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Psoter WJ, Morse DE, Sánchez-Ayendez M, Vega CMV, Aguilar ML, Buxó-Martinez CJ, Psoter JA, Kerr AR, Lane CM, Scaringi VJ, Elias A. Increasing opportunistic oral cancer screening examinations: findings from focus groups with general dentists in Puerto Rico. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:277-83. [PMID: 24894606 PMCID: PMC4257890 DOI: 10.1007/s13187-014-0679-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This study aims to identify educational and training modalities that dentists in Puerto Rico (PR) believe will increase the quality and quantity of opportunistic oral cancer screening examinations (OCS) in dental offices on the island. The study was conducted in three phases: a systematic search of relevant literature, an expert review and consensus panel, and focus groups (FG) involving PR general dentists. To increase OCS by dentists in PR, the FG participants proposed a small group, hands-on OCS training, an integrated oral cancer course, and readily available videos, photographs, and computer simulations to further demonstrate OCS performance and facilitate differential diagnosis. OCS training requirements for licensure and re-licensure, improving OCS dentist-patient communication skills, and establishment of an oral lesion referral center were also viewed favorably. In conclusion, general dentists in our FGs believed the quality and quantity of OCS in Puerto Rico can be increased through the application of specific continuing education and training modalities.
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Affiliation(s)
| | - Douglas E. Morse
- New York University College of Dentistry Department of Epidemiology & Health Promotion
| | - Melba Sánchez-Ayendez
- Formerly, Department of Human Development Graduate School of Public Health University of Puerto Rico Medical Sciences Campus
| | - Carmen M Vélez Vega
- Department of Social Sciences Graduate School of Public Health University of Puerto Rico Medical Sciences Campus
| | - Maria L. Aguilar
- Department of Restorative Dental Science Division of Prosthodontics University of Florida College of Dentistry Health Science Center
| | | | | | - Alexander R. Kerr
- New York University College of Dentistry Oral and Maxillofacial Pathology, Radiology and Medicine
| | | | | | - Augusto Elias
- School of Dental Medicine, University of Puerto Rico Medical Sciences Campus
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Güneri P, Epstein JB. Late stage diagnosis of oral cancer: components and possible solutions. Oral Oncol 2014; 50:1131-6. [PMID: 25255960 DOI: 10.1016/j.oraloncology.2014.09.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/06/2014] [Accepted: 09/06/2014] [Indexed: 02/02/2023]
Abstract
Stage of disease at the diagnosis of oral cancer is thought to be a significant factor in prognosis and outcome (International Agency for Research on Cancer/World Health Organization, 2014). Unfortunately, we continue to diagnose almost 2/3 of these cancers at advanced stages of disease despite the ongoing research for devices/methods to aid the clinicians in detection and accurate oral mucosal lesion diagnosis. This paper explores both the nature of oral cancer and the adjuncts available for detection, and presents the current issues in diagnostic delays of oral cancer detection.
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Affiliation(s)
- Pelin Güneri
- Department of Oral and Maxillofacial Radiology, Ege University, School of Dentistry, Bornova 35100, İzmir, Turkey.
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Otolaryngology and Head and Neck Surgery City of Hope National Medical Center, Duarte CA, 8500 Whilshire Blvd, Suite 800, Beverly Hills, CA 90211, USA
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SOUSA MICHELECARDOSO, ALVES MONICAGHISLAINEOLIVEIRA, SOUZA LUCIANOALBINO, BRANDÃO ADRIANAAIGOTTIHABERBECK, ALMEIDA JANETEDIAS, CABRAL LUIZANTONIOGUIMARÃES. Correlation of clinical, cytological and histological findings in oral squamous cell carcinomas. Oncol Lett 2014; 8:799-802. [PMID: 25013502 PMCID: PMC4081384 DOI: 10.3892/ol.2014.2212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/24/2014] [Indexed: 11/23/2022] Open
Abstract
The present study aimed to investigate the efficiency of exfoliative cytology by correlating the clinical lesions of oral squamous cell carcinoma (OSCC) with exfoliative cytology and histopathological findings. Cases of OSCC diagnosed between 1984 and 2010 were analyzed. The inclusion criteria for the present study were the availability of detailed clinical findings and a diagnosis of the disease through exfoliative cytology and histopathology. The cases were assessed and assigned scores, which were then submitted to modal expression analysis, which considers the higher frequency scores, thus relating the variables. The cytological findings demonstrated that the majority of the cases had malignant potential. Exfoliative cytology should be used as a supplementary tool for the diagnosis of OSCC, as it enables the early detection of these lesions. However, cytology should not be used as a substitute for histopathological examination.
