Oral cancer prevention

Abstract

Oral cancer is one of the few conditions that dental professionals may encounter within their surgeries that can be fatal. It is therefore essential that members of the dental team understand the epidemiology and natural history of the condition and possible options for prevention, screening, and treatment. From a public health perspective, oral cancer presents many interesting challenges. First, is the condition a public health problem? In this chapter the epidemiology of oral cancer will be reviewed to highlight the extent, trends, and impact of the condition. Second, what options exist to prevent the disease and how best can these be implemented? As we will discuss, although progress has been made in the treatment of the disease, survival rates have not improved substantially in recent decades (Cancer Research UK 2012; ONS 2005; Stell and McCormick 1985). The potential for screening of the condition has been extensively reviewed, and currently a national screening programme is not recommended due to a lack of evidence on effectiveness (Chamberlain 1993). Although various initiatives have recently attempted to coordinate and expand the prevention of oral cancer (Cancer Research UK 2005; British Dental Association 2000; NHS Scotland 2005), the preventive activities presently undertaken by the dental profession alone are unlikely to be successful. A clear need exists for a more comprehensive public health strategy to tackle the underlying causes of the disease in a coordinated and strategic fashion. This chapter will therefore outline the scope and detail of such a strategy. Oral and oropharngeal cancers commonly include cancer of the lip, tongue, mouth, oropharynx, piriform sinus, hypopharynx, and other ill-defined sites of the lip, oral cavity, and pharynx (ICD-10, C00–C06, C09– C10, and C12–C14). In the UK, oral cancer is the fifteenth most common cancer, accounting for around 2% of all new cases. In 2009 there were 6,236 new cases of oral cancer in the UK: 4,097 (66%) in men and 2,139 (34%) in women (Cancer Research UK 2012 ). The most commonly diagnosed type of oral cancers are cancer of the mouth and tongue, collectively accounting for 60% of cases in the UK.