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Vazquez FL, Coracin FL, Arantes KLBF, Ferigatto JL, Nascimento-Júnior AC, Barroso EM, Prata EM, Longatto-Filho A, Buexm LA, Tieghi-Neto V, Mauad EC, Warnakulasuriya S, Gama RR. An oral cancer screening program in Brazil: Analysis of seven years of outcome after its implementation in the suburban cities of São Paulo. Oral Oncol 2024; 154:106826. [PMID: 38733949 DOI: 10.1016/j.oraloncology.2024.106826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To describe the implementation of an oral cancer screening program at the Barretos Cancer Hospital (BCH) and present the outcome based on data obtained from 2014 to 2020. MATERIALS AND METHODS The residents of the Regional Health District of Barretos (DRS-V) were personally invited by community health agents or nurses, and among 13,973 people, 15,222 oral examinations were carried out over the years in 18 of its municipalities. Oral examinations were performed at the Mobile Dental Unit and at the Prevention Department of the BCH. Inclusion criteria were being 35 years of age or older, having a personal history of tobacco or alcohol consumption, or having a lesion in the oral cavity found by community health agent or self-reported, regardless of age or risk factors. RESULTS AND CONCLUSION The main result of our study was the stages of oral cancer among screen detected cases were smaller compared to cases in the hospital registry, in the state and in Brazil. Oral cancer detection rate per 1,000 oral examinations was 10.7.The early stages of oral cancer found by screening in primary care facilities or using mobile units suggest that, when organized, screening may improve the prognosis of oral cancer.
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Affiliation(s)
- F L Vazquez
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil.
| | - F L Coracin
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - K L B F Arantes
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - J L Ferigatto
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | | | - E M Barroso
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - E M Prata
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - A Longatto-Filho
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil; National Cancer Intitute (INCA), Washington Luís 35, Rio de Janeiro, RJ, Brazil
| | - L A Buexm
- National Cancer Intitute (INCA), Washington Luís 35, Rio de Janeiro, RJ, Brazil
| | - V Tieghi-Neto
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - E C Mauad
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | | | - R R Gama
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
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Pedroso CM, Normando AG, Pérez-de-Oliveira ME, Simonato LE, Goes MF, Ribeiro AC, Brandão TB, Lopes MA, Warnakulasuriya S, Santos-Silva AR. Oral cancer screening outcomes in the Latin American region with special relevance to Brazil and Cuba: a systematic review. Med Oral Patol Oral Cir Bucal 2024:26361. [PMID: 38368529 DOI: 10.4317/medoral.26361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/11/2023] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The Latin American region represents a hotspot for oral cancer incidence and mortality. To reduce oral cancer mortality rates, screening for early detection of subjects with suspicious or innocuous oral lesions has been promoted. A systematic review was performed to assess the outcomes of oral cancer screening in the Latin American region. MATERIAL AND METHODS An electronic search was conducted in eight databases and grey literature. The eligibility criteria included screening where adult participants underwent any screening test during an organized screening program. Screening programs were assessed to understand trends in oral cancer diagnosis. Rates of oral cancers diagnosed in screening programs were classified as increase, decrease, or stable based on each year assessed. RESULTS Following our searches, twelve studies conducted in Brazil and Cuba were included. The screening tests reported were visual oral examination (VOE) and in one study in addition light-based fluorescence testing. 13,277,608 individuals were screened and a total of 1,516 oral cancers were detected (0.01%). Only two studies aimed to screen high-risk individuals (smokers and drinkers). Oral cancer cases diagnosed during screening programs were proportionately stable over the years 1997 to 2009 but increased from 2010 to 2021. The fluorescence-associated VOE test demonstrated a sensitivity of 100% and a specificity of 90%. Similarly, the VOE test alone exhibited a sensitivity of 100%, with specificity ranging from 75% to 90%. CONCLUSIONS Screening studies conducted in Latin American countries had serious limitations both in methodology (lack of examiner training) and in reporting data (lack of description of clinical categories of screen positives). Capacitation of health workers to perform VOE in well-designed screening programs should be implemented.
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Affiliation(s)
- C-M Pedroso
- Oral Diagnosis Department Piracicaba Dental School, University of Campinas (UNICAMP) Av. Limeira, 901, Caixa Postal 52, Piracicaba, SP 13414-903, Brazil
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3
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Evans HG, Murphy MF, Foy R, Dhiman P, Green L, Kotze A, von Neree L, Palmer AJ, Robinson SE, Shah A, Tomini F, Trompeter S, Warnakulasuriya S, Wong WK, Stanworth SJ. Harnessing the potential of data-driven strategies to optimise transfusion practice. Br J Haematol 2024; 204:74-85. [PMID: 37964471 DOI: 10.1111/bjh.19158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023]
Abstract
No one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence-based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost-effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on 'A data-enabled programme of research to improve transfusion practices'. The overarching aim of the BTRU is to accelerate the development of data-driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice.
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Affiliation(s)
- H G Evans
- NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - M F Murphy
- NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - R Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Botnar Research Centre, Oxford, UK
| | - L Green
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
- NHS Blood and Transplant, London, UK
| | - A Kotze
- Leeds Teaching Hospitals, Leeds, UK
| | - L von Neree
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A J Palmer
- Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - S E Robinson
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Shah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - F Tomini
- Queen Mary University of London, London, UK
| | - S Trompeter
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - S Warnakulasuriya
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - W K Wong
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S J Stanworth
- NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
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4
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Hazarey V, Desai KM, Warnakulasuriya S. Proliferative verrucous leukoplakia/multifocal leukoplakia in patients with and without oral submucous fibrosis. Med Oral Patol Oral Cir Bucal 2024; 29:e119-e127. [PMID: 37992140 PMCID: PMC10765335 DOI: 10.4317/medoral.26106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Oral submucous fibrosis (OSF) and proliferative verrucous leukoplakia (PVL) are established as oral potentially malignant disorders. Dual pathology of the two conditions is not commonly encountered in clinical practice. This study aims to present a case series of multifocal leukoplakia in patients with and without OSF to outline the clinical behavior and challenges in the management of this high-risk group in clinical practice. MATERIAL AND METHODS We retrospectively analyzed cases of six Indian patients (four with OSF) managed over a period of 5.5 to 13 years at the Government Dental College, Nagpur. Patient data consisting of age, gender, medical history, habits, clinical findings, and biopsy reports were recorded at the initial visit. During follow-up visits, the clinicopathological data were reassessed. When surgical intervention failed to arrest the disease or when surgery was contraindicated metronomic therapy with Folitrax 15 mg once a week and Celecoxib 100mg twice daily was initiated. RESULTS All patients developed PVL after the initial pathology diagnosis of OSF or oral leukoplakia. Initial lesions were either homogenous or non-homogenous leukoplakia. All patients developed multiple recurrences, regional or systemic metastasis. Despite thorough interventions, the patients died of, or with the disease. CONCLUSIONS The occurrence of two or more oral potentially malignant disorders poses challenges in patient management and possibly presents a higher risk of malignant transformation. More clinical trials are necessary to assess the benefits of metronomic therapy for patients diagnosed with aggressive PVL concurrently found with OSF.
