10.59987/ads/2012.3-4.106-112
Aims: the aim of this study was to analyse the awareness of oral cancer among young adults in the city of Rome.
Materials and methods: during the orientation period for new graduates students, or “Porte aperte“, organised by the Sapienza University of Rome in July 2009 and 2010, a survey among young people regarding their knowledge on the risk factors, the importance of early diagnosis, and the methods for primary and secondary prevention of oral cancer was conducted. A total of 1125 questionnaires were administered to subjects who agreed to respond to assess the level of knowledge of the disease.
Results: only 45.3% of the sample population was aware of the existence of oral cancer; among these individuals, 36.9% did not perceive seriousness of the malignancy. High school students who attended a scientific high school knew the risk factors better than the students who attended classical and technical high school.
Conclusions: rigorous educational programs along with diagnostic strategies promise to reduce the burden of oral cancer. The data obtained from this study highlight the need to increase health education, especially among young people in humanistic or technical high schools and universities (Classical High School, Technical Institutes, Faculty of Letters, Faculty of Law) where there is a lack of knowledge concerning oral cancer prevention.
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Cognitive experience of oral cancer among young people of “Sapienza” University of Rome
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Cognitive experience of oral cancer among young people of “Sapienza” University of Rome
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                                                                                                       Original article


Cognitive experience of oral cancer among young
people of “Sapienza” University of Rome




                                                                                             li
                                                                                          na
Livia Ottolenghi, DDS1                                       where there is a lack of knowledge concerning oral
Umberto Romeo, DDS1                                          cancer prevention.




                                                                                       io
Francesco Carpenteri, DDS1
Sergio Fiorentini, Student1                                  Keywords: oral cancer, prevention, late diagnosis.
Dimitri Boatta, Student1
Anna Rita Vestri, MD2




                                                                                    az
Ersilia Barbato, DDS1                                        Introduction
Antonella Polimeni, MD1
                                                             Oral cancer is one of the most common cancers world-
                                                             wide and is highly invasive and debilitating. With approx-




                                                                     n
    Sapienza University of Rome, Italy                       imately 6000 new cases per year in Italy, oral cancer
1
    Faculty of Medicine and Dentistry, Department            represents a public health problem. Squamous cell car-




                                                                  er
    of Odontostomatological and Maxillofacial Sciences       cinoma of the oral cavity represents about 2% of all ma-
2
    Faculty of Pharmacy and Medicine, Department             lignant neoplasms and 47% of those developing in the
    of Public Health and Infectious Diseases                 head and neck area, with survival rates that are among
                                                             the lowest of all major cancers. More deadly than breast

Corresponding author:
Francesco Carpenteri, DDS
                                         nt                  cancer, cervical cancer and prostate cancer, oral cancer
                                                             was estimated to kill one person every hour, every day
                                                             (1,2). The tongue is the most common site involved, and
                                       iI
Faculty of Medicine and Dentistry, Department                this incidence is increasing mainly in young people, pos-
of Odontostomatological and Maxillofacial Sciences,          sibly related to human papilloma virus infections. Progno-
Sapienza University of Rome, italy                           sis depends on the stage: the 5-year survival rate of
                                     on

Largo Beltranelli, 36                                        tongue squamous cell carcinoma, whatever the T stage,
00157 Rome, Italy                                            is 73% in pN0 cases, 40% in patients with positive nodes
Phone: +39 06 89571787                                       without extracapsular spread (pN1 ECS–), and 29% when
Email: francescocarpenteri@gmail.com                         nodes are metastatic with extracapsular spread (pN1
                              i


                                                             ECS+: p ≥ 0.0001) (3-6).
                           iz


                                                             These statistics are dramatic, especially if we consider
Summary                                                      that the disease arises in the foreground on the oral mu-
Aims: the aim of this study was to analyse the awareness     cosa, which is easily accessible to endoral objective ex-
              Ed




of oral cancer among young adults in the city of Rome.       amination. Thus, the lesions are ignored or not observed
Materials and methods: during the orientation period         by patients or healthcare professionals. In part, the late di-
for new graduates students, or “Porte aperte“, organised     agnosis may result from an incomplete understanding or
by the Sapienza University of Rome in July 2009 and          a lack of awareness that small asymptomatic lesions
2010, a survey among young people regarding their            have a significant malignant potential.
knowledge on the risk factors, the importance of early di-   Furthermore, a delay in diagnosis or monitoring of the dis-
 IC




agnosis, and the methods for primary and secondary           ease in advanced stages may be caused by the patient
prevention of oral cancer was conducted. A total of 1125     or health personnel (7). Health education with programs
questionnaires were administered to subjects who             designed to motivate patients to undergo periodic checks
agreed to respond to assess the level of knowledge of
                                                             are the best way to promote prevention (8).
C




the disease.
                                                             Dental health care providers play a key role in the preven-
Results: only 45.3% of the sample population was aware
                                                             tion of oral cancer; these health workers, with the detec-
of the existence of oral cancer; among these individuals,
                                                             tion of neoplastic disease and the proper health educa-
36.9% did not perceive seriousness of the malignancy.
                                                             tion, contribute to the reduction of poor outcomes from this
©




