Maryland Comprehensive Cancer Control Plan
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  • 1. Maryland Comprehensive Cancer Control Plan Oral Cavity and Oropharyngeal Cancer Prevention Committee
  • 2. Methods
    • Examined issues
    • Reviewed data
    • Identified problems and solutions
    • Developed flow chart
  • 3. Risk Factors
    • Tobacco
      • Cigarettes
      • Cigars
      • Snuff
      • Spit tobacco
      • Pipes
    • Alcohol
    • Sunlight – lip cancer
    • Lack of fruits and vegetables
    • Viruses – e.g., Human papilloma virus
  • 4. The Problem
  • 5. Oral Cancer in Maryland
    • Maryland ranks 8th in mortality among all states
    • 6th highest mortality rate in the US for African American men
    • 5-year survival rate in Maryland for African Americans is 33% (whites - 55%)
    • Nearly a 15% higher death rate from oral cancer in Maryland than the US
    • Ries et. al. SEER Cancer Statistics review, 1973-1996
  • 6. Oral Cancer Mortality Rates Maryland
  • 7. HP 2010 Oral Cancer Objectives
    • Objective 21-6 – Oral Cancer Staging
    • Increase the proportion of oral and pharyngeal cancers detected at the earliest stage
      • Target: 50 percent
      • Baseline: 35 percent of oral and pharyngeal cancers (stage I, local )
    • Objective 21-7 – Oral Cancer Examinations
    • Increase the proportion of adults who, in the past 12 months, report having an examination for oral and pharyngeal cancers
      • Target: 20 percent
      • Baseline: 13 percent of adults aged 40 years and older
    • Objective 3-6 - Oral Cancer Mortality Rate
    • Reduce the oral and pharyngeal cancer death rate
      • Target: 2.7 deaths per 100,000 population
      • Baseline: 3.0 deaths per 100,000 population in 1998 (age adjusted to the year 2000 standard population)
  • 8. Oral Cancer Stage 1 Diagnosis Maryland
  • 9. Oral Cancer Prevention The Maryland State Model
    • Phase I - Needs Assessment
    • Phase II - Development and Pilot Testing of Educational Interventions
    • Phase III - Program Evaluation
  • 10. Oral Cavity and Oropharyngeal Cancer Prevention Committee Proceedings and Recommendations
  • 11. Oral Cancer Early Detection and Diagnosis
    • Access to dental services disparity
      • Limited for those populations at highest risk
        • Poor
        • Adults
        • Older adults
    • More likely to visit a physician, family nurse practitioner or physician’s assistant than dentist
    • Oral cancer examination responsibility of all health care practitioners
  • 12. Addressing Oral Cancer Prevention Main Issues
    • Lack of oral cancer literacy
        • Awareness
        • Behavior
    • Disparities
        • Education and awareness
        • Mortality
        • Survival
        • Access
  • 13. Addressing Oral Cancer Prevention Main Focus
    • Direct oral cancer literacy for:
      • Public
      • Healthcare Providers
      • Media
      • Policy Makers
    • Address disparities
      • Intertwined with lack of literacy
      • Access to services
  • 14. Oral Cancer Literacy What Everyone Needs to Know
    • Public, health care providers, policymakers and media
      • Risk assessment and risk reduction
      • Risk factors
      • Signs and symptoms
      • Behavior modification
        • Public to request oral cancer examination
        • Providers to incorporate adequate oral cancer examination into standard of care
      • Adequacy of oral cancer examination
      • Frequency of oral cancer examination
  • 15. Public
    • Educational interventions
      • Schools
      • Workplace
      • Hospitals
      • Faith-based institutions
      • Recreational and sports organizations
    • Develop messages targeted to different needs and values of the community
      • Those engaged in risk behaviors
      • Those not engaged in risk behaviors
      • Culturally appropriate
      • Age and gender appropriate
    • Literacy to lead to use of appropriate screening, referral, follow-up & treatment services
  • 16. Healthcare Providers
    • Provider education specific to primary care providers (PCP) and dental health professionals
      • No dental coverage for Maryland adults under Medicaid
      • Medicare does not cover dental services
      • Maryland adults have medical coverage under Medicaid and Medicare and will visit PCP
    • Curriculum Change
      • Make oral cancer exams part of standard of care and practice for all health care providers
    • CME/CEUs
    • Lead to appropriate screening, referral, treatment and follow-up services
  • 17. Media
    • Plays key role in increasing awareness of both healthcare providers and the public
    • Immediate access to mass population
    • Public service announcements
    • Paid advertisements
    • Explore what is the best form of communication to reach specific communities
      • Talk radio
      • Television
      • Print
  • 18. Policy Makers
    • Education targeted to policy makers and advocates
    • Issues to be addressed:
      • Coverage of medically necessary dental procedures
      • Mandating CME/CEU in oral cancer prevention for re-licensure (model after CPR)
      • Uniform dental coverage for Medicaid adults
      • Management of uninsured/undocumented individuals
      • Funding for research such as practice patterns (PCP v. Dental), screening effectiveness and evaluation of existing programs
      • Continuation of existing programs targeted towards oral cancer (i.e., Office of Oral Health program)
      • Oral cancer competency module for medical and dental licensure
  • 19. Oral Cancer Literacy Provider*
    • Funding for Research
    • Covering of medically necessary dental procedures
    • Uniform adult dental coverage that includes preventive services as well as emergency care
    • Management/incorporation uninsured and undocumented populations
    • CME/CEU
    • Medical & Dental Board Licensure and Re-licensure
    • Oral Cancer Competency Module on Licensure Exams
    Provider Education PCP Dental Health Professionals Curriculum Change CME/CEUs Curriculum Change CME/CEUs Use and provide appropriate screening, referral, follow-up, and treatment Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, Website Government, Providers
    • *What everyone needs to know:
    • Risk assessment and risk reduction
    • Risk factors
    • Signs and symptoms
    • Oral cancer exam- steps
    • Frequency of oral cancer exam
    Awareness Oral Cancer Prevention, Early Detection, and Treatment Model Public* Media* Policy Makers*
  • 20. Disparities
    • Main issues
      • Lack of access
      • Lack of oral health literacy
    • Ultimate Goal
      • Reduce disparities in oral cancer mortality and morbidity
  • 21. Oral Cavity and Oropharyngeal Prevention Committee Members Thank You!
    • Albert Bedell, PhD - Maryland Academy of General Dentistry
    • Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck Surgery
    • Catherine Carroll, CRNP - Chase Brexton Health Services, Inc.
    • Harry Goodman, DMD - University of Maryland Dental School
    • Alice M. Horowitz, PhD – National Institute of Dental and Craniofacial Research
    • Robert D. Jones, DDS - Maryland Association of Community Dental Programs and Maryland State Dental Association
    • Fred Magaziner, DDS - American Academy of General Dentistry and American College of Dentists
    • Ilise Marrazzo, MPH (Chairperson) – Dept. Health and Mental Hygiene, Office of Oral Health
    • Kelly Sage, MS – Dept. Health and Mental Hygiene, Office of Oral Health
    • Yale Stenzler, EdD - Oral Cancer Survivor
    • Sheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' Association
    • Rodney Taylor, MD - University of Maryland Department of Otolaryngology
    • Brooks Woodward, DDS - Chase Brexton Health Services, Inc.
    • David Zauche - American Cancer Society
  • 22. Questions?