European Association of Dental Public Health Prevention of Oral Cancer
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1 European Association of Dental Public Health Prevention of Oral Cancer Special Interest Working Group Thursday 14th November 2013 PD Dr. Katrin Hertrampf, MPH Dr. Colwyn Jones, Associate Editor Malta 2013
2 Prevention of Oral Cancer Special Interest Working Group Agenda Welcome and introduction - Self introduction plus reason(s) for SIWG attendance - Annual report from 2012 meeting - Oral cancer in Scotland and beyond Introduction of the position paper Working in Subgroups (discussion about additional points in the introduction) Working in Subgroups (discussion about content Mat&Med an initial framework Malta 2013
3 Prevention of Oral Cancer Special Interest Working Group Task to fulfil before the next SIWG meeting (framework of the results and discussion sections) Other suggestions for SIWG programme Next meeting for the SIWG; June 2014 Gothenburg, Sweden Thanks from the chairs Agenda Malta 2013
4 The position paper Introduction Overview about the actual situation - WHO - European countries - Gender differences - Socio-economic differences Malta 2013
5 European Association of Dental Public Health Expert Working Group 5. Prevention of Oral Cancer Thursday 14th November 2013, 3.00pm pm Dr Colwyn Jones, Associate Editor Community Dental Health c/o NHS Health Scotland Thistle House 91 Haymarket Terrace Edinburgh EH12 5HE, Scotland colwyn.jones@nhs.net
6 Head & neck cancer (ICD-10; C00-C14, C30-C32) Cancer of the lip, oral cavity and pharynx: C00-C14 (non melanoma) Cancer of the mouth: (IARC) C03-C06 Cancer of the oral cavity: C01-C06 Cancer of the salivary glands: C07-C08 Cancer of the tongue: C01-C02 Cancer of the nose, middle ear & sinuses: C30/31 Cancer of the larynx: C32
7 The State of Oral Health in Europe, Platform for Better Oral Health in Europe 2012
8 GLOBOCAN 2008 (IARC) Estimated age-standardised incidence rate per 100,000, lip and oral cancer, Males, all ages, 2008, Europe.
9 Country Rate 1 Cyprus Greece Iceland Sweden Norway Finland United Kingdom Austria Bosnia Herzegovena FYR Macedonia Switzerland Ireland Latvia The Netherlands Germany Italy Malta Serbia Bulgaria Czech Republic 6.65 Estimated agestandardised incidence Rate per 100,000, lip and oral cancer, Males, all ages, 2008, Europe. GLOBOCAN 2008 (IARC)
10 Country Rate 21 Denmark Montenegro Albania Poland Slovenia Estonia Republic of Moldova France (metropolitan) Belgium Lithuania Russian Federation Croatia Belarus Ukraine Romania Luxembourg Portugal Spain Slovakia Hungary Estimated agestandardised incidence Rate per 100,000, lip and oral cancer, Males, all ages, 2008, Europe. GLOBOCAN 2008 (IARC)
11 In the UK Squamous cell carcinoma - 85% Miscellaneous tumours Metastatic disease primary tumour classification
12 Presentation of Oral Cancer Age (Europe) 98% are over 40 years of age 50% are over 60 years of age Gender Male 4:1 Smoker/drinker (including smokeless tobacco) 75% of cases *Mehanna et al, Head & Neck cancer BMJ 2010; 341, 663.
13 Rate per 100,000 EASR population Head & Neck Cancer Incidence in Scotland. All ages, male and female European age standardised population Males All ages 10 5 Females
14 EASR rates per 100, Head & Neck cancer (ICD-10, C00-C14, C30-C32) in Scotland, European Age Head & Standardised neck cancer (ICD-10 Population C00-C14, C30-C32) Incidence in Scotland, using and European mortality age-standardised rates by population SIMD incidence quintile, and mortality persons rates by SIMD (Incidence 2006 quintile, 2002/06. persons, (incidence Mortality 2002/06, 2004/08) mortality 2004/08) (Least deprived) (Most deprived)
15 Smoking / tobacco use (OR ever vs never smoking = 2.13, 95% CI = 1.52 to 2.98), Alcohol (OR >3 drinks / day vs never drinking = 2.04, 95% CI = 1.29 to 3.21). Alcohol & tobacco synergism causes 75% of head & neck cancers; 37-fold increase in RR males, smoked & drunk alcohol heavily for over 20 years, compared to teetotal, non-smokers Diet low in fresh fruit and vegetables each portion of fruit (OR % CI = 0.40 to 0.65) vegetables (OR % CI = 0.38 to 0.65) Human Papilloma Virus (HPV) infection (OR 1.5 CI = 1.1 to 2.1) for oral cavity (HPV 16) perhaps subset of oral / oropharyngeal cancers Sunshine / Unknown Head & neck cancer
16 Prevention of Oral Cancer 1. Smoking cessation smokeless tobacco 2. Moderation of alcohol intake 3. Improve diet fruit and vegetables 4. Human Papilloma Virus oropharyngeal subset (?) HPV vaccination 5. Sun protection cancer of the lip!
17 Head & neck cancer, Scotland (C00-C14, C30-C32) Scottish Cancer Registry, ISD 2011 N H&N % of total Position in cancer league Male % 4 th commonest Prostate (C61) 1 st Female % 9 th commonest Breast (C50) 1 st Both % 6 th commonest Lung (C33-C34) 1st
18 Prevention of Oral Cancer 1. Smoking cessation Ban on tobacco advertising Reduce availability time / place Ban on smoking in public places / workplaces Increase tobacco duty Enforce age limits Enforce import / smuggling laws
19 Prevention of Oral Cancer 1.1 Smokeless tobacco Prohibit sale of smokeless tobacco Ban on advertising Increase tobacco duty Enforce age limits Enforce import / smuggling laws
20
21 Prevention of Oral Cancer 2. Moderation of alcohol intake Ban on alcohol advertising Reduce availability time / place Increase alcohol duty / minimum pricing Enforce age limits Enforce drink / driving laws Enforce import / smuggling laws
22 Prevention of Oral Cancer 3. Improve diet fruit & vegetables Food standards in schools Free fruit in schools Salad bar for all retail meals Sugar, salt, fat tax
23 Prevention of Oral Cancer 4. Human Papilloma Virus oropharyngeal subset (?) HPV vaccination Other approaches 5. Sun protection cancer of the lip!
24 Oral cancer screening Early presentation = better 5-year survival Treatment is disfiguring Not a common disease High risk categories likelihood of correct reach Visual screening test has poor discrimination Natural history of the disease uncertain Large number of false positives = worried well!!! Recommendation; Opportunistic screening of high risk individuals in primary care
25 The position paper Introduction Working in Subgroups What is in common? What is different? - The examination of the oral cavity - Risk factors - Trends in age - The role of the cancer registries Malta 2013
26 The position paper Working in Subgroups An initial framework: Material & Methods What are the main aspects, we should address? What is the preventive approach? - Risk reduction - Examination of the oral cavity Malta 2013
27 Prevention of Oral Cancer Special Interest Working Group Task to fulfil before the next SIWG meeting (framework of the results and discussion sections) Other suggestions for SIWG programme Next meeting for the SIWG; June 2014 Gothenburg, Sweden Thanks from the chairs Agenda Malta 2013
28 Thank you very much Malta 2013
Prevention of Oral Cancer Special Interest Working Group
Prevention of Oral Cancer Special Interest Working Group Dr Colwyn Jones, Consultant in Dental Public Health, NHS Health Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland. colwyn.jones@nhs.net
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