Evaluation of mouth self-examination in the control of oral cancer.

This study was planned to evaluate the feasibility of mouth self-examination (MSE). Some 450 college students distributed to 9000 households a brochure describing the risk factors of oral cancer, the appearance of premalignant and malignant lesions of the oral cavity and the methods of MSE with pictures. All subjects with tobacco habits and/or aged 30 years or over were asked to read the brochure carefully and to report to the clinic conducted in their locality on fixed days, if they suspected an abnormality while practising MSE. Out of the approximately 22,000 eligible subjects, 8028 (36%) practised MSE. Among the 247 subjects reporting to the clinics seven (3%) had oral cancer and 85 (34%) had oral precancerous lesions; the others had either benign lesions or normal anatomical variations. Six of the seven subjects with oral cancer had stage I disease, five of whom accepted treatment and were alive disease-free 5 years later. The detection rates of oral cancer compared favourably with the previously reported detection rates using trained health workers. Although this study demonstrated that MSE is feasible, larger studies are required to evaluate whether health education could result in a sustained practice of MSE resulting in reduction in incidence of and mortality from oral cancer.     

Evaluation of an Interventional Health Education Project: Screening of Breast Cancer and Health Education (SHE)

There is an increasing incidence of breast cancer in India, especially among younger women. The study’s main objective was to create awareness related to breast cancer and breast self-examination by community health workers and assess the effectiveness of improving knowledge and practice. Secondary objective was to conduct clinical breast examination (CBE) of women and prompt referral. Methods: An outcome evaluation of the Educational Interventional project was conducted in a hilly district of Uttarakhand. Twenty Accredited Social Health Activists (ASHA) were identified and trained in breast cancer awareness, the procedure of breast self-examination, and screening methods. These ASHA’s further created awareness among study participants (women above 30 years). A structured questionnaire on knowledge and practice was administered before and after educational intervention by ASHA workers. Clinical Breast Examination (CBE) camps were held for women at high risk for breast cancer who were referred to the Division of Breast Surgery, AIIMS Rishikesh, for further management. Result: One thousand sixty-one females participated in health education sessions by ASHAs. There was an improvement in knowledge and practice regarding Breast Self-examination after health education intervention. A low prevalence of risk factors for breast cancer was found among attendees of the CBE camp. 3.2% of participants had abnormalities on breast examination needing further workup. Conclusion: In the pre-test assessment, we found a low awareness and practice regarding breast cancer which increased significantly among women after behavioral change intervention. The prevalence of risk factors for breast cancer was very low. Trained community health workers were found to be effective in raising awareness, selective screening, and prompt referral.     

Factors Affecting Oral Cancer Awareness in a High-risk Population in India

Objectives: To evaluate the awareness of oral cancer, its risk factors and to estimate the prevalence of riskfactors in a high-risk semi-urban population in India. Methods: A questionnaire-based survey was carried outby house-to-house interview on a single day by 120 health volunteers. The data were analyzed using SPSS 11.0software for links between prevalence of risk factors and oral cancer awareness, as well as other confoundingvariables. Results: A total of 1885 persons participated in the survey. Of the surveyed population, 86% hadheard about oral cancer and 32% knew someone with oral cancer. Sixty-two percent of the subjects correctlyidentified the causes; this included 77% of the subjects who identifying smoking, 64% alcohol and 79% panchewing as a cause of oral cancer. More than 42% believed that poor oral health could lead to oral cancer and53% thought that oral cancer is an incurable disease. Forty percent of males and 14% females had one or morehigh-risk habits. It was observed that the awareness was proportional to the education level (p<0.001) andinversely proportional to the prevalence of risk factor habits (p<0.001) . Eighty-two percent of the smokers,75% of the tobacco chewers and 66% of those who consumed alcohol were aware that their habits could lead tooral cancer. Conclusions: Overall, the awareness of oral cancer in this high-risk population was satisfactory,though certain gaps exist, pointing to a need for targeted health education and risk factor cessation counseling.     

Evaluation of factors associated with skin self-examination.

