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Martínez-Ramírez J, Saldivia-Siracusa C, González-Pérez LV, Cuadra Zelaya FJM, Gerber-Mora R, Cabrera OFG, Bologna-Molina R, Gilligan G, Delgado-Azañero W, Rajendra Santosh AB, González-Arriagada WA, Villarroel-Dorrego M, Rojas BV, Gallagher KPD, Tager EMJR, Aranda-Romo S, García-Heredia GL, Garcia EC, Hurtado I, Turcios CA, Espinal LPS, González RAM, Prado Ribeiro AC, Ribeiro-Rotta RF, Kowalski LP, Curado MP, Toporcov TN, Sollecito TP, Carvalho AL, Lopes MA, Warnakulasuriya S, Santos-Silva AR. Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean. Oral Dis 2024; 30:4174-4184. [PMID: 38380784 DOI: 10.1111/odi.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.
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Affiliation(s)
- Josefina Martínez-Ramírez
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
- Faculty of Dentistry, University of El Salvador, San Salvador, El Salvador
| | | | - Leonor-Victoria González-Pérez
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
- Laboratory of Immunodetection and Bioanalysis, Investigation Group POPCAD, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | | | - Roberto Gerber-Mora
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Ronell Bologna-Molina
- Research Department, School of Dentistry, Universidad Juárez del Estado de Durango, Durango, Mexico
- Molecular Pathology Area, School of Dentistry, Universidad de la República, Montevideo, Uruguay
| | - Gerardo Gilligan
- Oral Medicine Department, School of Dentistry, Universidad Nacional de Córdoba, Haya de la Torre SN, Córdoba, Argentina
| | - Wilson Delgado-Azañero
- Department of Oral Pathology, Oral Medicine and Oral Surgery, School of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arvind Babu Rajendra Santosh
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
- Department of Oral Medicine, Faculty of Dentistry, Universitas Airlangga, Surabaya, Indonesia
| | - Wilfredo Alejandro González-Arriagada
- Universidad de los Andes, Facultad de Odontología, Santiago, Chile
- Centro de Investigación e Innovación em Biomedicina, Universidad de los Andes, Las Condes, Chile
| | | | - Bernardo Venegas Rojas
- Department of Stomatology, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Karen Patricia Domínguez Gallagher
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
- Oral Pathology, School of Dentistry, National University of Asunción, Asunción, Paraguay
| | - Elena María José Román Tager
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Saray Aranda-Romo
- Diagnostic clinic, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | | | - Ileana Hurtado
- School of Dentistry, University of San Carlos, Guatemala City, Guatemala
| | | | | | | | - Ana Carolina Prado Ribeiro
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Oral Medicine Service, Sírio Libanês Hospital, São Paulo, Brazil
| | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
- Head and Neck Surgery Department and LIM 28, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Paula Curado
- Group of Epidemiology and Statistics on Cancer, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Tatiana Natasha Toporcov
- Epidemiology Department, Faculdade de Saude Pública da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer, London, UK
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Ramírez-Amador V, Anaya-Saavedra G, Petti S, Lara-Flores N, Aranda-Romo S, Cruz-Monroy E, Muela-Campos D, Nava-Villalba M, Ocampo-Acosta F, Pulido-Díaz K, Rumayor-Piña A. Oral cancer and precancer in Oral Pathology and Medicine curricula of Mexican dental schools. Oral Dis 2024; 30:2150-2157. [PMID: 37265065 DOI: 10.1111/odi.14639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To identify the teaching-learning process characteristics of Oral Pathology and Medicine (OP&M) related to oral potentially malignant disorders (OPMDs) and oral cancer (OC), in the dental schools' curricula in Mexico, to analyze the approach given to this topic worldwide, and to provide the possible solution strategies. MATERIALS AND METHODS Questionnaires were sent to OP&M deans and professors from public Mexican Universities to explore the curriculum and academic profile of the dental schools. The recommendations gathered from a workshop with expert professors on the challenges in OPMD/OC teaching were reported. RESULTS Twenty-two dental schools participated (22 deans, 30 professors). The most widely used strategies were clinical-case resolving (86%) and presentations (73%). Although 77.3% of the programs included maxillofacial lesions, only 40.9% contemplated OPMD/OC. Only 45% of the programs developed community activities for early OC detection. The workshop recommendations were (i) multidisciplinary approach to OPMD/OC teaching, involving OP&M professors in other dental and nondental courses; (ii) implementation of the most effective teaching techniques (currently, problem-based learning and clinical-case presentation) in OP&M curricula; (iii) education of OP&M professors on teaching-learning processes. CONCLUSIONS These recommendations from the Mexican context, integrated with similar experiences from other countries could contribute to develop a unique, internationally acknowledged OP&M curriculum.
