PO.PR01.02 · 预防研究
在大型医疗系统中开展口腔癌筛查的可行性与挑战
Feasibility and challenges of oral cancer screening in a large healthcare system
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：在美国，过去25年间口腔癌和口咽癌的发病率不断上升——主要是由于HPV相关口咽部恶性肿瘤数量的增加。尽管过去几十年吸烟率一直在下降，但口腔恶性肿瘤的发病率保持稳定。问题在于，数十年间以晚期（III/IV期）口腔癌就诊的患者比例相似。尽管专业组织（如美国牙科协会、美国耳鼻喉科学会）已采取措施推广筛查，并开展了关于口腔癌的全国性宣传活动，情况依然如此。我们决定考察在一个包括牙科医生以及大量头颈癌外科医生和工作人员的大型医疗系统中建立口腔癌筛查体系的可行性。方法：明尼苏达州的HealthPartners/Park Nicollet医疗系统在区域内服务约136万名患者，一家大型综合牙科诊所已成为该系统的一部分数十年。我们根据公开的吸烟统计数据以及依据当前ADA建议的潜在恶性病变，考察了口腔癌高危患者的数量。该医疗系统由约37名耳鼻喉科医生和中级医疗提供者提供服务，他们在口腔病变识别及头颈癌治疗方面接受过广泛培训，并设有牙科诊所。这是一个整合系统，基于我们此前的培训和对从业者的外联工作可实现快速转诊。结果：对于2种高危口腔潜在恶性疾病（OPMD），参考已发表的白斑病发病率介于0.44%-3.4%之间。口腔扁平苔藓的已发表发病率为0.48-1.0%。明尼苏达州成年吸烟者比例为12.2%。基于这些假设，根据OL和OLP的发病率统计，我们每年需要为白斑病和口腔扁平苔藓患者开展12,512至59,840次就诊。如果纳入常规吸烟者，则每年将超过200,000次患者就诊。仅就这些疾病而言，我们可能需要额外增加6至100名专门从事口腔癌筛查的从业者来完成每年的就诊。讨论/结论：为完成预计的口腔癌筛查就诊量以匹配显性癌症患者的数量，当前每位耳鼻喉科从业者都必须在现有日程上每周增加50%的就诊量，或依据我们提出的假设，至少增加6名专门从事口腔癌筛查的从业者。我们得出结论：尽管对口腔病变患者进行检查和转诊是可行的，但系统内OPMD患者的庞大数量（不含吸烟者）在全民筛查情形下将使系统不堪重负。
查看英文原文 English abstract
Introduction: In the US oral and oral pharyngeal cancers are increasing in incidence over the past 25 years- primarily due to the increased numbers of HPV oropharyngeal associated malignancies. Although smoking has been decreasing over the past several decades the incidence of oral cavity malignancies is stable. Problematically, similar percentages of patients present with advanced (Stage III/IV) oral cancer over several decades. This is despite adopted efforts in professional organizations to promote screening (e.g. American Dental Association, American Academy Otolaryngology) as well as national awareness campaigns on mouth cancer. We decided to examine the feasibility of instituting an oral cancer screening system in a large health care system that includes dental physicians and significant numbers of head and neck cancer surgeons and staff. Methods: The HealthPartners/Park Nicollet health care system in Minnesota services approximately 1.36 million patients regionally and a large comprehensive dental practice has been part of this system for several decades. We examined numbers of patients at high risk for oral cancer based on publicly available statistics on smoking and potentially malignant disorders based on current ADA recommendations. The healthcare system is serviced by approximately 37 otolaryngologists and mid level providers with extensive training in the identification of oral cavity lesions and head and neck cancer treatment as well as dental clinics. This is an integrated system whereby rapid referrals occur based on our prior training and outreach efforts to practitioners. Results: For 2 High risk Oral potentially malignant disorders (OPMD), the reference published incidence of leukoplakia is between .44% -3.4%. For oral lichen planus published incidence is 0.48-1.0%. The percentage of adult smokers in MN is 12.2%. Using these assumptions, we would need to conduct between 12,512 and 59,840 visits a year for leukoplakia and oral lichen planus patients, as judged by OL and OLP incidence statistics. If we included regular smokers this would become over 200,000 patient visits a year. For these conditions alone, we would need to potentially add between 6 and 100 practitioners dedicated to oral cancer screening for yearly visits. Discussion/Conclusions: To service projected oral cancer screening visits to the number of overt cancer patients each of the current otolaryngologic practitioners would have to increase their visits by 50% a week to their current schedules or add minimally 6 practitioners for the singular purpose of oral cancer screening under our proposed hypothesis. We conclude that although the examination and referral of oral lesions patients is feasible the sheer numbers of OPMD patients in the system (excluding smokers) would overwhelm the system in a universal screening scenario.
利益披露 Disclosure
E. Becker, None..
D. Hamlar, None..
F. G. Ondrey, None.