Graduate project leads to new research focus in dentistry

What started out as a graduate research project to analyze oral cancer rates in vulnerable populations is now the foundation for many new research projects at the School of Dentistry.

The oral cancer screening project, initiated in one of the most underserved populations in Edmonton – the Boyle Street community – has led to the creation of an Oral Cancer Research Program.

The project first proposed by graduate student Parvaneh Badri, now involves numerous researchers, clinicians, dentistry and dental hygiene students, and graduate students.

The program, now led by professor and associate chair in research Maryam Amin, along with Badri’s PhD advisory committee member Seema Ganatra , clinical professor of oral medicine and pathology, is working to create oral cancer screening opportunities by setting up targeted clinics.

“As a team we are advocating for oral cancer screening in targeted populations,” says Badri. “We are advocating to our medical colleagues to make oral cancer screening a part of their global screening processes. For us to sell this to our policy makers we need to back it up with research and data.”

First, Badri conducted a scoping review to learn more about oral cavity cancer (OCC) and oropharyngeal cancer (OPC) in Alberta. In this study, she found that most of the OCC and OPC lesions are diagnosed at an advanced clinical stage with a significantly high number of advanced OPC lesions in stage IV of which In 2017, Badri and Ganatra launched the Boyle Street Community screening project, which was completed in February 2020. In total, 322 participants were recruited from the Boyle McCauley Health Centre Dental Clinic, George Spady Society Shelter-DetoxSupervised Consumption Centre, Operation Friendship Seniors Society, and Bissell Centre West.

“The oral cancer screening examinations performed on site by the research team included a specialist, dentists, and dental hygienists, showed that the prevalence of oral cancer and precancer lesions in this population was significantly higher than the provincial and national rate in the average population,” says Badri.

While the screening project was underway, the team also analyzed oral and oropharyngeal cancer cases from the Alberta Cancer Registry between 2005 and 2017. The final part of Badri’s graduate project involving chart audits from the Cross Cancer Institute, showed that most oral cancer patients had advanced stage IV disease prior to diagnosis.

“Our main concern was there is a delay in the diagnosis of oral cancer even when screening and dental services are easily accessible,” says Badri. “We know the earlier the diagnosis, the higher the survival rate. Unfortunately, the more vulnerable populations go to the dentist less often, so we are trying to get to them instead. Oral cancer screening through visual and tactile examination helps in the detection of malignant and potentially malignant lesions in early stages with 80 per cent to 5-year survival rates.”

Badri says many socioeconomic factors come in to play when seeing the delay in diagnosis.

But while oral cavity cancers globally are declining, the numbers are staying the same or slightly increasing.

“One reason might be related to the influx of South Asian immigrants in our province in recent years. Typically, these groups have higher rates of oral cavity cancer due to tobacco use,” says Ganatra.

This is one of many examples why building a cancer research focus in dentistry is vital.

“The majority of provincial research is focused on treatment and the quality of life – not on prevention,” says Amin. “Instead of waiting for our patients to come to us, which they often do when cancer is already in Stage IV , we are going to them.”

In the next phase of this study and project, researchers propose to measure a comprehensive set of healthcare costs associated with the management of oral cancer in Alberta and cross-examine it with patients’ income and treatment outcomes.

“The ultimate goal of this study is to improve early detection, survival, and quality of life of oral cancer patients who are economically and socially disadvantaged, and therefore, at high-risk for late diagnosis of cancer,” says Amin.