Early detection and excision of thin lesions may be important in reducing mortality from melanoma. Periodic skin self-examination may be beneficial in identifying thin lesions. The purpose of this study was to evaluate factors associated with skin self-examination. The study population was comprised of 549 Caucasian residents of Connecticut 18 years of age or older who were selected as controls as part of a population-based case-control study on skin self-examination and melanoma conducted during 1987-1989. Personal interviews were conducted to obtain information on skin self-examination, demographics, history of cancer, phenotypic characteristics, sun exposure habits, and screening and health behaviors. Nevus counts were performed by trained nurse interviewers. Logistic regression was used to model the relationship between the variables of interest and skin self-examination. Female gender was identified a priori as a predictor of skin self-examination, and thus all analyses were stratified by gender. Age, education, and marital status were also identified a priori as important predictor variables and were selected for inclusion in the final models. Skin awareness was a strong factor associated with skin self-examination for both females and males. For females, previous benign biopsy or the presence of an abnormal mole was identified as important for future skin self-examination using our criteria. A family history of cancer, physician examination, and change in diet to reduce cancer risk increased the likelihood of skin self-examination in males but not females. In women, light hair color may increase the likelihood of performing skin self-examination. Older age and college or postgraduate education was associated with a decreased likelihood of performing skin self-examination in both males and females. Identifying factors associated with skin self-examination will enable health care providers to target individuals who may not be performing skin self-examination but who are at increased risk for developing melanoma.     

Detection of oral cancer using basic health workers in an area of high oral cancer incidence in India

In the rural health care delivery system in India, basic health workers (BHW) go house-to-house to help in the preventive and therapeutic measures of certain diseases. Some 53 BHW were trained by the dentists of the research team for examining the oral cavity of high-risk individuals and categorizing them into normals or those with referable or nonreferable lesions. Referable lesions comprised nodular leukoplakia, submucous fibrosis, and ulcers and growths suggestive of oral cancer. In a 1-year period, 39,331 high-risk individuals were examined by BHW and 523 (1.3%) were referred for further diagnosis. Some 72% arrived at the referral center and 20 oral cancers were confirmed among these individuals. Reexamination in the field by the dentists was conducted for 5% of the sample to obtain sensitivity and specificity estimates of BHW diagnosis. The findings indicate that incorporation of an oral cancer detection program in the existing health care infrastructure is feasible and beneficial.     

Oral Cancer Knowledge,Attitudes, and Practices among Newly Graduated Dentists in Kuwait

Background: Oral cancer awareness among newly graduated dentists could have a substantial impact in the prevention and early detection of oral cancer. Objective: This survey was undertaken to assess the knowledge, opinion, attitudes, and practices on oral cancer among newly graduated dentists in Kuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the newly graduated dentists. Of the 310 dentists who participated, 171 (55.2%) were males and 139 (44.8%) were females. The questionnaire included 23- questions on oral cancer knowledge, opinion, attitudes, and practices. Results: The mean age of the dentists was 25.8 ± 2.4 years and their mean years of experience 1.5 ± 1.7 years. Overall, a great majority of dentists (95.8%) recognized tobacco use and alcohol consumption as very important risk factors for oral cancer occurrence. Almost all of participants were aware of the most common form of oral cancer (94.2%). Most of the dentists correctly identified the most common site of oral cancer (93.5%). Majority of the participants recognized the most commonly associated lesions with oral cancer (91.6%). While 37.4% of the dentists agreed that they were adequately trained in oral cancer screening, most (89.7%) believed that patients should have mandatory oral cancer screening at the clinics. Also, majority (95.8%) expressed their willingness to attend continuing education and training courses in cancer screening and prevention. Most of the dentists (81.9%) referred a patient with a suspicious lesion to a specialist. Conclusions: Majority of the dentists were aware and knowledgeable about various aspects of oral cancer. There is a need to emphasize and reinforce the training programs in oral cancer education mainly in prevention and early detection. Continuing education programs and workshops are highly recommended to raise awareness of the dentists on risk factors and diagnosis of oral cancer.     

Betel quid and oral cancer: prospects for prevention.

Betel-quid chewing is an ancient and socially accepted practice. The introduction of tobacco reinforced this practice, and now almost all habitual chewers of betel quids include tobacco. It is well established that chewing of betel quid with tobacco causes oral cancer and is largely responsible for the high incidence of oral cancer in several South Asian countries. The feasibility of primary prevention of oral cancer was studied in a population-based prospective intervention study. A cohort of 12,212 betel-quid chewers and smokers was exposed to a programme of health education for stopping chewing and smoking and subjected to annual examinations for detection of oral precancerous lesions. Evaluations after one, five and eight years showed that primary prevention of oral cancer is feasible and practicable. Early detection of oral cancer is an important control measure. In a secondary prevention study, 53 basic health workers were trained in the detection and referral of lesions suspected of being oral cancer. Over one year, they examined more than 39,000 high-risk individuals, resulting in the detection of 20 cases of oral cancer. The sensitivity and specificity of their diagnoses was assessed through a re-examination of a 5% sample: we concluded that it was possible to incorporate a secondary prevention programme into the existing health care system.     

