Dominika Pomykala
5 year, 11th group
Knowledge of oral cancer risk factors among international
medical and dental students at Lithuanian University of
Heal-th Sciences
Master’s Thesis
Supervisor
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
CLINIC OF PREVENTIVE AND PAEDIATRIC DENTISTRY
Knowledge of oral cancer risk factors among international medical and dental students in Lithuanian University of Health Sciences
Master’s Thesis
The thesis was done
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EVALUATION TABLE OF CLINICAL–EXPERIMENTAL MASTER’S THESIS
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3
No. MT parts MT evaluation aspects
Compliance with MT requirements and evaluation Yes Partiall y No 1 Summary (0.5 point)
Is summary informative and in compliance with
the thesis content and requirements? 0.3 0.1 0 2 Are keywords in compliance with the thesis
essence? 0.2 0.1 0 3 Introductio n, aim and tasks (1 point)
Are the novelty, relevance and significance of
the work justified in the introduction of the thesis? 0.4 0.2 0 4 Are the problem, hypothesis, aim and tasks formed clearly and properly? 0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6
Review of literature (1.5 points)
Is the author’s familiarization with the works of
other authors sufficient? 0.4 0.2 0
7
Have the most relevant researches of the scientists discussed properly and are the most
important results and conclusions presented? 0.6 0.3 0 8 Is the reviewed scientific literature related enough to the topic analysed in the thesis? 0.2 0.1 0 9 Is the author’s ability to analyse and systemize the scientific literature sufficient? 0.3 0.1 0
10
Material and
methods (2 points)
IS the research methodology explained comprehensively? Is it suitable to
achieve the set aim? 0.6 0.3 0
11
Are the samples and groups of respondents formed and described properly? Were the
selection criteria suitable? 0.6 0.3 0
12
Are other research materials and tools
(questionnaires, drugs, reagents, equipment, etc.)
described properly? 0.4 0.2 0
13
Are the statistical programmes used to analyse data, the formulas and criteria used to assess the
level of statistical reliability described properly? 0.4 0.2 0 14 Results (2points) Do the research results answer to the set aim and tasks comprehensively? 0.4 0.2 0 15 Does presentation of tables and pictures satisfy the requirements? 0.4 0.2 0
4
17 Is the statistical significance of data
indicated?
0.4 0.2 0
18 Has the statistical analysis of data been carried out properly?
0.4 0.2 0
19
Discussion (1.5 points)
Were the received results (their
importance, drawbacks) and reliability
of received results assessed properly? 0.4 0.2 0
20
Was the relation of the received results with the latest data of other researchers
assessed properly? 0.4 0.2 0
21 Does author present the
interpretation of results?
0.4 0.2 0
22
Do the data presented in other sections (introduction, review of
literature, results) repeat? 0 0.2 0.3
23
Conclusions (0.5 points)
Do the conclusions reflect the topic,
aim and tasks of the Master’s thesis? 0.2 0.1 0
24
Are the conclusions based on the analysed material? Do they correspond
to the research results? 0.2 0.1 0
25 Are the conclusions clear and laconic? 0.1 0.1 0
26
References (1point)
Is the references list formed according to the
requirements?
0.4 0.2 0
27
Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?
0.2 0.1 0
28 Is the scientific level of references suitable for Master’s thesis? 0.2 0.1 0
29
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years – at least 40%?
0.2 0.1 0
Additional sections, which may increase the collected number of points
30 Annexes Do the presented annexes help to understand the analysed topic? +0.2 +0.1 0
31
Practical recommendatio ns
Are the practical recommendations suggested and are they related to the received results?
+0.4 +0.2 0
General requirements, non-compliance with which reduce the number of points
32
General
requirements Is the thesis volume sufficient (excluding annexes)? 15-20 pages (-2 <15 pages (-5
33 Is the thesis volume -2
points
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Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Reviewer’s name and surname Reviewer’s signature
34 Does the thesis structure satisfy therequirements of Master’s thesis? -1 point -2 points
35
Is the thesis written in correct language, scientifically, logically and laconically?
-0.5 point -1 points
36 Are there any grammatical, style orcomputer literacy-related mistakes? -2 points -1 points
37
Is text consistent, integral, and are the volumes of its structural parts
balanced? -0.2 point
-0.5 poin ts
38 Amount of plagiarism in the thesis. (not evaluated)>20%
39
Is the content (names of sections and subsections and enumeration of pages) in compliance with the thesis structure and aims?