High school students who attended a scientific high
school knew the risk factors better than the students        serious disease. Recent research conducted in a group
who attended classical and technical high school.            of Italian cancer centres demonstrated that an average of
Conclusions: rigorous educational programs along with        6 months elapses between the diagnosis of cancer and
diagnostic strategies promise to reduce the burden of        the start of an appropriate therapy, a period that irre-
oral cancer. The data obtained from this study highlight     versibly influences the therapeutic approach to this dis-
the need to increase health education, especially            ease. It is reasonable that all patients who present symp-
among young people in humanistic or technical high           toms of suspected neoplastic nature have access to a
schools and universities (Classical High School, Tech-       specialist visit no later than 2 weeks from the first contact
nical Institutes, Faculty of Letters, Faculty of Law)        with services and to have a definitive diagnosis no later

106                                                                           Annali di Stomatologia 2012; III (3/4): 106-112
Cognitive experience of oral cancer among young people of “Sapienza” University of Rome


than one month (objective set by the British National              Faculty of Medicine and Odontology. This group admin-
Health Service in relation to time considered desirable in         istered 1125 questionnaires to subjects who agreed to
cancer diagnos) (9). Currently, early diagnosis is, for            participate (661 subjects in 2009 and 464 subjects in
many neoplastic diseases, essential to achieve good                2010) to assess the knowledge of oral disease within this
therapeutic results, with a positive impact in terms of not        population. Data were collected regarding the type of




                                                                                                    li
only prolonged survival but also improved quality of life          work or study activities, the age of population, the pres-
(10,11). An early cancer diagnosis made when the dis-              ence of doctors in the family context and the possibility to




                                                                                                 na
ease is not at an advanced stage allows the possibility to         made preventive specialist check-ups (Tabs.1-4).
offer the patient surgical techniques that are less invasive       Afterwards informational brochures (13) were distributed
and destructive.                                                   to the students illustrating the incidence of various risk fac-
Thus, early diagnosis represents an important chapter of           tors, the general characteristics of the disease, the signs




                                                                                              io
cancer care that must be solved by services through two            and symptoms and what to do when they are present. Our
different points of view:                                          work has focused on risk factors that the international sci-
- the view of a single patient who presents as a “sus-             entific literature indicates as being the most involved in the
      pect case” with the target of rapid diagnosis, obtained      aetiopathogenesis of oral cancer, i.e., smoking, alcohol




                                                                                           az
      through a careful clinical examination by operators          and sunlight (14-23).
      able to identify the symptoms that qualify the patient
      as the bearer of a possible tumour;
- the view of the whole population whose goal is early             Statistical analysis




                                                                            n
      diagnosis when the disease has not yet clinically
      manifested itself by offering participation in screening     The data are reported using frequency counts and per-




                                                                         er
      programs.                                                    centages. To evaluate the possible associations between
This project, was set-up as a campaign to raise aware-             variables the chi-squared test or the Fisher’s exact test
ness of such a disease that, despite being serious, is only        were used, where appropriate. Tests are adjusted for all
little known to the general public.


Materials and methods
                                               nt                  pairwise comparisons within a row of each innermost
                                                                   subtable using the Bonferroni correction. The statistical
                                                                   significance was set at 5%, and the analysis was con-
                                                                   ducted with SPSS v13.
                                             iI
In the orientation period for high school graduates stu-
dents, organised by the Sapienza University of Rome in             Results
                                           on

July 2009 and 2010, a survey among young people was
conducted. The survey concerned the knowledge of risk              A total of 1125 questionnaires were completed, which
factors, importance of early diagnosis, and the methods            could be divided into the following populations: 248 work-
of primary and secondary prevention of oral cancer (12).           ers (22.1%), 402 High School students (35.7%), and 475
                                 i


During the three days of the “Porte aperte alla Sapienza”,         University students (42.2%).
                              iz


a team of students enrolled to the degree course of Den-           The High School students were further subdivided into the
tistry has been working at the stand dedicated to the              following groups: 130 from Classical High School (11.6%),
              Ed




Category                                                  Frequency                                   Percentage

High School students                                         402                                          35.7

Classical High School                                        130                                          11.6
 IC




Scientific High School                                       167                                          14.8
Technical High School                                        105                                           9.3

University students                                          475                                          42.2
C




Law                                                          122                                          10.8
Letters and Philosophy                                       118                                          10.5
Medicine and Surgery                                         112                                          10.0
©




SMFN*                                                        123                                          10.9

Other                                                        248                                          22.1

Total                                                       1125                                          100

*Faculty of Mathematical, Physical and Natural Sciences


Table 1. Sample composition.


