Maryland Comprehensive Cancer Control Plan Oral Cavity and Oropharyngeal Cancer Prevention Committee

Methods Examined issues Examined issues Reviewed data Reviewed data Identified problems and solutions Identified problems and solutions Developed flow chart Developed flow chart

Risk Factors Tobacco Tobacco Cigarettes Cigarettes Cigars Cigars Snuff Snuff Spit tobacco Spit tobacco Pipes Pipes Alcohol Alcohol Sunlight – lip cancer Sunlight – lip cancer Lack of fruits and vegetables Lack of fruits and vegetables Viruses – e.g., Human papilloma virus Viruses – e.g., Human papilloma virus

The Problem

Oral Cancer in Maryland Maryland ranks 8th in mortality among all states Maryland ranks 8th in mortality among all states 6th highest mortality rate in the US for African American men 6th highest mortality rate in the US for African American men 5-year survival rate in Maryland for African Americans is 33% (whites - 55%) 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 Nearly a 15% higher death rate from oral cancer in Maryland than the US Ries et. al. SEER Cancer Statistics review,

Oral Cancer Mortality Rates Maryland

HP 2010 Oral Cancer Objectives Objective 21-6 – Oral Cancer Staging Increase the proportion of oral and pharyngeal cancers detected at the earliest stage Increase the proportion of oral and pharyngeal cancers detected at the earliest stage Target: 50 percent Target: 50 percent Baseline: 35 percent of oral and pharyngeal cancers (stage I, local ) 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 Target: 20 percent Baseline: 13 percent of adults aged 40 years and older Baseline: 13 percent of adults aged 40 years and older Objective Oral Cancer Mortality Rate Reduce the oral and pharyngeal cancer death rate Target: 2.7 deaths per 100,000 population 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) Baseline: 3.0 deaths per 100,000 population in 1998 (age adjusted to the year 2000 standard population)

Oral Cancer Stage 1 Diagnosis Maryland

Oral Cancer Prevention The Maryland State Model Phase I - Needs Assessment Phase I - Needs Assessment Phase II - Development and Pilot Testing of Educational Interventions Phase II - Development and Pilot Testing of Educational Interventions Phase III - Program Evaluation Phase III - Program Evaluation

Oral Cavity and Oropharyngeal Cancer Prevention Committee Proceedings and Recommendations

Oral Cancer Early Detection and Diagnosis Access to dental services disparity Access to dental services disparity Limited for those populations at highest risk Limited for those populations at highest risk Poor Poor Adults Adults Older adults Older adults More likely to visit a physician, family nurse practitioner or physician’s assistant than dentist More likely to visit a physician, family nurse practitioner or physician’s assistant than dentist Oral cancer examination responsibility of all health care practitioners Oral cancer examination responsibility of all health care practitioners

Addressing Oral Cancer Prevention Main Issues Lack of oral cancer literacy Lack of oral cancer literacy Awareness Awareness Behavior Behavior Disparities Disparities Education and awareness Education and awareness Mortality Mortality Survival Survival Access Access

Addressing Oral Cancer Prevention Main Focus Direct oral cancer literacy for: Direct oral cancer literacy for: Public Public Healthcare Providers Healthcare Providers Media Media Policy Makers Policy Makers Address disparities Address disparities Intertwined with lack of literacy Intertwined with lack of literacy Access to services Access to services

Oral Cancer Literacy What Everyone Needs to Know Public, health care providers, policymakers and media Public, health care providers, policymakers and media Risk assessment and risk reduction Risk assessment and risk reduction Risk factors Risk factors Signs and symptoms Signs and symptoms Behavior modification Behavior modification Public to request oral cancer examination Public to request oral cancer examination Providers to incorporate adequate oral cancer examination into standard of care Providers to incorporate adequate oral cancer examination into standard of care Adequacy of oral cancer examination Adequacy of oral cancer examination Frequency of oral cancer examination Frequency of oral cancer examination

