|Year : 2022 | Volume
| Issue : 2 | Page : 115-121
Oral cancer awareness and attitude toward its screening among health-care practitioners in Saudi Arabia
Hattan A Zaki1, Rahaf S Almukhlifi1, Somaya S Alrowaithi2, Mahir A Mirah3, Roqia Abdoh4, Muhannad M Kaaki1, Ismail Abdouh1
1 Department of Oral Basic and Clinical Sciences, College of Dentistry, Taibah University, Medina, Saudi Arabia
2 Staff Dentist at Prince Mohammad Bin Abdulaziz Hospital, Medina, Saudi Arabia
3 Department of Restorative Dental Sciences, College of Dentistry, Taibah University, Medina, Saudi Arabia
4 Department of Prosthodontic, Ministry of Health, King Fahad Hospital, Specialized Dental Center, Medina, Saudi Arabia
|Date of Submission||30-Mar-2022|
|Date of Decision||08-Apr-2022|
|Date of Acceptance||27-Apr-2022|
|Date of Web Publication||31-Aug-2022|
Dr. Hattan A Zaki
Department of Oral Basic and Clinical Sciences, College of Dentistry, Taibah University, Prince Mohammed Bin Abdulaziz Street, Al Madinah Al Munawarah City
Source of Support: None, Conflict of Interest: None
Introduction: Oral cancer (OC) is a major health problem globally; it is the sixth-most common cancer worldwide, affecting anywhere in the oral cavity and associated with multiple risk factors, including the awareness and practices from medical and dental practitioners regarding OC.
Aim: This study aims to explore the level of awareness of medical and dental practitioners regarding OC and attitude toward its screening in Saudi Arabia, Madinah.
Materials and Methods: A cross-sectional study was conducted between December 2020 and March 2021 among medical and dental students, interns, and practitioners in Madinah. A total of 265 participants were included in the survey. Data were collected and statistically analyzed and the significance level was set at (P < 0.05).
Results and Discussion: About 86.9% of the participants were belongs to the dental field, while 13.6% were from the medical field. Half of the respondents (50.2%) were not sure if they feel confident regarding their knowledge concerning the prevention and detection of OC. About 53.8% indicated that they usually do not perform OC screening. However, 88.7% of the respondents are willing to know more information about OC. Dental practitioners were significantly feeling more confident in their knowledge concerning the prevention and detection of OC (P = 0.001). However, a higher number of medical practitioners (44.4%) indicated that they were poorly informed about OC clinical appearances (P = 0.001).
Conclusion: This study highlighted the importance of improving knowledge and awareness of medical and dental practitioners regarding OC in Madinah Western Saudi Arabia. Current results demonstrate that medical and dental practitioners should be encouraged to take an active role in raising awareness about OC, its signs and symptoms and the associated risk factors; hence, this can aid in the early detection of OC among relevant population.
Keywords: Cancer awareness, cancer screening, oral cancer, oral health, oral health-care knowledge
|How to cite this article:|
Zaki HA, Almukhlifi RS, Alrowaithi SS, Mirah MA, Abdoh R, Kaaki MM, Abdouh I. Oral cancer awareness and attitude toward its screening among health-care practitioners in Saudi Arabia. Saudi J Oral Sci 2022;9:115-21
|How to cite this URL:|
Zaki HA, Almukhlifi RS, Alrowaithi SS, Mirah MA, Abdoh R, Kaaki MM, Abdouh I. Oral cancer awareness and attitude toward its screening among health-care practitioners in Saudi Arabia. Saudi J Oral Sci [serial online] 2022 [cited 2022 Oct 5];9:115-21. Available from: https://www.saudijos.org/text.asp?2022/9/2/115/355220
| Introduction|| |
Cancer is the uncontrolled division of abnormal cells that can invade nearby tissues, organs, and spread to other parts of the body, which can lead to death. Cancer was evident and recorded in humans and animals before about 3000 BC. Since then, scientists are trying to find a cure for this lethal disease. However, there are many treatment modalities for cancer that can increase the survival rate of these patients. Cancer can invade any site of the body mostly the lungs, breast, and colorectal, but it can also come in the oral cavity and pharynx.
