|Year : 2016 | Volume
| Issue : 2 | Page : 252-255
Assessment of the sociodemographic characteristics and efficacy of screening for oral, head and neck potential malignant lesions in apparently healthy adults in Jos Nigeria
AA Adoga1, OA Silas2, JP Yaro1, ET Okwori1, AA Iduh1, CJ Mgbachi1
1 Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
2 Department of Pathology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
|Date of Web Publication||6-Jan-2017|
A A Adoga
Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State
Source of Support: None, Conflict of Interest: None
Background: The efficacy of screening for oral, head and neck cancers (HNCs) in adequately identifying high-risk groups is controversial. Objectives: This study aims to review our experience with a free oral, HNC-screening program to determine the sociodemographic characteristics of the participants and the effectiveness of this program to improve future programs. Materials and Methods: A prospective cross-sectional survey of participants in a free oral, HNC screening exercise was performed in the years 2009, 2012, and 2013. Results: In the years of screening, 135 participants presented aged between 21 and 83 years (mean = 47.0; ±15.6) with a male to female ratio of 1.2:1. 32.6% consumed alcohol, and 17.8% were smokers. Smoking (P = 0.04) and alcohol use (P = 0.05) were associated with higher rates of suspicious malignant symptoms. There was no statistical correlation between symptom prevalence and the number of participants requiring immediate consultation for oral, HNC (r = 0.47), and those referred for routine follow-up (r = 0.34). Premalignant and malignant lesions were diagnosed in 5 males aged 44–72 years. 83.7% found the screening program beneficial in increasing their awareness of the disease. Conclusions: This hospital-based screening demonstrates improved awareness among people about oral, HNCs, and survival outcomes on a small scale. A community-based screening with health education to target a larger high-risk population is recommended to encourage individuals to modify high-risk factors and improve outcomes.
Keywords: Efficacy, head and neck cancer, Jos, oral, screening
|How to cite this article:|
Adoga A A, Silas O A, Yaro J P, Okwori E T, Iduh A A, Mgbachi C J. Assessment of the sociodemographic characteristics and efficacy of screening for oral, head and neck potential malignant lesions in apparently healthy adults in Jos Nigeria. Indian J Cancer 2016;53:252-5
|How to cite this URL:|
Adoga A A, Silas O A, Yaro J P, Okwori E T, Iduh A A, Mgbachi C J. Assessment of the sociodemographic characteristics and efficacy of screening for oral, head and neck potential malignant lesions in apparently healthy adults in Jos Nigeria. Indian J Cancer [serial online] 2016 [cited 2020 Apr 2];53:252-5. Available from: http://www.indianjcancer.com/text.asp?2016/53/2/252/197713
| » Introduction|| |
Two-thirds of the cases of head and neck cancer (HNC) occur in developing countries.
No true incidences exist in Nigeria because most studies available are hospital based. However, previous studies from Jos and Ibadan, Nigeria, report an incidence of 38 and 62 cases/year, respectively.,
The primary risk factors for HNC are tobacco use, alcohol consumption, viral etiologies such as human papillomavirus (HPV) and Epstein–Barr virus (EBV) with chronic exposure of the mucosa of the upper aerodigestive tract to these and other risk factors producing dysplastic changes leading to cancer.
Late-stage presentation and diagnosis is a feature of HNC, especially in developing countries with resultant poor prognosis and low average survival rates despite the remarkable advances in the diagnosis and treatment recorded over the years. Those that survive often live with major cosmetic, functional, and psychological disabilities such as speech, chewing, swallowing, and breathing.
Early detection and excision of potentially malignant lesions of the head and neck region reduces malignant transformation and invariably improve survival rates. To achieve this, screening programs for oral, HNCs have been introduced over the years with existing protocols, some of these programs proving to be cost-effective in early detection.
The Jos University Teaching Hospital under the screening program of the HNC Alliance (formerly Yul Brynner HNC foundation) tagged oral HNC awareness week (OHANCAW) had conducted free screening for oral, HNCs in 2009, 2012, and 2013.
This study aims to review our experience with this screening program to determine the sociodemographic characteristics of the individuals screened and the effectiveness of this program to improve future programs.
| » Materials and Methods|| |
This is an observational cross-sectional study carried out at the Jos University Teaching Hospital, Jos, Nigeria, in 2009, 2012, and 2013.
Approval for this study was obtained from the Ethical Clearance Committee of the Jos University Teaching Hospital.
Assessment tools: Materials required for the OHANCAW were sent via regular mail by the HNC Alliance. These materials were:
- A memory stick containing information on the screening exercise for public education and enlightenment
- Screening forms which included portions to be completed by participants, i.e. bio-data, if they or their family members had been treated for HNC before, if they use tobacco or alcoholic beverages and if they had any symptoms suggestive of HNC at the time of presentation for the screening. The form also included portions for the release of liability by the participants and screening examination findings to be completed by the practitioner
- T-shirts for the medical team involved in the screening exercise and in our center included the nurses, resident doctors, and the staff in the pathology department
- Posters for the screening exercise
The materials for the examination of the participants were those provided by the Jos University Teaching Hospital in the Otolaryngology outpatient clinics.
