**7. Control and prevention measures**

Due to recent developments in the diagnosis and treatment of cancers, the survival of patients with cancers of the breast, colon and ovary has increased. However, over the past 50 years, the survival of patients with oral cancer has not changed [53]. In other words, oral cancer has a poor prognosis and the overall 5-year survival rate is 40%, although if diagnosed at an early stage (I and II), the survival rate can exceed 80% [54]. Up to 50% of oral cancers are diagnosed at an advanced stage (stages III and IV) because most patients are asymptomatic in the early stages

and do not seek medical help until they see clear symptoms such as pain, bleeding or a mass in the mouth or neck [55]. When the diagnostic delay is more than a month, the risk of having an advanced stage of oral cancer increases significantly [56]. In most cases, the patient is responsible for a large part of the diagnostic delay. However, delays can also be the result of an incorrect medical approach, as there is no suspicion of oral malignancy and it is not diagnosed and treated in a timely and sufficient manner [56, 57]. Clinical and pathological stage in diagnosis is the most important factor in prognosis [11].

Prevention of this devastating disease can be due to fundamental changes in the socio-economic situation, as well as measures to reduce demand, production, marketing and use of tobacco and alcohol products [58]. A healthy diet, oral hygiene and awareness of the signs and symptoms of the disease are important. Success depends on the political will, intersectoral actions, and culturally sensitive public health messages that are disseminated through educational campaigns and mass media initiatives [59].

Primary prevention of oral cancer therefore consists in education of people on the lifestyle changes such as non-smoking and alcohol consumption and protection from sunlight can reduce the risk of oral cancer [8]. Despite the increasing awareness of oral cancer in the general population, in the last 40 years the percentage of patients seeking medical attention with advanced disease has not changed significantly [51]. At least three-quarters of all oral cancers can be prevented by quitting smoking and drinking alcohol. Eliminating these two known factors also reduces cancer recurrence. In India and Sri Lanka, non-smoking tobacco education programs are designed specifically for adolescents to reduce the incidence of oral cancer. HPV vaccination can also be of importance, even though its effectiveness in not as well defined as it is in the prevention of anogenital and cervical cancer [11].

The goal of secondary prevention is early detection of cancer in the oral cavity in one of accessible places. The chance of curing oral cancers increases if they are diagnosed and treated early. Treatment of early-stage oral cancer increases patient survival. Unfortunately, most oral cancers are diagnosed at a more advanced stage and when they become symptomatic, which greatly reduces a person's chances of recovery, so early detection of precancerous lesions or early-stage oral cancer is very valuable. Diagnosis of suspected cases of oral cancer is made by assessing the patient's demographic characteristics and assessing specific habits, especially tobacco and alcohol consumption and other irritating factors that may play a role in causing oral cancer.

Routine biopsy in people with clinically characteristic precancerous lesions may lead to early detection of the underlying cause of oral cancer. In addition to history, physical examination, and biopsy, simultaneous evaluation of the upper aerodigestive tract is essential because patients with oral cancer are at risk for cancer of other parts of the head, neck, and lungs [25].

Oral health status and family history should also be evaluated for any syndromes that may increase the risk of oral cancer. In addition to the history, a complete examination of the head and neck is performed to carefully examine the location and spread of the primary tumor and identify metastases. It is noteworthy that early-stage cancerous lesions may be red or white plaques and non-ulcerative. More advanced cancers are ulcerative, aggressive, fungal, and prominent, or both. Cancer may develop within precancerous lesions such as leukoplakia or erythroplakia. Therefore, increasing the awareness of dentists is very important in getting a complete history and examination of the head and neck. Symptoms to consider include:


*Oral Cancer: Epidemiology, Prevention, Early Detection, and Treatment DOI: http://dx.doi.org/10.5772/intechopen.99236*


Unlike other frequent cancers (for example, colon or cervical cancer), a standard population-based screening program for oral cancer is not cost-effective and cannot be recommended [51]. Screening programs can be valuable in patients from high-risk groups (smokers and alcoholics) or in patients with a previous diagnosis of cancer outside the head and neck [60]. In countries with regular dental practice attendance, opportunistic screening for oral mucosal lesions (early-stage cancer or precancerous lesions) in general dental practice could also be relevant in reducing diagnostic delay [61].

Visual screening involves regular visual and physical examination of the intraoral mucosa under intense light to observe the symptoms of oral potentially malignant disorders (OPMD) as well as early oral cancer, followed by careful examination and digital palpation of the neck for lymph node enlargement. This is a providerdependent mental test. Accordingly, its performance in detecting lesions varies among providers. Comprehensive knowledge of oral anatomy, natural history of oral carcinogenesis, and clinical-pathological features of OPMDs and preclinical cancers are important prerequisites for effective oral vision screening providers [59]. A significant 34% reduction in oral cancer mortality among a high-risk group of smokers and alcoholics after three rounds of oral vision screening has been shown in a randomized controlled cluster trial in India [62, 63]. A 15-year follow-up showed a steady decline in oral cancer mortality, with a further decline in those who adhere to frequent screening courses. 38% reduction in oral cancer incidence (95% CI 8–59%) and 81% reduction in oral cancer mortality (95% CI 69–89%) in tobacco and /or alcohol users who They were screened four times [62].

Known risk factors, long natural history, easy diagnosis of precancerous lesions by oral examination make oral cavity cancer very suitable for population screening. Oral cancer usually occurs in accessible places, which can be diagnosed early by visual inspection and touch. Therefore, oral self-examination is possible for everyone because it is a method for early detection of precancerous oral lesions without the need for a simple, non-invasive and inexpensive healthcare professional [64]. It should be strongly supported for ordinary people, especially high-risk people [52]. A quasi-experimental study in Australia found the importance of oral self-examination in reducing the incidence and mortality of oral cancers [65].

Also, prompt treatment is essential for successful secondary prevention. Secondary prevention is also called cancer control [66]. Surgery and radiation therapy are widely used to treat premature oral cancer, either alone or in combination. The choice of method depends on the location of the tumor, cosmetic and functional outcomes, patient age, comorbidities, patient preference, and specialization [59].

The third prevention targets the final stages. More than 70% of advanced cancers have severe pain and other distressing symptoms. Pain control and palliative care are the third most important prevention strategies [67].
