Abstract
目的
调查北京市居民对口腔癌及相关知识的认知现状.
方法
采用方便抽样方法,对北京市居民(非医学相关人员)进行口腔癌及其相关防治知识的认知情况进行问卷调查.
结果
完成问卷调查共1 483份,其中男性663份(44.6%),女性820份(55.3%),年龄15~91岁.79.2%的被调查者能做到早晚各刷一次牙,仍有16.6%被调查者每天只刷一次牙.当被问及听说过哪些癌症时,肺癌知晓率最高,达94.3%,肝癌,胃癌次之,达92.5%,92.4%,口腔癌的知晓率最低,仅47.7%.口腔癌知晓率与户口(P=0.015),长期居住地(P=0.028),家庭人均年收入(P=0.024),刷牙频率(P<0.001),自我检查口腔频率(P<0.001)及是否嚼槟榔(P=0.015)有关.多数被调查者从电视节目(24.3%),手机新闻/电子杂志(22.0%),微信(11.3%)及与朋友或身边的人聊天(14.6%)获知口腔癌相关信息.知道吸烟是口腔癌危险因素的仅34.9%,且其认识与年龄(P=0.011),教育水平(P=0.007),刷牙频率(P<0.001)及自我检查口腔(P=0.002)有关.知道饮酒是口腔癌危险因素的仅23.5%,其认识与教育水平(P=0.002),长期居住地(P=0.022),刷牙频率(P=0.009),自我检查口腔频率(P=0.005)有关.知道嚼槟榔是口腔癌危险因素的只有35.1%,其认识与年龄(P=0.040),学历(P=0.002),户口(P=0.002),家庭人均年收入(P=0.005),刷牙频率(P=0.001),自我检查口腔(P<0.001),嚼槟榔(P=0.002)有关.知道口内长期不愈的溃疡,白色斑块,红色斑块是口腔癌早期症状的分别有35.7%,21.6%,16.9%.
结论
北京市居民对口腔癌及其相关防治知识的认识存在严重不足,尚有部分居民还未形成良好的个人口腔卫生习惯,需采取针对性措施提高大众对口腔癌及相关防治知识的认知情况,如利用各种新媒体形式对大众进行口腔卫生健康知识宣教,以减少口腔癌发病率,提高早期就诊率和患者生存率.
Keywords: 口腔肿瘤, 调查和问卷, 认知, 北京
Abstract
Objective
To investigate the oral cancer awareness, its related knowledge among residents in Beijing.
Methods
A questionnaire survey was conducted among Beijing residents (non-medical related personnel) on the knowledge of oral cancer and its prevention and treatment.
Results
A total of 1 483 questionnaires were completed, including 663 males (44.6%) and 820 females (55.3%), ranging from 15 to 91 years. Lung cancer was the most mentioned as heard of (94.3%), followed by liver cancer (92.5%) and gastric cancer (92.4%), while oral cancer was the least heard of (47.7%). Family account (P=0.015), residence (P=0.028), income (P=0.024), frequency of brushing teeth (P<0.001), frequency of mouth self-examination (P<0.001) and chew betel nut chewing (P=0.015) were significantly associated with oral cancer awareness. Most respondents learned about oral cancer from TV programs (24.3%), phone news (22.0%), WeChat (11.3%) and chatting with friends or people around (14.6%). Only 34.9% knew that smoking was a risk factor of oral cancer, and this knowledge was associated with age (P=0.011), education level (P=0.007), frequency of brushing teeth (P<0.001), and frequency of mouth self-examination (P=0.002). Only 23.5% knew that drinking was a risk factor of oral cancer, and this knowledge was associated with education level (P=0.002), residence (P=0.022), frequency of brushing teeth (P=0.009), and frequency of mouth self-examination (P=0.005). Only 35.1% knew that betel nut chewing was a risk factor for oral cancer, and this know-ledge was associated with age (P=0.040), education level (P=0.002), family account (P=0.002), income (P=0.005), frequency of brushing teeth (P=0.001), frequency of mouth self-examination (P<0.001), and betel nut chewing (P=0.002). Only 35.7%, 21.6% and 16.9%, respectively, knew that long-term unhealed ulcers, white plaques and red plaques in the mouth were the early signs of oral cancer.
Conclusion
This survey demonstrates a general lack of public awareness and knowledge about signs and symptoms of oral cancer, and its risk factors and treatment. Some residents have not formed good oral hygiene habits. Specific measures should be taken to improve the public awareness of oral cancer and related knowledge about prevention and treatment, such as the use of various new media for the public to promote their oral health knowledge, in order to reduce the incidence of oral cancer, improve early attendance rates and the patients' survival rates.
