ORAL HEALTH

Health Evidence Bulletins - Wales
Team Leader: Mr Tony Glenn

Date of completion: 9/7/1997

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


Oral Cancer

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
4a. A reduction in tobacco use leads to a decreased incidence of oral cancer and precanceri,ii,iii,iv,v.

(Health gain notation - 1 "beneficial")

 

i. Scully C. Oral pre-cancer: preventive and medical approaches to management. Oral Oncology. European Journal of Cancer 1995; 31B (1): 16-26
(Type IV evidence - observational studies);
ii. Boyle P, Macfarlane GJ, Maisonneuve P, Zheng T, Scully C, Tedesco B. Epidemiology of mouth cancer in 1989: a review. Journal of the Royal Society of Medicine 1990; 83: 724-730
(Type IV evidence - observational studies);
iii. Johnson NW, Warnakulasuriya KAAS. Epidemiology and aetiology of oral cancer in the United Kingdom. Community Dental Health 1993; 10 (Suppl.1): 13-29
(Type IV evidence - observational studies);
iv. Gupta PC, Murti PR, Bhosle RB, Mehta FS, Pindborg JJ. Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-year follow-up study of 12,212 users. Oral Diseases 1995; 1: 54-58
(Type IV evidence - observational studies);
v. La Vecchia C, Tavani A, Franceschi S, Levi F, Corrao G, Negri E. Epidemiology and prevention of oral cancer. Oral Oncology 1997; 33(5): 302-312
(Type IV evidence - observational studies)
4b. A reduction in alcohol consumption leads to a decreased incidence of oral cancer and precanceri,ii.

(Health gain notation - 1 "beneficial")

i. Scully C. Oral pre-cancer: preventive and medical approaches to management. Oral Oncology. European Journal of Cancer 1995; 31B (1): 16-26
(Type IV evidence - observational studies);
ii. Johnson NW, Warnakulasuriya KAAS. Epidemiology and aetiology of oral cancer in the United Kingdom. Community Dental Health 1993; 10(Suppl.1): 13-29
(Type IV evidence - observational studies);

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4c. An increased consumption of fruit and vegetables leads to a decreased incidence of oral cancer and precanceri,ii,iii,iv.

(Health gain notation - 1 "beneficial")

i. Scully C. Oral pre-cancer: preventive and medical approaches to management. Oral Oncology. European Journal of Cancer 1995; 31B (1): 16-26
(Type IV evidence - observational studies);
ii. Boyle P, MacFarlane GJ, Blot WJ, Chiesa F et al.. European School of Oncology Advisory Report to the European Commission for the Europe Against Cancer Programme: Oral Carcinogenesis in Europe. Oral Oncology. European Journal of Cancer 1995; 31B (2): 75-85
(Type IV evidence - observational studies);
iii. La Vecchia C, Franceschi S, Levi F, Lucchini F, Negri E. Diet and human oral carcinoma in Europe. Oral Oncology. European Journal of Cancer 1993; 29B (1): 17-22
(Type IV evidence - observational studies);
iv. Johnson NW, Warnakulasuriya KAAS. Epidemiology and aetiology of oral cancer in the United Kingdom. Community Dental Health 1993; 10(Suppl.1): 13-29
(Type IV evidence - observational studies)
4d. Health education of ‘at risk’ groups in the prevention of oral cancer appears promising but requires further evaluationi. Further research is recommended.
(Health gain notation - 2 "likely to be beneficial")
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain.
Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
4e. Education of medical and dental professionals in the prevention of oral cancer appears promising but requires further evaluationi.
(Health gain notation - 2 "likely to be beneficial")
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain.
Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)

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4f. Early diagnosis of oral cancer can dramatically increase survival i. Further research is recommended to evaluate the effect of early diagnosis on survival rates.
(Health gain notation - 1 "beneficial")
i. Silverman S. Early diagnosis of oral cancer . Cancer 1988; 62: 1796-1799(112)
(Type V evidence - expert opinion)
4g. The following approach to diagnosis and assessment of oral cancers is recommended i: history, visual examination of soft tissue, palpation, biopsy, radiographs (xrays), computerised tomography (CT) scans.
(Health gain notation - 1 "beneficial")
i. Welsh Health Planning Forum. Oral Health. Protocol for Investment in Health Gain. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
4h. Effective treatment and care for individuals with oral cancer includes surgery, radiotherapy, chemotherapy and reconstructive surgery i.
(Health gain notation - 1 "beneficial")
i. Lippman SM, Benner SE, Hong WK.  Cancer Chemoprevention. Journal of Clinical Oncology 1994; 12(4): 851-873
4i. There may be some evidence available soon concerning the role of chemopreventive agents (retinoids/beta-carotenes) in the reversal of carcinogenesis i.
(Health gain notation - 4 "unknown")
i. Lippman SM, Benner SE, Hong WK. Cancer Chemoprevention. Journal of Clinical Oncology 1994; 12 (4): 851-873
(Type I evidence - systematic review)
4j. Effective rehabilitation and continuing care of oral cancer patients includes implants, implant-supported prostheses, restorative dentistry, psychological support, speech therapy, smoking cessation and regular follow-up examination i,ii.

(Health gain notation - 3 "trade-off between beneficial and adverse effects")

i. Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion);
ii. Finlay PM, Dawson F, Robertson AG, Soutar DS. An evaluation of functional outcome after surgery and radiotherapy for intraoral cancer. British Journal of Oral and Maxillofacial Surgery 1992; 30: 14-17
(Type V evidence - expert opinion)
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk