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The ability to spot mouth cancer undoubtedly continues as one of the most critical roles a dental professional has. Early diagnosis identified by practitioners can save a person's life. While being an enormous responsibility, being able to transform a person's quality of life remains a great honour and allows us to form a connection to a patient which is truly special and that will last forever.

Regrettably, the pandemic has created a number of barriers that have made education, awareness, and early diagnosis of mouth cancer extremely difficult. Urgent action is needed for us to tackle these challenges, as without intervention, there is a growing fear that unnecessary lives will be lost.

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The state of mouth cancer

Before, we discuss the issues at hand, let's first take a look at the current landscape of mouth cancer in the UK. The most recent annual figures put mouth cancer cases in the UK at 8,722. It means that one person every hour is diagnosed with the disease - a solemn thought.1

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Recalling my first years in dentistry, it was not unusual for a practitioner to go their whole career without identifying a case of mouth cancer. This is far from the scenario today. Mouth cancer incidence has rocketed by 97% in the last 20 years,2 and we are now in a position where dental professionals are not just coming across one case throughout their career, but several.

' Recalling my first years in dentistry, it was not unusual for a practitioner to go their whole career without identifying a case of mouth cancer. This is far from the scenario today.'

Sadly, survival figures have barely improved during that time and the devastating reality is that most cases are simply caught too late. Spotting mouth cancer early transforms a patient's survival outcome from 50% to 90%.3 This is the only fact we need to highlight the importance of early detection. It is here however, where the challenges begin.

Limited access to primary care

The early stages of the pandemic were disastrous for dentistry. Practice closures and restrictions due to COVID-19 meant that businesses struggled to survive while livelihoods were put in tremendous jeopardy. It was an exceptionally difficult time for the profession, and as a result, patients suffered.

A report we collected from one of the UK's biggest NHS Foundation Trusts confirmed that mouth cancer referrals fell by 65% in the six-months after the first lockdown.4 It was a similar case across other areas of the country.

More than a year later, NHS dentistry continues to feel the effects of the backlog caused by the pandemic. This is particularly evident in rural areas, where we have seen recent incidences of unrest from members of the public unable to access dental care. The lasting impact of any backlog is incredibly concerning for mouth cancer referrals. The more patients presenting with advanced stages of the disease will likely lead to a reduction of five-to-ten-year survival rates.

It is essential that at a time of inevitable dental rationing practices prioritise seeing patients who are presenting with possible symptoms of mouth cancer.

This is also likely to occur due to limited face-to-face access to GPs - a trend which is set to continue into and beyond 2022.

Improving patient awareness

One of the biggest challenges to be overcome is improving public awareness of mouth cancer, which remains very poor. More than one-in-ten (14%) adults remain unaware that cancer can occur in the mouth.5

A lack of awareness about the signs and symptoms of mouth cancer is also worrying. Our charity's new investigation into public knowledge of the disease shows that awareness of the most common symptoms is as low as 20%.6

' The lasting impact of any backlog is incredibly concerning for mouth cancer referrals. The more patients presenting with advanced stages of the disease will likely lead to a reduction of five-to-ten-year survival rates.'

Given the lack of awareness about the early warning signs, it is not surprising that nearly two-in-three have never checked their mouth for signs of cancer while most (83%) of those who do check are either not confident about what they are looking for, or do not know what to look for at all.2 The population are around three times more likely to conduct routine self-checks for testicular and breast cancer than for mouth cancer.5

A lack of regular mouth cancer examinations at home is one of the most fundamental reasons behind late diagnosis. In the UK, nearly two-in-three (62%) patients are diagnosed in stages III and IV. Overall, just under half (45%) of all mouth cancers are diagnosed in stage IV, when the cancer is at its most advanced.7

Lockdown habits

COVID-19 has had a severe impact on a wide spectrum of the nation's health and wellbeing. The implications to a patient's oral health have certainly not been immune to changes in lifestyle over the pandemic, and unfortunately, the same can be said of mouth cancer.

Nearly one-in-five (17%) people have admitted to now drinking more alcohol - one of the main risk factors for the disease. A small cohort of our participants (2%) claim to have taken up smoking during the various lockdowns while for 7% of smokers, their tobacco intake has increased.6 This is particularly worrying when we dig deeper into how much people know about the risk factors associated with mouth cancer.

Crucially, awareness of risk factors is low among those who smoke and drink alcohol to excess. Almost half (45%) of cigarette smokers do not know that smoking causes mouth cancer. And, of those who exceed government guidelines of 14-units of alcohol a week, around half (53%) do not know that excessive alcohol use is linked to mouth cancer.5

Conclusion

Over the last year, we have been introduced to a number of incredibly difficult challenges in our fight to beat mouth cancer. Lockdowns and backlogs to primary care have led to concerns around more mouth cancers going undiagnosed.

During November, Mouth Cancer Action Month will be calling on government to increase NHS dental provision and urge them to consider giving GPs and pharmacy the power for direct referrals. Both of these measures would help ease pressures from an over-burdened system and help diagnose more mouth cancers early.

The charity campaign will also be speaking directly to patients to improve their awareness of mouth cancer. We want more patients to self-check at home and act quickly on unusual changes in their mouth. Awareness of the early signs associated with mouth cancer must improve, as does a patient's understanding about their own level of risk, based on lifestyle choices.

All dental professionals have an important role to play in the early detection of mouth cancer and November's Mouth Cancer Action Month presents us with the perfect opportunity to raise awareness amongst our patients and across the local community.

If you would like to know more about mouth cancer, or discover how you can support Mouth Cancer Action Month, visit www.mouthcancer.org