Oral cancer awareness low in Singapore

In Singapore, public awareness of oral cancer is limited compared with other common cancers, a survey suggests.

“[We found] a relative lack of knowledge and awareness of oral cancer amongst the Singapore public and general university students,” said the researchers.

A self-administered questionnaire was disseminated among undergrads from the medical, dental, and other faculties of the National University of Singapore and the general public. A total of 470 complete responses (n=321 from the student groups; 149 from the general public) were available for final analysis. Mean age was 22 years for student respondents and 44 years for the general public cohort. Overall, 62 percent were female. [Int Dent J 2023;S0020-6539(22)00277-5]

Oral cancer awareness rate was high among medical and dental students (98 percent and 90 percent, respectively). But among the nonmedical/dental students and general public, the combined rate was only 66 percent.

Medical and dental students were generally aware of oral cancer risk factors such as alcohol intake, betel quid chewing, and viruses (74–100 percent). The corresponding rate was lower among those without medical/dental background (38–56 percent). Almost all participants were able to identify smoking as a risk factor.

Awareness key to early detection, prevention

Given the general lack of awareness, most oral cancer cases are diagnosed at an advanced stage. [Int J Environ Res Public Health 2020;17:9160] “[I]f detected early, oral cancer can often be treated successfully with low morbidity and good functional outcomes,” the researchers underscored.

“[Our] survey identifies substantial room for creating greater awareness of oral cancer in Singapore … Due to the significant morbidity and impact on quality of life, efforts to prevent the disease and increase early detection are necessary,” said the researchers.

Coupled with diagnostic tools to detect early presenting features, campaigns to increase awareness can contribute to reducing the burden of oral cancer. [Oral Oncol 2020;105:104632; Br Dent J 2003;194:497-502] “Community education and early exposure to knowledge are decisive factors in raising awareness of oral cancer in the general public,” they continued.

Oral cancer burden may continue to increase

Of all continents, Asia has the highest incidence of oral cancer, which could be attributable to local lifestyles and cultural practices. [CA Cancer J Clin 2017;67:51-64]

In Singapore, oral cancer incidence is relatively low, with a 5-year prevalence across all age groups. [Oral Oncol 2009;45:309-316] However, this could rise with the increased migration from high-prevalence countries (eg, China, India), as some migrant communities from these countries continue to adhere to cultural and traditional practices (eg, betel nut usage). [BMC Oral Health 2021;21:44; Oral Diseases 2018;24:44-48]

Moreover, there is an emerging incidence of HPV-associated oral cancer, particularly among younger cohorts in developed countries. [Hum Vaccin Immunother 2019;15:1920-1928] However, most are not familiar with the association between HPV and oral cancer. [Oncology 2018;94:133-141] “This is alarming … [This could also] increase the burden of oral cancer in Singapore in the coming years,” the researchers stressed.

“[Our findings] can be used to guide future interventions to increase public awareness … Increased awareness of this disease and its causes, course, and outcomes will empower a community to seek earlier professional advice, receive a timelier diagnosis, and thus ensure better treatment outcomes,” they concluded.

Although some subgroups (eg, Malays, Indians, non-university-attending individuals, non-residents) were underrepresented in the study, the investigators noted that this “pilot study provides an important baseline assessment of oral cancer awareness and knowledge of several groups in Singapore and has meaningful findings for dental education and public health.”