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
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
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
The position paper Introduction Overview about the actual situation - WHO - European countries - Gender differences - Socio-economic differences Malta 2013
European Association of Dental Public Health Expert Working Group 5. Prevention of Oral Cancer Thursday 14th November 2013, 3.00pm - 5.30pm 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
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
The State of Oral Health in Europe, Platform for Better Oral Health in Europe 2012
GLOBOCAN 2008 (IARC) Estimated age-standardised incidence rate per 100,000, lip and oral cancer, Males, all ages, 2008, Europe.
Country Rate 1 Cyprus 2.29 2 Greece 2.29 3 Iceland 2.61 4 Sweden 4.51 5 Norway 4.64 6 Finland 4.86 7 United Kingdom 4.90 8 Austria 5.08 9 Bosnia Herzegovena 5.18 10 FYR Macedonia 5.25 11 Switzerland 5.41 12 Ireland 5.43 13 Latvia 5.55 14 The Netherlands 5.72 15 Germany 5.84 16 Italy 5.96 17 Malta 6.39 18 Serbia 6.56 19 Bulgaria 6.63 20 Czech Republic 6.65 Estimated agestandardised incidence Rate per 100,000, lip and oral cancer, Males, all ages, 2008, Europe. GLOBOCAN 2008 (IARC)
Country Rate 21 Denmark 7.08 22 Montenegro 7.28 23 Albania 7.29 24 Poland 7.33 25 Slovenia 7.35 26 Estonia 7.48 27 Republic of Moldova 7.87 28 France (metropolitan) 8.15 29 Belgium 8.18 30 Lithuania 8.21 31 Russian Federation 9.13 32 Croatia 9.16 33 Belarus 9.17 34 Ukraine 9.27 35 Romania 9.38 36 Luxembourg 9.50 37 Portugal 9.89 38 Spain 11.01 39 Slovakia 11.44 40 Hungary 16.51 Estimated agestandardised incidence Rate per 100,000, lip and oral cancer, Males, all ages, 2008, Europe. GLOBOCAN 2008 (IARC)
In the UK Squamous cell carcinoma - 85% Miscellaneous tumours Metastatic disease primary tumour classification
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.
Rate per 100,000 EASR population 30 25 Head & Neck Cancer Incidence in Scotland. All ages, male and female 1985-2007. European age standardised population Males 20 15 All ages 10 5 Females 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
EASR rates per 100,000 30 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) 28.7 25 20 20.4 15 12.7 15.1 10 9.8 7.1 10.5 5 2.7 3.7 4.9 0 1 (Least deprived) 2 3 4 5 (Most deprived)
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 0.49 95% CI = 0.40 to 0.65) vegetables (OR 0.50 95% 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
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!
Head & neck cancer, Scotland (C00-C14, C30-C32) Scottish Cancer Registry, ISD 2011 N H&N % of total Position in cancer league Male 821 5.6% 4 th commonest Prostate (C61) 1 st Female 365 2.3% 9 th commonest Breast (C50) 1 st Both 1186 3.9% 6 th commonest Lung (C33-C34) 1st
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
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
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
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
Prevention of Oral Cancer 4. Human Papilloma Virus oropharyngeal subset (?) HPV vaccination Other approaches 5. Sun protection cancer of the lip!
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
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
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
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
Thank you very much Malta 2013