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Raman S, Shafie AA, Tan BY, Abraham MT, Chen Kiong S, Cheong SC. Economic Evaluation of Oral Cancer Screening Programs: Review of Outcomes and Study Designs. Healthcare (Basel) 2023; 11:healthcare11081198. [PMID: 37108032 PMCID: PMC10138408 DOI: 10.3390/healthcare11081198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
A lack of guidance on economic evaluations for oral cancer screening programs forms a challenge for policymakers and researchers to fill the knowledge gap on their cost-effectiveness. This systematic review thus aims to compare the outcomes and design of such evaluations. A search for economic evaluations of oral cancer screening was performed on Medline, CINAHL, Cochrane, PubMed, health technology assessment databases, and EBSCO Open Dissertations. The quality of studies was appraised using QHES and the Philips Checklist. Data abstraction was based on reported outcomes and study design characteristics. Of the 362 studies identified, 28 were evaluated for eligibility. The final six studies reviewed consisted of modeling approaches (n = 4), a randomized controlled trial (n = 1), and a retrospective observational study (n = 1). Screening initiatives were mostly shown to be cost-effective compared to non-screening. However, inter-study comparisons remained ambiguous due to large variations. The observational and randomized controlled trials provided considerably accurate evidence of implementation costs and outcomes. Modeling approaches, conversely, appeared more feasible for the estimation of long-term consequences and the exploration of strategy options. The current evidence of the cost-effectiveness of oral cancer screening remains heterogeneous and inadequate to support its institutionalization. Nevertheless, evaluations incorporating modeling methods may provide a practical and robust solution.
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Affiliation(s)
- Sivaraj Raman
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Shah Alam 40170, Malaysia
| | - Asrul Akmal Shafie
- Institutional Planning and Strategic Center, Universiti Sains Malaysia, Penang 11800, Malaysia
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Bee Ying Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Mannil Thomas Abraham
- Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah, Ministry of Health, Klang 41200, Malaysia
| | - Shim Chen Kiong
- Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak, Ministry of Health, Kuching 93586, Malaysia
| | - Sok Ching Cheong
- Digital Health Research Unit, Cancer Research Malaysia, Subang Jaya 47500, Malaysia
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
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Estai M, Kanagasingam Y, Mehdizadeh M, Vignarajan J, Norman R, Huang B, Spallek H, Irving M, Arora A, Kruger E, Tennant M. Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination. J Public Health Dent 2021; 82:166-175. [PMID: 33495989 DOI: 10.1111/jphd.12443] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 12/12/2020] [Accepted: 01/03/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children. METHODS Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index. RESULTS One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30 percent to 39 percent but was not significantly different from the prevalence (42 percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80 percent and 99.7-99.9 percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82 percent) and children ≤7-year-olds (67-78 percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa = 0.72-0.87). CONCLUSIONS The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.
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Affiliation(s)
- Mohamed Estai
- The Australian e-Health Research Centre, CSIRO, Perth, Australia.,School of Human Sciences, University of Western Australia, Perth, Australia
| | | | | | | | - Richard Norman
- School of Population Health, Curtin University, Perth, Australia
| | - Boyen Huang
- School of Dentistry and Health Sciences, Charles Sturt University, Orange, Australia
| | - Heiko Spallek
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Irving
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Estie Kruger
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Marc Tennant
- School of Human Sciences, University of Western Australia, Perth, Australia
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Screening for oral cancer utilising risk-factor analysis is ineffective in high-risk populations. Br J Oral Maxillofac Surg 2020; 59:e17-e22. [PMID: 33248802 DOI: 10.1016/j.bjoms.2020.08.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/11/2020] [Indexed: 11/20/2022]
Abstract
Screening for oral cancer by direct visual examination is believed to be ineffective because of the difficulty in differentiating a small number of malignancies from the much more prevalent benign oral mucosal lesions (OML) that are found in high-risk individuals. Standardised clinical diagnoses were recorded for all the OMLs identified during oral visual examination of 1111 individuals with risk factors for oral cancer, including tobacco and areca nut (paan) consumption. Suspicious lesions were referred for biopsy and definitive diagnosis. A total of 1438 OMLs with 32 different clinical diagnoses were identified in 604 participants. Analysis of referrals revealed two distinct groups: visually benign lesions (VBLs) none of which was referred, and visually complex lesions (VCLs) comprising 661 OMLs with nine different clinical diagnoses. After biopsy the VCLs included known potentially malignant disorders (PMDs) as well as benign lesions such as paan mucositis. VCLs (but not VBLs) share risk factors with oral cancer (p<0.05 for paan 5.82 (CI: 1.98 to 8.43), and smoking 3.59 (CI: 1.12 to 4.47)). They are clinically indistinguishable from, but much more prevalent than, oral cancer, and most will never undergo malignant change. They therefore can prevent dentists from accurately detecting malignancy during the clinical examination of high-risk patients. However, they can easily be differentiated from other benign lesions by visual examination alone. Further research into diagnostic technology is needed to help differentiate them from oral cancers.
