مقالات پذیرفته شده در سومین کنگره بین المللی زیست پزشکی
Oral cavity cancers, the economic burden and the importance of early screening
Oral cavity cancers, the economic burden and the importance of early screening
MINOU NAJARNOBARI,1,*
1. TEHRAN UNIVERSITY OF MEDICAL SCIENCES, DENTAL SCHOOL
Introduction: Oral cancers are part of a group commonly referred to as head and neck cancers, and of all head and neck cancers, they comprise about 85% of that category. Oral cancer is the sixth most prevalent cancer type across the world. Based on the latest reports, the oral cancer incidence rate in Iran is about 1400 new cases per 100,000 individuals per year, and approximately 95% of oral cancers occur in people older than 40 years, with an average age at diagnosis of 60 years. The majority of oral cancers are squamous cell cancers. Other malignant diseases that can occur in the oral cavity include tumors of the salivary glands, lymph nodes, bone, and soft tissue. Aside from considerable effects on the patients’ health and quality of life, oral cancers impose high costs on the health system.
Methods: Cultural habits, including betel quid chewing containing potent carcinogens, alcohol consumption, and reverse smoking, as well as low socioeconomic status and low consumption of fruits and vegetables are the main risk factors for oral cancerous lesions contributing to this high prevalence. The most common sites of predilection for oral cancer are dorsal surface of tongue, floor of the mouth, labial/buccal mucosa, gingiva, palate, and alveolar mucosa.
Results: The cancer and cancer therapy are associated with morbidities that may negatively affect the quality of life. The choices of treatment will vary from surgery and enucleating the lesion along with chemotherapy, radiation therapy to gene and immunotherapy. This treatment protocols depend on the site and size of the lesion, lymph node status, the presence of local bone involvement, the ability to achieve adequate surgical margins. Treatment decisions are also impacted by appraisal of the ability to preserve oropharyngeal function, including speech, swallowing, spread, and esthetics. By the way, the most effective method to prevent and diagnose oral cancer is routine clinical examinations. By including a simple oral cancer screening during routine dental visits, particularly those at high risks, the dentist and other public health nurses can exactly diagnose any precancerous and malign lesions at early stages. This would increase long-term survival of patients, particularly those at higher risks and give the clinician better chance to manage and cure the malignancy.
Conclusion: With an annual rate of 400,000 new patients afflicted with oral cancer and 130,000 deaths, oral cancer is one the most significant causes of death, especially in developing countries. Despite the screening simplicity of oral cancer, less than half of the cases are detected in an early stage. On one hand, the main reason for delay in detection is that the disease is asymptomatic and without pain in the early stages. On the other hand, adults’ level of awareness concerning the risk factors and symptoms of oral cancer is low. More than this, the economic burden of oral cancer is high worldwide and approximately $64,245,173 in Iran. So, not only planning an early detection and screening program for oral cancer may improve the patient's quality of life, it could potentially decrease the health care costs, morbidity, and mortality as well.