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Affiliation(s)
- V Hazarey
- King's College London Bessemer, Rd, SE 5 9RA, London
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5
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Aguirre-Urizar JM, Warnakulasuriya S. The significance of oral epithelial dysplasia in the clinical management of oral potentially malignant disorders. Int J Oral Maxillofac Surg 2023; 52:510-511. [PMID: 36050141 DOI: 10.1016/j.ijom.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J M Aguirre-Urizar
- Department of the Stomatology II, University of the Basque Country/EHU, Leioa, Spain.
| | - S Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London and WHO Collaborating Centre for Oral Cancer, London, UK.
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Abstract
Areca nut chewing is one of the major risk factors for oral cancer, with large-magnitude risks reported in studies comparing betel quid chewers and never users, and it has been evaluated as a group 1 carcinogen by the International Agency for Research on Cancer. Data from a high-quality meta-analysis examining risk estimates are presented in summary form with additional information from more recent studies (pooled adjusted relative risk, 7.9; 95% CI, 7.1 to 8.7). The risk of oral cancer increases in a dose-response manner with the daily number of quids consumed and the number of years chewing. In the Indian subcontinent and in Taiwan, approximately half of oral cancers reported are attributed to betel quid chewing (population attributable fraction, 53.7% for residents in Taiwan and 49.5% for the Indian population), a disease burden that could be prevented. Oral leukoplakia and oral submucous fibrosis are 2 main oral potentially malignant disorders caused by areca nut chewing that can progress to oral cancer with continued use. Ex-chewers seem to demonstrate lower risks than current chewers, but the impact of areca nut cessation on oral cancer risk has not been scientifically evaluated on the basis of randomized controlled studies. These data strongly reconfirm that betel quid chewing, primarily areca nut use, should be taken into account in assessing the cancer risk of South Asian, East Asian populations and Pacific Islanders for the development of oral cancer.
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Affiliation(s)
- S. Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, and the WHO Collaborating Centre for Oral Cancer, London, UK
- S. Warnakulasuriya, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Denmark Hill, London, SE5 9RA, UK.
| | - T.H.H. Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
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7
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Monteiro L, Silva P, Delgado L, Amaral B, Garcês F, Salazar F, Pacheco JJ, Lopes C, Bousbaa H, Warnakulasuriya S. Expression of spindle assembly checkpoint proteins BubR1 and Mad2 expression as potential biomarkers of malignant transformation of oral leukoplakia: an observational cohort study. Med Oral Patol Oral Cir Bucal 2021; 26:e719-e728. [PMID: 34704983 PMCID: PMC8601638 DOI: 10.4317/medoral.24511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background The Spindle Assembly Checkpoint (SAC) is a surveillance mechanism essential to ensure the accuracy of chromosome segregation during mitosis. Our aim was to evaluate the expression of SAC proteins in oral carcinogenesis, and to assess their potential in predicting malignant transformation of oral leukoplakia. Material and Methods We analysed the immunoexpression of BubR1, Mad2, Bub3, and Spindly proteins in 64 oral biopsies from 52 oral leukoplakias and 12 normal tissues. Univariate and multivariate analysis were performed to evaluate predictive factors for malignant transformation (MT). Results We observed that BubR1 and Mad2 were more highly expressed in high dysplasia grade lesions than in low grade or normal tissues (P<0.05). High expression of Spindly was significantly correlated with a high Ki-67 score (P=0.004). Six (11.5%) oral leukoplakias underwent malignant transformation. In univariate analysis, the binary dysplasia grade (high grade) (P<0.001) was associated with a higher risk of malignant transformation as well as high BubR1 (P<0.001) and high Mad2 (P=0.013) expression. In multivariate analysis, high expression of BubR1 and Mad2 when combined showed an increased risk for malignant transformation (P=0.013; HR of 4.6, 95% CI of 1.4-15.1). Conclusions Our findings reveal that BubR1 and Mad2 were associated with an increased risk for malignant transformation independently of histological grade and could be potential and useful predictive risk markers of malignant transformation in oral leukoplakias. Key words:BubR1, Mad2, Spindly, Bub3, Oral Leukoplakia, epithelial dysplasia, Oral squamous cell carcinoma.
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Affiliation(s)
- L Monteiro
- Rua Central de Gandra, 1317 4585-116 Gandra PRD, Portugal
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8
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González-Moles MÁ, Warnakulasuriya S, González-Ruiz I, Ayén Á, González-Ruiz L, Ruiz-Ávila I, Ramos-García P. Dysplasia in oral lichen planus: relevance, controversies and challenges. A position paper. Med Oral Patol Oral Cir Bucal 2021; 26:e541-e548. [PMID: 34162824 PMCID: PMC8254877 DOI: 10.4317/medoral.24610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background Patients with oral lichen planus (OLP) have an increased risk of oral cancer. For this reason, OLP is classified as an oral potentially malignant disorder. However, the precise personal (or individual) risk is unknown. Recent meta-analytical studies have reported that dysplastic OLP may transform to cancer in around 6% of cases, while the rate of transformation is lower (<1.5%) in non-dysplastic cases. The presence of epithelial dysplasia has emerged as the most powerful indicator for assessing cancer risk in oral potentially malignant disorders in routine practice. However, the general acceptance of epithelial dysplasia as an accompanying histologic feature in OLP is subject to great controversy. Many pathologists consider the presence of dysplasia as a criterion to exclude OLP when routinely reporting on this disease. This practice, widespread among oral pathology professionals, has resulted in the underestimation of the potential for malignancy of OLP. Material and Methods A review of the literature was carried out in order to critically analyze the relevance, controversies and challenges encountered across the diagnosis of epithelial dysplasia in OLP. Results 12 studies have been published examining dysplastic changes in OLP, reporting Figures ranging from 0.54% to 25% of cases with dysplasia in the first diagnostic biopsy. The diagnosis of dysplasia in the OLP poses an additional difficulty due to the fact that the affected oral epithelium per se develops changes related to autoimmune aggression. Among the most frequent histological features of OLP that develops dysplasia are basal cell hyperplasia with basaloid appearance, loss of basal cells polarity, cellular and nuclear pleomorphism and irregular stratification. Conclusions Epithelial dysplasia should not be considered an exclusion criterion for OLP; its evaluation requires experienced pathologists in this field. Key words:Oral lichen planus, epithelial dysplasia, oral cancer.
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Affiliation(s)
- M-Á González-Moles
- Oral Medicine Department, School of Dentistry, University of Granada Granada, Paseo de Cartuja s/n, 18071 Granada, Spain
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9
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Abstract
Oral cancer is a major public health problem, and there is an increasing trend
for oral cancer to affect young men and women. Public awareness is poor, and
many patients present with late-stage disease, contributing to high mortality.