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Al-Dhahli Z, Al-Sheibani SM, Al-Kalbani F, Hyder J. Outcomes of the National Head and Neck Cancer Awareness and Screening Campaign in Oman. Sultan Qaboos Univ Med J 2020; 20:e173-e178. [PMID: 32655909 PMCID: PMC7328845 DOI: 10.18295/squmj.2020.20.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives The prognosis of head and neck cancer (HNC) depends substantially on disease stage at the time of diagnosis. Unfortunately, the majority of HNC patients present at relatively late stages. In Oman, a national screening campaign was conducted to increase public awareness of HNC and encourage early detection. This study aimed to report the outcomes of that campaign. Methods The campaign took the form of biannual events conducted at a tertiary care centre and in public malls in Muscat, Oman from April 2015 to July 2019. Data were collected from participants using the Head and Neck Cancer Alliance screening form. Otolaryngologists and oral maxillofacial surgeons performed a thorough physical evaluation of the head and neck region. Results Of the 1,500 individuals visiting the hospital and malls during the campaign events, a total of 509 agreed to undergo screening (response rate: 33.9%). Of these, 12.8% had positive screening results and 5.9% required further evaluation. However, none of the cases with suspicious findings were found to be malignant after a thorough evaluation. Overall, 16.9% of the participants were aware of the early signs of HNC; in addition, 5.5% knew how to perform an oral self-examination. Conclusion Screening is a simple and safe method for the prevention and early detection of HNC. Mass screening and public awareness programmes may help to reduce the burden of this disease in Oman.
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Affiliation(s)
- Zaina Al-Dhahli
- Department of Ear, Nose & Throat, Oman Medical Specialty Board, Muscat, Oman
| | | | | | - Jamil Hyder
- Department of Ear, Nose & Throat, Al-Nahdha Hospital, Muscat, Oman
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Estai M, Kanagasingam Y, Mehdizadeh M, Vignarajan J, Norman R, Huang B, Spallek H, Irving M, Arora A, Kruger E, Tennant M. Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial. BMC Oral Health 2020; 20:11. [PMID: 31937284 PMCID: PMC6961289 DOI: 10.1186/s12903-019-0992-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children. METHODS/DESIGN We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4-15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care. DISCUSSION The current project seeks to take advantage of mobile technology to acquire dental images from a child's mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.
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Affiliation(s)
- Mohamed Estai
- The Australian e-Health Research Centre, CSIRO, 147 Underwood Avenue, Floreat WA, Perth, 6014, Australia.
- School of Human Sciences, University of Western Australia, Perth, Australia.
