A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Promoting oral cancer awareness and early detection using a mass media approach

Background and Aim: Less than 50% of oral cancer cases are diagnosed at early stages of the disease andthis is in part due to poor awareness and lack of knowledge on the signs and symptoms of oral cancer. This studysought to measure the baseline awareness of oral cancer in Malaysia and aimed to increase public awarenessand knowledge of oral cancer using a mass media campaign. Methods: Baseline awareness and impact of thecampaign was measured using self-administered questionnaires sent via email to individuals. The campaign wasaired on two national television channels and the reach was monitored through an independent programmemonitoring system. Results: 78.2% of respondents had heard of oral cancer, and this increased significantly afterthe campaign. However, the ability to recognize signs and symptoms remains unchanged. We found that the levelof awareness differed between the distinct ethnic subgroups and the reach of the campaign was not uniformacross all ethnicities. Conclusion: This substantial study to measure the oral cancer awareness in Malaysiaprovides important baseline data for the planning of public health policies. Despite encouraging evidence thata mass media campaign could increase the awareness of oral cancer, further research is required to addressthe acceptability, comprehensiveness and effectiveness. Furthermore, different campaign approaches may berequired for specific ethnic groups in a multi-ethnic country such as Malaysia.     

Effectiveness of a community-based oral cancer awareness campaign (United States)

OBJECTIVE: The purpose of this study was to provide the first systematic evaluation in the United States of a community-based oral cancer awareness campaign. METHODS: We used a non-equivalent control group design and random-digit-dialing methods to examine billboard effectiveness and pre- and post-billboard impact between intervention and control counties in adult probability samples in Florida, USA. RESULTS: Respondents in the intervention county were more likely than controls to correctly identify the billboard message to get tested for oral cancer, and less likely than controls to report ever having an oral cancer examination, or to have heard of oral cancer. Results of pre-post analyses within each county showed that oral cancer examinations were significantly more frequent in both counties after the campaign. There were no significant differences between counties on the proportion of individuals who reported having seen the campaign or on any other item measuring billboard awareness or impact. CONCLUSIONS: Results suggest the Florida billboard campaign had limited success in increasing public awareness. Future cancer awareness campaigns should incorporate theoretical models, target high-risk groups and the broader community and provide culturally relevant messages as part of a multi-media campaign.     

Awareness and knowledge of oral cancer among university students in Malaysia

Objectives: This study aimed to assess the level of knowledge of oral cancer and its associated factorsamong university students in Malaysia. Methods: A cross sectional study was conducted among 200 universitystudents in Malaysia. A self administered questionnaire was used to collect data. It included questions on sociodemographicdata, awareness and knowledge of oral cancer. Results: Mean age of the respondents was 21.5±2.5and the age ranged from 18 to 27 years. The majority of the respondents were aware of oral cancer (92.0%)and recognized the followings as signs and symptoms of oral cancer: ulcer and oral bleeding (71.0%), followedby swelling (61.5%). A satisfactory knowledge was observed on the following risk factors; smoking (95.5%),poor oral hygiene (90.5%), family history (90.0%), alcohol (84.5%) and poor fitting dentures (83.0%). However,unsatisfactory knowledge was observed about hot/spicy food (46.5%), obesity (36.0%), old age (31.5%), dietaryfactor (29.0%) and smokeless tobacco (25.5%). Knowledge of oral cancer was associated significantly with age(p<0.01), year of study (p<0.01) and course of study (p<0.01). Conclusion: Instead of satisfactory awarenessand knowledge of oral cancer and its clinical presentations, inadequate knowledge was observed about its riskfactors. There is a need to introduce oral cancer education among university students.     

Public awareness that HPV is a risk factor for cervical cancer

We assessed awareness of human papillomavirus (HPV) in a population sample of British women (n=1620) using similar questions to those in a survey in 2002. Only 2.5% cited HPV as the cause of cervical cancer without prompting; up from 0.9% in 2002. Public education about HPV is urgently needed.     

