title: Are we able to reduce the mortality and morbidity  of oral cancer; some considerations.
abstract: Oral cancer makes up 1%-2% of all cancers that may arise in the body. The majority of oral cancers consists of squamous cell carcinomas. Oral cancer carries a considerable mortality rate, being mainly dependent on the stage of the disease at admission. Worldwide some 50% of the patients with oral cancer present with advanced disease. There are several ways of trying to diagnose oral cancer in a lower tumor stage, being 1) mass screening or screening in selected patients, 2) reduction of patients' delay, and 3) reduction of doctors' delay. Oral cancer population-based screening ("mass screening") programs do not meet the guidelines for a successful outcome. There may be some benefit when focusing on high-risk groups, such as heavy smokers and heavy drinkers. Reported reasons for patients' delay range from fear of a diagnosis of cancer, limited accessibility of primary health care, to unawareness of the possibility of malignant oral diseases. Apparently, information campaigns in news programs and TV have little effect on patients' delay. Mouth self-examination may have some value in reducing patients'delay. Doctors' delay includes dentists' delay and diagnostic delay caused by other medical and dental health care professionals. Doctors' delay may vary from almost zero days up to more than six months.  Usually, morbidity of cancer treatment is measured by quality of life (QoL) questionnaires. In the past decades this topic has drawn a lot of attention worldwide. It is a challenge to decrease the morbidity that is associated with the various treatment modalities that are used in oral cancer without substantially compromising the survival rate.  Smoking cessation contributes to reducing the risk of oral cancers, with a 50% reduction in risk within five years. Indeed, risk factor reduction seems to be the most effective tool in an attempt to decrease the morbidity and mortality of oral cancer.
authors.affiliation: VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Department of Oral and Maxillofacial Surgery and Oral Pathology, PO Box 7057, 1007 MB Amsterdam, The Netherlands. i.vanderwaal@vumc.nl
authors.forename: Isaäc
authors.initials: I
authors.lastname: van der Waal
mesh_terms: D055088:Early Detection of Cancer; D006801:Humans; D009062:Mouth Neoplasms / Q000150:complications / Q000401:mortality* / Q000517:prevention & control*