Addiction units are key.

THE Need for oral cancer screening in drug and alcohol addiction treatment units in Ireland to target those most at risk of this disease has been highlighted by a new report.

Dr Eleanor O'Sullivan of Cork University Dental School and Hospital explains that patients with head and neck cancer, otherwise known as oral and pharyngeal cancer (OPC), have a good rate of survival if caught on time, but tragically many of those most at risk of this disease fail to come to the attention of the health profession until it is too late.

"Roughly 95 per cent of people who get head and neck cancer tend to drink and smoke heavily and one in 10 is an alcoholics. This group do not tend to be particularly health conscious and don't go for regular dental or health check-ups which is why I believe we need to go out looking for them," she explains.

Although OPC remains a relatively unknown disease with 60 per cent of cases presenting late due to lack of public awareness, O'Sullivan points out that it is the sixth most common cancer worldwide and accounts for 4 per cent of cancers in Ireland.

There are 300 new cases of OPC in the Republic every year and 150 deaths from the disease which kills more people than Hodgkin's disease, malignant melanoma and cervical cancer, according to O'Sullivan.

In her Oral Cancer Screening Study of High Risk Individuals, the UCC lecturer screened 210 patients in four addiction treatment centres in Cork city and its suburbs. Among this group of heavy drinkers and smokers, she detected one cancer and two pre-cancers - this represents a 1.3 per cent pick-up rate which, she says, is very high.

Her study showed that the rate of tobacco and alcohol intake encountered in the addiction treatment centres was extremely high and there was evidence to suggest that people were indulging in risky behaviour at a very young age. Some of those she screened began smoking as young as six years of age and were regular drinkers by 13.

She tells HEALTHplus: "We are talking about a group of people who do not tend to come to the attention of the healthcare profession apart from visits to AE and their own GPs. In Ireland, there are nine official rehab institutions for people with various addiction problems and these, along with psychiatric outpatient clinics, are the settings we need to target in the early detection of head and neck cancer."

O'Sullivan points out that most people undergo a general health check on admission to addiction units and she strongly recommends that an oral cancer examination forms part of this check-up. This is a very simple and cost-effective procedure, she says, which can be done by the unit's own GP if they are trained or by a visiting dental team.

"Early detection of head and neck cancer is a universal problem, it's not just Ireland, because it remains silent for a long time. Apart from laryngeal cancer which presents with hoarseness, the other signs and symptoms are relatively innocuous such as painless mouth ulcers and little lumps and bumps," she says.

Many patients wait until their symptoms are causing them severe pain and functional problems before seeking medical treatment, explains O'Sullivan, at which point their cancer is probably quite advanced. One- third of OPC patients present to their GPs when there is neck node involvement which reduces their outcome prognosis by 50 per cent.

Widespread screening for OPC is not recommended by the World Health Organisation (WHO), but O'Sullivan believes targeted screening of addiction treatment units is the most effective way of detecting the disease an an early stage in high-risk patients.

The signs and symptoms of OPC include non-healing mouth ulcers, persistent white patches, pigmented areas or lumps, red/white speckled area, neck mass, speech changes, swallowing difficulty and sore throat.

Source: Michelle McDonagh, The Irish Times, 25/11/2008