Keywords: Mouth neoplasms, Surveys and questionnaires, Cognition, Beijing
口腔癌是头颈部常见的恶性肿瘤,2018年全球约有35.5万新发病例,17.7万死亡病例[1],口腔癌已经成为一个日趋严重的世界范围内的问题.据2015年统计,中国约有4.8万例口腔癌和咽癌新发病例, 2.2万死亡病例[2].口腔癌多位于口腔内浅表部位,直视即可发现异常,且影响进食,咀嚼,发音,言语等,但临床上超过半数的口腔癌病例在就诊时已是晚期,民众对口腔卫生和健康缺乏足够的重视,对口腔癌早期表现及潜在恶性病变的警惕性不高及长期不良或有害的生活习惯(吸烟,饮酒等)是造成早期发现少,诊断率低,就诊时癌多处于进展期的主要原因[3].因此,若能提高大众对口腔癌及其相关危险因素,早期表现等的认识水平,使其减少高危因素的接触与暴露,在出现潜在恶性病变或在病变早期阶段及时就医,对提高口腔癌患者的生存率,改善患者术后生活质量,减少社会医疗资源的消耗具有重要意义.
本研究旨在通过问卷调查的形式,了解北京市居民对口腔癌及相关知识的认知现状.
1. 资料与方法
1.1. 调查对象
调查对象为15岁以上的北京市非医学相关的常住人口,即不包括医生,护士及医学生.定义常住人口为在北京市实际居住半年以上的人口,无论是否拥有北京户口.
1.2. 抽样方法
采用方便抽样,调查员在北京市人流量相对较大的商业中心,公园等地点开展调查,只要路人自愿参加并满足条件即纳入.
1.3. 问卷设计
根据既往类似文献加上本研究希望了解的关于口腔癌治疗方面的内容设计调查问卷的问题,主要包括以下3个方面:(1)一般情况:性别,年龄,职业,学历,户口性质,长期居住城区,家庭人均年收入,婚姻状态,医保类型;(2)生活方式及习惯:是否吸烟,饮酒,嚼槟榔,刷牙频率,是否自我检查口腔及看口腔科医生频率;(3)口腔癌相关知识:包括全球十大高发癌症知晓率,是否知晓口腔癌及知晓口腔癌途径,身边有无熟人患或患过口腔癌,口腔癌的好发部位,好发年龄,是否可预防,是否可传染,患口腔癌风险是否随年龄增加,口腔癌的危险因素,可能的早期表现,若出现这些症状会如何处理,口腔癌的治疗效果,费用,死亡率,早发现是否能提高治疗成功率,是否能通过改变生活方式或习惯来降低患口腔癌的风险.
1.4. 预调查
召集7名口腔医学专业学生做为调查员,由本调查问卷制定者就调查要求,注意事项,问卷填写方式等进行统一培训后,分别对20名非医学专业大学生进行问卷调查,以本调查问卷制定者调查结果为标准,分别行Kappa一致性检验,Kappa值均大于0.9,一致性强.问卷填写的方式采用面对面交流,由调查员填写问卷;文化水平较高者可由本人填写,调查员在一旁解答调查对象提出的问题,并检查其填写内容是否合格,有疑义者调查员询问,确定,再填写.
1.5. 统计方法
应用SPSS 24.0统计软件进行统计分析.问卷的每道问题的答案均用频数(百分比)表示.应用卡方检验评价一般情况,生活方式及习惯与口腔癌相关知识认知情况之间的可能联系.对单因素分析中有统计学意义的项目进行多元Logistic回归分析.P<0.05为差异有统计学意义.
2. 结果
2.1. 基本情况
本次调查时间为2018年5--12月,共历时8个月,收集有效问卷1 483份,其中男性663(44.7%)份,女性820(55.3%)份.年龄15~91岁,平均年龄34.9岁,中位年龄31岁.其他一般背景信息见表1.
1.