-0.2 point -0.5 points
40
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point -0.5 poin ts 41 Was the permit of the BioethicalCommittee received (if necessary)? -1 point
42 Are there explanations of the key terms and abbreviations (if needed)?
-0.2 point -0.5 points 43
Is the quality of the thesis typography (quality of printing,
visual aids, binding) good? -0.2 point
-0.5 poin ts
*In total (maximum 10 points):
TABLE OF CONTENTS
SUMMARY………7
INTRODUCTION………..8
REVIEW OF LITERATURE………10
MATERIAL AND METHODS………12
RESULTS……….15 DISCUSSION………..22 ACKNOWLEDGEMENT………24 CONFLICT OF INTERESTS………..24 CONCLUSION……….24 PRACTICAL RECOMMENDATIONS...24 REFERENCES……….25 ANNEXES………33
Knowledge of oral cancer risk factors among international medical and dental
students at Lithuanian University of Health Sciences
SUMMARY
The aim of study: To evaluate the knowledge of oral cancer risk factors among the international
dental and medical students in Lithuanian University of Health Sciences.
The material and methods: A cross-sectional study was conducted among international medical
and dental students at the Lithuanian University of Health Sciences in 2018-2019. In total 253 stu-dents participated with a response rate of 79.5%. A self- administered English questionnaire consi-sting of items with several optionsabout oral cancer risk factors. Statistical data analysis was per-formed by using SPSS 22 version. To establish relationships between categorical variables χ2 test was used. The level of significance was set at p<0.05. The study was approved by the Bioethics Center of the LSMU (No BEC-OF-50). Cronbach’s alpha was found to be 0.8 (a good value).
Results: Majority of participants (96.8%) agreed that tobacco is a risk factor of oral cancer.
Mean-while, a half (52.2%) of students reported excessive alcohol consumption as a risk factor. Consider-ing the sunlight’s exposure as a risk factor of oral cancer, more dental students (34.8%) were aware than medical students (23.2%) (p=0.047). More international medical (38.4%) than dental students (19.1%) knew that oral cancer is related to gender (p=0.003). The mean score of knowledge about oral cancer risk factorswas 22.3 (4.302) and it was defined as a moderate level of knowledge about risk factors of oral cancer.
Conclusion: International medical and dental students reported moderate knowledge about the
main risk factors of oral cancer. Clinical dental students had the highest knowledge level among dental and medical students.
Keywords: Oral cancer risk factors, knowledge of dental students, knowledge of medical students,
INTRODUCTION
Oral cancer is a malignant neoplasm. Oral cancer is traditionally defined as a squamous cell carci-noma (OSCC) [1] because 90% of oral cancers are histologically originated in the squamous cells in the oral cavity [2]. The disease is complex and multifactorial. Oral cancers include the main subsi-tes of the lip, oral cavity, nasopharynx, and pharynx [3]. Most of the tumours are located on the flo-or of the mouth, the anteriflo-or base of the mouth, the alveolar process of the lower jaw, the edge of the tongue and base of the tongue [4].
World Health Organization (WHO) data shows that there are an estimated 657,000 new cases of cancers of the oral cavity and pharynx each year, and more than 330,000 deaths [3]. According to The World Cancer Research Fund oral cancer is the 16th most common malignancy worldwide which consist of 2.1% of all cancers [5].
Incidence of oral cancer varies depending on geographic region. Lip cancer dominates in the areas where solar radiation is strong, this disease has a high prevalence in Papua New Guinea and Aus-tralia [6]. Oral cancer is the most popular type of cancer in Papua New Guinea, it is caused by the popularity of betel quid use and increased tobacco consumption [7].
The patient must be exposed to causative factors for a prolonged period of time to develop cancer [8].Some causative factors can be relatively easy to eliminate by making changes in daily life. The most significant risk factors are prolonged alcohol and tobacco consumption [9]. Moreover, human papillomavirus (HPV) and excessive exposure to sunlight play a significant role in oral caries oc-currence as well. Consequently, most types of oral cancer can be prevented and can be treated espe-cially in early stages [9-11].
