Use of skin and oral cancer examinations in the United States, 1998

Need for Primary Care Providers to Carry out Annual Oral Cancer Examinations

Oral and/or oral pharyngeal cancer (OPC) has an approximately 53% five-year survival rate in the United States. It is postulated that the rationale for this low survival rate is due to delayed diagnosis and treatment of OPC at its later stages. Recently the United States Preventive Services Task Force found insufficient evidence to recommend for or against oral cancer examination (OCE) by primary care providers (PCP), i.e., medical providers who are not dental providers or otolaryngologists. The purpose of the paper is to provide a logical discussion of the varied research on OCE, while presenting the evidence for annual opportunistic OCE in the primary care setting. Trained PCPs in OCE have the likelihood of detecting OPC at an early non symptomatic stage, which could result in lower treatment morbidity and mortality due to the disease. This review of the OCE research summarizes evidence that points to a logical benefit of OCE. Opportunistic annual non symptomatic OCE by PCPs who have been trained in OCE techniques may result in consistent early detection of OPC, particularly for patients at high risk for developing the disease.

Self-reported oral cancer screening by smoking status in Maryland: trends over time

OBJECTIVES

The study aims to examine whether a higher proportion of current and former smokers reported having an oral cancer screening (OCS) exam in the past year compared with never smokers in Maryland between 2002 and 2008.

METHODS

Secondary analysis of the Maryland Cancer Surveys (conducted in 2002, 2004, 2006, and 2008), population-based, random-digit-dial surveys on cancer screening among adults age 40 years and older. Of 20,197 individuals who responded to the surveys, 19,054 answered questions on OCS and smoking. Results are weighted to the Maryland population.

RESULTS

Self-reported OCS in the past year increased from 33 percent in 2002 to 40 percent in 2008. Screening among never and former smokers increased from about 35 percent to 42 percent and from 35 percent to 43 percent, respectively; screening among current smokers remained between 23 percent and 25 percent. In the adjusted analysis, current smokers had decreased odds of screening compared with never smokers; no significant difference was observed between former and never smokers. When the variable dental visit in the last year was included in the adjusted analysis, it became the strongest predictor of OCS.

CONCLUSIONS

Between 2002 and 2008, self-reported OCS in the last year increased among former and never smokers, but remained unchanged for current smokers. A visit to a dental professional attenuated the difference in OCS between current and never smokers. Dental visit in the last year was the strongest predictor of OCS.

A population-based study of factors associated with early versus late stage oral cavity cancer diagnoses

Oral cavity cancers can be detected early yet many are diagnosed with advanced disease. We assessed risk factors for advanced stage disease in a population-based study. Study population was all Ontario patients with anterior tongue or floor of mouth cancers diagnosed between 1991 and 2000 (n=2033). Data are from a retrospective chart review. Risk factors included: demographic characteristics, co-morbidity, precancerous lesions, dental status, smoking, alcohol use, and social marginalization. Multivariate regression analyses assessed independent associations while controlling for disease grade and site. Forty percent had advanced disease. Eighty-nine percent presented with symptoms and 66% were referred by a family physician. Risk factors in the tongue group were being: age ≥80 (RR 1.47), widowed (RR 1.34), social marginalized (RR 1.69), a current smoker (RR 1.26), or a smoker-heavy drinker (RR 1.73). Risk factors in the floor of mouth group were being: age ≥70 (70-79: RR 1.24 and ≥80: RR 1.43), and socially marginalized (RR 1.22). Having a pre-cancerous lesion (RR 0.44) or a regular dentist (RR 0.84) was protective in the floor of mouth group. Risk factors for those with co-morbid illnesses were being: age ≥70 (70-79: RR 1.28 and ≥80: RR 1.55), separated/divorced (RR 1.26), socially marginalized (RR 1.37), or a smoker-heavy drinker (RR 1.44); while having a regular dentist was protective (RR 0.83). Targeted education to alert those at risk about oral cancer warning signs and better training coupled with opportunistic oral cavity exams by family physicians could reduce the burden of this disease.

Evaluation of a multifaceted social marketing campaign to increase awareness of and screening for oral cancer in African Americans

OBJECTIVES

A 2-year social marketing media campaign and community education activities were organized to promote screening for oral cancer in a high-risk population in Detroit/Wayne County, Michigan. Long-term goals of the campaign were to reduce the oral cancer death rate, increase the proportion of oral cancers detected at an early stage, and increase the proportion of adults who report having been screened. The intermediate goals of the campaign were to increase awareness of oral cancer and of oral cancer screening. This article presents outcomes related to the intermediate goals of the campaign.

