Oral Cancer Prevention

Group 21Group Members - Maryan Al Khauri,

Hasanain Alani, Myung Jin Maria Cho, Kala Mapes, Kyubo Yoon

Community DentistryDSD8430

Public Health Problem: Oral Cancer● Includes cancers of the lips, tongue, oral cavity and pharynx. ● Responsible for 2-3 % of all cancer deaths in the United States. ● Among the most debilitating and disfiguring of all cancers.● The sixth most common cancer type among U.S. white males and the fourth most

common among African-American males. ● 30,000 new cases are diagnosed annually with more than 8,000 deaths occur

annually. ● 5 years survival rate is only 52 %. ● About one- half of cases and majority of deaths occur in people 65 years of age

or older. ● The primary risk factors in the United States include:

– Tobacco– Alcohol– Exposure to the sun for lip cancer. – Human papilloma virus.

PICO Question

In the Detroit inner city, how does a tobacco cessation program compared to oral screenings for disease reduce the risk of oral cancer?

Literature Review 1) Smoking Cessation in the Dental Setting.

❖ The authors assessed interventions for smoking cessation (smokeless tobacco and cigarette smokers) in a dental setting, community school, and college setting. They found that behavioral counseling conducted by an oral health provider, including an oral exam, in all settings increases the rate of tobacco abstinence in prevention of oral cancer.

Level of Evidence: Systematic Review - high

Literature Review

2) Intervention Study For Primary Prevention of Oral Cancer Among 36,000 Indian Tobacco Users.

❖ The authors describe a cohort prospective study, involving tobacco chewers and smokers that were selected from 3 rural districts in India. These individuals were interviewed for their tobacco habits and were examined for the presence of oral leukoplakia and other precancerous oral lesions, first in a baseline survey, and then annually for a 5 year period.

❖ By personal advice and via the mass media they were encouraged to quit or reduce their smoking habits. A control cohort was provided by parallel study conducted earlier in the same areas with the same methodology but on different individuals and without any educational intervention.

❖ In two districts, the 5 year age adjusted incidence rate of leukoplakia and other precancerous conditions in the intervention group was significantly less than the control, and the reduction was consistent across all tobacco habits and both sexes.

❖ This study demonstrates that changes in tobacco habits of rural population in general can be achieved through educational effort and that such changes will lead to primary prevention of oral cancer.

Level of Evidence: Cohort Prospective Study- medium

Literature Review 3) Dentists’ Perception of the Role they Play in Early Detection of Oral Cancer

❖ This study asked 3 things to dentists in Malaysia - general information on dentist, early detection of oral cancer, and risk habits associated with oral cancer. The main result of this study was that there was a significant association between the levels of confidence with respect to how often a dentist would give advice to their patients on risk habit cessation.

Level of Evidence: Meta-analyses - high

Literature Review 4) Smoking cessation as a part of oral health care delivery – Patient's perceptions:

❖ A descriptive study was conducted in August 2011 using self administered questionnaire checked for face and content validity by experts. Four groups of 86 patients each who visited dental college and hospital. Descriptive statistics were done to analyze the data from the questionnaire. There was a noteworthy variance in the knowledge of smokers and non-smokers about the effects of smoking and tobacco on oral cancer and aging. Patients had positive insight about the role of dentists in smoking cessation methods and advice. If advised by their dentist, patients showed willingness to quit smoking.

Level of Evidence: Cohort Study - Medium

Literature Review

5) An Alarming Lack of Public Awareness towards Oral Cancer.

❖ To assess public awareness and knowledge of oral cancer, particularly its association with tobacco and alcohol use, the authors carried out a survey of adults over the age of 16 years. The result highlighted a general lack of awareness among the public about oral cancer and a lack of knowledge about its causation. It was indicated that oral cancer was one of the least heard of cancers, and only a low percentage of people were aware of the link between smoking and oral cancer.

Level of Evidence: Random Omnibus Survey - low

InterventionArticle: Interventions for tobacco cessation in the dental setting

INTERVENTION: A Smoking Cessation Program with Oral Cancer Screening

RATIONALE: Tobacco use is the primary risk factor for oral cancer. Oral cancer screening is a preventive measure for the disease.

