Oral Cancer Control Research Articles

Outcome of early detection approach in control of breast, cervical, and oral cancer: Experience from a rural cancer center in India.

In low- and middle-income countries most of the cancer patients attend the hospital at a late stage and treatment completion of these cases is challenging. The early detection program (EDP), in rural areas of Punjab state, India was initiated to identify breast, cervical, and oral cancer at an early stage by raising awareness and providing easy access to diagnosis and treatment. A total of 361 health education programs and 99 early detection clinics were organized. The symptomatic and self-interested (non-symptomatic individuals who opted for screening) cases visited the detection clinic. They were screened for breast, cervical, and/or oral cancer. Further diagnosis and treatment of screen-positive cases were carried out at Homi Bhabha Cancer Hospital (HBCH), Sangrur. Community leaders and healthcare workers were involved in all the activities. The EDP, Sangrur removed barriers between cancer diagnosis and treatment with the help of project staff. From 2019 to 2023, a total of 221,317 populations were covered. Symptomatic and self-interested individuals attended the breast (1627), cervical (1601), and oral (1111) examinations. 46 breast (in situ-4.3%; localized-52.2%), 9 cervical (localized-77.8%), and 12 oral (localized-66.7%) cancer cases were detected, and treatment completion was 82.6%, 77.8%, and 50.0%, respectively. We compared cancer staging and treatment completion of cases detected through EDP with the cases attended HBCH from Sangrur district in 2018; the difference between two groups is statistically significant. Due to the early detection approach, there is disease down-staging and improvement in treatment completion. This approach is feasible and can be implemented to control these cancers in low- and middle-income countries.

Cancer screening uptake by women from India's largest state Uttar Pradesh: district-wise analysis from the fifth round of National Family Health Survey (2019-2021).

The Government of India (GOI) has launched a nationwide cervical, breast and oral cancer prevention and control program. However, the fifth round of the National Family Health Survey (NFHS-5), a nationwide survey conducted by the Ministry of Health and Family Welfare (MoHFW), GOI, has shown concerning results on screening uptake by both men and women across India. This study was conducted to describe the uptake of cancer screening by women residing in Uttar Pradesh (UP), the largest state of India. We analyzed NFHS-5 data available in public domain to determine the number of women (aged 30-49 years) participating in cancer screening across the 71 districts in UP state. We utilized population projections for the year 2021 provided by the population projections for India and states for calculating the number of women. The district-wise estimation was done using a projection of district-level annual population. Although the GOI has made screening available for common cancers, NFHS-5 results indicated that the screening uptake among women aged 30-49 years is a cause for concern. The data revealed less than 1% of women underwent screening, and some of the districts showed no screening uptake. GOI has laid down a framework for cancer screening; however, poor participation among women calls for research to understand the barriers to cancer screening and to develop interventions to address these barriers.

Current advances of oral cancer in Taiwan.

To provide updated statistics of oral cancer incidence and mortality in Taiwan, and to describe recent developments for oral cancer control to reduce oral cancer incidence and mortality. The Taiwan Cancer Registry Annual Report 2023, the Taiwan Cancer Registry Online Interactive Search System, and the 2023 Health Promotion Administration Annual Report are consulted and summarized. A literature search using PubMed was also conducted to identify Taiwan oral cancer control-related studies. Taiwan, with a long history of areca/betel quid chewing, has battled with oral cancer for decades. In 2021, the male lip and oral cavity cancer incidence is 29.77 (per 100,000 persons) and mortality is 11.25. Over these years, the male chewing prevalence was reduced to 6.2% in 2018. Taiwan has a sustained national oral cancer screening programme provided to high-risk groups biennially. Although the age-standardized incidence rates have been slowly decreasing since 2009, due to Taiwan's ageing population, the actual oral cancer burden is still stringent. The collaboration of multi-ministries and agencies on promoting areca nut and betel quid control, improving oral cancer awareness, and delivering cancer care remains essential to prevent oral cancer and reduce oral cancer deaths.