Turkish dentists' knowledge of head and neck cancer therapy-related complications: implications for the future

The objective was to determine the level of knowledge about the orodental complications and their prevention/management in head and neck cancer therapy. Materials and methods: A 15-item questionnaire which was obtained from National Institute of Dental and Craniofacial Research that contained information about the orodental complications of the cancer therapy and the dentists' role to provide their treatment protocols. The pollsters visited 380 respondents, and the replies were analysed with stratified and logistic data analyses. Overall correct replies ranged from 14.71% to 99.5%. The participants knew the basic knowledge of the complications of cancer therapy; however, they failed to answer to the questions about the required clinical practices. The gender (P = 0.967), age (P = 0.977) and the duration of practice (P = 0.99) were not significant factors in providing correct replies. The rate of correct replies were not different among the test groups (P = 0.953). As a conclusion, rectification of dental curricula, organization of postgraduation courses, foundation of national councils for stimulation of the healthcare providers to incorporate knowledge into practice, to monitor the continuity of those programmes, and to award the dental practitioners who keep up the recent literature and optimal clinical practice are vital to improve the life quality of cancer patients.     

The beliefs and knowledge of patients newly diagnosed with cancer in a UK ethnically diverse population

Aims

To compare knowledge about the outcome of cancer treatment and beliefs about the causes of cancer among British South Asian (BSA) cancer patients of predominantly Gujarati origin with the beliefs held by British White (BW) cancer patients. We also wanted to determine if these beliefs impacted upon the patients’ mental health.

Materials and methods

We administered a questionnaire about cancer beliefs to 94 BSA and 185 BW newly diagnosed cancer patients at the Leicestershire Cancer Centre. Using a Likert seven-item scale, we analysed patients’ views on confidentiality, outcome and cancer treatment and 15 items about beliefs about the causes of cancer. Patients also completed the Hospital Anxiety and Depression Scale, Patient Health Questionnaire, Mini-MAC, Distress Thermometer and newly developed Cancer Insight and Denial, and Physician/Patient Trust questionnaires.

Results

Most (232/279; 83.2%) believed cancer was curable. However, significantly more BSA (10.6% versus 2.7% BW P = 0.001) believed cancer was incurable. Although most (86.4%) agreed that smoking can cause cancer, there was a widespread lack of knowledge of the importance of diet and obesity as contributing causes of cancer. There was, in general, an over-emphasis on pollution, stress and injury as important aetiological agents. There was a strong belief in supernatural involvement in the development of cancer among a minority of BSA patients. Twenty per cent of this sample believed that treatment, especially surgery, caused the cancer to spread and this was associated with significant depression in BSAs (P = 0.019) and anxiety in both BW (P = 0.006) and BSA (P = 0.0134) patients.

Conclusion

Our results show that there is a continual need for education about the causes of cancer both in BW and BSA patients.     

Patient delay in oral cancer: a qualitative study of patients' experiences

Up to 30% of patients delay seeking the advice of a healthcare professional after self-discovery of symptom(s) of oral cancer. Reasons for this patient delay are poorly understood. The aim of the present study was to explore patients' initial experiences and reactions to developing symptoms of oral cancer, and to identify factors influencing their decision to consult a health care professional. In-depth semi-structured interviews were conducted with 17 consecutive patients who had received a diagnosis of oral squamous cell carcinoma, but had yet to start treatment. Participants were asked about their beliefs about their symptoms over the course of the disease and their decision to seek help. The tape-recorded interviews were transcribed verbatim and analysed using 'Framework analysis'. Oral symptoms were rarely attributed to cancer and were frequently interpreted as minor oral conditions. As a result of these beliefs, patients tended to postpone seeking help or fail to be concerned over their symptoms. Prior to seeking help, patients responded to symptoms by using self-medication, changing the way they ate and disclosing their discovery of symptoms to friends or family. Problems with access to healthcare professionals and patients' social responsibilities acted as barriers to prompt help-seeking. This study has documented that an individual's interpretation of oral cancer symptoms may be misguided and this can adversely affect subsequent help-seeking behaviour.     

