Maryland Comprehensive Cancer Control Plan Oral Cavity and Oropharyngeal Cancer Prevention Committee

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Maryland Comprehensive Cancer Control PlanOral
Cavity and Oropharyngeal Cancer Prevention
Committee
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Methods

• Examined issues
• Reviewed data
• Identified problems and solutions
• Developed flow chart

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Risk Factors

• Tobacco
• Cigarettes
• Cigars
• Snuff
• Spit tobacco
• Pipes
• Alcohol
• Sunlight lip cancer
• Lack of fruits and vegetables
• Viruses e.g., Human papilloma virus

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The Problem
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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

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Oral Cancer Mortality RatesMaryland
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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)

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Oral Cancer Stage 1 DiagnosisMaryland
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Oral Cancer PreventionThe Maryland State Model

• Phase I - Needs Assessment
• Phase II - Development and Pilot Testing of
  Educational Interventions
• Phase III - Program Evaluation

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Oral Cavity and Oropharyngeal Cancer Prevention
Committee

• Proceedings and Recommendations

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Oral CancerEarly 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 physicians assistant than
  dentist
• Oral cancer examination responsibility of all
  health care practitioners

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Addressing Oral Cancer PreventionMain Issues

• Lack of oral cancer literacy
• Awareness
• Behavior
• Disparities
• Education and awareness
• Mortality
• Survival
• Access

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Addressing Oral Cancer PreventionMain Focus

• Direct oral cancer literacy for
• Public
• Healthcare Providers
• Media
• Policy Makers
• Address disparities
• Intertwined with lack of literacy
• Access to services

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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

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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

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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

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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

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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

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Oral Cancer Prevention, Early Detection, and
Treatment Model
Educational interventions, such as
Schools/agencies, Workplace, Hospitals,
Faith-based institutions, Service organizations,
Sports and recreation, Website Government,
Providers
Public
Use and provide appropriate screening, referral,
follow-up, and treatment
Curriculum Change
Oral Cancer Literacy
Provider
Provider Education
PCP
CME/CEUs
Dental Health Professionals
Curriculum Change
CME/CEUs

• What everyone needs to know
• Risk assessment and risk reduction
• Risk factors
• Signs and symptoms
• Oral cancer exam- steps
• Frequency of oral cancer exam

Media
Awareness
Policy Makers

• 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

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Disparities

• Main issues
• Lack of access
• Lack of oral health literacy
• Ultimate Goal
• Reduce disparities in oral cancer mortality and
  morbidity

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Oral Cavity and Oropharyngeal Prevention
Committee MembersThank 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

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Questions?