Knowledge, attitude about breast cancer and practice of breast cancer screening among female health care professionals: a study from Turkey

The awareness of health professionals about breast cancer prevention is of vital importance, since their beliefs and behaviors may have a major impact on other women. The aim of this study was to investigate the knowledge, and attitudes regarding risk factors for breast cancer as well as screening such as breast self-examination, clinical breast examination and mammography among different groups of female health professionals. In this cross- sectional study, 444 female health professionals in various health centers located in Corum Province, Turkey, were interviewed using a self-administered questionnaire. The mean age was 33.1 ± 6.1 and most were married (81.3%). The rate of feeling under risk regarding breast cancer among female health personnel was 31.3%. The majority (98.4 %) perceived breast self-examination as a beneficial method for the early detection of breast cancer. Although 81.3 % of the participants stated that they did breast self examination, only 27.3 % reported doing so on a regular basis (performed monthly or once per menstrual cycle). The most common reason for not doing breast self-examination was the belief that it was not necessary (45.8 %). Of the entire group, the rate of having a mammography was 10.1% and the rate of clinical breast examination was 24.8%. Health professionals are a direct source of medical information to the public. The use of breast self-examination and mammography was found lower than expected when considering the fact that participants were health care professionals.     

Reproducibility and validity of oral visual inspection by trained health workers in the detection of oral precancer and cancer.

A randomized intervention trial is in progress in Kerala, India, to evaluate the effectiveness of oral visual inspection by trained health workers (HWs) in the prevention of oral cancer. Fourteen health workers with college graduation as the basic qualification were trained in oral visual inspection to identify oral cancers and precancers among the participants of the screening trial and to refer them for further confirmation and management. The aim of the present study was to evaluate the reproducibility and validity of the screening test provided by the health worker against the reference oral visual findings of three physicians. A total of 2069 subjects who had already been examined were re-examined by the health workers and physicians. The sensitivity and the specificity of the oral visual inspection were 94.3% and 99.3% respectively. There was moderate agreement between the findings of the initial and the repeat mouth examinations carried out by the health workers, which were on average 6 months apart. There was almost perfect agreement (kappa = 0.85) between the findings of the health workers and the physicians in identifying the different types of oral precancerous lesions. The findings of our study indicate that it is possible to train resource persons to perform the oral cancer screening test as accurately as doctors, although experience appears to be a crucial component of health workers'' accuracy. The efficacy of such an approach to reduce the incidence of and mortality from oral cancer, however, remains to be proven.     

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants’ perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.     

An integrated approach to worksite tobacco use prevention and oral cancer screening among factory workers in Mumbai, India

Background: Tobacco control and cessation interventions are among the most cost effective medical interventions but health systems in low resource countries lack the infrastructure to promote prevention and cessation among tobacco users. Workplace settings have the potential to provide opportunities and access for tobacco prevention interventions. Methods: This is a single group study evaluating tobacco use prevention and cessation through a structured three stage intervention program for tobacco users comprising education on harmful effects of tobacco, oral cancer screening and behavior therapy for tobacco cessation at the worksite. Results: All the 739 workers who were invited participated in tobacco awareness program and were screened for oral pre cancer lesions. 291 (39.4%) workers were found to be users of tobacco in some form. Education, gender and alcohol use (p<0.0001) were some of the factors associated with tobacco user status. The prevalence of clinical oral precancer lesions among tobacco users was 21.6%. Alcohol consumption (p<0.001), the type of tobacco consumed (p<0.018), personal medical history of chronic diseases (p<0.007) and combined use of alcohol and tobacco (p<0.001) were some factors found to be associated with presence of oral pre cancer lesions. Conclusion: An integrated approach for worksite based tobacco use prevention with oral cancer screening program showed good acceptance and participation and was effective in addressing the problem of tobacco consumption among the factory workers.     