Early detection of oral cancer ensures a better prognosis and increases chances of survival, thus hi-gher awareness about oral cancer is a contribution to faster diagnosis and detection in less advanced stage [12]. It has been shown that almost half of the cases of oral cancers, worldwide are diagnosed at advanced stages III and IV. TNM stage at presentation significantly affects five-year survival [13].
Current evidence shows that community-based screening has a value in reducing the oral cancer mortality in a high-risk group of population. Premalignant lesions in oral cavity like leukoplakia or erythroplakia can be detected in an early stage. The oral cavity is easily accessible for screening by direct visual examination with little discomfort, therefore it is essential to include a special scre-ening during routine dental visits [14].
Proper knowledge about oral cancer risk factors among dental and medical students who are future medical professionals is essential to prevent oral cancer development [15].
Health care professionals should have at least a basic level of understanding of the aetiology and pathogenesis and how it affects the clinical presentation and management of the disease [16]. In society medical professionals treat not only the existing disease but also educate and promote health. Aware and educated dentists and doctors pay attention to harmful habits of patients and im-plement strategies to reduce the risk of disease development [17].
Fundamental knowledge about oral health shouldn’t be skipped during the educational process of medical students. It’s important that doctors have a good understanding of oral cavity findings be-cause it’s a predictor of general health. Many systemic diseases have its manifestation in the oral cavity [18]. Oral findings include autoimmune, hematologic, endocrine, and neoplastic processes [19].
Worldwideseveral studies have been conducted to assess the knowledge, opinions and practices of medical and dental students regarding oral cancer and revealed an inadequate level of knowledge about oral cancer including lack of knowledge about risk factors and proper examination techniques [20-25].
This lack of knowledge of oral cancer risk factors and awareness among dental and medical stu-dents as future doctors should be improved.
Hypothesis
We expect that dental international students are more aware of the oral cancer risk factors than med-ical international students. Furthermore, dental students of the clinmed-ical group should have more pro-found knowledge than dental students of the preclinical year.
The aim of the study: To evaluate the knowledge of oral cancer risk factors among the
in-ternational dental and medical students at Lithuanian University of Health Sciences.
Objectives:
1. To collect and analyse the data related to the knowledge of international dental and medical students about oral cancer risk factors.
2. To compare results among international dental and medical students.
1. REVIEW OF LITERATURE
In the literature, various studies have been carried out to assess knowledge of oral cancer risk fac-tors among medical and dental students.
Rahman et al. performed a study to asses dental students knowledge of oral cancer in The United Arab Emirates and they found, that there is an apparent deficiency of knowledge among dental stu-dents and an urgent need to pay attention to those aspects during teaching process [26].A similar study was performed in Romania by Dumitrescu, et al. and a significant association was found be-tween the year of study in the dental school, age, and knowledge of the oral cancer knowledge sco-res, therefore authors concluded that improvements in curricula and clinical training in dental facul-ties were necessary in Romania [27].
In the past, the causes of oral cancer have been mostly related to risk factors such as tobacco and alcohol use. Recent evidence shows that the aetiology is changing as the incidence of oropharyngeal cancer (OPC) caused by oral HPV infections is rising [28]. Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is responsible for several can-cers at different anatomic sites, including oropharynx [29]. HPV- positive oropharyngeal cancan-cers are mainly associated with sexual behaviour [30]. It’s considered that cases of HPV- related oropha-ryngeal cancers will soon overtake HPV linked to cervical cancers [31]. American Dental Associa-tion encourages dentist to promote HPV vaccinaAssocia-tion among their patients as a preventive method of oral and oropharyngeal HPV infection [32].Some evidence shows that vaccination can reduce oral cancer incidence [33].
Students should be knowledgeable about HPV as a risk factor not only to promote healthy be-haviour among their future patients but also to protect their own health as they are in the risk group [34]. A study done among Polish students presents inadequate awareness of the fact that the occur-rence of oral cancer may be associated with high-risk sexual behaviours. More than half (41.8%) did not associate the occurrence of malignant neoplasms of the oral cavity with oral sex [34].
The study carried out in Australia revealed that medical students had little insufficient knowledge of oral health, a potential relationship between systemic diseases and oral diseases, oral cancer and dental emergencies [35].The level of students practical clinical skills should be improved as study confirms that it’s less retained than theoretical knowledge [24].