| | - Yogesan Kanagasingam
- The Australian e-Health Research Centre, CSIRO, 147 Underwood Avenue, Floreat WA, Perth, 6014, Australia
| | - Maryam Mehdizadeh
- The Australian e-Health Research Centre, CSIRO, 147 Underwood Avenue, Floreat WA, Perth, 6014, Australia
| | - Janardhan Vignarajan
- The Australian e-Health Research Centre, CSIRO, 147 Underwood Avenue, Floreat WA, Perth, 6014, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Boyen Huang
- School of Dentistry and Health Sciences, Charles Sturt University, Orange, Australia
| | - Heiko Spallek
- Faculty of Medicine and Health, School of Dentistry, University of Sydney, Sydney, Australia
| | - Michelle Irving
- Faculty of Medicine and Health, School of Dentistry, University of Sydney, Sydney, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, NSW, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Estie Kruger
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Marc Tennant
- School of Human Sciences, University of Western Australia, Perth, Australia
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Finding an oral potentially malignant disorder in screening program is related to early diagnosis of oral cavity cancer – Experience from real world evidence. Oral Oncol 2019; 89:107-114. [DOI: 10.1016/j.oraloncology.2018.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/23/2023]
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Meena JK, Verma A, Upadhyay SK. Opportunistic Screening for Detection and Socio-epidemiological Risk Assessment of Oral Cancer Patients in Rural Jodhpur, India. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_90_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Globally, India has a high burden (20%) of oral cancer with 1% prevalence of premalignant lesions. Most cases are attributed to modifiable risk factors such as substance abuse (tobacco and alcohol), dietary deficiencies, and environmental exposures (solar radiation and air pollution) aggravated by delayed detection and care especially in rural areas. Objective: The objective of the study was to study the risk factors of oral cancer pathogenesis among the rural residents of Jodhpur, India, through opportunistic oral screening approach at primary care facilities. Methodology: An unmatched case–control study was done at two randomly chosen rural health centres in Jodhpur, India. A total of 84 cases and 168 controls were included during 6 months study period (2016). Randomly selected outpatient department attendees were interviewed and screened for oral cancer and premalignant lesions. A structured questionnaire interview along with comprehensive oral, head and neck examination was conducted. Data were analyzed using multivariate logistic regression, and confidentiality of data was maintained. Results: The majority of the study participants were rural residents (82.9%) with poor socioeconomic status. Opportunistic oral screening revealed a variety of cancerous and precancerous lesions. Most common case pathologies were submucosal fibrosis (40.5%), inadequate mouth opening (35.7%), cheek bites (28.6%), leukoplakia (23.8%) etc. Multivariate analysis suggested that tobacco intake (adjusted odds ratio = 13.6, P ≤ 0.01) dietary deficiency (7.4, <0.01), oral sepsis (7.0, <0.01), oral lesions (6.8, <0.01), and sun radiation exposure (9.5, <0.01) were significantly associated with oral cancer pathology. Conclusion: The study provides strong evidence that tobacco, dietary deficiency, oral sepsis and lesions, and sun radiation exposure are independent risk factors for oral cancer. It also reiterates the importance and application of opportunistic oral cancer screening at primary care level.
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Affiliation(s)
- Jitendra Kumar Meena
- Department of Community Medicine, Geetanjali Medical College and Hospital, Udaipur
| | - Anjana Verma
- Department of Community Medicine, Geetanjali Medical College and Hospital, Udaipur
| | - Sandeep Kumar Upadhyay
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Bugter O, Hardillo JA, Baatenburg de Jong RJ, Amelink A, Robinson DJ. Optical pre-screening for laryngeal cancer using reflectance spectroscopy of the buccal mucosa. BIOMEDICAL OPTICS EXPRESS 2018; 9:4665-4678. [PMID: 30319894 PMCID: PMC6179391 DOI: 10.1364/boe.9.004665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 05/04/2023]
Abstract
A new approach in early cancer detection focuses on detecting field cancerization (FC) instead of the tumor itself. The aim of the current study is to investigate whether reflectance spectroscopy can detect FC in the buccal mucosa of patients with laryngeal cancer. The optical properties of the buccal mucosa of patients were measured with multidiameter single-fiber reflectance spectroscopy. The blood oxygen saturation and blood volume fraction were significantly lower in the buccal mucosa of laryngeal cancer patients than in non-oncologic controls. The data of these two parameters were combined to form a single 'biomarker α', which optimally discriminates these two groups. Alpha was lower in the laryngeal cancer group (0.28) than the control group (0.30, p = 0.007). Alpha could identify oncologic patients with a sensitivity of 78% and a specificity of 74%. These results might be the first step toward optical pre-screening for laryngeal cancer.
