ORAL CANCER

Bryce Jay, Monisha Kumar and Maria Naude

“Beliefs about and risk factors for oral cancer – do they vary between the sexes?”

Oral cancer

Any cancerous tissue growth within the oral cavity; including the tongue, lips, gingiva and palate.

The eleventh highest incidence rate of all cancers worldwide, with approximately 274 300 new cases diagnosed and 127 500 deaths reported in 2004 (Ferlay, Bray, Pisani & Parkin, 2004).

The majority of cases occur in third world countries, with incidence rates in developed countries, such as Australia, being far lower by comparison.

In 2008 oral cancer accounted for only 0.6% of all deaths that year (Australian Bureau of Statistics (ABS), 2008).

However, the incidence and mortality in Australia is on the rise, increasing from 962 deaths in 2006 to 1206 in 2008; with the rates for males being approximately twice that of females (ABS, 2006; ABS 2008).

The rate of incidence worldwide can be in part attributed to a general lack of awareness of oral cancer and its risk factors (Petti & Scully, 2006).

Rationale

Previous studies have concluded that it is not an exceptionally well known form of cancer (Rogers, Hunter & Lowe, 2010).

However, few studies have investigated the level of awareness of oral cancer and it’s risk factors, such as smoking tobacco, in order to offer a potential explanation for the far higher prevalence of the disease among males.

In addition to poor living conditions, the major risk factors for oral cancer relate to unhealthy lifestyles (i.e. poor diet, sun exposure and use of tobacco and alcohol), and limited availability and accessibility of oral health services.

The implementation of effective measures for the prevention of oral cancer and promotion of oral health is urgently needed (Peterson, Bourgeois, Ogawa, Estupinan-Day & Ndiaye 2005).

Objective

The aim of this project was to gauge peoples’ level of knowledge of oral cancer and its risk factors. In particular differences between males and females were analyzed to offer a potential explanation for the discrepancies in incidence and mortality rates between genders.

Another aim was to determine the most popular method in which awareness of oral cancer could be raised.

The findings of this study could be used to direct any future health promotion campaigns regarding oral cancer.

Method Questionnaire

Participants over 18 were opportunistically selected.

Equal numbers of males and females were sought out.

From rural and metropolitan areas

The researchers or someone on their behalf approached participants in public settings Such as: The Wellness House, Restaurants, Cadia Mine

Questionnaire design

12 questions, including open and closed. The first 4 questions gathered the participants

demographic information: age, sex, and residence, education level.

Later questions assessed their knowledge of the symptoms and risk factors of oral cancer.

Final questions asked participants to give their opinion on methods of increasing oral cancer awareness and how willing they were to make changes in their life to prevent developing cancer.

Response

Conducted over a three week period

200 participants 105 (52.5%) were male and 95 (47.5%) were female. 36 participants were smokers (18.5%)

56.5% resided in a rural or regional location

38.5% hold a university degree or higher level of education.

Scoring Surveys

Description of oral cancer- N/A Wrong understanding eg cancer of body

organs Poor understanding eg cancer or cancer in

the mouth Good understanding eg cancer of the lips,

tongue and throat (etc) often caused by smoking…

What would you most associate with oral cancer? Gum discouloration Abnormal lumps/ swelling Persistent pain Loosing your teeth unexpectedly

How would you rate the following factors as risks for oral cancer:

Smoking (high) Poor oral hygiene (none) Alcohol (high) Non alcoholic mouthwash

(none) Exposure to sun (high) Prescription

medications (none) Male gender (moderate) Dental procedures

(none) Poor diet (slight) Lack of exercise (none)

(Peterson et al, 2005) (Morse, Psoter, Cleveland , Cohen , Mohit-Tabatabai, Kosis and Eisenberg 2007)

(Rodriguez, Altieri, Chatenoud , Gallus, Bosetti, Negri, Franceschi, Levi, Talamini, Vecchia, 2003)

Results

A large proportion (78%) of participants indicated that they had previously heard of oral cancer.

Of those who had heard of the disease, 63.5% offered an applicable description of the disease and out of those, 29.5% were judged to have given an answer which displayed a good understanding of the disease.

Most participants (69%) were able to correctly indicate that gum discoloration and abnormal swelling and lumps were symptoms of oral cancer.

No significant difference between males and females was noted.

Participant’s knowledge regarding the risk factors of oral cancer was generally poor, with scores ranging from 0 to 8 out of ten and an average score of 3.5.

Smoking was the risk factor most commonly rated correctly, with 88.5% of participants correctly rating it as a high risk.

However, only 19.5% correctly identified alcohol as a high risk factor. A slight difference in the answers of males and females regarding alcohol as a risk factor was noted with 23.2% of females answering correctly compared to only 16.2% of males.

Symptom most associated with oral cancer CORRECT 43.5% had finished a university degree or higher 26.8% had a trade/apprenticeship/certificate/diploma

51.7% of metropolitan people had a university degree or higher 28.3% of regional/rural people had a university degree or

higher

Highest education level vs. Smoking 41.7% (5) of the people who did not complete school smoked 26.3% (15) of the people who finished school smoked 18.5% (10) of people with a trade/apprenticeship/certificate/diploma

smoked 7.8% (6) of people with university degree or higher smoked

Residence vs. Smoking In total 18.5% of the participants smoked (25% of these were metro, 75%

were rural/regional)

Age Group vs. Smoking Out of the 37 (18.5%) smokers in the study

51.4% (19) were between the ages of 18 – 34

Comparable to national statistics:

The highest rates of daily smoking among Australian men were in the 18-24 years age group (34%) ; for women in the 25-34 years age group (27%) (Cancer Council Australia, 2010).

