- Email: [email protected]
Cancer prevention through education
J Oral Maxillolac Surg 51:827.1993
Cancer Prevention Through Education Despite intensive research into the possible causes and cures of oral cancer, with over 30,000 new cases reported each year and more than 8,000 deaths occurring annually, it still remains a serious public health problem. Since the prognosis is best when the malignancy is confined to the original site, early detection is still the most potent weapon against this dreaded disease. This has lead to extensive campaigns by many public and private organizations, including the American Association of Oral and Maxillofacial Surgeons, designed to inform people about risk factors as well as how to recognize the most incipient stages oforal cancer. In spite of these efforts, however, the public still seems to be rather ill-informed. This is confirmed by the findings of a recent national health survey by the National Institute of Dental Research, in which more than 41,000 people were asked about the causes and early warning signs of oral cancer. Regardless ofeducation, background, or race, fewer than half of the adults surveyed were able to correctly identify the symptoms of oral cancer, and most could not accurately list the early warning signs. Only 46% could name a correct sign of cancer of the mouth or lip, and only 32% correctly identified a sore or lesion that does not heal as a major clinical indicator. In terms ofunderstanding risk factors, the knowledge was not much greater. Although most respondents were aware that use of tobacco and excessive exposure to the sun are significant risk factors, fewer than half of those queried knew that regular use ofalcohol was also a major factor. Surprisingly, people with less than a high school education were more likely to know about this adverse affect of alcohol consumption than those with some college education. It is clear that there is much to be done in further educating the American public about the risks oforal cancer as well as the need for its early detection. There are a number of things that we as oral and maxillofacial surgeons can do in this regard. Although oral cancer can occur at almost any age, it is more prevalent in the over-40 age group, and it is particularly important that patients in this group be carefully screened even though they may be presenting for treatment ofcomplaints unrelated to the oral cavity. Cancer of the oral cavity is especially suitable for screening because it requires only a simple visual and palpatory examination, rather than complex, expensive labora-
tory tests. Such an examination should become a routine part of every patient's evaluation. In addition to screening for oral cancer, it is important to be on the lookout for possible precancerous lesions-in particular leukoplakias and erythroplasias. Up to 18% of all leukoplakias eventually transform into malignancies, and therefore early detection and removal can significantly reduce the incidence of oral cancer. Although it is not possible to predict which precancerous lesions will ultimately undergo malignant transformation, the risks of removing them are far less than those associated with a watch and wait policy. Counseling patients against the use of tobacco is another action that needs to be taken. Premalignant lesions and malignancies are more common among persons who smoke, and especially among those who are also heavy drinkers of alcohol. We need to be concerned about the increasing use of smokeless tobacco. Far from being a safe substitute for cigarettes, smokeless tobacco also can cause precancerous and cancerous lesions. Persons who have used tobacco in any form for a long time, although they may have now stopped, not only need an initial screening, but also should have at least annual reexaminations. Practicing oral cancer prevention in the officeis only one of our obligations, however. In addition to educating our patients, we need to educate the general practitioner and the public . Our Association has attempted to do this through a public information campaign and the AAOMS Surgical Update but, based on the findings of the National Institute of Dental Research survey, these efforts need to be intensified. In addition, we need to mount our own individual edu. cational programs . These should include lectures to dental societiesand study clubs, and appearances before lay public, high school, and college groups . We also need to provide informational material in our reception areas where accompanying persons as well as patients can see it. All of these efforts need to be made on a continual basis since sporadic attempts are evidently ineffectual. Oral cancer is among the most serious conditions that we encounter. Fortunately, early detection is possible, and this can lead to more successful therapy and greatly reduced mortality. This is only possible, however, if we educate as well as treat. DANIEL M. LASKIN
827
Cancer Prevention Through Education Despite intensive research into the possible causes and cures of oral cancer, with over 30,000 new cases reported each year and more than 8,000 deaths occurring annually, it still remains a serious public health problem. Since the prognosis is best when the malignancy is confined to the original site, early detection is still the most potent weapon against this dreaded disease. This has lead to extensive campaigns by many public and private organizations, including the American Association of Oral and Maxillofacial Surgeons, designed to inform people about risk factors as well as how to recognize the most incipient stages oforal cancer. In spite of these efforts, however, the public still seems to be rather ill-informed. This is confirmed by the findings of a recent national health survey by the National Institute of Dental Research, in which more than 41,000 people were asked about the causes and early warning signs of oral cancer. Regardless ofeducation, background, or race, fewer than half of the adults surveyed were able to correctly identify the symptoms of oral cancer, and most could not accurately list the early warning signs. Only 46% could name a correct sign of cancer of the mouth or lip, and only 32% correctly identified a sore or lesion that does not heal as a major clinical indicator. In terms ofunderstanding risk factors, the knowledge was not much greater. Although most respondents were aware that use of tobacco and excessive exposure to the sun are significant risk factors, fewer than half of those queried knew that regular use ofalcohol was also a major factor. Surprisingly, people with less than a high school education were more likely to know about this adverse affect of alcohol consumption than those with some college education. It is clear that there is much to be done in further educating the American public about the risks oforal cancer as well as the need for its early detection. There are a number of things that we as oral and maxillofacial surgeons can do in this regard. Although oral cancer can occur at almost any age, it is more prevalent in the over-40 age group, and it is particularly important that patients in this group be carefully screened even though they may be presenting for treatment ofcomplaints unrelated to the oral cavity. Cancer of the oral cavity is especially suitable for screening because it requires only a simple visual and palpatory examination, rather than complex, expensive labora-
tory tests. Such an examination should become a routine part of every patient's evaluation. In addition to screening for oral cancer, it is important to be on the lookout for possible precancerous lesions-in particular leukoplakias and erythroplasias. Up to 18% of all leukoplakias eventually transform into malignancies, and therefore early detection and removal can significantly reduce the incidence of oral cancer. Although it is not possible to predict which precancerous lesions will ultimately undergo malignant transformation, the risks of removing them are far less than those associated with a watch and wait policy. Counseling patients against the use of tobacco is another action that needs to be taken. Premalignant lesions and malignancies are more common among persons who smoke, and especially among those who are also heavy drinkers of alcohol. We need to be concerned about the increasing use of smokeless tobacco. Far from being a safe substitute for cigarettes, smokeless tobacco also can cause precancerous and cancerous lesions. Persons who have used tobacco in any form for a long time, although they may have now stopped, not only need an initial screening, but also should have at least annual reexaminations. Practicing oral cancer prevention in the officeis only one of our obligations, however. In addition to educating our patients, we need to educate the general practitioner and the public . Our Association has attempted to do this through a public information campaign and the AAOMS Surgical Update but, based on the findings of the National Institute of Dental Research survey, these efforts need to be intensified. In addition, we need to mount our own individual edu. cational programs . These should include lectures to dental societiesand study clubs, and appearances before lay public, high school, and college groups . We also need to provide informational material in our reception areas where accompanying persons as well as patients can see it. All of these efforts need to be made on a continual basis since sporadic attempts are evidently ineffectual. Oral cancer is among the most serious conditions that we encounter. Fortunately, early detection is possible, and this can lead to more successful therapy and greatly reduced mortality. This is only possible, however, if we educate as well as treat. DANIEL M. LASKIN
827