The meeting called for the development of early detection guidelines will help to design diagnostic assessment programs, among other things—read more below.
The Global Oral Cancer Forum (GOCF) was held March 4–5th, 2016 at New York University's Kimmel Center, New York City. It was made possible through an educational grant from Henry Schein Cares Foundation. Many thanks to those at Henry Schein, in particular Michele Penrose, and Shannon Nanne, RDH, Executive Director of the Global Oral Cancer Forum. This article will review some of the lessons learned at that meeting, and other sections of this newsletter will do the same.
The mix of over 240 participants included academics, clinicians, activists, industry partners, survivors, government officials, and other stakeholders from 44 countries. There were lectures, presentations, interactive sessions, posters, and a social event. Partners of the GOCF include the American Dental Hygienists’ Association (ADHA), FDI World Dental Federation (FDI), World Health Organization (WHO), and many others listed on the website. (1)
The meeting opened with a welcome from A. Ross Kerr, DDS, MSD, from New York University College of Dentistry. This was followed by greetings from Steven W. Kess, president, Henry Schein Cares Foundation, and Hiroshi Ogawa, DDS, MDSc, PhD, dental officer of the World Health Organization (WHO). This was followed by a presentation entitled “Making an Impact: The Power of Public-Private Partnerships” by Stanley M. Bergman, chairman and CEO, Henry Schein Inc. The keynote presentation was given by Michael C. Alfano, DMD, PhD, executive vice president emeritus, New York University. Dr. Alfano also presented the Innovation Leadership Award to Brian R. Hill, founder of the Oral Cancer Foundation, who is an entrepreneur, activist, philanthropist, and oral cancer survivor.
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At the meeting, Mr. Hill stated that he knows that dental hygienists are performing oral cancer exams. According to Mr. Hill, dental hygienists can "recognize" that something looks "different," and refer to the appropriate health-care professional. He stated on Facebook that “they [RDHs] actually can do so much more. My point was in rebuttal to something that I had heard from a professional earlier in a group conversation, about the merits of having RDHs do screening. I asked an RDH in the group to spontaneously name the characteristics of a lesion . . . she rattled them right off: indurated, ulcerated, friable, exophytic, altered color, etc. I said its quite clear that RDHs can easily determine that something is not like the tissue around it and discover that!!”
The next portion of the meeting discussed regional disparities in oral cancer. There were representatives from Australia, the United States, Spain, Italy, China, Sri Lanka, Malaysia, South Africa, Saudi Arabia, Argentina, and Brazil. Much of the discussion centered on tobacco control. Tobacco will kill as many as one billion people this century. (2) There are distinct variations in the incidence of oral cavity and pharyngeal cancers around the world. This is due, in part, to different lifestyles related to the use of tobacco, areca nut, alcohol consumption, and sexual activity (HPV virus). (3)
The incidence continues to be elevated in less economically developed countries, where the prevalence of key risk factors, such as cigarette smoking, tobacco chewing, and alcohol use remain high. On the other hand, in countries such as the United States, Canada, and parts of Europe, we have seen declines oral cavity and pharyngeal cancers due to decreasing tobacco use. (4) The report conveyed an increased incidence in women, which parallels increased tobacco use by women in certain parts of the world. The group also acknowledged that HPV has emerged as a risk factor for oral pharyngeal cancer. They stressed the need for primary prevention through education and prophylactic HPV vaccination for all oral cavity and pharyngeal cancers. (4)
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The next group explored understanding gaps in the oral cancer continuum and developing strategies to improve outcomes. Oral cancer has one of the lowest overall five-year survival rates, close to 50%, and higher rates are reported from the United States, 63.2% in five years. (5) The group listed risk factors sex/gender; socioeconomic and nutritional status; lifestyle-related risk factors; presence of comorbidities; location of the tumor; disease stage, including nodal status; and expression of several key biomarkers. (6)
Part of the reason for the high death rate is late stage at diagnosis. This may be due to many factors, such as patient delay, provider-related diagnostic delay, referral delay, tumor aggressiveness, or other factors. In many cases full professional examinations are not performed, causing suspicious lesions to be missed. Misdiagnosis as a result of not sending a patient for a biopsy, ignoring a lesion that does not look suspicious, or diagnosing a lesion as a benign entity can cause false negatives. Lack of understanding and experience with the disease is also a factor for late stage diagnosis, as stated by professionals. (6)
There are numerous resources available to professionals to increase understanding and assessment of oral cavity and pharyngeal cancers. The Lifelong Learning Programme provides information for dental and primary health care professionals in key aspects of early diagnosis and prevention of oral cancer. (7) A publication of the British Dental Association (BDA) is entitled “Early detection and prevention of oral cancer: a management strategy for dental practice.” (8)
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The meeting concluded that development of early detection guidelines will help to design diagnostic assessment programs. These guidelines would need to be evidence based with standards of care that take into account local settings. It is hoped that these guidelines will improve the quality of care and referral of those with suspicious lesions.
References
1. Home page. The Global Oral Cancer Forum website. http://www.globaloralcancerforum.org/. Accessed March 30, 2016.
2. WHO report on the global tobacco epidemic, 2008. The MPOWER package. Geneva: World Health Organization; 2008.
3. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009; 45(4-5):309-316.
4. Group 1 whitepaper: Global burden of oral cavity and pharyngeal cancers. Global Oral Cancer Forum website. http://www.globaloralcancerforum.org/img/White-Paper-Group-1.pdf. Accessed March 30, 2016.
5. National Cancer Institute. SEER Stat Fact Sheets: Oral Cavity and Pharynx Cancer. National Cancer Institute website. http://seer.cancer.gov/statfacts/html/oralcav.html. Accessed March 18, 2016.
6. Group 2 whitepaper: Understanding gaps in the oral cancer continuum and developing strategies to improve outcomes. Global Oral Cancer Forum webiste. http://www.globaloralcancerforum.org/img/White-Paper-Group-2.pdf. Accessed March 30, 2016.
7. Home page. Oral Cancer LDV. http://www.oralcancerldv.org/en/. Accessed March 30, 2016.
8. Speight P, Warnakulasuriya S, Ogden G, eds. Early detection and prevention of oral cancer: a management strategy for dental practice. London: British Dental Association; 2010.
