Late screening and detection of head and neck cancer in Saudi Arabia: is it a policy or a literacy issue?
Letter to the Editor

Late screening and detection of head and neck cancer in Saudi Arabia: is it a policy or a literacy issue?

Kehinde Kazeem Kanmodi1,2,3,4,5,6

1Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria; 2Mental and Oral Health Development Organization Inc., Birnin Kebbi, Nigeria; 3Department of Community Health, Aminu Musa Habib College of Health Sciences and Technology, Yauri, Nigeria; 4Dental Clinic, Adonai Hospital, Mararaba, Nigeria; 5Department of Political Science, National Open University of Nigeria, Abuja, Nigeria; 6Birnin Kebbi Study Centre, National Teachers’ Institute, Birnin Kebbi, Nigeria

Correspondence to: Dr. Kehinde Kazeem Kanmodi. Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria. Email: kanmodikehinde@yahoo.com.

Received: 24 May 2020; Accepted: 31 August 2020; Published: 11 September 2020.

doi: 10.21037/fomm-20-31


I read with keen interest the recently published article by Durani et al., in which they conducted a hospital-based retrospective study exploring the clinic-epidemiological profile of head and neck cancer (HNC) patients treated at the King Fahad Medical City, Riyadh, Saudi Arabia. The study showed that 15.1% and 64.6% of HNC patients presented at TNM stage 3 and 4, respectively; these two stages are advanced cancer stages which are associated with poor treatment outcomes and poor quality of life (1). This finding, as obtained in the article of Durani et al., fits with the epidemiology from other papers published nationally, in Saudi Arabia (2,3).

Over the years, the issue of late HNC presentation among Saudi Arabians has been an issue of serious public health concern (1-4); however, the magnitude of public health response towards the prevention of the disease has left so much to be desired (5-11).

Saudi Arabia is an oil-rich country, with good health policies on general cancer prevention and care strategies compared to many other developing countries in the world. However, the country’s current policy status on HNC prevention and care strategies is still very weak (5). For instance, Saudi Arabia has a weak and weakly enforced policy/law restricting tobacco use despite the alarming rate of cigarette smoking (as about 2 out of every Saudi Arabians aged ≥15 years are current users of tobacco) among its populace (12). Also, the country lacks a working policy preventing harmful alcohol use or guiding routine immunization activities against human papillomavirus (HPV) (tobacco, alcohol and HPV are one of the major HNC risk factors in Saudi Arabia) (5-7); in addition, the country also lacks a particular mechanical strategy for data gathering on HNC screening, diagnosis, care, and prognosis (8). Unlike in the USA—a highly developed country—the burden of HNC and as well as the rate of late HNC presentation amongst its populace is relatively lower when compared to that of Saudi Arabia; this is simply because better public health efforts, especially in the area of public health policy making and implementation (favouring HNC prevention and cure), are in place unlike in Saudi Arabia (13-15).

Furthermore, recent studies had shown that the majority of the lay public members and even the healthcare practitioners in Saudi Arabia lack basic knowledge on HNC risk factors, symptoms, and screening—high rate of HNC illiteracy (8-10). Pertinently, scientific research had shown that those cancer patients who are aware of cancer do present earlier at the hospital for cancer screening, detection, and care, more often than those who are unaware of it (11). Hence, the high rate of delayed HNC presentation in the hospitals in Saudi Arabia can be attributed to the very low HNC literacy rate among Saudi Arabians.

Based on the above, it can be concluded that the high rate of late presentation of HNC patients in Saudi Arabia can be linked to low public HNC literacy and weak policy on HNC prevention (1,4-11); this is a problematic issue that requires urgent public health attention.