LEVEL OF EVIDENCE: High Level of Evidence since our main study was a systematic review and there was a large volume of data in support of oral cancer prevention using these methods.

Prevention Program

What? • An ongoing program involving smoking cessation instruction and oral screening

when a patient visits the clinic (our article supports combined program of these two).

• Pre and post-intervention questionnaires• Patient compliance follow-up conducted on next dental visit• Promote sustainable programs to patients - Mouth Self-Examination (MSE)• Continuing education for dental health providers

Prevention ProgramWhere? UDM Clinic

Prevention ProgramHow?

• Self-assessment of patients - questionnaires and Mouth Self-Examination (MSE)• Discussion with patients regarding smoking (tobacco, smokeless tobacco,

marijuana, etc.) and the health effects of them• Describe smoking cessation program we provide at the school• Suggest medications for smoking cessation such as patches, gum, lozenge, nasal

spray (all nicotine based) + non-nicotine based medications• Community class or presentation with many visuals, utilize both dental students

and faculty members in education of patients. • Reward patients if they bring friends, family members, etc.• Educate dental students how to address smoking cessation program to patients

with smoking habits. • Analyze data from questionnaires and observation to see things in community

level. Can utilize the result of data to make the program more strategic and effective

Program OutcomeSHORT TERM OUTCOMES: • Improve the knowledge of oral cancer• Raise oral cancer awareness • Decrease smoking habits of patients (give motivation to patients)

LONG TERM OUTCOMES:• Prolonged smoking cessation• Improved oral cancer literacy in the community• Improved oral health care literacy• Early detection of oral cancer will reduce incidences of further oral

cancer progression in the community• Give patients active role via Mouth Self-Examination

Bibliography1. Carr, AB, Ebbert, J. (2012). Interventions for tobacco cessation in the dental setting. Cochrane Database Systematic Reviews, 6, CD005084. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916957/

2. Civljak, M, Sheikh, A, Stead LF, Car J. (2010). Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2010, Issue 9. Art. NO: CD007078. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007078.pub3/ful

3. Cruz, G., Ostroff, J., Kumar, J., & Gajendra, S. (2005). Preventing and detecting oral cancer: Oral health care providers' readiness to provide health behavior counseling and oral cancer examinations. Journal of the American Dental Association, 594-601.

4. Gupta, P. C., J. J. Pindborg, R. B. Bhonsle, P. R. Murti, F. S. Mehta, M. B. Aghi, D. K. Daftary, H. T. Shah, and P. N. Sinor. (1986). Intervention Study For Primary Prevention of Oral Cancer Among 36000 Indian Tobacco Users. The LANCET, 327 (8492): 1235–1239.

5. Horowitz, A. M., T. F. Drury, H. S. Goodman, and J. A. Yellowitz. (2000). Oral Pharyngeal Cancer Prevention

and Early Detection. Dentists’ Opinions and Practices. The Journal of the American Dental Association, 131(4):

453-462.

Bibliography6. Majmudar, V., Mishra, A., Kulkarni, V., Dusane, R., & Shastri, S. (2015). Tobacco-related knowledge, attitudes, and

practices among urban low socioeconomic women in Mumbai, India. Indian J Med Paediatric Oncology, 36(1), 32-27.

Retrieved April 21, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363848

7. Saleh, A., Kong, Y., Vengu, N., Badrudeen, H., Zain, R., Cheong, S. (2014). Dentists’ Perception of the Role they

Play in Early Detection of Oral Cancer. Asian Pacific Journal of Cancer Prevention, 15, 229-237.

8. Sood, P., Narang, R., Swathi, V., Mittal, L., & Jha, K. (n.d.). Smoking cessation as a part of oral health care

delivery – Patient's perceptions. Journal of Pierre Fauchard Academy (India Chapter), 129-134.

9. Warnakulasuriya, S., Sutherland, G., & Scully, C. (2005). Tobacco, oral cancer, and treatment of dependence.

Oral Oncology, 41. 244-260.

10. Warnakulasuriya, K., Harris, C., Scarrott, D., Watt, R., Gelbier, S., Peters, T., & Johnson, N. (1999). An alarming lack of public awareness towards oral cancer. British Dental Journal, 319-322.