Download Current updates on early detection and prevention of oral cancer

Journal of Medicine, Radiology, Pathology & Surgery (2015), 1, 1–2
EDITORIAL
Current updates on early detection and prevention
of oral cancer
Oral cancer is ranked among the top 10 cancers in the world.
Oral squamous cell carcinoma (OSCC) constitutes more than
90% of oral cancers. The risk factors for OSCC are well-known.
Tobacco and alcohol being the major causes make the disease
preventable. Data reveal that only around half of the patients
survive the disease over 5 years. Despite advances in treatment
modalities over past decades, a significant improvement in
prognosis is not achieved. This is attributable to the failure to
detect small lesions and potentially malignant lesions early,
which precludes successful treatment. Therefore, early detection
is the key to improve survival rate in oral cancer patients.[1]
Early detection is possible through screening programs and by
employing specific diagnostic aids and biomarkers.[2] Although
extensive research and clinical application of diagnostic aids
and biomarkers are rising, they lack practical feasibility when
applied to larger population at risk and low socio-economic
groups. A recent systematic review on screening programs and
preventive measures on oral cancer concludes that systematic
visual oral examination by a clinician is by far the most common
method for screening. Cost-effectiveness and feasibility increase
its popularity. Visibility of the lesion may be enhanced by
employing special dyes.[3]
A cluster-randomized control trial conducted by
Sankaranarayanan et al. (2013) reported a sensitivity of 67.4%
for the visual examination in detecting oral cancer. They
concluded that those who adhere to repeated screening rounds
demonstrate a sustained reduction in oral cancer mortality, thus
highlighting the significance of population-based screening
programs targeting tobacco and/or alcohol users.[4] The National
Institute of Dental and Craniofacial Research and World Health
Organization propose that screening for oral cancer should
involve a systematic visual inspection of the oral cavity and
palpation of the tongue, floor of the mouth and regional lymph
nodes. If any abnormality persists for more than 2 weeks, then it
calls for a re-evaluation and should be considered for biopsy.[5,6]
Screening may be targeted at high risk groups or opportunistic,
that involves people who attend health services for other reasons
or a population as a whole based on statistics.[3]
In contrary, a review by the US Preventive Services Task
Force (USPSTF) on the evidence on efficacy and accuracy of
oral cancer screening programs revealed inadequate evidence
on the diagnostic accuracy and benefits of oral cancer screening
in asymptomatic adults. USPSTF has thus recommended
counseling to prevent tobacco use and to reduce alcohol misuse.[7]
Unavoidably high-risk groups mostly belong to lower socioeconomic groups, who least attend the dental clinics or utilize
other health services, thus limiting an opportunity for visual
examination by a clinician.[8] In a study by Horowitz et al., fewer
than 25% of subjects knew about tobacco or alcohol as risk
factors for oral cancer. This reflects the minimal awareness of
oral cancer among general public. To overcome this basic issue,
leaflet containing cancer information was used, which resulted in
a significant raise in the knowledge level of general public, thus
reducing patient part of delay.[9-11] Therefore mass screening or
health education for oral self-examination becomes crucial.
Further, a delay of 3-5 weeks is observed in diagnosis
due lack of knowledge or lack of training among health
professionals, which necessitates a universal training program
for health professionals to detect early cancerous changes of
oral mucosa.[12,13] Diagnostic aids such as, light-based detection
systems are under extensive research, but so far, controlled
studies have shown no promising results. They can be adjunctive
to clinical examination in detecting cancerous or potentially
malignant lesions. Biopsy still remains the gold standard in
definitive diagnosis of suspected lesions.[2]
Since oral cancer is preventable, reduction in risk factor
appears to be the most effective means to reduce cancer
morbidity and mortality. Combined effect of alcohol and
tobacco is multiplicative or greater than multiplicative in most
studies.[1] Dentists and dental auxiliary personnel can conduct
tobacco cessation counseling. Smoking cessation shows a 50%
reduction in risk of oral cancers within 5 years.[14]
Currently, health education, prompt screening and counseling
the high risk groups form the mainstay of early detection and
screening. A thirst for universally applicable objective methods
which detect the initial malignant changes is unanswered.