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Affiliation(s)
- Oisín Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
- Center for Optical Diagnostics and Therapy, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Jose A. Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Robert J. Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Arjen Amelink
- Department of Optics, the Netherlands Organization for Applied Scientific Research (TNO), Stieltjesweg 1, 2628 CK Delft, the Netherlands
| | - Dominic J. Robinson
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
- Center for Optical Diagnostics and Therapy, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
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Estai M, Winters J, Kanagasingam Y, Shiikha J, Checker H, Kruger E, Tennant M. Validity and reliability of remote dental screening by different oral health professionals using a store-and-forward telehealth model. Br Dent J 2018; 221:411-414. [PMID: 27713449 DOI: 10.1038/sj.bdj.2016.733] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/09/2022]
Abstract
Objective This study was conducted to evaluate the validity and reliability of intraoral photographic assessments by different members of a dental team as a means for dental screening in children.Methods The intraoral photographic records of 126 children (2 to 18 years old) were obtained from routine clinical records taken before dental treatment. Intraoral photographs were obtained using a DSLR camera and then uploaded to a cloud-based server using store-and-forward telehealth technology. Images were reviewed by an expert panel to formulate a benchmark screening baseline, to which the screeners' data were compared. The photographic assessments conducted by a mid-level dental practitioner (MLDP) and dentist, were compared to the benchmark expert panel assessment.Results The screeners' assessments by means of intraoral photography, when compared to the expert panel assessment had a sensitivity value of 82-89% and specificity value of 97%. The inter-examiner agreement between the expert panel assessment and photographic method (assessed by a dentist and MLDP), was almost perfect, with a kappa score ranging from 0.82 to 0.88. The mean DFT/dft score for the children as determined by the expert panel's review and photographic assessment ranging from 5.41 to 5.79, with mean scores between the two assessment methods not significantly different (P = 0.746).Conclusion Our results suggested that oral health professionals (other than dentists) have the potential to screen for caries from intraoral photographs with the same diagnostic accuracy and reliability as dentists. This strategy has implications for supporting the use of MLDPs such as dental therapists or hygienists to screen for oral disease using telehealth.
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Affiliation(s)
- M Estai
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
| | - J Winters
- Dental Department, Princess Margaret Hospital, Australia
| | | | - J Shiikha
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
| | - H Checker
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
| | - E Kruger
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
| | - M Tennant
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
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Pivovar A, Gonçalves Dos Santos ZFD, Torres-Pereira CC. Oral cancer screening for high-risk individuals in the primary healthcare setting using an active approach. J Oral Pathol Med 2017; 46:786-791. [DOI: 10.1111/jop.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Allana Pivovar
- Graduate Program in Dentistry; Federal University of Paraná School of Dentistry; Curitiba Paraná Brazil
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Estai M, Kanagasingam Y, Huang B, Shiikha J, Kruger E, Bunt S, Tennant M. Comparison of a Smartphone-Based Photographic Method with Face-to-Face Caries Assessment: A Mobile Teledentistry Model. Telemed J E Health 2016; 23:435-440. [PMID: 27854186 DOI: 10.1089/tmj.2016.0122] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study sought to evaluate the efficacy of a mobile teledentistry approach using a smartphone camera for remote screening of dental caries. MATERIALS AND METHODS An image acquisition Android App was created to facilitate the acquisition and transmission of dental images to a store-and-forward based telemedicine server. One hundred participants who were attending routine checkups at dental clinics were enrolled in 2014. Following a face-to-face oral screening by a screener (dentist), images of patients' teeth were obtained using a smartphone camera. These images, along with patient information, were then transmitted from the Android App to the server through the Internet for later independent assessment by two charters (off-site dentists). The assessments of these charters were then compared to the benchmark face-to-face caries assessment. RESULTS Sensitivity values for the photographic method when compared to the benchmark face-to-face caries assessment were moderate, and ranged from 60% to 63%. Weighted kappa (K) as a measure of intragrader agreement for the photographic assessment was estimated as almost perfect (K = 0.84). The intergrader agreement for the photographic method compared to the face-to-face caries assessment ranged from moderate to substantial (K = 0.54-0.66). CONCLUSIONS Despite some limitations, the mobile teledentistry approach has shown the potential to detect occlusal caries from photographs taken by a smartphone camera with an acceptable diagnostic performance compared to traditional face-to-face screening. This study suggests that telemedicine and cellular phone technology can be combined to create an inexpensive and reliable screening tool.
