oral cancer It represents about 4% of all tumors in the world. Tobacco and alcohol consumption are considered the main risk factors for its development, and their effects are synergistic. Diet, human papillomavirus (HPV) infection, genetic predisposition and poor oral health are other factors that have been associated with this type of cancer.
The WHO argues that its management should be an integral and inseparable part of other cancer detection programs. Today we know that its treatment is very complex and multidisciplinary, often including surgery and radiotherapy, and with very high costs. On the contrary, the approach to incipient injuriesdetected early, it can be resolved through simpler, less expensive surgeries and, most importantly, with better quality of life and survival for patients.
In Spain, estimates made suggest that only 25-30% are diagnosed at an early stage of oral cancers.
For this reason, we unfortunately use the term too often diagnostic delay, which is used in contrast to early detection of cancer and is defined as the time elapsed from the moment the patient detects their first sign or symptom and their definitive diagnosis. Diagnostic delays include both those attributable to the patient and those that must be attributed to the care model itself. To standardize this concept, the Aarhus Declaration suggested standardizing the different time intervals, through clear definitions, and abandoning the generic and ambiguous term of diagnostic delay. The different phases covered in the aforementioned declaration include the patient's detection of any anomaly, the perception of the need for review, consultation with a healthcare professional, diagnosis and initiation of treatment.
In an excellent systematic review, Professor Varela, from the University of Santiago de Compostela, analyzes the impact of these steps. The main data obtained shows an average consultation time between the patient and the healthcare professional of around 80 days. On the other hand, the average time of “professional recommendation”, that is, from basic care (PC) to specialized care, is around 16 days, a period five times shorter than the patient's consultation time. As can be deduced from this systematic review, the average patient time is the longest in the entire clinical process analyzed. Adequate health awareness about oral cancer, with a good level of information and health attitude, combined with adequate accessibility to the health system, clearly affect the average length of the care-seeking interval.
Considering the importance of the population's level of knowledge about warning signs and symptoms and potentially dangerous factors, it seems clear that importance of health information campaigns who try to reduce this delay in patients seeking diagnosis.
95% oral care is provided by the private sector
Another priority axis in many interventions of this type is to try to increase the level of knowledge of healthcare personnel (dentists and primary care doctors) about oral cancer, mainly at the level of intraoral examination, prioritizing it in risk groups. Promoting regular visits to the dentist should also be included as an irreplaceable method for carrying out opportunistic screening, i.e. take advantage of the patient coming to do the intraoral exam looking for potentially malignant lesions or oral cancer. The dentist is of great help in raising awareness about the health of these patients, informing them about risk factors with an individualized approach, especially in those with potentially more dangerous habits. It is essential that there is good coordination at the PC level between doctors and dentists, so as not to waste opportunities and take advantage of synergies to improve the agility in referring a patient to a specialized center for diagnosis and definitive treatment.
The dentist, therefore, is a fundamental factor on two major fronts: in the education of patients treated, especially those considered at risk, and in the early clinical diagnosis of injuries for their subsequent immediate referral to specialized care. In relation to health education, three priorities were proposed: inform patients about warning signs (long-lasting ulcer that does not resolve, presence of leukoplakia and/or erythroplakia in the mouth, among others); about the main risk factors (smoking, alcohol consumption, HPV, diet and excessive solar radiation); and instruct on self-exploration.
As for the clinical diagnosis, it must include a scrupulous extra and intraoral examination, looking for potentially malignant lesions or oral cancer. All of the above indicate survival hopes in population numbers if the tumor is diagnosed in its early stages: the five-year survival rate approaches 80% falling sharply below 40% in the late stages.
The approach to oral cancer must be multidisciplinary, with clear participation from the National Health System and its first line of prevention and detection are, without a doubt, PC dentists. It must also include strategies that allow work in synergy with social workers to reach less favored population subgroups. Public Health dentists play a fundamental role in the entire process. Its role in preventive and educational functions, opportunistic screening through intra and extraoral exploration, early diagnosis, biopsy and referral to specialized care is undeniable.
They are also of great importance in the preventive and therapeutic dental management of cancer patients, who require protocolized care before, during and after treatment. However, in a context of dental care model like ours, where 95% of oral care is provided in the private sphere, complementary help is irreplaceable, especially in prevention, detection and early referral of private care for PC and specialized services throughout this process. Let's not forget that.