A study conducted in Zagreb assessed knowledge among dental students regarding oral cancer and found that a higher percentage of non-smokers than smokers considered smoking cessation an im-portant preventive measure of oral cancer [24]. This confirms students attitude regarding smoking as a risk factor of oral cancer. Therefore, a more constructive approach and education of students about the harmful effects of tobacco and the benefits of smoking cessation in the disease prevention and treatment during the teaching process should also be featured [24].
There are many oral mucosal lesions and conditions that may increase the chance of developing oral squamous cell carcinoma. An oral premalignant lesion is defined as any lesion or condition of the oral mucosa that has the potential for malignant transformation [36].Quick identification of these lesions may allow for interventions which will minimize or eliminate this risk [37].These disorders, now termed ‘potentially malignant disorders’, include well-recognized lesions such as leukoplakia and erythroplakia and also a number of other more generalized conditions such as oral lichen planus and chronic hyperplastic candidosis [38].
The study conducted among dental students in Spain showed that overall students knowledge in dif-ferentiating nonmalignant from malignant lesions was satisfactory with a success rate averaged 73.9%. However, when the distinction for potentially malignant disorders was included, their ove-rall success rate decreased to 42.8%. Furthermore, their success rate was at its lowest at the end of the dental curriculum [40].
An effort to increase awareness among students may represent a powerful strategy to increase knowledge about risk factors, which is highly related to lifestyle habits and behaviour, thereby re-ducing the incidence and mortality of oral cancer [41].
2. MATERIAL AND METHODS
A cross-sectional study was conducted to assess the knowledge of oral cancer risk factors among international medical and dental students at the Lithuanian University of Health Sciences during the 2018-2019 study year. A total of 253 international students participated in this study (115
in-ternational dental students and 138 inin-ternational medical students). The response rate was 79.5%. The study was approved by the Bioethics Center of the Lithuanian University of Health Sciences (No BEC-OF-50).
Students were requested to participate in the survey on a voluntary basis and to fill in the question-naire. The students received an explanation about the main aim prior to filling the questionquestion-naire. Completed questionnaires were collected at the end or beginning of the lecture. Participation was voluntary, and all participants remained anonymous.
2.1Subjects
Overall, the participants were 50.6% males and 49.4% females in this survey (p>0.05). The distrib-ution of students from each study year was quite equal (p>0.05). The second and fifth year were the biggest group among dentists. The biggest group from medical students were participants from 5th year and the smallest from 6th year (Table 1).
Analysing the data all participants were grouped into medical and dental students, while later dental ones were dichotomized into preclinical (1st and 2nd study year) and clinical (3rd-5th study year) students (Table 1).
Table 1. Distribution of participants by gender and academic year.
p value- comparison between international dental preclinical and clinical dental students (p>0.05)
2.2 Questionnaire
A self- administered English questionnaire consisted of 21 questions about general information (gender, faculty and study year) and knowledge regarding oral cancer risks factors. The questions regarding topic grouped into three categories: oral cancer risk factors (those supported by scientific evidence), non-risk factors (those not supported by scientific evidence), diagnostic signs and symp-toms and question about medical professional to whom is necessary to refer the patient.
16 questions had the following options of answers, yes, no and I don’t know, and two questions with multiple choice answers.
Later level of knowledge of oral cancer risk factorswas calculated by giving a score for each cor-rect response to the 15 items regarding oral cancer risk factors and 1 item regarding diagnostic signs. Every correct answer was counted as 2 points, partially correct (I don’t know) as 1 and incor-rect as 0, respectively. Overall, the maximum score was 32. Based on the knowledge index, the
Variables
Faculty International dental students
(N=115) International medical students (N=138)
N % N %
Gender
Male 53 46.1 75 54.3
Female
62 53.9 63 45.7
Academic year of studies 1st year 23 20 22 15.9 2nd year 25 21.7 24 17.4 3rd year 21 18.3 26 18.8 4th year 21 18.3 27 19.6 5th year 25 21.7 29 21 6th year 0 0 10 7.2
level of knowledge of oral cancer risk factors was classified three categories: good ( >27 points), moderate score (17-26 points) and poor (<17 points).
