Steps to further reduce oral cancer burden for Marylanders

Maybury et al. reported the outcomes of oral cancer early detection and prevention statewide model in Maryland at the 2011 Maryland Oral Health Summit (1). The report cited the reduction of oral cancer incidences and mortalities in Maryland from 1995 to 2009, which significantly improved the state’s ranking in the nation. It suggested that the Comprehensive Cancer Control Plan developed in the state has contributed to the success and that the Maryland approach may serve as a model for other states. It is commendable that Maryland took a concerted effort to address the high oral cancer incidence and the racial disparity issue from early 2000. The authors of the report have personally devoted substantial efforts in all the phases of the comprehensive plan. A statewide oral cancer prevention program with emphasis on problem identification (survey), training, and coordination is unique and effective. The authors acknowledged remaining challenges and made three specific recommendations with which I fully agree. While we see progress being made, caution should be taken in evaluating multiple factors that contribute to the reduced oral cancer incidence and oral cancer mortality because factors other than the interventions implemented by State of Maryland may also weigh in for the changes in oral cancer incidence and oral cancer mortality such as the way people are using tobacco products and the advances in treating oral cancer. It should be noted that the most recent incidence and mortality statistics were derived from the 2007 data (2). The mortality rate of Blacks in Maryland peaked in 1983 at nine per 100,000 and reduced gradually to about 3.1 per 100,000 in 2007. The mortality rates for Maryland Whites also reduced, from 4.5 to 2.3 per 100,000, during the same period. However, the gap between Whites and Blacks remains in Maryland. Similar trends are seen at the national level. Given the first Maryland Comprehensive Cancer Control Plan started in 2004, we should be mindful in interpreting the potential contribution of this Plan to the reduction in oral cancer incidence and mortality. Recently released Maryland oral cancer statistics provides a warning sign and reveals the gradual increase in the proportion of oral cancers diagnosed at distant metastasis stage since 2004 (available at http:// fha.maryland.gov/cancer/cancerplan/publications.cfm). To make additional progress in addressing the Plan we need to invest in the following three areas: • Build a research network, such as the Practice-Based Dental Research Network, to include major practitioners who provide oral cancer screening, diagnosis, and treatment and researchers who have expertise in conducing translational biology-based prevention and early detection investigations. This research network could provide an opportunity to develop and test novel oral cancer risk assessment tools and prevention strategies that reflect the evolving pathogenesis of these cancers. A good example is the recent increase of oropharyngeal cancer incidence in the country, which has been linked to human papilloma virus infection. • Create policies to ensure a high-quality and sustainable provider network to serve the community. The policies should ensure that providers perform quality oral cancer screenings, are credentialed and certified, and are compensated for their service. A statewide database to link electronic patient diagnostic information, the cancer registry, provider services, and reimbursement data may help evaluate quality of providers in identifying early stage oral cancers. • Training for student providers at all levels. At the University of Maryland School of Dentistry, we are enhancing our curriculum to allow our students to gain more knowledge in medicine and include an expanded overview of the pathogenesis of oral cancer and its diagnosis and prevention. Providing dental school faculty and dentists in the community with well-designed courses to gain new and refresh knowledge in the field oral cancer prevention and early detection also is necessary. In fact, a mandate to attend such courses for the providers as part of their relicensure may translate into a better work force in our fight to reduce oral cancer incidence and mortality for Marylanders. Journal of Public Health Dentistry . ISSN 0022-4006