Knowledge and awareness about oral cancer in the community

Resumo

Oral cancer-related deaths rank seventh for males and tenth for females in Europe, with Spain showing overall five-year survival rates of 53%. Despite the oral cavity offers no difficulties for routine exploration, almost 50 % of oral cancers are diagnosed at advanced stages. It has been suggested that if this neoplasm were diagnosed and treated at early stages, five-year survival rates would exceed 80%. Considering the most important contributor to diagnostic delay is the patient while assessing whether a sign/symptom is worth consultation, the chances for seeking help depend on the interpretation of a symptom as dangerous for the person’s welfare. Since despite of therapeutic advances only a 5% improvement in overall survival has been achieved in the last 20 years with half of all oral cancers diagnosed at advanced stages, significant improvements in survival may most probably come from the side of early diagnosis, and assessing public’s awareness and knowledge of this neoplasm seems to be the stepping stone for any attempt to tackle this problem. Knowledge about of this neoplasm is reported to be low worldwide. Data from Spain rely on a single study undertaken in a sole city and shows that 22% of the participants had ever heard of oral cancer with poor knowledge of its signs, symptoms and risk factors. Apart from health professionals and individuals alike, members of the public can obtain health-related information from other sources. Online audio-visual resources are easy to use and provide effortless access to information. Recent reports disclosed most useful oral cancer videos in English and Portuguese languages have less chances to be viewed by the public than worse ones. Objectives -To investigate oral cancer awareness in Galicia and knowledge of risk factors, signs and symptoms. -To investigate the health-seeking behaviour of lay people when experiencing a lesion compatible with oral cancer. -To disclose the information about oral cancer are available at video-sharing online platforms, and whether it may be useful to shorten patients’ appraisal time. Methods & materials 1. A cross-sectional, community-based survey of randomly selected respondents undertaken in all four capitals of the Galician provinces at different areas in each city in a sort of pathfinder method. 2. A cross-sectional study undertaken at the arguably three most popular video-sharing sites using “cáncer de boca” and “cáncer oral” as keywords. The first 100 results (one search per keyword per platform) were retrieved and analysed in six dimensions (aetiology, risk factors, prevention, early detection, treatment, and prognosis). Visualization rate and interaction and usefulness indices were calculated and the presence of non-scientifically supported information assessed. Results A total of 5,727 people entered the survey (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% males (n=2,729). Oral cancer was mentioned by 3% as their first, unprompted response. Active knowledge of oral cancer (unprompted) was shown by 1,024 individuals (17.95%). This percentage increased to 73.1% (n=4,189) when asked about this neoplasm (passive knowledge). Awareness had an OR=1.30 (1.14-1.48) in women regarding to men and increased with the educational level. Responses on oral cancer symptoms ranked non-healing ulcerations as the most suggestive sign, (prompted and unprompted), followed by mouth swelling (unprompted), and sore tongue or mouth (prompted). Regarding risk factors, the most frequently identified was tobacco (55.3%; n=3,169), followed by alcohol (12.5%; n=708), poor oral hygiene (10.8%; n=618), diet (6.5%; n=377), and genetics (4.5%; n=248). Current smokers were significantly more aware of tobacco as risk factor. Participants considered at risk were less aware of oral cancer. When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, 62.8% would see their primary care physician (n=3,597) and 23.8% (n=1,371) would see their dentist. Self-treatment (1.8%) is the reported behaviour predominant among those circulating an alternative path (11.5%) to diagnosis/treatment. Knowledge about the existence of oral cancer also influences behaviour: people reporting no knowledge on oral cancer would visit a physician (68.7% vs. 31.3%) and were more prone to stoic or risky behaviours. Regarding audio-visual resources, most were retrieved from YouTube® (92.2%; n=117) and were produced mainly by mass-media (46.5%; n=59), followed by individuals who identified themselves as healthcare professionals (21.2%; n=27). Generally speaking, these videos did not provide comprehensive information on oral cancer, with a median of two oral cancer dimensions considered (IQR: 1.00-4.00) and a median usefulness score of 5.00 (IQR: 3.00-7.00). Despite being the most viewed, videos by laypersons were the least useful and the least comprehensive. The most useful videos were authored by educational institutions, which offered the widest perspective and a higher interaction index. Their main strengths were including representative images (p=0.005), mentioning tobacco chewing (p=0.257), the inclusion of ulceration as a suspicious symptom (p=0.271), and explicit recommendations for check-ups (p=0.263) and risk factors avoidance (p=0.160). A highly significant positive correlation (0.643; p<0.001) could be observed between usefulness and comprehensiveness, together with negative correlations between visualization rate and usefulness (-0.186; p<0.05), and visualization rate and comprehensiveness (-0.183; p<0.05). Conclusions - General population has low awareness of oral cancer with poor knowledge of risk factors and main alarm signs. In addition, laypersons in the risk group scored lower values in the main variables analysed; even those highly educated showed insufficient awareness and knowledge of oral cancer. Thus, there is a clear need for educational interventions tailored to the target audience and aimed at increasing knowledge and awareness of oral cancer to promote primary prevention of oral cancer and minimising the time interval of patients with symptomatic oral cancer in their path to treatment. - General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer. - Online audio-visual material about oral cancer in Spanish is incomplete, of limited usefulness, and often includes non-scientifically supported information. Most of these resources are produced by mass media and healthcare professionals, with minor contributions from educational and healthcare institutions. Visualization rates negatively correlated with the usefulness and comprehensiveness of the contents in these digital objects.