2.3 Statistical analysis
Statistical data analysis was carried out by using SPSS 22 version. To establish relationships be-tween categorical variables, the Pearson chi-squared test (χ2) was used. While Mann-Whitney U test was used to compare the mean scores between groups.The level of significance was set at p<0.05. The confidence interval was 95%.
Cronbach’s alpha served as a measure of the internal consistency of the questionnaire, it was found to be 0.8 (a good value).
3. RESULTS
Questions addressed real oral cancer risk factors (those supported by scientific evidence) and risk factors not supported by research like eating spicy food or wearing dentures.
The overall majority of participants (96.8%) agreed that usage of tobacco is a risk factor of oral cancer. (Table 2)
Merely a half (52.2%) of students reported excessive alcohol consumption as a risk factor. (Table 2) Meanwhile statistically significant difference of knowing about alcohol consumption as a risk factor was found between dental and medical international students( 58.3% vs. 47.1%) (p=0.017). Moreover, significantly more preclinical dental students (72.5%) answered correctly to this state-ment than the clinical group (p=0.025). (Table 4)
Considering the sunlight’s exposure as a risk factor of oral cancer, more dental students (34.8%) were aware than medical students (23.2%) (p=0.047). Moreover, preclinical dental students showed better knowledge over a clinical dental group (52.5% vs. 25.3%) (p=0.007). (Table 4)
Overall (61.3 %) of participants thinks that gender is not related to a higher risk of oral cancer. More international medical (38.4%) than dental students (19.1%) knew that oral cancer is related to gender (p=0.003). (Table 4) 70.8% participants agree that the risk of getting oral cancer increase with age. Subsequently, the majority of students (74.3 %) disagreed that oral cancer is contagious.
More than half of participants (65.6%) were aware that oral cancer can manifest without initial complaint, pain or symptoms. Furthermore, the majority of students knew that oral cancer can be prevented (86.2%) and treated (85.4%) (Table 2).
Table 2.Responses given by participants.
Statement Yes
N(%) No N(%) I dont know N(%) 1.Tobacco use in any form (cigarettes, cigar or a pipe) will increase a
person’s chance of getting oral cancer. 245 (96.8) 4 (1.6) 4 (1.6) 2. Is alcohol consumption a risk factor for oral cancer? 132 (52.2) 37(14.6) 84(33.2) 3. Does the risk of oral cancer increase with age? 179 (70.8) 23 (9.1) 51 (20.2)
4. Is oral cancer contagious? 36 (14.2) 188 (74.3) 29(11.5)
5.Can oral cancer be treated? 216 (85.4) 6 (2.4) 31 (12.3)
6. Can oral cancer be prevented? 218(86.2) 8(3.2) 27(10.7)
7. Excessive exposure to sunlight will increase a person’s chance
of getting oral cancer. 72 (28.5) 103 (40.7) 78 (30.8)
8. Does early diagnosis improve recovery? 240 (94.9) 6 (2.4) 7(2.8) 9. Can oral cancer manifest without initial complaint, pain or
symptoms? 166 (65.6) 19(7.5) 68(26.9)
10. Certain types of HPV (Human Papillomavirus) can lead to oral
cancer? 138(54.5) 21(8.3) 94 (37.2)
11. Are oral- genital contacts (oral sex) increasing the risk of oral
cancer? 98 (38.7) 74 (29.2) 81 (32)
12. Frequently biting the cheek or lip will increase a person’s chance of
getting oral cancer. 75 (29.6) 105 (41.5) 73 (28.9)
13. Eating hot spicy food will increase chance of getting oral cancer. 51(20.2) 133(52.6) 69(27.3) 14. Is gender related to a higher risk of oral cancer? 23(9.1) 75(29.6) 155(61.3) 15. Is wearing dentures a risk factor of oral cancer 54(21.3) 109(43.1) 90(35.6) 16. Do you feel that there is a need for additional training/ information
Questions regarding risk factors not supported by scientific research resulted in more diverse an-swers.
