PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
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Latedetectionanddelayedtreatment ‐SystematicreviewconclusionsAsystematicreviewwascompletedregardingthefactorsassociatedwithpatientdelaysinceasubstantialnumber<strong>of</strong>patientsdelayseekingtreatmentaftertheirself‐discovery<strong>of</strong>symptoms<strong>of</strong>oralcancer.Itwasdeterminedthatthereasonsfordelaysarepoorlyunderstoodandthereisnotadequateresearchtoestablishdefinitiverelationships(Scott,CommunityDentOralEpidemiol2006;34:337‐343).InacommentaryontheScottpaperpublishedinEvidenceBasedDentistry,thatfollowingstatementwasmade:“Thereremainsalack<strong>of</strong>awareness<strong>of</strong>mouthcanceramongstpatientsandpr<strong>of</strong>essionalswhichmaycontributetopatientdelay.”ThecommentaryalsostatedthattreatmentdelaysraisetheissueastowhetherascreeningprogramshouldbeintroducedbutthecurrentUnitedKingdompolicy(www.library.nhs.uk/screening/viewResource.aspx?searchText=Oral+Cancer&resID=61087)isthatscreeningprogramsshouldnotbe<strong>of</strong>feredbuthealthpr<strong>of</strong>essionalsshouldbeencouragedtoperformscreenings(Richards,Evidence‐BasedDentistry2007;8:21).Race/ethnicityCancers<strong>of</strong>theoralcavity,pharynx,andlarynxweremoreadvancedatdiagnosisforAfrican‐<strong>American</strong>sandHispanicsthenWhites.The5‐yearsurvivalratesforthesesiteswerealsosignificantlylowerforAfrican‐<strong>American</strong>sthanCaucasians.African‐<strong>American</strong>swerelesslikelytobetreatedfortheircancerthanHispanicsorCaucasians(Shavers,CancerandMetastasisReviews2003;22:25‐28).Inwhites,8.9%<strong>of</strong>tumorshadmetastasizedatthetime<strong>of</strong>diagnosiswhereas19.7%<strong>of</strong>tumorshadmetastasizedinblacksatthetime<strong>of</strong>diagnosis(Tomar,Cancercausesandcontrol2004;15:601‐609).Thefactorscontributingtothepoorersurvival<strong>of</strong>Black<strong>American</strong>scomparedtoWhite<strong>American</strong>swerediagnosisatamoreadvancedstage,socioeconomicstatus,anddifferencesintreatment(Arbes,CancerCausesandControl1999;10:513‐523).OralcancerwasdiagnosedatamoreadvancedstageinBlacksandtheyhadlargertumorsatthetime<strong>of</strong>diagnosis.Theauthorsindicatedthatmany“many<strong>American</strong>swhodonothaveasource<strong>of</strong>regulardentalcaremayreceiveprimarymedicalcare,andmayseeeitheraphysicianoranursepractitionereitherforroutinefollow‐uporonanemergencybasis.Therefore,primarycarephysiciansandnursepractitionerscouldplayanimportantroleintheinitialscreeningfororalcanceriftheyweretrainedinperforminganorals<strong>of</strong>t‐tissueexamination(Shiboski,CommunityDentOralEpidemiol2007;35:233‐240).Afocusgroupapproachwasusedtoevaluateattitudes,knowledge,andhealth‐seekingbehaviours<strong>of</strong>fiveimmigrantminoritycommunities(Haitian,Caribbean,Latino,Korean,andChinese).Theyindicated“theprevalentmisinformationobservedamongallgroupswarrantsthepromptdevelopment<strong>of</strong>culturallycompetentprogramsforcancercontrolwithimmigrantminorities”(Gany,EthnHealth2006;11:19‐39).Theonlinepopulationisbecomingincreasinglydiverse.Sincecancerinformationwebsitesareapopulardestination,onepublicationindicatesa“culturaldigitaldivide”existsandthattheInternetshouldfacilitateweb‐basededucation<strong>of</strong>immigrants(Changrani,JCancerEduc2005;20:183‐186). 102010 CDEL Re-recognition <strong>of</strong> the Specialty Report 194 <strong>of</strong> 279
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