Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contact Us Login 
An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
  Table of Contents    
ONLINE ONLY ARTICLES - ORIGINAL ARTICLE  
Year : 2020  |  Volume : 24  |  Issue : 3  |  Page : 582-583
 

Analysis of the results obtained by national research groups with the Russian state cancer program for the screening of diseases of the oral mucosa and the vermillion border


1 A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
2 Regional Dentistry Policlinic of Tula, Russia

Date of Submission06-Jul-2020
Date of Decision26-Jul-2020
Date of Acceptance06-Aug-2020
Date of Web Publication09-Jan-2021

Correspondence Address:
Lyudmila Nikolaevna Maksimovskaya
Delegatskaya Street, 20/1, Moscow 127473
Russia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.JOMFP_289_20

Rights and Permissions

 

   Abstract 


Aims and Objectives: The purpose of the article is to analyze the results obtained by the national research groups with the Russian State Cancer Program for the screening of diseases of the oral mucosa and the vermillion border. This article analyzes the results obtained by national research groups in the implementation of the Russian State Cancer Program.
Background: Based on the Department of Therapeutic Dentistry of A.I. Yevdokimov Moscow State University of Medicine and Dentistry, national research groups were created to implement the state program draft for the screening of oncological and precancerous diseases of the oral mucosa and the vermillion border – a grant of the “A” format to support applied research on a competitive basis in the form of subsidies of the federal target program.
Materials and methods: From 2015 to the first half of 2019, the national clinical groups studied the epidemiology (prevalence rate and structure) of oncological and precancerous diseases of the oral mucosa and the vermillion border in 486,059 persons aged 18-92 years living in Tula, the Tula region, Moscow and Noyabrsk as a result of active pathology detection during targeted examination of the population (screening) and appealability in the preclinical period, early, timely and late detection.
Results: the results of the research confirm low cancer alertness of practicing dentists. An individual patient registration card has been developed to systematize data and create a diagnostic register for the screening of cancer and precancerous diseases of the oral mucosa and the vermillion border.
Conclusion: A project has been developed to implement the Russian State Cancer Program for oncological and precancerous diseases of the oral mucosa among the population of the Russian Federation.


Keywords: Cancer screening, national program, oral mucosa, precancer


How to cite this article:
Maksimovskaya LN, Abramova MY, Erk AA. Analysis of the results obtained by national research groups with the Russian state cancer program for the screening of diseases of the oral mucosa and the vermillion border. J Oral Maxillofac Pathol 2020;24:582-3

How to cite this URL:
Maksimovskaya LN, Abramova MY, Erk AA. Analysis of the results obtained by national research groups with the Russian state cancer program for the screening of diseases of the oral mucosa and the vermillion border. J Oral Maxillofac Pathol [serial online] 2020 [cited 2021 Jan 21];24:582-3. Available from: https://www.jomfp.in/text.asp?2020/24/3/582/306646





   Introduction Top


In the world, cancer of the oral mucosa accounts for 40% of oncologic diseases of the head and neck, which determines its second place after cancer of the larynx.[1] The detection of the disease at early stages is characteristic of about 36%–45% of cases.[2],[3],[4],[5],[6],[7] Low detection rates of cancer of the oral mucosa are inconsistent with the fact that in 84% of cases, it is preceded by precancerous diseases of the oral mucosa and the vermillion border. Moreover, the 5-year survival rate at the T2N0M0 stage is <60% and when regional metastases are detected, it decreases by the factor of two.[8],[9] In Russia, from 3378 to 11,000 new cases of cancer of the oral mucosa are registered annually.[8],[10] Over the past decade, the mortality rate in the1st year from diagnosis has remained unchanged at about 45%.[10] The overall 5-year survival rate does not exceed 50% with induction chemotherapy and 70.4% – with combined treatment and surgery at the first stage of therapy of the oral mucosa cancer at the T2N0M0 stage. This allows recognizing this treatment method as the most optimal for this pathology.[6],[11],[12],[13],[14],[15],[16],[17] The most widespread diseases are cancer of the tongue (from 62.4% to 75% of patients), the oral floor (14.3%) and other parts of the oral cavity (37.4%).[8],[10] The most common form of cancer of the oral mucosa, which accounts for 95% of all malignant tumors of this location, is squamous cell carcinoma, which is based on the accumulation of heterogeneous genetic changes in squamous epithelium and their increased ability to proliferate invasion and malignancy.[12],[13]

