oral cancer

A recently published study analysed the effect of Primary Health Care (PHC) on the incidence and mortality rates of oral cancer.

With over 600,000 new cases diagnosed every year, head and neck cancers are the seventh most frequent malignancies globally. Half of these cases are attributable to oral cancer. While the occurrence of oral cancer is on the rise, its global distribution is not even.  For example, India and France have some of the highest incidence rates by country, whereas South America has the highest incidence rates when compared to other continents. Brazil is exhibiting a rising incidence rate with as many as 16,340 new cases diagnosed in 2016. The occurrence of oral cancer is also observed to be more common in men than women.

The cause of oral cancer is associated with multiple genetic, environmental, and behavioural factors, such as smoking and alcohol consumption. Depending on the type and stage of diagnosis, oral cancer can be managed and cured. However, research studies investigating the role of primary health care in the control and reduction of oral cancer are few and far between. Additionally, there is very little evidence on the effect of public health initiatives on oral cancer incidence and mortality.

Primary health care (PHC) is the preferred method of entry into the public health system in Brazil. It can provide a place to identify risks and perform early diagnosis and to give the best care for cancer patients. In 2004, the diagnosis of oral cavity lesions was included in routine PHC examinations. Professionals within primary care should perform routine oral examinations in an effort to detect, diagnose, and treat early-stage cancers and thus to increase the chances of survival.

Although there have been advances in access to dental services, major issues in the structure and work processes of PHC remain. There are low numbers of dental practitioners in early detection initiatives. Additionally,only 37% of the Brazilian population was covered by the PHC oral health policy in 2016. Others problems highlighted in the Brazilian PHC system include a lack of training, preventative screening actions, and socioeconomic inequities.

The introduction of a diagnostic network enables primary care services to identify potentially malignant lesions, and this is crucial in decreasing the number of people seeking medical care at an advanced stage of the disease. Within the last 40 years, the proportion of patients diagnosed with advanced stages of oral cancer has remained unchanged. Evidence suggests that a well structured PHC could decrease the incidence and mortality rates of oral cancer. Unfortunately, the structure and work processes of oral primary care remain undefined in low to middle-income countries.

This recent study conducted in Brazil and published BMC Cancer set out to analyse the effect of the parameters related to the PHC structure and work processes on the incidence and mortality rates of oral cancer. The researchers hypothesized that better coverage, supply availability, and prevention activities in primary health care would that a positive impact on reducing the incidence and mortality of oral cancer.

The results of this study found that the oral cancer incidence rate was positively associated with the proportion of adults over 60 years and adult smokers. The results also showed a positive association between the rate of oral cancer-related mortality and the proportion of adults over 60 years and the performance of preventative and diagnostic actions for oral cancer. An inverse association was observed between mortality and the coverage of primary care teams, meaning that as coverage decreased, mortality increased.

This study has demonstrated that in Brazil the primary health care structure and work processes help to decrease the mortality rate of oral cancer but not the incidence rate of the disease itself. The results of this study highlight the need for expanding investments in PHC in an attempt to prevent oral cancer-related deaths.

Written by Jade Marie Evans, MPharm, Medical Writer

Reference: Rocha et al. (2017). Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer. Available: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3700-z. Last accessed 18th Nov 2017

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