Oral cancer is often preceded by a clinical premalignant phase accessible to
visual inspection, and thus there are opportunities for earlier detection and to
reduce morbidity and mortality. Screening asymptomatic individuals by systematic
visual oral examinations to detect the disease has been shown to be feasible. A
positive screen includes both oral cancer and oral potentially malignant
disorders. We review key screening studies undertaken, including 1 randomized
clinical trial. Screening of high-risk groups is cost-effective. Strengths and
weaknesses of oral cancer screening studies are presented to help guide new
research in primary care settings and invigorated by the prospect of using
emerging new technologies that may help to improve discriminatory accuracy of
case detection. Most national organizations, including the US Preventive
Services Task Force, have so far not recommended population-based screening due
a lack of sufficient evidence that screening leads to a reduction in oral cancer
mortality. Where health care resources are high, opportunistic screening in
dental practices is recommended, although the paucity of research in primary
care is alarming. The results of surveys suggest that dentists do perform oral
cancer screenings, but there is only weak evidence that screening in dental
practices leads to downstaging of disease. Where health care resources are low,
the feasibility of using primary health care workers for oral cancer screening
has been tested, and measures indicate good outcomes. Most studies reported in
the literature are based on 1 round of screening, whereas screening should be a
continuous process. This review identifies a huge potential for new research
directions on screening for oral cancer.
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Affiliation(s)
- S. Warnakulasuriya
- King’s College London and WHO
Collaborating Centre for Oral Cancer, London, UK
- S. Warnakulasuriya, Faculty of Dentistry,
Oral & Craniofacial Sciences, King’s College London and WHO Collaborating
Centre for Oral Cancer, London, UK.
| | - A.R. Kerr
- Department of Oral and Maxillofacial
Pathology, Radiology & Medicine, New York University College of Dentistry, New
York, NY, USA
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10
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Karim Z, Kallarakkal T, Amtha R, Guledgud M, Telang A, Ramanathan A, Zaini Z, Gunardi I, Telang L, Yang Y, Patil K, Doddawad V, Kamaraj L, Saikrishna D, Warnakulasuriya S, Zain R. Combination of Cytopathology and DNA Ploidy Increases the Performance of Oral Epithelial Dysplasia Prediction in Oral Potentially Malignant Disorders. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.67600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Grading of oral epithelial dysplasia (OED) by a pathologist is currently the key guide used for treatment planning of oral potentially malignant disorders (OPMDs). Conventional oral examination (COE) clinically detects OPMDs but may not predict their risk status to transform to cancer. Therefore, there is a need for a reliable test to predict OED in OPMDs. Aim: This study was conducted to evaluate COE, liquid based cytology (Cytopath) and DNA image cytometry (Ploidy) in predicting OED in OPMDs. Methods: A total of 179 patients from Malaysia, India and Indonesia underwent COE followed by brush biopsies and scalpel biopsies. Brush-biopsy samples were analyzed for cytopathology and DNA ploidy at Dental Faculty, University of Malaya. Histopathological findings of presence/absence of OED were used as the reference standard. Calculations for sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (A) were done for individual tools and in combinations. The Youden index (Sn+Sp-1) was used as a measure of overall performance. The relevant medical ethics committees of the different research locations approved the study. Results: For COE, the sensitivity (Sn) was high (100%) and the specificity (Sp) was low (5.9%), while both Cytopath and Ploidy showed a low sensitivity (Sn) (28.6% and 22.2%) and high specificity (Sp) (94.3% and 82.3%). All 3 tools individually have high negative predictive value (NPV) for predicting presence of OED (COE-100%, Cytopath-66.7%, Ploidy-78.5%). When combining outcomes from all 3 tools, the best performance indicated by Youden index (42.1) is which defines a positive case when both COE and Cytopath show abnormal. In general, using results from at least 2 tools had better Youden indices than using these tools individually. Conclusion: COE as a screening tool by virtue of its high Sn would be a suitable first level diagnostic test, while the Cytopath and the Ploidy individually with high Sp may be used as a second level test to predict presence of OED. Combining the COE with cytopathology would be the best combination for a high performance of the tools. Cytopathology (when performed by a trained cytologist) would allow for most of the false positives from the first level test to be correctly identified as true negative at the second level. Longitudinal data are needed to assess which of these may correctly identify the malignant potential of OPMDs. Acknowledgment: Grant: High Impact Research - Ministry of Higher Education (HIR-MOHE UM000025/C3)
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Affiliation(s)
- Z.B.A. Karim
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - T.G. Kallarakkal
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - R. Amtha
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - M.V. Guledgud
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - A. Telang
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - A. Ramanathan
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - Z. Zaini
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - I. Gunardi
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - L.A. Telang
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - Y.H. Yang
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - K. Patil
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - V.G. Doddawad
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - L. Kamaraj
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - D. Saikrishna
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - S. Warnakulasuriya
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - R.B. Zain
- Klinik Pakar Bedah Mulut, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
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11
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Amarasinghe AAHK, Usgodaarachchi US, Johnson NW, Warnakulasuriya S. High Prevalence of Lifestyle Factors Attributable for Oral Cancer, and of Oral Potentially Malignant Disorders in Rural
Sri Lanka. Asian Pac J Cancer Prev 2018; 19:2485-2492. [PMID: 30256041 PMCID: PMC6249476 DOI: 10.22034/apjcp.2018.19.9.2485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Oral Cancer is a major public health problem in most of the South East Asian countries including Sri Lanka. Use of tobacco in the form of smokeless tobacco and smoking, use of alcohol and betel quid chewing are the major contributory factors for causation oral cancer. The aim of this study was to investigate the prevalence of lifestyle factors responsible for causation of oral cancer and Oral Potentially Malignant Disorders (OPMD) in the Sabaragamuwa province of Sri Lanka. Methods: A cross-sectional community based study was conducted in Sabaragamuwa province by interviewing, then conducting an oral examination, on 1029 subjects over 30 years of age, over a one year period from November 2006. The study protocol included an interviewer-administered questionnaire to gather socio-demographic factors, recording of habits that included areca/betel chewing, smoking, and alcohol consumption. A three-day food diary was obtained, particularly to assess the consumption of tea, fruits and vegetables. The weight and height of residents was taken for calculation of Body Mass Index (BMI). Results: One hundred and two individuals with one or more OPMD were detected among these 1029 subjects. The prevalence of OPMD, weighted according to the estate sector and gender, was estimated as 11.3%. The prevalence of daily betel quid chewing in this study was 53.8%: 15.7% without tobacco and 47.4% with tobacco. The prevalence of individuals who reported consumption of alcohol at least weekly was 13.4%. A significant minority, 31.7%, were under nourished, with a BMI < 18.5. Forty six percent of the males practiced combined habits of betel quid chewing, smoking and regular use of alcohol. Conclusions: This study discloses high prevalence of OPMD and of lifestyle factors for oral cancer in these communities. There is an urgent need for a comprehensive strategy to control the use of tobacco, betel quid chewing and alcohol for prevention of oral cancer.
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Affiliation(s)
- A A H K Amarasinghe
- Institute of Oral Health, Maharagama, Sri Lanka.,Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, QLD 4222, Australia.