The main method for detecting oncological and precancerous diseases of the oral mucosa and the vermillion border is the clinical method.[18],[19],[20],[21],[22],[23] Special methods include simple and expanded stomatoscopy,[23],[24] the ViziLite chemiluminescent diagnostic method[7],[25],[26] using disposable flashlights and reagents, as well as the method for determining salivary tumor markers.[27] The implementation of the Russian National Cancer Program is based on two methods for early detection of neoplasms – early diagnostics and screening, recommended by the World Health Organization. These methods are financed by federal target allocations (government tasks).

The purpose of the article is to analyze the results obtained by the national research groups with the Russian State Cancer Program for the screening of diseases of the oral mucosa and the vermillion border.


   Materials and Methods Top


Based on the Department of Therapeutic Dentistry of A. I. Yevdokimov Moscow State University of Medicine and Dentistry, national research groups were created to implement the state program draft for the screening of oncological and precancerous diseases of the oral mucosa and the vermillion border – a grant of the “A” format to support applied research on a competitive basis in the form of subsidies of the federal target program. From 2015 to the first half of 2019, the national clinical groups studied the epidemiology (prevalence rate and structure) of oncological and precancerous diseases of the oral mucosa and the vermillion border in 486,059 persons aged 18–92 years living in Tula, the Tula region, Moscow and Noyabrsk as a result of active pathology detection during a targeted examination of the population (screening) and appealability in the preclinical period, early, timely and late detection. Moreover, screening was carried out on an ongoing basis as a part of annual examinations of those who first applied for dental care to the bases of the creation of the national clinical groups, as well as one-off examinations for employees of the Paris Commune enterprise and patients of the Center for Gerontology of the Pension for Labor Veterans No. 1 of the Moscow Department of Labor and Social Protection of Population. Clinical checkup and examination using autofluorescence stomatoscopy with a LED AFS device (medical device registration certificate No. FSR 2011/10669 dated October 5, 2017), developed jointly by A. I. Yevdokimov Moscow State University of Medicine and Dentistry and Prokhorov General Physics Institute of the Russian Academy of Sciences.


   Results Top


The first national research group was created in Tula and the Tula region; in 2015 and 2016, it examined 76,940 persons in Tula. Then, from 2017 to the first half of 2019, three groups screened oncological and precancerous diseases of the oral mucosa and the vermillion border in 409,119 persons aged 18–92 years. Among them, 221,069 persons lived in Tula, 184,504 in the Tula region, 3245 in Moscow and 301 – in Noyabrsk (Yamalo-Nenets Autonomous Okrug). Of two existing main ways, 570 persons in Moscow were admitted for diagnosis and treatment after the onset of symptoms of the oral mucosa diseases. The rest (residents of Tula, the Tula region and Noyabrsk, 2562 patients of the Department of Therapeutic Dentistry of the Dental Clinical Center of A. I. Yevdokimov Moscow State University of Medicine and Dentistry, 67 employees of the Paris Commune enterprise and 46 patients of the Center for Gerontology of the Pension for Labor Veterans No. 1 of the Moscow Department of Labor and Social Protection of Population) were examined using the active detection method – screening. [Table 1] shows the prevalence and structure of oral mucosa diseases detected using screening in 2017 – first half of 2019, according to which, 7.25% of the examined patients in Tula, 4.13% in the Tula region, 18.61% in Moscow and 8.31% in Noyabrsk had oral mucosal diseases. We identified four groups of diseases of the oral mucosa and the vermillion border. Chronic trauma, leukoplakia, erythroplakia, lupus erythematosus (erosive-ulcerative form), flat lichen (erosive-ulcerative and hyperkeratotic form), warty (nodular) precancer, limited precancerous hyperkeratosis and abrasive (precancerous) Manganotti cheilitis were classified as precancers.

