Abstract
Introduction: Oral cancer screening is one of the strategy to improve survival of oral cancer patients. The opportunistic screening for high-risk population in hospital other than dentistry department is feasible.
Objective: To study the outcome of oral cancer screening in family medicine and otolaryngology clinic.
Material and Method: The study performed at otolaryngology and family doctor clinic during 1 Oct 2018- 30 Jan 2020 after permission from Ethic committee of Rajavithi Hospital. Inclusion criterias were 40 years of age or older with history of tobacco usage, alcohol consumption and betel quid chewing as personal habit by continuous use at least 6 month regularly. Visual screening was performed by ENT or general practitioner all the mucosa of oral cavity.
Result: The study population were 482 cases with history of habitual smoking, alcohol drinking or betel nut chewing. There were male in 91.3% and mean age of 54.7±12.9 yrs. The opportunity in hospital for oral cancer screening were appointment for follow up 49%, walk-in with symptom 43%, companion with patient 5.2%. Abnormal lesion found 7.9%, which was leukoplakia that defined as premalignant lesion in 25 cases.
Conclusion: Visual oral cancer screening for high-risk group by opportunistic screening in general practice is feasible and benefit for management of precancerous lesion, which is a strategy to improve survival oral cancer for early management and detection.
Keywords: Visual oral cancer screening; High-risk screening; Opportunistic screening; Early detection
Introduction
Oral cancer is one the most common cancer in Thailand, which Cancer Registry reported the age-standardized incidence rate in 2015 of 5.5 and 4.3 per 100,000 in male and female respectively [1]. This is the cause of death for Thai population reported in 2014 of 1.4 percent. The important risk factors are tobacco and alcohol which rates of consumption has not change in past 10 years. The oral cancer presented at OPD ENT mostly advanced stage. The survival of oral cancer has not been change despite advanced in surgical and radiation technique. Early detection and screening by Sankaranarayanan [2,3] for oral cancer has shown to be effective in reduced mortality and morbidity. The visual screening is the method that was reported to be the tool in India and others reported later to support the evidence [4-8].
Speight et al., [6] demonstrated using a simulated model that an oral examination of high-risk individuals may be a cost-effective screening strategy. Most of Oral cancer screening reported in literature performed by dentist [7-9] but few by otolaryngologist or family doctor who has opportunity in oral exam too. Therefore, the aim of this study was to evaluate the feasibility of oral cancer screening in ENT clinic and general practice clinic and the result of detection.
Materials and Methods
After permission from Ethic committee of Rajavithi Hospital. The study performed at otolaryngology and family doctor clinic during 1 Oct 2018-30 Jan 2020. Inclusion criteria’s were 40 years of age or older with history of tobacco usage, alcohol consumption and betel quid chewing as personal habit by continuous use at least 6 month regularly. Visual screening was performed by ENT or general practitioner all the mucosa at lip, floor of mouth, buccal, tongue, hard palate, retro molar trigone and alveolar ridge. The abnormal as leukoplakia, erythroplakia (red lesion ) or ulcer, tumor were recorded as positive finding. The patients who had the history of head and neck cancer were excluded. Statistic analysis This study used descriptive statistics for general data presentation.
Figure 1: Characteristic of abnormal lesion.
Results
The study population were high-risk group for oral cancer which were male in 91.3% and mean age of 54.7±12.9 yrs. Cigarette smoking of 83.6%. The quantity of smoking was 8.82 pack-year. Number of pack year was of smoking was 8.82 pack-year with mean duration of exposure 16,1 yrs. More than half of population (58.3%) quit smoking with duration of 14.9±12 yrs. The population of habitual alcohol consumption was 82.9% with mean duration of 17.1±12 yrs and still have routine alcohol drinking in 59.7%. The more exposure of both cigarette smoking with habitual alcohol consumption 67.8%. Only 1.5% of population that chew betel nut. The opportunity in hospital for oral cancer screening were appointment for follow up of chronic disease such as hypertension, diabetes mellitus, dyslipidemia etc. 49%, walk-in with symptom 43%, companion with patient 5.2% (Table 1). Abnormal lesion found 7.9%, which was leukoplakia, which defined as premalignant lesion in 25 cases (Figure 1). The biopsy was performed with consent in one case with pathological report of pseudoepitheliomatous hyperplasia. Tumor or ulcer in oral cavity found in six cases, which were sialolith one case, pyogenic granuloma one case, ulcer from irritation : ulcer heal post dental/denture extraction 2 case, ulcer heal after medication one case, odontogenic tumor 1 case. No malignancy found in this study. No statistically significant difference between the group that found abnormal lesion to normal finding except the duration of smoking (Table 2).
Number
%
Gender
Male
Female
442
40
91.7
8.3
Age
(mean±S.D.)
(Min-Max)
54.7±12.9
(20-87)
Cigarette Smoking
403
83.6
Number pack-year (mean)
Min-Max
Current smoking
Duration of smoking
Duration of stop smoking (yrs)
(mean±S.D.)
Median (Min-Max)
10.8±12.7
0.05-90
168
16.1 yrs
(0.6-51)
14.9±12.0
10 (1-54)
41.7
Habitual Alcohol consumption
400
82.9
Duration (yrs) (mean±S.D.)
