Patients' Perceptions of Oral Cancer Screening in Dental Practice

A Cross-Sectional Study

Oluwatunmise Awojobi; Suzanne E Scott; Tim Newton

Disclosures

BMC Oral Health. 2012;12(55) 

In This Article

Results

Response Rate

Out of a possible 362 eligible adults who were approached to take part in the survey, 186 adults (51%) completed and returned their questionnaires. Two respondents were excluded from the final analysis because they reported having had oral cancer previously. Table 1 has a summary of the socio-demographic characteristics of participants.

Chi square tests indicated that there were no significant variations between participants recruited from the two boroughs apart from respondents from the Southwark practice being more likely to be under 40 years of age (69.5%) compared to those recruited from the Lewisham practice (30.5%) (X 2 = 7.281, p= 0.007).

Healthcare Utilization

Seventy-eight percent of participants reported visiting their Dentist within the past year in addition to their current visit. A higher proportion, (89%), reported visiting their GP within the same period. Of all the respondents, 50% reported visiting their Dentists for regular checkups, 18% for occasional checkups and 34% only visit the Dentist when having trouble with their teeth.

Health-related Behaviours: Risk Factors

Alcohol Use. Twenty three percent of respondents reported never having a drink that contains alcohol while 30% reported having alcoholic drinks two to three times a week or more.

Alcohol Use Disorders Identification Test Consumption (Audit-C) scores were calculated for 118 respondents who had sufficient data to compute the score. The mean Audit-C score was 3.93 (95%CI 3.53, 4.33) with a median of 4 and range 1 to 10. Thirty seven percent (N=44) of respondents had a score of 5 or more which is the high risk category.

Tobacco Use. Table 2 shows current and lifetime tobacco use as well as quantities smoked. The proportion of ever-smokers in this sample was 58%, with 24% of respondents reporting being current smokers and 34% being previous smokers who had quit. Of those who had quit, 35% stopped smoking more than 10 years ago. About 10% of ever-smokers (current or ex-smokers) reported having their first cigarette less than five minutes after waking up but the majority (53%) had their first cigarette about an hour or more after waking. Four respondents (2%) reported chewing some form of tobacco. On average respondents smoked more during the weekends than on weekdays with a mean value of 13.44 cigarettes smoked during the weekends compared to 10.49 during the week.

Knowledge and Awareness of Oral Cancer

Seventy three percent of respondents reported having heard of oral cancer while 20% said they had not and 7% were unsure if they had heard of it or not. When asked how much they knew about the disease, only 6% reported that they knew 'a lot', and the vast majority (77%) reported that they knew 'a little' or 'nothing at all' (Table 3).

The mean oral cancer knowledge score (risk factor subscale) was 9.96 (95% CI 9.79, 10.28) with a range of 3 to 12 items answered correctly out of 13 items. The mean oral cancer knowledge score (screening subscale) was 6.09 (95% CI 5.95, 6.31) with a range of 2 to 7 items answered correctly out of 7 items.

Emotion and Attitudes Towards Screening for Oral Cancer

Thirty nine percent of respondents said they would not feel anxious, worried or concerned about having their mouths checked for signs of oral cancer with a further 25% indicating they would only feel a little anxious, worried or concerned. The mean emotion score was 2.52 (95%CI 2.01, 2.88). Only a minority (1%) reported extreme levels of anxiety, worry and concern about oral cancer screening. With regards to attitudes, overall there was a generally positive attitude to screening with a mean score of 13.04 (95%CI 12.68, 13.41). Approximately 21% of respondents had very positive attitudes to being screened obtaining the highest possible score of 16.

Experience of Oral Cancer Screening

Table 4 summarizes the data regarding participants' awareness of oral cancer screening. When asked whether Dentists were trained to check for signs of oral cancer more than half (56%) of respondents said they did not know or were unsure. Furthermore, 72% also did not know if their own Dentist screens them for signs of oral cancer as part of their routine check up, and 60% said they did not know if their mouths had ever been checked for signs of oral cancer by any Dentist. Consequently, when asked when their most recent check took place 56.4% reported not knowing and 27.1% said that their mouths had never been checked. Only 13% indicated that their chin or neck had ever been felt as part of their examination. Of those who recall this extra oral examination, 44% said they received an explanation for this.

Ninety-two percent of respondents indicated that they would like their Dentists to tell them if their mouths were being checked for signs of oral cancer. Only 5% did not want to be told and 3.4% were unsure. Moreover, 97% said they would like help from their Dentists to help them reduce their risk of getting oral cancer.

Help-seeking Behaviour

Proportions of participants reporting that they would visit their Doctor rather than their Dentist for individual signs of oral cancer were 62% for white patch, 61% for red patch, 51% for an ulcer and 54% for a swelling. This trend was reversed in the case of pain in the mouth where the majority (50.9%) indicated they would visit the Dentist. Seventy-seven percent of participants anticipated delaying seeking help for at least one sign of oral cancer.

Relationships Between Variables, Sociodemographics and Health Behaviours

There was a small but significant correlation between alcohol use and attitudes to screening (rho=0.154, p=0.047) as well as knowledge about oral cancer screening (rho=0.226, p=0.004). Those who drank alcohol had a more positive attitude to screening and had more accurate knowledge about what screening for oral cancer entails. Similarly, ever smokers were found to have more positive attitudes to being screened for oral cancer (rho=0.157, p=0.042) compared to those who had never smoked. However, ever smokers were less aware that their Dentist screened them routinely for signs of oral cancer (rho= −0.151, p=0.044). Older participants (those 40 years and older) were less worried about being checked for signs of oral cancer by their Dentist than those in the younger age group (rho= −0.167, p=0.049). Married participants were more likely to want to know if their Dentist was screening them for signs than non- married (single, divorced or widowed) (rho= 0.218, p=0.004).

A Mann–Whitney U test revealed white respondents were less emotional about screening (Md = 0) than black respondents (Md = 3) as well as respondents from other ethnic backgrounds (Md = 2) (z= 13.250, p = 0.001). White people were also significantly more knowledgeable about what screening entails (z = 12.882, p = 0.002) than the other ethnic groups, with a median value of 7 compared to a slightly lower score of 6 for Black and Other ethnic groups. Additionally patients who had previously heard of oral cancer had more positive attitudes to screening (rho=0.189, p=0.014). A Kruskal-Wallis test revealed statistically significant differences in attitudes to screening as well as knowledge of screening between participants with different socioeconomic classification. Those in intermediate occupations had more positive attitudes (Md = 14.50) compared to managerial and professional occupations (Md = 12) or semi-routine/routine occupations (Md = 13) (X 2 = 16.271, p=0.006). Similarly, respondents who were classified as having intermediate occupations also had the highest score for knowledge of what an oral cancer screening entails with a median score of 7 whereas all other groups had a median score of 6 (X 2=11.417, p=0.44). Finally, a Mann–Whitney U test revealed respondents who went for regular checkups had significantly more positive attitudes to screening(Md= 13.50) than those who went occasionally (Md=12.36) or only with trouble (Md=12.97).

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