A systematic review of patient acceptance of screening for oral cancer outside of dental care settings

Prevalence and risk factors of oral potentially malignant disorders in Indonesia: a cross-sectional study undertaken in 5 provinces

Detection of subjects with oral potentially malignant disorders in a population is key to early detection of oral cancer (OC) with consequent reduction of cancer-related morbidity and mortality. Our aim was to investigate the prevalence and associated risk factors for OPMD in representative provinces of Indonesia. This cross-sectional study was undertaken in five Indonesian provinces: West Java (WJ), Jakarta (JKT), West Papua (WP), West Kalimantan (WK) and Banda Aceh (BA). Respondents answered a previously validated questionnaire including information on ethnicity, occupation, socioeconomic status (SES), oral health practices, and behaviours associated with oral cancer. An oral examination was undertaken using WHO standardized methodology. Data were analysed using ANOVA, Chi-Square, and logistic regression to assess association between risk factors and mucosal disease. A total of 973 respondents between the ages of 17 and 82 years was enrolled (WJ 35.5%,JKT 13.3% WP 18.3%, WK 9%, BA 23.9%). Tobacco smoking (14.8%), Betel quid (BQ) chewing (12.6%) and alcohol drinking (4%) varied geographically. A well-established OPMD was detected in 137 (14.1%) respondents and 2 (0.2%) presented with chronic ulceration later diagnosed as OC. Leukoplakia was the most common OPMD found (9.7%), while the prevalence of oral submucous fibrosis (OSMF), not previously described in the nation, was 2.3%. Poor knowledge of OC risk factors, poor oral hygiene behaviours, low-income SES and ethnicity were significantly associated with the presence of an OPMD. There is a previously under-reported high prevalence of OPMD in Indonesia. Overall, we found a strong correlation between the presence of an OPMD and individual habituation to known risk factors.

Knowledge of Oral Cancer Amongst Dental Patients Attending Public Clinics in South East Queensland, Australia

Patient knowledge of risk factors, signs and symptoms associated with oral cancers is crucial for increasing the likelihood of patient presentation for opportunistic screening and reducing delay in patient appraisal for early detection. This study aimed to assess the knowledge of oral cancer and to ascertain socio-demographic factors that influence knowledge amongst adult dental patients attending public clinics in Brisbane, Australia. A convenience sample of 213 adult dental patients who attended the Herston and Stafford public health clinics in Brisbane, Australia, between July and August 2019 participated in the self-administered questionnaire. Multivariate analyses were performed to identify predictors for oral cancer knowledge. Patients were well informed of smoking as a risk factor (n = 135; 84.4%), whereas only 53.8% (n = 82) of participants agreed that heavy alcohol consumption was a risk factor. A larger proportion of participants identified difficulty of moving the tongue (n = 79; 49.4%) and pain on swallowing (n = 72; 45.0%) compared to the proportion who identified fixed red patches (n = 61; 38.1%) and fixed white patches (n = 57; 35.6%) as a sign or symptom. Education level and gender were significant knowledge predictors for alcohol (p = 0.01), old age (p = 0.008) and family history (p = 0.004) as a risk factors for oral cancer. Those with a family history of cancer were more likely to identify a red patch (p = 0.02), bleeding gums (p = 0.001) and altered sensation (p = 0.023) as a sign or symptom of oral cancer. Overall, patient knowledge was greater for risk factors than for signs and symptoms for oral cancer. Symptoms associated with later stages of cancer were recognised by a greater proportion of patients compared to early stages of oral cancer. These results indicate the need for targeted public health initiatives to improve patient knowledge.

Modeling oral cancer screening in the United States population

OBJECTIVES

To evaluate the impact of oral cancer screening if applied to the United States (US) population or various high-risk populations in the US.

METHODS

We modeled the effects of applying an oral cancer screening program to the US population assuming a similar mortality reduction as seen in the randomized Kerala trial. We combined data on the incidence of oral cancer in the Surveillance, End Results, and Epidemiology database, data on the relative risk in various high-risk groups from the Prostate, Lung, Cervical, and Ovarian screening trial, and the National Lung Screening Trial and data on the prevalence of cigarette use from the National Health Interview Survey.

