Most adult Americans know how to light a cigarette and order a drink, but a great number of them are clueless about the consequence of these two destructive habits – oral and head and neck cancer.
Oral and head and neck cancer (OHNC) is the term used for the group of cancers found in head and neck region, including the oral cavity (mouth, floor of mouth, lips, teeth, gums, lining of lips and cheeks), oropharynx (the back one-third of the tongue), the nasopharynx (area behind the nose), hypopharynx (lower part of the throat), and larynx (voice box).
It is estimated that nearly 40,000 new cases of oral, head, and neck cancer were diagnosed in 2003; approximately 85 percent of them attributable to tobacco use and heavy alcohol consumption. The five year survival rate for OHNC is only 56 percent, a rate that has remained unchanged over several decades. Considering that most adults who smoke today started using tobacco before the age of 18 and adolescent tobacco users are three times more likely to drink alcohol than non-tobacco users, the Federal Government has included improved survival and early detection of oral and head and neck cancer as two of the nation’s health objectives.
Experts believe that increased efforts to educate the public about OHNC will lead to early detection and treatment of these cancers, increasing survival. The current study endeavors to document the public’s belief about OHNC in order to raise awareness and education initiatives to prompt earlier disease recognition. The results of “Survey of Oral and Head and Neck Cancer Knowledge among the American Public” will be presented by authors, T. A. Day, MD, of the Head and Neck Tumor Program, Medical University of South Carolina, Charleston, S. G. Reed and G. F. Cannick, of College of Dental Medicine, Medical University of South Carolina, Charleston, and A.M. Horowitz, of the National Institute of Dental and Craniofacial Research, Bethesda, MD, at the 6th International Conference on Head and Neck Cancer (http://www.sic2004.org) being held August 7-11, 2004, at the Wardman Park Marriott, in Washington, D.C.
Methodology: A nationally representative sample of 1,013 Americans ages 18 or older were interviewed by telephone from February 27, 2003 to March 2, 2003 using an unrestricted Random Digit Dialing (RDD) technique that significantly reduces serial bias and ensures that respondents with both listed and unlisted numbers are reached. Only one interview was conducted per household. A subgroup of 269 tobacco users was developed from the original sample based on respondent’s answers.
Survey questions were developed from prior studies on oral cancer including those used in supplements to the National Health Interview Surveys from 1990 and 1992. They included information on self-perceived knowledge about the early signs, symptoms, and risk factors for oral and head and neck cancers. The results were weighted to known proportions for age, gender, geographic region, and race. A margin of error is noted of plus or minus 3.1 percent for all respondents; plus or minus six percent for those who used tobacco.
Knowledge: Sixty-two percent of respondents said that they were “not very” or “not at all” knowledgeable about OHNC; five percent considered themselves “very” or “extremely” knowledgeable. Tobacco users reported a 58 percent and seven percent knowledge level, respectively.
Location of cancers: Forty-nine percent of respondents did not know that OHNC most commonly occur in the mouth and throat; 23 percent correctly identified throat cancer, and 17 percent correctly identified mouth cancer. A total of 25 percent inaccurately considered brain cancer to be included in the category of OHNC.
Incidence: When asked how many people would be diagnosed with OHNC in the US this year, 19 percent accurately selected the broad range of 10,000-60,000. Only twenty-two percent of tobacco users identified the correct response.
Risk Factors: Only forty-two percent of respondents and 44 percent of tobacco users accurately selected smoking, 18 and 13 percent respectively selected chewing tobacco. Environmental pollution was considered a higher risk than sun exposure, alcohol, or diet for both groups although there is limited evidence to support this.
Early Detection: Only twelve percent of respondents and ten percent of tobacco users correctly identified the earliest signs of oral cancer (red or white sores in the mouth that do not heal). Hoarseness as an early symptom of voice box cancer was correctly selected by only two percent overall and one percent of tobacco users. Thirty-nine percent of all respondents and 42 percent of tobacco users reported that they did not know any symptoms. Interestingly, seventeen percent incorrectly selected headache as a symptom.
Treatment: Athough surgery followed by radiation remains the most common treatments, the respondents selected chemotherapy (43 percent) followed by radiation therapy (41 percent) and surgery (27 percent). More than one third (39 percent) did no know what treatments were available.
Treatment Related Morbidity: Results for the overall group and tobacco users were similar when asked to identify possible side effects to treatment for OHNC. The more common and most life-altering side effects of treatment for OHNC were rarely selected: disfigurement (four percent), loss of taste (four percent), difficulty speaking (two percent), sore mouth and gums (one percent), and xerostomia (dry mouth) (one percent).Forty-six percent reported that they did not know, while hair loss (31 percent), nausea (21 percent), vomiting (seven percent) were most commonly selected.
Examinations: Only twenty-six percent of respondents reported having been examined by a doctor for OHNC, while 94 percent of the participants reported never having been taught how to examine themselves for OHNC.
Tobacco and Alcohol Usage: Twenty-six percent of respondents reported using tobacco products such as cigarettes or chewing tobacco. Three percent of the overall group reported consuming more than four alcoholic drinks per day, while six percent of tobacco users responded the same.
Conclusion: Knowledge about oral and head and neck cancer, its risk factors, early signs and symptoms, and possible treatments is severely lacking in the American public, particularly in high risk groups. Early identification of OHNC symptoms and prompt medical diagnosis may increase survival rates. The study authors suggest that health education programs should be expanded to inform the public about OHNC, especially those at high risk for developing these cancers.