This exploratory study sought to document the extent of the missed opportunity for increasing oral cancer awareness within dental practices. In similarity to the findings in the United States a low proportion of participants in this study were aware that they had been checked for oral cancer by their dentist (at their last appointment or ever). In, addition those patients with risk factors (age, tobacco use, alcohol consumption) were not any more aware that oral cancer screening is conducted by their dentist, compared to those without such risk factors.
Respondents who were more at risk (via alcohol use, smoking status) were also significantly more likely to have positive attitudes to screening. Furthermore, higher risk patients are said to visit the Dentist less regularly than low risk patients, however the results of the current study indicate that regularity of visit does not affect attitudes to screening. There was no significant difference in attitudes between those who visited their Dentist within a year and those that visited more than two years ago. Furthermore, unlike the study by West et al. that found only 4.4% reported not having heard of oral cancer, in this study 19.7% said they had not heard of oral cancer. This gives cause for concern as low levels of awareness will affect the chances of early presentation.
Using the opportunity provided by a dental appointment to raise awareness may be increasingly vital to encouraging early detection of oral cancer. This sample of patients reported very positive attitudes towards screening for oral cancer (including being told that this screening is taking place) and low levels of negative emotion about being screened. This is a positive message from participants and this supports data from the United States. Choi et al. also found patients would like their Dentists to tell them if they were being screened for signs of oral cancer. A contradiction however can be seen in that same study as Dentists expressed concern that screening will make patients anxious.
Symptom misinterpretation is a common reason for delayed diagnosis. Overall, a high percentage of patients anticipated a delay in seeking help for at least one sign of oral cancer in this survey with patients intending to seek help for an average of 2.4 of the five signs presented. This could contribute considerably to a delay in diagnosis and treatment. This study also found that a higher proportion of participants reported that they intended to seek help from a Doctor than from a Dentist for the signs of oral cancer. There is a need to ensure Doctors are specifically trained in referral and care pathway for oral cancers so that they are equipped to adequately support their patients and not contribute further to any delay.
An additional finding is that there are differences in knowledge, awareness and experiences between groups according to their sociodemographics (e.g. ethnicity) and other variables. For instance, white people were more knowledgeable about what screening entails and ever smokers were less aware that their Dentists screened them routinely. This highlights the fact that interventions and strategies may need to be targeted more closely to certain groups.
This study has some limitations that should be considered. One limitation is the response rate (51%). It is difficult to demonstrate that the people who chose not to participate in the study were not significantly different from the people who did. Findings need therefore to be interpreted with caution. However many of those recruited had risk factors for oral cancer and had poor knowledge of oral cancer. This sample's risk status does not appear to be much different from that of the wider local population (21). Current smoking rates in this study (23.9%) are higher than that for London (20.8%) but slightly lower than most recent rates reported for Lewisham (27.1%) and Southwark (26.9%). However, 60% of all respondents had ever smoked, which means a high proportion are at an increased risk of getting oral cancer when other factors like age (63% over 40 years of age) and alcohol use (77% consumed alcohol) are taken into account.
Additionally, this study did not set out to determine whether dentists are performing full and thorough oral cancer screening with high risk patients, however it does indicate that patients are unaware that oral cancer screening is taking place. Kujan et al. reported over 95% of GDPs and Specialist Dentists reported using a visual examination for oral cancer screening. In a previous study of 2519 UK Dentists, 84% reported that they perform screening of the oral mucosa routinely in practice and this figure was 82% in a more recent US Study. Based on these figures it is likely screening may indeed be taking place but the gap is found in that Dentists may not be communicating this fact to their patients.
BMC Oral Health. 2012;12(55) © 2012 BioMed Central, Ltd.