RESULTS

When extrapolating to the US population we predict the number needed to screen to prevent one oral cancer death (NNS) = 9,845 in all individuals aged 35 + . Screening efficiency would increase if applied to higher-risk populations. If oral cancer screening were applied to male ≥ 60 pack-year current smokers or former smokers who have quit within 15 years aged 50-79 we predict a 4.6% reduction in oral cancer mortality with an NNS = 1,485.

CONCLUSIONS

Targeted screening of individuals at high risk for oral cancer has the potential to maximize the efficiency of screening and meaningfully impact oral cancer mortality. We suggest a future screening trial in high-risk individuals be considered to clarify the role of oral cancer screening in the US.

Factors influencing oral cancer screening preferences in patients attending Tertiary Care University Oral Health Clinic

BACKGROUND

Understanding factors that influence patients' preferences towards oral cancer (OC) screening is imperative to provide high-quality evidence-based OC screening interventions that can be targeted for population-level uptake. This study determined adult patients' knowledge and awareness of OC, and how health behaviours influenced their preferences towards OC screening.

METHODS

This cross-sectional study used a 42-point questionnaire, between February and May 2020 using a combination of in-person and telephone interviews. Chi-square test and multiple logistic regression analysis were applied to confounding factors that returned statistical significance against OC knowledge and awareness. Significance of P < 0.05 was accepted.

RESULTS

Sixty-eight (38.6%) participants out of a total 176 had good knowledge of OC and 89 (50.6%) had good awareness. A total of 31.8% reported preference for OC screening by a general dental practitioner (GDP) over a general medical practitioner (GMP). Majority (72.7%) reported acceptance of OC screening at their next GDP visit. Ages 56-70 (OR = 0.357, 95% CI) and previous smokers (OR = 0.336, 95% CI) significantly influenced screening preferences. Knowledge of risk factors did not significantly influence OC screening preferences (χ²  = 3.178, P = 0.075).

CONCLUSIONS

Significant gaps in OC knowledge, screening and role of GDPs exist with smoking history and age influencing OC screening preferences.

Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study

BACKGROUND

In Australia, Indian immigrants are one of the fastest-growing communities. Since oral cancer is widespread in India, the indulgence of Indians in customs of areca (betel) nut use in Australia may be linked to the recent rise in oral cancer cases. Since GPs (general practitioners) are primary healthcare providers, it is pivotal to ensure the oral cancer awareness of GPs. This study aimed to explore oral cancer risk-related knowledge, beliefs, and clinical practices of GPs in Australia.

METHODS

Fourteen semi-structured interviews were conducted with GPs practicing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach.

RESULTS

All GPs were knowledgeable of major oral cancer causative factors including tobacco and alcohol, but some had limited understanding about the risks associated with areca nut preparations. Positive attitudes were evident, with all participants acknowledging the importance of oral cancer risk assessment. Most GPs recalled not performing oral cancer routine check-ups.

CONCLUSION

GPs presented good oral cancer knowledge except for emerging risk factors such as areca nut use. Varied beliefs and inconsistent clinical practices relating to oral cancer screening is concerning. Accessible oral cancer training around emerging risk factors may benefit GPs.

Adjuncts for the evaluation of potentially malignant disorders in the oral cavity: Diagnostic test accuracy systematic review and meta-analysis-a report of the American Dental Association

BACKGROUND

Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.

TYPES OF STUDIES REVIEWED

The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.

The role of long non-coding RNA ANRIL in the carcinogenesis of oral cancer by targeting miR-125a

Recently, increasing evidence has indicated that lncRNAs may play a critical role in the progression of oral cancer (OC). However, whether lncRNA-ANRIL is involved in the tumorigenesis of OC remains undetermined. In the present study, ANRIL showed significantly higher, while miR-125a showed lower, expression in OC tissues and sera than in normal controls. MTT, colony formation, flow cytometry analysis, wound-healing, transwell and mice xenograft model assays were used to detect the proliferation, migration, and invasion of ARNIL-overexpressing HB56 cells and ARNIL-knockdown CAL27 cells. The results showed that cell proliferation, migration, and invasion were significantly increased by ARNIL overexpression and decreased by ARNIL silencing in oral cancer cells. Furthermore, we found a negative correlation between ARNIL and miR-125a, and ARNIL acts as a miRNA-sponge by directly interacting with miR-125a.