Overall, (43.1%) respondents don’t consider wearing dentures as a risk factor of oral cancer. A two-third of dental students considered incorrectly wearing dentures as a risk factor. Of oral cancer. Sig-nificantly more preclinical dental students (60%) believed that dentures can be risk factor than clin-ical ones (15.0 %) doesn’t consider it as a risk factor (P<0.001) (Table 4)
More than a half all participants (54.5%) agreed that HPV can be a risk factor for oral cancer. Fur-thermore, more preclinical dental students agreed with this statement that clinical group students (77.5% vs. 45.3%) (p=0.003). In contrast, only 38.7% of participants considered oral-genital con-tacts to increase potential risk to develop oral cancer, while more preclinical dental students (57.5%) agreed with this statement than clinical group (25.3%) (p=0.002) (Table 4)
A half of preclinical dental students agreed that frequently biting the cheek or lip will increase a person’s chance of getting oral cancer compared with clinical dental students (20%) (p=0.003) (Ta-ble 4)
Eating hot spicy food is considered a non risk factor (not supported by research) and a statistically significant number of students from clinical years (65.3%) seemed to be more aware of it than den-tal students from the preclinical group (45%) (p=0.023) (Table 4)
Table 3.Questionnaire response regarding questions about diagnostic signs of precancerous lesions and referring to a certain medical specialist for further treatment management.
p value- comparison between international dental and medical students (p>0.05)
Only 21% of participants correctly identified all precancerous lesions (Table 3). Consequently, 43% of students would refer patients with suspected oral malignancy to the oncologist and 31.6% of them to a maxillofacial surgeon. 21% of participants would refer a patient for a consult to more than one specialist.
Majority of participants (87%) found additional training important and necessary (Table 2). Faculty
Total N (%) Odontology N(%) Medicine (%)
Oral cancer may present as all these precancerous lesions (persistent ulcer, an erosion, red patch, white patch)
Yes 25 (22) 29 (21) 54 (21)
No 90 (78) 109 (79) 199 (79)
Total 115 (100) 138 (100) 253 (100)
Where would you refer (as a general doctor/dentist) a patient if you suspect an oral malignancy ? Maxilofacial surgeon/ oral surgeon 41( 36) 39 (28) 80 (31.6) Oncologist 48 (41.7) 60 (43) 108 (43) ENT surgeon 2 (1.7) 4 (3) 6 (2) Plastic surgeon 0 1 (0.7) 1 (0.4) None of these 4 (3.4) 3 (2) 7 (3)
More than one
specialist 20 (17.2) 31 (22) 51 (20)
Table 4. Comparison of answers between international dental preclinical and clinical years students (N=118)
p value- comparison between international dental preclinical and clinical dental students Statement Odontology students N (%)
P- value
Preclinical Clinical
Yes No I dont
know Yes No I dont know
Is alcohol consumption a risk factor for oral cancer?
29 (72) 4 (10) 7(18) 38 (50) 5 (7) 32 (43) 0.025 Excessive exposure to sunlight will increase a person’s chance of getting oral cancer.
21(52) 12 (30) 7(18) 19(25) 26 (35) 30 (40) 0.007 Certain types of HPV (Human Papillomavirus) can lead to oral cancer?
31(77.5) 3(7.5) 6(15) 34(45) 7(10) 34(45) 0.003
Are oral- genital contacts (oral sex) increasing the risk of oral cancer?
23(57) 10(25) 7(18) 19(25) 23(31) 33(44) 0.002
Frequently biting the cheek or lip will increase a person’s chance of getting oral cancer.
20(50) 10(25) 10(25) 23(31) 37(49) 15(20) 0.003
Eating hot spicy food will increase chance of getting oral cancer.
13(32.5) 18(45) 9(22.5) 9(12) 49(65) 17(23) 0.023 Is wearing dentures a risk factor of oral cancer
Overall, the mean score of knowledge about oral cancer risk factorswas 22.3 (4.302) and it was de-fined as a moderate level of knowledge about risk factors of oral cancer. Figure No. 1 Illustrates that majority of the participants (74.7%) had moderate knowledge about oral cancer risk factors, where-as merely 9.4% of students in both faculties had a poor level of knowledge about oral cancer risk factors.