METHODS

The intermediate goals of the campaign were assessed by the number of calls to a toll-free hotline, which media venues led to calls, number of screenings conducted by the free screening clinic, number of precancers and cancers detected, and the number of sessions conducted, organizations involved, and persons participating in the community education program. The costs per screened case and cancers detected were also evaluated. The media campaign promoted screening using billboards, radio and newspaper ads, and a toll-free hotline. Culturally relevant messages were developed collaboratively with focus groups representing the target audience. Billboards were placed in highly visible locations around Detroit, Michigan. Sixty-second messages on the impact of oral cancer and that screening is 'painless and free' were aired on radio stations popular with the target audience. Ads displaying the hotline were placed in two local newspapers. Callers to the hotline were scheduled for a free screening with a clinic operated by the project. Referral to an oral surgeon was scheduled if a suspicious lesion was found. Free education sessions were also conducted with community-based organizations. Costs associated with the campaign and hotline were totaled, and the cost per screening and cancer detected were calculated.

RESULTS

During the campaign, 1327 radio spots aired; 42 billboards were displayed; two newspaper ads were printed; and 242 education sessions were conducted. The hotline received 1783 calls. The majority of callers reported that their call was prompted by a radio ad (57%). The clinic screened 1020 adults and referred 78 for further examination. Three cancers, two precancers, and 12 benign tumors were detected. The total cost associated with the campaign and toll-free hotline was $795,898.

CONCLUSIONS

A multifaceted social marketing campaign including radio ads, billboards, and education sessions can effectively target a high-risk population and that given an outlet could result in a significant number of people getting screened at a relatively low cost.

Perspectives of African Americans and dentists concerning dentist-patient communication on oral cancer screening

OBJECTIVE

Mortality rates for oral cancer have not improved appreciably in decades, with Blacks less likely than others to survive 5-years post-treatment. Oral cancer is the fifth most common cancer among African American males, representing a pressing public health concern. This study compared how dentists and African American adults view the current state of dentist-patient communication regarding oral cancer and its detection.

METHODS

Five focus groups with 56 African American adults and two focus groups with 17 dentists were conducted in order to compare responses regarding oral cancer information needs and dentist-patient communication on oral cancer screening.

RESULTS

African American adults showed little knowledge about oral cancer and cancer screening, and great need for information. However, dentists reported rarely engaging in information exchange with their patients even while performing the examination.

CONCLUSION

African Americans' request for screening information and dentists' reticence about performing the screening and initiating communication with patients indicate a need for both public education on oral cancer and improved continuing education courses for dentists.

PRACTICE IMPLICATIONS

The dental care community should develop clear guidelines for communicating with patients about oral cancer and engage in continuing education on oral cancer screening procedure. Increased public health efforts aimed at increasing oral cancer awareness and knowledge among the public are warranted.

Oral cancer knowledge and awareness: primary and secondary effects of an information leaflet

Information leaflets can be stored and read several times at the patient's own convenience and speed and, therefore, might contribute to increasing the long-term oral cancer knowledge and awareness. This hypothesis was investigated in a sample of adults living in a small central Italian town. The two groups of patients selected (Intervention, 100 subjects; Control, 84 subjects) were all aged 40 years and had never received oral cancer counselling or examination previously. Subjects completed a questionnaire (PRE) containing items regarding oral cancer epidemiology and prevention. Thereafter, the Intervention patients received the oral cancer information leaflet. One year later, patients from both groups were re-contacted and most (97 Intervention, 79 Control subjects, overall participation rate, 95.7%) completed the same questionnaire (POST). The POST questionnaire score, the score increment and the proportion of patients who sought an oral cancer examination during the year follow-up were used as markers of long-term knowledge, knowledge improvement and awareness, respectively. The between group differences in mean PRE score, POST score, score increment and proportion of subjects who had an examination were assessed by conventional statistical tests. The effect of leaflet corrected for confounders also was assessed using multiple regression analyses. No difference in PRE score and awareness was found. However, the mean POST score and the score increment were significantly higher in the Intervention group. The leaflet significantly increased knowledge but not awareness, with statistically significant effects from high educational level and younger age. It is concluded that the information leaflet had a significant effect in raising the long-term oral cancer knowledge in the general public. It also had a secondary effect on disease awareness in the locale.