The Structure and Function of Oral Cancer Control in Kerala, India: A Narrative Review of Cancer Control Policy Documents from 1988 to 2020

The government of Kerala was the first state in India to come out with a comprehensive plan for cancer control based on National Cancer Control Program. The purpose of this review was to identify the structure and function of cancer control in Kerala, India with specific reference to oral cancer. A systematic search was done in PubMed using the keywords “Health Policy”, “Cancer”, “Oral cancer”, “Guiding document” and “Kerala”. All government of Kerala health-related websites were searched electronically for cancer-related policy documents. The medical library catalogs of the two government Comprehensive Cancer Care Centres in the state were searched. All available Government documents, institutional documents, other online resources related to cancer prevention were collected. A checklist was prepared to review the documents. Out of 18 documents identified, two cancer-specific policy documents and two health policy documents were included in the review.The cancer control strategies outlined in the reviewed documents presented a pragmatic vision for cancer control in low-resource settings. The concept called the ‘Kerala Cancer Care Grid’ outlined in one of the documents is a novel strategy to address the geographical inequality in access to cancer care. It recognized interdepartmental coordination and partnership with private sector institutions and community organizations as crucial for achieving comprehensive cancer control. In the reviewed documents, oral cancer was discussed mainly in the context of early detection, health education, and capacity building at the primary care level.

Association of exposure factors and their causal relationship with oral cancer: A Mendelian randomization study.

There is a strong association among risk factors for oral cancer (ORCA), such as smoking, alcohol consumption, fiber intake, and red meat intake. The apparent synergistic effects reported in previous observational studies may also underestimate the independent effects. Our study aims to further explore the potential etiology and causality of oral cancer. This study used the genome-wide associations study database (GWAS) in European populations for Mendelian randomization (MR) analysis to explore exposure factors associated with ORCA and detect the genetic causality between these exposures and ORCA risk. Our results demonstrated that in univariate MR analysis, the five exposure factors (celery intake, average weekly beer and cider intake, spirits intake, and pork intake) were risk factors, and oily fish intake was a safety factor, but in multivariate MR analysis, pork intake had the greatest impact on oral cancer when the five food/drink intakes were simultaneously consumed. The causal relationship between the five exposure factors (oily fish intake, celery intake, pork intake, average weekly beer and cider intake, and spirits intake) and oral cancer was analyzed. The causal effects of pork on oral cancer may be underestimated. Prevention of oral cancer requires better education about lifestyle-related risk factors, and improved awareness and tools for early diagnosis. Our study provides some risk factors that cannot be ignored for the cause prevention of oral cancer, such as pork intake, and its role in oral cancer prevention and control.

A scientometric study of oral cancer research in South and Southeast Asia with emphasis on risk factors control

Background/purposeSouth Asia and Southeast Asia are the regions with relatively high and increased disease burden of oral cancer. The purpose of this study was to analyze the scientometric characteristics of oral cancer research in these regions. Materials and methodsThere are 8 countries from South Asia and 11 countries from Southeast Asia. All the articles on oral cancer from these countries were retrieved in the Scopus database. ResultsA total of 5660 articles originated from South Asia (n = 4718) and Southeast Asia (n = 942). India (n = 4302; 91.2%) was the country publishing most articles on oral cancer in South Asia, and Malaysia (n = 355; 37.7%) was first in Southeast Asia. Tobacco smoking, alcohol consumption, and areca nut as risk factors were common keywords, attention should be paid to them while developing polices for oral cancer control. In India, the most topic including distinctive keywords was diagnostics (sensitivity/specificity, saliva, and predictive value), followed by molecular biology (antioxidants, lipid peroxidation, and glutathione), experimental in vivo (hamster and cheek pouch), and risk factor (smokeless tobacco). In Malaysia, the most topic containing keywords was molecular biology followed by epidemiology and drug research. ConclusionThis study for the first time reported the scientometric characteristics of oral cancer research in South Asia (India) and Southeast Asia (Malaysia). It is essential to improve the public awareness of risk factors control to reduce the oral cancer burden, especially in low-and middle-income countries.

Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Community-based Screening of Oral Cancer in Selected Districts of Nepal: A Cross-Sectional Study.

