The stark reality of oral cancer in Northern Ireland requires immediate action – starting with a joined up cancer and oral health strategy.
Oral cancer is on the rise.
Tragically, most patients are currently presenting with late stage cancer. If we are to prevent more needless suffering and increasing morbidity rates, we must take immediate action. Causal factors are common to other cancers and chronic health conditions, so this is a systemic issue requiring a systemic approach.
I was recently invited by the Chair of the All Party Group on Cancer to present to MLAs at Stormont. I put it to them that with oral cancer cases rising across the UK, Northern Ireland could lead the way with a joined-up cancer and oral health strategy.
Here is an overview of the case I made and what you need to know about oral cancer, more precisely referred to as head and neck cancers, in Northern Ireland.
Socioeconomic patterns cannot be ignored
The current statistics for head and neck cancers paint a bleak picture.
“In a pattern seen across the rest of the UK, the vast majority of cases are coming from the most socially deprived areas.”
Traditionally a disease of older men, the average age of onset is decreasing and we are seeing increasing cases in women. In a pattern seen across the rest of the UK, the vast majority of cases are coming from the most socially deprived areas.
These areas are typically where we encounter endemic causal factors such as high rates of smoking and alcohol consumption as well as poor quality diets.
Unfortunately these are not patients who typically engage with the healthcare system, and where we also see the highest rates of other chronic health conditions such as cardiovascular disease and diabetes.
This is why it is vital that oral health is seen as being part of overall health. People need to be made aware that the risks involved with these practices extend to their oral health. Raising awareness of head and neck cancer is essential and a prime example of this.
Public awareness needs to be raised
The Oral Health Foundation found that 75% of adults in the UK could not identify the main signs and symptoms of head and neck cancers. This is something that needs to be addressed urgently.
“75% of adults in the UK could not identify the main signs and symptoms of head and neck cancers.”
In Northern Ireland, 60% of patients are presenting with late stage cancer (Stage III and IV), a problem that has likely been exacerbated by the impact of COVID-19.
Raising awareness of the risk factors and signs carries significant implications for the type of treatments that can be provided and whether it can be curative or merely palliative. This would have an enormous impact on survival and mortality rates.
GDPs are leading the screening efforts and are best placed to assess and refer patients presenting with symptoms for the appropriate care.
However, a third of adults in Northern Ireland are not registered with a general dentist. This, combined with the lack of public awareness around the disease, means that only 34% of head and neck cancer sufferers are being diagnosed at the dentist while a slightly higher percentage are presenting to their GP.
GPs do tremendous work in this area, but it's always more appropriate for patients experiencing any oral issues to visit their dentist. The prognosis when caught in its earlier stages is significantly better.
With cancer screenings included with every check up, it is vital that people are aware that dentists are best placed to monitor any potential signs and that they attend regularly.
A new way forward
A new cancer policy for Northern Ireland is set to be launched in the near future - and head and neck cancer must be embedded within this.
It is similarly vital that it is embedded in a new oral health policy to raise public awareness of the signs and symptoms and appropriate route to care. The full impact of COVID-19 on cancer rates and oral health is yet to be seen, so urging the public to see their dentist if they notice any of the signs and symptoms of oral cancers could not come at a more important time.
“I am optimistic that we can make significant inroads and begin to change the current picture.”
I am proud of the work the BDA have done so far, in partnership with Cancer Focus NI, to get head and neck cancer on the agenda. I was very encouraged by the level of engagement by MLAs during our meeting, which was also attended by the acting CDO, Dr Michael Donaldson, at Stormont last week.
We now have the opportunity to work with Professor Mark Lawler, an internationally recognised expert in cancer involved in international and cross-border initiatives, on data gathering and hopefully future research projects.
Working together with Cancer Focus, our political colleagues and the acting CDO on a joined-up strategy, I am optimistic that we can make significant inroads and begin to change the current picture.
Looking ahead
Dentistry, and the healthcare system more broadly, are still recovering from the seismic shock of dealing with COVID-19. The current trajectory may be very concerning, but we have the opportunity for these vital messages to form part of our recovery plan as we try to build back better.
My hope is that, going forward, oral health will not be viewed as something separate but as part of general systemic health. We will continue to work tirelessly to this end and to turn the tide on this important issue.
Gerry McKenna
Chair of the BDA Hospitals Group, NI Division
