BackgroundOne of the salient but silent public health problems, oralcancer is a killer disease but with a cure. It gives rise to disabilities anddeath but the possibility of survival is surprisingly high when detected early.
Therefore, oral cancer screening procedures are a mandatory know-how for dentalsurgeons working at any level. Starting from their days of their undergraduateeducation to the training they receive during their house-job, they should endup in a position where they are able to identify all suspicious lesions andsearch for prompt specialist opinion where they are fazed or unsure. MethodsA cross sectional questionnaire based study was conductedamongst 150 house officers from Sardar Begum Dental College Peshawar, Khyber Collegeof Dentistry Peshawar and Prime Dental College Peshawar. A self-designed closeended questionnaire with 4 open ended questions was distributed amongst all thehouse officers of the above mentioned. ResultsOf the 150 house officers approached, 128 filled thequestionnaire with a response rate of 85.33%.
Only 0.8% of the totalparticipants i.e. only 1 participant managed to score above average knowledgeregarding oral cancer screening methods while 58.6% had average knowledge,30.2% were below average and 10.2% had poor knowledge. 81.
3% said they didn’tfeel adequately trained to screen patients for oral cancer and 95.3% felt aneed for its improved training during their respective bachelor’s program.ConclusionsThe study brings to light a dire need for an improvedapproach towards oral cancer screening methods during the undergraduate yearsin the dental colleges of Peshawar. Keywords: IntroductionOral cancer isthe eighth most common cancer worldwide11. It includes cancers ofthe lip, tongue and rest of the oral cavity, except for cancers of the majorsalivary glands1.
In developing countries mostly and in some underdeveloped countries, it is responsible for sizeable mortality and morbidityrates. Though on an estimate cancer incidence is 14 million new cases, alone oralcancer has a 1.8% mortality worldwide and claims about 300.000 deaths (2.1%)annually2, 3. Patient survivalpresenting with late stage disease is only 30% whereas detection at an earlystage has shown that survival from oral cancer at 5 years is better than90%,. The survival rate for oral cancer over 5-years has remained less than 50%over the last 50 years for the following reasons11 12: (i) Diagnosisat advanced stages for 60% cases (III and IV); and (ii)) Oral cancer is subjectto the “field cancerisation phenomenon”, and has the highest risk ofdevelopment of second primary tumors of any cancer.
But even afterall this, if caught early, oral cancer is extremely treatable (i.e., in stage 1or 2)8. Unfortunately, late stage diagnosis (i.e., stage 3 or 4) isall too common 9 and the most common cause is the failure to obtainan oral cancer screening from a dentist or physician 10.
Early diagnosisfor oral cancer is ensured by the immediate response of professionals andpatients to early signs and symptoms so that a prompt diagnosis and a focused treatmentplan can be formed before the disease becomes advanced. However, an estimated30% of patients wait more than three months before consulting a healthcareprofessional about signs of oral cancer4. Delayed presentation hasbeen found to be influenced by the process of symptom interpretation, knowledgeof oral cancer, coping responses and barriers to seeking help such as problemswith access and their social circumstances and responsibilities.5A number of screeningtechniques have been proposed for oral cancer. The simplest of which involvesvisual examination of the oral mucosa as shown by Kujan et al in 2006.
In a Cochrane review it was concludedthat there was not enough evidence to determine whether oral screening byvisual examination, or any other modality, in the general population couldreduce mortality from oral cancer Kujan et al in 2006, but in researches conducted by Field et al in 1995, Lim et al in 2003 and Speight et al in 2006, it has been suggested by an increasingnumber of studies that oral screening could very feasibly be carried outeconomically as a part of routine dental checkups in general dental practice.7A handful ofcountries in the world like Cuba, have a national oral cancer screening program.The program uses annual visual examination in dental practices as found by Fernandez Garrote et al in 1995. While there is some evidence thatrepeated screenings led to a reduced likelihood of advanced stage oral cancer (Sankaranarayanan et al, 2002), overall there has been limited evidenceof a shift from advanced to earlier stage oral cancer following introduction ofthe programme (Fernandez Garrote et al, 1995).
7Another advantageof oral cancer screening is that during a routine exam, informing high riskpatients that you are checking for early signs of oral cancer, could prove tobe a golden opportunity to educate them about the existence of oral cancer andadvise them on preventive measures and early detection. The British DentalAssociation (BDA) does advise that patients should normally be told that anoral cancer check is being carried out.6 It is clear thatscreening for and early detection of cancer and pre-cancerous lesions have thepotential to reduce the morbidity and mortality of this disease. 13A cross sectional descriptive, questionnaire-based surveymethod was conducted to assess the level of KAP regarding oral cancer screeningamong the house officers in the dental colleges of Peshawar city, KPK.