Annali di Stomatologia 2012; III (3/4): 106-112                                                                              107
L. Ottolenghi et al.



Type Activities                   Mean           N                SD           Median            Minimum             Maximum

Workers                           37.35         248              7.786          37.00                24                  61

High School students              18.75         402              1.097          19.00                16                  25




                                                                                                    li
University students               21.79         475              2.462          21.00                18                  29




                                                                                                 na
Total                             24.13        1125              8.219          21.00                16                  61

Table 2. Sample age.




                                                                                              io
Question                                                                                   Frequency              Percentage




                                                                                           az
1. Have you ever heard about the oral cancer?                          No                     615                    54.7
                                                                       Yes                    510                    45.3
                                                                       Tot.                   1125                   100.0




                                                                            n
2. Oral cancer is a benign or malignant tumour?                        Malignant              493                    43.8




                                                                         er
                                                                       Benign                  83                     7.4
                                                                       Do not know            549                    48.8
                                                                       Tot.                   1125                   100.0



                                           nt
3. Smoking may increase the risk of developing oral cancer? No
                                                            Yes
                                                            Do not know
                                                                                               24
                                                                                              903
                                                                                              198
                                                                                                                      2.1
                                                                                                                     80.3
                                                                                                                     17.6
                                         iI
                                                            Tot.                              1125                   100.0

4. Alcohol may increase the risk of developing oral cancer?            No                     194                    17.2
                                       on

                                                                       Yes                    474                    42.2
                                                                       Do not know            457                    40.6
                                                                       Tot.                   1125                   100.0

5. A long exposure to sunlight may contribute                          No                     317                    28.2
                               i
                            iz


   to the onset of oral cancer?                                        Yes                    230                    20.4
                                                                       Do not know            578                    51.4
                                                                       Tot.                   1125                   100.0
             Ed




6. Early diagnosis of oral cancer may help?                            No                       8                     0.7
                                                                       Yes                    893                    79.4
                                                                       Do not know            224                    19.9
                                                                       Tot.                   1125                   100.0
 IC




7. Do you know that you can make a visit for prevention                No                     638                    56.7
   of oral cancer?                                                     Yes                    487                    43.3
                                                                       Tot.                   1125                   100.0
C




8. Have you ever made a dentist’s visit for prevention                 No                     1093                   97.2
   of oral cancer?                                                     Yes                     32                     2.8
                                                                       Tot.                   1125                   100.0
©




9. Has your dentist ever proposed a prevention visit to you?           No                     1102                   98.0
                                                                       Yes                     23                     2.0
                                                                       Tot.                   1125                   100.0

10. Do you think that it is helpful to make a prevention visit         No                      30                     2.7
    even if there are no symptoms?                                     Yes                    908                    80.7
                                                                       Do not know            187                    16.6
                                                                       Tot.                   1125                   100.0
Table 3. Questionnaire administered.


108                                                                                  Annali di Stomatologia 2012; III (3/4): 106-112
Cognitive experience of oral cancer among young people of “Sapienza” University of Rome


167 from Scientific High School (14.8%), and 105 from              The highest results were obtained among the University
Technical High School (9.3%). The university students              students of scientific faculties, which largely knew about
were further subdivided into the following groups: 122 fre-        oral cancer (74% Faculty of Medicine and Surgery; 65%
quented the Faculty of Law (10.8%), 118 the Faculty of             Faculty of Mathematical, Physical and Natural Sciences).
Letters and Philosophy (10.5%), 112 the Faculty of Med-            A university education increases knowledge of oral can-




                                                                                                   li
icine and Surgery (10.0%), and 123 the Faculty of Math-            cer in a statistically significant way in comparison with the
ematical, Physical and Natural Sciences – SMFN                     high school students (p<0.0001) (Tabs. 3,5).