一般背景信息
Socio-demographic characteristic
| Variable | n (%) |
| Gender | |
| Male | 663 (44.7) |
| Female | 820 (55.3) |
| Age | |
| 15-29 years | 653 (44.0) |
| 30-44 years | 522 (35.2) |
| 45-59 years | 189 (12.7) |
| ≥60 years | 119 (8.0) |
| Education | |
| Primary or below | 40 (2.7) |
| Middle high | 93 (6.3) |
| High or technical school | 202 (13.6) |
| University or college | 892 (60.1) |
| Graduate or higher | 256 (17.3) |
| Account | |
| Rural | 435 (29.3) |
| Urban | 1 048 (70.7) |
| Residence | |
| Downtown | 233 (15.7) |
| Suburbs | 657 (44.3) |
| Outer suburbs | 528 (35.6) |
| Rural | 65 (4.4) |
| Marital status | |
| Married | 791 (53.3) |
| Single | 650 (43.8) |
| Widow/Divorced/Separated | 42 (2.8) |
| Income | |
| <20 000 yuan | 509 (34.3) |
| 20 000-40 000 yuan | 301 (20.3) |
| 40 000-60 000 yuan | 267 (18.0) |
| >60 000 yuan | 406 (27.4) |
| Medical insurance | |
| Yes | 1 371 (92.4) |
| No | 112 (7.6) |
2.2. 生活方式及口腔卫生习惯
被调查者中有14.5%吸烟,85.5%不吸烟;仅1.7%嚼槟榔.79.2%的被调查者能做到早晚各刷一次牙,仍有16.6%被调查者每天只刷一次牙.多数被调查者没有自我检查口腔的习惯, 49.5%仅当口腔出现溃疡等问题时才会仔细检查自己的口腔状况.
2.3. 不同癌症知晓率
当被问及听说过哪些癌症时,肺癌是知晓率最高的,达 94.3%;肝癌,胃癌次之,达92.5%,92.4%;口腔癌的知晓率最低,仅47.7%(图1).口腔癌知晓率与户口(P=0.015),长期居住地(P=0.028),家庭人均年收入(P=0.024),刷牙频率(P<0.001),自我检查口腔频率(P<0.001)及是否嚼槟榔(P=0.015)有关(表2).多因素分析中,仅刷牙频率,自我检查口腔,嚼槟榔有统计学意义(表3).
1.
不同癌症知晓率
Awareness of different cancers
2.
与口腔癌知晓率,危险因素,早期表现认知情况相关的单因素分析
Univariate analysis----factors associated with awareness rate, risk factors and early signs of oral cancern(%)
| Variable | n | Awareness rate | Early signs | Risk factors | ||||
| Ulcer | White plaques | Red plaques | Smoking | Chewing betel nut | Drinking | |||
| Total | 707 (47.7) | 530 (35.7) | 320 (21.6) | 251 (16.9) | 518 (34.9) | 520 (35.1) | 348 (23.5) | |
| Age | ||||||||
| 15-29 years | 653 | 324 (49.6) | 249 (38.1) | 146 (22.4) | 117 (17.9) | 236 (36.1) | 247 (37.8) | 162 (24.8) |
| 30-44 years | 522 | 243 (46.6) | 186 (35.6) | 117 (22.4) | 85 (16.3) | 201 (38.5) | 191 (36.6) | 131 (25.1) |
| 45-59 years | 189 | 77 (40.7) | 60 (31.7) | 33 (17.5) | 27 (14.3) | 45 (23.8) | 50 (26.5) | 31 (16.4) |
| ≥60 years | 119 | 63 (52.9) | 35 (29.4) | 24 (20.2) | 22 (18.5) | 36 (30.3) | 32 (26.9) | 24 (20.2) |
| P | 0.102 | <0.001 | 0.040 | 0.874 | 0.011 | 0.040 | 0.200 | |
| Education | ||||||||
| Primary or below | 40 | 22 (55.0) | 10 (25.0) | 10 (25.0) | 11 (27.5) | 12 (30.0) | 12 (30.0) | 10 (25.0) |
| Middle high | 93 | 35 (37.6) | 23 (24.7) | 12 (12.9) | 11 (11.8) | 20 (21.5) | 18 (19.4) | 12 (12.9) |
| High or technical school | 202 | 85 (42.1) | 54 (26.7) | 40 (19.8) | 34 (16.8) | 55 (27.2) | 51 (25.2) | 38 (18.8) |
| University or college | 892 | 437 (49.0) | 340 (38.1) | 192 (21.5) | 150 (16.8) | 328 (36.8) | 336 (37.7) | 220 (24.7) |
| Graduate or higher | 256 | 128 (50.0) | 103 (40.2) | 66 (25.8) | 45 (17.6) | 103 (40.2) | 103 (40.2) | 68 (26.6) |
