Tackle social inequalities in mouth cancer battle

Mouth cancer has been slammed as a ‘horrible, insidious disease’ at the start of a month-long drive to raise awareness of its risk to the nation.
Speaking at the launch of Mouth Cancer Action Month at Westminster this week, Professor David Conway, clinical senior lecturer in dental public health at the University of Glasgow’s dental school, was also calling for a political sea change to help the disadvantaged upon whom mouth cancer impacts the greatest.
He drew heavily on his recent research – the award-winning research, Socioeconomic Risk Factors Associated with Upper Aerodigestive Tract Cancer, the largest study of its kind – to flag up the socio-economic influences upon those most likely to be affected disease.
Addressing a roomful of oral health experts and campaigners yesterday (Monday), Professor Conway talked of the health inequalities that existed, suggesting that while mouth cancer ‘hides under the radar of public attention’, there was enough evidence to suggest that differences between the most deprived and least deprived in society has an affect upon who is most likely to fall victim.
Statistics show that one person dies every five hours in the UK from mouth cancer, making it the UK’s fastest growing cancer.

Mouth cancer is twice more common in men than in women, though an increasing number of women are being diagnosed with the disease – and people who smoke and drink to excess are up to 30 times more likely to develop mouth cancer.

Poor diet is linked to a third of all cancer cases, and experts suggest HPV could overtake tobacco and alcohol as the main risk factor within the coming decade.

Citing the low level evidence of diet and the high level evidence of smoking and alcohol, Professor Conway said: ‘Education is the most powerful socio-economic factor. We need to look at the bigger picture. Public health and prevention programmes need to take into account socio-economic circumstances. Health services need to further shift from treatment to prevention.’
However, Professor Conway applauded the British Dental Health Foundation’s November campaign for ‘shifting this awareness-raising to actually “actioning” it’ – and urged governments to do the same, suggesting that ‘understanding and tackling social inequalities in oral health’ were key.
Quoting from George Orwell in The Road to Wigan Pier, he concluded: ’Economic injustice will stop the moment we want it to stop and no sooner, and if we genuinely want it to stop the method adopted hardly matters.’
Also at the Westminster launch, it was reported that annual mouth cancer cases have increased by 41% in the last decade with under half of those diagnosed surviving beyond five years of the diagnosis.

The BDHF’s Daniel Davis and Nigel Carter also added their voices to the campaign and suggested the dental team were in ‘prime position’ to carry out vital mouth cancer checks.
Despite the publicity surrounding Hollywood actor Michael Douglas’s battle with throat cancer, they added that it was a ‘sad fact’ that awareness of the risks of mouth cancer had ‘not moved forward’.
Sponsors of the campaign include dental payment plan experts, Denplan.
According to Henry Clover, its deputy chief dental officer, the company has been instrumental in providing practical advice and real support – including posters and information packs – to 6,000 member practices over the past 12 years.
The Faculty of General Dental Practice (UK) welcomed the BDHF and recognised the important role dental professionals play in the screening of patients for signs of mouth cancer.
Lawrence Mudford, chair of the FGDP(UK)’s education committee, said: ‘The primary care dental team has the opportunity to save lives through vigilance and monitoring for early signs of the disease, and we urge dental professionals to ensure that a thorough assessment for mouth cancer is a part of every dental check.’
The FGDP(UK)’s publication clinical examination and record keeping (CERK) recommends the following:
• The soft tissues of the mouth and tongue should be examined at each attendance and new abnormalities or changes recorded
• A note should be made of the size, site, shape, colour and texture of any pathological lesions.

If available, intra-oral photographs should be taken of any unusual features to provide visual documentation.
The CERK guidance also highlights the fact that although many oral cancers arise de novo, several oral conditions can precede oral carcinoma, and the detection and diagnosis of such premalignant lesions permits patients to be referred for advice regarding lifestyle modifications and, where necessary, treatment.
CERK also includes an examination checklist and example record to support the detection of oral cancer.
The Foundation’s website can be found at www.dentalhealth.org.

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