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Affiliation(s)
- Mohamed Estai
- 1 International Research Collaborative-Oral Health and Equity: School of Anatomy, Physiology and Human Biology, University of Western Australia , Perth, Australia
| | | | - Boyen Huang
- 3 School of Dentistry and Health Sciences, Charles Sturt University , Orange, Australia
| | - Julia Shiikha
- 1 International Research Collaborative-Oral Health and Equity: School of Anatomy, Physiology and Human Biology, University of Western Australia , Perth, Australia
| | - Estie Kruger
- 1 International Research Collaborative-Oral Health and Equity: School of Anatomy, Physiology and Human Biology, University of Western Australia , Perth, Australia
| | - Stuart Bunt
- 1 International Research Collaborative-Oral Health and Equity: School of Anatomy, Physiology and Human Biology, University of Western Australia , Perth, Australia
| | - Marc Tennant
- 1 International Research Collaborative-Oral Health and Equity: School of Anatomy, Physiology and Human Biology, University of Western Australia , Perth, Australia
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Greenhough B, Dembinsky M, Dyck I, Brown T, Robson J, Homer K, Sajani C, Carter L, Duffy SW, Ornstein M. Evaluating a DVD promoting breast cancer awareness among black women aged 25-50 years in East London. J Epidemiol Community Health 2016; 70:678-82. [PMID: 26787203 DOI: 10.1136/jech-2015-206540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/22/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The mean age of presentation for breast cancer among black women is substantially earlier than their white counterparts. Black women also present with adverse prognostic factors that have major clinical implications, including lower survival. To pilot the use of a 6 min DVD on breast cancer in young (under 50 years) black women, to raise awareness and examine the impact of the DVD on increased consultation and referral rates among these women. METHODS Two general practices (intervention practices) in the Hackney area were randomised to have the DVD mailed to all black women aged 25-50 years registered with the practices, and two practices to no intervention (control practices). EMIS data was used to compare consultation rates preintervention and postintervention, in the intervention as well as control practices. Interviews with practice staff and focus groups with patients in participating practices provided qualitative data on the study context and DVD effectiveness. RESULTS A trend of declining consultations for breast symptoms was observed (-22% and -31% among non-black women in the control and intervention practices, and -23% among black women in the control practice) except among the target population of black women aged 25-50 years for the DVD in the intervention practices, which saw an increase of 28% in consultations. The qualitative data indicated that the DVD was well received in the target population, and suggested further ways of disseminating awareness messages and overcoming barriers to help-seeking. CONCLUSIONS Pilot results suggest that the strategy of distributing the DVD may increase consultations for breast problems.
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Affiliation(s)
| | | | - Isabel Dyck
- School of Geography, Queen Mary University of London, London, UK
| | - Tim Brown
- School of Geography, Queen Mary University of London, London, UK
| | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Cynthia Sajani
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UK
| | - Mark Ornstein
- Homerton University Hospital NHS Foundation Trust, London, UK
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Conceiving a national head and neck cancer screening programme. The Journal of Laryngology & Otology 2015; 130:8-14. [PMID: 26585180 DOI: 10.1017/s0022215115003084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study was undertaken to determine the optimum approach to screening for head and neck cancer based on international experiences. OBJECTIVE To determine whether or not head and neck cancer is suitable for screening, and, if so, what the ideal approach should be. METHODS An electronic search of online databases up to and including May 2014 was conducted. Key search terms included 'head and neck', 'cancer', 'screening', 'larynx', 'oropharynx' and 'oral'. RESULTS Subset analysis of high-risk cohorts showed statistically significant improvements in early detection of head and neck cancer via screening. CONCLUSION Current levels of public awareness regarding head and neck cancers are suboptimal, despite increased incidence and mortality. Scheduled and opportunistic screening, coupled with efforts to enhance education and health behaviour modification, are highly recommended for pre-defined, high-risk, targeted populations. This can enable early detection and therefore improve morbidity and mortality.