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Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Master, Metropolitan Autonomous University, México City, Mexico
| | | | - Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Norma Lara-Flores
- Health Care Department, Metropolitan Autonomous University, México City, Mexico
| | | | - Eduardo Cruz-Monroy
- Oral and Maxillofacial Pathology Specialty Program, Mexican National Autonomous University, Mexico City, Mexico
| | | | - Mario Nava-Villalba
- Pathology Research and Diagnostic Center, Department of Microbiology and Pathology, Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Fabián Ocampo-Acosta
- Oral and Maxillofacial Pathology, Medicine Department, Autonomous University of Baja California, Tijuana, Baja California, Mexico
| | - Katya Pulido-Díaz
- Faculty of Health Sciences, Autonomous University of Baja California, Tijuana, Baja California, Mexico
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Louredo BVR, de Lima-Souza RA, Pérez-de-Oliveira ME, Warnakulasuriya S, Kerr AR, Kowalski LP, Hunter KD, Prado-Ribeiro AC, Vargas PA, Santos-Silva ARD. Reported physical examination methods for screening of oral cancer and oral potentially malignant disorders: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:136-152. [PMID: 37989648 DOI: 10.1016/j.oooo.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE This systematic review aimed to describe the method followed during physical examination and the anatomical structures of the head and neck assessed in screening for oral cancer and oral potentially malignant disorders (OPMDs). STUDY DESIGN An extensive literature search was carried out using MEDLINE/PubMed, EMBASE, Scopus, LILACS, Web of Science, Cochrane databases, and gray literature. The risk of bias was available in all papers included. RESULTS Of 9,688 records identified, 27 were included in this review, reporting data from 356,250 individuals screened and distributed across 11 countries. Most of these (n = 19) were based on 1 round of screening conducted by a dental professional or other health care workers. Most screening programs included visual inspection and palpation of the lips, oral cavity, and the most visible oropharyngeal sites, but the descriptions reported were imprecise. Additional inspection and palpation of the neck (submental, submandibular, cervical, and supraclavicular regions) to assess for the presence of swellings and any palpable neck nodes were also performed in 15 programs. CONCLUSION In conclusion, there was considerable heterogeneity in the method of physical examination in screening programs for oral cancer and OPMDs among the included studies.
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Affiliation(s)
| | - Reydson Alcides de Lima-Souza
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil; Department of Pathology, School of Medicine Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer and Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Alexander Ross Kerr
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil; Department of Head and Neck Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Keith David Hunter
- Liverpool Head and Neck Centre, Molecular and Clinical Medicine, University of Liverpool, Liverpool, UK
| | - Ana Carolina Prado-Ribeiro
- Dental Oncology Service, São Paulo State Cancer Institute, University of São Paulo Medical School, São Paulo, Brazil; Oral Medicine Service, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Alan Roger Dos Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
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Mavedatnia D, Cuddy K, Klieb H, Blanas N, Goodman J, Gilbert M, Eskander A. Oral cancer screening knowledge and practices among dental professionals at the University of Toronto. BMC Oral Health 2023; 23:343. [PMID: 37254183 DOI: 10.1186/s12903-023-03062-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Opportunistic oral cancer screening during visits to the dentist is a non-invasive and accessible option for detection of pre-malignant lesions and early-stage malignancies. The objective of this study was to investigate the knowledge, practices, and attitudes towards oral cancer screening among dentists. METHODS A 42-item survey was sent to 650 dental professionals affiliated with the University of Toronto. Data regarding training/practice characteristics, knowledge of oral cavity cancer, current screening practices, attitudes towards screening, and remuneration were collected. RESULTS Ninety-one dentists responded. Most obtained their dental degree from Canada (71.4%) and were practicing in large urban centers (87.9%). Most dentists correctly identified the oral tongue (87.8%) and floor of mouth (80%) as the two of most common sites of oral cavity cancer but only 56% correctly identified the most common presentation. 91% performed intra/extra oral examinations at every patient visit. Only 9.9% of dentists discussed the risk factors of oral cancer and 33% were not familiar with resources for smoking cessation and alcohol abuse. International medical graduates were more likely to discuss risk factor management than Canadian medical graduates (p < 0.01). Over 80% of dentists referred to a specialist when a suspected lesion was found. The greatest barrier for oral cancer screening was lack of time. Almost all dentists (98.8%) reported that their screening practices do not differ depending on the patient's insurance status and 63.8% reported compensation would not influence their decision to perform oral examinations. CONCLUSION Most dentists have a good knowledge of the presentation and risk factors associated with oral cavity cancer. Most dentists perform screening with every patient, with no influence from compensation and insurance status. Dentists are therefore an excellent first contact for oral cavity cancer screening for the general public and for high-risk populations.
