Key Points
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This was an evaluation of the first high profile public awareness campaign in the West of Scotland.
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This paper focuses on the public's awareness of oral cancer, which is known to be very low.
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The paper evaluates patients presenting to rapid access clinics of secondary care units with suspicious lesions.
Abstract
Aim
In 2003, the West of Scotland Cancer Awareness Programme (WoSCAP) launched their oral cancer campaign to raise public awareness of the disease in five NHS boards across the West of Scotland. The aim of this study was to evaluate the campaign by reviewing patients attending rapid access clinics in the 11 secondary care units across the five boards.
Design
Data were collected in 2004 during the second phase of the campaign via a two part self-completing questionnaire; the first part collected information from the patients and the second part from the clinicians, in rapid access clinics in the secondary care units.
Results
In total, 580 questionnaires were given out in the clinics with 538 completed patient sections (response rate 93%) and 500 completed clinician sections (response rate of 86%). More than two thirds of rapid access secondary care patients had seen a recent health campaign related to mouth cancer, and 46% responded that the campaign had encouraged them to seek advice more quickly. Of the patients examined in the clinics, 5% had a provisional diagnosis of a malignant lesion, 7% a potentially malignant lesion, and the majority of lesions were benign. The clinicians deemed 30% of the referrals to be inappropriate.
Conclusions
The results show a high percentage of patients attending rapid access clinics were aware of the campaign. However, there were a disproportionate number of inappropriate referrals to the rapid access clinics compared to genuinely urgent cases.
Main
Characteristics of patients attending rapid access clinics during the West of Scotland Cancer Awareness Programme oral cancer campaign J. Rodgers, L. M. D. Macpherson, G. L. F. Smith, A. J. Crighton, A. T. M. Carton, and D. I. Conway British Dental Journal 2007; 202: E28
Editor's summary
This is the second paper assessing the West of Scotland Cancer Awareness Programme (WoSCAP) oral cancer campaign by lead authors Rodgers and Macpherson. The first looked at GDPs' perceptions of the campaign (Br Dent J 2006; 200: 693–697) and found that the majority of GDPs gave it a positive assessment and reported an increased awareness of oral cancer among their patients. This second paper looks at the characteristics of patients who attended rapid access clinics across the participating NHS boards, in an effort to assess public awareness of the oral cancer campaign.
Of the 538 patients surveyed for this paper, 64% were aware of the campaign and 46% indicated that it had encouraged them to seek advice sooner than they would otherwise have done. This proportion amounted to almost 70% of those respondents who were aware of the campaign. Most of the patients who were aware of the campaign reported that they had heard about it from a television advertisement, and it is encouraging that this method of raising awareness appears to have been successful. This finding is useful for informing future public health campaigns.
Another interesting, if perhaps unsurprising finding is that only 38% of those referred by primary care practitioners were considered by the hospital clinicians to be appropriate urgent referrals. While this figure is low, any effective campaign to raise public awareness of cancer is likely to result in a significant number of referrals that turn out to be unnecessary. The most important finding of this paper is that the campaign resulted in a good level of public awareness, which was, after all, its main aim. In combination with the earlier paper, this work provides important information that should enable the improvement and successful design of public awareness campaigns, both for cancer and other conditions, in the future.
The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 202 issue 11.
Rowena Milan, Journal Editor
Author questions and answers
Why did you undertake this research?
The West of Scotland Cancer Awareness Programme (WoSCAP) oral cancer campaign had planned many aspects of the evaluation but there was a gap in the evaluation with respect to the impact the campaign had on the dental aspects, specifically the secondary care oral and maxillofacial surgery departments. This piece of work addressed this question as well as informing us on the public health aspects of the impact of the campaign on secondary care.
What would you like to do next in this area to follow on from this work?
Since completing this piece of work, I have begun an audit of patients accessing Glasgow Dental Hospital Oral Medicine Department Rapid Access Clinic to see how the patients attending during the time of the WoSCAP Campaign compare to those before and after the campaign in terms of clinical diagnosis and stage of disease. I am hoping that the outcome of this audit will give an indication of the clinical evaluation of the campaign as the results of the previous piece of work gave the public health evaluation of the campaign.
The aims of the audit are to:
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compare the numbers of patients attending the study clinic during the time of the WoSCAP Campaign with the numbers that attended before the campaign
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compare the numbers of patients with a confirmed histological diagnosis of a malignant lesion during the time of the campaign with those before the campaign
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follow those patients with a confirmed histological diagnosis of a malignant lesion to ascertain the stage of their disease during the time of the campaign and compare with those before the campaign.
This audit began in March 2006. The results of this audit could potentially inform any future campaigns on the clinical aspects of such an awareness campaign.
Comment
There are approximately 4,400 new cases of oral cancer per year in the UK. It is therefore important that the public are aware what to look for, and what factors put them at higher risk. We already know that risk factors for oral cancer include men ≥40 years old, smokers of ≥20 cigarettes per day and drinkers of ≥28 units of alcohol per week. Unfortunately a study by Netuveli and co-workers in 20061 shows patients who fall into these categories are less likely to be regular dental attenders.
While the gold standard would involve setting up a screening programme, there has to be a cheap, acceptable test which provides a low rate of false positives and false negatives for screening to work. Kujan et al.2 concluded that there is no evidence to recommend a particular screening test for oral cancer and an earlier work by the BDA in 20003 suggests that opportunistic screening is the best that can currently be achieved. We therefore need to identify the target population, and encourage them to attend for review.
This study details the WoSCAP campaign and assesses how many patients presenting at rapid access clinics were aware of this health promotion programme. 64% of patients indicated that they had seen or heard of a mouth cancer campaign during the past six months. 46% reported that the publicity had encouraged them to seek advice more quickly. Interestingly, the study found that people were more likely to present to their doctor if they suspected mouth cancer, despite the publicity campaign specifically mentioning dentists.
There has to be a many-faceted approach to the prevention, early diagnosis and treatment of mouth cancer. This study shows that awareness programmes do have an impact and that a greater number of patients involved in this programme attended for advice and assessment than would have otherwise been the case.
References
Netuveli G, Sheiham A, Watt R G . Does the 'inverse screening law' apply to oral cancer screening and regular dental check-ups? J Med Screen 2006; 13: 47–50.
Kujan O, Glenny A M, Oliver R J, Thakker N, Sloan P . Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev 2006: 3: CD004150.
British Dental Association. Opportunistic oral cancer screening. London: BDA, 2000.
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Wylie, J. Rapid access oral cancer clinic attendees. Br Dent J 202, 680–681 (2007). https://doi.org/10.1038/bdj.2007.496
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DOI: https://doi.org/10.1038/bdj.2007.496