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Petti S, Warnakulasuriya S. Betel quid chewing among adult male immigrants from the Indian subcontinent to Italy. Oral Dis 2018; 24:44-48. [PMID: 29480602 DOI: 10.1111/odi.12768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Betel quid chewing (BQC) is an important oral cancer risk factor widespread in the Indian subcontinent. This usage also is common among migrants from this region. As the number of immigrants from South-East Asia is dramatically increasing in Italy, this survey was aimed at investigating BQC prevalence among immigrants from the Indian subcontinent. SUBJECTS AND METHODS First-generation adult male immigrants coming from Pakistan, India, Sri Lanka, and Bangladesh, living in Rome, were consecutively selected. They were interviewed using a validated questionnaire. Descriptive statistics were performed, and factors associated to regular BQC were investigated through regression analysis. RESULTS A total of 211 subjects (mean age, 33.8 years) living in Rome for 11 years, on average, participated in the study. BQC prevalence was 37.9% with few differences between Pakistani, Sri Lankans, and Indians. Prevalence among Bangladeshi was 7.3%. 69% of the consumers chewed BQ at least twice daily, 90% chewed BQ with tobacco; 30.3% subjects were smokers and chewers. Chewing parents, smoking, health illiteracy were associated with BQC. Most chewers believed that BQ helps to relieve stress. CONCLUSIONS The number of oral cancers in Italy is expected to increase because of BQC dissemination. Therefore, specific awareness campaigns directed to residents of South-East Asian origin are needed.
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Affiliation(s)
- S Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - S Warnakulasuriya
- King's College London and WHO collaborating Centre for Oral Cancer, London, UK
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Abstract
A variety of devices and techniques are now available to aid the clinician in visualising clinical changes that may be found in the oral cavity. These techniques can now be applied at chairside to characterise these changes and many offer a real time result at the point of care. They may assist in a practitioner referring a case earlier to a specialist to undertake further investigations. The translational value of the research published so far has been limited as these technologies have not been adapted for routine use in primary care. This review aims to examine the utility of these adjunctive aids in clinical practice based on the current available evidence.
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Affiliation(s)
- S Warnakulasuriya
- King's College London and WHO Collaborating Centre for Oral Cancer UK
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Monteiro L, Barbieri C, Warnakulasuriya S, Martins M, Salazar F, Pacheco JJ, Vescovi P, Meleti M. Type of surgical treatment and recurrence of oral leukoplakia: A retrospective clinical study. Med Oral Patol Oral Cir Bucal 2017; 22:e520-e526. [PMID: 28809365 PMCID: PMC5694172 DOI: 10.4317/medoral.21645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/19/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Oral leukoplakia (OL) is the most typical potentially malignant disorder of the oral mucosa. We aimed to evaluate the clinical outcome of oral leukoplakia treated with several types of lasers and with the use of quantic molecular resonance (QMR) lancet, in terms of recurrence rate. MATERIAL AND METHODS Eighty-seven previously untreated OL (52 occurring in females and 35 in males, mean age of 59.4 ± 13.9 years) were consecutively submitted to surgical treatment at University Hospital of Parma, Italy, and Hospital de Valongo, Portugal, (1999 to 2012). Interventions were subclassified into 5 groups according to the instrument used for the surgical removal of OL (cold blade - 17; Nd:YAG 1064nm laser - 14; Er:YAG 2940nm laser - 33; CO2 10600nm laser - 15; and QMR scalpel - 8). The mean follow-up period after treatment was 21.6 months (range 1-151 months). The outcome of treatment was scored through the same clinical protocol in the two participating units. Statistical analysis were carried by univariate analysis using chi-square test (or Pearson's test when appropriate). RESULTS Recurrences were observed in 24 cases of OL (27.6%). Malignant transformation occurred in one patient (1.1%) after a period of 35 months. Statistical comparison of the 5 surgical treatment modalities showed no differences in clinical outcomes nor in the recurrence rate of OL. However, when Er:YAG laser group was compared with traditional scalpel, a significantly better outcome in cases treated with Er:YAG laser (P = 0.015) was highlighted. CONCLUSIONS Our results suggests that Er:YAG laser could be a promising option for the treatment of OL.
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Affiliation(s)
- L Monteiro
- Medicine and Oral Surgery Department, Instituto Univesitário de Ciências da Saúde, Rua Central de Gandra, 1317, 4585-116 Gandra PRD, Portugal,
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Ofluoglu D, Ergun S, Warnakulasuriya S, Namdar-Pekiner F, Tanyeri H. An evaluation of the efficacy of a topical gel with Triester Glycerol Oxide (TGO) in the treatment of minor recurrent aphthous stomatitis in a Turkish cohort: A randomized, double-blind, placebo-controlled clinical trial. Med Oral Patol Oral Cir Bucal 2017; 22:e159-e166. [PMID: 28160585 PMCID: PMC5359701 DOI: 10.4317/medoral.21469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/08/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Triester glycerol oxide gel (Protefix® Queisser Pharma, Germany) is a new topical agent that has the property of adherence to the oral mucosa by forming a lipid film which protects against mechanical trauma and may help to reduce oral tissue moisture loss and inflammation. The aim of this clinical trial was to determine the efficacy of a topical TGO gel and to also compare it with triamcinolone acetonide pomade in the treatment of minor recurrent aphthous stomatitis. MATERIAL AND METHODS This study was a randomized, double-blind, placebo-controlled clinical trial and 180 patients with the complaint of minor aphthous ulcers were enrolled in this study. The sociodemographic data and clinical characteristics of the ulcer were collected by questionnaire. Ulcer size and pain level measurements were performed and the efficacy indices for ulcer pain and size were calculated at day 0,2,4,6 by the same investigator. RESULTS Significant differences were not detected among the demographics and ulcer histories including age, gender, onset of ulcer, mean healing time, family RAS history and ulcer localization between three groups. The pain score in TGO group was found statistically lower at day 2,4, and 6. Efficacy index and improvement rate of TGO group, regarding pain score, was higher than the other two groups at day 2 and 4. The reduction in ulcer size was statistically higher in TGO group than the other two groups at day 4 and 6. CONCLUSIONS Topical application of TGO gel could decrease pain intensity, accelerate ulcer healing without any side effects, utilizing an easy appliable and accessible procedure. Therefore TGO gel could be a well-tolerated, safe, topical therapeutic agent in the clinical practice of RAS treatment.