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Affiliation(s)
| | - Karl Cuddy
- Division of Oral and Maxillofacial Surgery, University of Toronto, Mount Sinai, Princess Margaret and Humber River Hospitals, Toronto, ON, Canada
| | - Hagen Klieb
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Nick Blanas
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Jade Goodman
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Melanie Gilbert
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, ON, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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Knowledge of Oral Cancer Risk Factors among International Medical and Dental Students at the Lithuanian University of Health Sciences: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11020271. [PMID: 36673639 PMCID: PMC9859494 DOI: 10.3390/healthcare11020271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
The aim of this study was to evaluate knowledge of oral cancer risk factors among international dental and medical students at the Lithuanian University of Health Sciences (LSMU). A cross-sectional study was conducted among international medical and dental students at the LSMU in 2018−2019. In total, 253 students participated, for a response rate of 76.2%. An anonymous self-administered English questionnaire, consisting of 18 items, covered background information (gender, faculty and academic study year), and statements about risk factors for oral cancer and attitudes towards the prevention and treatment of oral cancer. The fifteen statements had the following answer options: yes, no and I don’t know. The statistical data analysis was performed using SPSS version 22. Overall, a good, fair and poor knowledge of oral risk factors was reported by 15.02%, 56.92% and 28.06% of the participants, respectively. The mean score for knowledge of oral cancer risk factors was 10.01 (SD = 2.56), which was defined as fair knowledge. Cronbach’s alpha was found to be 0.78 (a good value). Bartlett’s sphericity test and the KMO index were adequate (χ2 = 677.563, p < 0.001; KMO = 0.788). This study demonstrates a lack of knowledge of oral cancer risk factors among international medical and dental students.
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de Lima Medeiros Y, de Matos Silveira G, Clemente VB, Leite ICG, Vilela EM, de Abreu Guimarães LD. Knowledge about oral cancer among dental students and Primary Health Care dentists: A Brazilian study. J Dent Educ 2022; 86:1488-1497. [DOI: 10.1002/jdd.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 11/12/2022]
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Yang CC, Su YF, Cheng HC, Juan YC, Chiu YW, Wu CH, Chen PY, Lee YH, Chen YL, Chen YT, Peng CY, Lu MY, Yu CH, Huang YF, Kao SY, Fwu CW, Liu CJ. Improving the Diagnostic Performance by Adding Methylation Marker to Conventional Visual Examination in Identifying Oral Cancer. Diagnostics (Basel) 2022; 12:diagnostics12071544. [PMID: 35885450 PMCID: PMC9320763 DOI: 10.3390/diagnostics12071544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Visual oral examination (VOE) is a conventional oral cancer screening method. This study aimed to evaluate the value of methylation marker to assist VOE in identifying oral epithelial dysplasia and oral squamous cell carcinoma (OED/OSCC) from non-cancerous lesions in a real-world situation. Methods: 201 patients with high-risk personal habits who self-perceived oral anomaly were VOE examined, ZNF582 methylation (ZNF582m) tested, and histologically diagnosed. Results: Among them, 132 patients (65.7%) were histologically diagnosed OED/OSCC. Using VOE, 56.1% OED/OSCC patients had possible oral cancer, whereas 37.7% non-OED/OSCC patients had leukoplakia. ZNF582m-positive was detected in 90.2% OED/OSCC patients and 44.9% non-OED/OSCC patients. Various logistic regression models were postulated to evaluate the diagnostic performance of conventional VOE and new strategies using ZNF582m. ROC analysis and its corresponding C-index demonstrated that either triage or co-testing models of VOE and ZNF582m could improve diagnostic performance and discriminative abilities compared with the VOE only approach. Conclusions: In conclusion, methylation marker test shows equivalent performance to an experienced judgment by oral maxillofacial surgeons and plays a significantly supplementary role in increasing the efficacy in identifying oral malignant lesions. ZNF582m may be an especially important tool for family physicians or general dentists to properly diagnose suspicious oral lesions.
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Affiliation(s)
- Cheng-Chieh Yang
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yee-Fun Su
- iStat Biomedical Co., Ltd., New Taipei City 22102, Taiwan; (Y.-F.S.); (Y.-C.J.)
| | - Han-Chieh Cheng
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yi-Chen Juan
- iStat Biomedical Co., Ltd., New Taipei City 22102, Taiwan; (Y.-F.S.); (Y.-C.J.)
| | - Yu-Wei Chiu
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Cheng-Hsien Wu
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Pei-Yin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Hsien Lee
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yen-Lin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yi-Tzu Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chih-Yu Peng
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Ming-Yi Lu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chuan-Hang Yu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Feng Huang
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Shou-Yen Kao
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Chyng-Wen Fwu
- iStat Biomedical Co., Ltd., New Taipei City 22102, Taiwan; (Y.-F.S.); (Y.-C.J.)
