Maryland Comprehensive Cancer Control Plan
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Maryland Comprehensive Cancer Control Plan Oral Cavity and Oropharyngeal Cancer Prevention Committee. Methods. Examined issues Reviewed data Identified problems and solutions Developed flow chart. Risk Factors. Tobacco Cigarettes Cigars Snuff Spit tobacco Pipes Alcohol

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Maryland Comprehensive Cancer Control PlanOral Cavity and Oropharyngeal Cancer Prevention Committee


  • Examined issues

  • Reviewed data

  • Identified problems and solutions

  • Developed flow chart

Risk factors
Risk Factors

  • Tobacco

    • Cigarettes

    • Cigars

    • Snuff

    • Spit tobacco

    • Pipes

  • Alcohol

  • Sunlight – lip cancer

  • Lack of fruits and vegetables

  • Viruses – e.g., Human papilloma virus

Oral cancer in maryland
Oral Cancer in Maryland

  • Maryland ranks 8th in mortality among all states

  • 6th highest mortality rate in the US for African American men

  • 5-year survival rate in Maryland for African Americans is 33% (whites - 55%)

  • Nearly a 15% higher death rate from oral cancer in Maryland than the US

    Ries et. al. SEER Cancer Statistics review, 1973-1996

Hp 2010 oral cancer objectives
HP 2010 Oral Cancer Objectives

Objective 21-6 – Oral Cancer Staging

Increase the proportion of oral and pharyngeal cancers detected at the earliest stage

  • Target: 50 percent

  • Baseline: 35 percent of oral and pharyngeal cancers (stage I, local )

    Objective 21-7 – Oral Cancer Examinations

    Increase the proportion of adults who, in the past 12 months, report having an examination for oral and pharyngeal cancers

  • Target: 20 percent

  • Baseline: 13 percent of adults aged 40 years and older

    Objective 3-6 - Oral Cancer Mortality Rate

    Reduce the oral and pharyngeal cancer death rate

  • Target: 2.7 deaths per 100,000 population

  • Baseline: 3.0 deaths per 100,000 population in 1998 (age adjusted to the year 2000 standard population)

Oral cancer prevention the maryland state model
Oral Cancer PreventionTheMaryland State Model

  • Phase I -Needs Assessment

  • Phase II -Development and Pilot Testing of Educational Interventions

  • Phase III -Program Evaluation

Oral cavity and oropharyngeal cancer prevention committee

Oral Cavity and Oropharyngeal Cancer Prevention Committee

Proceedings and Recommendations

Oral cancer early detection and diagnosis
Oral CancerEarly Detection and Diagnosis

  • Access to dental services disparity

    • Limited for those populations at highest risk

      • Poor

      • Adults

      • Older adults

  • More likely to visit a physician, family nurse practitioner or physician’s assistant than dentist

  • Oral cancer examination responsibility of all health care practitioners

Addressing oral cancer prevention main issues

Lack of oral cancer literacy




Education and awareness




Addressing Oral Cancer PreventionMain Issues

Addressing oral cancer prevention main focus
Addressing Oral Cancer PreventionMain Focus

  • Direct oral cancer literacy for:

    • Public

    • Healthcare Providers

    • Media

    • Policy Makers

  • Address disparities

    • Intertwined with lack of literacy

    • Access to services

Oral cancer literacy what everyone needs to know
Oral Cancer LiteracyWhat Everyone Needs to Know

  • Public, health care providers, policymakers and media

    • Risk assessment and risk reduction

    • Risk factors

    • Signs and symptoms

    • Behavior modification

      • Public to request oral cancer examination

      • Providers to incorporate adequate oral cancer examination into standard of care

    • Adequacy of oral cancer examination

    • Frequency of oral cancer examination


  • Educational interventions

    • Schools

    • Workplace

    • Hospitals

    • Faith-based institutions

    • Recreational and sports organizations

  • Develop messages targeted to different needs and values of the community

    • Those engaged in risk behaviors

    • Those not engaged in risk behaviors

    • Culturally appropriate

    • Age and gender appropriate

  • Literacy to lead to use of appropriate screening, referral, follow-up & treatment services

Healthcare providers
Healthcare Providers

  • Provider education specific to primary care providers (PCP) and dental health professionals

    • No dental coverage for Maryland adults under Medicaid

    • Medicare does not cover dental services

    • Maryland adults have medical coverage under Medicaid and Medicare and will visit PCP

  • Curriculum Change

    • Make oral cancer exams part of standard of care and practice for all health care providers

  • CME/CEUs

  • Lead to appropriate screening, referral, treatment and follow-up services


  • Plays key role in increasing awareness of both healthcare providers and the public

  • Immediate access to mass population

  • Public service announcements

  • Paid advertisements

  • Explore what is the best form of communication to reach specific communities

    • Talk radio

    • Television

    • Print

Policy makers
Policy Makers

  • Education targeted to policy makers and advocates

  • Issues to be addressed:

    • Coverage of medically necessary dental procedures

    • Mandating CME/CEU in oral cancer prevention for re-licensure (model after CPR)

    • Uniform dental coverage for Medicaid adults

    • Management of uninsured/undocumented individuals

    • Funding for research such as practice patterns (PCP v. Dental), screening effectiveness and evaluation of existing programs

    • Continuation of existing programs targeted towards oral cancer (i.e., Office of Oral Health program)

    • Oral cancer competency module for medical and dental licensure


Oral Cancer Prevention, Early Detection, and Treatment Model

Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, Website

Government, Providers


Use and provide appropriate screening, referral, follow-up, and treatment

Curriculum Change

Oral Cancer Literacy



Provider Education


Dental Health Professionals

Curriculum Change


*What everyone needs to know:

  • Risk assessment and risk reduction

  • Risk factors

  • Signs and symptoms

  • Oral cancer exam- steps

  • Frequency of oral cancer exam



Policy Makers*

  • Funding for Research

  • Covering of medically necessary dental procedures

  • Uniform adult dental coverage that includes preventive services as well as emergency care

  • Management/incorporation uninsured and undocumented populations


  • Medical & Dental Board Licensure and Re-licensure

  • Oral Cancer Competency Module on Licensure Exams


  • Main issues

    • Lack of access

    • Lack of oral health literacy

  • Ultimate Goal

    • Reduce disparities in oral cancer mortality and morbidity

Oral cavity and oropharyngeal prevention committee members thank you
Oral Cavity and Oropharyngeal Prevention Committee MembersThank You!

  • Albert Bedell, PhD - Maryland Academy of General Dentistry

  • Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck Surgery

  • Catherine Carroll, CRNP - Chase Brexton Health Services, Inc.

  • Harry Goodman, DMD - University of Maryland Dental School

  • Alice M. Horowitz, PhD – National Institute of Dental and Craniofacial Research

  • Robert D. Jones, DDS - Maryland Association of Community Dental Programs and Maryland State Dental Association

  • Fred Magaziner, DDS - American Academy of General Dentistry and American College of Dentists

  • Ilise Marrazzo, MPH (Chairperson) – Dept. Health and Mental Hygiene, Office of Oral Health

  • Kelly Sage, MS – Dept. Health and Mental Hygiene, Office of Oral Health

  • Yale Stenzler, EdD - Oral Cancer Survivor

  • Sheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' Association

  • Rodney Taylor, MD - University of Maryland Department of Otolaryngology

  • Brooks Woodward, DDS - Chase Brexton Health Services, Inc.

  • David Zauche - American Cancer Society