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Embedding oral health within the cancer strategy

Influencing policy to make oral health a vital element of the cancer strategy for Northern Ireland.

Gerry Mckenna
Gerry McKenna Chair BDA Hospitals Group for Northern Ireland

Unfortunately, the importance of oral health is often overlooked as a major contributory factor in the maintenance of good overall health. This is despite a significant body of evidence which demonstrates strong associations between poor oral health and diabetes, cardiovascular disease and malnutrition.

That’s why I welcomed the news in August that the Department of Health would make it a priority to launch a consultation on the newly produced cancer strategy for Northern Ireland 2021-2031. This was our chance to make the case for oral health to be considered a vital part of the cancer strategy and we took it.

Here’s how we’ve been advocating for change, highlighting systemic risks and influencing policy:

Advocating for change

We’d already put in significant work prior to the publication of the strategy to raise awareness with policymakers and highlight the importance of oral health and dentistry for effective cancer screening, diagnosis and treatment. From contributing to Mouth Cancer Awareness Month and the annual Cancer Focus Northern Ireland Men’s Health Conference, to presenting findings directly to MLAs at Stormont about oral cancer, I am proud of what we have accomplished.

Earlier this year, I briefed Stormont’s All Party Group on Cancer on the key issues that need to be addressed, using the data gathered by the Northern Ireland Cancer Registry. The increasing numbers of cases, the vast majority of which are coming from our most deprived areas, is cause enough for concern. But MLAs were most struck to learn that 60% of cases are presenting as advanced (Stages III and IV) disease, leaving patients with fewer treatment options and less hopeful prognoses. The then acting Chief Dental Officer for Northern Ireland, Michael Donaldson, reiterated the seriousness of these issues.

Any healthcare policy which puts reducing health inequalities at its core has the potential to deliver very positive outcomes for oral cancer and oral health in Northern Ireland.

Highlighting systemic risk

One of the major issues we are contending with is low rates of dental registration in Northern Ireland, particularly in lower socio-economic groups. This means those most at risk of developing oral cancer are missing out on vital screening services. It is notable that a recurring theme throughout the strategy is the reduction of health inequalities. This approach should lead to higher detection rates.

Whilst important for all aspects of healthcare, oral cancer presentation runs along extremely clear socio-economic gradients in Northern Ireland. Our messaging has been clear. Any healthcare policy which puts reducing health inequalities at its core has the potential to deliver very positive outcomes for oral cancer and oral health in Northern Ireland.

Influencing policy

It is good to see that our messages on oral cancer have been listened to and understood by senior politicians and the Steering Group Members responsible for the new strategy. The document clearly highlights the high prevalence of head and neck cancer in Northern Ireland as the fourth most common cancer in men. Preventative measures are also highlighted, such as the reduction of tobacco and alcohol consumption and good oral health. Indeed, one of the strategy’s 67 recommendations, is to “raise public awareness of the risk factors and early signs of mouth cancer and the importance of regular dental check-ups for those at increased risk.” Our messages are getting through.

During Oral Questions in the Assembly on 28 September, Robin Swann, Minister for Health made this clear: “dentists provide a vital service as part of our healthcare family. The important point to make is that dentists are not just about teeth. They are about checking the mouth for things such as oral cancers. They do so much. Our dentists, because of the vital role that they play and the input that they can have, are included in our cancer strategy.” I am pleased that the vital role dentists play in providing screening for oral cancer is being so clearly acknowledged.

Next steps

The cancer strategy is ambitious and will require additional funding to support its implementation, as the Minister acknowledges in his introductory remarks. This will pose a significant challenge, given the current pressures on health budgets.

However, we will continue to work with organisations such as Cancer Focus NI to support its success. I am hopeful that together we can improve the lives of those most at risk of oral cancer in Northern Ireland.