- Correspondence: (C.-W.F.); (C.-J.L.); Tel.: +886-(2)2696-3518 (C.-W.F.); +886-(2)5433535 (C.-J.L.)
| | - Chung-Ji Liu
- Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Correspondence: (C.-W.F.); (C.-J.L.); Tel.: +886-(2)2696-3518 (C.-W.F.); +886-(2)5433535 (C.-J.L.)
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Datta M, Guillaud M, Chaitanya N, Shyam N, Palat G, Kumari P, Rapelli V, Jn J, Kumari S, Broughton S, Sutcliffe S, Laronde DM. Use of DNA image cytometry in conducting oral cancer screening in rural India. Cytopathology 2022; 33:600-610. [PMID: 35713951 DOI: 10.1111/cyt.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Oral cancer screening can assist in the early detection of oral potentially malignant lesions (OPMLs) and prevention of oral cancers. It can be challenging for clinicians to differentiate OPMLs from benign conditions. Adjunct screening tools such as fluorescence visualization (FV) and DNA image cytometry (DNA-ICM) have shown success in identifying OPMLs in high-risk clinics. For the first time we aimed to assess these technologies into Indian rural settings and evaluate if these tools helped clinicians identify high-risk lesions during screening. METHODS Dental students and residents screened participants in five screening camps held in villages outside of Hyderabad, India, using extraoral, intraoral, and FV examinations. Lesion and normal tissue brushings were collected for DNA-ICM analysis and cytology. RESULTS Of the 1116 participants screened, 184 lesions were observed in 152 participants. Based on white light examination (WLE), 45 lesions were recommended for biopsy. Thirty-five were completed on site; 25(71%) were diagnosed with low-grade dysplasias (17 mild dysplasia, 8 moderate dysplasia) and the remaining 10 showed no signs of dysplasia. FV loss was noted in all but one dysplastic lesion and showed a sensitivity of 96% and specificity of 17%. Cytology combined with DNA-ICM had a 64% sensitivity and 86% specificity in detecting dysplasia. CONCLUSION DNA-ICM combined with cytology identified majority of dysplastic lesions and identified additional lesions, which were not considered high-risk during WLE to biopsy on site. Efforts to follow-up with these participants are ongoing. FV identified most high-risk lesions but added limited value over WLE.
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Affiliation(s)
- Madhurima Datta
- Faculty of Dentistry, University of British Columbia, Vancouver, Canada.,Cancer Control Research, BC Cancer, Vancouver, Canada
| | - Martial Guillaud
- Imaging Unit, Integrative Oncology, BC Cancer, 675 West 10th Avenue, Vancouver, B.C, V5Z 1L3, Canada.,Department of Statistics, The University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Ndvn Shyam
- Government Dental College, Osmania University, Hyderabad, India
| | - Gayatri Palat
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Priya Kumari
- Nizam's College, Department of Zoology, Hyderabad, India
| | - Vineela Rapelli
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Jagannath Jn
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Sanjeeva Kumari
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | | | - Simon Sutcliffe
- Two Worlds Cancer Collaboration Foundation, Kelowna, BC, Canada
| | - Denise M Laronde
- Faculty of Dentistry, University of British Columbia, Vancouver, Canada.,Cancer Control Research, BC Cancer, Vancouver, Canada
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Thomaz EBAF, Costa EM, Queiroz RCDS, Emmi DT, Ribeiro AGA, Silva NCD, Hugo FN, Figueiredo N. Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis. Community Dent Oral Epidemiol 2021; 50:38-47. [PMID: 34967970 DOI: 10.1111/cdoe.12711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/07/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018. METHOD This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. RESULTS The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. CONCLUSIONS There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.