Oral and oropharyngeal cancer is the sixth-most common cancer worldwide, with an annual incidence of 630,000 cases which is higher in developing countries.,, It can appear anywhere in the oral cavity; however, the most common cancer in this region is squamous cell carcinoma. The risk of oral cancer (OC) can increase with the use of tobacco, alcohol drinking, ultraviolet exposure, and human papillomavirus. Similarly, males and people older than 50 years old are more likely to develop OC than women and people younger than 50.,,
Unfortunately, most of the patients are diagnosed in the late stage of the disease, which can be detected earlier by prober diagnosis during regular dental check-up; therefore, it has high morbidity and mortality rates.,, This delay in diagnosis can be either from patients or health-care professionals (HCP)., Around 63.5% of patients seek professional help after 3–4 months since the first symptom. The high morbidity associated with the disease, such as disfigurement, dysarthria, dysphagia, and difficulties in mastication, affects life quality. Avoiding the risk factors and raising awareness among the population and HCP can aid to early detection and reducing the incidence, morbidity, and mortality rates can be achieved.,,
In Saudi Arabia (SA), OC is the third-most common cancer. A review conducted by Basha et al. showed that the prevalence of OC in SA varied from 21.6% to 68.6%. The main risk factors in the Saudi population are smoking and smokeless tobacco in 21.4% of the cases.,, In Jazan, the use of smokeless tobacco such as Shammah and Qat is more common in females than males. This can explain why the ratio of male-to-female is 0.7:1, which is in contrast to what was published in the American Cancer Society for the rest or the world.,
Several studies worldwide assessed the level of awareness regarding OC among medical and dental students and practitioners.,,,, A study done in Riyadh assessed the awareness of OC among dental and medical practitioners. It showed that more than 33% of the practitioners have a low level of knowledge regarding OC risk factors and its signs and symptoms.
To our best knowledge, no study assessed the level of OC awareness among the population and health-care providers in Madinah. The aim of this study was to investigate the level of OC awareness and attitude toward its screening among the general population, dental and medical students, interns, and practitioners. This study's results helped identify the gaps and therefore assess the need for educational programs. The objectives were to assess the awareness of the general population regarding OC, its risk factors and screening, clinical presentations and the team involved in treating it, and to assess the awareness of medical and dental fields regarding OC, its risk factors, clinical presentations, attitude toward its screening, and the team involved in treating it.
| Materials and Methods|| |
A cross-sectional descriptive observational study was conducted to investigate the level of OC awareness and attitude toward its screening among medical and dental students, interns, and health-care practitioners in Madinah, Saudi Arabia. This study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Research Ethics Committee of the College of Dentistry at Taibah University (TUCDREC), study reference number (No. 03122020). A convenient sampling technique was used during the period from December 2020 to March 2021. The data were obtained through electronic anonymous self-administered questionnaire, which was designed and validated. The questionnaire was written in English, targeting a sample size of 265. The estimated number of students, interns, and health-care practitioners from all government and private medical and dental facilities in Madinah was 6097. According to the Ministry of Health website, the number of health-care practitioners in the medical and dental fields is 4541. The estimated number of medical students and interns at Taibah University (TU) is 840, and at AlRayan Colleges is 400. The number of dental students and interns at TU is 316.
Students, interns, general practitioners, residents, specialists, and consultants from both medical and dental fields were included in the study. The introductory section at the beginning of both questionnaires includes the aim of the study. Furthermore, it includes information about the voluntary nature of their decision to participate, the protection of their privacy and confidentiality. They were informed that the questionnaire is anonymous, and their completion of the questionnaire was considered indicative of their consent to participate.