Information regarding the free screening exercise was disseminated via the electronic media, public lectures, during conversations with colleagues, friends and close relatives and by the use of posters placed at various locations in the hospital and other public places.
In the weeks of screening, which was undertaken at the Otolaryngology Outpatient Clinics of the Jos University Teaching Hospital, participants were given the screening forms to fill out portions needed by them to complete and a thorough oral, head and neck examination performed on each of the participants looking out for suspicious premalignant lesions.
Data were analyzed using EPI-Info database version 3.5.3 (EPI Info, Center for Disease Control, Atlanta, Georgia, USA, 2011).
| » Results|| |
A total of 135 participants were screened aged between 21 and 83 years (mean = 47.0; standard deviation = ± 15.6) comprising 74 (54.8%) males and 61 (45.7%) females with a male to female ratio of 1.2:1 and individuals aged 31–50 years constituted the majority of the participants [Table 1].
Civil servants (government workers) constituted majority - 50 (37%) of those screened followed by housewives (n = 16; 11.9%) and farmers (n = 14; 10.4%). The least group by profession screened were tailors [Table 2].
Seventy-four (54.8%) participants did not hear about the screening exercise.
Forty-four (32.6%) participants were exposed to alcohol with 18 (13.3%) drinking alcohol for between 10 and 50 years duration.
Twenty-four (17.8%) participants attested to using tobacco with 8 (6.0%) actively smoking 10 or more sticks of cigarettes for duration of 4–35 years. There was however no reported chewing of tobacco among the participants.
Nine (6.7%) participants were aware of an association between symptoms and HNC. The most common presenting symptom was sore throat followed closely by otalgia and hoarseness [Table 3]. Dysphagia, epistaxis, hoarseness, oral sores, oral bleeding and the presence of a neck mass were significant predictors of suspicious lesions requiring further oral, head and neck evaluation (P < 0.05).
Logistic regression analysis reveals no statistical correlation between symptom prevalence and the number of participants requiring immediate consultation for oral, HNC (r = 0.47), and those referred for routine follow-up (r = 0.34).
Participants who were either currently smoking or exposed in the past had higher rates of suspicious symptoms than those who never smoked (P = 0.04). Similarly, regular and prolonged alcohol use was associated with suspicious symptom prevalence (P = 0.05).
Only 2 (1.5%) subjects had prior knowledge of oral self-examination.
Seventeen (12.6%; males = 13, females = 4) participants required further evaluation for HNC of which 5 (3.7%, All males aged between 44 and 72 years; average age = 58 years) had histological diagnoses of cancer and premalignant lesions-adenoid cystic carcinoma of right parotid (n = 1), in situ carcinoma of the oral tongue (n = 2), lymphoma of the right tonsil (n = 1), and squamous cell carcinoma of the nasopharynx (n = 1). The last two invasive cancers were diagnosed as early stage tumors. The subject with tonsil lymphoma was also diagnosed with the human immuno-deficiency viral (HIV) disease and has been on the highly active antiretroviral therapy (HAART). All the participants had surgical excision of their tumors, 2 (parotid and tongue cancers) of who were referred for postoperative chemoradiation therapy. All subjects are still being followed up in our outpatient clinic with no history of tumor recurrence. The remaining 12 participants were diagnosed with benign conditions.
One hundred and thirteen (83.7%) participants found the screening program beneficial in increasing their awareness of oral, HNCs with 96 (71.1%) ready to be volunteers for a similar screening exercise.
| » Discussion|| |
Older males have continued to be the most affected by HNCs from various epidemiological reports all over the world. This is similar to the finding in our study in which all the participants diagnosed with cancer and precancerous lesions were males aged between 44 and 72 years (average 58 years).
Our screening exercise recorded mostly young and middle-aged males who constitute a high-risk group as the major participants. This is different from findings in another screening exercise where females formed the bulk of participants. It was encouraging to see the younger age group participating in the screening exercise as reports from Africa has shown that oral, HNCs occur more in younger Africans compared to those in developed countries. This higher prevalence in younger Africans has been attributed to the lower life expectancy among Africans and the earlier exposure to several risk factors. The number of participants found to have premalignant diseases and cancers in this study was few, but the peak age incidence is similar to the finding in Ilorin, Nigeria, by Ologe et al. This small number is because this was a hospital-based screening and not a community-based exercise.
Government workers of various calibers were the largest group screened in our study and artisans the least number screened. The relationship between occupation/socioeconomic status and the incidence of oral, HNC is not clearly defined. People of low socioeconomic status, however, are unlikely able to access proper health care and therefore more prevalent to oral, HNCs. This is more so in an environment where financing health care is achieved via out of pocket payments than health insurance.
We recorded a statistical association between exposure to smoking and alcohol consumption with higher rates of suspicious symptoms in participants.