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Affiliation(s)
| | | | | | | | | | - Núbia Cristina da Silva
- Methods Analytics and Technology for Health Consortium, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nilcema Figueiredo
- Academic Area of Social Medicine, Federal University of Pernambuco, Recife, Brazil
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10
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Intraoral Photography Recommendations for Remote Risk Assessment and Monitoring of Oral Mucosal Lesions. Int Dent J 2021; 71:384-389. [PMID: 33618833 PMCID: PMC9275315 DOI: 10.1016/j.identj.2020.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Oral cancer is a global health issue with substantial morbidity and a high mortality rate mainly because of late-stage diagnosis. Cancerous lesions are often preceded by potentially malignant lesions that may be detected during routine dental examinations. Not only is the oral cavity easily accessible for screening, but the clinical risk factors of the disease are also known. However, patients may not always be able to access screening services or receive follow-up for diagnosed lesions. In these circumstances, intraoral photos are crucial for timely triage, risk assessment, and monitoring of oral lesions. Further, photos form an integral part of a patient's records, facilitate patient education and communication between health care providers, and provide important information during the referral process. To ensure that intraoral photos are of good quality and standardised there is a need to establish recommendations regarding intraoral photography in oral mucosal screening. This article recommends methods to help health professionals and patients obtain interpretable intraoral photographs. Suggestions to achieve ideal lighting, mirror placement, camera angle, and retraction have been discussed. These recommendations are adaptable to easily available smartphone or point-and-shoot cameras and may be further used to develop future teledentistry platforms.
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11
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Kang SK, Mali RD, Braithwaite RS, Kerr AR, McDevitt J. Point-of-care characterization and risk-based management of oral lesions in primary dental clinics: A simulation model. PLoS One 2020; 15:e0244446. [PMID: 33382762 PMCID: PMC7774939 DOI: 10.1371/journal.pone.0244446] [Citation(s) in RCA: 1] [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: 06/30/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.
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Affiliation(s)
- Stella K. Kang
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Rahul D. Mali
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - R. Scott Braithwaite
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Alexander R. Kerr
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, New York, United States of America
| | - John McDevitt
- Department of Biomaterials, New York University College of Dentistry, New York, New York, United States of America
- Chemical and Biomolecular Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States of America
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12
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Ilhan B, Lin K, Guneri P, Wilder-Smith P. Improving Oral Cancer Outcomes with Imaging and Artificial Intelligence. J Dent Res 2020; 99:241-248. [PMID: 32077795 DOI: 10.1177/0022034520902128] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Early diagnosis is the most important determinant of oral and oropharyngeal squamous cell carcinoma (OPSCC) outcomes, yet most of these cancers are detected late, when outcomes are poor. Typically, nonspecialists such as dentists screen for oral cancer risk, and then they refer high-risk patients to specialists for biopsy-based diagnosis. Because the clinical appearance of oral mucosal lesions is not an adequate indicator of their diagnosis, status, or risk level, this initial triage process is inaccurate, with poor sensitivity and specificity. The objective of this study is to provide an overview of emerging optical imaging modalities and novel artificial intelligence-based approaches, as well as to evaluate their individual and combined utility and implications for improving oral cancer detection and outcomes. The principles of image-based approaches to detecting oral cancer are placed within the context of clinical needs and parameters. A brief overview of artificial intelligence approaches and algorithms is presented, and studies that use these 2 approaches singly and together are cited and evaluated. In recent years, a range of novel imaging modalities has been investigated for their applicability to improving oral cancer outcomes, yet none of them have found widespread adoption or significantly affected clinical practice or outcomes. Artificial intelligence approaches are beginning to have considerable impact in improving diagnostic accuracy in some fields of medicine, but to date, only limited studies apply to oral cancer. These studies demonstrate that artificial intelligence approaches combined with imaging can have considerable impact on oral cancer outcomes, with applications ranging from low-cost screening with smartphone-based probes to algorithm-guided detection of oral lesion heterogeneity and margins using optical coherence tomography. Combined imaging and artificial intelligence approaches can improve oral cancer outcomes through improved detection and diagnosis.