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Affiliation(s)
- MICHELE CARDOSO SOUSA
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
| | - MONICA GHISLAINE OLIVEIRA ALVES
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
| | - LUCIANO ALBINO SOUZA
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
| | - ADRIANA AIGOTTI HABERBECK BRANDÃO
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
| | - JANETE DIAS ALMEIDA
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
| | - LUIZ ANTONIO GUIMARÃES CABRAL
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
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The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma. J Am Dent Assoc 2013. [PMID: 23204089 DOI: 10.14219/jada.archive.2012.0096] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC. METHODS The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC. CLINICAL IMPLICATIONS On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.
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Cytokines and tumor metastasis gene variants in oral cancer and precancer in Puerto Rico. PLoS One 2013; 8:e79187. [PMID: 24278120 PMCID: PMC3835869 DOI: 10.1371/journal.pone.0079187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/24/2013] [Indexed: 01/20/2023] Open
Abstract
Objectives A cross-sectional epidemiological study explored genetic susceptibility to oral precancer and cancer in Puerto Rico (PR). Materials and Methods Three hundred three individuals with a benign oral condition, oral precancer (oral epithelial hyperplasia/hyperkeratosis, oral epithelial dysplasia), or oral squamous cell carcinoma (SCCA) were identified via PR pathology laboratories. A standardized, structured questionnaire obtained information on epidemiological variables; buccal cells were collected for genetic analysis. Genotyping was performed using Taqman® assays. Allelic frequencies of single nucleotide polymorphisms (SNPs) were evaluated in cytokine genes and genes influencing tumor metastasis. Risk estimates for a diagnosis of oral precancer or SCCA while having a variant allele were generated using logistic regression. Adjusted models controlled for age, gender, ancestry, education, smoking and alcohol consumption. Results Relative to persons with a benign oral lesion, individuals with homozygous recessive allelic variants of tumor necrosis factor (TNF-α) −238 A/G SNP had a reduced odds of having an oral precancer (ORadjusted = 0.15; 95% CI 0.03–0.70). The transforming growth factor beta-1 (TGFβ-1 −509 C/T) polymorphism was inversely associated with having an oral SCCA among persons homozygous for the recessive variant (ORcrude = 0.27; 95% CI 0.09–0.79). The matrix metalloproteinase gene (MMP-1) variant, rs5854, was associated with oral SCCA; participants with even one variant allele were more likely to have oral SCCA (ORadjusted = 2.62, 95% CI 1.05–6.53) compared to people with ancestral alleles. Conclusion Our exploratory analyses suggest that genetic alterations in immune system genes and genes with metastatic potential are associated with oral precancer and SCCA risk in PR.
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Erdei E, Sheng H, Maestas E, Mackey A, White KA, Li L, Dong Y, Taylor J, Berwick M, Morse DE. Self-reported ethnicity and genetic ancestry in relation to oral cancer and pre-cancer in Puerto Rico. PLoS One 2011; 6:e23950. [PMID: 21897864 PMCID: PMC3163652 DOI: 10.1371/journal.pone.0023950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 07/28/2011] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hispanics are known to be an extremely diverse and genetically admixed ethnic group. The lack of methodologies to control for ethnicity and the unknown admixture in complex study populations of Hispanics has left a gap in understanding certain cancer disparity issues. Incidence rates for oral and pharyngeal cancer (OPC) in Puerto Rico are among the highest in the Western Hemisphere. We conducted an epidemiological study to examine risk and protective factors, in addition to possible genetic susceptibility components, for oral cancer and precancer in Puerto Rico. METHODOLOGY/PRINCIPAL FINDINGS We recruited 310 Puerto Rico residents who had been diagnosed with either an incident oral squamous cell carcinoma, oral precancer, or benign oral condition. Participants completed an in-person interview and contributed buccal cells for DNA extraction. ABI Biosystem Taqman™ primer sets were used for genotyping 12 ancestry informative markers (AIMs). Ancestral group estimates were generated using maximum likelihood estimation software (LEADMIX), and additional principal component analysis was carried out to detect population substructures. We used unconditional logistic regression to assess the contribution of ancestry to the risk of being diagnosed with either an oral cancer or precancer while controlling for other potential confounders. The maximum likelihood estimates showed that study participants had a group average ancestry contribution of 69.9% European, 24.5% African, and 5.7% detectable Native American. The African and Indigenous American group estimates were significantly higher than anticipated. Neither self-identified ethnicity nor ancestry markers showed any significant associations with oral cancer/precancer risk in our study. CONCLUSIONS/SIGNIFICANCE The application of ancestry informative markers (AIMs), specifically designed for Hispanics, suggests no hidden population substructure is present based on our sampling and provides a viable approach for the evaluation and control of ancestry in future studies involving Hispanic populations.