Tobacco use in all forms and alcohol abuse has long been associated with an increased risk of oral, HNCs due to their cytotoxic and mutagenic effects on exposed mucosa of the upper aerodigestive tract. However, it has been established that cigarette smoking is associated with lesser risk of development of oral, HNC than cigar and pipe smoking because of the filters in cigarettes, which reduce the carcinogen load in contact with the oral mucosa. Cigarette smoking was the only exposure reported among participants in our study.
Alcohol plays a synergistic role by irritating the oral mucosa and providing the solvent for carcinogens in tobacco. This effect probably explains why the oral tongue was the most common site affected in our study. However, the number of participants eventually diagnosed with premalignant and malignant diseases during this screening exercise was small and unrepresentative; therefore, it would be inconclusive to state the most common histologic tumor type encountered. Screening of a large population preferably a community-based exercise would be adequately representative.
Other risk factors in the etiology of oral, HNC have been established such as the HPV and EBV, which interfere with cell cycle control by encoding viral oncoproteins  but our study did not set out to associate these factors in the etiology of this disease among participants.
The role of the HIV and the prevalence and behavior of oral, HNCs is well known as is the role of antiretroviral therapy on the prognosis of this disease in seropositive individuals. The participant who had HIV has done well on HAART as we continue to follow him up in the outpatient clinic.
The beneficial effect of early detection of oral, HNCs with the aim of improving outcomes has been stated in several studies. The role of screening exercises in improving the education and awareness of individuals in society regarding this disease is also stated  as it is in our study in which a significant number of participants (83.7%) believed that screening improved their awareness and a similar large number (71.1%) agreeing to be volunteers for such screening exercise. Educating participants on the early symptoms and risk factors and the deleterious effects of this disease would have motivated them to volunteer for future screening programs.
The relatively low turnout of participants for the three screening exercises conducted could be because of patients presenting to the Otolaryngology outpatient for specific conditions other than an interest in the free screening exercise. This could also explain why the most common presenting symptom among participants was sore throat and why the incidence of benign lesions was higher in this study. A mouth ulcer was the most significant predictor of participants with lesions suspicious of malignancy, and symptoms such as neck masses and hoarseness were not an unexpected finding.
Consistent with another study, ours has demonstrated a lack of knowledge of the risk factors and the early symptoms of neoplasms among screened participants. Screening therefore provides the opportunity for healthcare providers to educate people in a community about these neoplasms and also to encourage them in risk factor modifications to reduce morbidity and mortality.
| » Conclusions|| |
This screening for oral, HNC has demonstrated a reduction in morbidity and mortality of oral, HNC by detecting potentially malignant diseases in high-risk individuals and improving survival outcomes though on a smaller scale.
It has also demonstrated an improved awareness among people about the disease.
This screening is however hospital based and probably explains the low turnout of participants and low number of detected premalignant lesions and cancers in our study. This also suggests that the target group for screening is not adequately met. There is a need for a community-based screening to target a larger high-risk population.
Health education is also required to encourage individuals to modify high-risk factors and improve outcomes.
We wish to thank ALL the nursing staff of the Otorhinolaryngology Department for their help with the screening exercise.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Marur S, Forastiere AA. Head and neck cancer: Changing epidemiology, diagnosis, and treatment. Mayo Clin Proc 2008;83:489-501.
Bhatia PL. Head and neck cancer in Plateau state of Nigeria. West Afr J Med 1990;9:304-10.
Adisa AO, Adeyemi BF, Oluwasola AO, Kolude B, Akang EE, Lawoyin JO. Clinico-pathological profile of head and neck malignancies at University College Hospital, Ibadan, Nigeria. Head Face Med 2011;7:9.
Oji C. Late presentation of orofacial tumours. J Craniomaxillofac Surg 1999;27:94-9.
Gourin CG, Kaboli KC, Blume EJ, Nance MA, Koch WM. Characteristics of participants in a free oral, head and neck cancer screening program. Laryngoscope 2009;119:679-82.
Larizadeh MH, Damghani MA, Shabani M. Epidemiological characteristics of head and neck cancers in southeast of Iran. Iran J Cancer Prev 2014;7:80-6.
Ologe FE, Adeniji KA, Segun-Busari S. Clinicopathological study of head and neck cancers in Ilorin, Nigeria. Trop Doct 2005;35:2-4.
Choi SY, Kahyo H. Effect of cigarette smoking and alcohol consumption in the aetiology of cancer of the oral cavity, pharynx and larynx. Int J Epidemiol 1991;20:878-85.
Pezzuto F, Buonaguro L, Caponigro F, Ionna F, Starita N, Annunziata C, et al.
Update on head and neck cancer: Current knowledge on epidemiology, risk factors, molecular features and novel therapies. Oncology 2015;89:125-36.
Younai FS. Current trends in the incidence and presentation of oropharyngeal cancer. J Calif Dent Assoc 2016;44:93-100.
[Table 1], [Table 2], [Table 3]