Comment

Dentists have been exhorted to perform opportunistic screening for oral cancer, when adults attend for routine oral examinations. ¹ It is argued that lesions in pre-symptomatic stages may be detected, thus improving long-term prognosis. However, such advice presupposes that dentists can make a valuable contribution because patients at risk present for regular routine dental checks. This paper challenges the value of that assumption regarding a specific high-risk group.

While not exclusive to Bangladeshis in the UK, a number of studies have confirmed the very high prevalence of betel quid ('paan') and tobacco chewing among members of this community, compared with other groups originating from the Indian sub-continent. A higher proportion of women eat 'paan' and with greater frequency while many Bangladeshi men smoke. The association of tobacco/paan chewing with oral cancer has been derived mainly from studies in India, but is now supported by evidence from the four Thames regions, where about 5 per cent of the total burden of oral cancer is among Asian migrants with high rates of tobacco-chewing habits.²

The authors selected their sample from medical practices in Tower Hamlets. Given the methodological problems inherent in obtaining a population sample and the very high medical consultation rates among Bangladeshis, the findings are unlikely to substantially misrepresent the situation in this population group. This methodology opens up debate about the potential for working with primary care medical practices in offering alternative approaches for screening for Bangladeshis, particularly as doctors were perceived as the appropriate person to consult with mouth ulcers or a sore mouth.

One third of the population reported that they had visited a dentist within the past year, while one quarter had never been. This raises questions about their perception of the value of dental services, as well as how access could be facilitated. A symptomatic approach was the norm, so that in the absence of a 'problem', attendance is unlikely to occur. Language difficulties presented the greatest problem for access, especially among females, while the use of advocates or interpreters and extended surgery opening hours were seen as helpful.

Overall, this paper confirms an important challenge, which while pertinent to Bangladeshis, can have wider implications for other less-accessible, high-risk population groups. The provision of a supportive environment in order to promote oral health in acceptable and appropriate ways,³ must involve working with the communities themselves.