Abstract B20: Access to dental service in an urban low-income community and its impact on oral cancer prevention
Authors: Hau Keith , Ng Samson , Liu Yi-Ping , Zed Christopher , Littlejohn Doreen , Poh Catherine 
Published: June 2012

Introduction: Vancouver's Downtown Eastside (DTES) community, one of poorest locales in Canada, has shown to be high-risk for oral mucosal abnormalities, including oral cancer. From our previous study, this community not only exposes to high-risk factors but has also high incidence of oral cancer: one oral cancer patient identified in 150 screened dental patients. This is much higher comparing to the rest of Canada and the US (1:10,000). Studies have shown that regular dental care is related to early-staged oral cancer detection. Traditionally dentistry is within the private health sector and access to dental service can be challenging to the DTES residents.

Objective: 1) To determine the frequency of oral cancer risk behaviors; 2) To explore the available social assistant program to dental care; 3) To assess the dental care service utilization and its potential barriers in the DTES.

Methods: To increase access, mobile screening clinics are set up at 3 main gathering locations: Vancouver Native Health Society (VNHS), Women's centre (WC) and LifeSkill's Centre (LC). Eligibility includes those of age 18 or over, reside in DTES at least for the past 3 months, and are able to sign a consent to participate. Using person-to-person interview, questionnaires for demographics, risk behaviors, perceived dental health status, available health care assistance programs, and dental care service utilization are used collect data. The oral health status is obtained through dental and oral mucosal examination by a dentist and an oral pathologist respectively. Each participant is given an incentive package as well as a five dollar honorarium after completion of questionnaire and screening.

Results: A total of 106 participants were screened through 3 mobile clinics at each centre (VNHS: 40; WC: 44; LS: 22). Participants are more female (57%), middle-aged (average age, 48.3 years), Aboriginal (65%), low-income (annual income ≤12000, 71%), and less educated (≤ grade 12, 57%). Many are heavy smokers (20 or more pack-years, 32%), heavy drinkers (male ≥ 3 units or female ≥ 2 units daily, 57%), and have high-risk behavior vulnerable to the human papillomavirus infection (≥ 6 oral sex partners, 27%). Their host immunity is compromised by the prevalence of HIV (41%) and Hepatitis C viral (42%) infection. One in two participants has never heard of oral cancer. Among 106 screened, 20% show oral mucosal abnormalities, including infection (N=11), trauma (N = 7), and potential premalignant conditions requiring further investigation (N=3). The majority (71%) is under coverage of limited assistance from Federal (51%) and/or Provincial government (20%) but only half of the participants (49%) used any dental services within the past 12 months. This is much less comparing to the national level (74%). For those having social assistance in dental care, the main barriers are cost or ‘not enough insurance coverage’ (28%), and not the priority (9%).

Conclusion: The pilot data show that this is a community at high-risk for oral cancer. Regular screening is essential. How to use existing limited resources and raising awareness of oral cancer are vital for oral cancer prevention in this high-risk community.

Citation Information: Cancer Prev Res 2011;4(10 Suppl):B20.