk factors (e.g., cigarette smoking), HPV vaccination rates, and to identify the spatial distribution of social and environmental factors (e.g., social vulnerability, dental care access) in SD. Finally, this article discusses how nurses can contribute to oral cancer prevention and early detection. Methods: This descriptive study used data from multiple data sources (e.g., SD Department of Health, HRSA, County Health Rankings). Maps were created using ArcGIS. Findings: From the 66 SD counties, nearly 17% presented high-level shortage scores and were also highly socially vulnerable. HPV vaccination among youth was higher than the national average. Studies showed that improving nurse’s knowledge by training on oral cancer is needed and this may increase nurses’ practice in oral cancer prevention and control. Conclusions: Primary care professionals like nurse practitioners can assist in early detection of oral cancer and promote awareness of signs and main risk factors in rural areas. As part of the total patient care, nurses hold a vital role in prevention and early detection of oral cancer. These efforts with referral to oral cancer screening are vital for decreasing oral cancers morbidity and mortality rates primarily. Keywords: Rural health, Nurses, oral cancer, dentalcare access, Geographic Information Systems DOI: https://doi.org/10.14574/ojrnhc.v21i2.692

Introduction: Oral and oropharyngeal cancers are prevalent in the head-and-neck region, with global rates decreasing. However, in India, they are rising due to a lack of knowledge about risk factors and symptoms. The Indian government launched the National Health Mission to provide accessible, affordable, and reliable primary health care. Accredited social health activist (ASHA) workers can link health services to rural people. This study aimed to evaluate the awareness level among these workers about potentially malignant oral disorders and oral cancer (OC). Materials and Methods: A predesigned semi-structured questionnaire-based descriptive cross-sectional study was conducted among 150 voluntary ASHA workers from randomly selected blocks of Thrissur district, Kerala, to collect the data. Results: Our study showed that the majority of ASHA workers (82.3%) were aware of the role of tobacco in OC. A substantial portion of workers (88.4%) expressed that early detection of OC is possible at its initial stage. Less than 10% (7.5%) of all the ASHA workers were educated by dentists, whereas almost three-quarters (75.5%) of ASHAs preferred primary health center health practitioners as primary representatives for early OC detection, despite their being poorly trained in the early diagnosis and detection of OC. Conclusion: India has made progress in controlling malignancies but still lags in reducing OC mortality rates. Spreading knowledge of contributory agents and early detection methods through ASHA workers could reduce the incidence and mortality of OC. Including more dentists in the public health system and training ASHA workers on early OC detection can play a major role in reducing its incidence.

The aim of this study is to assess dental students’ opinions of the dentists’ role in primary prevention of human papillomavirus (HPV)-related oral cancer using a cross-sectional web-based survey. A questionnaire, containing questions about knowledge of HPV and oral cancer, confidence in head and neck examination and role of the dentist in preventing HPV-related oral cancer, was sent to all students of the Academic Centre of Dentistry Amsterdam (n = 912). One hundred and twenty-six (n = 126) students completed the questionnaire. Significantly, more master students (75%) than bachelor students (54.3%) were aware that HPV is a causative factor for oral cancer. Master students had more knowledge of HPV than bachelor students, but knowledge about HPV vaccination was irrespective of the study phase. The majority of dental students agreed that it is important to discuss HPV vaccination with patients. Eighty-nine percent of the students think that more education about symptoms of oral cancer will increase screening for oral cancer. Development of a protocol for screening in dental practices was considered even more important. According to dental students, dentists should discuss HPV as a risk factor for oral cancer with patients. Future dentists are willing to be involved in both primary and secondary prevention of HPV-related oral cancer. Therefore, screening for oral cancer and education about HPV vaccination should be integral elements of the dental curriculum.

