Oral cancer patients delaying treatment due to pandemic

Taiwan: Oral cancer is the most common cancer among young and middle-aged men in Taiwan. According to the cancer registration data of the National Health Administration, 9 out of 8,204 cases of oral cancer were male.

Experts warn that the COVID-19 pandemic has made many patients afraid of seeking medical treatment and screening. It is found that many patients wait until their condition has deteriorated to the fourth stage of oral cancer before seeking medical treatment. The healthcare authorities are calling on the public to seek medical attention as soon as possible and follow up with the doctor once every two years.

Smoking, drinking, and eating betel nuts are the most common causes of oral cancer in the country. Studies have shown that the risk of upper aerodigestive tract cancer is 5 times higher for those who chew betel nut than those who do not.

According to the average statistics compiled by the National Health Administration, 3,395 people die of oral cancer every year.

National oral cancer screening data found that up to 75% of oral lesions discovered through screening are precancerous lesions and early-stage cancers.

The most effective way of mitigating the risk of malignant transformation of precancerous lesions, the experts say, is to cut down on smoking and beer, in combination with treatment.

Regular checks and inspections can reduce the risk of death by 26%, while early detection and timely treatment can increase the survival rate by more than 80%.

According to Dr Lu Yixing, director of the Cancer Center of Mackay Hospital General Hospital, the COVID-19 pandemic has made people afraid to seek medical treatment and screening, usually doing so only when the condition has become serious.

As a result, over the past two years, the severity of the disease in patients is much greater than before. This includes cases where cancer cells with lung and bone metastases and even local tumours are larger than previously imagined, making medical intervention more difficult.

Dr Lu pointed out that the proportion of patients with oral cancer in the fourth stage was recently found to be very high. There are also stages 4A, 4B, and 4C in the fourth stage. Now many patients are in stages 4B and 4C. Not only do they require spending more energy and time in intensive treatment, but the treatment results may not be ideal.

Some patients and their families may be discouraged and give up treatment as a consequence. That the impact of the pandemic, resulting in delayed medical treatment for between half a year to a year would have such serious consequences, has surprised even the medical experts.

Dr Lu further noted mask-wearing regulations that differ between clinics, have caused confusion in the diagnosis of cancer patients.

While some clinics may not necessarily require patients to take off their masks for routine examinations, patients and their families have been known to refuse to remove their masks for fear of contracting the virus.

“If it is unclear whether there is a foreign body or tumour in the mouth or throat, it is difficult to detect when the patient has the mask on,” Dr Lu said.

“Doctors should resume their normal diagnostic routines even if the symptoms appear minor.”

Another cause for concern, Dr Lu noted, has to do with the rampant use of new types of cigarettes such as electronic cigarettes and heated cigarettes.

Since the new types of cigarettes have only had a short time to market, he cautioned about the lack of clinical evidence to support their use.

According to him, studies have confirmed that electronic cigarettes and heated cigarettes cause pulmonary fibrosis, but the correlation with oral cancer needs to be further investigated.

“Smoking still enters from the oral cavity, and the essential oils, pigments, and a small amount of nicotine in the tobacco products will pass through the oral cavity,” he noted.

“Although the research is unclear, the relationship between the two cannot be denied.”

A very small number of people who do not smoke, drink or eat betel nuts suffer from oral cancer. According to Dr Lu’s analysis, this minority group of oral cancer patients, typically elderly patients, can generally be subdivided into two categories.

The first relates to the size of the patient’s dentures and the shape of their mouth, which require periodic and moderate adjustments to the dentures. The second relates to excessive cleaning of the tongue coating, which can cause damage to the oral mucosa due to strong stimulation. However, these two events lead to only 10% of cancer cases, which is quite rare.

“Oral mucosal examination is performed by a physician by visual inspection and palpation of the oral mucosa to diagnose whether there are suspected precancerous lesions or signs of cancer. The examination process takes only three minutes,” said Dr Wu Zhaojun, director of the National Health Commission.

Dr Wu reminded that oral mucosal examinations could help to detect precancerous lesions early and prevent cancer.

To treat and reduce the chance of cancer, people over the age of 30 who are eligible for government subsidies and who have the habit of smoking and drinking can bring their health insurance card to the health insurance special dental and otolaryngology clinics every 2 years to receive oral mucosal examinations.

After examination, it is found that if the early (stage 0-1) lesions can be treated in time for oral cancer, the 5-year survival rate can be as high as 80%; if the detection or treatment is delayed, the survival rate of advanced cases is usually less than 40%.

The National Health Administration reminds that as long as one of the symptoms of “plaque sclerosis” appears in the mouth, the patient should seek medical attention as soon as possible, and if necessary, undergo a biopsy to confirm the diagnosis and early treatment.