Oral mucosal screening and referral attitudes of Australian oral health therapists and dental hygienists in Queensland

Basaloid Squamous Cell Carcinoma, an Aggressive and Rare Cancer of the Oral Cavity: Can We Prevent It at the Primary Care Setting?

Oral cavity cancer represents about 2%-3% of all cancers worldwide, with more than 355,000 new cases per year, one-third of which are reported in developed countries. Oral cancer is also known to be extremely aggressive when detected late, thus presenting one of the lowest cancer survival rates. It is estimated that as much as 90% of oral cancers are attributable to tobacco and/or alcohol consumption and that high-risk human papillomaviruses (HPV) infections pose an independently increased risk for their development. Therefore, it can be a preventable disease when associated with changes in lifestyle and possible modifiable risk factors, combined with early and preventive intervention. Basaloid squamous cell carcinoma (BSCC) constitutes an aggressive and rare form of oral cancer, being one of the rarest and most aggressive variants of squamous cell carcinoma (SCC, the most common), and usually presents as a high-grade disease with a poor prognosis. It is typically associated with heavy smoking and alcohol abuse, occurring most commonly in older men. Here, we report a clinical case of a 60-year-old man with excessive consumption of both tobacco and alcohol, poor oral hygiene, and partial edentulousness who came to our primary health department with complaints of odynophagia twice in a four-year time-lapse. The first time, two whitish ulcerated lesions on the left tonsil were detected and biopsied but revealed a negative histological result. After four years, he came again to our primary health care department with similar complaints of odynophagia and also sore throat with radiation to the right ear, accompanied by globus sensation and anorexia. No suspicious lesions were detected, except a globally hyperemic oropharynx. Considering the history of abusive consumption, no improvement with symptomatic treatment, and persistent clinical signs, an extended diagnostic approach was carried out. After four months, a pharyngeal mass measuring 53 mm was detected on pharyngeal-neck computed tomography (CT), and the diagnosis of a BSCC located in the right tonsillar pillar and base of the tongue was finally determined. Unlike other cancers that have been detected earlier through screening programs, oral cancer is often detected at an advanced stage, compromising survival and quality of life. The opportunity to intervene early and preventively in consumption habits, promote healthy lifestyles, and try to prevent disease is unique at the primary care level. Moreover, opportunistic screening through a thorough examination of the oral cavity is extremely important for timely diagnosis and treatment.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The economic burden of oral squamous cell carcinoma in Australia

OBJECTIVES

The financial burden of treatment for oral squamous cell carcinoma in Australia has never been reported, and there is a paucity of international data. Here, we report the direct costs of treatment of surgically resectable oral cancer in a tertiary public hospital in Australia over a 15-year period.

MATERIALS AND METHODS

Pathology department records, records of hospital attendance and hospital finance department records were interrogated to determine the direct costs of inpatient and outpatient treatment. Costs were adjusted using the total health price index so that all costs were equivalent to costings for the 2016/2017 financial year.

RESULTS

A total of 113 cases were identified as suitable for inclusion. Complete inpatient and outpatient hospital attendance and costing data for treatment and subsequent 2-year follow-up was available for 29 cases. The average total cost over the 2-year period was $92 958AUD (median $102 722, range $11 662-$181 512). On average, 92.8% of costs were incurred in the first year post-diagnosis. Inpatient costs, outpatient costs and total costs increased with increasing pathological cancer stage. Both 1- and 2-year post-diagnosis overall cost for patients with Stage 4 oral cavity cancer were more than two times greater than for patients with Stage 1 oral cancer.

CONCLUSION

It is well documented that patients diagnosed at an earlier stage will have better survival outcomes, and it is assumed that the economic burden of their treatment will be less. We have shown that there is a direct correlation between cancer stage and cancer treatment cost. The findings provide clear economic support for oral cancer screening initiatives to detect earlier stage cancers, and the need to investigate novel techniques and technologies to detect oral squamous cell carcinoma early and reduce recurrence and mortality rates.