The significant difference in the revealed diseases of the oral mucosa revealed by two research groups in Tula, the Tula region and Moscow is explained by different ways of detection: appealability and screening. In 2017 – first half of 2019, 854 persons were sent to oncologic dispensaries, 168 of them, as a result of histological and immunohistochemical analyses, were diagnosed with malignant neoplasms (C1–C7, C9 and C10 according to ICD-10): lesion of the tongue beyond one and more location, side surface, floor, back of the tongue or dorslim of tongue, frontal 2/3 of the tongue, hard and soft palate, oral floor beyond one location, front and side oral floor, vermillion border of the lower lip, gums of the upper and lower jaw, mucosa, cheek skin, salivary gland, oropharynx and fossa tonsillaris. Most often, the process was localized in the tongue (43.3%) and the oral floor (20%). In other locations, the process was accounted for 36.7%. The stages of the detected malignant neoplasms are presented in [Table 2].
Table 1: The prevalence and structure of diseases detected using screening in 2017 – first half of 2019

Click here to view
Table 2: The detection of malignant diseases of the oral mucosa in terms of the stage of development

Click here to view


Among benign neoplasms, hemangiomas were most often detected (215 cases, 51% of benign neoplasms). Epulises, fibromas and papillomas were revealed equally often. The most widespread location was not discovered.

Verrucous and erosive-ulcerative leukoplakia (214 cases, 38.01% of detected precancerous diseases) and lichen planus (erosive-ulcerative, including as a part of Grinspan–Villapol Syndrome, and hyperkeratotic form) (124 cases, 22.02% of detected precancerous diseases) prevailed among precancers.

Considering that one of the problems of early detection of oncological and precancerous diseases of the oral mucosa and the vermillion border is the inattentive dental examination, an analysis of the results of the checkup of the employees of the Paris Commune enterprise was carried out according to questionnaires that registered their visits to dentists of public and private health-care organizations from 1 to 4 weeks before active detection. Among 67 examined patients, 54 persons (80.6%) had pathological elements, of which only five persons (7.81%) had been informed at previous visits before screening [Table 3]. For the first time, nine persons (13.43%) were diagnosed with tongue diseases, one (1.49%) was sent to laboratory tests because of chronic candidiasis and one (1.49%) because of a blood disease. All patients with precancerous diseases and benign neoplasms were admitted to dispensary: 537 persons – in health-care organizations of Tula, 324 – the Tula region, 281 – Moscow and 10 – Noyabrsk.
Table 3: The structure of pathological elements in the employees of the Paris commune enterprise detected using screening

Click here to view



   Discussion Top


The goal of the work has been achieved – the results of the activities of national research groups under the Russian State Cancer Program for screening of oncological diseases of the oral mucosa and vermillion border have been analyzed.

The results of the studies have confirmed the opinions of Davydov and Aksel Ye;[2] Pozdnyakova and Smirnova Yu;[3] Paches et al.;[5] Polyakov et al.[6] and Gelfand et al.,[10],[11] testifying to the extremely low oncological alertness of practicing dentists, which leads to ignoring the initial stage of malignancy of pathological elements, accompanied by painless seals, cracks and erosion. It is proved that one of the problems of early detection of cancer and precancerous diseases of the oral mucosa and the vermillion border is the inattentive attitude of dentists to the patient's examination. Thus, 80.60% of the patients with primary and secondary elements of damage to oral mucous membrane visited dentists' offices of state or private medical organizations 1 to 4 weeks before active case detection, but that time, pathological elements were not determined. The authors' studies have confirmed the effectiveness of using two techniques for the early detection of neoplasms – early diagnosis and screening, recommended by the World Health Organization based on clinical examination and research using autofluorescence stomatoscopy.[18],[19],[20],[22],[23] As a result of oncoscreening of 854 people with precancerous diseases and suspected cancer of the oral mucous membrane and vermillion border, referred to an oncologist, 168 patients were diagnosed with malignant neoplasms (C1–C7, C9 and C10, according to ICD-10): lesion of the tongue beyond one and more location, side surface, floor, dorslim, frontal 2/3 of the tongue, hard and soft palate, oral floor beyond one location, front and side oral floor, vermillion border of the lower lip, gums of the upper and lower jaw, mucosa, cheek skin, salivary gland, oropharynx and fossa tonsillaris. Most often, the process was localized in the tongue (43.3%) and the oral floor (20%), which was consistent with the works of Gelfand et al., 2016 and Omanova et al., 2017. In other locations, the process was accounted in 36.7%. The use of early diagnosis and screening provided the identification of patients with a Stage 1–2 of the process in 42.86%–58.33% of cases, Stage 3 in 26.19–30.62% of cases and Stage 4 in 26.53%–15.48% of cases, which was significantly different from detection by reversibility, in which Stage 1–2 was registered only in 42.86% of cases and Stage 3 in 85.71% of cases.