Increasing awareness question: 120 (60%) people chose TV advertisement Next 29 (14.5%) people chose other forms of awareness including

all of the above/school education/social networks/internet/health lifestyle magazines

Question:

Would you lead a healthier life to reduce your chance of getting cancer

OR

enjoy life as you can never be sure whether you will get cancer

77.5% participants chose a healthier life 43.9% had a university degree or higher Only 56.8% of smokers chose this

43.2% of smokers chose to enjoy life Only 17.8% of non smokers chose this

(other random stats) Other risk factors for Oral Cancer (not statistically significant)

25% of the participants were able to correctly name another risk factor for oral cancer

Most who answered and got the risk wrong chose to answer with….

Driving too fast, bungee jumping without ropes

Kissing & plutonium reactor 24/7

Singing or shouting too loud

Most of these were males between the ages of 18-30

Oral Cancer description (not statistically significant)

Total =127

59 (29.5%) good understanding

62 (31%) poor understanding

6 (3%) wrong understanding

73 (36.5%) N/A

50-64yr olds – were 40% of the good understanding

Define a good understanding as =

Common Answers:

‘Cancer’

Most common = ‘cancer of the mouth’

Followed by = ‘cancer of the oral region’

Some silly answers

‘Mouth cancer – oral sound dirty’

‘Oral cancer looks painful and yuck’

An example of the a good understanding (29.5%):

To a neoplasmic growth of the oral mucosa

Compare results to previous studies or stats Knowledge of HIGH risk factors Rogers found that 21% of people knew that

alcohol was a risk factor,25% in Cruz’s study 19.5% in our study rated alcohol as a high

risk factor Rogers found that 74% of people knew that

smoking was a risk factor, 76% in Cruz’s study 88.5% in our study rated smoking as a

high risk factors

Validity of the data

Only 200 participants However almost equal numbers or males and females,

rural/regional and metropolitan participants 18.5% smokers

In 2007 only 18% of Australian males 15.2% females were daily smokers (Cancer Council, 2010)

By recruiting participants from healthcare settings such as the Wellness House, which offers a variety of services for a wide range of people, the data collected represents a cross-section which is comparable to the general population.

One limitation of the study was the fact that not all participants filled out the survey correctly and some did not complete all questions, meaning that their responses were unable to be used in the study

What we can infer

Overall the knowledge and awareness of oral cancer was poor. A large proportion of the participants were able to correctly identify the early symptoms of oral cancer, although this could have been influenced by the survey design. As the first two of the multiple choice options were correct and the majority of participants chose the first option this may have affected the results.

What to do with the outcome Use as a pilot study Education –

In high school Regional/rural

Learning to identify symptoms Alcohol as well as smoking as risk factors

TV advertisements were the most popular suggestions to increase awareness followed by social networks or internet Labels alcohol/stores rather than labels

Main points

Lack of awareness of alcohol as a HIGH risk factor

Correlation between higher education/ age Less likely to smoke Better understanding of oral cancer Better awareness of risk factors

Conclusion

The results of this study indicate that no difference in awareness and knowledge of oral cancer and its risk factors exists between males and females.

Further research needs to be undertaken to offer a conclusive reason for the disparity in incidence and mortality rates.

Overall awareness is poor, with most people being unaware that alcohol use and sun exposure are high risk factors.

The increasing incidence of oral cancer and the ability to prevent the disease through healthy living, suggests a need to raise awareness of the disease to prevent unnecessary deaths and loss of quality of life.

References

Australian Bureau of Statistics (2008) ‘Causes of Death, Australia, 2008’, Retrieved August 4, 2010 from: http://www.abs.gov.au/ausstats/abs@.nsf/Products/60E6662B7045E704CA2576F600122FB2?opendocument

Australian Bureau of Statistics (2006) ‘Causes of Death, Australia, 2006’, Retrieved August 4, 2010 from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/F7F39BFACAE7FF34CA257410000FAF96?opendocument

Cancer Council Australia (2010) Smoking rates in Australia. Retrieved September 19, 2010 from: http://www.cancercouncil.com.au/editorial.asp?pageid=371

Ferlay J, Bray F, Pisani P, Parkin DM. (2004) Cancer incidence, mortality and prevalence worldwide. IARC CancerBase. Lyon: IARC Press; 5(2)

Jaber MA, Porter SR, Speight P, Eveson JW and Scully C. (2003) ‘Oral epithelial dysplasia: clinical characteristics of western European residents.’ Oral Oncology 39(6): 589-596

Morse DE, Psoter WJ, Cleveland D, Cohen D, Mohit-Tabatabai M, Kosis DL and Eisenberg E. (2007) ‘Smoking and drinking in relation to oral cancer and oral epithelial dysplasia.’ Cancer Causes Control. 18(9): 919–929.

Peterson P.E., Bourgeois D., Ogawa H., Estupinan-Day S. & Ndiaye C. (2005) ‘The global burden of oral diseases and risks to oral health’ Bulletin of the World Health Organization 83:661-669.

Petti S, Scully C, (2006), ‘Oral cancer knowledge and awareness: primary and secondary effects of an information leaflet.’, Oral Oncology, 43: 408-415

Rodriguez T, Altieri A, Chatenoud L, Gallus, S, Bosetti C, Negri E, Franceschi S, Levi F, Talamini R, Vecchia C, (2003) ‘Risk factors for oral and pharyngeal cancer in young adults’, Oral Oncology, 40: 207–213

Rogers SN, Hunter R, Lowe D (2010) ‘Awareness of oral cancer in the Mersey region’ British Journal of Oral and Maxillofacial Surgery, 281-287