Written by: Gustavo D. Cruz, D.M.D., M.P.H.; and collegues
JADA August 2002 issue

Oral and pharyngeal cancers account for 3 percent of all diagnosed malignancies in the United States.¹ An estimated 32,000 new cases are diagnosed annually, In addition, more than 8,000 deaths are attributable to oral cancer each year. Major risk factors for oral cancer include alcohol and tobacco use, as well as sun exposure for lip cancer; tobacco use is responsible for 90 percent of these cancers²; and heavy smokers who are older than 40 years of age and use alcohol are at the highest risk.³ Epidemiologic findings highlight the disproportionate incidence, morbidity and mortality associated with oral and pharyngeal cancers in minority populations, particularly African-American males.⁴

Patients diagnosed with localized tumors have a five-year survival rate of 80 percent, whereas patients diagnosed with regional metastasis have a five-year survival rate of 40 percent.⁵ Unfortunately, more than one-half of all oral and pharyngeal cancers in the United States are diagnosed at late stages. Although oral cancers are curable when diagnosed and treated early, the overall U.S. five-year survival rate for oral cancers is only 52 percent.⁴ Similar to observations for other types of cancer, racial and ethnic minorities typically are diagnosed with oral cancer at later stages.⁶

Screening high-risk people is a promising goal for decreasing the morbidity and mortality attributable to oral cancers.⁷,⁸ Although no studies have demonstrated the efficacy of population-based oral cancer screenings, the American Cancer Society recommends annual oral cancer examinations for all people 40 years of age or older.⁹ The U.S. Preventive Service Task Force recommends a careful oral cancer examination for all people who use tobacco or alcohol.¹⁰ Furthermore, patients who have oral and head and neck cancer have reported frequent visits to oral and medical health care providers before their diagnoses.¹¹ Those health care visits represent potential opportunities for early detection and education.

Given that 85 percent of head and neck cancers are readily visible,¹² oral cancer screenings are an inexpensive, safe and noninvasive method of detection. Oral cancer screenings also may provide an excellent opportunity for raising public awareness and providing patient education and counseling regarding behavioral risk factors and how to reduce them. Since people older than 40 years of age who use alcohol and tobacco are at the highest risk of developing oral cancers, screening this high-risk cohort is of paramount public health importance. Furthermore, oral cancer has been found to meet most of Wilson and Jungner's¹³ criteria for a disease suitable for screening.¹⁴ Unfortunately, despite the low cost and likely public health benefits-particularly for people at high risk-jrimary care physicians and dentist have not routinely offered oral cancer screening. ^15,16Several population-based surveys have found that the oral cancer screening is an underused service in this country. ^17,18 For example, based on responses to the 1992 National Health Interview Survey, Horowitz and Nourjah ¹⁸ found that only 15 percent of the respondents reported ever having had an oral cancer examination. Community-based free oral cancer screening programs have been understood by who are at high risk owing to their history of alcohol use, tobacco use or both.^19,20

Given the lack of public awareness of the signs, symptoms and risk factors associated with oral cancer, which has been hypothesized to be a potent barrier for the early detection of oral cancers,^18,21 we conducted a brief, prescreening survey at a free three day oral cancer screening conducted in New York City to assess the risk factors and
health education needs of the screening subjects.

Specifically, we conducted this study to determine subjects' knowledge of oral cancer risk factors, to assess their awareness and history of oral cancer examinations, and to identify the predictors associated with oral cancer awareness, history of examinations and knowledge of risk factors.

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