Oral Cancer Knowledge,Attitudes and Practices among Primary Oral Health Care Dentists in Kuwait

Background: Oral cancer signifies a public health concern of international importance. Early detection of oral cancercan improve the prognosis and the 5-year survival rate. Objective: The aim of this study was to assess the level of oralcancer knowledge, opinion, attitudes and practices among dentists working at the primary oral health care centers inKuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the dentists working atthe primary oral health care centers in Kuwait. A total of 289 dentists participated in the present study. The questionnaireincluded 23- questions on oral cancer knowledge, opinion, attitudes and practices. Results: The mean age of the dentistswas 35.2 ± 10.9 years. Approximately, all dentists (99.7%) were aware of the major risk factors that were most likelyassociated with oral cancer. Overall, majority of the participants knew the most common form of oral cancer (80.6%),most common site (80.3%) and the likely lesions associated with oral cancer occurrence (87.9%). A large number ofdental practitioners (81%) would routinely refer a patient with a suspicious lesion to a specialist. Nearly one-third (32%)reviewed their patients’ oral cancer risk factors. Approximately two-thirds (62%) assessed the use of tobacco in theirpractice. Almost, all (92.4%) were interested in attending continuing education courses on oral cancer. Conclusions:Majority of the participants presented good knowledge about various aspects of oral cancer. More continuing educationprograms on risk factors and diagnosis of oral cancer should be organized to train the dentists. Oral cancer screeningshould be a routine procedure for the high risk patients at the primary oral health care centers in Kuwait.     

Breast Cancer Knowledge and Related Behaviors among Women in Abha City, Southwestern Saudi Arabia

Breast cancer is the most common malignancy among women in Saudi Arabia. A cross-sectional study was conducted on 1,092 women attending urban primary health care centers in Abha City southwestern Saudi Arabia about breast cancer knowledge, attitudes, and related practices. Only 22.0 % heard about mammography, and 41.5 % heard about breast self-examination (BSE). More than half of the women in the study identified changes occurring in case of breast cancer and identified risk factors. Only 8.3 % were examined by clinical breast examination (CBE), 6.2 % were examined by mammography, and 29.7 % performed BSE. The study points to the insufficient knowledge of women and the low practice of BSE, CBE, and mammography. Public awareness should be enhanced by all available means including mass media, schools, social gatherings, and waiting areas in primary health care centers. There is an urgent need for continuing medical education programs for health care workers in the region concerning breast cancer.     

Oral Cancer Awareness and its Determinants among a SelectedMalaysian Population

Objective: To assess oral cancer awareness, its associated factors and related sources of information among aselected group of Malaysians. Methods: A cross-sectional survey was conducted on all Malaysian ethnic groupsaged ≥15 years old at eight strategically chosen shopping malls within a two week time period. Data wereanalysed using chi-square tests and multiple logistic regression. Significance level was set at α Results:Most (84.2%) respondents had heard of oral cancer. Smoking was the most (92.4%) recognized high risk habit.Similar levels of awareness were seen for unhealed ulcers (57.3%) and red/white patches (58.0%) as signs of oralcancer. Age, gender, ethnicity, marital status, education, occupation and income were significantly associatedwith oral cancer awareness (p<0.05). Conclusions: There was a general lack of awareness regarding the riskhabits, early signs and symptoms, and the benefits of detecting this disease at an early stage. Mass media andhealth campaigns were the main sources of information about oral cancer. In our Malaysian population, genderand age were significantly associated with the awareness of early signs and symptoms and prevention of oralcancer, respectively.     

Comparison of Different Screening Methods in Estimating thePrevalence of Precancer and Cancer Amongst Male Inmatesof a Jail in Maharashtra,India

Aim: To compare the effectiveness of self-examination, clinical examination and screening methods using 1%toluidine blue and Lugol’s iodine in estimating the prevalence of lesions at risk of malignancy and oral malignantdisease amongst the male inmates of Yerwada Central Jail, Pune. Material and Methods: Study was carried outon male inmates in two phases. In the first phase self-examination and clinical examination was carried out on2,257 male inmates. 164 suspicious cases were subjected to phase II of the study out of whom, 82 participantswere screened with 1% toluidine blue and 2% Lugol’s iodine followed by biopsy procedure. Results: Sensitivityand specificity for self-examination with clinical examination was 92.2% and 96.6% respectively. Sensitivity,specificity, positive (PPV) and negative predictive values (NPV) and positive (+LR) and negative likelihood ratio(-LR) for Toluidine Blue were 88.1%, 66.6% 97.1%, 30%, 2.63 and 0.17 respectively while for Lugol’s Iodinethey were 94.7%, 83.8%, 98.6%, 55.5%, 5.67 and 0.06 respectively. Conclusions: Prevalence of lesions at riskof malignancy and oral malignant disease by self-examination was 7.8% and by clinical examination was 6.3%.Self-examination is an effective tool in early detection of oral cancer. Use of Lugol’s iodine as a screening toolfor oral lesions is highly effective in inmate populations.     

