Editorial :
Oral cancer is the eighth most
common cancer in the world among men and the 14th among women, accounting for
nearly 3 per cent of all cancer
cases worldwide.1Despite better understanding of the disease process and
numerous advances in treatment, the 5-year survival rate of oral cancer
has remained approximately 50 per cent.2
Deaths associated with oral cancer
are particularly high because this cancer is all too frequently diagnosed late
in its development. Discovery at these later stages not only increases the
probability of metastasis, but also give time to the primary tumour to invade
more deeply into surrounding structures.
A solution to this problem is be to enhance the knowledge and clinical skills of
oral health care professionals in order to detect oral potentially malignant disorders
(OPMDs) and/or oral cancers at their earliest disease process. This can be achieved by increasing
public knowledge and awareness about the significance of standard oral cancer screening
as well as opportunistic screening of high-risk groups by general dental practitioners
(GDPs). Another approach could be the introduction and usage of adjunctive
tools that may facilitate the oral health care professionals
to identify or assess suspicious oral lesions that may have the potential of becoming
malignant. It is vital to provide clinical guidelines to the GDPs on the proper
utility of oral cancer screening
measures to not only facilitate them in clinical decision- making but also
making these decisions informed and accurate. The first and the foremost step in
the screening of oral cancer is to attain a detailed and comprehensive history of the patient followed by a
systematic visual oral examination,
where a health practitioner visually examines both extraoral and intraoral region to identify and record any
oral mucosal abnormality that appear suspicious
and need further investigation. If a lesion is identified, detailed evaluation of
the lesion with particular attention to specific characteristics such as
duration, size, color, site, texture and any associated symptoms is performed.
In addition to writing all the clinical notes and taking an image of the
clinically evident oral lesion at the first visit, it is recommended that
clinical pictures are taken during each of the follow-up appointments. This not
only serve the medico legal purpose but also helps the health practitioner to compare the progress of
the lesion over a period of time and to modify or continue the treatment plan accordingly. The current gold standard for the
assessment of OPMDs and establishing a definitive oral cancer diagnosis is to
perform a surgical biopsy followed by histopathological analysis. In addition,
a number of adjunctive tools are available which being diagnostic tools, also
have the aptitude to identify OPMDs, enhance visualization and assist in selection
of biopsy site. 3-6 However,
these tools should be used with caution in the background of proper training
and experience as they may result in misdiagnosis and/ or unnecessary biopsies.
Development of firm guidelines is
crucial to not only assess screening programs but also regulate their
suitability before they are employed. This will result in the program to be
more targeted and cost-effective with lesser probability for over- diagnosis.
The UK National Screening Committee for example has listed 22 criteria that
need to be met before introducing a screening program 7. The quality of scientific evidence that is required to show the
advantages of screening for the target population is very challenging.
Development of an ideal screening test demands a number of characteristics that
need to be present8 .
The ideal scenario would be to carry out a prospective randomized control trial
to gather evidence about the effectiveness of the screening test shown by
reduced mortality rate
of the patients who are offered the test. To demonstrate this, the study needs
to have a large sample population and a prolonged follow-up. Breast cancer
screening by mammography and colorectal cancer screening by faecal occult blood
testing are the only cancer screening procedures for the general population
which are based on this ideal setting. In developed countries, oral cance r
being a less common health problem compare to breast and colorectal cancer, no
large-scale prospective studies have been performed. Furthermore, it will take
many years to produce mortality results if a study to measure the accuracy of
the newer tools in oral cancer screening is started now. Having said that,
evidence of benefit for the implication of screening programs may also be
obtained by smaller clinical
trials that show that screening results in early cancer detection. Moreover, observational studies can also be
useful in this context by showing comparison of subjects, which are screened,
and those that are not screened. Screening of cervical cancer by Pap smear, which
is the most long-established cancer-screening program, is one such exampl e. One
easier way to address this issue is to perform opportunistic screening rather
than population-based screening. Opportunistic screening is offering screening
test to people who visit dental office for other dental related problems or as
part of a routine care. The justification for the recommendation of the oral cancer screening to
be carried out as opportunistic screening during the routine follow-up
appointments is based on the fact the procedure is very simple and requires
very little additional time to perform. Also the potential benefits this
program produce greatly outweighs the minimum risks that may be encountered. 1. IARC Working Group on the
Evaluation of Carcinogenic Risks to Humans. Tobacco smoking and involuntary smoking (2004)
Lyon, France: Vol 3;IARC Press. Kamran Habib Awan, Department of Oral Medicine & Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Tel. +966 1 4677422; Fax +966 1 4679018 E-mail: kamranhabibawan@gmail.com Awan KH (2017) Overcoming oral cancer menace NHC e101: 1-2 Oral cancer, Women health care
Overcoming oral cancer menace
Full-Text
Reference
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8.Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic
aids for the detection of oral cancer (2008) Oral Oncol 44:10-22.*Corresponding author
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