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.
1American Cancer Society. Cancer facts and figures. Atanta: American
Cancer Society; 1999
2 Peto R, Lopez A, Boreham J, Thun M, Heath C. Health effects of tobacco use: global estimates and projections. In: Slama K, ed. Tobacco and Health: Proceedings of the Ninth World Congress on Tobacco and Health, Paris, Oct 10-14, 1994. New York: Plenum Press; 1995.
3 Vokes EE, Weicheselbaum RR, Lippman SM, Honk WK. Head and neck cancer. N Engl J Med 1993; 328(3): 184-94.
4 Swango, PA. Cancers of the oral cavity and pharynx in the United States: an epidemiologic overview. J Public Health Dent 1996;56(6): 309-18.
5 Ries LA, Kosray CL, hankey BF, Miller BA, Clegg L, Edwards BK, eds. SEER cancer statistics review, 1973-1996. Bethesda, Md.: National Cancer Institute; 1999
6 Arbes SJ, Slade GC. Racial differences in stage at diagnosis of screenable oral cancers in North Carolina.
J Public Health Dent 1996;56(6):352-4
7 Mashberg A. Samit A. Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers. CA
Cancer J Clin 1995;45:328-51.
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prevention and early detection. J Public Health Dent 1996;56(6):319-30.
9 Update January 1992: the American Cancer Society guidelines for cancer-related checkup. CA Cancer J
10 DiGuiseppe C, Atkins D. Guide to clinical preventive services: Report of the U.S. Preventive Services Task Force. 2nd ed. Baltimore: Williams & Wilkins; 1996.
11Prout MN, Heeeren TC, Barber CE, et al. Use of health services before diagnosis of head and neck center among Boston residents. Am J Prey Med 1990;6(2):77-83.
12 Barry P, Katz PR. On cancer screening in the elderly. J Am Geriatr Soc 1989;37:913-4.
13 Wilson JM, JungnerG. Principles and practice of screening for disease. Geneva: World Health Organization; 1968.
14 Speight PM, Downer MC, Zarzewska J. eds. Screening for oral cancer and precancer: report of a UK working group. Community Dent Health 1993; l0(supplement 1):1-89.
15 Goodman HS, Yellowitz JA, Horowitz AM. Oral cancer prevention: the role of family practioners. Arch Fam Med l995;4:628-36.
16 Martin LM, Bouquot JE, Wingo PA, Heath CW Jr. Cancer prevention in the dental practice: oral cancer screening and tobacco cessation advice. J Public Health Dent 1996;56(6):336-40.
17 Horowitz AM, Moon HS, Goodman HS, Yellowitz JA. Maryland adults' knowledge of oral cancer and
having oral cancer examinations. J Public Health Dent 1998;58(4):281-7.
18 Horowitz AM, Nourjah PA. Factors associated with having oral cancer examinations among US adults
40 years of age or older. J Public Health Dent 1996;56(6):331-5.
19 Clayman GL, Chamberlain RM, Lee JJ, Lippman Sm, Honk Wk. Screening at a health fair to identify subjects for an oral leukoplakia chemoprevention trial. J Cancer Educ 1995; 10(2):88-90.
20 Ostroff JS, Hay JL, Schantz SP, Maher MM. A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program. Psychol Health 2000; 14:979-90.
21 Warnakulasuriya KA, Harris CK, Scarrott DM, et al. An alarming lack of public awareness towards oral cancer. Br Dent J 1999;187:319-22.