Pav Chana stresses the importance of screening for oral cancer.
Oral cancer is the 11th most common cancer in the world, making it a lot more common than the average general practitioner may think (Scott et al, 2006). According to Cancer Research UK, one in 175 men and one in 150 women will be diagnosed with oral cancer during their lifetime. Over the years oral cancer has become a lot more common, with figures showing the rate of oral cancer in 1992-1995 was eight cases per 100,000, but between 2012 and 2014 it increased to 13 cases per 100,000. The incidence rates are expected to continue to rise by 33% in the UK alone by 2035.
Risk factors for oral cancer include tobacco, alcohol and areca nut. Tobacco usage combined with alcohol is a major etiological risk factor in oral cancer. Other uncommon risk factors include viruses such as the human papilloma virus (particularly type 16), syphilis, and chronic candidiasis. Poor diet is also thought to play a part, but is now not considered a significant risk factor (Cawson et al, 2002).
Practitioners working in areas of high deprivation should potentially be more expectant of coming across oral cancer lesions, as oral cancer is more likely to occur in areas of social deprivation. This could be due to the casual relationship between tobacco usage, alcohol consumption, poor diet, and lower socioeconomic status (Rylands et al, 2016).
According to Scott and colleagues (2006), oral cancer has a low five-year survival rate and treating oral cancer at an early stage is believed to be effective in reducing death from oral cancer. Therefore, early diagnosis by dentists is imperative. Although, some patients delay seeking help for lesions, it is still our responsibility to be vigilant of every patient who walks into our surgery.
We should be screening the risk of oral cancer for every patient, and arguably this should take priority of classifying the patient’s caries, periodontal and tooth surface loss risk.
In 2015, the National Institute for Health and Care Excellence updated its guidelines on the urgent referral pathway, which all general practitioners should be familiar with. It is also important that we are familiar with local referral protocols for suspected oral cancer lesions.
We should always want to improve our knowledge and stay up to date ensuring that we are providing the best possible oral cancer screening for our patients.
Are we going wrong?
Understandably, lack of experience in identifying malignant lesions can be a barrier. I’m sure many clinicians have been at the cross road of ‘urgent referral or not?’ Non-urgent referrals to a local oral medicine unit can take as long as three months, which is a stark contrast to the two-week wait for urgent referrals.
Therefore, should all general practitioners adopt the attitude, if in doubt urgently refer? The ever-increasing time pressure of the NHS UDA system means that check ups are often squeezed into short appointment times, which means that substandard examinations of soft tissues and a less than thorough enquiry into the risk factors of oral cancers is being carried out.
Also a lack of knowledge may be a downfall of early diagnosis; therefore it is imperative GDPs keep up to date with CPD. Furthermore, more emphasis and more exposure to oral cancer patients may be beneficial to undergraduate students who are the next generation of dentists.
Cawson RA, Odell EW, Porter SR (2002) Cawson’s essentials or oral pathology and medicine. Edinburgh: Churchill Livingstone
Rylands J, Lowe D and Rogers S (2016) Outcomes by area of residence deprivation in a cohort of oral cancer patients. Oral Oncology 52: 30-36
Scott SE, Grunfield EA, McGurk M (2006) Patient’s delay in oral cancer: a systematic review. Community Dent Oral Epidemiol 34: 337-43