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Paulino YC, Hurwitz EL, Warnakulasuriya S, Gatewood RR, Pierson KD, Tenorio LF, Novotny R, Palafox NA, Wilkens LR, Badowski G. Screening for oral potentially malignant disorders among areca (betel) nut chewers in Guam and Saipan. BMC Oral Health 2014; 14:151. [PMID: 25495475 PMCID: PMC4292829 DOI: 10.1186/1472-6831-14-151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 12/04/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The Mariana Islands, including Guam and Saipan, are home to many ethnic subpopulations of Micronesia. Oral cancer incidence rates vary among subpopulations, and areca (betel) nut chewing, a habit with carcinogenic risks, is common. Our objectives were to conduct a screening program to detect oral potentially malignant disorders (OPMD) in betel nut chewers, measure their betel nut chewing practices, and assess the prevalence of the oral human papillomavirus (HPV) infection in a subset of betel nut chewers in these islands. METHODS A cross-section of 300 betel nut chewers ≥18 years old [in Guam (n = 137) and in Saipan (n = 163)] were recruited between January 2011-June 2012. We collected demographic, socioeconomic, and oral behavioural characteristics. Latent class analysis was used to identify chewing patterns from selected chewing behaviours. Following calibration of OPMD against an expert, a registered oral hygienist conducted oral examinations by house to house visits and referred positive cases to the study dentist for a second oral examination. Buccal smears were collected from a subset (n = 123) for HPV testing. RESULTS Two classes of betel nut chewers were identified on 7 betel nut behaviours, smoking, and alcohol use; a key difference between the two Classes was the addition of ingredients to the betel quid among those in Class 2. When compared on other characteristics, Class 1 chewers were older, had been chewing for more years, and chewed fewer nuts per day although chewing episodes lasted longer than Class 2 chewers. More Class 1 chewers visited the dentist regularly than Class 2 chewers. Of the 300 participants, 46 (15.3%; 3.8% for Class 1 and 19.4% for Class 2) had OPMD and one (0.3%) was confirmed to have squamous cell carcinoma. The prevalence of oral HPV was 5.7% (7/123), although none were high-risk types. CONCLUSIONS We found two patterns of betel nut chewing behaviour; Class 2 had a higher frequency of OPMD. Additional epidemiologic research is needed to examine the relationship between pattern of chewing behaviours and oral cancer incidence. Based on risk stratification, oral screening in Guam and Saipan can be targeted to Class 2 chewers.
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Affiliation(s)
- Yvette C Paulino
- />Cancer Research Center of Guam, University of Guam, UOG Station, Mangilao, GU USA
| | - Eric L Hurwitz
- />University of Hawai’i, Cancer Center, 701 Ilalo Street, Honolulu, HI USA
| | - Saman Warnakulasuriya
- />King’s College London Dental Institute and WHO Collaborating Centre for Oral Cancer, London, UK
| | - Robert R Gatewood
- />Reflection Center Suite 303, 222 Chalan Santo Papa, Hagatna, GU USA
| | - Kenneth D Pierson
- />Saipan Seventh-Day Adventist Clinic, Quartermaster Road, Chalan Lau Lau, Saipan, MP USA
| | | | - Rachel Novotny
- />University of Hawai’i, Cancer Center, 701 Ilalo Street, Honolulu, HI USA
| | - Neal A Palafox
- />University of Hawai’i, Cancer Center, 701 Ilalo Street, Honolulu, HI USA
| | - Lynne R Wilkens
- />University of Hawai’i, Cancer Center, 701 Ilalo Street, Honolulu, HI USA
| | - Grazyna Badowski
- />Cancer Research Center of Guam, University of Guam, UOG Station, Mangilao, GU USA
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Warnakulasuriya S, Fennell N, Diz P, Seoane J, Rapidis A. An appraisal of oral cancer and pre-cancer screening programmes in Europe: a systematic review. J Oral Pathol Med 2014; 44:559-70. [DOI: 10.1111/jop.12267] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nathalie Fennell
- King's College London; WHO Collaborating Centre for Oral Cancer; London UK
| | - Pedro Diz
- University of Santiago de Compostela; Galicia Spain
