1. Maryland Oral Cancer Prevention, Education and Training Initiative 2003 Maryland State Council on Cancer Control November 12, 2003 Ilise D. Marrazzo,MPH Acting Director, Office of Oral Health Family Health Administration Maryland Department of Health & Mental Hygiene

2. Oral Cancer in Maryland Maryland ranks 8th in mortality among all states 6th highest mortality rate in the US for African American men 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 Ries et. al. SEER Cancer Statistics review, 1973-1996

3. 2002 Telephone Survey Survey of Maryland Adult’s Knowledge of Oral Cancer 2002 – 1,127 randomly selected Maryland adults by telephone interview. – 42% reported ever having had an oral cancer exam; – 73% had never heard of a test or exam for oral cancer; – 77% of those surveyed who had ever had an oral cancer exam had their exam performed by a dentist; – 97% said smoking increased the risk for oral cancer – only 46% said that alcohol increased the risk for oral cancer.

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

5. The Problem

6. History 2000 – “Reduce Oral Cancer Mortality” legislation (SB791) Educate public and increase awareness; Train healthcare providers to screen and refer patients; Promote smoking cessation programs. – Cigarette Restitution Fund (CRF) Oral cancer included as one of the 7 targeted cancers; Local health departments choose to include oral cancer in screening and treatment programs.

7. History 2001 – 2003 – OOH awarded 2-year grants to local health departments for oral cancer prevention and education. – Maryland Oral Cancer Awareness week proclaimed by the Governor. 2004 – 9 counties conducting screenings with CRF funding – 19 counties education & prevention activities with OOH funding – OOH funds education and prevention activities including public education and provider education

8. Initiative Highlights FY 2003 – both CRF & OOH: – Website: www.Maryland-OralCancer.org – Over 6,500 screened (1case of oral cancer); – Over 350 healthcare providers educated; – Over 6,500 individuals attended oral cancer ed.; – Print ads, t.v. and radio PSAs, and editorials. Best Practices: – Eastern Shore Oral Cancer Coalition; – Linkages with county smoking cessation services; – Outreach to firefighters, road workers, watermen, farmers, barber shops.

9. Oral Cancer Literacy What Everyone Needs To Know Risk assessment and risk reduction Risk factors Signs and symptoms Behavior modification – Public to request oral cancer examination – Providers to incorporate adequate oral cancer examination into standard of care Adequacy of oral cancer examination Frequency of oral cancer examination

10. 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 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*

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

12. Current and Future Plans RO1 Application: State Models for Oral Cancer Prevention and Early Detection Implementation of the Comprehensive Cancer Control Plan Identifying models that could be replicated in other areas of the State