ORAL CANCER AND PUBLIC AWARNESS.
By: Dr. Adil Rasool Malik
Oral cancer survival rates are strongly dependent upon the stage in which the diagnosis is made. Patients diagnosed with oral cancer within the localized state have substiantially greater chance of substantially greater chance of successful treatment, and there is greater chance of morbidity if the patient is diagnosed with cancer in later stages. Successful early detection symbolizes one of the superlative techniques which will eventually increase the oral cancer survival rate and quality of life worldwide. Globally oral cancer is ranked fourth most frequent cancer in men and eighth most frequent cancer in women. Worldwide the annual inicidence of oral cancer is around 5000000 accounting for approximately 3%of all the malignancies. Thus, the disease creates the substantial world wide health burden. The incidence of oral cancer varies from one region to another in world.
In india, Bangladesh and Pakistan oral cancer is most common type of malignancy. In india it accounts for more than 50% of all the malignancies. Oral cancer is largly related to lifestyle. Major life style factors of this type of cancer are the misuse of tobacco and misuse of alcohol. In addition smoking, the use of smokeless tobacco has been largely associated with oral cancer. About 40% of the head and neck malignancies are known to be sqamous cell carcinomas arising in oral cavity.
SIGNS AND SYMPTOMS
- Oral cancer often starts as tiny, unnoticed white or red spot or sore anywhere in the mouth.
- It can affect any area of the oral cavity including the lips, gums, check lining, tongue and hard/soft palate.
- A sore that bleeds easily or doesn’t not heal.
- A colour change of the oral tissues.
- A lump, thickening,rough spot, crush or small eroded area.
- Pain,tenderness or numbness anywhere in the mouth or on the lips.
- Difficulty chewing swallowing, speaking moving the jaw or tongue.
- A change in the way the teeth fit together.
The Buccal cancer in India is the most common site for oral cancer in both men and women. This is also true of “developed” countries. However, in some developing countries, site prevalences differ, owing to different habits. For example, nasopharyngeal cancer in Southeast Asia and tongue in United States are the most common oral and pharyngeal sites. As a matter of fact, oral and pharyngeal cancer is one of the three leading sites of all cancers in that area of the world. Oral cancer incidence has remained stable, relative to the occurrence of newly diagnosed cancers of all sites, with absolute numbers only slightly increasing each year. The only oral site contrary to this trend was the lip, in which a reduction occurred over the past 10 years. Decades ago, the lip used to be the leading oral site.
Oral Cancer Risk and Smoking:
Smoking may be viewed as a worldwide epidemic, causing serious diseases and immense health problems. Apart from its effect on mortality, smoking results in a considerably increased morbidity rate with consequent losses in working days and productivity, excessive demand on medical services, and increased health expenditures. Globally, the consequences of tobacco use are staggering. By the year 2020, it is estimated that 8.4 mi people will die annually from tobacco-related diseases, more than two-thirds occurring in developing countries. If current trends continue, more people will perish annually from tobacco-related illness than from any single disease. Reports from the US surgeon general and others conclude that cigarette smoking is the main single cause of cancer mortality in the United States, contributing to an estimated 30% of all cancer deaths and substantially to cancers of the head and neck. A federal law requires that health warnings be printed on all cigarette packages sold in the United States. A recent federal report describing smoking trends among American high school students indicated that in 2001, almost 29% of students in grades 9 through 12 were current smokers and 14% were everyday smokers.
Regular Dental Check-ups Important for Early Detection of Oral Cancer:
Oral cancer screening is a part of a dental examination. Regular check –ups, including an examination of the entire mouth are essential in the early detection of cancerous and precancerous conditions. You may have a very small, but dangerous, oral spot or sore and not be aware of it.
Your dentist will carefully examine the inside of your mouth and tongue and in some patients may notice a flat, painless, white or red spot or a small sore. Although most of these are harmless, some are not. Harmful oral spots or sores often look identical to those that are harmless, but testing can tell them apart.
PUBLIC HEALTH AWARNESS.
Low public awareness of oral cancer and delays in symptomatic patients presenting to health services have been identified as contributing factors to poor survival rates. In order to promote diagnosis treatment of oral cancer at an earlier stage public awareness campaigns have been recommended encouranging those with sign and symptoms to attend primary care services at early age. The use of awareness campaigns to promte earlier diagnosis of oral cancer is also explores for both patient and health professional perspective. It has been seen that awarnesss raising campaigns can increase knowledge of the disease and attendance at health services in the short term, those at lesser risk often respond and evidence of longer term impact is very limited.
Today there are many annual campaigns organized by international and national bodies to raise public awareness of cancer and other health matters. Eg worlds cancer day, worlds aids day, world oral health day. IN 2016, systematic review was published which examined the evidence of effectiveness of interventions aimed at raising cancer awareness and promoting early presentation with cancer symptoms. It was found that some limited evidences that interventions delivered at the individual level could promote cancer knowledge and awareness in short term, particularly for more intensive and tailored interventions, but no evidence that is translated into promoting early presentation with cancer symptoms. The individual level interventions included written information via letters, brochures and leaflets: telephone counseling and computer interactive programmes within the primary care setting.
In relation to community bases interventions, the review found that approaches such as small group education programmes and health promotion programmes in leisure centers, workplaces and health clubs were again associated with limited evidence of effectiveness in promoting cancer awareness.
According to Indian government ministrial task on health equalities characteristics of interventions that are less likely to be effective in reducing the health equalities include”:
Information based campaigns( mass- media information campaigns).
Written materials( pamphlets, foodlabelling).
Campaigns reliant on people taking the initiative to opt in.
Campaigns/ message designed for the whole population.
Approaches which involve significiant price or other barriers
(The author is practicing oral pathologist, researching on oral cancer from last 5 years)