Phenothiazinium photosensitisers XI. Improved toluidine blue photoantimicrobials

The phenothiazinium derivative toluidine blue O (TBO) is widely employed as a photoantimicrobial agent in clinical trialling, particularly in dentistry. However, its activity against a range of pathogenic microbial species is not significantly different to that of the standard photoantimicrobial methylene blue. In the current study, derivatives of TBO with varying hydrocarbon substitution in chromophore position 2 were synthesised via the established anilinethiosulphonic route, using the mild oxidant silver(II) carbonate to allow substituent preservation. The resulting series of analogues demonstrated the expected increases in visible absorption wavelength and lipophilicity with increasing hydrocarbon content, as well as decreased aggregation for derivatives with bulkier substituents, and all produced singlet oxygen on illumination in vitro. Screening against a range of bacterial and fungal pathogens relevant to infection control showed remarkable increases in activity relative to the parent compound, particularly against the clinically important Gram-negative bacterium Pseudomonas aeruginosa. In addition, in order to demonstrate clinical relevance, the photoactivities of the new derivatives against microbial targets were compared to conventional antibacterial and antifungal drugs, as well as biocides commonly used for local disinfection. Activity here was also generally greater than that of the conventional agents used for comparison, considerably so relative to the local disinfectant agents.

Oral Cancer Diagnosis in Primary Care

The incidence of oral cancer in the UK is rising, with approximately 7,300 new cases diagnosed in 2012. The number of oral cancer cases in the UK has risen by more than a quarter in the last decade. Mouth cancer is within the ten most common cancers encountered among men in the UK. Primary care practitioners, both in a dental and medical setting, have a role in the early diagnosis of oral malignancy, and in providing patients with information regarding risk factors such as smoking, alcohol and betel quid use. The purpose of this paper is to present the epidemiology and risk factors related to oral cancer and particularly review the literature regarding the level of awareness and practice in primary care as recorded in relevant research.

How many individuals must be screened to reduce oral cancer mortality rate in the Western context? A challenge

OBJECTIVE

Controlling oral cancer (OC) through screening is appealing. Advantages of this are as follows: OC is often preceded by visible premalignant lesions, early-stage survival is threefold greater than late-stage survival, and visual screening is inexpensive. Disadvantages of this are as follows: high frequency of false positives, undemonstrated cost-effectiveness, and irregular screening attendance by high-risk individuals. Screening effectiveness in Western countries has not been proven, because of low OC prevalence, which disproportionally increases the number of individuals needed to screen (NNS) to decrease mortality. This study estimated the NNS to obtain an evident decrease in OC mortality rate in the UK.

METHODS

Data gathered from reliable databanks were used. NNS to detect one case (NNScase ) was estimated using a Bayesian approach. NNS to prevent one death (NNSdeath ) was assessed multiplying NNScase by the number of cases that must be screen-detected to prevent one death. NNS to decrease mortality rate by 1% (NNSmortality ) was assessed multiplying NNSdeath by 1% of annual OC deaths.

RESULTS

NNSmortality was overall 1 125 000 (95% confidence interval - 95CI, 690 000-1 870 000), males 551 000 (95CI, 337 000-916 000), and females 571 000 (95CI, 347 000-942 000).

CONCLUSIONS

An OC visual screening campaign capable of producing an evident decrease in mortality rate in the UK requires a large number of adults to be annually and regularly screened.

Effects of a case management program on patients with oral precancerous lesions: a randomized controlled trial

PURPOSE

The aim of this study is to identify the effects of a case management program on knowledge about oral cancer, preventive behavior for oral cancer, and level of uncertainty for patients with oral precancerous lesions.

METHODS

A randomized controlled trial was conducted with two groups, using a pre- and posttest design. The experimental group received a case management program and telephone follow-up sessions; the control group received routine care. Patients were assessed at three time points: first visit to the otolaryngology clinic for biopsy examination (T0), and then at 2 weeks (T1) and 4 weeks (T2) after the biopsy examination.

RESULTS

Patients in both groups had significantly higher levels of knowledge about oral cancer, preventive behavior for oral cancer, and lower level of uncertainty at T2 compared to T0. At T2, participants in the experimental group had significantly greater knowledge about oral cancer, more preventive behavior for oral cancer, and less uncertainty compared to those in the control group.

CONCLUSIONS

The case management program with telephone counseling effectively improved knowledge about oral cancer, preventive behavior for oral cancer, and uncertainty levels in patients with oral precancerous lesions in the four weeks after receiving a biopsy examination. The case management program can be applied with positive results to patients receiving different types of cancer screening, including colorectal, breast, and cervical screening.