The questionnaire consisted of 21 items. Some items of the questionnaire were taken from the National Cancer Institute. It is structured in six sections:
(1) Demographic data, (2) Awareness regarding OC, (3) Risk factors of OC, (4) OC screening, (5) Signs and symptoms of OC, and (6) The team involved in treating OC.
Data were collected, coded, and analyzed using the Statistical Package for Social Sciences (SPSS) software version 27.0 (IBM Corp., Armonk, NY, USA). Parametric and nonparametric tests have been used, and the level of significance was at (P < 0.05).
| Results|| |
[Table 1] shows the frequency and percentage of the demographic characteristics of the respondents. Numbers and percentages were used to summarize each variable. Almost half of the population were female, while 46.4% were males with an age range between 19 and 56 years. With respect to their educational level, most of the respondents were students, 38.5%, while 23.4% were interns, 19.4% were general practitioners, 11.7% were consultants, 4.5% were residents, while only 2.3% were specialists.
Awareness and risk factors regarding oral cancer
[Table 2] shows the frequency distribution of participant responses regarding awareness and risk factors of OC. Most of the respondents, 74.7%, indicated that OC includes cancer in both the mouth and pharynx. A higher number of female respondents (75.4%) indicated they take a detailed medical history when they see a new patient compared to male respondents (66.7%) (P = 0.026). About 67.5% indicated brush biopsy as a method for the diagnosis of OC, while nearly similar results were reported for using other methods for diagnosis of OC such as exfoliative cytology, fluorescent imaging, toluidine blue, and scalpel biopsy.
|Table 2: Frequency distribution of participant responses regarding awareness and risk factors of oral cancer|
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Half of the respondents were not sure if they were confident in their knowledge concerning the prevention and detection of OC. About 29.4% were confident in their knowledge concerning prevention and detection of OC, while 20.4% indicated they were not confident in their knowledge concerning prevention and detection of OC. A higher number of male respondents (39%) indicated they are very confident in their knowledge concerning the prevention and detection of OC to female respondents (21.1%). Furthermore, a higher number of respondents in the dental field (32.3%) indicated that they are very confident in their knowledge concerning the prevention and detection of OC to respondents from the medical field (11.1%). There was a statistically significant association between respondents' gender, field and if they are confident in their knowledge concerning prevention and detection of OC (P = 0.001 and P = 0.001, respectively). Furthermore, 88.7% of the respondents were willing to know more information about OC. Different values have been reported regarding the risk factors for OC, with the highest number related to tobacco and having a history of OC 97.4%, 92.1%, respectively [Table 2].
Oral cancer screening
[Table 3] shows the frequency distribution of participant responses regarding screening of OC. A Chi-square test of association was conducted between respondents' gender and if they are confident in when performing OC screening. A higher number of male respondents (35%) indicated that they are very confident when performing OC screening to female respondents (12.8%) (P < 0.001).
|Table 3: Frequency distribution of participant responses regarding screening of oral cancer|
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The present results highlighted that 60.8% of the respondents hardly complete a comprehensive OC screening and only 9.1% of them indicated that they often complete a comprehensive OC screening. About 14.6% of males often complete a comprehensive OC screening, while 4.2% of females often complete this screening (P = 0.031).
Signs and symptoms of oral cancer
[Table 4] shows the frequency distribution of participant responses regarding signs and symptoms of OC, the most common suggested sites for OC and what OC screening should include. Furthermore, knowledge regarding the appearance of OC and its associated changes have been evaluated. There was a statistically significant association between respondents' gender and field and how they feel about OC clinical appearance (P < 0.001 and P = 0.001), respectively. A higher number of male respondents (12.2%) indicated that they were very well informed about oral clinical appearances, while 4.2% of female respondents indicated they were very well informed. Furthermore, none of the medical field respondents were very well informed about OC appearance, while a higher number of dental field respondents (45.3%) indicated that they were adequately informed about oral clinical appearances.
