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Oral Cancer Prevention

This document discusses oral cancer prevention. It begins by introducing oral cancer as a condition dental professionals may encounter. It then covers the epidemiology, risk factors, limitations of treatment, prevention options, and a public health approach. The key causes of oral cancer are tobacco and alcohol use. While treatment has improved quality of life, survival rates have not changed significantly. A comprehensive prevention strategy is needed, including reducing risk factors, opportunistic screening of high-risk groups, counseling patients, and prompt referral of suspicious lesions. A public health approach should address the social determinants of oral cancer and utilize health promotion strategies.

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Gautam G J
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119 views24 pages

Oral Cancer Prevention

This document discusses oral cancer prevention. It begins by introducing oral cancer as a condition dental professionals may encounter. It then covers the epidemiology, risk factors, limitations of treatment, prevention options, and a public health approach. The key causes of oral cancer are tobacco and alcohol use. While treatment has improved quality of life, survival rates have not changed significantly. A comprehensive prevention strategy is needed, including reducing risk factors, opportunistic screening of high-risk groups, counseling patients, and prompt referral of suspicious lesions. A public health approach should address the social determinants of oral cancer and utilize health promotion strategies.

Uploaded by

Gautam G J
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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You are on page 1/ 24

ORAL CANCER

PREVENTION
By gautam gj
CONTENTS

Introduction

Epidemiology of oral cancer

Limitations of treatment

Etiology

Preventive options

A clinical approach to the prevention


of oral cancer

Public health approach

Conclusion
INTRODUCTION

 Oral cancer is one of the few conditions that dental professionals


may encounter within their surgeries that can be fatal.

 It is therefore essential that members of the dental team understand


the epidemiology and natural history of the condition and possible
options for prevention, screening, and treatment.

 Although progress has been made in the treatment of the disease,


survival rates have not improved substantially in recent decades.
(Cancer Research UK 2012 ; ONS 2005; Stell and McCormick 1985 ).
INTRODUCTION

 A Comprehensive public health strategy is required to tackle the


underlying causes of the disease in a coordinated and strategic
fashion.
EPIDEMIOLOGY OF ORAL
CANCER

Incidence rates and trends:


 Oral and oro-pharngeal cancers commonly include cancer of the lip,
tongue, mouth, oropharynx, piriform sinus, hypo/laryngopharynx, and
other ill-defined sites of the lip, oral cavity, and pharynx.

 In the UK, oral cancer is the fifteenth most common cancer and The most
commonly diagnosed type of oral cancers are cancer of the mouth and
tongue.

 A north–south divide in oral cancer incidence exists across the UK, and
almost half of cases in people aged 65 and over. Oral cancer incidence is
also strongly associated with deprivation and a recent rise over few decades
EPIDEMIOLOGY OF ORAL
CANCER

Incidence rates and trends:


 A recent systematic review and meta-analysis showed that oral cancer
rates across the world, including low income countries, were consistently
higher amongst poorer, less-educated and lower social classes (Conway et
al . 2008 ).

 Internationally the incidence varies considerably, with very high rates


found particularly in India and Sri Lanka, where oral malignancy is the
commonest type of cancer, accounting for 40% of all cancers.

 A male predilection is also a stat.


LIMITATIONS OF
TREATMENT

 Although quality of life of cancer patients have been improved


through technology and improved surgical techniques, there have
been no marked improvement in survival rates. (Cancer Research
UK 2012 ; ONS 2005; Stell and McCormick 1985 )

 The overall 5-year survival rate is around 50%, although for lip
cancer 90% will survive the disease for at least 5 years.
LIMITATIONS OF
TREATMENT

Factors influencing survival from oral cancer:

● Site of lesion (the further back in the mouth, the

poorer the prognosis).

● Size of lesion.

● Degree of differentiation.

● Involvement of regional lymph nodes.

● Presence of distant metastases.

 Most disadvantaged patients dying sooner than more affluent ones.


ETIOLOGY

 Oral cancer etiology is largely understood and can be prevented by taking


appropriate measures.

 Tobacco and alcohol, together cause 75–90% of all cases.

