Maryland Maryland Comprehensive Cancer Comprehensive Cancer

Control PlanControl Plan

Oral Cavity and Oral Cavity and Oropharyngeal Cancer Oropharyngeal Cancer Prevention CommitteePrevention Committee

MethodsMethods

Examined issuesExamined issues Reviewed dataReviewed data Identified problems and Identified problems and

solutionssolutions Developed flow chartDeveloped flow chart

Risk FactorsRisk Factors

TobaccoTobacco CigarettesCigarettes CigarsCigars SnuffSnuff Spit tobaccoSpit tobacco PipesPipes

AlcoholAlcohol Sunlight – lip cancerSunlight – lip cancer Lack of fruits and vegetablesLack of fruits and vegetables Viruses – e.g., Human papilloma virusViruses – e.g., Human papilloma virus

The ProblemThe Problem

Oral Cancer in MarylandOral Cancer in Maryland

Maryland ranks 8th in mortality Maryland ranks 8th in mortality among all statesamong all states

6th highest mortality rate in the US 6th highest mortality rate in the US for African American menfor African American men

5-year survival rate in Maryland for 5-year survival rate in Maryland for African Americans is 33% (whites - African Americans is 33% (whites - 55%)55%)

Nearly a 15% higher death rate from Nearly a 15% higher death rate from oral cancer in Maryland than the USoral cancer in Maryland than the USRies et. al. SEER Cancer Statistics review, 1973-Ries et. al. SEER Cancer Statistics review, 1973-19961996

Oral Cancer Mortality Oral Cancer Mortality RatesRates

MarylandMarylandMaryland Oral & Pharyngeal Cancer

Mortality Rates by Gender

0123456

1992 1993 1994 1995 1996

Rat

es p

er 1

00,0

00

Po

pu

lati

on

MD males MD females US males US females

Figure 3: Oral Cancer in Maryland: A Longitudinal Analysis 1992-1996. Maryland Cancer Registry and the Office of Oral Health, Maryland Department of Health and Mental Hygiene

HP 2010 Oral Cancer HP 2010 Oral Cancer ObjectivesObjectives

Objective 21-6 – Oral Cancer StagingObjective 21-6 – Oral Cancer Staging Increase the proportion of oral and pharyngeal Increase the proportion of oral and pharyngeal

cancers detected at the earliest stagecancers detected at the earliest stage Target: 50 percentTarget: 50 percent Baseline: 35 percent of oral and pharyngeal cancers Baseline: 35 percent of oral and pharyngeal cancers

(stage I, local )(stage I, local )Objective 21-7 – Oral Cancer ExaminationsObjective 21-7 – Oral Cancer Examinations

Increase the proportion of adults who, in the past 12 Increase the proportion of adults who, in the past 12 months, report having an examination for oral and months, report having an examination for oral and pharyngeal cancerspharyngeal cancers Target: 20 percentTarget: 20 percent Baseline: 13 percent of adults aged 40 years and Baseline: 13 percent of adults aged 40 years and

olderolderObjective 3-6 - Oral Cancer Mortality RateObjective 3-6 - Oral Cancer Mortality Rate

Reduce the oral and pharyngeal cancer death rateReduce the oral and pharyngeal cancer death rate Target: 2.7 deaths per 100,000 populationTarget: 2.7 deaths per 100,000 population Baseline: 3.0 deaths per 100,000 population in 1998 Baseline: 3.0 deaths per 100,000 population in 1998

(age adjusted to(age adjusted to the year 2000 standard population) the year 2000 standard population)

Oral Cancer Stage 1 Oral Cancer Stage 1 DiagnosisDiagnosisMarylandMaryland

Percent of Oral Cancer Cases Diagnosed at Stage 1

35.1

50

0102030405060

1Stage I Diagnosis Maryland Stage I Diagnosis Healthy People 2010 Goal

Figure 4: Oral Cancer in Maryland: A Longitudinal Analysis 1992-1996. Maryland Cancer Registry and the Office of Oral Health, Maryland Department of Health and Mental Hygiene