                                                                                                na
(10.9%).                                                           Of those interviewed, 81.2% identified smoking as a risk
Of the entire study population, 45.3% (510 subjects)               factor, with the highest values found in areas of scientific
knew of the existence of oral cancer; among these, 36.9%           study (91.1% Faculty of Medicine and Surgery; 86.2%
(444 subjects) do not perceive the seriousness of the ma-          Faculty of Mathematical, Physical and Natural Sciences).




                                                                                             io
lignancy. There is a statistically significant difference in the   Knowledge of oral cancer was found to be lower in sub-
perception of malignancy between those ones who have               jects with humanistic preparation (73.8% Faculty of Law;
heard about oral cancer and those who have not                     73.7% Faculty of Letters and Philosophy). Although smok-
(p<0.0001). Importantly, having a family member who                ing was perceived by the population as a clear risk fac-




                                                                                          az
practices a medical discipline significantly improved              tor in the aetiopathogenesis of oral cancer, it should be
knowledge of the disease (54.3%) (p<0.0001) (Tab.4).               emphasised that alcohol and sunlight were less known




                                                                           n
                                                                    Question 1: Have you ever heard about oral cancer?

                                                                               No                            Yes




                                                                        er
                                                                   Frequency        Percentage    Frequency        Percentage
Question 2: Oral cancer is a benign
or malignant tumour?

                                               nt Malignant
                                                  Benign
                                                                      171
                                                                       56
                                                                                      27.8
                                                                                       9.1
                                                                                                      322
                                                                                                       27
                                                                                                                      63.1
                                                                                                                       5.3
                                             iI
                                                  Do not know         388             63.1            161             31.6
                                                  Tot.                615             100.0           510             100.0
                                           on

Presence of family members who practice medical disciplines
                                      No                    478                       77.7            347             68.0
                                      Yes                   137                       22.3            163             32.0
                                      Tot.                  615                       100.0           510             100.0
                                 i


Table 4. Knowledge of oral cancer in the sample.
                              iz



                                                                   Question 1: Have you ever heard about oral cancer?
              Ed




                                                                               No                            Yes

Category                                                           Frequency        Percentage    Frequency        Percentage

High School students                                                  256              41.6           146             28.6
 IC




       Classical High School                                           68              11.1           62              12.2
       Scientific High School                                         123              20.0           44              8.6
       Technical High School                                           65              10.5           40               7.8
C




University stundents                                                  221              35.9           254             49.8
       Law                                                            79               12.8            43              8.4
       Letters and Philosophy                                         70               11.4           48               9.4
       Medicine and Surgery                                           29               4.7            83              16.3
©




       SMFN *                                                         43                7              80             15.7

Other                                                                 138              22.5           110             21.6

Total                                                                 615             100.0           510             100.0

*Faculty of Mathematical, Physical and Natural Sciences


Table 5. Knowledge of oral cancer per category.


Annali di Stomatologia 2012; III (3/4): 106-112                                                                               109
L. Ottolenghi et al.


factors. Of those interviewed, 42.4% (for alcohol) and             tor in their family recognised smoking as a risk factor,
21.1% (for sunlight) considered these factors as possible          50.3% recognised alcohol and 24.3% identified expo-
causes of oral cancer.                                             sure to sunlight as a risk factor.
Among the High School students, those who attended a               Regarding the prevention of oral cancer, only 43.3% (487
scientific high school had a greater knowledge of the risk         of 1125 interviewed subjects) were aware of the possibil-




                                                                                                    li
factors than those who attended a Classical High School            ity of preventive health screenings, whereas 80.7% (908
or Technical High School. More specifically, with regard to        of total) recognised this as a useful event even in the ab-




                                                                                                 na
smoking, 83.2% of scientific high school students identi-          sence of symptoms; however, only 2.8% (32 subjects of
fied smoking as a clear risk factor compared with 76.9%            1125) had received a specialist check, with 12.5% (4
of those who attended classical high school. There is a            subjects of 32) of these interviewed students having re-
statistically significant difference of knowledge of the risk      ceived a specialist check due to suggestions from their




                                                                                              io
factor “smoke“ between the humanistic studies (Classical           dentist. In our population, only 2% (23 subjects out of
High School, Faculty of Letters) and scientific studies            1125) were asked by their own dentist to make a visit for
(Scientific High School, Faculty of Medicine and Sur-              the prevention of oral cancer.
gery) (p = 0.0399).