The early detection and excision of potentially malignant disorders (PMD) of the lip and oral cavity that require intervention may reduce malignant transformations (though will not totally eliminate malignancy occurring), or if malignancy is detected during surveillance, there is some evidence that appropriate treatment may improve survival rates. To estimate the diagnostic accuracy of conventional oral examination (COE), vital rinsing, light-based detection, biomarkers and mouth self examination (MSE), used singly or in combination, for the early detection of PMD or cancer of the lip and oral cavity in apparently healthy adults. We searched MEDLINE (OVID) (1946 to April 2013) and four other electronic databases (the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Group's Trials Register, EMBASE (OVID), and MEDION) from inception to April 2013. The electronic databases were searched on 30 April 2013. There were no restrictions on language in the searches of the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. We selected studies that reported the diagnostic test accuracy of any of the aforementioned tests in detecting PMD or cancer of the lip or oral cavity. Diagnosis of PMD or cancer was made by specialist clinicians or pathologists, or alternatively through follow-up. Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction and quality assessment were carried out by at least two authors independently and in duplicate. Studies were assessed for methodological quality using QUADAS-2. We reported the sensitivity and specificity of the included studies. Thirteen studies, recruiting 68,362 participants, were included. These studies evaluated the diagnostic accuracy of COE (10 studies), MSE (two studies). One randomised controlled of test accuracy trial directly evaluated COE and vital rinsing. There were no eligible diagnostic accuracy studies evaluating light-based detection or blood or salivary sample analysis (which tests for the presence of bio-markers of PMD and oral cancer). Given the clinical heterogeneity of the included studies in terms of the participants recruited, setting, prevalence of target condition, the application of the index test and reference standard and the flow and timing of the process, the data could not be pooled. For COE (10 studies, 25,568 participants), prevalence in the diagnostic test accuracy sample ranged from 1% to 51%. For the eight studies with prevalence of 10% or lower, the sensitivity estimates were highly variable, and ranged from 0.50 (95% confidence interval (CI) 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00) with uniform specificity estimates around 0.98 (95% CI 0.97 to 1.00). Estimates of sensitivity and specificity were 0.95 (95% CI 0.92 to 0.97) and 0.81 (95% CI 0.79 to 0.83) for one study with prevalence of 22% and 0.97 (95% CI 0.96 to 0.98) and 0.75 (95% CI 0.73 to 0.77) for one study with prevalence of 51%. Three studies were judged to be at low risk of bias overall; two were judged to be at high risk of bias resulting from the flow and timing domain; and for five studies the overall risk of bias was judged as unclear resulting from insufficient information to form a judgement for at least one of the four quality assessment domains. Applicability was of low concern overall for two studies; high concern overall for three studies due to high risk population, and unclear overall applicability for five studies. Estimates of sensitivity for MSE (two studies, 34,819 participants) were 0.18 (95% CI 0.13 to 0.24) and 0.33 (95% CI 0.10 to 0.65); specificity for MSE was 1.00 (95% CI 1.00 to 1.00) and 0.54 (95% CI 0.37 to 0.69). One study (7975 participants) directly compared COE with COE plus vital rinsing in a randomised controlled trial. This study found a higher detection rate for oral cavity cancer in the conventional oral examination plus vital rinsing adjunct trial arm. The prevalence of the target condition both between and within index tests varied considerably. For COE estimates of sensitivity over the range of prevalence levels varied widely. Observed estimates of specificity were more homogeneous. Index tests at a prevalence reported in the population (between 1% and 5%) were better at correctly classifying the absence of PMD or oral cavity cancer in disease-free individuals that classifying the presence in diseased individuals. Incorrectly classifying disease-free individuals as having the disease would have clinical and financial implications following inappropriate referral; incorrectly classifying individuals with the disease as disease-free will mean PMD or oral cavity cancer will only be diagnosed later when the disease will be more severe. General dental practitioners and dental care professionals should remain vigilant for signs of PMD and oral cancer whilst performing routine oral examinations in practice.

With increasing numbers of oral cancer diagnoses and guidance recommending that patients approach their doctors or dentists for assessments, when searching for information regarding mouth cancer, patients may first look to their dental practice website. This study aimed to evaluate the variance of patient information provided regarding oral cancer on dental practice websites. Dental practices within the Manchester area with an active website were included with assessment of whether there was any information provided regarding reducing oral cancer risk factors, signs to look out for and if oral cancer screening was included as part of the general check-up, using a three-point score based on the joint statement from the British and Irish Society for Oral Medicine (BISOM) and Cancer Research UK (CRUK) regarding oral cancer diagnosis and prevention. In total, 66.6% (n=60) of practices provided no accessible information regarding oral cancer screening and prevention on their websites. Only 12.2% (n=11) discussed all three factors of oral screening, symptoms and reducing risk factors. Screening as part of routine examination was most frequently mentioned at 27% (n=24), risk factors were discussed by 23% (n=21) of practices and symptoms to be aware of by 13% (n=12). There is a lack of information available to patients on dental practice websites regarding oral cancer. To overcome lack of quality assurance on the internet, dentists can provide factual information via their dental practice websites. This could help with improving patient awareness and therefore aiding in early detection, improving patient outcomes.

OP143: Leonardo da Vinci Partnership – A lifelong learning programme to raise awareness of dental and medical professionals within Europe for the early detection of oral cancer – Phase 2

Professional and community efforts to prevent morbidity and mortality from oral cancer

Oral cavity cancer, or just oral cancer, is cancer that start in the mouth (also called the oral cavity). Oropharyngeal cancer starts in the oropharynx, which is the part of the throat just behind the mouth. The major causes of oral cancer include tobacco use, areca nut chewing and heavy alcohol drinking; avoiding these can prevent the disease. Preceded by precancerous lesions, early oral cancers present as small painless ulcers or growths that can be detected, by careful physical examination, and if effectively treated by the physician. Prevention, early detection and treatment are effective interventions to reduce the worldwide burden of oral cancer. Early detection of oral cancer needs more than just understanding of the signs and symptoms of disease. The process must be managed effectively and handled sensitively. Every member of the dental team has a part to play and protocols should be developed for effective delivery of Dental and healthcare professionals have a crucial role to play in raising awareness of the dangers to oral health associated with smoking and the use of smokeless tobacco. Early detection of oral cancer needs more than just understanding of the signs and symptoms of disease. In its early stages, oral cancer can be treated in up to 90% of cases.