Oral Cancer PreventionOral Cancer PreventionTheThe Maryland State ModelMaryland State Model

Phase I -Phase I - Needs AssessmentNeeds Assessment

Phase II -Phase II - Development and Development and Pilot Testing of Educational Pilot Testing of Educational InterventionsInterventions

Phase III -Phase III - Program EvaluationProgram Evaluation

Oral Cavity and Oral Cavity and Oropharyngeal Cancer Oropharyngeal Cancer

Prevention Prevention CommitteeCommittee

Proceedings and Proceedings and RecommendationsRecommendations

Oral CancerOral CancerEarly Detection and DiagnosisEarly Detection and Diagnosis

Access to dental services disparity Access to dental services disparity Limited for those populations at highest riskLimited for those populations at highest risk

PoorPoor AdultsAdults Older adultsOlder adults

More likely to visit a physician, family nurse More likely to visit a physician, family nurse practitioner or physician’s assistant than practitioner or physician’s assistant than dentistdentist

Oral cancer examination responsibility of all Oral cancer examination responsibility of all health care practitionershealth care practitioners

Addressing Oral Cancer Addressing Oral Cancer PreventionPreventionMain IssuesMain Issues

Lack of oral cancer literacyLack of oral cancer literacyAwarenessAwarenessBehaviorBehavior

DisparitiesDisparitiesEducation and awarenessEducation and awarenessMortalityMortalitySurvival Survival AccessAccess

Addressing Oral Cancer Addressing Oral Cancer PreventionPreventionMain FocusMain Focus

Direct oral cancer literacy for:Direct oral cancer literacy for: PublicPublic Healthcare ProvidersHealthcare Providers MediaMedia Policy MakersPolicy Makers

Address disparitiesAddress disparities Intertwined with lack of literacy Intertwined with lack of literacy Access to servicesAccess to services

Oral Cancer LiteracyOral Cancer Literacy What Everyone Needs to KnowWhat Everyone Needs to Know

Public, health care providers, Public, health care providers, policymakers and mediapolicymakers and media Risk assessment and risk reductionRisk assessment and risk reduction Risk factorsRisk factors Signs and symptomsSigns and symptoms Behavior modificationBehavior modification

Public to request oral cancer examinationPublic to request oral cancer examination Providers to incorporate adequate oral Providers to incorporate adequate oral

cancer examination into standard of carecancer examination into standard of care Adequacy of oral cancer examinationAdequacy of oral cancer examination Frequency of oral cancer examinationFrequency of oral cancer examination

PublicPublic Educational interventionsEducational interventions

SchoolsSchools WorkplaceWorkplace HospitalsHospitals Faith-based institutionsFaith-based institutions Recreational and sports organizationsRecreational and sports organizations

Develop messages targeted to different Develop messages targeted to different needs and values of the communityneeds and values of the community Those engaged in risk behaviorsThose engaged in risk behaviors Those not engaged in risk behaviorsThose not engaged in risk behaviors Culturally appropriateCulturally appropriate Age and gender appropriateAge and gender appropriate

Literacy to lead to use of appropriate Literacy to lead to use of appropriate screening, referral, follow-up & treatment screening, referral, follow-up & treatment servicesservices

Healthcare ProvidersHealthcare Providers Provider education specific to primary care Provider education specific to primary care

providers (PCP) and dental health professionalsproviders (PCP) and dental health professionals No dental coverage for Maryland adults under No dental coverage for Maryland adults under

MedicaidMedicaid Medicare does not cover dental services Medicare does not cover dental services Maryland adults have medical coverage under Maryland adults have medical coverage under

Medicaid and Medicare and will visit PCPMedicaid and Medicare and will visit PCP Curriculum ChangeCurriculum Change

Make oral cancer exams part of standard of care and Make oral cancer exams part of standard of care and practice for all health care providerspractice for all health care providers

