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Prevention of oral cancers.pptx
- 1. PREVENTION OF ORAL CANCERS Dr Kumari Liyanage, Registrar in Com. Dent,
- 2. Oral disease burden ………………… Oral cancer 3/ day - deaths The commonest cancer among males* 6/ day - diagnosed * National Cancer Registry, Sri Lanka 70% - at stage III & IV
- 3. LEADING CANCER SITES OF MALES IN SL ,2014 15.8% Lung, 9.5% Leukemia 7.6% Colon & rectal, 6.9% prostate, 6.5% unspecified, 5.7% Larynx, 5.1% lymphomas, 5 Leukemia, 3.9% bladder 3.5% Other, 30.5% Oral cancer
- 4. Leading cancer sites for Females 2014 breast, 25.2% Thyroid, 11.2% Cervix, 8.6% ovary, 7.3% Colon & rectum, 7.3% oesophugus, 5.4% uterus, 4.7% Oral cavity, 4% unspecified, 3.3% lymphomas, 3.2% Other, 19.9%
- 8. Burden of oral cancer • Globally accounted for 8.8 million deaths in 2015 • Incidence -17 per 100000 males in SL • 2-3 deaths per day in SL • Ranks 2nd place in Sri Lankan population when both sexes are combined • 2152 new cases in 2018
- 9. Risk Factors of OC & OPMD 1. Betel quid / areca nut chewing 2. Tobacco in various forms – smoking / smokeless 3. Heavy alcohol consumption 4. Dietary micronutrient deficiency 5. UV radiation – outdoor work 6. HPV 7. Poor Oral Hygiene / Periodontal disease 8. Immune deficiency 9. Mouthwashes 10. Genetics 11. Maté drinking 9
- 14. Prevalence of risk factors Betel quid chewing • 34-44 age group 34% & 65-74 age group 47.7%(NOHS,2002/2003) • 34-44 age group 39.4% & 65-74 age group 49.6%(NOHS2015/2016) • 18-69 years 26% males and 5 % females are currently using smokeless tobacco (STEP survey 2015)
- 15. Risk groups
- 16. How to identify high risk individuals
- 17. Issues leading to increased burden • Oral CA common among people live in law SES • Lack of awareness • Late presentation- about 76% cases present in stage 3 or 4 • (5 year survival rate remains 50%)
- 18. Activities targeting prevention & early diagnosis of oral CA • Opportunistic screening • Developing sustainable Continuous Active screening program for risk groups. • Promote self oral examination • Creating awareness and interventions for preventing risk behaviors • Monitoring and evaluation screening programs
- 19. Screening for oral cancers • Fulfills all the criteria for screening including Long latent period Most cost effective approach • Oral CA Preceded by OPMD • 1. Leukoplakia • 2. Erythroplakia • 3. erythroleokoplakia • 4. OSMF • 5.OLP
- 20. Burden of OPMD • Prevalence among 35-34 age group 1.57% • Prevalence Among 65-74 age group 3.68% • Prevalence among rural and estate sector 11%
- 21. OPMD BURDEN IN GALLE DISTRICT
- 22. Reported cases of OPMD in DHs 0 5 10 15 20 DH Ambalangoda DH Baddegama DH Hiniduma DH Imaduwa DH Karandeniya DH Batapola DH Hikkaduwa DH Induruwa DH Rathgama DH Madampagama DH Benthota DH Ahangama DH Habaraduwa DH Neluwa OHC Habaraduwa 1818 1 2 7 0 0 2 0 1 0 0 18 9 0 Number of OPMD reported in 2018
- 23. Reported cases of OPMD in BHS 0 10 20 30 40 50 60 70 80 BH Balappitiya BH Elpitiya BH Udugama 72 12 8 Number of OPMD reported in 2018
- 24. Reported cases of OPMD INADCS (Galle district) 0 2 4 6 8 10 12 14 0 0 0 14 9 0 5 0 13 Number of OPMD reported in 2018
- 30. Our role • Conducting screening programs at MOH level with MOH staff • Increase awareness among primary health care staff • Promote self oral examination • Conducting training programs to develop the skills of identifying OPMD • Interventions to implement legislations • Encourage PHMM and PHII
- 33. Guidelines • National Guideline for management of OPMD for Dental and Medical Practitioners • Hand book for primary health care workers • Tobacco cessation Toolkit (5As & 5Rs )
- 35. Legislations in relation to smokeless tobacco use in Sri Lanka • Sri lanka is the 4th country to impose total ban on SLT use Regulations on prohibiting Tobacco products NO 1 of 2016 • “No person shall manufacture,import,sell or offer for sale any smokeless tobacco products,flavoured,coloured or sweetened cigarette that contain tobacco and any electronic cigarette that contain tobacco” • ‘”Tobacco products means any product manufactured wholly or partially from tobacco and which is intended to be smoked, sniffed,sucked or chewed”(NATA act no 27 of 2006)
- 36. References • National Cancer Control Programme Sri Lanka. (2015). Cancer Incidence Data: Sri Lanka Year 2009. Colombo: NCCP. 11th Publication. • Annual Health Bulletin, 2015, Medicall Statistics Unit, Ministry of Health, Sri Lanka (Retrieved from www.health.gov.lk) • Ariyawardana, A., Sitheeque, M., Ranasinghe, A., Perera, I., Tilakaratne, W., Amaratunga, E., . . . Warnakulasuriya, S. (2007). Prevalence of oral cancer and pre‐cancer and associated risk factors among tea estate workers in the central Sri Lanka. Journal of Oral Pathology & Medicine, 36(10), 581- 587. • OPMD Guideline, 2013, National cancer Control Programme, Ministry of Health • Tobacco cessation toolkit for dental surgeons and health professionals,2019:Center for research in oral cancer ,UOP. • National Authority on Tobacco and Alcohol Act, No. 27 of 2006