Oral cancer screening plays a vital role in the prevention and control of oral cancer. This study aimed to determine the prevalence of oral potentially malignant disorders (OPMDs) in the Nepalese community. A cross-sectional study was conducted in six purposively selected districts in Nepal from May to December 2019. It utilized a camp-based approach, where a standardized questionnaire was administered through face-to-face interviews. Screening of oral cancer was performed by direct visualization and palpation. The study included adults aged 18 years and above, while those already diagnosed with oral cancer were excluded. Logistic regression was used to find out the association between OPMDs and the related variables. A total of 1930 participants with a mean age of 44.3 years (SD=15.1) underwent oral cancer screening. Among them, 32% were current tobacco users, 2% were ex-users, and 11% were alcohol consumers. OPMDs, including suspected cancer, were identified in 139 (7.2%, 95% CI=6.1-8.4) participants. The most common lesion detected was leukoplakia (4.2%), followed by submucous fibrosis (1.5%), erythroplakia (0.9%), and palatal changes due to reverse smoking (0.1%). Additionally, 10 participants were suspected of having oral cancer. Older age group (AOR=7.00; 95% CI=2.76-17.77), male gender (AOR=2.52; 95% CI=1.58-4.02), tobacco chewers (AOR = 14.30; 95% CI=8.82-23.19), and smokers (AOR=4.67; 95% CI=2.88-7.57)) were identified as predictors of OPMDs. This study revealed a high prevalence of OPMDs in Nepal, highlighting the need for oral cancer screening. The findings emphasize the importance of developing strategies to reduce tobacco use and implementing tobacco cessation intervention programs in Nepal to alleviate the burden of oral cancer.

Surface-enhanced Raman spectroscopy for the characterization of different anatomical subtypes of oral cavity cancer

Background The prognosis for oral cancer patients is still very poor worldwide. Early detection and treatment therapy remain the key issue to be addressed for improved patient survival. The characteristic Raman spectral features associated with the biochemical changes in the blood serum samples can be used for the diagnosis of diseases, particularly for oral cancer. Surface-enhanced Raman spectroscopy (SERS) is a promising technique for non-invasive and early detection of oral cancer by analyzing molecular changes in body fluids.Objectives To detect oral cavity anatomical subsites (buccal mucosa, cheek, hard palate, lips, mandible, maxilla, tongue and tonsillar region) cancers by using blood serum samples, SERS with principal component analysis is used.Material and Method SERS is employed with silver nanoparticles for the analysis and detection of oral cancer serum samples by comparing with healthy serum samples. SERS spectra are recorded by Raman instrument and preprocessed using the statistical tool. Principal component analysis (PCA) and Partial least square discriminant analysis (PLS-DA) are used to discriminate between oral cancer serum samples and control serum samples.Results Some major SERS peaks are observed at 1136 cm−1 (Phospholipids) and 1006 cm−1 (Phenylalanine) remain higher in intensities for oral cancer spectra as compared to healthy spectra. The peak at 1241 cm−1 (amide III) is observed only in oral cancer serum samples while absent in healthy serum samples. Higher protein and DNA contents were detected in SERS mean spectra of oral cancer. Moreover, PCA is used to identify the biochemical differences in the form of SERS features which is used to differentiate between oral cancer and healthy blood serum samples, while PLS-DA is used to build differentiation model of oral cancer serum samples and healthy control serum samples. PLS-DA provides successful differentiation with 94% specificity and 95.5% sensitivity.Conclusions SERS can be used for the diagnosis of oral cancer and to identify metabolic changes that occur during disease development.

Immediate resection of positive margins improves local control in oral tongue cancer

ObjectivesThis study investigates the impact of immediate resection of positive margins on local control of oral tongue cancer. Materials and MethodsWe analyzed 273 consecutive oral tongue cancers resected from 2013 to 2018. Additional resection was performed in cases during the initial operation based on surgeon inspection of the specimen and/or frozen margins. Positive margins were defined as invasive carcinoma/high-grade dysplasia < 1 mm from the inked edge. Patients were grouped as follows: negative margin (Group 1); positive margin with immediate additional tissue resection (Group 2); and positive margin without additional tissue resection (Group 3). ResultsOverall, the rate of local recurrence was 7.7 % (21/273), and the rate of positive main specimen margin was 17.9 %. Of these patients, 38.8 % (19/49) underwent immediate additional resection of the presumed positive margin. Group 3 had higher local recurrence rates than Group 1 after adjustment for T-stage (aHR 2.8 [95 % CI 1.0–7.7], p = 0.04). Group 2 had similar rates of local recurrence (aHR 0.45 [95 % CI 0.06–3.6], p = 0.45). Three year local recurrence free survival for Groups 1, 2, and 3 were 91 %, 92 % and 73 %, respectively. Compared to the main specimen margin, sensitivity of intraoperative frozen tumor bed margins was 17.4 %, and specificity was 95 %. ConclusionIn patients with positive main specimen margins, anticipation and detection in real-time with immediate additional tissue resection reduced local recurrence to rates similar to those with negative main specimen margins. These findings support the use of technology to provide real-time intraoperative margin data and guide additional resection for improved local control.