| P | 0.080 | <0.001 | 0.084 | 0.498 | 0.007 | 0.002 | 0.002 | |
| Account | ||||||||
| Rural | 435 | 186 (42.8) | 137 (31.5) | 75 (17.2) | 60 (13.8) | 134 (30.8) | 123 (28.3) | 92 (21.1) |
| Urban | 1 048 | 521 (49.7) | 393 (37.5) | 245 (23.4) | 191 (18.2) | 384 (36.6) | 397 (37.9) | 256 (24.4) |
| P | 0.015 | 0.022 | 0.012 | 0.015 | 0.119 | 0.002 | 0.174 | |
| Residence | ||||||||
| Downtown | 233 | 121 (51.9) | 86 (36.9) | 55 (23.6) | 46 (19.7) | 81 (34.8) | 81 (34.8) | 66 (28.3) |
| Suburbs | 657 | 331 (50.4) | 249 (37.9) | 149 (22.7) | 114 (17.4) | 251 (38.2) | 260 (39.6) | 159 (24.2) |
| Outer suburbs | 528 | 229 (43.4) | 178 (33.7) | 101 (19.1) | 81 (15.3) | 167 (31.6) | 164 (31.1) | 111 (21.0) |
| Rural | 65 | 26 (40.0) | 17 (26.2) | 15 (23.1) | 10 (15.4) | 19 (29.2) | 15 (23.1) | 12 (18.5) |
| P | 0.028 | 0.012 | 0.011 | 0.372 | 0.176 | 0.056 | 0.022 | |
| Income | ||||||||
| <20 000 yuan | 509 | 230 (45.2) | 167 (32.8) | 98 (19.3) | 74 (14.5) | 163 (32.0) | 164 (32.2) | 124 (24.4) |
| 20 000-40 000 yuan | 301 | 132 (43.9) | 95 (31.6) | 62 (20.6) | 47 (15.6) | 100 (33.2) | 95 (31.6) | 61 (20.3) |
| 40 000-60 000 yuan | 267 | 126 (47.2) | 88 (33.0) | 53 (19.9) | 50 (18.7) | 90 (33.7) | 87 (32.6) | 59 (22.1) |
| >60 000 yuan | 406 | 219 (53.9) | 180 (44.3) | 107 (26.4) | 80 (19.7) | 165 (40.6) | 174 (42.9) | 104 (25.6) |
| P | 0.024 | <0.001 | 0.024 | 0.177 | 0.069 | 0.005 | 0.491 | |
| Frequency of brushing teeth | ||||||||
| Once in the morning | 199 | 62 (31.2) | 47 (23.6) | 28 (14.1) | 19 (9.5) | 43 (21.6) | 42 (21.1) | 26 (13.1) |
| Once in the evening | 48 | 23 (47.9) | 14 (29.2) | 10 (20.8) | 5 (10.4) | 17 (35.4) | 15 (31.3) | 11 (22.9) |
| Twice a day | 1 174 | 584 (49.7) | 437 (37.2) | 259 (22.1) | 208 (17.7) | 429 (36.5) | 432 (36.8) | 290 (24.7) |
| Over three times | 62 | 38 (61.3) | 32 (51.6) | 23 (37.1) | 19 (30.6) | 29 (46.8) | 31 (50.0) | 21 (33.9) |
| P | <0.001 | <0.001 | 0.003 | 0.001 | <0.001 | 0.001 | 0.009 | |
| Mouth self-examination | ||||||||
| Never | 332 | 124 (37.3) | 81 (24.4) | 44 (13.3) | 38 (11.4) | 80 (24.1) | 76 (22.9) | 57 (17.2) |
| Nearly every day | 161 | 84 (52.2) | 59 (36.6) | 37 (23.0) | 33 (20.5) | 60 (37.3) | 61 (37.9) | 48 (29.8) |
| Three or four times a week | 256 | 146 (57.0) | 113 (44.1) | 66 (25.8) | 56 (21.9) | 105 (41.0) | 112 (43.8) | 72 (28.1) |
| Occasionally | 734 | 353 (48.1) | 277 (37.7) | 173 (23.6) | 124 (16.9) | 273 (37.2) | 271 (36.9) | 171 (23.3) |
| P | <0.001 | <0.001 | <0.001 | 0.004 | 0.002 | <0.001 | 0.005 | |
| Chewing betel nut | ||||||||
| No | 1 448 | 686 (47.4) | 515 (35.6) | 311 (21.5) | 246 (17.0) | 504 (34.8) | 507 (35.0) | 339 (23.4) |
| Yes | 25 | 18 (72.0) | 13 (52.0) | 6 (24.0) | 5 (20.0) | 11 (44.0) | 11 (44.0) | 7 (28.0) |
| P | 0.015 | 0.204 | 0.400 | 0.603 | 0.204 | 0.002 | 0.800 | |
3.