Evaluation of a Lectin-Based Imaging System for the Chairside Detection of Oral Dysplasia and Malignancy

PURPOSE

Currently available oral cancer screening adjuncts have not enhanced clinical screening methods because of high false positives and negatives, highlighting the need for a molecularly specific technique for accurate screening of suspicious oral lesions. The purpose of this study was to evaluate the in vivo screening accuracy of an oral lesion identification system that evaluates aberrant glycosylation patterns using a fluorescently labeled lectin (wheat germ agglutinin and fluorescein isothiocyanate [WGA-FITC]).

MATERIALS AND METHODS

The authors designed and implemented a prospective cohort study at 3 institutions composed of patients with and without suspicious oral lesions. Oral cavities were screened by clinical examination and with the oral lesion identification system according to a stepwise procedure that included the topical application and fluorescence visualization of a fluorescent nuclear stain and WGA-FITC. Tissue samples were obtained from all enrolled patients for histopathological diagnosis and were used to calculate sensitivity and specificity metrics (primary outcome variable) irrespective of the oral lesion identification system result.

RESULTS

The sample was composed of 97 patients; 86 had 100 clinically suspicious lesions and 11 without such lesions were included as a control group. Use of the oral lesion identification system resulted in 100, 100, and 74% sensitivity for cancer, high-grade dysplasia, and low-grade dysplasia, respectively, and a specificity of 80%. Clinical diagnosis yielded similar sensitivity values of 84, 100, and 88% for cancer, high-grade dysplasia, and low-grade dysplasia, respectively, and a specificity of 76%. Use of the oral lesion identification system enhanced the visualization of lesion dimensionality and borders.

CONCLUSIONS

The results of this study suggest the oral lesion identification system was a beneficial adjunct to standard clinical examination, because the system provided sensitivity and specificity values similar to or greater than clinical diagnosis.

Oral cancer screening practices of oral health professionals in Australia

Background

To evaluate oral cancer-related screening practices of Oral Health Professionals (OHPs - dentists, dental hygienists, dental therapists, and oral health therapists) practising in Victoria, Australia.

Methods

A 36-item survey was distributed to 3343 OHPs. Items included socio-demographic and work-related characteristics; self-assessed knowledge of oral cancer; perceived level of confidence in discussing oral health behaviors with patients; oral cancer screening practices; and self-evaluated need for additional training on screening procedures for oral cancer.

Results

A total of 380 OHPs responded this survey, achieving an overall response rate of 9.4%. Forty-five were excluded from further analysis. Of these 335 OHP, 72% were dentists; (n = 241); either GDP or Dental Specialists; 13.7% (n = 46) were dental hygienists; 12.2% (n = 41) were oral health therapists, and the remaining 2.1% (n = 7) were dental therapists. While the majority (95.2%) agreed that oral cancer screening should be routinely performed, in actual practice around half (51.4%) screened all their patients. Another 12.8% “Very rarely” conducted screening examinations. The probability of routinely conducting an oral cancer screening was explored utilising Logistic Regression Analysis. Four variables remained statistically significant (p < 0.0001). Results indicate that the likelihood of conducting an oral cancer screening rose with increasing levels of OHPs’ confidence in oral cancer-related knowledge (OR = 1.35; 95% CI: 1.09–1.67) and with higher levels of confidence in discussing oral hygiene practices with patients (OR = 1.25; 95% CI: 1.03–1.52). Results also showed that dental specialists were less likely to perform oral cancer screening examinations compared with other OHPs (OR = 0.18; 95% CI: 0.07–0.52) and the likelihood of performing an oral cancer screening decreased when the “patient complained of a problem” (OR = 0.21; 95% CI: 0.10–0.44).

Conclusion

Only half the study sample performed oral cancer screening examinations for all of their patients. This study provides evidence of the need for further oral cancer-related education and screening training for OHPs, which is vital to enhance oral cancer prevention and early detection.