Potential of melatonin to reverse epigenetic aberrations in oral cancer: new findings.

It is now an accepted principle that epigenetic alterations cause cellular dyshomeostasis and functional changes, both of which are essential for the initiation and completion of the tumor cycle. Oral carcinogenesis is no exception in this regard, as most of the tumors in the different subsites of the oral cavity arise from the cross-reaction between (epi)genetic inheritance and the huge challenge of environmental stressors. Currently, the biochemical machinery is put at the service of the tumor program, halting the cell cycle, triggering uncontrolled proliferation, driving angiogenesis and resistance to apoptosis, until the archetypes of the tumor phenotype are reached. Melatonin has the ability to dynamically affect the epigenetic code. It has become accepted that melatonin can reverse (epi)genetic aberrations present in oral and other cancers, suggesting the possibility of enhancing the oncostatic capacity of standard multimodal treatments by incorporating this indolamine as an adjuvant. First steps in this direction confirm the potential of melatonin as a countermeasure to mitigate the detrimental side effects of conventional first-line radiochemotherapy. This single effect could produce synergies of extraordinary clinical importance, allowing doses to be increased and treatments not to be interrupted, ultimately improving patients' quality of life and prognosis. Motivated by the urgency of improving the medical management of oral cancer, many authors advocate moving from in vitro and preclinical research, where the bulk of melatonin cancer research is concentrated, to systematic randomized clinical trials on large cohorts. Recognizing the challenge to improve the clinical management of cancer, our motivation is to encourage comprehensive and robust research to reveal the clinical potential of melatonin in oral cancer control. To improve the outcome and quality of life of patients with oral cancer, here we provide the latest evidence of the oncolytic activity that melatonin can achieve by manipulating epigenetic patterns in oronasopharyngeal tissue.

Analysis of the strategic conduct of managers and professionals involved in oral cancer prevention and control

Resumo Gestores e profissionais de saúde são os agentes responsáveis pela implementação das políticas públicas nos serviços de saúde, sendo de fundamental importância compreender as formas como agem no cotidiano. O objetivo desta pesquisa é analisar as condutas estratégicas de gestores e profissionais que intervêm na prevenção e no controle do câncer bucal. Trata-se de pesquisa qualitativa, realizada por meio de 23 entrevistas com gestores e profissionais de cinco municípios da região de saúde Metropolitana I do Rio de Janeiro e três entrevistas com o corpo técnico estadual. Realizou-se a análise da conduta estratégica prevista na Teoria da Estruturação de Giddens. Verificou-se que esses agentes, sensibilizados pelas representações do câncer na sociedade, se mobilizam como potenciais agentes facilitadores do acesso e criam alternativas informais aos protocolos mais restritores. No entanto, essa mobilização não costuma ocorrer no período anterior à suspeita do câncer, constituindo uma contradição importante. Destacou-se a importância da ampliação da atenção primária e do aperfeiçoamento das ações de promoção da saúde, prevenção do câncer e educação permanente para garantia do direito ao acesso ao diagnóstico e tratamento precoce do câncer bucal.

Prevention and control of oral cancer: contribution of the Bipartite Inter-Managers Commission in the state of Rio de Janeiro