| | - Juan Seoane
- University of Santiago de Compostela; Galicia Spain
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Parashari A, Singh V, Mittal T, Ahmed S, Grewal H, Gupta S, Sehgal A. Low cost technology for screening early cancerous lesions of oral cavity in rural settings. Ann Med Health Sci Res 2014; 4:146-8. [PMID: 24669350 PMCID: PMC3952289 DOI: 10.4103/2141-9248.126628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low cost technologies are needed in resource poor rural settings for detection of pre-cancer and cancer lesions of the oral cavity. AIM The study was undertaken to investigate the feasibility of a low cost technology (Magnivisualizer) for the early detection any lesions of the oral cavity among tobacco users in a resource poor rural field setting. SUBJECTS AND METHODS A total of 1329 tobacco users were motivated to come forward for oral examination in the camp organized for this purpose. Their oral cavities were screened with a torch and Magnivisualizer by a Dentist. RESULTS With torch light, 104/1329 (7.8%) lesions were identified, though only 62/104 (59.6%) positive lesions could be differentiated into various categories. However, through Magnivisualizer 156/1329 (11.7%) lesions were detected and 153/156 (98.1%) positive lesions were differentiated into different categories. CONCLUSION Magnivisualizer offers an alternative instrument for detecting most of the early cancerous and high-grade precancerous lesions and it can be used in the rural field settings.
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Affiliation(s)
- A Parashari
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - V Singh
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - T Mittal
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - S Ahmed
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - H Grewal
- Department of Orthodontics, Guru Teg Bahadur Hospital, New Delhi, India
| | - S Gupta
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - A Sehgal
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
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Croucher R, Haque MF, Kassim S. Oral pain before and after smokeless tobacco cessation in U.K.-resident Bangladeshi women: cross-sectional analyses. Nicotine Tob Res 2012; 15:896-903. [PMID: 23042981 DOI: 10.1093/ntr/nts203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Paan quid with tobacco (PQT) use is common in South Asian populations. Oral pain following a PQT cessation attempt is commonly reported. Factors determining this await full exploration. METHODS This prospective study of PQT chewers used a prepiloted interview and clinical examination. Oral pain, socioeconomic position, oral status, health service use, tobacco use and dependency, and psychological distress measures were collected from U.K.-resident Bangladeshi women before and after their quit attempts. Analysis included descriptive and analytic modeling of oral pain determinants, using multiple logistic regressions and a significance value p ≤ .05. RESULTS A total of 150 females (mean age 51.2 [SD = 13.7, range = 24-84] years) completed the study. Baseline oral pain prevalence was 39% and 73% at follow-up. Completed education level predicted baseline oral pain (OR = 3.43, 95% CI [1.66, 7.11], p = .001). Follow-up oral pain was predicted by completed education level (OR = 3.74, 95% CI [1.43, 9.79], p = .007), anxiety (OR = 3.52, 95% CI [1.23, 10.07], p = .019), choosing behavioral support alone in the cessation attempt (OR = 3.12, 95% CI [1.26, 8.70], p = .015), failure to stop tobacco chewing during the cessation attempt (OR = 4.16, 95% CI [1.44, 12.04], p = .009), and tooth wear (attrition) (OR = 5.71, 95% CI [1.84, 17.79], p = .003). Lower dependency level (OR = 0.79, 95% CI [0.64, 0.97], p = .023) was protective. CONCLUSION Dental care access, nicotine replacement therapy, and anxiety management should be incorporated into cessation service delivery protocols to manage oral pain onset and facilitate successful cessation.
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Affiliation(s)
- Ray Croucher
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, London, United Kingdom.