Established risk factors:


● Smoking tobacco.
● Chewing tobacco/oral snuff.
● Chewing betel quid (pan).
● Human papillomavirus (HPV) infection.
● Heavy consumption of alcohol.
● Presence of potentially malignant lesions.
ETIOLOGY

Predisposing factors:
● Dietary deficiencies (vitamins A, C, and E,
and iron).
● Genetic disposition.
● Sunlight (lip cancer).
● Dental trauma.
 A diet rich in fruit and vegetables reduces oral cancer risk. A meta-
analysis showed a significant risk reduction of about 50% for each
additional daily serving of fruit and vegetables (Pavia et al . 2006 ).
 Infection with the human papillomavirus (HPV) increases risk,
particularly in the oropharynx. Certain oral lesions such as leukoplakia
(white patches) and erythroplakia (red patches) can precede the
development of malignancies.
PREVENTIVE OPTIONS

 Treatment for oral cancer is expensive for both the individual and
society but prognosis is poor.

 At least three quarters of oral cancers could be prevented if tobacco


and alcohol consumption were better controlled. (Cancer Research
UK 2012 )

 The dental profession has tended to focus attention at an individual


level and especially on the need for oral cancer screening.
PREVENTIVE OPTIONS

 To screen or not to screen, that is the question.

 An alternative option is the opportunistic screening of high-risk


groups attending primary dental care services.
A CLINICAL APPROACH TO THE
PREVENTION OF ORAL CANCER

Comprehensive medical history:


 A comprehensive and thorough medical history should always be
taken with all new patients, and at recall appointments for existing
patients.

 All practitioners should routinely ask their patients about their


tobacco and alcohol habits.

 These details must be recorded and referred to at subsequent


appointments.
A CLINICAL APPROACH TO THE
PREVENTION OF ORAL CANCER

Detailed and thorough oral examination:

 A thorough and detailed extra- and intra-oral examination of the hard


and soft tissues should be undertaken during dental check-ups,
especially for those at greater risk of oral cancer.
A CLINICAL APPROACH TO THE
PREVENTION OF ORAL CANCER

Patient counselling:
Dental team has an important role in advising and supporting patients to
adopt healthier choices to prevent oral cancer and three points need to be
stressed,

1 Stop smoking or chewing tobacco.

2 Be moderate in alcohol use (3–4 units daily for men

and 2–3 units daily for women).

3 It is important to eat at least five or more portions

of fresh fruit and vegetables a day.


A CLINICAL APPROACH TO THE
PREVENTION OF ORAL CANCER

Patient counselling:
 Smoking cessation is one of the areas of health promotion where
good evidence exists to demonstrate effectiveness (NICE 2006 ; Raw
et al . 1998 ).

 It is therefore very important that members of the dental team


become involved in smoking cessation activity within their practices
in the following manner:
A CLINICAL APPROACH TO THE
PREVENTION OF ORAL CANCER

Patient counselling:
 Very brief advice on the harmful effects of high alcohol consumption
on oral health is therefore an important preventive role for the dental
team as suggested by a substantial body of research.

Prompt and appropriate referral


 It is essential that dental practitioners should request an urgent
specialist appointment for any patient with a lesion that is suspected
of malignancy (Cancer Research UK 2005 ). Prompt referral is
critical as any delay may affect the long-term prognosis.
PUBLIC HEALTH APPROACH

 A public health strategy to reduce oral cancer should be based upon the
following principles:

● An understanding of the underlying social , economic, and


political determinants of oral cancer

● A directed population approach

● Common risk-factor approach

● Work in partnerships

● Work with community members

● Utilizing a range of complementary health promotion approaches


PUBLIC HEALTH APPROACH

Based upon the Ottawa Charter (WHO 1986 ), outlines a range of


options for a public health

approach to oral cancer prevention.


CONCLUSION

 Although the number of oral cancer cases is relatively small, the


impact of the disease on individuals affected and the wider society
is great.

 Advances in treatments may have improved the quality of life of


oral cancer suffers, but survival rates have remained largely
unchanged for several decades.
CONCLUSION

 A greater emphasis needs to be placed upon implementing


evidence-based preventive measures within clinical dental
settings.

 In addition, there is a need for a supporting public health strategy


to address the wider social, economic, and political determinants
of oral cancer.
THANK YOU

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