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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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Bhattacharjee T, Mandal P, Gangopadhyay S. Smokeless tobacco use and related oral mucosal changes in Bengali Women. J Family Med Prim Care 2020; 9:2741-2746. [PMID: 32984118 PMCID: PMC7491812 DOI: 10.4103/jfmpc.jfmpc_100_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Tobacco use is called the single most cause of preventable cause of death all over the world. The various study confirmed that smokeless tobacco use is directly related to oral cancer and pre-cancer. The prevalence of smokeless tobacco use varies widely in different countries and states based on age group, gender, with varied socioeconomic, cultural and educational backgrounds. CONTEXT Bengali female population. AIM Explore the pattern of smokeless tobacco use and oral mucosal changes caused by it. METHODS 155 women aged 15 years and above were selected. Face-to-face interview was conducted using a structured questionnaire. Data were summarized and statistically, analysis was done. STATISTICAL ANALYSIS USED Chi-square test and univariate logistic regression done. RESULTS The prevalence of current smokeless tobacco use was found to be 18.7%. On univariate logistic regression, it was found that there was a significant association between smokeless tobacco use and less educated females, odds ratio 0.4209 (0.1855-0.9550) family income less than 10,000, odds ratio 3.9773 (1.3047-12.1242), and oral changes odds ratio 0.2693 (0.1027-0.7061). CONCLUSIONS Health care providers, as well as social workers, should give all efforts to bring the women from behind the curtain and educate them about the hazards of smokeless tobacco use.
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Affiliation(s)
- Tathagata Bhattacharjee
- Department of Oral Pathology and Microbiology, North Bengal Dental College and Hospital, Darjeeling, WestBengal, India
| | - Pallab Mandal
- Department of Oral Pathology and Microbiology, North Bengal Dental College and Hospital, Darjeeling, WestBengal, India
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Rocha TAH, Thomaz EBAF, da Silva NC, de Sousa Queiroz RC, de Souza MR, Barbosa ACQ, Thumé E, Rocha JVM, Alvares V, de Almeida DG, Vissoci JRN, Staton CA, Facchini LA. Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer. BMC Cancer 2017; 17:706. [PMID: 29084516 PMCID: PMC5661925 DOI: 10.1186/s12885-017-3700-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. Methods An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). Results The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52−9; p = 0.014). Conclusions In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths. Electronic supplementary material The online version of this article (10.1186/s12885-017-3700-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Federal University of Minas Gerais, School of Economics, Center of post-graduate and Research in Administration, Belo Horizonte, Minas Gerais, Brazil. .,Business Administration Department - Observatory of human resources for health, Universidade Federal de Minas Gerais, Antonio Carlos, avenue, 6627, Belo Horizonte, Minas Gerais, Brazil.
| | | | | | | | | | - Allan Claudius Queiroz Barbosa
- Faculty of Economics, Department of Administrative Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Elaine Thumé
- Faculty of Nursing, Department of Collective Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Viviane Alvares
- National School of Public Health, Nova University of Lisbon, Lisboa, Portugal
| | | | - João Ricardo Nickenig Vissoci
- Duke Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA
| | - Catherine Ann Staton
- Duke Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA
| | - Luiz Augusto Facchini
- Faculty of Medicine, Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Lombardo EM, da Cunha AR, Carrard VC, Bavaresco CS. [Delayed referrals of oral cancer patients: the perception of dental surgeons]. CIENCIA & SAUDE COLETIVA 2015; 19:1223-32. [PMID: 24820605 DOI: 10.1590/1413-81232014194.00942013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/25/2013] [Indexed: 11/21/2022] Open
Abstract
The scope of this study was to verify the possible reasons to justify the delay in the referral of oral cancer patients to specialized health care sectors from the standpoint of the dental surgeons involved in Primary Health Care (PHC) in Porto Alegre, state of Rio Grande do Sul. This target public of this study was dental surgeons working in five different labor environments in PHC in Porto Alegre. Criteria for inclusion was dental surgeons graduated in and working in PHC. The data collection instrument was the focus group technique and application of a structured questionnaire. After data collection, interpretative analysis was conducted with classification of the information under four main headings: professional, team, community and services network. The results suggest that there are several factors associated with delayed in referral of patients with oral cancer to specialized health care sectors. These include omission of early diagnosis, lack of multidisciplinary work and insufficient attention to the need for joint community responsibility with patients for their own health status. It is also due to deficiencies in the health service network, specifically regarding the quality of communication between professionals at different levels of the health services.