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Affiliation(s)
- D Ofluoglu
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, 34093 Istanbul, Turkey,
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Prue G, Lawler M, Baker P, Warnakulasuriya S. Human papillomavirus (HPV): making the case for ‘Immunisation for All’. Oral Dis 2016; 23:726-730. [DOI: 10.1111/odi.12562] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/27/2022]
Affiliation(s)
- G Prue
- School of Nursing and Midwifery; Queen's University Belfast; Belfast UK
| | - M Lawler
- Centre for Cancer Research and Cell Biology; Queen's University Belfast; Belfast UK
- European Cancer Concord; Leeds UK
| | | | - S Warnakulasuriya
- King's College London; London UK
- WHO Collaborating Centre for Oral Cancer; London UK
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Khan A, Khan Z, Warnakulasuriya S. Cancer-associated toll-like receptor modulation and insinuation in infection susceptibility: association or coincidence? Ann Oncol 2016; 27:984-997. [DOI: 10.1093/annonc/mdw053] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis 2016; 22:609-19. [DOI: 10.1111/odi.12428] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Affiliation(s)
- LJ Jin
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
| | - IB Lamster
- Department of Health Policy and Management; Mailman School of Public Health; Columbia University; New York NY USA
| | - JS Greenspan
- Department of Orofacial Sciences; School of Dentistry at University of California, San Francisco; San Francisco CA USA
| | - NB Pitts
- Dental Innovation and Translation Centre; King's College London Dental Institute; London UK
| | - C Scully
- WHO Collaborating Centre for Oral Health-General Health; and University College; London UK
| | - S Warnakulasuriya
- King's College London Dental Institute; and WHO Collaborating Centre for Oral Cancer; London UK
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Warnakulasuriya S, Ariyawardana A. Malignant transformation of oral leukoplakia: a systematic review of observational studies. J Oral Pathol Med 2015; 45:155-66. [PMID: 26189354 DOI: 10.1111/jop.12339] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 12/15/2022]
Abstract
UNLABELLED The aim of this systematic review was to ascertain the malignant transformation rate of oral leukoplakia and the associated risk factors. METHOD Published literature was searched through several search engines from 1960 to the end of December 2013. The inclusion criteria included 'leukoplakia', 'pre-cancer', 'malignant transformation', 'follow-up' and 'outcome'. Two reviewers extracted the data independently and also assessed the quality of evidence. RESULTS The search strategy resulted in 1032 abstracts or full-text articles, of which 24 met the inclusion criteria. There was much variation in the definitions used by the various authors in their original reports to define oral leukoplakia or in the criteria used to recruit their patients for follow-up. The estimated overall (mean) malignant transformation rate for the total population described in these 24 studies amounts to 3.5% (405/11423), with a wide range between 0.13% and 34.0%. Based on the evidence presented, the features that stand out as significant determinants contributing to malignant potential of OL include advanced age, female sex, leukoplakia exceeding 200 mm(2) , non-homogeneous type (eg. erythroleukoplakia) and the higher grades of dysplasia. CONCLUSION The review indicates that drawing meaningful evidence-based conclusions are difficult from retrospective studies of this nature. However, many of the determinants exposed in the review require further investigation by well-designed prospective studies.
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Affiliation(s)
- S Warnakulasuriya
- Department of Oral Medicine, King's College London and WHO Collaborating Centre for Oral Cancer, London, UK
| | - A Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Qld, Australia
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Awan KH, Morgan PR, Warnakulasuriya S. Assessing the accuracy of autofluorescence, chemiluminescence and toluidine blue as diagnostic tools for oral potentially malignant disorders--a clinicopathological evaluation. Clin Oral Investig 2015; 19:2267-72. [PMID: 25804887 DOI: 10.1007/s00784-015-1457-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Early detection of oral cancer and their precursors is the key to reducing the high mortality rate attributable to oral cancer. A variety of new chair-side diagnostic tools are currently available that may enhance oral mucosal examination and facilitate the detection of benign and malignant disorders. The aim of this study was to investigate the accuracy of autofluorescence, chemiluminescence and toluidine blue (TBlue) when used in combination against conventional oral examination and surgical biopsy for the detection and assessing risk status of oral potentially malignant disorders. MATERIALS AND METHODS A total of 126 patients, with white, red and mixed white and red patches were included. Following a comprehensive oral examination, all patients underwent a standard protocol of autofluorescence, chemiluminescence and TBlue examination. A surgical biopsy was performed to assess oral epithelial dysplasia. RESULTS Seventy patients had leukoplakia/erythroplakia and 44 had epithelial dysplasia. In relation to leukoplakia/erythroplakia, autofluorescence, chemiluminescence and TBlue showed a sensitivity of 87.1, 77.1 and 52.9 % and a specificity of 21.4, 26.8 and 67.9 %, respectively. For dysplasia cases, autofluorescence, chemiluminescence and TBlue showed sensitivity and specificity of 84.1, 77.3 and 56.8 % and 15.3, 27.8 and 65.8 %, respectively. CONCLUSION While all the three tests were useful in detecting oral mucosal changes, their accuracy in identifying oral potentially malignant disorders (OPMD) is questionable. However, in combination, the tests yielded better results, with improved specificity. CLINICAL RELEVANCE These research tools are helpful in specialist clinics but further studies are necessary to examine their role in screening in primary care settings.
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Affiliation(s)
- K H Awan
- Department of Clinical and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| | - P R Morgan
- Head and Neck Pathology, Dental Institute, King's College London, London, UK
| | - S Warnakulasuriya
- Department of Oral Medicine, Dental Institute, WHO Collaborating Center for Oral Cancer, King's College London, London, UK
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Awan KH, Hammam MK, Warnakulasuriya S. Knowledge and attitude of tobacco use and cessation among dental professionals. Saudi Dent J 2015; 27:99-104. [PMID: 26082577 PMCID: PMC4459113 DOI: 10.1016/j.sdentj.2014.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022] Open
Abstract
Aim Smoking is the one of the most preventable causes of death worldwide. Dental professionals may play an important role in anti-smoking campaigns. The aim of this study was to evaluate current knowledge of and attitudes toward smoking and its cessation among dental professionals. Materials and methods This questionnaire-based study was carried out among general dental practitioners (GDPs) and dental students in Saudi Arabia. The questionnaire was used to collect data on sociodemographic characteristics, knowledge, and attitudes toward tobacco use and cessation. Data were analyzed using SPSS software (version 18.0; IBM) and the Mann–Whitney U-test, with a significance level of p < 0.001. Results A total of 342 participants (130 GDPs, 212 dental students) with the mean age of 24 (standard deviation, 5) years participated in the study. One-third (33.8%, n = 44) of GDPs and 30.2% (n = 64) of dental students were smokers; small percentages (GDPs, 9.1% [n = 4]; dental students, 7.8% [n = 5]) were heavy smokers. The majority of participants rated both smoking cessation and prevention together as a very important preventive measure. Families were rated as the most important factor responsible for smoking cessation, whereas general practitioners were rated as the most important factor for providing assistance with cessation. Conclusion More meaningful participation of dental professionals in tobacco cessation is needed, with implications for related curriculum changes.