|Table 4: Frequency distribution of participant responses regarding signs and symptoms of oral cancer|
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The team involved in treating oral cancer
[Table 5] shows the frequency of the participant responses regarding the team involved in treating OC. About 52% of males indicated they do not know the number of team members involved in treating OC, 27.6% indicated 5 team members, 14.6% indicated 10 team members, while 5.7% indicated 14 team members. About 69% of females indicated that they do not know the number of team members involved in treating OC, 18.3% indicated 5 team members, 9.2% indicated 10 team members, while 3.5% indicated 14 team members. There was a statistically significant association between respondents' gender and how many team member they thinks should be involved in treating oral (P = 0.046).
|Table 5: Frequency table of the participant responses regarding the team involved in treating oral cancer|
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Regarding patients' referral, different values have been reported and there was a statistically significant association between respondents' gender, field and who they would refer a patient to when they suspect oral malignancy P = 0.015 and P < 0.001), respectively. About 70.7% of male respondents indicated that they would refer a patient to an oral medicine specialist when suspected of having oral malignancy, 26.8% of them would refer them to an oral and maxillofacial surgeon, 1.6% would refer them to a dentist, while 0.8% would refer them to an otolaryngologist. A higher number of the female respondents would also refer them to an oral medicine specialist, 19% would refer them to an oral and maxillofacial surgeon, 9.2% would refer them to an otolaryngologist, while 2.1% would refer them to a dentist. Furthermore, 47.2% of respondents from the medical field indicated that they would refer a patient to an oral medicine specialist, 27.8% to an otolaryngologist, 22.2% to an oral and maxillofacial surgeon and 2.8% to a dentist. A higher number of respondents (72.9%) who are from the dental field would also refer them to an oral medicine specialist, 22.7% to an oral and maxillofacial surgeon, 1.7% to either otolaryngologist or dentist.
Different values have been reported regarding who should be involved in treating OC patients. Variety of specialties have been chosen, with most of the respondents (90.2%) indicating that oral and maxillofacial surgeons to be involved in treating OC, 87.9%, 81.1% indicated oral pathology and oral medicine specialists, respectively, while 70.6% indicated radiation oncologists to be involved in treating OC.
| Discussion|| |
This study was designed to assess the level of awareness and knowledge regarding OC among medical and dental fields in Madinah, its risk factors, OC screening, signs and symptoms, and the team involved in treating it. As evident, OC is commonly diagnosed at an advanced stage which leads to increased mortality. Early diagnosis and management of those patients could increase the survival rate as it would help in appropriate and effective treatment; hence, each cancer type requires a specific treatment regimen. In our study, only half of the participants (51.1%) chose that they will use scalpel biopsy to diagnose OC, while it is known to be the gold standard method to diagnose this disease. In addition, around (88.7%) of the participants stated that they are willing to know more information about OC. However, almost half of the participants (50.2%) are not sure about their knowledge level concerning detecting the disease, and (20.4%) are not confident in their knowledge level.
Regarding risk factors of OC, in a study done by Awan, et al., 62.4%) of the respondents stated that smoking is a risk factor. However, a study done by Basheer et al. has a similar result to ours, in which 97.3% and 86.4% of the participants identified tobacco smoking and tobacco chewing as risk factors, respectively. In this study, most of the participants (97.3%) identified tobacco as a risk factor.
In terms of considering alcohol drinking as a risk factor, a study done Basheer et al., 51.1% of participants agreed it is a risk factor. Moreover, in a study done by Awan et al., only 17.6% identified alcohol as a risk factor. However, in the present study, 85.2% considered it as a risk factor. For betel quid use, in a study done by Awan et al., 55.3% of respondents consider it as a risk factor. On the other hand, only 29.5% in the current study stated it is a risk factor.