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Brocklehurst P, Ashley J, Walsh T, Tickle M. Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol 2012; 40:239-46. [DOI: 10.1111/j.1600-0528.2012.00671.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Patient awareness of oral cancer health advice in a dental access centre: a mixed methods study. Br Dent J 2011; 210:E9. [PMID: 21436799 DOI: 10.1038/sj.bdj.2011.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In the United Kingdom in 2006, 5,325 persons were diagnosed with oral cancer; and in 2007 it caused around 1,850 deaths. The purpose of this study was to assess the patient awareness, in a dental access centre, of a poster and leaflet campaign providing information about smoking and excess alcohol consumption as risk factors in the development of oral cancer, and to explore dental patients' beliefs and perceptions about these risk factors. METHODS Posters and leaflets providing information about risk factors for oral cancer were displayed in the patient waiting areas of a dental access centre. Data were collected prospectively in relation to the smoking and drinking habits of patients attending the centre. This information was used to categorise patients into one of four groups ranging from low to high consumption. During triage, patients were asked if they had read any of the information about oral cancer that was on display, and patients in the high risk groups were asked to participate in a semi-structured interview that would explore their knowledge about risk factors and their views on the delivery of healthcare messages in relation to oral cancer. RESULTS Data on risk status and exposure to the poster and leaflet campaign were collected for 1,161 patients attending during the study period. More than 50% of these patients were smokers, with 36% in the high or very high tobacco and alcohol use groups. Approximately 40% of patients within each consumption group had read any of the information available. Nine patients agreed to be interviewed and overall knowledge about risk factors for oral cancer, even after reading the information was poor. CONCLUSION Dental access centres attract a significant number of patients with lifestyle habits that make them vulnerable to oral cancer, and as such are well placed to deliver oral health messages to this high risk group. However, the delivery of information through a simple poster and leaflet campaign is likely to have limited impact.
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Brocklehurst PR, Baker SR, Speight PM. Primary Care Clinicians and the Detection and Referral of Potentially Malignant Disorders in the Mouth: A Summary of the Current Evidence. ACTA ACUST UNITED AC 2010; 17:65-71. [DOI: 10.1308/135576110791013749] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The importance of detecting oral malignant disease is paramount. Recent government strategies have placed an emphasis on the early detection of cancer. This paper presents a brief account of the current debate around the role of oral cancer screening and provides a summary of the results of three practice-based studies that were supported by the British Society for General Dental Surgery and the Faculty of General Dental Practice (UK). Overall, there appears to be a lack of rigour among some general dental practitioners when screening for potentially malignant disorders and their incidence in dental practice is perceived to be low. Barriers remain to the implementation of smoking-cessation schemes and many general dental practitioners feel out of their depth in tackling the abuse of alcohol, despite recognising its importance as a risk factor. Patients continue to present to their general medical practitioner (GMP) when they are concerned about something in their mouth that is not related to their teeth. GMPs’ ability to manage early oral cancer is discussed. A prospective randomised controlled trial (RCT), or a demonstration study, is recommended to investigate the numbers of cases of oral cancer diagnosed in primary dental care and primary medical care and to develop standardised referral criteria for early cases of this disease to reduce under- and over-referral. The RCT could also examine the potential of using auxiliary healthcare workers and examine the impact of such a programme upon secondary care services.
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Affiliation(s)
| | - Sarah R Baker
- Oral Health and Development, School of Clinical Dentistry, University of Sheffield, UK
| | - Paul M Speight
- School of Clinical Dentistry, University of Sheffield, UK
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Richards MA. The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. Br J Cancer 2010; 101 Suppl 2:S1-4. [PMID: 19956152 PMCID: PMC2790704 DOI: 10.1038/sj.bjc.6605382] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A National Awareness and Early Diagnosis Initiative (NAEDI) has been established in England as part of the Government's strategy to improve cancer outcomes. One of the early priorities for this initiative has been to assemble the diverse evidence linking late diagnosis with poor survival and avoidable deaths. This supplement brings together new perspectives on existing research in this area together with findings from recently commissioned research. This paper describes a provisional model, the ‘NAEDI pathway’, for testing hypotheses relating to late diagnosis and its impact. Key findings from other papers in this supplement are also highlighted.
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Affiliation(s)
- M A Richards
- National Cancer Action Team, St Thomas' Hospital, Westminster Bridge Road, London, UK.
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