与口腔癌知晓率相关的多元Logistic回归分析
Multiple Logistic regression analyses----factors associated with awareness of oral cancer
| Variable | n (%) | OR | 95%CI | P |
| Frequency of brushing teeth | ||||
| Once in the morning | 62 (31.2) | 1 | ||
| Once in the evening | 23 (47.9) | 1.845 | 0.960-3.548 | 0.066 |
| Twice a day | 584 (49.7) | 1.839 | 1.304-2.594 | 0.001 |
| Over three times | 38 (61.3) | 2.559 | 1.376-4.758 | 0.003 |
| Mouth self-examination | ||||
| Never | 124 (37.3) | 1 | ||
| Nearly every day | 84 (52.2) | 1.455 | 0.977-2.168 | 0.065 |
| Three or four times a week | 146 (57.0) | 1.804 | 1.272-2.560 | 0.001 |
| Occasionally | 353 (48.1) | 1.347 | 1.018-1.781 | 0.037 |
| Chewing betel nut | ||||
| No | 686 (47.4) | 1 | ||
| Yes | 18 (72.0) | 3.303 | 1.328-8.214 | 0.010 |
2.4. 口腔癌知识知晓途径
多数被调查者是从电视节目(24.3%),手机新闻(22.0%),微信(11.3%)及与朋友或身边的人聊天(14.6%)获知口腔癌相关信息的(图2).其中有3.1%的被调查者身边的亲人或朋友(曾)患口腔癌.
2.
口腔癌知晓途径
Source of information about oral cancer
2.5. 口腔癌相关危险因素认知情况
25.7%的被调查者认为患口腔癌的风险是随年龄增加而增高的.有34.9%认为吸烟更易患口腔癌,59.9%不清楚吸烟是否会增加患口腔癌的风险.35.1%认为嚼槟榔是口腔癌的高危因素,62.3%不清楚.仅23.5%的被调查者认为过量饮酒者更容易患口腔癌,65.1%的被调查者不清楚,还有11.5%的被调查者认为这二者无关,甚至其中还有少数人(2.7%)认为过量饮酒者更不容易患口腔癌.21.5%的被调查者认为口腔癌的好发年龄在40岁以上,而72.0%的被调查者不清楚.
被调查者对吸烟是口腔癌的危险因素的认识与年龄(P=0.011),教育水平(P=0.007),刷牙频率(P<0.001)及自我检查口腔(P=0.002)有关(表2), 多因素分析中,仅刷牙频率及自我检查口腔有统计学意义(表4).对嚼槟榔是口腔癌的危险因素的认识与年龄(P=0.040),学历(P=0.002),户口(P=0.002),家庭人均年收入(P=0.005),刷牙频率(P=0.001),自我检查口腔(P<0.001),嚼槟榔(P=0.002)有关(表2),多因素分析中,户口,家庭人均年收入,刷牙频率和自我检查口腔有统计学意义(表4).被调查者对过量饮酒是口腔癌的危险因素的认识与教育水平(P=0.002),长期居住地(P=0.022),刷牙频率(P=0.009),自我检查口腔频率(P=0.005)有关(表2),多因素分析中,仅刷牙频率和自我检查口腔有统计学意义(表4).
4.
与口腔癌危险因素认知情况相关的多元Logistic回归分析
Multiple Logistic regression analyses----factors associated with risk factors of oral cancer
| Variable | n (%) | OR | 95%CI | P |
| Smoking | ||||
| Frequency of brushing teeth | ||||
| Once in the morning | 43 (21.6) | 1 | ||
| Once in the evening | 17 (35.4) | 1.695 | 0.843-3.406 | 0.139 |
| Twice a day | 429 (36.5) | 1.574 | 1.075-2.305 | 0.020 |
| Over three times | 29 (46.8) | 2.252 | 1.203-4.214 | 0.011 |
| Mouth self-examination | ||||
| Never | 80 (24.1) | 1 | ||
| Nearly every day | 60 (37.3) | 1.496 | 0.975-2.294 | 0.065 |
| Three or four times a week | 105 (41.0) | 1.743 | 1.198-2.535 | 0.004 |
| Occasionally | 273 (37.2) | 1.526 | 1.112-2.093 | 0.009 |
| Chewing betel nut | ||||
| Account | ||||
| Rural | 123 (28.3) | 1 | ||
| Urban | 397 (37.9) | 1.447 | 1.101-1.902 | 0.008 |
| Income | ||||
| <20 000 yuan | 164 (32.2) | 1 | ||
| 20 000-40 000 yuan | 95 (31.6) | 1.039 | 0.755-1.428 | 0.816 |
| 40 000-60 000 yuan | 87 (32.6) | 0.985 | 0.708-1.369 | 0.927 |
