Oral Cancer Screening: Targeting High-Risk South Asian Populations in the United Kingdom
Abstract
South Asians residing in the UK are known to be significantly different in terms of
socio-economic and cultural influences from the UK population in general. They
are at substantially higher risk of developing oral cancer (OSCC) and the
potentially malignant disorder (PMD) oral submucous fibrosis (OSF). To overcome
barriers to conventional health service use, a mobile dental unit was the base for
screening within the South Asian community. Bilingual advocates ensured cultural
acceptability and actively recruited high-risk individuals for screening as well as
being involved at the secondary referral centre to facilitate attendance for definitive
diagnosis of positive screened individuals.
In total 1596 high-risk individuals were screened and 5.4% referred with
suspicious lesions. No OSCC was detected in any positive screened individuals
but PMDs were confirmed in 29%, with dysplasia (15%) and OSF (9%) the
commonest lesions referred. Due to the complex presentation of OSCC the most
appropriate gold standard screening outcome is the detection of individuals who
cannot be discharged from long-term follow-up at the secondary referral centre.
On this basis screening specificity was 99% and Positive Predictive Value (PPV)
79%. The low PPV was attributed to the high prevalence of complex oral mucosal
lesions (46%) that cannot be definitively diagnosed as benign by visual
examination alone, which indicates diagnostic aids are required for screening this
high-risk population.
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Compliance with referral for positive screened individuals was only 76% and
immediate incisional biopsy of positive screened individuals would be needed to
improve this. In addition to histological detection of dysplasia, molecular markers
of disease could readily be investigated by immunohistochemistry and the
expression of keratins are ideal candidates due to their responsiveness to
pathological signalling and abnormal expression in oral (pre)cancer. Analysis of 28
fresh frozen OSF samples and 6 site-matched controls, using a panel of 22
monoclonal antibodies, revealed changes in keratin 17 expression which
correlated with disease severity.
A mobile dental unit staffed by suitably experienced dentists and cultural
advocates and equipped for immediate histological diagnosis of positive screened
individuals is required in order to undertake effective and ethical oral cancer
screening in high-risk UK based South Asian populations.
Authors
Lalli, AnandCollections
- Theses [3822]