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Affiliation(s)
- K H Awan
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - M K Hammam
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - S Warnakulasuriya
- Oral Medicine, Department of Clinical & Diagnostic Sciences, King's College London, Dental Institute, United Kingdom ; WHO Collaborating Centre for Oral Cancer, United Kingdom
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Rashid A, Warnakulasuriya S. The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review. J Oral Pathol Med 2014; 44:307-28. [PMID: 25183259 DOI: 10.1111/jop.12218] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In recent decades, optical techniques utilising the principles of chemiluminescence and tissue autofluorescence have emerged to facilitate the early detection of any oral mucosal changes suspicious of cancer. PURPOSE To evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of oral cancer and oral potentially malignant disorders (OPMDs). METHODS A systematic review of the published literature to evaluate the effectiveness of the ViziLite(®) and ViziLite(®) Plus with toluidine blue, MicroLux™/DL and the VELscope™ as aids in the detection of oral cancer and OPMDs. RESULTS Twenty-five primary studies published between 2004 and 2013 satisfied our criteria for selection - 13 utilised chemiluminescence and 12 tissue autofluorescence. Some had utilised both study methods on the same population. Chemiluminescence shows good sensitivity at detecting any OPMDs and oral cancer. However, it preferentially detects leukoplakia and may fail to spot red patches. The additive use of toluidine blue may improve specificity. Tissue autofluorescence is sensitive at detecting white, red and white and red patches, and the area of fluorescence visualisation loss (FVL) often extends beyond the clinically visible lesion. However, in addition to OPMDs, VELScope may detect erythematous lesions of benign inflammation resulting in false-positive test results. CONCLUSION There is limited evidence for their use in primary care, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.
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Affiliation(s)
- A Rashid
- Department of Oral and Maxillofacial Surgery, King's College Hospital, London, UK
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Saruhanoğlu A, Ergun S, Kaya M, Warnakulasuriya S, Erbağcı M, Öztürk Ş, Deniz E, Özel S, Çefle K, Palanduz Ş, Tanyeri H. Evaluation of micronuclear frequencies in both circulating lymphocytes and buccal epithelial cells of patients with oral lichen planus and oral lichenoid contact reactions. Oral Dis 2013; 20:521-7. [DOI: 10.1111/odi.12169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 03/25/2013] [Accepted: 07/11/2013] [Indexed: 12/24/2022]
Affiliation(s)
- A Saruhanoğlu
- Faculty of Dentistry Department of Oral Surgery Istanbul University Istanbul Turkey
| | - S Ergun
- Faculty of Dentistry Department of Oral Surgery Istanbul University Istanbul Turkey
| | - M Kaya
- Medical Genetics Programme at the Institute of Health Sciences Istanbul University Istanbul Turkey
| | | | - M Erbağcı
- Medical Genetics Programme at the Institute of Health Sciences Istanbul University Istanbul Turkey
| | - Ş Öztürk
- Faculty of Medicine Division of Medical Genetics Department of Internal Medicine Istanbul University Istanbul Turkey
| | - E Deniz
- Faculty of Dentistry Department of Oral Surgery Yeditepe University Yeditepe Turkey
| | - S Özel
- Faculty of Medicine Department of Biostatistics and Medical Informatics Istanbul University Istanbul Turkey
| | - K Çefle
- Faculty of Medicine Division of Medical Genetics Department of Internal Medicine Istanbul University Istanbul Turkey
| | - Ş Palanduz
- Faculty of Medicine Division of Medical Genetics Department of Internal Medicine Istanbul University Istanbul Turkey
| | - H Tanyeri
- Faculty of Dentistry Department of Oral Surgery Istanbul University Istanbul Turkey
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Kimura M, Nagao T, Machida J, Warnakulasuriya S. Mutation of keratin 4 gene causing white sponge nevus in a Japanese family. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2012.10.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ramseier CA, Aurich P, Bottini C, Warnakulasuriya S, Davis JM. Curriculum survey on tobacco education in European dental schools. Br Dent J 2012; 213:E12. [DOI: 10.1038/sj.bdj.2012.892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Areca-nut (AN) chewing habit has been associated with oral diseases including oral cancer, oral submucous fibrosis and periodontal disease; however, some authors have reported that the AN-chewing abuse may also jeopardize the systemic health among its users. OBJECTIVES The objective was to review any reported association between AN-chewing and the metabolic syndrome (MetS). METHODS To address the research question "Is there an association between areca-nut chewing habit and the MetS?" the MEDLINE and PubMed databases were searched from 1991 up to and including April 2010. The search criteria included: human studies, metabolic syndrome, diabetes, areca nut (AN). Only articles published in English were included. RESULTS Eight cohort studies were included in the review. The sample size of the selected studies ranged from 210 to 56,116 individuals (age range 15-83 years). The daily frequencies of AN-chewing reported by the users ranged between once a day to 76 times daily. The duration of use ranged from 6 years to ≥ 20 years. Two studies associated AN-chewing habit with hyperglycemia and type 2 diabetes while five studies studies reported an association between AN-chewing and metabolic syndrome. Four studies related AN-chewing with obesity and an increased body mass index. Higher triacylglycerol levels were reported in one study among AN-chewers compared to non-chewers. Though the numbers of publications on this subject are limited, the available studies indicate that AN-chewing could be associated with the metabolic syndrome, and individually with two of the recognized components of the syndrome i.e. diabetes mellitus and central obesity.
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Affiliation(s)
- F Javed
- Eng. A. B. Research Chair for Growth Factors and Bone Regeneration, College of Dentistry, King Saud University, P.O.Box 60169, Riyadh 11545, Kingdom of Saudi Arabia.
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Awan KH, Yang YH, Morgan PR, Warnakulasuriya S. Utility of toluidine blue as a diagnostic adjunct in the detection of potentially malignant disorders of the oral cavity - a clinical and histological assessment. Oral Dis 2012; 18:728-33. [DOI: 10.1111/j.1601-0825.2012.01935.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Awan KH, Morgan PR, Warnakulasuriya S. Evaluation of an autofluorescence based imaging system (VELscope™) in the detection of oral potentially malignant disorders and benign keratoses. Oral Oncol 2011; 47:274-7. [PMID: 21396880 DOI: 10.1016/j.oraloncology.2011.02.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 01/28/2011] [Accepted: 02/01/2011] [Indexed: 12/11/2022]
Abstract
Early detection of oral cancer is crucial in improving survival rate. Identification and detection of oral potentially malignant disorders (OPMD) allow delivery of interventions to reduce the evolution of these disorders to malignancy. A variety of new and emerging diagnostic aids and adjunctive techniques are currently available to potentially assist in the detection of OPMD. The objective of the present study was to evaluate the accuracy of autofluorescence against conventional oral examination and surgical biopsy. A total of 126 patients, 70 males and 56 females (mean age 58.5±11.9 years) who presented to the Oral Medicine Clinics at King's and Guy's Hospitals, London with oral white and red patches suspicious of OPMD were enrolled. Following a complete visual and autofluorescence examination, all underwent an incisional biopsy for histopathological assessment. Seventy patients had oral leukoplakia/erythroplakia, 32 had oral lichen planus, 9 chronic hyperplastic candidiasis and rest frictional keratosis (13) or oral submucous fibrosis (2). Of 126 lesions, 105 (83%) showed loss of fluorescence. Following biopsy 44 had oral epithelial dysplasia (29 mild, 8 moderate and 7 severe). The sensitivity (se) and specificity (sp) of autofluorescence for the detection of a dysplastic lesion was 84.1% and 15.3% respectively. While VELscope was useful in confirming the presence of oral leukoplakia and erythroplakia and other oral mucosal disorders, the device was unable to discriminate high-risk from low-risk lesions.
