Report outlines the benefits of oral cancer screening examination

All residents at adult addiction treatment centres in Ireland should undergo an oral cancer screening examination upon admission to the centre, according to Dr Eleanor O’Sullivan of Cork University Dental School and Hospital in her report on Oral Cancer Screening Study of High Risk Individuals.

In Ireland, oral and pharyngeal cancer represents approximately 4% of cancer patients (registrations) and is responsible for 1.5% (or 150) of cancer deaths each year. 

‘It kills more people than malignant melanoma, Hodgkin’s disease or cervical cancer,’ said Dr O’Sullivan, ‘yet it has a low profile among the general public and even among many healthcare providers although it is the sixth most common cancer world-wide.’

Many oral and pharyngeal cancers can be detected by a relatively simple, painless oral examination. If detected early, minimal surgical intervention generally results in good outcomes.
Dr O’Sullivan said: ‘These facts should make oral cancer a very rare and easily treated cancer in Ireland in 2008. Unfortunately, many patients still present with advanced lesions and for this reason, the five-year survival rate has improved little in the last 40 years, remaining at less than 50%.’

For the Oral Cancer Screening Study of High Risk Individuals, Dr O’Sullivan investigated the feasibility, suitability and acceptability of a targeted oral health screening programme for addiction treatment centre residents in Cork to assess the potential benefit of a similar process nationally.

In the pilot study, 283 residents in four addiction treatment centres in Cork city and the suburbs were invited to undergo an oral health screening examination, consisting of a simple, painless, non-invasive inspection of the hard and soft tissues of the mouth. Only 20 residents (7%) refused to undergo the screening examination, 10 were excluded as they didn’t match the study criteria and some others didn’t participate for various reasons, but which ultimately represented a very high take-up. This would, Dr O’Sullivan believes, have a positive impact on the cost-effectiveness of such a screening programme done on a national basis.

Almost three-quarters of the study group were male. While the age of the participants ranged from 18 to 73, 60% of the clients were under 40 years of age and outside the ideal target age for head and neck cancer.  

The early starting age of smoking and drinking among the younger residents was a cause of concern to Dr O’Sullivan. She said: ‘Some of the smokers had started at age six while the average age for the drinkers was just 13 years. Older residents reported that they had started to drink at, on average, 22 years of age, which suggests that people are now beginning to drink at a younger age. Indeed, 9% of Irish alcoholics are now aged between 19 and 35 years.’

Dentists are currently the only primary health care professionals trained specifically in oral cancer examination. However, only a third of the adult Irish population visit a dentist annually, while less than 50% visit bi-annually. In fact, attendance rates among older adults, medical card-holders and those with no natural teeth are even lower. 

Furthermore, international research indicates that individuals with an increased risk of oral cancer (males over 40 years, consuming more than 28 units of alcohol per week and smoking more than 20 cigarettes a day) generally exhibit low rates of dental attendance.

Ideally, oral cancer examinations should become a standard part of any comprehensive medical examination (check-up) and for all routine adult hospital admission procedures, particularly for those with smoking and alcohol-related disease. ‘This is an issue that needs to be addressed as it would only take a GP about 90 seconds to do an oral examination on a patient and this simple intervention could greatly improve the early diagnosis of OPC,’ commented Dr O’Sullivan.

Appropriate educational resources should be designed to meet the needs of all healthcare professionals to ensure that all health care professionals are:
1. Aware of the key features of OPC
2. Confident in their ability to carry out a basic oral cancer examination, appropriate to their speciality
3. Able to deliver a brief intervention in risk factor modification.

An educational needs assessment study is currently being planned by Dr O’Sullivan to explore the perceived need, preferred options and professed barriers to participation in such training. 

Dr O’Sullivan has worked as clinical lecturer in the Oral Surgery Department at the Cork University Dental School and Hospital for over 15 years. Her special interest is in oral and pharyngeal cancer. The study was supported by a grant from the Irish Cancer Society.