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Affiliation(s)
| | | | - Vinicius Coelho Carrard
- Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul
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Brocklehurst P, Pemberton MN, Macey R, Cotton C, Walsh T, Lewis M. Comparative accuracy of different members of the dental team in detecting malignant and non-malignant oral lesions. Br Dent J 2015; 218:525-9. [DOI: 10.1038/sj.bdj.2015.344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 11/09/2022]
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Brocklehurst PR, Baker SR, Speight PM. Oral cancer screening: what have we learnt and what is there still to achieve? Future Oncol 2010; 6:299-304. [PMID: 20146588 DOI: 10.2217/fon.09.163] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oral cancer is an important global healthcare problem. In the UK, the incidence is increasing and late-stage presentation is common. Determining the feasibility of a national screening program for oral cancer is therefore an important step in the prevention of the disease. Evidence exists to suggest that an oral examination of high-risk individuals may be a cost-effective screening strategy. However, questions remain over which primary care environment would be the most suitable and the criteria for a positive screen and referral. Further research is needed in the form of clinical trials or demonstration studies in primary care. The impact on secondary care, the role of auxiliaries and training needs also need to be determined. In addition, the assessment of adjunctive aids and evaluation of potential biomarkers are considered important.
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Factors which determine the referral of potentially malignant disorders by primary care dentists. J Dent 2010; 38:569-78. [PMID: 20417679 DOI: 10.1016/j.jdent.2010.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 04/14/2010] [Accepted: 04/17/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The detection of potentially malignant disorders (PMD) is of paramount importance, yet few studies have examined what factors or cues primary care dentists (PCDs) take into account when diagnosing and referring PMD. The objective of this study was to determine what cues PCDs use when making a decision to refer PMD to secondary care. METHODS Ten clinical vignettes were presented to PCDs using a website in the public domain. Five vignettes represented PMD and five represented benign conditions. Participants were asked to provide a differential diagnosis, a referral decision and score 12 supplied cues based on their importance in this decision. Optimal data analysis was then used to determine which of the 12 cues were significant at predicting the participants' referral decision. RESULTS 147 participants responded and the number of accurate diagnoses for the PMD group ranged from 46.3 to 79.5%, whilst the number of correct referral decisions ranged from 77.6 to 86.9%. The number of accurate diagnoses and referral decisions in the benign group ranged from 63.0 to 89.0% and 40.1 to 71.9% respectively. Risk factors were statistically significant in their ability to predict a referral decision in both groups, but overall there appeared to be a lack of discrimination in the referral decision. CONCLUSION The results show that PCDs use a range of cues in the decision making process and suggest that if they are at all in doubt or are faced with worrying cues, their default position is to refer. Whilst this is reassuring, greater education of PCDs and standardised criteria are essential to avoid over-referral.
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A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer. Br Dent J 2010; 208:E3; discussion 72-3. [PMID: 20098360 DOI: 10.1038/sj.bdj.2010.54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2009] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS Many oral squamous cell carcinomas present as late stage disease and so the detection of early and pre-malignancy is considered to be of paramount importance. The majority of research examining primary care dentists' experience of the detection and management of early disease has been undertaken using questionnaires, with the inherent bias this introduces. The aim of this study was to use qualitative methods to develop a richer account of practitioners' views about screening and what factors influence the decision to refer a patient. METHODS Semi-structured interviews were undertaken with eighteen dentists in Sheffield, transcribed and analysed using thematic analysis. Ten codes were identified according to the aims of the study and organized into four overarching themes. RESULTS Although many dentists were screening regularly, some did not appear to be adopting a rigorous and systematic approach. A number of participants also placed more reliance on 'classical' presentations rather than the more varied presentation of potentially malignant lesions and were more influenced by the clinical history of the lesion rather than risk factors. CONCLUSION Overall, the present research suggests that for some dentists, more rigour is required when examining for early disease.
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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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