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The goal of the British Columbia Oral Cancer Prevention Program is to create a province-wide oral screening program.

Community Screening Initiative

The goal of the British Columbia Oral Cancer Prevention Program (BC OCPP) is to create a province-wide oral screening program that integrates molecular features of developing oral pre-malignant lesions with novel visualization and computer technology to identify and manage high risk disease in community settings. The plan is to use these tools as overlapping sieves in a step-by-step fashion to progressively filter out patients in the community with high-risk oral pre-malignant lesions (OPL’s) and triage them to dysplasia clinics for management. See below:

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"A 5-step approach to patient management is proposed using devices/ protocols developed and validated by the BC OCPP. Steps involve a set of “filters” to control patient flow: 1) Identification of patients requiring follow-up by dentists in the community, facilitated by use of visualization devices; 2) Collection of a biopsy and/or exfoliated cell samples directly by the dentist or by an Oral Medicine Specialist/ ENT surgeon after referral; 3) Assessment of biopsies and rinses at the BC Oral Biopsy Service with histology, Image Cytometry and/or Getafics to triage either back to the community for follow-up (little or no risk), or forward to: 4) Intermediate-risk dysplasia clinics in the community or 5) “High-risk” dysplasia clinics in cancer centres. Higher cost molecular tools at these sites will guide intervention (microsatellite analysis for Loss of Heterzygosity, in vivo optical probes and confocal microscopes, and oral genomic array CGH profiles."

c10group1.jpg Oral cancer is an important health problem with a high mortality rate (~62% 5-year survival) mainly due to the advanced stage at which it is diagnosed. Oral cancer screening, the detection of oral cancer (and precancer) by checking for disease in people who do not show any symptoms of the disease, can be effective at finding early disease. British Columbia’s dental professionals are currently taught how to look for signs of oral precancer and cancer as part of their dental education. However, there is a need for continuing education for these professionals to maintain and promote their skills, and to incorporate this behaviour into consistent daily routine.


The primary objective of this study was to develop, implement and evaluate an education module on oral cancer screening for community dental offices. This module incorporated both conventional and novel detection methods (autofluorescence visualization). Ten community dental offices in the Greater Vancouver area with an interest in oral cancer screening, took part in a one-day workshop in September, 2006, which included a review of oral cancer risk factors, statistics, clinical risk factors, a review of screening practices and an introduction to autofluorescence visualization. These offices then proceeded to screen adult patients in their offices for 4 months. More than 2000 patients were screened. A focus group was held at the completion of this project (February, 2007) to gather participants input into the development of the education module and feedback on screening (both conventional and adjunctive autofluorescence visualization). This information will provide the basis for developing protocols for oral precancer and cancer screening.

 

A partnership between BC Cancer, 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 BC Cancer, 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.

 

The BC OCPP actively participated in several community health fairs in 2006. They included the April 2006 Renfrew Community Centre in conjunction with the BC Dental Society’s "Oral Health Month" as well as the Vancouver Downtown Eastside, SUCCESS "Annual Health Fair" held in October 2006.

 

The South Asian (SA) community represents one of the largest and fastest growing minority populations in BC. Oral cancer is a leading cancer in SA countries because its people chew betel quid (with or without tobacco)in addition to consuming tobacco and alcohol.

SA immigrants often bring risk habits into their new countries of settlement. A study in the United Kingdom has shown that the relative risks for oral cancer among SA men and women are 1.4 and 3.7 times higher that non-SA men and women, with the increase attributed to continuation of chewing betel quid and smokeless tobacco after immigration.


Dr Ajit Auluck is leading a SA initiative that is examing BC statistics to determine whether a similar elevated risk for oral cancer is occurring among the SA population in this province. In a recently completed retrospective analysis of data from the British Columbia Cancer Registry, he has shown that a similar elevation in oral cancer risk is indeed occurring in BC. Furthermore, not only do SA men and women have 1.3 and 1.6 times higher incidence of the disease but they also have 1.4 and 2.2 times higher disease-specific mortality rates compared to the general population.


Several initiatives for oral cancer control in the SA population are ongoing with plans for further expansion on prevention through health promotion and education strategies as well as the development of an oral cancer screening initiative. Current qualitative research is focused on understanding the socio-cultural context of high risk behaviours such as chewing betel quid and smokeless tobacco in order to make culturally appropriate health education materials for prevention of high risk behaviours among the SA community. Screening in community meeting places has begun, with future plans to create a referral pathway for SA men and women with high risk oral lesions through partnerships between existing networks of the BC Oral Cancer Prevention Program.

 

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