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Affiliation(s)
- K H Awan
- Oral Medicine, Department of Clinical & Diagnostic Sciences, King's College London Dental Institute, United Kingdom
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Warnakulasuriya S, Jone RP, Wickramasinghe AR, Sathiakumar N. P2-547 Tile: musculoskeletal disorders and associated factors among nurses in Sri Lanka. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976m.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ariyawardana A, Warnakulasuriya S. Declining oral cancer rates in Sri Lanka: are we winning the war after being at the top of the cancer league table? Oral Dis 2011; 17:636-41. [PMID: 21762396 DOI: 10.1111/j.1601-0825.2011.01809.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the age-standardized incidence, demography, recent trends and patterns of incidence of oral cancer in Sri Lanka between 1985 and 2005. MATERIALS AND METHODS Data on oral and oropharyngeal cancers were obtained from the published hospital-based cancer registry reports in the years 1985, 1990, 1995, 2000, and 2005. The data were analyzed by gender, age (<40 or >40 years), and by site. A linear regression analysis was performed on the age-standardized oral and oropharyngeal cancer incidence rates to examine the trends over a 20-year period. RESULTS There was a steady decline in the age-standardized incidence of lip and oral cavity cancers over the past 20 years in both men and women. A significant reduction of 1.9% per year is noted over this period. Contrary to this, cancers of the oropharynx (C09, C10, and C14) showed a slight increase over the same period. CONCLUSIONS Reversal of betel quid use and smoking must be considered in accounting for declining trends for oral cancer. Increasing rates of oropharyngeal cancer raises the issue whether risk factors for the oropharynx are different to those of the oral cavity, and this may need further investigation.
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Affiliation(s)
- A Ariyawardana
- Faculty of Dental Sciences, Department of Oral Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Warnakulasuriya S, Kovacevic T, Madden P, Coupland VH, Sperandio M, Odell E, Møller H. Factors predicting malignant transformation in oral potentially malignant disorders among patients accrued over a 10-year period in South East England. J Oral Pathol Med 2011; 40:677-83. [DOI: 10.1111/j.1600-0714.2011.01054.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Awan KH, Morgan PR, Warnakulasuriya S. Utility of chemiluminescence (ViziLite™) in the detection of oral potentially malignant disorders and benign keratoses. J Oral Pathol Med 2011; 40:541-4. [DOI: 10.1111/j.1600-0714.2011.01048.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Johnson NW, Warnakulasuriya S, Gupta PC, Dimba E, Chindia M, Otoh EC, Sankaranarayanan R, Califano J, Kowalski L. Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions. Adv Dent Res 2011; 23:237-46. [PMID: 21490236 DOI: 10.1177/0022034511402082] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
The mouth and oropharynx are among the ten most common sites affected by cancer worldwide, but global incidence varies widely. Five-year survival rates exceed 50% in only the best treatment centers. Causes are predominantly lifestyle-related: Tobacco, areca nut, alcohol, poor diet, viral infections, and pollution are all important etiological factors. Oral cancer is a disease of the poor and dispossessed, and reducing social inequalities requires national policies co-ordinated with wider health and social initiatives - the common risk factor approach: control of the environment; safe water; adequate food; public and professional education about early signs and symptoms; early diagnosis and intervention; evidence-based treatments appropriate to available resources; and thoughtful rehabilitation and palliative care. Reductions in inequalities, both within and between countries, are more likely to accrue from the application of existing knowledge in a whole-of-society approach. Basic research aimed at determining individual predisposition and acquired genetic determinants of carcinogenesis and tumor progression, thus allowing for targeted therapies, should be pursued opportunistically.
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Affiliation(s)
- N W Johnson
- Griffith Health Institute, Griffith University, Queensland, Australia.
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Kerr AR, Warnakulasuriya S, Mighell AJ, Dietrich T, Nasser M, Rimal J, Jalil A, Bornstein MM, Nagao T, Fortune F, Hazarey VH, Reichart PA, Silverman S, Johnson NW. A systematic review of medical interventions for oral submucous fibrosis and future research opportunities. Oral Dis 2011; 17 Suppl 1:42-57. [DOI: 10.1111/j.1601-0825.2011.01791.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Warnakulasuriya S, Kashyap R, Dasanayake AP. Is workplace screening for potentially malignant oral disorders feasible in India? J Oral Pathol Med 2010; 39:672-6. [DOI: 10.1111/j.1600-0714.2010.00915.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amarasinghe HK, Johnson NW, Lalloo R, Kumaraarachchi M, Warnakulasuriya S. Derivation and validation of a risk-factor model for detection of oral potentially malignant disorders in populations with high prevalence. Br J Cancer 2010; 103:303-9. [PMID: 20628386 PMCID: PMC2920027 DOI: 10.1038/sj.bjc.6605778] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 06/03/2010] [Accepted: 06/11/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Oral and pharyngeal cancers constitute the sixth most common type of cancer globally, with high morbidity and mortality. In many countries, most cases of oral cancer arise from long-standing, pre-existing lesions, yet advanced malignancies prevail. A new approach to early detection is needed. We aimed to validate a model for screening so that only high-risk individuals receive the clinical examination. METHODS A community-based case-control study (n=1029) in rural Sri Lanka assessed risk factors and markers for oral potentially malignant disorders (OPMD) by administering a questionnaire followed by an oral examination. We then developed a model based on age, socioeconomic status and habits of betel-quid chewing, alcohol drinking and tobacco smoking, with weightings based on odds ratios from the multiple logistic regression. A total, single score was calculated per individual. Standard receiver-operator characteristic curves were plotted for the total score and presence of OPMD. The model was validated on a new sample of 410 subjects in a different community. RESULTS A score of 12.0 produced optimal sensitivity (95.5%), specificity (75.9%), false-positive rate (24.0%), false-negative rate (4.5%), positive predictive value (35.9%) and negative predictive value (99.2%). CONCLUSION This model is suitable for detection of OPMD and oral cancer in high-risk communities, for example, in Asia, the Pacific and the global diaspora therefrom. A combined risk-factor score of 12.0 was optimal for participation in oral cancer/OPMD screening in Sri Lanka. The model, or local adaptations, should have wide applicability.
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Gómez I, Warnakulasuriya S, Varela-Centelles PI, López-Jornet P, Suárez-Cunqueiro M, Diz-Dios P, Seoane J. Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay? Oral Dis 2010; 16:333-42. [PMID: 20233328 DOI: 10.1111/j.1601-0825.2009.01642.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Worldwide, oral cancer has one of the lowest survival rates and poor prognosis remains unaffected despite recent therapeutic advances. Reducing diagnostic delay to achieve earlier detection is a cornerstone to improve survival. Thus, intervention strategies to minimize diagnostic delays resulting from patient factors and to identify groups at risk in different geographical areas seem to be necessary. The identification of a 'scheduling delay' in oral cancer justifies the introduction of additional educational interventions aimed at the whole health care team at dental and medical practices. The access to and the kind of healthcare system in a particular country are also relevant in this context, particularly the referral system. The design of a simple, clear, fail-safe, fast-track referral scheme for those suspected with cancer may diminish greatly the length of the delay. Moreover, there is a need for future investigations, which are methodologically adequate, that consider cultural and geographical aspects and use patient survival as the final outcome, that are able to recognize the agents/factors responsible for diagnostic delay by patients as well as healthcare providers and those attributable to the healthcare systems.
