Oral Oncology 50 (2014) e63
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the editor Why head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factor
Comment on – Why head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factor I would like to congratulate author, J. Adrien, C. Bertolus, L. Gambotti, A. Mallet and B. Baujat for their published article ‘‘why head and neck squamous cell carcinoma diagnosed so late? Influence on health care disparities and socio-economic factor.’’ in Oral Oncology 2014; 50(2):90–97. Article is very informative, which put light on neglected part of patients awareness regarding cancerous lesion. First I would like to bring your notice that in title of your article, why head and neck squamous cell carcinoma diagnose so late? It is well known that they never diagnosed late but diagnosed in late stage of cancer. On the basis of your study observation, I would like to add some other important factor than socio-economic and health care disparities which influences diagnosis in late stage are, A. Visibility of lesion (anatomical site)(1) B. Discomfort due to lesion(2) As mention in table III, oral cavity lesions are diagnosed in early stages than the lesions present in oropharynx and hypopharynx, where the visibility is poor. The disease primarily arises in the oral cavity are easily accessible to direct visual and tactile examination [1] some lesions are ignored or missed by patients, health care professionals or both is mainly because of no direct visibility and inaccessibility. In part, this may be due to an incomplete understanding or awareness of even small asymptomatic lesion can have significant malignant potential. Most of the oral lesions are detected only after they become symptomatic or causes discomfort [2]. Signs and symptom of the
http://dx.doi.org/10.1016/j.oraloncology.2014.08.011 1368-8375/Ó 2014 Elsevier Ltd. All rights reserved.
disease rather than their appearance express mainly in late stages which include discomfort, pain or any asymmetry. In your study, patient reported on the basis of first symptom are in T3/T4 stages. Patients of T1/T2 stages reported early because of having good visibility of lesion. Which means patient will bother to visit a physician only after he noticed any visible lesion or any discomfort. In comparison with educational status and late stage diagnosis, both stages T1/T2 and T3/T4, cases are equally distributed. This proves educational status does not matter for the diagnosis in early or late stage. In relation with health care disparities, approach towards diagnosis and equipped primary health centers are contributory factors in diagnosing early or late stages of lesion [3]. Conclusion: On the basis of results of the study and above mention factors [visibility of lesion (anatomical site) and discomfort due to lesion] are must be considered before socio-economic and health care disparities for late stage diagnosis of oral squamous cell carcinoma. References [1] Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 2008;44(1):10–22. [2] Mashberg A, Samit AM. Early detection diagnosis and management of oral and oropharyngeal cancer. CA: A Cancer J Clinicians 2008;39(2):67–88. [3] Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 2006;17(1):5–19.
Kamlesh N. Dekate MGM Dental College and Hospital, 204, Vastu Shilp, Plot 179, Sector 10, Kharghar, Navi Mumbai 410210, India Tel.: +91 9223290372. E-mail address: [email protected] Available online 11 September 2014
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the editor Why head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factor
Comment on – Why head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factor I would like to congratulate author, J. Adrien, C. Bertolus, L. Gambotti, A. Mallet and B. Baujat for their published article ‘‘why head and neck squamous cell carcinoma diagnosed so late? Influence on health care disparities and socio-economic factor.’’ in Oral Oncology 2014; 50(2):90–97. Article is very informative, which put light on neglected part of patients awareness regarding cancerous lesion. First I would like to bring your notice that in title of your article, why head and neck squamous cell carcinoma diagnose so late? It is well known that they never diagnosed late but diagnosed in late stage of cancer. On the basis of your study observation, I would like to add some other important factor than socio-economic and health care disparities which influences diagnosis in late stage are, A. Visibility of lesion (anatomical site)(1) B. Discomfort due to lesion(2) As mention in table III, oral cavity lesions are diagnosed in early stages than the lesions present in oropharynx and hypopharynx, where the visibility is poor. The disease primarily arises in the oral cavity are easily accessible to direct visual and tactile examination [1] some lesions are ignored or missed by patients, health care professionals or both is mainly because of no direct visibility and inaccessibility. In part, this may be due to an incomplete understanding or awareness of even small asymptomatic lesion can have significant malignant potential. Most of the oral lesions are detected only after they become symptomatic or causes discomfort [2]. Signs and symptom of the
http://dx.doi.org/10.1016/j.oraloncology.2014.08.011 1368-8375/Ó 2014 Elsevier Ltd. All rights reserved.
disease rather than their appearance express mainly in late stages which include discomfort, pain or any asymmetry. In your study, patient reported on the basis of first symptom are in T3/T4 stages. Patients of T1/T2 stages reported early because of having good visibility of lesion. Which means patient will bother to visit a physician only after he noticed any visible lesion or any discomfort. In comparison with educational status and late stage diagnosis, both stages T1/T2 and T3/T4, cases are equally distributed. This proves educational status does not matter for the diagnosis in early or late stage. In relation with health care disparities, approach towards diagnosis and equipped primary health centers are contributory factors in diagnosing early or late stages of lesion [3]. Conclusion: On the basis of results of the study and above mention factors [visibility of lesion (anatomical site) and discomfort due to lesion] are must be considered before socio-economic and health care disparities for late stage diagnosis of oral squamous cell carcinoma. References [1] Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 2008;44(1):10–22. [2] Mashberg A, Samit AM. Early detection diagnosis and management of oral and oropharyngeal cancer. CA: A Cancer J Clinicians 2008;39(2):67–88. [3] Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 2006;17(1):5–19.
Kamlesh N. Dekate MGM Dental College and Hospital, 204, Vastu Shilp, Plot 179, Sector 10, Kharghar, Navi Mumbai 410210, India Tel.: +91 9223290372. E-mail address: [email protected] Available online 11 September 2014