Public Educational interventions Educational interventions Schools Schools Workplace Workplace Hospitals Hospitals Faith-based institutions Faith-based institutions Recreational and sports organizations Recreational and sports organizations Develop messages targeted to different needs and values of the community Develop messages targeted to different needs and values of the community Those engaged in risk behaviors Those engaged in risk behaviors Those not engaged in risk behaviors Those not engaged in risk behaviors Culturally appropriate Culturally appropriate Age and gender appropriate Age and gender appropriate Literacy to lead to use of appropriate screening, referral, follow-up & treatment services Literacy to lead to use of appropriate screening, referral, follow-up & treatment services

Healthcare Providers Provider education specific to primary care providers (PCP) and dental health professionals Provider education specific to primary care providers (PCP) and dental health professionals No dental coverage for Maryland adults under Medicaid No dental coverage for Maryland adults under Medicaid Medicare does not cover dental services Medicare does not cover dental services Maryland adults have medical coverage under Medicaid and Medicare and will visit PCP Maryland adults have medical coverage under Medicaid and Medicare and will visit PCP Curriculum Change Curriculum Change Make oral cancer exams part of standard of care and practice for all health care providers Make oral cancer exams part of standard of care and practice for all health care providers CME/CEUs CME/CEUs Lead to appropriate screening, referral, treatment and follow-up services Lead to appropriate screening, referral, treatment and follow-up services

Media Plays key role in increasing awareness of both healthcare providers and the public Plays key role in increasing awareness of both healthcare providers and the public Immediate access to mass population Immediate access to mass population Public service announcements Public service announcements Paid advertisements Paid advertisements Explore what is the best form of communication to reach specific communities Explore what is the best form of communication to reach specific communities Talk radio Television Print

Policy Makers Education targeted to policy makers and advocates Education targeted to policy makers and advocates Issues to be addressed: 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 Literacy Provider*   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   CME/CEU   Medical & Dental Board Licensure and Re-licensure   Oral Cancer Competency Module on Licensure Exams Provider Education PCP Dental Health Professionals Curriculum Change CME/CEUs Curriculum Change CME/CEUs Use and provide appropriate screening, referral, follow-up, and treatment Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, Website Government, Providers Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, Website Government, Providers *What everyone needs to know: Risk assessment and risk reduction Risk factors Signs and symptoms Oral cancer exam- steps Frequency of oral cancer exam *What everyone needs to know: Risk assessment and risk reduction Risk factors Signs and symptoms Oral cancer exam- steps Frequency of oral cancer exam Awareness Oral Cancer Prevention, Early Detection, and Treatment Model Public* Media* Policy Makers*

Disparities Main issues Main issues Lack of access Lack of access Lack of oral health literacy Lack of oral health literacy Ultimate Goal Ultimate Goal Reduce disparities in oral cancer mortality and morbidity Reduce disparities in oral cancer mortality and morbidity

Oral Cavity and Oropharyngeal Prevention Committee Members Thank You! Albert Bedell, PhD - Maryland Academy of General Dentistry Albert Bedell, PhD - Maryland Academy of General Dentistry Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck Surgery Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck Surgery Catherine Carroll, CRNP - Chase Brexton Health Services, Inc. Catherine Carroll, CRNP - Chase Brexton Health Services, Inc. Harry Goodman, DMD - University of Maryland Dental School Harry Goodman, DMD - University of Maryland Dental School Alice M. Horowitz, PhD – National Institute of Dental and Craniofacial Research 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 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 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 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 Kelly Sage, MS – Dept. Health and Mental Hygiene, Office of Oral Health Yale Stenzler, EdD - Oral Cancer Survivor Yale Stenzler, EdD - Oral Cancer Survivor Sheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' Association Sheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' Association Rodney Taylor, MD - University of Maryland Department of Otolaryngology Rodney Taylor, MD - University of Maryland Department of Otolaryngology Brooks Woodward, DDS - Chase Brexton Health Services, Inc. Brooks Woodward, DDS - Chase Brexton Health Services, Inc. David Zauche - American Cancer Society David Zauche - American Cancer Society

Questions?