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Affiliation(s)
- B Ilhan
- Department of Oral & Maxillofacial Radiology, Ege University Faculty of Dentistry, Bornova-Izmir, Turkey
| | - K Lin
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - P Guneri
- Department of Oral & Maxillofacial Radiology, Ege University Faculty of Dentistry, Bornova-Izmir, Turkey
| | - P Wilder-Smith
- Beckman Laser Institute, University of California, Irvine, CA, USA
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Gobbo M, Ottaviani G, Rupel K, Zoi V, Di Lenarda R, Biasotto M, Poropat A. Self-perception and physician's awareness on early detection of tongue cancer: experience of the Oral Medicine Unit of Trieste. ACTA ACUST UNITED AC 2020; 69:95-99. [PMID: 32489088 DOI: 10.23736/s0026-4970.19.04212-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this retrospective study was to characterize the outpatient oral medicine referral pattern for tongue lesions with particular emphasis on cancer. METHODS Records of patients referred to the Oral Medicine department for any tongue lesions needing biopsy between 2009 and 2016 were retrospectively analyzed. All cases diagnosed as tongue cancer were screened for medical history, referral pattern, treatment/diagnosis/follow-up. RESULTS Among 266 patients, 39 were diagnosed with cancer, 43.6% were smokers and 10.3% alcohol consumers, 38.5% felt pain, 53.8% noticed the lesion or felt its presence, 46.2% were referred from another specialist. For people aware or informed of the lesion. the mean time waited before consultation was 7.9 months. In 53.8% of cases, narrow-band-imaging guided the biopsy. In 29 patients, biopsy was performed the day of the visit. Patients were referred from dentists (42.1%), Primary-care-Physician (10.5%), Emergency-Dental-Unit (7.9%), Radiotherapist (7.9%), Otolaryngologist (7.9%), Dermatologist (26%), infectious diseases unit (2.6%), auto-referral in 18.4%. Lesion was defined by referring doctor as "suspicious" (13.1%), white (10.5%), vegentans (5.3%), Lichen-like (5.3%), ulcerative (2.6%), Tumoral (26.3%), Bollous (2.6%). An unweighted Kappa Value of 0.024, assessed low concordance between referral diagnosis and diagnosis performed by the Oral Medicine specialist before the biopsy. CONCLUSIONS Patients are not always aware of the risk of oral cancer. Accurate information should be provided to patients as well as to specialists rather than just dentists as regard as the risk factors for oral cancer, the importance of referral to specialized departments and timing. The use of new technologies should be widespread.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy -
| | - Giulia Ottaviani
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Katia Rupel
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Valentina Zoi
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Biasotto
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Augusto Poropat
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Akinkugbe AA, Garcia DT, Brickhouse TH, Mosavel M. Lifestyle risk factor related disparities in oral cancer examination in the U.S: a population-based cross-sectional study. BMC Public Health 2020; 20:153. [PMID: 32005213 PMCID: PMC6995129 DOI: 10.1186/s12889-020-8247-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/20/2020] [Indexed: 01/09/2023] Open
Abstract
Background Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination. Methods Adult participants ≥30 years (n = 9374) of the 2013–2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression estimated odds ratios (OR) and 95% confidence intervals (CIs) of ever and past year oral cancer examination adjusted for age, gender, race/ethnicity, education, income, and time since last dental visit. Results One third (33%) reported ever been examined for oral cancer, 66% of whom reported an examination in the past year. Adjusted OR (95% CI) of past year examination comparing current and former smokers to non-smokers were 0.51 (0.29, 0.88) and 0.74 (0.53, 1.04) respectively. Similarly, current and former alcohol drinkers relative to abstainers were less likely to report a past year oral cancer examination, OR (95% CI) = 0.84 (0.53, 1.30) and 0.50 (0.30, 0.83) respectively. Conclusion This study showed that smokers and alcohol users were less likely than abstainers to self-report a past year oral cancer examination. Access to affordable and targeted oral cancer examination within the dental care setting might ensure that these high-risk individuals get timely examinations and earlier diagnosis that might improve prognosis and survival.
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Affiliation(s)
- Aderonke A Akinkugbe
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, 1101 East Leigh Street, Richmond, VA, 23298-0566, USA. .,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, USA.
| | - Dina T Garcia
- Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, USA.,Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tegwyn H Brickhouse
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, 1101 East Leigh Street, Richmond, VA, 23298-0566, USA.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, USA
| | - Maghboeba Mosavel
- Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, USA.,Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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15
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Kogi S, DaSilva J, Mikasa Y, Lee C, Ishikawa-Nagai S, Yang Q, Kihara H, Abe R, Yamada H. Knowledge and Practice of Oral Cancer Screening in Teaching Faculty-Comparison of Specialty and Year of Clinical Experience. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:455-462. [PMID: 29354870 DOI: 10.1007/s13187-018-1323-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to assess the knowledge, practice, confidence, and perceived barriers to oral cancer screening among teaching faculty in Japan. Results were compared by specialist as well as years of clinical experience. A 25-question survey was used to assess the oral cancer screening practices of faculty dentists at Iwate Medical University, School of Dental Medicine, the only dental school located in the northeast (Tohoku) region of Japan. The study was approved by the Institutional Review Board of Iwate Medical University. The response rate was 83% (n = 110, 71.8% were male). This survey revealed that only 43.6% of the dentists performed oral cancer screening frequently (always or usually) at the initial appointment, and there was no significant differences between specialists and clinical experience. Visual inspection of the oral cavity was the primary screening method, but the frequency and content of the examination (TMJ and tonsil) was significantly different between specialties. A history of cancer and tobacco use motivated providers to perform an examination and was significantly different between various specialists and clinically experienced providers. In contrast, HPV and alcohol consumption were a weak motivator. The confidence level of providers on their examination knowledge/skills was poor, especially among junior faculty. More than 80% of junior faculty indicated a lack of knowledge/skills as a major barrier.