| >60 000 yuan | 174 (42.9) | 1.379 | 1.036-1.836 | 0.028 |
| Frequency of brushing teeth | ||||
| Once in the morning | 42 (21.1) | 1 | ||
| Once in the evening | 15 (31.3) | 1.424 | 0.690-2.937 | 0.339 |
| Twice a day | 432 (36.8) | 1.531 | 1.037-2.260 | 0.032 |
| Over three times | 31 (50.0) | 2.266 | 1.203-4.270 | 0.011 |
| Mouth self-examination | ||||
| Never | 76 (22.9) | 1 | ||
| Nearly every day | 61 (37.9) | 1.567 | 1.017-2.414 | 0.042 |
| Three or four times a week | 112 (43.8) | 2.020 | 1.383-2.949 | <0.001 |
| Occasionally | 271 (36.9) | 1.560 | 1.132-2.149 | 0.007 |
| Drinking | ||||
| Frequency of brushing teeth | ||||
| Once in the morning | 26 (13.1) | 1 | ||
| Once in the evening | 11 (22.9) | 1.786 | 0.803-3.976 | 0.155 |
| Twice a day | 290 (24.7) | 1.786 | 1.130-2.824 | 0.013 |
| Over three times | 21 (33.9) | 2.482 | 1.237-4.979 | 0.010 |
| Mouth self-examination | ||||
| Never | 57 (17.2) | 1 | ||
| Nearly every day | 48 (29.8) | 1.656 | 1.042-2.630 | 0.033 |
| Three or four times a week | 72 (28.1) | 1.504 | 0.992-2.280 | 0.054 |
| Occasionally | 171 (23.3) | 1.215 | 0.851-1.734 | 0.284 |
2.6. 口腔癌早期表现认知情况
仅有35.7%的被调查者认为口内长期不愈合的溃疡可能是口腔癌,认为口内的白色斑块是口腔癌的可能表现的仅有 21.6%,红色斑块仅有16.9%.约60%以上的被调查者不清楚口腔癌的可能早期症状.
被调查者对长期不愈合的溃疡是口腔癌的早期症状的认识与年龄(P<0.001),教育水平(P<0.001),户口(P=0.022),长期居住地(P=0.012),家庭人均年收入(P<0.001),刷牙频率(P<0.001),自我检查口腔频率(P<0.001)有关(表2),而在多因素分析中,仅家庭人均年收入,刷牙频率及自我检查口腔有统计学意义(表5).对白色斑块是口腔癌的可能早期表现的认识与年龄(P=0.040),户口(P=0.012),长期居住地(P=0.011),家庭人均年收入(P=0.024),刷牙频率(P=0.003)及自我检查口腔频率(P=0.004)有关(表2),多因素分析中,仅户口,刷牙频率及自我检查口腔有统计学意义(表5).被调查者对红色斑块的认识与户口(P=0.015),刷牙频率(P=0.001),自我检查口腔频率(P=0.004)有关(表2),多因素分析中,仅刷牙频率及自我检查口腔频率有统计学意义(表5).
5.
与口腔癌早期表现认知情况相关的多元Logistic回归分析
Multiple Logistic regression analyses----factors associated with early signs of oral cancer
| Variable | n (%) | OR | 95%CI | P |
| Ulcer | ||||
| Income | ||||
| <20 000 yuan | 167 (32.8) | 1 | ||
| 20 000-40 000 yuan | 95 (31.6) | 1.014 | 0.739-1.392 | 0.932 |
| 40 000-60 000 yuan | 88 (33.0) | 1.008 | 0.727-1.399 | 0.960 |
| >60 000 yuan | 180 (44.3) | 1.502 | 1.130-1.997 | 0.005 |
| Frequency of brushing teeth | ||||
| Once in the morning | 47 (23.6) | 1 | ||
| Once in the evening | 14 (29.2) | 1.087 | 0.527-2.241 | 0.821 |
| Twice a day | 437 (37.2) | 1.421 | 0.976-2.070 | 0.067 |
| Over three times | 32 (51.6) | 2.264 | 1.205-4.256 | 0.011 |
| Mouth self-examination | ||||
| Never | 81 (24.4) | 1 | ||
| Nearly every day | 59 (36.6) | 1.454 | 0.945-2.235 | 0.088 |
| Three or four times a week | 113 (44.1) | 1.957 | 1.345-2.847 | <0.001 |
| Occasionally | 277 (37.7) | 1.559 | 1.137-2.138 | 0.006 |