Considering the faculty, this score was higher among medical international students than among dental ones 22.49(4.375) vs. 22.08(4.220) (p=0.446). Comparing this mean score by gender, it was slightly higher among females 22.5(4.401) than males 22.11(4.211) (p=0.467) (Table 5)
The clinical years dental international students had the highest mean score of knowledge among all the participants 24.04(3.047), whereas preclinical years dental students had the lowest score
(19.33(4.117)) (p=0.0001), respectively (Table 5)
Table 5. Comparison of mean scores of the level of knowledge about oral cancer risk factors be-tween gender, faculty and within dental faculty among international dental and medical students at the LSMU (N=253)
MS (SD)- mean score (standard deviation)
Variables MS (SD) P value Gender Men 22.11(4.21) 0.467 Female 22.50 (4.40) Faculty Odontology 22.08 (4.22) 0.446 Medicine 22.49 (4.38)
International dental students
Preclinical years 19.33 (4.12)
0.0001
Figure 1. Distribution of level of knowledge about oral cancer risk factors among international
dental and medical students at the LSMU (N=253)
9%
75%
16%
4. DISCUSSION
Our study showed that LSMU international dental and medical students presented a moderate level of knowledge about oral cancer risk factors.
Dental and medical students throughout their study years come across topics related to cancer pre-vention, diagnostics, development and treatment during different courses.
The topics related to oral cancer are raised during preclinical and clinical study years at the LSMU. Dental students learn about basic issues about oral cancer risk factors during pathological physiolo-gy, pathological anatomy, oral and maxillofacial surgery, prevention of oral diseases, oral mucosa diseases and maxillofacial function pathology and radiology subjects. Medical students come across these topics for example during oncology, radiology module and maxillofacial surgery subjects [42].
Topics related to oral cancer should be included in the curriculum for all medical professionals: dentists, therapists, hygienists, clinical dental technicians and general medical professionals, be-cause they are the first point of contact for the patient [16]. Basic understanding of the disease and its peculiarities helps to improve early detection and educate patients.
Usage of tobacco products is one of the most common risk factor of oral cancer and in most studies regarding oral cancer, participants were asked about the correlation with smoking. Our study showed that (96.8%) of students participating in this research agree that smoking is a risk factor of oral cancer. It is consistent with other studies carried out in different countries, such as Saudi Ara-bia, Malaysia, Romania, Arab Emirates [21,26,27,43].
Even though awareness about the negative effect of smoking is very high among students, there is still a noticeable percentage of students who use tobacco products on a regular bases. A study con-ducted in Lithuania showed that (31.5%) of international dental students were regular or occasional smokers [44]. The Global Health Professions Student Surveys (GHPSS) conducted among medical and dental students revealed that one-fifth of the students currently smoking cigarettes [45].
Cessation of smoking habits may result in regression or even disappearance of the leukoplakia and will diminish the risk of cancer development either at the site of the leukoplakia or elsewhere in the mouth or the upper aerodigestive tract [39].
Alcohol consumption is also recognized by students as a risk factor of oral cancer. It was reported that in 2012, a total of 162,547 cases of the oral cavity and oropharyngeal and hypopharyngeal can-cer cases were attributable to alcohol consumption [46].
In this study, half of the participants acknowledged this as a risk factor. Other studies show that higher alcohol consumption over a shorter period was more harmful than increased alcohol con-sumption over a longer period of time, and the most frequently consumed alcoholic beverages in a population is likely to be associated with the highest risk of head and neck cancer in that population [46].
It’s assumed that during studies students knowledge progressively increases and students from higher years suppose to have a better level of knowledge than students from preclinical years. Surprisingly preclinical students answered some questions better. Results revealed the higher awareness of some questions was among preclinical years students than clinical years students, but overall the mean score was higher among clinical students. In Romania clinical years students had significantly better knowledge than preclinical years students [27].
Students were relatively more knowledgeable about established risk factors of oral cancer, they were less knowledgeable about scientifically unsupported risk factors [47].
Most of the performed studies confirmed that the improvement of universities curricula regarding oral cancer and additional clinical training in oral cancer prevention is necessary for dental students [21, 26,27,48].
The results of my research confirmed hypothesis that clinical years dental students have the highest level of knowledge.
5. CONCLUSIONS
Overall, international students possess a moderate level of knowledge about oral cancer risk factors at the LSMU. Clinical dental students had the highest knowledge level among dental and medical students. However, knowledge and awareness among medical and dental students about oral cancer risk factors should be improved.