Screening conducted by national research groups during the first half of 2017 showed that patients had cancer in 7.25% of cases from the total number of cases of oral mucosa diseases in the city of Tula, in 4.13% of cases in the Tula region, in 18.61% of cases in Moscow and in 8.31% of cases in Noyabrsk.

During the study period, the productivity of the research group from Tula grew by the factor of 18.92, and screening coverage reached 482,513 people (298,009 in Tula and 184,504 in the Tula region). This proves the need to create national research groups to coordinate and conduct comparative studies with the aim of testing the innovative screening method and early detection of cancer and precancerous diseases of the oral mucosa. This is also evidenced by the dynamics of the frequency of detection of malignant neoplasms of the oral mucosa by stages and by the number of people registered in the dispensary.

An individual patient registration card has been developed to systematize the obtained data and create diagnostic registry for screening oncological and precancerous diseases of the oral mucosa and vermillion border in the Russian Federation.

The register has been created and the application for state registration of the database “Database of patients with precancerous and oncological diseases of the oral mucosa and vermillion border” has been submitted.

The results of the work can be applied only in those conditions that were taken into account when conducting the study.


   Conclusion Top


A project has been developed to implement the Russian State Cancer Program for oncological and precancerous diseases of the oral mucosa among the population of the Russian Federation. It includes the creation of national research groups, which, using the clinical and screening methods, as well as the primary detection method, determine the prevalence and structure of oral mucosal diseases and guide patients depending on the diagnosis and their medical examination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mazaki D, Becker J, Boecking A. Catologic and DNA cytometric very early diagnosis of oral cancer. J Oral Pathol Med 2006;33:398-404.  Back to cited text no. 1
    
2.
Davydov MI, Aksel Ye M. Statistics of malignant neoplasms in 2014: Data on Russia. Yevraziyskiy Onkologicheskiy Zhurnal 2016;4:824-61.  Back to cited text no. 2
    
3.
Pozdnyakova TI, Smirnova Yu A. Screening methods for the diagnosis of cancer of the oral mucosa. Dent Forum 2013;1:34-7.  Back to cited text no. 3
    
4.
Maksimovskaya LN, Alimova M. Principles of Cancer Alertness in Dentistry. XIV Moscow Assembly “Health of the Capital” Scientific and Practical Conference. Moscow; 2015.  Back to cited text no. 4
    
5.
Paches AI, Tabolinovskaya TD, Podvyaznikov SO, Choynzonov Ye TS. Modern Methods of Diagnosis and Treatment of Cancer of the Oral Mucosa. Moscow; 2011.  Back to cited text no. 5
    
6.
Polyakov AP, Kaprin AD, Ratushnyy MV. Method for eliminating a defect of the oral cavity and tongue with a complex free “chimeric” revascularized, reinnervated musculocutaneous flap after total glossectomy. Opukholi Golovy Shei 2017;7:12-8.  Back to cited text no. 6
    
7.
Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 2008;44:10-22.  Back to cited text no. 7
    
8.
Omanov IS, Gelfand IM, Udintsov DB. The reasonability of using induction chemotherapy in the treatment of cancer of the oral mucosa with the prevalence of the process with T1-2NOMO. Opukholi Golovy Shei 2017;7:37-44.  Back to cited text no. 8
    
9.
Tankéré F, Camproux A, Barry B, Guedon C, Depondt J, Gehanno P. Prognostic value of lymph node involvement in oral cancers: A study of 137 cases. Laryngoscope 2000;110:2061-5.  Back to cited text no. 9
    
10.
Gelfand IM, Romanov IS, Udintsov DB. Methods for the treatment of localized forms of cancer of the oral mucosa. Opukholi Golovy Shei 2016;6:43-5.  Back to cited text no. 10
    