RESUMO A ampliação do acesso à prevenção e controle do câncer bucal demanda a construção de uma rede intermunicipal de cuidado e a Comissão Intergestores Bipartite (CIB) tem papel central nesse processo. Objetiva-se analisar, sob a ótica da Teoria da Estruturação, a participação da CIB na estruturação da prevenção e controle do câncer bucal no Sistema Único de Saúde, no estado do Rio de Janeiro, Brasil. Realizou-se um estudo de caso exploratório, com análise de documentos da CIB do Rio de Janeiro entre 1996 e 2019. A coleta dos dados foi realizada no primeiro trimestre de 2020. Foram analisados 739 documentos pelas categorias: Constituição da rede de saúde; Financiamento das ações de saúde; Qualificação profissional em saúde. As discussões na CIB se mostraram limitadas devido uma característica mais municipalista e menos regionalizada no estado. O acesso ao tratamento rendeu debates que contribuíram com a expansão, mesmo que limitada, da rede hospitalar e com a reorganização da regulação. Identificou-se que esse espaço formal de negociação e decisão intergestores se transformou em um espaço meramente informativo ou deliberativo pro forma, o que traz limitações para estruturação das ações regionais de prevenção e controle do câncer bucal no estado do Rio de Janeiro.

Combination of fluorescence visualization and iodine solution-guided surgery for local control of early tongue cancer

The control of enclosed oral epithelial dysplasia is important for the control of oral cancer. Fluorescence visualization and iodine solution are able to detect oral epithelial dysplasia and surrounding oral cancer. The purpose of this study was to clarify the effectiveness of combining fluorescence visualization and iodine solution-guided surgery for early tongue cancer. Participants comprised 264 patients with primary early tongue cancer who underwent surgery. The surgical margin was set at 10 mm outside the clinical tumour, and 5 mm outside the area of fluorescence visualization loss, and 5mm outside the iodine unstained area. The 5-year disease-free survival rate was 87.1% vs 76.1% (P = 0.016) and the 5-year local control rate was 98.6% vs 93.0% (P = 0.008) for combination-guided surgery when compared to conventional surgery. Positive margin rates were 0% for cancer, and 6.5% and 0% for low- and high-grade dysplasia, respectively, with combination-guided surgery (P = 0.257). Multivariate analysis revealed that combination-guided surgery (odds ratio 0.140, 95% confidence interval 0.045–0.437; P < 0.001) and intraoperative frozen section examination (odds ratio 0.302; 95% confidence interval 0.115–0.791; P = 0.015) were significantly associated with local control. The combination of fluorescence visualization and iodine solution are effective in selecting surgical margins for early tongue cancer.

Evidence of areca nut consumption in the United States mainland: a cross-sectional study

BackgroundAreca nut (AN) is an addictive substance consumed in the Southeast region and is highly associated with oral premalignant lesions and oral cancer. The impact of AN use in the United States (US) is largely unknown, but the products are readily available and probably used by a significant fraction of Asian immigrants or descendants living in the US. We aimed at assessing AN use prevalence among the Asian community in Houston, Texas.MethodsA cross-sectional questionnaire was used to interview adult individuals (≥ 18 years of age) who self-identified as Asian immigrants or descendants residing in Houston. Means, frequencies, and proportions were reported. Factors associated with AN use were evaluated using logistic regression.ResultsWe surveyed 275 individuals (58% women, 43% between 35–54 years old, 67% born outside of the US, and 6% concurrent smokers). Among respondents, 91% were familiar with AN products, 17% self-reported ever use of AN products in the US, and 31% had friends/family members who were AN ever users. AN use was significantly associated with being Indian Subcontinent immigrants or descendants (ISID) (OR = 3·9; CI: 1·10,13·81; p = 0·035) and having friends/family members using AN products (OR = 6·2; CI: 1·69, 22·69; p = 0·006).ConclusionsOur findings provide quantitative data on the prevalence of AN ever use and context for future AN prevention and cessation interventions specific to the Southeast Asian groups living in the US mainland. This is crucial for the prevention and control of oral cancer and other detrimental conditions related to AN consumption.

Forecast of peak attainment and imminent decline after 2017 of oral cancer incidence in men in Taiwan

Oral cancer is the fourth most common cancer among men in Taiwan. The age-standardized incidence rate of oral cancer among men in Taiwan has increased since 1980 and became six times greater in 2014. To enable effective public health planning for oral cancer, research on the projection of oral cancer burden is essential. We conducted an age-period-cohort analysis on the incidence of oral cancer among men in Taiwan from 1997 to 2017 and extrapolated the trend to 2025. We found that the period trends for young adults aged between 25 and 44 have already peaked before 2017; the younger, the earlier, and then the trends declined. The cohort trends have peaked roughly at the 1972 birth cohort and then declined for all ages. Despite the increasing trend in the age-standardized incidence rate for oral cancer among men in Taiwan from 1997 to 2017, we forecast a peak attained, an imminent decline after 2017, and a decrease of 8.4% in age-standardized incidence rate from 2017 to 2025. The findings of this study contribute to developing efficient and comprehensive strategies for oral cancer prevention and control.