6. AKNOWLEDGEMENT
I would like to thank my supervisor Dr. Sandra Petrauskienė for her invaluable assistance and col-laboration. In addition the author also acknowledges all the medical and odontology students who participated in the survey for their contribution to this study.
7. ENSURING OF CONFIDENTIALITY
Confidentiality of responses will be maintained by using an anonymous questionnaire. The name, surname and address will not be included in the questionnaire. The generalized results of study will be published.
8. PRACTICAL RECOMMENDATIONS
Proper knowledge of dental and medical students about oral cancer risk factors can influence better prevention of oral cancer in the future. Therefore I believe that awareness about oral cancer among both medical and odontology students should be raised. This can be achieved by adding topics re-lated to the importance of prevention and directly to oral cancer to the curriculum. Also to include practical classes about a screening of oral cancer to improve diagnostics skills.
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EVALUATION FORM OF THE MASTER’S THESIS FOR THE MEMBER OF DEFENCE COMMITTEE
Graduate student _________________________________________________________________, of the year ______, and the group _____ of the integrated study programme of Odontology Master’s Thesis title: ...
...
No. MT evaluation aspects
Partially
1 Has the student’s presentation lasted for more than 10 minutes?
2 Has the student presented the main problem of the Master’s thesis, its aim and tasks?
3 Has the student provided information on research methodology and main research instruments?
4 Has the student presented the received results comprehensively?
5 Have the visual aids been informative and easy to understand?
6 Has the logical sequence of report been observed?
7 Have the conclusions been presented? Are they resulting from the results?
8 Have the practical recommendations been presented?
9 Have the questions of the reviewer and commission’s members been answered correctly and thoroughly?
Is the Master’s thesis in compliance with the essence of the
Evaluation
No Yes
Remarks of the member of evaluation committee of Master’s Thesis
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Evaluation of the Master’s Thesis
_____________________________________________________________________________
Member of the MT evaluation committee:
________________ ___________________________ _____________________
ANNEXES
Annex No. 1
Questionnaire
* Gender: Male/Female
* I am a student of the following department: Odontology/ Medicine * Academic year of studies 1 \ 2 \ 3 \ 4 \ 5 \6 (please circle)
Please choose the most suitable answer of the following questions: Tobacco use in any form (cigarettes, cigar or a pipe) will increase a person’s chance of getting oral cancer.
Yes No I don’t know
Is alcohol consumption a risk factor for oral cancer? Yes No I don’t know Does the risk of oral cancer increase with age? Yes No I don’t know
Is oral cancer contagious? Yes No I don’t know
Can oral cancer be treated? Yes No I don’t know
Can oral cancer be prevented? Yes No I don’t know
Excessive exposure to sunlight will increase a
person’s chance of getting oral cancer. Yes No I don’t know
Does early diagnosis improve recovery? Yes No I don’t know
Can oral cancer manifest without initial complaint,
pain or symptoms? Yes No I don’t know
Certain types of HPV (Human Papillomavirus) can
lead to oral cancer? Yes No I don’t know
Are oral- genital contacts (oral sex) increasing the
risk of oral cancer? Yes No I don’t know
Frequently biting the cheek or lip will increase a
person’s chance of getting oral cancer. Yes No I don’t know Eating hot spicy food will increase chance of
getting oral cancer. Yes No I don’t know
Is gender related to a higher risk of oral cancer? Yes, more likely in women
Yes, more likely in men
No, gender is not related
Thank you for participating!
CONSENT SHEET FORM OF RESEARCH PARTICIPANT
I, understand all information provided me in the information sheet and agree to participate in rese-arch of Dominika Pomykala, title of “The knowledge of oral cancer risk factors among international dental and medical students at Lithuanian University of Health Sciences” aimed to assess the know-ledge and awareness that international students have about oral cancer risk factors.
(Name, surname) of research participant _____________________ Nr._______________ Date ____________
Is wearing dentures a risk factor of oral cancer ? Yes No I don’t know Do you feel that there is a need for additional
training/ information regarding oral cancer? Yes No I don’t know
Oral cancer may present: (mark one or more) As a persistent ulcer
As an erosion Red patch White patch None of these
Where would you refer (as a general dentist or general doctors) a patient if you suspect an oral malignancy? (select one)
Maxillofacial surgeon/Oral surgeon Oncologist
ENT surgeon Plastic surgeon None of these