| White plaques | ||||
| Account | ||||
| Rural | 75 (17.2) | 1 | ||
| Urban | 245 (23.4) | 1.461 | 1.050-2.032 | 0.024 |
| Frequency of brushing teeth | ||||
| Once in the morning | 28 (14.1) | 1 | ||
| Once in the evening | 10 (20.8) | 1.415 | 0.622-3.219 | 0.407 |
| Twice a day | 259 (22.1) | 1.321 | 0.841-2.076 | 0.227 |
| Over three times | 23 (37.1) | 2.283 | 1.148-4.538 | 0.019 |
| Mouth self-examination | ||||
| Never | 44 (13.3) | 1 | ||
| Nearly every day | 37 (23.0) | 1.672 | 1.003-2.789 | 0.049 |
| Three or four times a week | 66 (25.8) | 1.989 | 1.267-3.122 | 0.003 |
| Occasionally | 173 (23.6) | 1.865 | 1.268-2.744 | 0.002 |
| Red plaques | ||||
| Frequency of brushing teeth | ||||
| Once in the morning | 19 (9.5) | 1 | ||
| Once in the evening | 5 (10.4) | 1.007 | 0.354-2.865 | 0.989 |
| Twice a day | 208 (17.7) | 1.673 | 0.998-2.802 | 0.051 |
| Over three times | 19 (30.6) | 3.110 | 1.476-6.553 | 0.003 |
| Mouth self-examination | ||||
| Never | 38 (11.4) | 1 | ||
| Nearly every day | 33 (20.5) | 1.591 | 0.938-2.697 | 0.085 |
| Three or four times a week | 56 (21.9) | 1.783 | 1.118-2.845 | 0.015 |
| Occasionally | 124 (16.9) | 1.378 | 0.923-2.058 | 0.117 |
2.7. 口腔癌相关防治知识认知情况
34.2%的被调查者认为口腔癌是可以预防的,64.4%的被调查者不清楚.27.4%的被调查者认为口腔癌不能传染,67.8%的被调查者不清楚.41.3%的被调查者认为可以通过改变我们自身的生活方式或习惯来降低患口腔癌的风险,57.7%不清楚,还有1%认为不可以.41.1%的被调查者认为早发现口腔癌能提高治疗的成功率,58.3%不清楚,还有极少数被调查者(0.5%)认为不能.
当口腔内出现长期不愈合的溃疡,白色或红色斑块时,大部分(分别为73.0%,58.3%,59.8%)被调查者选择去综合医院口腔科就诊,仅少数人(分别为13.9%,15.7%,16.0%)选择去口腔专科医院就诊,且去口腔专科医院就诊的这部分人中绝大多数并不清楚选择哪一科室进行挂号.对于口腔癌的治疗效果及治疗费用,超过75%的被调查者均不了解.68.5%的被调查者不清楚口腔癌的治疗方式,认为手术治疗有效者仅有 21.6%,放射治疗18.3%,化学药物治疗14.8%.79.4%不清楚口腔癌的死亡率有多高,知道口腔癌整体死亡率在50%左右的仅有9.0%.
3. 讨论
口腔癌早期治愈率可达90%,且治疗费用低,患者生活质量高,但口腔癌晚期花费巨大,即使各种新的治疗方法出现,多数也只是延长几个月生存期,且患者生活质量低下.口腔癌发病部位多数表浅,经口腔检查即可进行筛查,无需依靠CT等仪器,但目前的资料表明,口腔癌患者就诊时,超过半数已达晚期,许多患者病史长达2~6个月,其原因为大众对口腔癌的认知不足.本研究结果显示,大众对口腔癌的认识水平较低,半数以上甚至从未听说过口腔癌.本研究得到的口腔癌知晓率仅为47.7%,远远低于英国(95.6%)[4],印度(91.2%)[5],马来西亚(84.2%)[6]等国家,但也有少数国家或地区报道的居民口腔癌知晓率更低,只有23.7%(葡萄牙)[7].印度和马来西亚地区的口腔癌高知晓率和当地口腔癌发病率高关系密切.
大众对口腔癌相关危险因素的认知也很薄弱.本研究中,被调查者认为吸烟是口腔癌危险因素的仅有34.8%,远远低于印度(75.4%)[5],马来西亚(92.4%)[6],美国(54.5%)[8],也门(71.5%)[9],沙特阿拉伯(81.7%)[10],苏丹(66.2%)[11]和英国(74%)[12].认为嚼烟草是口腔癌危险因素之一的仅32.3%.烟草制品种类较多,吸食烟草方式各有不同.2010年Rogers等[12]在英国利物浦的调查显示,仅3%的被调查者认为嚼烟草是口腔癌的危险因素之一,而对于使用烟草,有高达 54.8%~91.2%的被调查者认为其是口腔癌的危险因素之一[4-5,7,9-11,13-14].这可能与近几十年来,全球禁烟行动的开展有关,绝大多数人知道吸烟有害健康,但多数人认为吸烟者更容易患肺癌,实际上,除肺癌外,吸烟者也容易患喉癌和口腔癌[15].
本研究中仅23.5%的被调查者认为饮酒是口腔癌的危险因素之一,与葡萄牙[7]和英国[12]相似,高于美国报道的4.8%[8],但低于大部分国外报道,如葡萄牙(63.3%)[13],印度(33.6%)[5],德国(43.0%)[14],马来西亚(52.0%)[6],也门(58.9%)[9],沙特阿拉伯(56.3%)[10],苏丹(60.1%)[11].