Questionnaires were distributed amongst male and female house officers ofSardar Begum Dental College, Khyber College of dentistry and Prime Dental College.A list of all the house officers was obtained from the SAS of the respectivecolleges. Prior to conduct of the study, ethical clearance was obtained fromthe Respective ethical committees.
A total of 180 house officers are present in the aforementioned dental colleges. All these house officers were selected for thisstudy. The study was conducted over a period of two months.
After informing theparticipants about the aim of the study and obtaining consent, questionnaireswere distributed amongst them in their respective wards. To ensure honesty andprevent improper data entry, the house officers were supervised during theprocedure. Participation was voluntary. The questions werederived from different articles. The questionnaire was prepared in English andcontained 25 questions split into three sections i.
e. knowledge, attitude andpractice. 4 of the questions in the knowledge section were open endedquestions. A pilot study was initially conducted before distribution amongstthe house officers.
3 questions were discarded and the final questionnaire thuscomprised of 25 items with 12 knowledge, 8 attitude and 5 practice basedquestions. For the purpose of analysis, each correct answer was given score “1”and wrong answers were given score “0”. Questions left unmarked were also given”0″. Answers to open-ended questions were in the form of a fixed number ofpoints. To assess these answers, we had a key for which every correctlymentioned point was scored “1” mark.
Overall individual scores on the questionswere based on the number of correct answers. The results were hypothesized with response scores whichsignificantly related to the level of KAP`s regarding oral cancer screeningamong the study participants.The data was entered into IBM SPSS 20 from thequestionnaires and analyzed.
Results Out of the 170 house officers, 130 house officersparticipated in the study with a response rate of 76.47%. Table 1 shows amajority of the participants to be females (66.9% n=87) and only (33.1%n=43) to be malerespondents.DiscussionOf the mostcommon cancers in the world is oral cancer. 267,000 new cases and 128,000deaths globally are reported annually. Two thirds of these cases are reportedfrom developing countries1.
One of the lowest 5 years survivalrates is for oral cancer. 40% of all cancers in South Asia are diagnosed to beoral cancers. In the Indian subcontinent, the incidence of oral cancer is veryhigh at about 3–7 times more than in countries with more resources. Our countryalong with our neighbor India is at the top in the prevalence of oral cancer inthe world.
Furthermore, we remain to be the population with oral cancer beingthe most common cancer among the male population. Oral cancer is the third mostcommon cancer in India after cervical and breast cancer among women. Theage-standardized incidence rate of oral cancer is reported at 12.6/100,000people. Reasons that can be attributed to the amplified prevalence of oralcancer in the Indian subcontinent include high exposure to sunlight due tofarming, smoking, and other smokeless tobacco habits, alcohol, spicy food, andneglect of overall oral health. It is said that one-third of all oral cancersare preventable and one-third of them occur due to risk factors. 2Screening for oral cancer is one of the most important butoverlooked factor in early diagnosis of the disease.
Questions included in the knowledge section were fairlybasic and to be expected from house officers. Data analysis showed that only 1participant was able to get a cumulative score enough to come in the aboveaverage knowledge category. 57.7% of the participants scored in the averageknowledge category while almost half of this figure was below average at30%.
A 10% of the participants remainedin the poor knowledge category. These are alarming figures as the questionswere designed to be simple and basic. Almost half of the participants considered their knowledgeto be insufficient regarding oral cancer screening methods. Keeping in mindthat these are all fresh graduates in their house job, which means they havenot even left their institutes this is not comforting. Strong educationalintervention is advised in the undergraduate curriculum.A strong majority of the participants (81.5%) feltinadequately trained to screen patients for oral cancer.
71.5% felt they wereadequately trained to perform a proper lymph node palpation. 7.7% didn’t thinkit was necessary to perform a complete oral cavity examination other thanpalpation of lymph nodes routinely in patients. There is a strong need forimproved training regarding screening methods for oral cancer, as was indicatedby 95.
4% of the participants, while an even greater 97.7% showed interest ingetting more information on oral cancer screening.An astounding 43.
1% said they were never taught any oralcancer screening procedure during their bachelor`s program. In the practice section of the questionnaire, 54.6% saidthey didn’t practice complete oral cavity examination in patientsroutinely.
63.1% said they didn’t routinely practice screening for oral cancersin high risk patients. 48.
5% said they routinely performed lymph node palpationin high risk patients. 17.7% said they don’t keep patients with oral lesions onfollow up.