Csépe Péter, Bánóczy Jolán, Dombi Csaba, Forrai Judit, Gyenes Mónika, Döbrossy Lajos
Semmelweis Egyetem, Közegészségtani Intézet, AOK, 1445 Budapest.
Magy Onkol. 2007;51(2):95-101. Epub 2007 Jul 29.
Oral cancer has been identified as a significant public health threat. It is reported that about 3,800 new cases of oral cancer are diagnosed in Hungary each year with approximately 1,700 associated deaths. Oral cancer is the 6th most common cancer in men. Most oral cancers are preventable; 75% of oral cancers are related to tobacco use, alcohol use, or use of both substances together. While there is insufficient evidence to support or refute the use of visual examination as a method of screening for oral cancer in the general population, screening in high-risk populations is highly recommended. It was presumed that high-risk behavior including tobacco and alcohol use is one of the characteristics of Roma people. The main aim of the study was to elaborate a screening model program for the Roma population to determine risk factors of oral cancer and establish early diagnosis hence to reduce morbidity and mortality. In the program we planned to survey the risk factors in the target population, establish the diagnosis of oral cancer and/or pre-cancer and direct the patients to health care facilities. First we determined the target population in four Hungarian towns with the help of Roma social workers and local public health officers. We assembled a questionnaire on risk factors. Training for Roma social workers and screening personnel was also accomplished. Screening for oral precancerous lesions and cancer and survey the risk factors in the target population were performed at the same time. Patients screened to be positive were referred to specialists. Altogether 1,146 persons, 656 male and 490 female (age 20-77 years, mean 40 years), participated in the screening; 84% of them reported on some kind of complaints. We have got valid data on risk factors in connection with oral cancer. More than fifty percent of participants did not clean their teeth regularly, 75% were smokers, while 45% drunk alcohol regularly. 1,6% of screened participants had oral lesions that did not require referral to a specialist, while 2.3% of the screened subjects had referable oral mucosal lesions including leukoplakia. The overwhelming majority (93%) of participants screened to be positive did not see dentist regularly. As a conclusion, we elaborated a screening model program, which is applicable for disadvantaged (e.g. Roma) population to determine risk factors of oral cancer and establish early diagnosis hence to reduce morbidity and mortality. We surveyed the risk factors in the target population, established the diagnosis of oral cancer and/or pre-cancer lesions and directed the patients to care facilities. We also assisted them to get appropriate long-term care and follow-up. The importance of screening activities targeted on high-risk population was underlined.
口腔癌已被确认为对公众健康的重大威胁。据报道，匈牙利每年约有3800例口腔癌新发病例，相关死亡人数约为1700人。口腔癌是男性中第六大常见癌症。大多数口腔癌是可预防的；75%的口腔癌与吸烟、饮酒或两者同时使用有关。虽然没有足够的证据支持或反驳将视觉检查作为普通人群口腔癌筛查方法，但强烈建议对高危人群进行筛查。据推测，包括吸烟和饮酒在内的高危行为是罗姆人的特征之一。该研究的主要目的是为罗姆人群制定一个筛查模型计划，以确定口腔癌的危险因素并建立早期诊断，从而降低发病率和死亡率。在该计划中，我们计划调查目标人群中的危险因素，诊断口腔癌和/或癌前病变，并将患者转诊至医疗机构。首先，我们在罗姆社会工作者和当地公共卫生官员的帮助下，确定了匈牙利四个城镇的目标人群。我们编制了一份关于危险因素的问卷。还对罗姆社会工作者和筛查人员进行了培训。同时进行口腔癌前病变和癌症的筛查以及对目标人群危险因素的调查。筛查呈阳性的患者被转诊至专科医生处。共有1146人参与了筛查，其中男性656人，女性490人（年龄20 - 77岁，平均40岁）；其中84%的人报告有某种不适。我们获得了与口腔癌相关的危险因素的有效数据。超过50%的参与者没有定期刷牙，75%的人吸烟，45%的人经常饮酒。1.6%的筛查参与者有不需要转诊至专科医生的口腔病变，而2.3%的筛查对象有可转诊的口腔黏膜病变，包括白斑。筛查呈阳性的参与者中绝大多数（93%）没有定期看牙医。总之，我们制定了一个筛查模型计划，该计划适用于弱势群体（如罗姆人），以确定口腔癌的危险因素并建立早期诊断，从而降低发病率和死亡率。我们调查了目标人群中的危险因素，诊断了口腔癌和/或癌前病变，并将患者转诊至护理机构。我们还协助他们获得适当的长期护理和随访。强调了针对高危人群开展筛查活动的重要性。
