Account LoginOral cancers tc oral cancer walk involve the tongue, lips, floor of the mouth, soft palate, tonsils, salivary glands, or back of the throat. The primary risk factors for tc oral cancer walk cancers in this country are tobacco and alcohol use; for lip cancer, exposure to the sun is most important see Chapter III. Advanced oral cancer and its sequelae cause chronic pain, loss of function, and irreparable, socially disfiguring impairment. The functional, cosmetic, and psychological insults suffered by oral cancer patients often result in social isolation, significantly esteroides consecuencias mujeres patients, their families and society. Of all the procedures available to control oral cancer, none has affected survival as much as has early 3 detection.
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Oral cancers usually involve the tongue, lips, floor of the mouth, soft palate, tonsils, salivary glands, or back of the throat. The primary risk factors for oral cancers in this country are tobacco and alcohol use; for lip cancer, exposure to the sun is most important see Chapter III. Advanced oral cancer and its sequelae cause chronic pain, loss of function, and irreparable, socially disfiguring impairment. The functional, cosmetic, and psychological insults suffered by oral cancer patients often result in social isolation, significantly burdening patients, their families and society.
Of all the procedures available to control oral cancer, none has affected survival as much as has early 3 detection. Unlike other parts of the body, the oral cavity is easily accessible and an oral cancer examination poses relatively little discomfort or embarrassment for the patient. Furthermore, those who are middle age or older, edentulous, of lower income status, black or Hispanic-the groups at highest risk for oral cancers-are even less likely to 9 visit a dentist.
Thus, other health care providers must assume more responsibility to ensure that the public receives oral cancer examinations on a routine basis. Primary care physicians should know that targeting those at high risk is a viable and cost-effective intervention for oral cancer when performed as part of routine practice. Oral cancer examinations also offer providers an opportunity to identify patients who use tobacco and alcohol and counsel them about their risk for cancers.
Oral cancer has one of the lowest 5-year survival rates of all major cancers, probably because most 15 lesions are not diagnosed until they are advanced. However, when detected early, the probability 16 of surviving from oral cancer is remarkably better than for most other cancers. Theoretically, morbidity and mortality due to oral cancers can be reduced dramatically with appropriate interventions; because of this potential, 13 of the objectives in Healthy People relate to oral cancer prevention and early detection Table 1.
Furthermore, health care providers, particularly dentists, physicians, nurse practitioners, nurses and dental hygienists, need to provide oral cancer examinations routinely and competently.
Equally important, members of the public need to know that an examination for oral cancer is available and that they can request one routinely. Thus, both health care providers and the general public need to increase their knowledge and change their behaviors or practices. Health promotion is a key to achieving these changes. It is widely accepted that health promotion influences knowledge and behaviors at all levels of social organization.
Health promotion is defined as follows: Education is the essential, common denominator of health promotion. Educating a variety of publics, including consumers, health care providers, legislators and other decision makers is necessary to improve awareness of preventive and early detection methods and procedures, gain their acceptance by these groups, and increase their use.
Education, alone, however, is insufficient to prevent diseases or conditions; simply having knowledge or information does not mean that appropriate behaviors or actions will follow. Still, knowledge is an important aspect of empowerment-without appropriate knowledge, individuals can neither make nor be expected to make intelligent decisions about their health.
Among other factors that influence behavior are beliefs, values, and attitudes. These factors influence decisions to consult health care providers about obtaining cancer examinations or to use tobacco and alcohol. A review of several studies that assessed oral cancer knowledge, opinions, and practices of health care providers suggests that many physicians and dentists do not detect oral lesions in their early stages because of inappropriate attitudes or lack of knowledge.
For example, physicians in Great Britain believed that dentists were primarily responsible for detecting oral cancer. Furthermore, physicians who believed they were inadequately trained to provide oral cancer examinations were less likely to provide them. Physicians, dentists, and other providers have a unique opportunity to detect malignant oral neoplasias while they are asymptomatic. Yet, studies have reported that physicians do not routinely examine their patients to identify early, suspicious oral lesions.
Studies reporting that physicians are more likely to refer head and neck cancer at an advanced stage 34,35 than dentists suggest that physicians are relatively less aware of signs and symptoms of oral cancer and, as a result, are not fulfilling their responsibilities for early detection.
When asked about barriers to completing cancer screenings in general in surveys that did not mention oral cancer , physicians have reported a treatment-based orientation, time constraints, lack of financial reimbursement, poor patient compliance, and lack of immediate results. Dentists also have been found to be remiss in early diagnosis and referral for oral cancers.
Schnetler found dentists to be less adept at diagnosis and early referral than physicians. Maguire 28 et al. In an older report from Scotland , Pogrel noted that dentists missed approximately twice as many 44 asymptomatic oral cancer cases as they found.
For example, Maguire et al. Findings from this study indicate that US adults are not well informed about the signs of oral cancers. There was a great lack of information or misinformation regardless of age, race, or ethnicity. Although two-thirds identified tobacco use as a risk factor for oral cancer, more people correctly identified smoking as a risk factor for heart disease, emphysema, or lung cancer than for oral cancer.
The question of interest actually described the oral cancer screening examination: Groups least likely to have been examined were: African-Americans or Hispanics; those with low levels of education; persons 65 years of age or older, 48 current users of tobacco products; and respondents with a low level of knowledge about risk factors 49 for oral cancer. The survey generally corroborated the findings; both, for example, found that the overall level of knowledge about risk factors for oral cancers was low and that a higher level of knowledge of risk factors for oral cancer was associated with a report of having had an oral cancer examination.