Indeed, the posterolateral surfaces of the tongue and the floor of the mouth are high-risk areas for OC. In some countries in Asia, buccal mucosa is a common OC site due to tobacco chewing habits. In our study, when the participants were asked about high-risk sites, 87.2% reported the tongue, 43.8% floor of the mouth, and only 38.1% chosen buccal mucosa. This was inconsistent with the study done in Malaysia (24); where up to 61.9% of the participants considered the tongue, 56.5% floor of the mouth, and 57.3% buccal mucosa are the most common sites for developing OC. In our study, more participants identified nonhealing ulcer for 2 weeks (83.8%) to be a very important predisposing condition when compared to erythroleukoplakia (59.2%). Comparable results were reported by Basheer et al. in Riyadh, Saudi Arabia; she stated that 82.4% of the participants identified nonhealing ulcers as the most common clinical presentation for OC compared to erythroleukoplakia where only (65%) chose it. On the other hand, Awan et al. stated that most of the participants (65.7%) reported leukoplakia as the most common sign for OC.
The majority of the participants in this study are considered primary health-care providers for both medical and dental fields. Usually, they spend more time with the patients and see a higher number of patients compared to other consultants/specialists. As a result, it is recommended to raise the awareness for all health-care providers, especially primary care providers, with regard to known risk factors, most common sites and early signs for OC in order to refer the patients to receive the required treatment. In our study, 69.3% of the participants would refer the patient to the oral medicine specialist if they suspected OC, and only (22.7%) would refer the patient to oral and maxillofacial surgeon. However, a study done by Basheer et al. stated that only 41.8% and 39.8% would refer the patient to oral and maxillofacial surgeon and oral medicine specialist, respectively.
Limitations of this study could be attributed to the variation in the years of experience as the participants in the questionnaire were from different group of ages, thus disclosing a wide variation in the level of education. Furthermore, the participants have different backgrounds as they graduated from different institutes and universities and subjected to different undergraduate curriculums and training programs. In addition, using electronic questionnaire led to low response rates as the participants usually are less likely to stay fully engaged for a survey of more than 8–10 min than with other research methods. Despite these limitations, this study provides useful information on the level of awareness about OC among HCPs in Medina, and it allows a rational understanding of the educational needs. However, suggestions for future work would be to further evaluate and provide an indication of the level of awareness of OC among HCPs and the willingness to treat patients with OC in a larger sample size. In view of the present results, there is perhaps sufficient evidence for the need to provide more education and training for HCPs regarding the OC and related oral health-care modalities.
| Conclusion|| |
Although OC is considered upsettingly high mortality disease with challenging treatment outcomes, health-care providers can play a crucial role in identifying health risks and providing advice and support for patients with OC. Unfortunately, current results revealed that the level of awareness about OC is low among HCPs in Medina, western Saudi Arabia. However, it showed that the HCPs are interested in receiving additional information about OC. Thus, increasing the level of knowledge about OC, its risk factors, and clinical presentation will significantly aid in prevention and early detection. Nevertheless, more efforts should be directed toward HCPs aiming to construct a detailed information on associated risk factors, clinical presentation, diagnosis, treatment options and prognosis, as well as information on the presumed adverse therapeutic side effects and more general advice on any related habits (e.g. tobacco smoking cessation, alcohol consumption, maintaining a healthy balanced diet, maintaining good oral hygiene and regular review by a general dental practitioner). Therefore, it is essential that HCPs are aware of the signs and symptoms of OC, able to effectively screen and refer patients appropriately.
This study has been conducted according to the guidelines of the Declaration of Helsinki and was approved by the TUCDREC, study reference number (No. 03122020).
All authors contributed to the work reported in this paper. This included conception, study design was done by HZ and MM, data collection acquisition and analysis were done by MK, RA and SA, interpreting the results and manuscript written by RA and IA. In addition, the authors contributed to the literature review, drafting, revising, and critically commenting on the article. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]