Most mouth cancer is preventable by a healthy lifestyle in line with government recommendations:
? Avoid tobacco and betel (areca) or their products
? Drink alcohol in moderation only
? Take five helpings of fruit and vegetables a day
? Avoid over-exposure to sunlight (for example by spending time in the shade around mid-day)
? Protect lips with sunscreen
? Exercise daily
? Avoid HPV infection
Tobacco in any form (smoked, chewed, or smokeless) should be avoided. It has been estimated that at least 75 per cent of oral cancers could be prevented by the elimination of tobacco smoking and chewing and a reduction in alcohol consumption. Smoking cessation reduces the increased risk by 35 per cent within one to four years and by 80 per cent after 20 years of quitting. Treatment of tobacco dependence is an important step and can be addressed through primary care practitioners (including
dentists) and specialist smoking cessation clinics.
Chewing betel nut (or areca nut) even without tobacco should be avoided. In high incidence Asian populations, oral cancer control could be achieved by implementation of policies to reduce betel quid chewing and improve public
awareness of dangers of daily use.
Cut down on alcohol: aim to drink no more than one standard drink a day (2-3 units) for women, or two standard
drinks a day (3-4 units) for men. Eat at least five servings of fruit and vegetables a day. There appears to be protection from fruits, cereals, dairy
products, and olive oil, mediated via folate, antioxidants (carotene, carotenoids, flavanones, flavonoids, phytosterols, vitamins A, C and E, riboflavin), iron, and magnesium. Protect lips with sunscreen and a wide-brimmed hat, and spend time in the shade, when the sun’s UV rays are strong. Protection against solar irradiation would reduce the incidence of lip cancers among white skinned populations.
High recreational physical activity significantly reduces head and neck cancer risks among subjects ≥45 years old.
Practising safer sex and HPV vaccination reduce the chances of infection with HPV. The 2007 Australian HPV vaccination for women programme had by 2011 already shown significant declines in the proportion of young women with genital warts, an absence of genital warts in vaccinated women, and large declines in genital warts in heterosexual men. The effect of an HPV vaccine tested on 5,840 sexually active women in Costa Rica (ages 18 - 25 years) showed that after four years, mouthwash samples in 15 women after placebo vaccine were infected but only one woman having received the HPV vaccine was infected with HPV.
What is the importance of health promotion?
Primary prevention of cancer involves lifestyle decisions. A healthy lifestyle is
theoretically possible and protects not only against many cancers, but also
against several other conditions, many of which are also life-threatening.
Who is responsible for health promotion for oral cancer prevention?
Health promotion for oral cancer prevention is the remit of the whole healthcare team, there are a number of national initiatives (for example www.ncbi.nlm.nih.gov/pubmed/18691457) some of which have been brought together under the umbrella of the International Consortium on Head and Neck Cancer Awareness (ICOHANCA) whose object is to increase cancer awareness, and hopefully lead to prevention and earlier diagnosis.
What lifestyle changes improve survival among treated cancer patients?
Smoking cessation even after an oral cancer diagnosis improves prognostic
outcomes. Cancer patients who admitted continuing to smoke during their radiotherapy had a poorer response and survival than those who claimed to quit smoking prior to beginning treatment. The risk for multiple primary cancers is higher in those who continue to smoke and drink alcohol after therapy. Among patients treated for head and neck cancer about 50 per cent continued to smoke after one year of treatment and 30 per cent developed a second primary tumour (compared with 13 per cent who quit).
References available on request.