Betel quid not containing tobacco and oral leukoplakia: a report on a cross-sectional study in Papua New Guinea and a meta-analysis of current evidence

Leukoplakia is an asymptomatic, potentially malignant change in the oral mucosa. Previous studies have reported that smoking and betel quid chewing are associated with increased risk of leukoplakia; few studies have reported on these associations in populations where betel quid does not contain tobacco. We conducted a case-control study nested in a cross-sectional study in Papua New Guinea and a systematic review of studies that included chewers of betel quid without tobacco. Our study recruited 1,670 adults. We recorded betel quid chewing and smoking. The prevalence of leukoplakia was 11.7%. In the nested case-control study of 197 cases and 1,282 controls, current betel chewing was associated with increased risk of leukoplakia with an adjusted odds ratio for current chewers of 3.8 (95% CI 1.7, 8.4) and in the heaviest chewers of 4.1 (95% CI 1.8, 9.1) compared to non-chewers. Current smoking was associated with an increased risk of leukoplakia with an adjusted odds ratio for current smokers of 6.4 (95% CI 4.1, 9.9) and amongst heaviest smokers of 9.8 (95% CI 5.9, 16.4) compared to non-smokers. The systematic review identified 5 studies examining risk of leukoplakia associated with betel quid chewing in populations where betel quid did not contain tobacco and that controlled for smoking. In studies that adjusted for smoking, the combined random effect odds ratio was 7.9 (95% CI 4.3, 14.6) in betel quid chewers. The results of this study and systematic review of similar studies provide evidence of the role of betel quid not containing tobacco and leukoplakia.     

Bidi smoking and oral cancer: a meta-analysis

Several epidemiological studies suggest that bidi smoking increases the risk of oral cancer. No systematic review, however, has been reported to examine how consistent the evidence is across the studies. We undertook a meta-analysis of epidemiological studies investigating the relationship between bidi smoking and oral cancer. Primary studies were identified through a computerized literature search of Medline. Articles abstracted were all epidemiological studies published as original articles in English during 1966-2002 that included quantitative information on bidi smoking and oral cancer. Summary odds ratios (OR) were calculated based on random effects model. A total of 12 case-control studies used for this meta-analysis provided the summary estimates of OR of bidi smoking for oral cancer compared to that of non-smokers. An increased risk of oral cancer was found for bidi smokers compared to never smokers (OR = 3.1, 95% confidence interval [CI] 2.0-5.0) whereas no significant pattern of risk was found for cigarette smokers (OR = 1.1, 95% CI = 0.7-1.8). There was substantial heterogeneity in the pooled OR estimate. Our results clearly indicate that bidi smokers are at increased risk of oral cancer. It is important that this information be incorporated into smoking prevention and cessation efforts, particularly among the urban poor and rural mass in South Asian countries where bidi smoking is widely prevalent.     

Dentition,oral hygiene,and risk of oral cancer: a case-control study in Beijing,People's Republic of China

