Prevention
of
Oral
Cancer
CHAPTER
69
By Carl Rosati
Prevention of Oral Cancer
69
Prepared by Carl Rosati, MD, FRCSC1
In 1979 the Canadian Task Force on the Periodic Health
Examination identified cancers of the oral cavity as a potentially
preventable cause of major morbidity and mortality. At the time,
early detection was considered possible but the quality of
evidence supporting the effectiveness of preventive strategies
and the effectiveness of treatments for oral cancers was limited
(C Recommendation). Review of the evidence from 1980 to
1993 has not changed this recommendation. However, smoking
cessation counselling is highlighted as a means of preventing oral
cancer and the recommendation to provide smoking cessation
counselling is consistent with that made in Chapter 43 which
deals more generally with the prevention of tobacco-caused
disease.
Burden of Suffering
The estimated incidence of oral cancers in Canada in 1993 was
3,120 and they accounted for 1,100 deaths, approximately 1.9% of all
Oral cancers account
for significant
mortality but their
prevalence is
relatively low
cancer deaths. The peak age for developing oral cancers is in the fifth
to seventh decades with a male to female ratio of about 2.5:1. The
lifetime probability of developing and dying from oral cancers in men is
1.71% and 0.61% and for women is 0.71% and 0.27%, respectively. The
potential years of life lost (PYLL) for oral cancer was 16,000 years in
Canada in 1989. Oral cancers account for significant mortality but
their prevalence is relatively low. This may affect the feasibility of large
scale screening with the adverse implications of the false positive and
false negative diagnoses generated by such a screening program.
Over 50% of oral cancers, when diagnosed, are beyond the
American Joint Committee for Cancer Staging and End Results’ TNM
Stage I. Consequently, there is major morbidity attributable both to
the disease and to the various forms of treatment and all health status
domains are affected. There is psychosocial disabil