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Affiliation(s)
- Esther Erdei
- Molecular Epidemiology Laboratory of the Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, New Mexico, United States of America.
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Li L, Psoter WJ, Buxó CJ, Elias A, Cuadrado L, Morse DE. Smoking and drinking in relation to oral potentially malignant disorders in Puerto Rico: a case-control study. BMC Cancer 2011; 11:324. [PMID: 21801414 PMCID: PMC3171384 DOI: 10.1186/1471-2407-11-324] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 07/29/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral cancer incidence is high on the Island of Puerto Rico (PR), particularly among males. As part of a larger study conducted in PR, we evaluated smoking and drinking as risk factors for oral potentially malignant disorders (OPMDs). METHODS Persons diagnosed with either an OPMD (n = 86) [oral epithelial dysplasia (OED), oral hyperkeratosis/epithelial hyperplasia without OED] or a benign oral tissue condition (n = 155) were identified through PR pathology laboratories. Subjects were interviewed using a standardized, structured questionnaire that obtained information, including detailed histories of smoking and drinking. Odds ratios (ORs) for smoking and drinking in relation to having an OPMD, relative to persons with a benign oral tissue condition, were obtained using logistic regression and adjusted for age, gender, education, fruit/vegetable intake and smoking or drinking. RESULTS For persons with an OPMD and relative to individuals with a benign oral tissue condition, the adjusted OR for current smoking was 4.32 (95% CI: 1.99-9.38), while for former smokers, the ORadj was 1.47 (95% CI: 0.67-3.21), each ORadj relative to never smokers. With regard to drinking, no adjusted ORs approached statistical significance, and few point estimates exceeded 1.0, whether consumption was defined in terms of ever, current, level (drinks/week), or beverage type. CONCLUSIONS In this study, conducted in Puerto Rico, current smoking was a substantial risk factor for OPMDs while former smokers had a considerably reduced risk compared to current smokers. There was little evidence suggesting that alcohol consumption was positively associated with OPMD risk.
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Affiliation(s)
- Lin Li
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY, 10003-1402, USA
| | - Walter J Psoter
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY, 10003-1402, USA
| | - Carmen J Buxó
- Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, 00936-5067 Puerto Rico
| | - Augusto Elias
- Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, 00936-5067 Puerto Rico
| | - Lumarie Cuadrado
- Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, 00936-5067 Puerto Rico
| | - Douglas E Morse
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY, 10003-1402, USA
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Morse DE, Vélez Vega CM, Psoter WJ, Vélez H, Buxó CJ, Baek LS, Elias A, Ayendez MS. Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study. BMC Public Health 2011; 11:391. [PMID: 21612663 PMCID: PMC3125369 DOI: 10.1186/1471-2458-11-391] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 05/26/2011] [Indexed: 01/22/2023] Open
Abstract
Background In Puerto Rico, relative to the United States, a disparity exists in detecting oral precancers and early cancers. To identify factors leading to the deficit in early detection, we obtained the perspectives of San Juan healthcare practitioners whose practice could be involved in the detection of such oral lesions. Methods Key informant (KI) interviews were conducted with ten clinicians practicing in or around San Juan, Puerto Rico. We then triangulated our KI interview findings with other data sources, including recent literature on oral cancer detection from various geographic areas, current curricula at the University of Puerto Rico Schools of Medicine and Dental Medicine, as well as local health insurance regulations. Results Key informant-identified factors that likely contribute to the detection deficit include: many practitioners are deficient in knowledge regarding oral cancer and precancer; oral cancer screening examinations are limited regarding which patients receive them and the elements included. In Puerto Rico, specialists generally perform oral biopsies, and patient referral can be delayed by various factors, including government-subsidized health insurance, often referred to as Reforma. Reforma-based issues include often inadequate clinician knowledge regarding Reforma requirements/provisions, diagnostic delays related to Reforma bureaucracy, and among primary physicians, a perceived financial disincentive in referring Reforma patients. Conclusions Addressing these issues may be useful in reducing the deficit in detecting oral precancers and early oral cancer in Puerto Rico.
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Affiliation(s)
- Douglas E Morse
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY 10003-1402, USA.
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