A simple screening program for oral cancer in a defined geographic area in southern India

Background: Community-level surveys of potentially malignant and malignant oral lesions are helpful to accurately determine the prevalence and aid in planning population-based strategies for oral cancer prevention. Objectives: We aimed to assess the disease burden through a systematic oral cancer screening program in a defined semi-urban population in Ranipet district (Tamil Nadu, India). Materials and Methods: A multiphase community-based screening program was conducted by the Ragas Dental College and Hospital, Chennai, India, in partnership with Thirumalai Mission Trust Hospital in Ranipet district (Tamil Nadu, India) in a zone-wise manner from Aug 1, 2018 to Dec 31, 2019. Phase I consisted of screening of those who fulfilled the eligibility criteria; demographic data were collected by trained dentists, following which toluidine blue staining of suspected potentially malignant lesions was done. Subjects whose oral lesions stained positive were referred to a hospital where the staining procedure was repeated for confirmation, and then biopsy was done for all subjects by a trained dentist. The subjects were followed up, and appropriate referrals were initiated for all the subjects based on their diagnosis. Descriptive statistics were used to analyze the distribution of potentially malignant cases. Sensitivity, specificity, and predictive values were calculated for the clinical diagnosis using the histopathologic diagnosis as the gold standard. Results: A total of 1389 tobacco users (1012 [72.9%] men) and 3140 non-tobacco users were evaluated. Among them, 194 (14%) demonstrated clinical abnormalities in their oral mucosa; 157 required follow-up and were referred. Of the 157 referrals, 140 (89.2%) went for follow-up, and 84 (64%) of them required biopsies. Of the 74 eligible biopsies examined (7 dropped out and 3 biopsies were rejected due to inadequate tissue), 1 had definite malignancy (1.4%), 41 (55.4%) had potentially malignant oral disorders, and 32 (43.2%) had non-specific features. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the clinical diagnosis made at the screening program were 88%, 25%, 61%, and 61%, respectively. Conclusion: Systematic visual oral screening restricted to high-risk individuals is a worthwhile initiative for the detection and control of oral cancer. Visual screening and early detection of premalignant oral disorders has the potential for early detection of potentially malignant and malignant oral lesions, and thus could play a pivotal role in disease control and improving patient outcomes. (Partial funding provided by the University Research Committee, The TN Dr. MGR Medical University, Guindy, Chennai; and the Thirumalai Charitable Trust, Ranipet, India)

Management of Positive Main Specimen Margin in Oral Tongue Cancer

<h3>Purpose/Objective(s)</h3> While surgical margins are considered one of the most critical prognostic factors in the management of oral tongue cancer, controversy exists regarding the value of additional resection of a positive main specimen margin. Furthermore, the use of frozen sections is not standardized and varies amongst institutions. Our primary objective was to investigate the impact of immediate resection of a positive margin on local control of oral tongue cancer. A secondary objective was to evaluate the utility of tumor bed margins in predicting the status of the main specimen margin. <h3>Materials/Methods</h3> A retrospective analysis of all oral tongue cancers treated at a NCI-designated comprehensive cancer center between 2013 and 2018 was performed (n=273). Tumors were resected <i>en bloc</i>, and intraoperative frozen tumor bed margins were performed in most patients (n=256). The main specimen was inspected by the surgeon, and additional resection during the initial surgery was performed if deemed necessary by inspection of the main specimen and/or frozen sections. Positive margins were defined as invasive carcinoma or high-grade dysplasia at or < 1mm from the inked edge of the main specimen. Based on re-resection status, main specimen margins were further divided into the following groups: negative; positive with re-resection; and positive without re-resection. Cox proportional hazards models were first used to assess univariate associations between potential predictors and local recurrence free survival (RFS). Variables with <i>p</i><0.05 were then entered into multivariable models for RFS. The Kaplan-Meier estimate was used to calculate RFS rate. <h3>Results</h3> The rate of positive main specimen margin was 17.9% (49/273). Of the patients with positive margins, 38.8% (19/49) underwent immediate re-resection of the margin. Local recurrence rate was 7.7% (21/273). In the multivariable model, independent predictors of local recurrence included advanced T stage (T4a vs T1, HR 9.3 [95% CI 1.9-45.2], <i>p</i>=0.006) and positive margin without re-resection (vs negative margin, HR 2.8 [95% CI 1.0-7.7], <i>p</i>=0.041). Five-year RFS was 0.91 for patients with negative margins, 0.92 for positive margins with re-resection, and 0.73 for positive margins without re-resection. The rate of positive tumor bed frozen margin was 7% (18/256), and the sensitivity of intraoperative tumor bed margins in detecting a positive main specimen margin was 17.4% (8/46). <h3>Conclusion</h3> Our data demonstrates that, in patients with a positive main specimen margin, immediate targeted resection achieved local control rates comparable to patients with a negative margin. Without additional resection, positive margins were associated with poorer local control. Thus, intraoperative evaluation of the surgical margin with immediate targeted resection during the initial surgery plays a critical role in the management of oral tongue cancer.