Median (Min-Max)
Current alcohol drinking
Duration of stop alcohol drinking (mean±S.D.)
Median (Min-Max)
17.12±12.14
12.50 (1-50)
239
10.55±10.09
8 (1-50)
59.7
Cigarette Smoking with habitual alcohol consumption
327
67.8
Betel Nut chewing
7
1.5
Opportunity in Hospital
Appointment
Walk-in with symptom
Companion with patient
Others
236
209
25
12
49.0
43.4
5.2
2.4
Finding
Abnormal lesion
Normal
38
444
7.9
92.1
Table 1: Data of population.
Total
Abnormal
Normal
p-value
Number
%
Number
%
Gender
0.758
Male
Female
442
40
36
2
8.1
5
406
38
91.9
95.0
Age (mean±S.D.)
53.26±12.01
54.86±13.02
0.467
Cigarette smoking
0.725
Current /History of cigarette
smoking
403
79
31
7
7.7
8.9
372
72
92.3
91.1
No History of cigarette smoking
Number pack-year
Duration of smoking
12.81±16.30
7.5 (0-6-7.5)
20.27±13.18
10.63±12.44
6 (0-90)
15.89±11.23
0.363
0.043*
Habitual Alcohol Drinking
0.112
Current/History of alcohol drinking
No History of alcohol drinking
Duration of Alcohol Drinking
400
82
28
10
19.76±14.77
7.0
12.2
372
72
16.89±11.88
93.0
87.8
0.257
Cigarette smoking and Alcohol drinking
0.171
Current/History of Cigarette smoking and Habitual alcohol drinking
No History of cigarette smoking and alcohol drinking
327
155
22
16
6.7
10.3
305
139
93.3
89.7
Betel Nut Chewing
0.439
Current/History of Betel Nut chewing
No History of Betel Nut Chewing
7
475
1
37
14.3
7.8
6
438
85.7
92.2
Opportunity in Hospital
0.43
Appointment
Walk-in with symptom
Companion with patient
Others
236
209
25
12
19
19
0
0
8.1
9.1
0
0
217
190
25
12
91.9
90.9
100.0
100.0
Table 2: characteristic between normal and abnormal finding groups.
Discussion
Until now the modality of treatment of oral cancer are developed by surgical technique that excised the large tumor with free flap reconstruction to the radiation with chemotherapy but the survival of oral cancer is not improved especially for advanced stage. The strategy have to be changed from treatment after the symptom progression to early detection and prevention before being malignancy. Oral cancer screening was reported by Sankaranarayanan [2,3] that visual oral cancer screening reduce mortality in high risk group by early detection. In India, the overall incidence of oral cancer was 9.1 per thousand population compared with 4.1 per thousand population from Globalcan report. The screening by opportunistic was found to be feasible for low incidence of oral cancer. Most of Opportunistic found by dentist but the high-risk population attend every outpatient department. In 2006, Yang KY et al., [5] reported role of otolaryngologist in oral cancer screening in Taiwan and found 3.9% positive lesion from 5,825 cases of screening which biopsy revealed malignancy in 76.2% of positive finding. Because of the research in otolaryngology clinic which oral cancer patient may attend make the incidence of oral cancer so high and did not report of stage that found which the aim of visual screening is the detection of early stage. In this report, the author conducted the oral cancer screening at general outpatient clinic by asking informed consent in the waiting area. The enrollment found other than the patients attend OPD but the companion of patients were enrolled 5.2% who had risk factors of oral cancer. The screener were otolaryngologists and general practitioners. Thirty-nine patients (7.9%) were recorded as abnormal finding. Compare with the finding by dentist [9,10] that reported more specific lesion categories than in this report due to specific finding of premalignant only by examiner. The dentist reported of denture stomatitis, Fordyce granules and leukoedema. Friction keratosis, which was not reported in this study. Consideration of Pre-malignant lesion which is leukoplakia in the patients with risk factors that long term changes to be malignancy found in 25 cases (5.2%) whose the dental etiology of mucosal lesion in 5 cases that all management initiate by physician who screen at that time not by patients who had the lesion. The benefit of prevention of oral cancer by visual screening without sophisticate equipment for examination can perform at OPD by screening of risk factors when attend the clinic and a few minute for oral exam and use only flashlight or headlight and tongue blade which is already available in general clinic. This prediction may have to find the cost effectiveness for the value of the management before changing of the lesion to cancer. Number of patients with precancerous lesion and early stage may be reported more than advanced stage cancers by examination of all patients with risk factors that have opportunity in hospital.
The limitation is that the study was done in the hospital in capital city which may not represent population in the province that may have the different of risk factors such as betel nut chewing. No malignancy found in this study because most of the oral cancer cases were refered to otolaryngologist clinic which was excluded from the study and a few of patient with symptom that attend the tertiary care hospital so the screening in the general hospital and large number of cases may find the oral cancer cases.
Conclusion
The visual screening for oral cancer by opportunity attend in hospital is feasible for early detection of precancerous lesion and early stage of cancer in general outpatient clinic and should be considered for new value in quality of care for improved survival of oral cancer patients.
References
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