Knowledge and attitude towards risk factors in oral cancer held by dental hygienists in the Autonomous Community of Murcia (Spain): a pilot study

The objective was to study the knowledge and attitude on risk factors in oral cancer held by dental hygienists working in private dental practices in the Autonomous Community of Murcia, Spain. An anonymous phone survey was made after obtaining consent from the interviewee. A simple randomized study was carried out and 240 dental hygienists were selected. The questionnaire was divided into three different parts: (1) professional data and years of practice; (2) knowledge of the risk factors in oral cancer and (3) education and training needs on oral cancer. The response rate was 58.3%. Regarding knowledge of the risk factors in oral cancer, 100% correctly identified tobacco and 90% alcohol, while only 50.7% identified sun exposure with labial cancer. Only 51.4% of the dental hygienists routinely gave advice to their patients on prevention of oral cancer. Furthermore, 57.1% did not consider themselves sufficiently well trained to discover suspected oral cancer lesions, and 84.3% recognized that their academic training on the early diagnosis and prevention of oral cancer was insufficient for their professional activity. To reduce morbidity and mortality of oral cancer it is necessary to implement training programs on oral cancer for dental hygienists, so they may acquire the necessary skills for its detection and prevention.     

Oral Potentially Malignant Disorders among Dental Patients: a Pilot Study in Jordan

Background: To determine the prevalence, types, and risk factors of oral potentially malignant disorders(OPMDs) among a group of Arab Jordanian dental patients, and to evaluate their awareness and attitudes towardearly diagnosis and treatment. Materials and Methods: A total of 1,041 patients attending a University Hospitalfor dental care were examined for the presence of OPMDs. Histopathological examination was performed onall cases clinically diagnosed and patients were directly interviewed to evaluate their knowledge and attitudestoward early detection and treatment of oral cancer. Results: The prevalence of OPMDs overall was 2.8%.Lichen planus/lichenoid lesions were the most common lesions (1.8%) followed by leukoplakias (0.48%), chronichyperplastic candidiosis (0.38%), and erythroplakia (0.096%). Smoking, alcohol, and age (>40 years) werethe main identifiable risk factors. Patients with OPMDs displayed a general lack of awareness and negativeattitudes towards early diagnosis and treatment. Conclusions: OPMDs among Arab dental patients are relativelyuncommon and awareness about oral cancer among Jordanian dental patients is low. Interventions to improvepublic knowledge about oral cancer and attitudes toward early diagnosis and treatment are urgently indicated.     

Oral Cancer Awareness of the General Public in Gorakhpur City,India

Objectives: Global cancer statistical data show that India has one of the highest incidence rates of oralcancer worldwide. Early detection is extremely important as it results in lower morbidity and death rates.The present study was undertaken to assess awareness of oral cancer and knowledge of its early signs and riskfactors in the general public of the semi-urban Gorakhpur area of Uttar Pradesh (India). It was also intendedto educate the same population for early detection by increasing their ability to recognize signs and risk factors.Method: A questionnaire-based household survey was conducted over a period of one month in different parts ofGorakhpur district, a region where tobacco use is apparently very high. A total of 2,093 persons participated inthe survey. The collected data were analyzed using SPSS software to assess and associate oral cancer awarenesswith the prevalence, and abstract risk factors, as well as other confounding variables. Results: The generalawareness, knowledge of signs and risk factors of oral cancer were found to be proportionate to the literacylevel with the highest rate of awareness being among high school and graduates and lowest among illiterates. Itwas also observed that on most of these dimensions the younger age groups (<30 years) were significantly moreknowledgeable. Conclusion: Overall, the awareness of oral cancer in the high-risk population of Gorakhpur wasnot satisfactory, pointing to a need for further dissemination of information on this issue and its associated risks.This is especially important for the youngsters, as this may possibly help them keep away from the deleterioushabit of tobacco indulgence in any form. If necessary risk factor cessation counselling should be provided.     

Factors Associated with Breast Cancer Awareness in Thai Women

Background: Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidenceand mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scalecommunity screening program in these resource-limited countries. Breast cancer awareness is an important tool whichmay, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality.Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, andprovide insights into developing effective health promotion interventions. Objective: To investigate factors associatedwith breast cancer awareness in Thai women. Methods: A cross-sectional sample of Thai women aged 20-64 yearswas collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). Aquestionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administeredand Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness.Results: In total, 660 Thai women participated in this study. Factors most often associated with the various breastcancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs andsymptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors.Conclusion: Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs andsymptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due tothese women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least inThai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge maybe more successful in engaging women with breast cancer screening services and increasing breast self-examination.