A STUDY ON QUALITY OF LIFE AND NUTRITIONAL STATUS OF ORAL CANCER TREATED PATIENTS IN CENTRAL INDIA

BACKGROUND: The modern day oral oncotherapy is now concerned on the oral quality of life after treatment of the patient. There is need to evaluate nal outcome following the different combination of treatment modalities available to make better therapeutic treatment decisions. Oral health-related quality of life (QHRQoL) and their nutritional status is gaining importance as a valuable outcome measure in oral cancer area and compare with the other control group. The aim of the study was to examine the nutritional status among the oral cancer patients and compare the QHRQoLof two groups (i.e., oral cancer group and control group) in Bhopal district. METHODS: The prospective study was conducted from August 2019 to January 2020. 124 oral cancer patients and 124 control people from the Bhopal district participated in this study. Nutritional status of oral cancer treated patients was assessed. QHRQoLof the oral cancer patients were compared with the control group. RESULTS: Among the 124 oral cancer patient, 67.74% were malnourished or at risk of malnutrition. Patients had worse QHRQoL among oral cancer group. There were highly statistically signicant differences found in the oral health impact prole and oral impacts on daily performances on comparing the oral cancer patients with the control group. CONCLUSIONS: This study indicated that oral cancer patients with malnutrition or risk of malnutrition have signicantly worse OHRQoL than with the control population group.

Role of Nurses in the Prevention and Early Detection of Oral Cavity and Pharynx Cancers

Purpose: The incidence of oral cavity and pharynx cancer is rising in the United States and South Dakota (SD) (2009-2018). In 2018, it was estimated that 396,937 of Americans were living with oral cavity and pharynx cancer. The 5-year relative survival rate for oral cancer is 66.2%, which is less than the survival rates for breast, colorectum, and prostate cancers. Tobacco and alcohol use and human papillomavirus (HPV16) exposure are some of the risk factors for oral cancer. Overall rural populations have higher cancer mortality than no rural population due to higher poverty, lower access to health services, and cigarette use. The purpose of this study is to investigate the prevalence of the oral cancer risk factors (e.g., cigarette smoking), HPV vaccination rates, and to identify the spatial distribution of social and environmental factors (e.g., social vulnerability, dental care access) in SD. Finally, this article discusses how nurses can contribute to oral cancer prevention and early detection. Methods: This descriptive study used data from multiple data sources (e.g., SD Department of Health, HRSA, County Health Rankings). Maps were created using ArcGIS. Findings: From the 66 SD counties, nearly 17% presented high-level shortage scores and were also highly socially vulnerable. HPV vaccination among youth was higher than the national average. Studies showed that improving nurse’s knowledge by training on oral cancer is needed and this may increase nurses’ practice in oral cancer prevention and control. Conclusions: Primary care professionals like nurse practitioners can assist in early detection of oral cancer and promote awareness of signs and main risk factors in rural areas. As part of the total patient care, nurses hold a vital role in prevention and early detection of oral cancer. These efforts with referral to oral cancer screening are vital for decreasing oral cancers morbidity and mortality rates primarily. Keywords: Rural health, Nurses, oral cancer, dentalcare access, Geographic Information Systems DOI: https://doi.org/10.14574/ojrnhc.v21i2.692