Roopa S. Rao, Shankargouda Patil, B. S. Ganavi
Department of Oral Pathology and Microbiology, Faculty of Dental Sciences,
MS Ramaiah University of Applied Sciences, Bengaluru - 560 054, Karnataka,
India. Phone: +91 – 8050798169. Email: [email protected]
doi: 10.15713/ins.jmrps.13
References
1.Warnakulasuriya S, Tilakaratne WM. Oral Medicine and
Pathology: A Guide to Diagnosis and Management. 1st ed.
Journal of Medicine, Radiology, Pathology & Surgery ● Vol. 1:3 ● May-June 20151
Rao, et al.
New Delhi: Jaypee Brothers Medical Publishers; 2014. p. 268‑329.
2. Mehrotra R, Gupta DK. Exciting new advances in oral cancer
diagnosis: Avenues to early detection. Head Neck Oncol 2011;3:33.
3. Brocklehurst P, Kujan O, O’Malley LA, Ogden G, Shepherd S,
Glenny AM. Screening programmes for the early detection
and prevention of oral cancer. Cochrane Database Syst Rev
2013;11:CD004150.
4.Sankaranarayanan R, Ramadas K, Thara S, Muwonge R,
Thomas G, Anju G, et al. Long term effect of visual screening
on oral cancer incidence and mortality in a randomized trial in
Kerala, India. Oral Oncol 2013;49:314-21.
5. Olson CM, Burda BU, Beil T, Whitlock EP. Screening for Oral
Cancer: A Targeted Evidence Update for the U.S. Preventive
Services Task Force. Evidence Synthesis No. 102. AHRQ
Publication No. 13-05186-EF-1. Rockville, MD: Agency for
Healthcare Research and Quality; 2013.
6. National Institute of Dental and Craniofacial Research. Detecting
Oral Cancer: A Guide for Health Care Professionals. Bethesda,
MD: National Institutes of Health; 2011. Available from:
http://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/
DetectingOralCancer.htm. [Last accessed on 2015 May 31].
7. Moyer VA, U.S. Preventive Services Task Force. Screening for oral
cancer: U.S. Preventive Services Task Force recommendation
statement. Ann Intern Med 2014;160:55-60.
8. Jornet PL, Garcia FJ, Berdugo ML, Perez FP, Lopez AP. Mouth
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Dent J 2015;60:59-64.
9.Horowitz AM, Canto MT, Child WL. Maryland adults’
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J Am Dent Assoc 2002;133:1058-63.
10.Petti S, Scully C. Oral cancer knowledge and awareness: primary
and secondary effects of an information leaflet. Oral Oncol
2007;43:408-15.
11.Farah CS, McCullough MJ. Oral cancer awareness for the
general practitioner: New approaches to patient care. Aust Dent
J 2008;53:2-10.
12.Peacock ZS, Pogrel MA, Schmidt BL. Exploring the reasons
for delay in treatment of oral cancer. J Am Dent Assoc
2008;139:1346-52.
13.Jovanovic A, Kostense PJ, Schulten EA, Snow GB, van der Waal I.
Delay in diagnosis of oral squamous cell carcinoma; a report from
The Netherlands. Eur J Cancer B Oral Oncol 1992;28B:37‑8.
14.van der Waal I, de Bree R, Brakenhoff R, Coebergh JW. Early
diagnosis in primary oral cancer: Is it possible? Med Oral Patol
Oral Cir Bucal 2011;16:e300-5.
How to cite this article: Rao RS, Patil S, Ganavi BS. Current
updates on early detection and prevention of oral cancer. J Med
Radiol Pathol Surg 2015;1:1-2.
Journal of Medicine, Radiology, Pathology & Surgery ● Vol. 1:3 ● May-June 2015