The latter finding is consistent with results from surveys about cervical, breast, and colorectal cancer. Oral cancer questions also were part of a recent pilot study about oral health among adults. Eighty-six percent recognized that regular use of chewing tobacco or snuff can increase the risk of oral cancer.
Of the few educational efforts targeting oral cancer, the majority have been directed to youths and young adults on the use of snuff or chewing tobacco. Over the last two decades, interest in health promotion and disease prevention has increased significantly. At least three factors are responsible for this trend: First, ever-increasing expenditures for health care, most of which pay for the treatment of diseases or conditions, have taken an ever larger proportion of the US gross national product.
Second, a growing body of data has confirmed that many chronic diseases result from lifestyle factors that, theoretically, could be changed. Third, and very important, a body of scientific literature in health education and promotion has accumulated.
Today, health promotion is recognized as a viable approach to preventing diseases and disorders and promoting health. A variety of educational campaigns have been mounted to urge people not to start using tobacco products or to stop if they have already started.
Today, school-based interventions frequently begin in primary grades; they may focus on developing self-esteem, on building skills to resist peer pressure, or on urging children to remain smoke-free.
These efforts are often implemented in conjunction with other community-based activities aimed at preventing children and youth from starting the habit and 55 urging users to stop. Unfortunately, these programs often do not identify tobacco products as risk factors for oral cancers. Similarly, efforts focusing on alcohol use as a risk factor for cirrhosis of the liver, liver cancer and fetal alcohol syndrome rarely identify alcohol as a risk factor for oral cancers.
However, recent intervention strategies for decreasing the use of tobacco products and alcohol bode well for reducing cancer incidence, including oral cancers. For example, many health institutions, businesses, airports, airlines, and schools have implemented smoke-free policies or provided only limited indoor space for smoking.
Overall, there is a growing trend in the US to consider smoking socially unacceptable, especially among more highly educated people. Although not as prominent as anti-smoking activities, there has been an increase in recent years of educational efforts about self-protection from exposure to the sun by using sun and lip screens, hats, and other coverings. In addition, the public is being urged to obtain skin cancer examinations on a routine basis.
There is a clear trend to use public policy to help decrease or prevent behaviors that contribute to 57 diseases. For example, some states and communities have taken steps to prevent or reduce the availability of tobacco products or alcohol for underage youths. Approaches have included increasing 58,59 taxes on tobacco products and enforcing laws prohibiting sales to minors.
Also, as a result of lawsuits against tobacco companies by states and individuals, there have been modifications of tobacco advertising, especially that directed at youth. Lawsuits and public policy initiatives frequently result from community action on the part of partnerships of organizations and individuals or coalitions. On another level, health care professionals are being urged to train themselves in methods of tobacco 60,61 cessation and to implement them in their practices.
However, these efforts are not primarily directed at reducing oral cancers. In fact, oral cancers frequently are not mentioned as part of the rationale for discontinuing tobacco use.
Still, dentists and physicians have the opportunity to make this point. Several government and private agencies are urging the increased consumption of fruits and vegetables to help prevent cancers and other diseases.
Because consuming of fruits and vegetables may provide protection against oral cancers, such initiatives may be beneficial. In addition, the Food and Drug Administration has changed its requirement for labeling. For example, alcohol is now labeled with a US government warning, a positive step although the labels, as are those on cigarettes, are inconspicuous and do not mention oral cancers.
How clinicians practice is determined in large part by their training and education. For example, dental sealants also a preventive procedure are under used by practitioners. Yet, dental students who are well trained in, and expected to be competent in, the use of sealants do use them once in 63,64 private practice. Early and comprehensive exposure of undergraduate medical and dental students to cancer prevention methods is necessary to predispose them to provide oral cancer examinations 22, effectively and routinely.
However, emphasis on prevention has never equaled emphasis on 68 treatment in most U. Furthermore, our knowledge of social and behavioral risk factors for disease has increased, but developing the skills to communicate this information to the public has not been addressed as well as it might be in most dental school curricula.
In fact, after an upswing in the s, emphasis on community health and prevention has declined. In addition, medical schools do not require students to evaluate oral cancer signs and symptoms and do not train their students in thorough oral examination techniques.
Regulatory guidance for educational curricula is essential to ensure proficiency. These guidelines should include requirements for student clinicians to complete a specific number of oral cancer screening examinations; such a standard could serve as a catalyst for clinical licensing examination boards to assess competency in conducting oral cancer examinations.
State, regional, and national licensing dental board examinations all contain some questions related to oral cancer. No state dental board, however, requires that applicants perform an oral cancer examination to obtain a license to practice. Because some states already assess expertise in other content areas before granting a license, it is reasonable to insist that all licensing boards require practitioners to demonstrate their expertise in oral cancer examinations. In addition, licensed practitioners should be required for relicensure to complete a continuing education course in oral 66 cancer.
Although some dental schools have a rigorous cancer education curriculum, the fact that students do not have to perform an oral cancer examination to obtain their license sends a message that the oral cancer examination is not as important to the health of the patient as are other procedures, such as the proper placement of an amalgam restoration.
Overall, there are numerous opportunities for licensing agencies and dental schools to increase their focus on oral cancer prevention and early detection. Although national survey information on oral cancers does not exist, this type of information would be very helpful in identifying educational and training shortcomings and subsequently in developing and implementing educational and clinical interventions. Research is also needed to determine knowledge levels, opinions, and practices related to oral cancer and its prevention among other health care providers, including dental hygienists, nurses, nurse practitioners, and physician assistants.
In addition, curricula and continuing education courses for these providers should be assessed relative to oral cancer prevention and early detection. Ultimately, the results of this research can be used to increase the volume of oral cancer examinations and thereby promote early detection of these diseases.
Yet, relatively few continuing education courses for dentists deal with oral cancer.