Covid-19 has redefined airborne transmission
Urgent Call to Action in Preventing Late-Stage Head and Neck Cancer Presentation
The COVID-19 Pandemic has placed significant strain on both primary care medical and dental services with regards to close-proximity aerosol transmission of the virus. Medical services have moved to a primarily remote and telemedicine service wherever possible with limited face to face contact. General practitioners are advised not to examine inside the oral cavity unless essential whilst wearing full PPE. In the dental sector, over 14 million dental appointments were missed in 2020 (BDA, 2020). Primary care dental services were reduced to emergencies only between March and June 2020. Although routine dentistry has now resumed, emergencies are still being prioritised and less patients are able to be seen per session. “Fallow time” requirements between aerosol generating procedures have cut capacity by between one third and three-quarters (GDC, 2021).
Pre-COVID, head and neck cancer was already a disease which presented late with 62% of cases diagnosed at stage III or IV. Unsurprisingly, more advanced disease is linked with greater patient morbidity and mortality. It is of deep concern to the authors that access to both primary medical and dental services are currently restricted as it is likely that patients with head and neck cancer will be missing valuable life-saving screening opportunities. An American study in May/June 2020 showed that there was a 25% reduction in newly diagnosed head and neck malignancy and the median primary tumour size was statistically significantly larger (Kiong et al., 2021). Similar evidence has been shown in Turin, Italy when during their March 2020 lockdown they received significantly reduced numbers of urgent referrals and diagnosed only 12% of their predicted head and neck oncology caseload (Arduino et al., 2020).
Given the current decline in the prevalence of COVID-19 in the community and the successful implementation of the UK vaccination programme, the authors believe it is time for the medical profession to recommence examining the oral cavity face to face.Likewise, there is a growing public health need to encourage patients to book in for routine check-ups with their dentist.That is because, as well as detecting cancer, inspection of the oral cavity is often a prognostic indicator for general health. Telemedicine is suboptimal for inspection of this complex area.Head and neck cancer is a ticking time bomb which will require the union of medical and dental specialties in the wake of the COVID-19 pandemic.
Arduino, Conrotto, D Broccoletti, R. (2020). The outbreak of Novel Coronavirus disease (COVID‐19) caused a worrying delay in the diagnosis of oral cancer in north‐west Italy: The Turin Metropolitan Area experience. Oral Dis. 10 epub.BDA. (2020). Dentists facing uphill struggle, as missed appointments top 14m. Available: https://bda.org/news-centre/press-releases/dentists-facing-uphill-strugg.... Last accessed 20/04/2020.GDC. (2021). Access to dental services has been severely limited and will take time to recover. Available: https://www.gdc-uk.org/information-standards-guidance/covid-19/the-impac.... Last accessed 20/04/2020.Kiong, K Diaz, E Gross, N Diaz, E Hanna, E. (2021). The impact of COVID‐19 on head and neck cancer diagnosis and disease extent. Head Neck. 10 , epub.
