Precancerous lesions of the oral cavity: prevention, diagnosis and cure. The state of art
Paolo Brunamonti Binello
University of Genoa / Executive Doctor “Ospedali Galliera” Hospital - Department of Specialized Surgeries - Genoa - Italy
Abstract:
The alarming increase in the incidence and mortality of carcinoma of the oral cavity (CCO) coupled with the absence of mass screening for its prevention are the basis of discussion on the prevention, diagnosis and cure of oral cancer. CCO represents 4% of all malignant neoplasias in european countries. It is necessary to spread more information about the risk factors that lead to pre-cancerous oral mucous lesions--(LPMO) which present histological aspects of epithelial dysplasia commonly known with the acronym of OIN ( Oral Intraepithelial Neoplasia). The analytical research reveals a perilous trending an increase of reported instances of CCO throughout Western Europe, with an average increase of reported carcinoma lesions at 3 to 4 units out of 100,000 annually. Further it has been revealed that males are more at risk for this type of cancer, showing an increase of instances of 2 to 3 times more than females. Meantime subjects over the age of 75 have an increased risk factor of 100 units of 100,000 people. The high mortality rated associated with CCO is alarming both in terms of real numbers and needless death. On average half of all patients with CCO die due to late diagnosis of this aggressive cancer. Up to our present day, the diagnostic element occurs late: generally 4 months after the appearance of symptoms. Close to 68% of all reportedly diagnosed cases are discovered in the advanced stages (3 and 4) of the illness, and only 32% at stage 1 and 2. The mortality rate due to CCO is also high, on the average half of the patients die due to the progression of the cancer, and sometimes with the growth of other primitive tumors. The first step in decreasing the mortality rate associated with CCO is to educate the general public as to the urgency of early detection and preventative therapies, and dispel misconceptions concerning the inter-connectedness between dental care and physical health. Dentists and specialist on Odontostomatology, in all its phases, will play a critical role with the observance of precise semeiological, an important diagnostic test that facilitates early detection of Leucoplakia, precursors to onset of CCO. A unified early detection protocol includes and strives to succeed in the following:
- Select the patients with a pre-disposition to certain histological examinations;
- Reduce the number of clinical cases which are not in the initial stages;
- Adopt a diagnostic system /therapy which will lead to the reduction of the mortality associated with CCO.
The Author’s findings are based on a cumulative 20-year study that have shown an increase of almost 7.000 diagnosed cases of CCO in during this period with an average follow up of close to 9 years.
