Published: Thursday, March 10, 2011
The BC Oral Cancer Prevention Program (BC OCPP) stresses the importance of establishing a functional referral pathway to triage patients as soon as they are identified as having a lesion with an increased risk of becoming malignant. Patients follow the referral pathway shown below, beginning with identification of a clinical lesion in the community dental setting, through to treatment and monitoring at one of several specialty clinics. Information on the referral pathway, specialty clinics and programs may be found below.
Community Oral Dysplasia Referral Pathway
Downloadable Forms
Please note that if dysplasia is determined as a final diagnosis, use the Dysplasia Clinic Referral Form; otherwise, please use the OMDP referral form.
To view PDF files, please install Adobe Reader. You may download this program for free from the Adobe website.
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British Columbia Oral Cancer Prevention Program (BC OCPP)
Led by Dr. Miriam Rosin, the British Columbia Oral Cancer Prevention Program (BC OCPP) is a multi-disciplinary team of clinicians and scientists with a broad range of skills, experience and expertise, focused on a common vision of the prevention of oral cancer through the development of a Province-wide strategy for B.C. The vision of the British Columbia Oral Cancer Prevention Program (BC OCPP) is to reduce the incidence and mortality of oral cancer through the development, validation and adoption of new techniques for early detection and treatment of pre-malignant oral disease and cancers. An integrated management structure will link community health professionals in a step-wise referral pathway, to ensure seamless management of the disease from early dysplasia to frank malignancy. The initial focus is a province-wide strategy for B.C. Its chief objectives are:
- To prevent the development of oral cancer, or to detect it at the earliest possible stage.
- To achieve a greater cancer cure rate through more clinically effective treatment.
- To improve the early detection of local and regional recurrences.
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BC Oral Biopsy Service (BC OBS)
Founded in 1980 and located in the Vancovuer General Hospital, the OBS is a centralized pathology review service for physicians and dentists, currently processing more than 4,000 biopsies per year. The service has 30 years of history and has developed into a central referral source for management of oral diseases for community dentists. The Director of the OBS is Dr. Lewei Zhang.
You may reach BC OBS through the following email addresses:
Dr. Lewei Zhang at lzhang@interchange.ubc.ca
Dr. Catherine Poh at cpoh@interchange.ubc.ca
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Electronic Biopsy Requisition (New Program)
In 2009, we began the process of converting the biopsy requisition forms used by the OBS from a manual, hand-written requisition to a new online electronic form which will:
- Improve patient care by decreasing data errors such as those from transcribing
- Improve efficiency for both the pathology lab and the submitting clinicians, e.g., elimination of the double effort of filling out the same information by both lab and clinicians; elimination of the need to fill in dentist’s addresses, provision of drop down boxes and check lists to make data submission quicker and easier.
- Create a new surveillance database to better monitor activities across BC to improve patient care.
The conversion to electronic forms will occur gradually throughout 2011 with the intent to move towards full electronic submission by spring 2012. Watch this website for periodic updates.
Oral Dysplasia Clinics
Dysplasia Clinic Referral Form Download
In response to limited consensus on the management of oral dysplasia, the BC OCPP has initiated the development of a series of oral dysplasia clinics that capitalize on the convergence of recent research discoveries and technological innovations. Five oral dysplasia clinics are currently operational and are described below.
Oral Mucosal Disease Program (OMDP), 2 Low-Moderate Risk Oral Dysplasia Clinics
The Oral Mucosal Disease Program Clinics at the UBC Faculty of Dentistry Specialty Clinic and the Vancouver Hospital Division of Dentistry are the sites of two Oral Dysplasia Clinics. All attending practitioners are specialty trained and fully credentialed in the evaluation and management of oral dysplasia and are affiliated with the BC OCPP. The Dysplasia Clinics nested within the Oral Mucosal Disease Program are dedicated to the care of individuals who have been determined to have a low or moderate risk disease profile. No biopsy is required for care within this program.
Patients seen in the OMDP clinics are appointed upon written referral from practitioners within the medical and dental communities. All referrals are specifically for evaluation and/or management of an oral mucosal condition. Each patient receives a comprehensive assessment, documentation of the disease profile and additional diagnostic investigations as required. Following the initial consultation a written report is generated and distributed to the referring practitioner and other appropriate care team members.
The director of the program is Dr. Michele Williams. Other attending faculty include Dr. Catherine Poh and Dr. Eli Whitney. Dr. Lewei Zhang is a consulting staff member.
OMDP – Vancouver Hospital Site, 2775 Laurel St, Vancouver
OMDP – UBC Specialty Clinic, 2199 Wesbrook Mall, Vancouver
BC Cancer Agency Oral Oncology Clinics, Three High Risk Dysplasia Clinics
The BC Cancer Agency Oral Dysplasia Clinics are dedicated to the care of individuals who have been determined to have a high risk disease profile. In these clinics specialty trained clinicians evaluate and collaborate in the management of patients with high-risk premalignant disease. The Vancouver Cancer Centre is the organizational hub for these clinics, the second of which is a fully operational clinic in the Fraser Valley Cancer Centre. A third clinic is in development at the Centre of the Southern Interior in Kelowna. These clinics are directly linked with the BC Cancer Agency Head and Neck Tumor Group, the BC Oral Biopsy Service and the Surgical Oncology Network of BC. This allows for seamless patient care flow. Candidates for care in these “high risk” clinics require biopsy proven evidence of dyplasia.
BC Cancer Agency, Vancouver Site, 600 West 10th Ave, Vancouver
BC Cancer Agency, Fraser Valley Site, 13750 96th Ave., Surrey
BC Cancer Agency, Centre for the Southern Interior, 399 Royal Avenue, Kelowna
Community Outreach Clinic – Portland Dental Clinic, Vancouver Downtown Eastside
A partnership between the BC Cancer Agency, UBC, and the Portland Dental Clinic is providing oral cancer screening to the Downtown Eastside community. One of the oldest and most diverse communities in Vancouver, the Downtown Eastside is marked by high poverty rates, substance abuse, drug trafficking, prostitution, HIV/AIDS, crime and unemployment. Preliminary research and screening indicates the residents are at higher risk of developing oral pre-malignant lesions, cancers and other oral mucosal diseases. Dr. Catherine Poh, of the BC Cancer Agency, holds screening sessions at the clinic twice per month, and through a series of focus groups held in the spring of 2006, has identified the unique problems and particular needs of this community. Topics include knowledge of oral cancer, existing access to medical/ dental care, basics of an oral screening program, optimal locations for screening clinics, and incentives to attend such clinics. A focus group with Downtown Eastside nurses is in the planning stages to obtain ideas on integrating oral cancer screening into existing patient care programs.
This program is one of several projects of the BC Oral Cancer Prevention Program, bringing dentists and oral hygiene professionals into the community to make first-line decisions about early stage biopsies and referrals for anti-cancer related care. So far, the program has identified several cases of severe oral disease, including people requiring treatment for cancer and pre-cancerous conditions.
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