The HNC burden in Saudi Arabia can be brought down to the barest minimum through painstaking policy review, planning, and implementation of HNC prevention strategies at all levels—primary, secondary and tertiary levels, if commenced as soon as possible. However, no matter how perfect a health policy or a plan is, if it is not properly implemented, it may not generate its desired public health outcomes. Hence, in order to achieve beautiful outcomes as regards the eradication of the huge burden of HNC in Saudi Arabia, the Saudi Arabian government needs to provide substantial financial support, reliable logistic measures, and human resources towards the implementation of HNC prevention strategies. These strategies should include massive HNC awareness campaigns using social media and news media, free community-based HNC screening programs, free or subsidized clinical care programs for HNC patients, regular follow-up of HNC patients, and regular documentation of HNC cases at the cancer registry of Saudi Arabia.


Acknowledgments

Funding: None.


Footnote

Provenance and Peer Review: This article was a free submission to the journal. The article has undergone external peer review.

Peer Review File: Available at http://dx.doi.org/10.21037/fomm-20-31

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/fomm-20-31). The author has no conflict of interest to declare.

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References

  1. Durani SK, Al-Dhahari S, Sebeih H, et al. Clinical characteristics of head and neck cancers at a tertiary care hospital. Popul Med 2020. doi: 10.18332/popmed/120072. [Crossref]
  2. al-Idrissi HY. Head and neck cancer in Saudi Arabia: retrospective analysis of 65 patients. J Int Med Res 1990;18:515-9. [Crossref] [PubMed]
  3. Basha S, Mohamed RN, Al-Thomali Y, et al. The prevalence of oral cancer in Saudi Arabia – a systematic review. Ann Med Health Sci Res 2019;9:553-7.
  4. Akhtar SS, Ijaz AI, Fadl FA, et al. Head and neck cancer in the central region of Saudi Arabia. Saudi Med J 2003;24:688-90. [PubMed]
  5. World Health Organization. Cancer country profile – Saudi Arabia. Available online: [Accessed on May 5, 2020].https://www.who.int/cancer/country-profiles/sau_en.pdf
  6. Bruni L, Albero G, Serrano B, et al. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in Saudi Arabia. Summary Report 17 June 2019 [Accessed on May 5, 2020].
  7. Elasbali AM, Ahmed HG. A review on the etiology of oral cancer in Saudi Arabia. Int J Med Res Health Sci 2018;7:161-70.
  8. Alhazzazi TY, Alghamdi FT. Head and Neck Cancer in Saudi Arabia: a Systematic Review. Asian Pac J Cancer Prev 2016;17:4043-8. [Crossref] [PubMed]
  9. Alqaryan S, Aldrees T, Almatrafi S, et al. Awareness of head and neck cancers in Saudi Arabia. A questionnaire based study. Saudi Med J 2020;41:400-5. [Crossref] [PubMed]
  10. Alhazzazi TY. Evaluation of Head and Neck Cancer Awareness and Screening Status in Jeddah, Saudi Arabia. Asian Pac J Cancer Prev 2016;17:1135-9. [Crossref] [PubMed]
  11. Ibrahim NA, Oludara MA. Socio-demographic factors and reasons associated with delay in breast cancer presentation: a study in Nigerian women. Breast. 2012;21:416-8. [Crossref] [PubMed]
  12. World Health Organization (WHO). WHO report on global tobacco epidemic, 2019: country profile: Saudi Arabia. Available online: https://www.who.int/tobacco/surveillance/policy/country_profile/sau.pdf?ua=1
  13. Mourad M, Jetmore T, Jategaonkar AA, et al. Epidemiological Trends of Head and Neck Cancer in the United States: A SEER Population Study. J Oral Maxillofac Surg 2017;75:2562-72. [Crossref] [PubMed]
  14. Gerstner AO. Early detection in head and neck cancer - current state and future perspectives. GMS Curr Top Otorhinolaryngol Head Neck Surg 2008;7:Doc06. [PubMed]
  15. Chow LQM. Head and Neck Cancer. N Engl J Med 2020;382:60-72. [Crossref] [PubMed]
doi: 10.21037/fomm-20-31
Cite this article as: Kanmodi KK. Late screening and detection of head and neck cancer in Saudi Arabia: is it a policy or a literacy issue? Front Oral Maxillofac Med 2020;2:22.