Early detection and prevention at heart of campaigns to raise awareness

Oral cancer rates are increasing across the UK and, in recent months, there has been a significant drive to raise awareness of it among health practitioners, politicians and the public. This has included the national Mouth Cancer Action Month in November, the launch of the BDA Scotland’s Oral Cancer: Plan for Action, and the annual Cancer Focus Northern Ireland Men’s Health Conference, where oral cancer was a key topic raised by Dr Gerry McKenna, Chair of the Northern Ireland BDA Hospitals Group. 

Everywhere, the calls have been the same. For the public: be alert, know the signs, visit your dentist regularly, if you see anything you are worried about get it checked. For politicians: understand the issue and invest in the strategies, infrastructure and joined-up services to support early detection and prevention.

The focus on these two elements is critical, as oral cancer is, of course, a largely preventable disease, with data from Scotland suggesting that nine in 10 cases could be prevented. The same data also shows that survival can be improved from 50 per cent to 90 per cent with early detection. 

In Northern Ireland, however, cases typically present quite late, which indicates that there is an issue with patients accessing care at an early stage. Late presentation not only decreases survival rates but also means that there is a significant requirement for oral rehabilitation, and specialists are often faced with having to provide care after large surgical resections. 

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Key facts

• There were about 8,300 new cases of oral cancer in the UK in 2013 – that’s 21 cases diagnosed every day
• The number of cases has grown by 49 per cent in the last 10 years and by 135 per cent in the last 20 years
• In males in the UK, oral cancer is the 11th most common cancer, with around 5,100 cases diagnosed
• in 2013
• In females in the UK, oral cancer is the 16th most common cancer, with about 2,500 cases diagnosed in 2013
• Almost half (45 per cent) of oral cancer cases in the UK each year are diagnosed in people aged 65 and over (2011-2013)
• Northern Ireland population:
• 1.8 million
•  2010-2014 NI Cancer Registry data shows an average of 311 head and neck cancer cases per year (males 216, females 95) in Northern Ireland
• Areas with high deprivation (Belfast) correspond to higher incidence rates
• Areas with lower deprivation (Northern and South-Eastern Trust) correspond to lower incidence rates

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With many late stage presentations appearing in patients with historic issues with alcohol and tobacco abuse, it is also critical that sufficient resources to be available for effective smoking cessation and alcohol treatment services, after all, alcohol are two of the three major causes of oral cancer.

Another issue is that patients often present to GMPs rather than GDPs – 25 per cent of Stage 1 and 44 per cent of Stage 4 cancers. This phenomenon is not unique to Northern Ireland, but it does suggest that more needs to be done to encourage the public to understand the role of their dentists in oral cancer prevention and detection, and to ensure that the public also understand the importance of regular attendance at dental check-ups. 

To halt and, hopefully, reverse the increase in cases it will be important to target those individuals who do not engage regularly with oral, or perhaps any health services, as well as raising awareness of the early signs of suspected oral cancer to encourage dental visits. However, changing the behaviour and understanding of individuals requires significant, sustained and ongoing investment in major education and engagement programmes. It also requires wholesale change to how people view their interactions with the dental profession and access to dental services. 

“There is clearly a real danger that boys in northern ireland will be left behind … and remain at risk”

Another worrying trend, which can be seen clearly in Northern Ireland, is an increasing incidence in younger age groups. Early, anecdotal evidence seems to suggest that it is the third of the three major causes of oral cancer driving this trend, namely HPV. It is no surprise, therefore, that there is significant concern that the Department of Health in Stormont has, as yet, provided no clarity as to whether the HPV vaccine will be extended to boys, as is the case in England, Scotland, Wales and most recently the Republic of Ireland. 

Speaking at the Cancer Focus event, Gerry McElwee, Head of Cancer Prevention, Cancer Focus NI, made the seriousness of the situation clear: “There is clearly a very real danger that boys in Northern Ireland will be left behind – and therefore remain at risk of potentially life-threatening diseases. The department should consider using new powers recently legislated for at Westminster to ensure local boys are not disadvantaged, as it is a decision that sits squarely in the public interest. There’s an urgent need for an implementation plan to enable the roll-out of a vaccination programme for local boys by next September. This should include a catch-up programme for boys which parallels that available for girls and vaccine uptake.”

There is no doubt oral cancer needs significant focus, and it is to be hoped that the recent drive has done much to raise awareness in the media, with the public and with those who determine healthcare policies and practices, that oral cancer is a growing problem and one that cannot be ignored or dealt with through simple public health initiatives.

Tackling this requires real investment in infrastructure and resources, major cultural changes and a willingness by governments and others to listen to the dental profession and finally accept that, in the words of Robert Donald, BDA Scotland Chair speaking at the launch of the BDA’s oral cancer action plan, dentists “are not tooth-smiths, we are oral physicians”. 

To really move forward, it will require the further involvement
of and consultation with the dental profession, as well as major investment and commitment from governments, politicians, the NHS and other stakeholder organisations. Tackling oral cancer is complicated and multi-factorial, but there is much than can be done with the will, the investment and the commitment of everyone.  

Tags: 2019, cancer, news