SPEAKING TO PATIENTS ABOUT MOUTH CANCER

Raising public awareness of mouth cancer is essential to saving lives. The Annual National Dental Health Survey carried out in 2011 showed that there are still over 5 million people in the UK who have not seen a dentist in the last 10 years. In addition to that over 50% of Britons did not know that cancer can occur in the mouth. One of the challenges facing the dental team is giving the public and patients the information that they need without causing alarm and anxiety. This section of the CPD is designed to advise the dental team how to speak to people in a sensitive yet informative way.

Informed Consent

  1. A patient must give informed consent for any examination or procedure of the mouth. A routine exam includes a mouth cancer screening and there is no legal reason why it should be mentioned specifically. However, the BDA do advise that patients should be told that a routine mouth cancer exam is carried out. Communication is vital to raising awareness, to increasing patient satisfaction and improving their understanding of what is happening during an examination.
  2. To use an adjunctive screening tool, patients must give specific informed consent in a written format. A full explanation of the procedure should be given and what it is that you are looking for. Adjunctive testing, although good at detecting abnormalities, can produce false-positive results. Therefore, it is important not to show alarm at a positive first result. It maybe that a review appointment is required to check the result prior to a referral.
  3. Say to patients that you are only checking for mouth cancer and you will refer to a specialist if you detect anything you feel requires further investigation. It is only with further tests, such as a biopsy, that a diagnosis can be made.

Raising Awareness and Improving Patient Understanding

Many clinicians and other members of the dental team find using the 'cancer' word intimidating and fear the reaction from patients when talking about it. A good way of introducing the subject is by putting up posters and leaflets in waiting areas, posting information on your website and social media pages and perhaps writing to patients to educate them about mouth cancer screening. Written information needs to be worded carefully and be simple as many people have little understanding of the subject. This gives people time to absorb the information and prepare themselves before seeing the dentist. Over time patients will become familiar with your strategy for the management of mouth cancer at your practice and anticipate a systematic screening and advice.

Answering Difficult Questions.

Patients will ask difficult questions and not only require a factual reply and advice but also emotional support. For this reason, all team members need to be prepared to answer questions and some agreed wording is often helpful to everyone concerned.

Here are a few examples of what patients can ask and some suggestions on how the dental team could answer them:-

What is cancer of the mouth?
It is a malignant growth which can occur in any part of the mouth and throat.

What are the signs of mouth cancer?
Most cancers appear as a painless mouth ulcer that does not heal normally. Less often, however, a white or red patch in the mouth may develop into a cancer. Also, look out for a persistent sore throat or hoarseness of the voice that does not disappear with in 6 weeks.

Am I at risk from mouth cancer?
Anyone can be affected by mouth cancer, whether they have their own teeth or not. Smoking greatly increases your risk of mouth cancer. Heavy drinking is also a risk. If you do both, your chances of getting mouth cancer are much greater. This cancer is more likely to occur in people over 40 years old. Also, it is twice as common in men as it is in women. Based on data from studies on young people, we know that around 25 per cent of younger cases (under 45 years) cannot be explained by the traditional risk factors of alcohol and tobacco. This may be because of exposure to the Human Papilloma Virus that is transmitted during oral sex. Therefore, it is important to make health professionals aware that there are potential patients that may present with mouth cancer symptoms without having those major risk factors. Indeed, it may be argued that being a young person, healthy, non-smoking, non-drinking, can be in itself a risk factor hindering early detection. This also requires care and sensitivity from team members directly involved in giving advice.

How many people get mouth cancer?
In the UK alone over 5,000 people get cancer of the mouth each year and this figure is rising year on year.

Why have you not checked me before for mouth cancer?
We have always checked your mouth for mouth cancer but we are trying to raise our patients' awareness of mouth cancer by talking the examination through with you.

Do I really need mouth cancer screening?
Evidence shows that new cases of mouth cancer are increasing year on year in this country. It is your choice to have an mouth cancer screen but we would advise that you have one. If we catch changes early then outcomes for patients are generally much better.

How can cancer of the mouth be detected early?
Mouth cancer can often be spotted during its early stages by your dentist. If mouth cancer is recognised early then the chances of a cure are good. Many people with mouth cancer go to their dentist or doctor too late. On average a delay of about three months has been reported between the first symptom and being seen by a specialist.

What happens if you find something?
If we find something it does not necessarily mean that you have mouth cancer. We are only checking for something that we feel needs further investigation. Being referred to hospital means that the doctors can carry out the necessary tests to give you a diagnosis.

What do you think it is?
I have found a small lump/ulcer/white patch that you say has been there for more than 3 weeks. We do not have the means to diagnose what it is in the surgery so I am referring you to a specialist who can carry out the necessary tests so you can find out what it is.

Can you die from mouth cancer?
Like any cancer, the earlier it is caught, the easier and more straightforward it is to treat.

The sooner you get seen by a specialist, the sooner you will receive the necessary treatment and care. Statistics show that early treatment results in a 90 % survival rate.

Why are you getting me back for a review and not referring me to hospital?

You have an ulcer/white patch and no other symptoms. Most ulcers/white patches clear up within 3 weeks. I want to see you again in 2-3 weeks and see if it has changed. If it has not then it would be wise for you to see a specialist who can do the necessary investigations to tell you what it is.

What are you looking for during a mouth cancer screen?
We are looking for ulcers and white patches that have not healed within 3 weeks and lumps and bumps in your mouth and on your neck. We have a leaflet that we can give you that shows how to check your own mouth and what to look for. Would you like one?

What is involved in a check up of the mouth?
The dentist examines the inside of your mouth with the help of a small mirror. Remember, your dentist is able to see parts of your mouth that you cannot see easily yourself. The dentist may also use a chair side tests that help to identify any malignant growth.

How can mouth cancer be prevented?>
Most cancers of the mouth can be prevented by not smoking or chewing tobacco/areca nut and by reducing the amount of alcohol you drink. A good diet with five portions of fresh vegetables and fruits per day may also help prevent cancer.

These are suggested answers and each team member may wish to enhance their reply depending on their job role.

Patients at risk should also receive appropriate advice about smoking cessation and safe alcohol consumption, as well as information on HPV, from the clinicians and be given appropriate leaflets to support this information. This might only happen where clinicians have been trained in this area, however all practices should be able to provide a simple leaflet with further contacts. The Mouth Cancer Foundation has posters which can be downloaded from the website which may be displayed and made visible to patients.
http://www.mouthcancerfoundation.org/get-info/merchandise