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Affiliation(s)
- Shintaro Kogi
- School of Dental Medicine, Iwate Medical University, 1-3-27 Uchimaru, Morioka, Iwate, 020-0805, Japan
| | - John DaSilva
- Harvard School of Dental Medicine, 188 Long wood Avenue, Boston, MA, 02115, USA
| | - Yusuke Mikasa
- Harvard School of Dental Medicine, 188 Long wood Avenue, Boston, MA, 02115, USA
| | - Cliff Lee
- Harvard School of Dental Medicine, 188 Long wood Avenue, Boston, MA, 02115, USA
| | | | - Qian Yang
- Harvard School of Dental Medicine, 188 Long wood Avenue, Boston, MA, 02115, USA
| | - Hidemichi Kihara
- School of Dental Medicine, Iwate Medical University, 1-3-27 Uchimaru, Morioka, Iwate, 020-0805, Japan
- Harvard School of Dental Medicine, 188 Long wood Avenue, Boston, MA, 02115, USA
| | - Ryosuke Abe
- School of Dental Medicine, Iwate Medical University, 1-3-27 Uchimaru, Morioka, Iwate, 020-0805, Japan
| | - Hiroyuki Yamada
- School of Dental Medicine, Iwate Medical University, 1-3-27 Uchimaru, Morioka, Iwate, 020-0805, Japan
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16
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LeHew CW, Weatherspoon DJ, Peterson CE, Goben A, Reitmajer K, Sroussi H, Kaste LM. The Health System and Policy Implications of Changing Epidemiology for Oral Cavity and Oropharyngeal Cancers in the United States From 1995 to 2016. Epidemiol Rev 2018; 39:132-147. [PMID: 28402398 DOI: 10.1093/epirev/mxw001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/26/2016] [Indexed: 12/19/2022] Open
Abstract
Oral cavity and oropharyngeal cancers are typically grouped under the general term, "oral cancer." Yet, the incidence of oropharyngeal cancers is increasing in the United States, while the incidence of oral cavity cancers has declined. These 2 distinct but conflated groups of oral cancers are attributed to different risk factors. Incidence and survival trends were examined across US population groups and by anatomical subsite. Disparities in incidence and survival by sex, race/ethnicity, and subsite were identified. Risk factors are complex, interactive, and not fully identified. Cancer control research illustrates health disparities in access to care and patient outcomes. Database and supplemental searches yielded 433 articles published between 1995 and 2016 characterizing aspects of oral cancer epidemiology relating to incidence, survival, risk, disparities, and cancer control. Oral cavity cancer survival in black men remains the most intractable burden. Although understanding of oral cancer etiology is improving, application to policy is limited. Cancer control efforts are diverse, sporadic, limited in scope, and generally lacking in success, and they need stratification by oral cavity cancers/oropharyngeal cancers. Further intervention and epidemiologic research, improved workforce capacity, and integrated care delivery are identified as important directions for public health policy. Sustained, multilevel campaigns modeled on tobacco control success are suggested.
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17
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Laronde DM, Corbett KK. Adjunctive screening devices for oral lesions: their use by Canadian Dental Hygienists and the need for knowledge translation. Int J Dent Hyg 2015; 15:187-194. [PMID: 26694690 DOI: 10.1111/idh.12190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
Screening for oral cancer and other mucosal conditions is a knowledge-to-action objective that should be easy: there is supportive evidence, it is fast and non-invasive, and the oral cavity is easy to visualize. However, over 60% of oral cancers are diagnosed late, when treatment is complex and prognosis poor. Adjunctive screening devices (ASDs), e.g. toluidine blue (TB), fluorescence visualization (FV), chemiluminescence (CL) and brush biopsies, were designed to assess risk of oral lesions or aid in identification and localization of oral premalignant and malignant lesions. Little is known on how clinicians feel about using ASDs. OBJECTIVES To evaluate use and level of comfort in using ASDs for oral cancer screening among dental hygienists. METHODS Online email survey of a stratified random sample of nearly 3000 dental hygienists from four Canadian provinces. RESULTS A total of 369 hygienists responded about ASDs. Ninety-three (25%) had used an ASD. Use was associated with six or more continuing education (CE) courses per year (P = 0.030), having a CE course in oral pathology within the last 3 years (P = 0.003) and having a screening protocol (P = 0.008). The most commonly used ASD is FV, which was the tool hygienists felt most comfortable using. Few used brush biopsies. Older graduates were more comfortable using TB (P = 0.014) and CL (0.033). CONCLUSION Current evidence and education through CE appears to bolster knowledge translation efforts for hygienists to become more comfortable in the use of ASDs. ASDs with minimal supporting evidence and not specifically targeted to hygienists, such as the brush biopsies, are not well utilized.