                                                                                           az
Importantly, even among high school students, there is a
lower perception of the importance of alcohol and sunlight         Discussion and conclusions
as possible aetiologic factors. Thus, alcohol is recognised
as a risk factor by 51.5% of Scientific High School students       In general, knowledge of oral cancer is poor among the




                                                                            n
compared with 38.1% of the students attending Technical            interviewed people, and the majority of the population was
High School and 43.8% of the students attending Classi-            not aware of the existence of oral cancer. Importantly, it




                                                                         er
cal High School. There is a statistically significant differ-      should be noted that high school or university courses that
ence of knowledge of the risk factor “alcohol” between Sci-        specialise in scientific branches provide significantly bet-
entific and Technical High School (p = 0.0331).                    ter awareness of the disease and its risk factors to stu-


                                            nt
Finally, sun exposure is known as a risk factor by 28.1%
of students in Scientific High School compared with 18.5%
of the students in Classical High School and 13.3% of the
students in Technical High School. There is a statistically
                                                                   dents enrolled in these courses. In addition, individuals
                                                                   with doctors in the family have a better perception of the
                                                                   disease than the rest of the sample.
                                                                   Recently in Italy, knowledge of cancer prevention has
                                          iI
significant difference of knowledge of the risk factor “sun-       spread widely, especially regarding lung or breast cancer,
light“ between the humanistic studies (Technical High              for which check-ups and preventive instrumental tests are
School, Faculty of Letters) and scientific studies (Scien-         regularly performed in the population. This culture of pre-
                                        on

tific High School, Faculty of Medicine and Surgery).               vention is absent for oral cancer, as evident from the re-
(p = 0.0057) (Graphs 1,2,3).                                       sults of the study. Therefore, it is crucial to inform and ed-
Additionally, having a doctor in the family can improve the        ucate the public regarding this serious disease: if this
knowledge of the risk factors involved in oral cancer. In          tumour is known and monitored with regular check-ups,
                                i


fact, 88.3% of the interviewed students who have a doc-            it can be prevented or treated effectively.
                             iz
              Ed
 IC
C
©




Graphic 1 - Perception of smoking as a risk factor among the subjects who reported being aware of oral cancer.
(QUESTION 3 = Smoking may increase the risk of developing oral cancer?)


110                                                                                  Annali di Stomatologia 2012; III (3/4): 106-112
Cognitive experience of oral cancer among young people of “Sapienza” University of Rome




                                                                                                     li
                                                                                                  na
                                                                                               io
                                                                             n              az
                                                                          er
                                              nt
                                            iI
Graphic 2 - Perception of alcohol as a risk factor among the subjects who reported being aware of oral cancer.
(QUESTION 4 = Alcohol may increase the risk of developing oral cancer?)
                                 i        on
                              iz
              Ed
 IC
C
©




Graphic 3 - Perception of sunlight as a risk factor among the subjects who reported being aware of oral cancer.
(QUESTION 5 = A long exposure to sunlight may contribute to the onset of oral cancer?)


Annali di Stomatologia 2012; III (3/4): 106-112                                                                   111
L. Ottolenghi et al.


The prevention of oral cancer has a major role in dental                      Rapido accesso alla diagnosi per il paziente con sospetta pa-
practice. Due to the identification of malignant disease                      tologia oncologica.
and a proper health education, health care professionals                10.   Yellowitz JA, Horowitz AM, Drury TF, Goodman HS. Survey
can contribute to decreasing the prevalence of this seri-                     of US dentists’ knowledge and opinions about oral pharyn-
                                                                              geal cancer. J Am Dent Assoc 2000;131:653-661.
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                                                                        11.   Sciubba JJ. Improving detection of precancerous and cancer-




                                                                                                            li
The data obtained from this study highlight the need to                       ous oral lesions. Computer-assisted analysis of the oral
increase health education, especially among younger                           brush biopsy. US Collaborative OralCDx Study Group. J Am




                                                                                                         na
people in high schools and university faculties, with hu-                     Dent Assoc 1999 130:1445-1457.
manistic or technical programs, in which the knowledge                  12.   www.nidcr.nih.gov/OralHealth/Topics/OralCancer/Detectin-
regarding prevention is more limited. A delay in the diag-                    gOralCancer.htm
nosis and a long waiting period prior to a confirmed di-                13.   www.nidcr.nih.gov/OralHealth/Topics/OralCancer/Oral-
                                                                              Cancer.htm




                                                                                                      io
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advanced stage, placing the life of the patient at serious              14.   Nagler R, Ben-Izhak O, Savulescu D, Krayzler E, Akrish S,
                                                                              Leschiner S et al. Oral cancer, cigarette smoke and mito-
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Currently, early diagnosis for many neoplastic diseases is




                                                                                                   az
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112                                                                                         Annali di Stomatologia 2012; III (3/4): 106-112