CME/CEUsCME/CEUs Lead to appropriate screening, referral, Lead to appropriate screening, referral,

treatment and follow-up servicestreatment and follow-up services

MediaMedia Plays key role in increasing awareness of Plays key role in increasing awareness of

both healthcare providers and the publicboth healthcare providers and the public Immediate access to mass populationImmediate access to mass population Public service announcementsPublic service announcements Paid advertisementsPaid advertisements Explore what is the best form of Explore what is the best form of

communication to reach specific communication to reach specific communitiescommunities Talk radio Television Print

Policy MakersPolicy Makers Education targeted to policy makers and Education targeted to policy makers and

advocatesadvocates Issues to be addressed: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

Oral Cancer Literacy

Provider*Provider*

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

Provider EducationProvider

EducationPCPPCP

Dental Health Professionals

Dental Health Professionals

Curriculum ChangeCurriculum ChangeCME/CEUsCME/CEUs

Curriculum ChangeCurriculum Change

CME/CEUsCME/CEUs

Use and provide

appropriate

screening, referral,

follow-up, and

treatment

Use and provide

appropriate

screening, referral,

follow-up, and

treatment

Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, WebsiteGovernment, Providers

Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, WebsiteGovernment, Providers

*What everyone needs to know:

Risk assessment and risk reduction Risk factors Signs and symptoms Oral cancer exam- steps Frequency of oral cancer exam

*What everyone needs to know:

Risk assessment and risk reduction Risk factors Signs and symptoms Oral cancer exam- steps Frequency of oral cancer exam

Awareness

Awareness

Oral Cancer Prevention, Early Detection, and Oral Cancer Prevention, Early Detection, and Treatment ModelTreatment Model

Public*Public*

Media*Media*

Policy Makers*Policy

Makers*

DisparitiesDisparities

Main issuesMain issues Lack of accessLack of access Lack of oral health literacyLack of oral health literacy

Ultimate GoalUltimate Goal Reduce disparities in oral Reduce disparities in oral

cancer mortality and morbiditycancer mortality and morbidity

Oral Cavity and Oropharyngeal Oral Cavity and Oropharyngeal Prevention Committee MembersPrevention Committee Members

Thank You!Thank You! Albert Bedell, PhD - Maryland Academy of General DentistryAlbert Bedell, PhD - Maryland Academy of General Dentistry Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck

SurgerySurgery Catherine Carroll, CRNP - Chase Brexton Health Services, Inc.Catherine Carroll, CRNP - Chase Brexton Health Services, Inc. Harry Goodman, DMD - University of Maryland Dental SchoolHarry Goodman, DMD - University of Maryland Dental School Alice M. Horowitz, PhD – National Institute of Dental and Craniofacial Alice M. Horowitz, PhD – National Institute of Dental and Craniofacial

Research Research Robert D. Jones, DDS - Maryland Association of Community Dental Robert D. Jones, DDS - Maryland Association of Community Dental

Programs and Maryland State Dental AssociationPrograms and Maryland State Dental Association Fred Magaziner, DDS - American Academy of General Dentistry and Fred Magaziner, DDS - American Academy of General Dentistry and

American College of DentistsAmerican College of Dentists Ilise Marrazzo, MPH (Chairperson) – Dept. Health and Mental Hygiene, Ilise Marrazzo, MPH (Chairperson) – Dept. Health and Mental Hygiene,

Office of Oral HealthOffice of Oral Health Kelly Sage, MS – Dept. Health and Mental Hygiene, Office of Oral HealthKelly Sage, MS – Dept. Health and Mental Hygiene, Office of Oral Health Yale Stenzler, EdD - Oral Cancer SurvivorYale Stenzler, EdD - Oral Cancer Survivor Sheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' AssociationSheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' Association Rodney Taylor, MD - University of Maryland Department of OtolaryngologyRodney Taylor, MD - University of Maryland Department of Otolaryngology Brooks Woodward, DDS - Chase Brexton Health Services, Inc.Brooks Woodward, DDS - Chase Brexton Health Services, Inc. David Zauche - American Cancer SocietyDavid Zauche - American Cancer Society

Questions?Questions?