1. Pedro Ferreira Trancoso, DDM MSc Oral Med
Early intervention in oral cancer project The Portuguese national strategy
Pedro Ferreira Trancoso, DDM MSc Oral Med
Portuguese Dental Association

2. Oral cancer The Portuguese reality
Cancer of the oral cavity and lip (data from 2012)
1294 new cases
967 new cases in males
6th most common cancer
Increasing incidence in oral cavity and oropharynx cancers in the past decade
Ferlay J, Soerjomataram I, Ervik M et al.GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: 2013.
Monteiro LS, Antunes L, Bento MJ, Warnakulasuriya S. Incidence rates and trends of lip, oral and oro-pharyngeal cancers in Portugal. J Oral Pathol Med 2013; 42: 345–51.

3. Oral cancer The Portuguese reality
Oral Cancer Awareness
Portuguese population reveals a lack of awareness of oral cancer signs and symptoms
Portuguese population fails to identify oral cancer risk factors
- 50% identified tobacco
- 25% identified alcohol
Portuguese population recognizes other less common cancers
Most individuals are aware that detection of oral cancer in early stages can increase the success of the treatment
Oral cancer awareness and knowledge among residents in the Oporto city, Portugal. Monteiro LS, Warnakulasuriya S, Cadilhe S, Sousa D, Trancoso PF, Antunes L, Salazar F, Pacheco JJ. J Investig Clin Dent May 15. doi: /jicd

4. Early intervention in oral cancer project
Joint project of the Portuguese Ministry of Health (Directorate-General of Health) and the Portuguese Dental Association
1st March 2014
euros/yearly
Estimated 5000 biopsies/year
Dentists, general medical practitioners, oncological head & neck surgical units of the national cancer hospitals and a national reference pathology institute
Supported by a software specifically designed to ensure communication between all parts in real time

5. Early intervention in oral cancer project
Clinical objectives
Early diagnosis of oral cancer (T1/T2)
Increase awareness of oral cancer among healthcare practitioners and general public
Reduce mortality rate by 5% in the next 5 years
Reduce morbidity rate
Socio-economical objectives
Reduce costs with treatment (surgery, radiotherapy, others)
Reduce costs with rehabilitation
Reduce costs related with absence to work
Reduce costs with long-term complications of treatment

6. Early intervention in oral cancer project
How was the program organized? The role of the Portuguese Dental Association.
Allocation of 240 dentists
Distribution according to geographical asymmetries and population density indexes to ensure access to all portuguese citizens in due time
Promotion of knowledge about oral cancer amongst general medical practitioners and other healthcare providers

7. Early intervention in oral cancer project
Early intervention in oral cancer: a guide for healthcare professionals
Distributed to:
Dentists registered with the Portuguese Dental Association
GMP’s within the national health system

8. Early intervention in oral cancer project
Allocation of candidates
921 applications
2 theoretical courses
Written exam
Sucessful candidates were required to enter a practical course to standardize biopsy criteria nationwide

9. Early intervention in oral cancer project
Biopsy techniques in animal model
Groups of 24 dentists
Personalized training

10. Early intervention in oral cancer project
The strategy
GMP’s are required to do an oral examination when a patient has an oral complaint or is referred for an oral complaint
Male smokers and heavy drinkers over 40 years old will have a mouth examination by the local GMP every 2 years
If a suspicious lesion is detected a diagnostic voucher is emitted

11. Early intervention in oral cancer project
GMP observes or is referred for a suspicious lesion
Diagnostic voucher is emitted
Referral to a dentist in the program
Possible aetiological factor is identified
Biopsy is indicated
Biopsy voucher emitted
Patient is discharged
Removal of aetiological factor
Biopsy is not indicated
Biopsy
Reference pathology laboratory
4 days
Benign
Cancer hospital
PML
Cancer
24 hours
Biopsy is not indicated

12. Early intervention in oral cancer project
Reimbursement
Portuguese Ministry of Health pays:
Diagnostic voucher – 15€
Biopsy voucher – 50€
Pathology voucher- 17,5€
Maximum cost of the program per patient until diagnosis
82,5€

13. Early intervention in oral cancer project
Results
Number of vouchers emitted
Number of vouchers used
Rate
Number of biopsy vouchers emitted
Number of biopsy vouchers used
Number of biopsies/Number of diagnostic vouchers used
Positive biopsies
Number of positive results/Number of biopsies performed
Number of potential malignant diseases detected
2014
2.412
685
28%
320
269
47% 14 5% 4
Medium time from oral lesion clinical detection to the appointment at the cancer hospital
varies from 10 to 15 days

14. Early intervention in oral cancer project
How to improve the program
Increase oral cancer awareness amongst portuguese population
Reduce risk factors exposition (tobacco, alcohol)
Increase usage of diagnostic vouchers emitted
Increase usage of biopsy vouchers
Increase awareness of GMP’s for oral cancer
Develop the diagnostic ability of GMP’s

15. Portuguese Dental Association Oral Cancer Working Group Paulo Melo, Pedro F Trancoso, António Mano Azul, José Frias Bulhosa, Otília Lopes, Luis Monteiro, Filipe Feitas Directorate-General of Health (Ministry of Health) Oral Cancer Workin Group Rui Calado, Marta Gromicho
Portuguese Dental Association