本研究中有35.1%的被调查者认为嚼槟榔是口腔癌的危险因素之一,明显低于2013年马来西亚报道的54.5%[6],其余国家或地区未见关于咀嚼槟榔认知情况的报道.这与咀嚼槟榔习惯的流行区域有关,巴布亚新几内亚,印度,斯里兰卡以及我国广东部分地区,台湾和湖南居民都有咀嚼槟榔的习惯,这些地区都是口腔癌的高发区[16],而在北京,槟榔并不流行.我们在调查过程中发现多数人并不知道槟榔是何物,知道槟榔的这部分人中绝大多数从未见过实物,只是曾见过关于长期咀嚼槟榔后得口腔癌的新闻报道.
本研究被调查者认为年龄是口腔癌危险因素的有25.7%,低于国外研究报道,如印度(31.1%)[5],德国(55%)[14],也门(42.5%)[9],沙特阿拉伯(32.4%)[10]和苏丹(>50%)[11].
大众对于口腔癌早期症状的了解程度也不高.本研究中有35.7%的被调查者认为口内长期不愈的溃疡可能是口腔癌的早期表现或症状,低于葡萄牙(90%)[13],印度(62.1%~82.4%)[5,17],马来西亚(57.3%)[6]和英国(66.5%)[4].认为红色斑块是口腔癌早期表现的有16.9%,认为白色斑块是口腔癌早期表现的有21.6%,低于葡萄牙(52.8%)[13],印度(39.8%)[5],马来西亚(58%)[6]等.大部分口腔癌是由长期存在的潜在恶性病变发展而来的,尤其在口腔癌高发地区.因此,加强口腔癌早期警示体征的公共教育,从而加强早期诊断,早期治疗十分重要.
本研究也对个人口腔卫生习惯进行了简单调查.83.4%的被调查者能做到每天至少早晚各刷一次牙,没有人不刷牙.被调查者中仅28.2%有自我检查口腔的习惯.一般来说,若口腔出现问题,应该较易发现,但临床上见到的大多是局部晚期,很大原因是人们对相关早期症状或表现不了解,不重视,没有及时就医.自我检查在提高乳腺癌早发现方面已得到有效应用,这个策略也可应用于口腔癌的早发现,但前提是提高人们的认知水平.
既往大部分文献及人们普遍认为,教育水平和生活水平越高的人对口腔癌的认识水平越高,但从此次调查结果来看,每天刷牙两次以上者,有自我检查口腔习惯者及咀嚼槟榔者似乎表现出更高的口腔癌知晓率.每天刷牙两次以上者及有自我检查口腔习惯者更能认识到吸烟,嚼烟草,嚼槟榔,饮酒是口腔癌的危险因素,也更了解口内长期不愈合的溃疡,白色斑块,红色斑块是口腔癌的早期表现.也就是说,口腔卫生习惯好的人其对口腔癌及相关知识的认知更高,与教育水平,生活水平的高低并没有太大联系.所以,养成良好的口腔卫生习惯不仅可以降低龋病,牙周病等的发生率,更重要的是能尽早发现口腔问题,从而尽早寻医求治.
许多国家及地区已认识到对口腔癌宣传教育的重要性及必要性.一些组织已在努力通过宣传册,电视广告,访谈节目等方式宣传提高公众意识,但是数据仍表明公众认知低[8].本研究也对人们获得口腔健康知识的渠道进行了调查,大部分被调查者是通过电视节目(24.3%),手机新闻/电子杂志(22.0%),身边的亲人朋友(14.6%),微信朋友圈(11.3%)知道口腔癌这一疾病的.若身边的亲人或朋友患/患过口腔癌,其对口腔癌的相关表现及危险因素的认识则更清楚.因此,除了传统的纸媒,可利用现代社会快捷,方便,迅速的新媒体方式对大众进行口腔健康知识宣教,例如电视节目,微信公众号,短视频APP等,就口腔癌的定义,相关危险因素,早期体征,自我检查方式,口腔卫生保健方法等进行宣传教育.
综上,本研究显示北京市居民口腔癌知晓率低,大部分居民对于口腔癌相关危险因素及早期症状完全不了解或了解很少,尚有部分居民还未形成良好的个人口腔卫生习惯.对此,需采取针对性措施以提高大众对口腔癌及相关防治知识的认知,例如利用各种新媒体形式对大众进行口腔卫生健康知识宣传教育.重视疾病预防,以减少口腔癌发病率,提高早期就诊率,从而提高生存率,减少社会疾病负担.
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