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Affiliation(s)
- I Gómez
- Department of Stomatology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
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Abstract
Major risk factors for oral cancer are cigarette smoking and alcohol misuse. Among Asian populations, regular use of betel quid (with or without added tobacco) increases oral cancer risks. Dentists should be aware of some emerging risk factors for oral, and particularly oropharyngeal cancer such as the role of the human papillomavirus infection (HPV). Decreases in risk could be achieved by encouraging high fruit and vegetable consumption. Some controversies related to the aetiology of this disease also need clarification. The objective of this paper is to provide an opinion on these debated controversies.
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Affiliation(s)
- S Warnakulasuriya
- Department of Oral Medicine/WHO Collaborating Centre for Oral Cancer and Precancer, King's College London Dental Institute, Denmark Hill Campus, Bessemer Road, London.
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Ergun S, Warnakulasuriya S, Duman N, Saruhanoğlu A, Sevinç B, Öztürk, Özel S, Çefle K, Palanduz, Tanyeri H. Micronuclear and sister chromatid exchange analyses in peripheral lymphocytes of patients with oral lichen planus - a pilot study. Oral Dis 2009; 15:499-504. [DOI: 10.1111/j.1601-0825.2009.01576.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kuroyanagi N, Machida J, Sakuma H, Miyabe S, Hashimoto O, Yokoi M, Warnakulasuriya S, Nagao T, Shimozato K. p53mutations in keratocystic odontogenic tumour. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1752-248x.2009.01048.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Poate TWJ, Sharma R, Moutasim KA, Escudier MP, Warnakulasuriya S. Orofacial presentations of sarcoidosis – a case series and review of the literature. Br Dent J 2008; 205:437-42. [DOI: 10.1038/sj.bdj.2008.892] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2008] [Indexed: 11/10/2022]
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Warnakulasuriya S, Reibel J, Bouquot J, Dabelsteen E. Oral epithelial dysplasia classification systems: predictive value, utility, weaknesses and scope for improvement. J Oral Pathol Med 2008; 37:127-33. [PMID: 18251935 DOI: 10.1111/j.1600-0714.2007.00584.x] [Citation(s) in RCA: 432] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Warnakulasuriya
- Department of Oral Medicine, King's College Dental Institute at Guy's, King's & St Thomas' Hospitals, London, UK.
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Ariyawardana A, Sitheeque MAM, Ranasinghe AW, Perera I, Tilakaratne WM, Amaratunga EAPD, Yang YH, Warnakulasuriya S. Prevalence of oral cancer and pre-cancer and associated risk factors among tea estate workers in the central Sri Lanka. J Oral Pathol Med 2007; 36:581-7. [PMID: 17944750 DOI: 10.1111/j.1600-0714.2007.00583.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND To screen for oral cancer or not is being debated, but for high-risk populations with minimal access to regular dental care systematic oral examinations could provide some benefit. METHODS We undertook oral mucosal examinations of labourers employed in tea estate plantations in Sri Lanka. In a two-stage screening procedure, first by estate medical officers and then by visiting specialists, we examined 12 716 persons at their workplaces achieving a coverage of one-sixth of the total workforce. RESULTS Fourteen oral cancers and 848 subjects with oral pre-cancer (6.7%) were detected giving population prevalences of 46.1 per 1000 for leukoplakia and 16.4 per 1000 for oral submucous fibrosis. Among subjects with any oral mucosal disorder (n = 1159) proportions of current users of betel quid, smokers and alcohol use was recorded at 92%, 31% and 61% respectively. The synergistic effect of these three risk habits on the development of oral leukoplakia was evident in mixed habit groups. CONCLUSIONS The prevalence of oral pre-cancer in tea estate labourers was higher than estimates reported in previous studies. In the absence of state-sponsored preventive activities, it is necessary to improve the capacity of individual health practitioners and small medical centres to participate in oral health promotion and oral cancer/pre-cancer screening.
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Affiliation(s)
- A Ariyawardana
- Department of Oral Medicine, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Abstract
At a workshop coordinated by the WHO Collaborating Centre for Oral Cancer and Precancer in the UK issues related to terminology, definitions and classification of oral precancer were discussed by an expert group. The consensus views of the Working Group are presented here. The term, 'potentially malignant disorders', was recommended to refer to precancer as it conveys that not all disorders described under this term may transform into cancer. Critically evaluating all definitions proposed so far for oral leukoplakia, the Working Group agreed that the term leukoplakia should be used to recognize 'white plaques of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer'. An outline was proposed for diagnosing oral leukoplakia that will prevent other oral white disorders being misclassified as leukoplakia. The Working Group discussed the caveats involved in the current use of terminology and classification of oral potentially malignant disorders, deficiencies of these complex systems, and how they have evolved over the past several decades. The terminology presented in this report reflects our best understanding of multi-step carcinogenesis in the oral mucosa, and aspires to engender consistency in use.
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Affiliation(s)
- S Warnakulasuriya
- Department of Oral Medicine, King's College London Dental Institute at Guy's, Denmark Hill Campus, Caldecot Road, London, UK.
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Sumeth Perera MW, Gunasinghe D, Perera PAJ, Ranasinghe A, Amaratunga P, Warnakulasuriya S, Kaluarachchi K. Development of an in vivo mouse model to study oral submucous fibrosis. J Oral Pathol Med 2007; 36:273-80. [PMID: 17448137 DOI: 10.1111/j.1600-0714.2007.00523.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidemiological data have shown an association of areca nut chewing with oral submucous fibrosis (OSF). Experimental evidence to confirm this has been limited. Fibrosis-promoting activity of areca nut was tested in an animal model. METHOD Buccal mucosa of a group of 20 female BALB/c strain mice, 10-12 weeks of age, was treated twice daily 6 days per week with topical application of aqueous areca nut extracts for 300-600 days. A control group (n = 20) was treated with 50 mM NaCl. The influence of areca nut on the oral epithelium and connective tissue was recorded semiquantitatively by light microscopy. RESULTS The areca nut-treated oral epithelium showed progressive changes in epithelial thickness leading to atrophy, increased cellularity of fibroblasts, fibrosis of connective tissue, focal infiltration of inflammatory cells and muscle atrophy. On killing after 600 days of treatment, the scores on cellularity, inflammation and muscle atrophy were significantly different to the control group (P = 0.03). CONCLUSION The study provides further evidence that areca nut contributes to the development of OSF in treated animals. The model has the potential to test synergism of areca nut with other carcinogens and any therapeutic interventions.
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Affiliation(s)
- M W Sumeth Perera
- Department of Biochemisty, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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