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Affiliation(s)
- D M Laronde
- Department of Oral Biological and Medical Sciences, University of British Columbia, Vancouver, BC, Canada.,Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada
| | - K K Corbett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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18
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Tax CL, Haslam SK, Brillant M, Doucette HJ, Cameron JE, Wade SE. Oral cancer screening: knowledge is not enough. Int J Dent Hyg 2015; 15:179-186. [PMID: 26333090 DOI: 10.1111/idh.12172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The purpose of this cross-sectional study was to investigate whether dental hygienists are transferring their knowledge of oral cancer screening into practice. This study also wanted to gain insight into the barriers that might prevent dental hygienists from performing these screenings. METHODS A 27-item survey instrument was constructed to study the oral cancer screening practices of licensed dental hygienists in Nova Scotia. A total of 623 practicing dental hygienists received the survey. The response rate was 34% (n = 212) yielding a maximum margin of error of 5.47 at a 95% confidence level. Descriptive statistics were calculated using IBM SPSS Statistics v21 software (Armonk, NY:IBM Corp). Qualitative thematic analysis was performed on any open-ended responses. RESULTS This study revealed that while dental hygienists perceived themselves as being knowledgeable about oral cancer screening, they were not transferring this knowledge to actual practice. Only a small percentage (13%) of respondents were performing a comprehensive extra-oral examination, and 7% were performing a comprehensive intra-oral examination. The respondents identified several barriers that prevented them from completing a comprehensive oral cancer screening. CONCLUSIONS Early detection of oral cancer reduces mortality rates so there is a professional responsibility to ensure that comprehensive oral cancer screenings are being performed on patients. Dental hygienists may not have the authority in a dental practice to overcome all of the barriers that are preventing them from performing these screenings. Public awareness about oral cancer screenings could increase the demand for screenings and thereby play a role in changing practice norms.
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Affiliation(s)
- C L Tax
- School of Dental Hygiene, Dalhousie University, Halifax, NS, Canada
| | - S Kim Haslam
- School of Dental Hygiene, Dalhousie University, Halifax, NS, Canada
| | - Mgs Brillant
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - H J Doucette
- School of Dental Hygiene, Dalhousie University, Halifax, NS, Canada
| | - J E Cameron
- School of Dental Hygiene, Dalhousie University, Halifax, NS, Canada
| | - S E Wade
- School of Dental Hygiene, Dalhousie University, Halifax, NS, Canada
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19
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Dost F, Do L, Farah CS. Lesion Evaluation, Screening and Identification of Oral Neoplasia Study: an assessment of high-risk Australian populations. Community Dent Oral Epidemiol 2015; 44:64-75. [DOI: 10.1111/cdoe.12191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/12/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Fatima Dost
- The University of Queensland Centre for Clinical Research; Herston Qld Australia
| | - Loc Do
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide SA Australia
| | - Camile S. Farah
- The University of Queensland Centre for Clinical Research; Herston Qld Australia
- School of Dentistry; Australian Centre for Oral Oncology Research & Education; The University of Western Australia; Nedlands WA Australia
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20
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Rashid A, Warnakulasuriya S. The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review. J Oral Pathol Med 2014; 44:307-28. [PMID: 25183259 DOI: 10.1111/jop.12218] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In recent decades, optical techniques utilising the principles of chemiluminescence and tissue autofluorescence have emerged to facilitate the early detection of any oral mucosal changes suspicious of cancer. PURPOSE To evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of oral cancer and oral potentially malignant disorders (OPMDs). METHODS A systematic review of the published literature to evaluate the effectiveness of the ViziLite(®) and ViziLite(®) Plus with toluidine blue, MicroLux™/DL and the VELscope™ as aids in the detection of oral cancer and OPMDs. RESULTS Twenty-five primary studies published between 2004 and 2013 satisfied our criteria for selection - 13 utilised chemiluminescence and 12 tissue autofluorescence. Some had utilised both study methods on the same population. Chemiluminescence shows good sensitivity at detecting any OPMDs and oral cancer. However, it preferentially detects leukoplakia and may fail to spot red patches. The additive use of toluidine blue may improve specificity. Tissue autofluorescence is sensitive at detecting white, red and white and red patches, and the area of fluorescence visualisation loss (FVL) often extends beyond the clinically visible lesion. However, in addition to OPMDs, VELScope may detect erythematous lesions of benign inflammation resulting in false-positive test results. CONCLUSION There is limited evidence for their use in primary care, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.
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Affiliation(s)
- A Rashid
- Department of Oral and Maxillofacial Surgery, King's College Hospital, London, UK
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