11.
Gelfand IM, Romanov IS, Udintsov DB. Treatment methods of early stages of the oral mucosa cancer. Opukholi Golovy Shei 2016;6:12-3.  Back to cited text no. 11
    
12.
Kaprin AD, Starinskiy VV, Petrova GV. The State of Cancer Care for the Population of Russia in 2014. MNIOI im. P.A. Gertsena filial FGBU “NMIRTS” Minzdrava Rossii; 2015.  Back to cited text no. 12
    
13.
Poddubnaya IV. Oncology. Reference Book of a Practicing Doctor. Moscow; 2009.  Back to cited text no. 13
    
14.
Kutukova SI, Manikhas GM, Yaremenko AI. The prognostic role of laboratory and immunohistochemical markers in the recurrence of squamous cell carcinoma of the oral mucosa. Opukholi Golovy Shei 2014;3:47-50.  Back to cited text no. 14
    
15.
Shakhsuvaryan SB, Krasnovskaya Ye S, Vertash Y. Cancer of the oral mucosa: classification, diagnosis, treatment, quantitative assessment of the degree of functional diseases in medical and social examination. Moscow: FGBU FB MSE Mintruda Rossii 2016;2:76-85.  Back to cited text no. 15
    
16.
Saprina OA. Transoral laser resection of tumors of the oral cavity and oropharynx. Opukholi Golovy Shei 2016;6:28-32.  Back to cited text no. 16
    
17.
Massano J, Regateiro FS, Januário G, Ferreira A. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:67-76.  Back to cited text no. 17
    
18.
Sdvizhkov AM, Kozhanov LG, Pages AI, Shatskaya IK. Some problems of the organization of diagnosis and treatment of cancer of the oral mucosa in Moscow. Sibirskiy Onkologicheskiy Zhurnal 2010;3:81.  Back to cited text no. 18
    
19.
Yanushevich OO, Krikheli NI, Volkova Ye A. Screening Methods for the Diagnosis of Precancerous Diseases of the Oral Mucosa. Moscow: Uchebno-Metodicheskoye posobiye; 2017.  Back to cited text no. 19
    
20.
de Veld DC, Skurichina M, Witjes MJ, Duin RP, Sterenborg HJ, Roodenburg JL. Clinical study for classification of benign, dysplastic, and malignant oral lesions using autofluorescence spectroscopy. J Biomed Opt 2004;9:940-50.  Back to cited text no. 20
    
21.
Maitland KC, Gillenwater AM, Williams MD, El-Naggar AK, Descour MR, Richards-Kortum RR. In vivo imaging of oral neoplasia using a miniaturized fiber optic confocal reflectance microscope. Oral Oncol 2008;44:1059-66.  Back to cited text no. 21
    
22.
Rethman MP, Carpenter W, Cohen EE. Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas. J Am Dent Ass 2010;144:509-20.  Back to cited text no. 22
    
23.
Mendes SF, de Oliveira Ramos G, Correa Rivero ER, Modolo F, Grando LJ, Inês Meurer M. Techniques for precancerous lesions diagnosis. J Oncol 2011:1-5.  Back to cited text no. 23
    
24.
Scheer M, Neugebauer J, Derman A, Fuss J, Drebber U, Zoeller JE. Autofluorescence imaging of potentially malignant mucosa lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:568-77.  Back to cited text no. 24
    
25.
Farah CS, McCullough MJ. A pilot case control study on the efficacy of acetic and watch and chemiluminescent illumination (Vizilite) in the visualization of oral mucosal white lesions. Oral Oncol 2007;24:296-302.  Back to cited text no. 25
    
26.
Farah CS, McIntosh L, Georgiou A, McCullough MJ. Efficacy of tissue autofluorescence imaging (VELScope) in the visualization of oral mucosal lesions. Head Neck 2012;34:856-62.  Back to cited text no. 26
    
27.
Ziober BL, Mauk MG, Falls EM, Chen Z, Ziober AF, Bau HH. Lab-on-a-chip for oral cancer screening and diagnosis. Head Neck 2008;30:111-21.  Back to cited text no. 27
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article
            

    

 
   Search
 
  
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Article in PDF (529 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed64    
    Printed0    
    Emailed0    
    PDF Downloaded7    
    Comments [Add]    

Recommend this journal

Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007