A case-control study of oral cancer was conducted in Beijing, People's Republic of China. The study was hospitalbased and controls were hospital in-patients matched to the cases by age and gender. A total of 404 case/control pairs were interviewed. This paper provides data regarding oral conditions as risk factors for oral cancer, with every patient having an intact mouth examined (pre-operation among cases) using a standard examination completed by trained oral physicians. After adjustment for tobacco smoking and alcohol consumption, poor dentition—as reflected by missing teeth—emerged as a strong risk factor for oral cancer: the odds ratio (OR) for those who had lost 15 – 32 teeth compared to those who had lost none was 5.3 for men and 7.3 for women and the trend was significant (P <0.01) in both genders. Those who reported that they did not brush their teeth also had an elevated risk (OR =6.9 for men, 2.5 for women). Compared to those who had no oral mucosal lesions on examination (OR=1.0), persons with leukoplakia and lichen planus also showed an elevated risk of oral cancer among men and women. Denture wearing per se did not increase oral cancer risk (OR=1.0 for men, 1.3 for women) although wearing metal dentures augmented risk (OR=5.5 for men). These findings indicate that oral hygiene and several oral conditions are risk factors for oral cancer, independently of the known risks associated with smoking and drinking.From the Department of Epidemiology, National Institute of Environmental Health and Engineering, Chinese Academy of Preventive Medicine, Beijing, China (ZT; HH; NS); Unit of Analytical Epidemiology, International Agency for Research on Cancer, Lyon, France (PB; ZT); Beijing Union Hospital (DJ); Cancer Institute, Chinese Academy of Medical Science (JP); Beijing Medical University Stomatological Hospital (MD); Beijing Municipal Stomatological Hospital (SL); University Department of Oral Medicine and Oral Surgery, Bristol Dental Hospital and School, UK (CS); Department of Epidemiology, Harvard School of Public Health (BM; ZT). Address correspondence to Dr Zheng at the Cancer Prevention Research Unit, Yale University, School of Medicine, 26 High Street, New Haven, CT 06510, USA. Dr Zheng was partly supported by a grant from the DuPont Company.     

Breast cancer and specific types of oral contraceptives: a large Norwegian cohort study

The aim of our study was to examine the risk of breast cancer according to specific types of estrogens and progestagens in oral contraceptives (OCs) based on the prospective Norwegian Women and Cancer study (NOWAC). Between 1991-97 women aged 30-70 years were drawn at random from the central person register and mailed an invitation and a questionnaire. Women (102,443) were enrolled with follow-up information collected throughout 1999 by linkage with national registries of cancer, mortality and emigration based on the unique national identification number. Among the 96,362 women included in the present analysis 851 invasive breast cancer were diagnosed. The adjusted risk of breast cancer increased with 25% for ever use of OCs and the risk increased with increasing duration of use (test for trend: p = 0.007). No association between time since last use and breast cancer risk was found after stratification on duration of use. Positive trend was still found for total duration of use among women who used OCs more than 5 years ago. Second generation of OCs had an increased risk with increasing duration of use. Classifying progestagens according to chemical groups, the relative risk increased significantly with increasing cumulative dose of levonorgestrel progestagen. It was difficult to conclude for the other groups due to lack of power. In a multivariate analysis the cumulative dose for all progestagen groups were non-significant, although we observed a significant increased risk with increasing milligram-months of estrogen exposure (p = 0.002). In conclusion, the increased risk of breast cancer related with OC formulations could be due mostly to estrogen component.     

Public Awareness and Knowledge of Oral Cancer in Yemen

Background: Oral cancer is in increasing in incidence in Yemen and indeed worldwide. Knowledge regardingrisk factors and early signs in the general population can help in prevention and early detection of the disease.Purpose: The aim of this study was to assess the level of awareness and knowledge of oral cancer in the generalpopulation in Yemen. Materials and Methods: A cross-sectional survey using a self-administered questionnairewas conducted on Yemeni adults aged ≥15 years old. A total of 543 persons participated, the collected databeing analyzed using SPSS software. The significance level was set at p<0.05. Results: Two thirds (71.5%) of theparticipants had heard about oral cancer. Smoking and smokeless tobacco usage were identified as the major riskfactors by 71.5% and 73.7% of the participants, respectively. Only 24.1% and 21.4%, respectively, were able tocorrectly identify red and white lesions as early signs of oral cancer. Knowledge of oral cancer was significantlyassociated with age (p<0.01), gender (p<0.05) and education level (p<0.001). Conclusions: The findings suggestthat the knowledge regarding oral cancer in this population is low. Therefore, educational programs are highlyneeded to improve such knowledge.