Oral Cancer Mortality Research Articles

Alcohol intake and oral cavity cancer risk among men in a prospective study in Kerala, India

The aim of the study was to evaluate the role of alcohol drinking and patterns of consumption in oral cancer incidence and mortality in a cohort study using data from the Trivandrum Oral Cancer Screening Study, India. At baseline, the study participants completed a lifestyle questionnaire including items on frequency and duration of alcohol consumption. They were followed up for oral cancer incidence and mortality. Data from 32 347 subjects, of whom 134 eventually developed oral cancer, were analysed to estimate risk of oral cancer incidence and mortality according to drinking patterns, using a Cox regression model adjusted for age, religion, education, occupation, body mass index (BMI), standard of living index, chewing habits, smoking habits, and vegetable and fruit intake. Current and past drinkers were each associated with significantly increased risk of developing oral cancer. The hazard ratio increased significantly by 49% (95% CI = 1-121%) among current drinkers and 90% (95% CI = 13-218%) among past drinkers. A significant dose-response relationship between intake frequency, duration and oral cancer risk (incidence and mortality) was observed. As with other lifestyle factors, alcohol intake plays an important role in oral carcinogenesis in this population, and understanding this role is relevant to developing public health policies targeting at-risk population.

Oral Cancer: Population Sample of the State of Alagoas at a Reference Hospital

SummaryThe incidence and mortality of oral cancer in Brazil remains high; the disease manifests varying features throughout the country.AimTo analyze the epidemiology of oral cancer, including the prevalence, type and site of lesions, the distribution in the state of Alagoas, staging, treatment, and social and demographic aspects.Materials and MethodsA descriptive retrospective study was carried out. Data were gathered from records of a hospital in Alagoas from January 2000 to December 2006.ResultsOf 396 cases (100% of the sample), 62.70% were male and 37.30% female. Most tumors were on the tongue. The mean age was 61.95 years (SD=14.56 years), and 95.2% of the sample were aged over 40 years. Most of lesions were stage II (57.04%). Radiotherapy was the most common treatment.ConclusionThis study revealed the epidemiology of oral cancer patients at a reference hospital in the state of Alagoas. The results showed that oral cancer occurs mostly in males in the sixth decade of life; the most common site is the tongue, followed by the floor of the mouth.

Screening programmes for the early detection and prevention of oral cancer

AbstractBackground: Screening programmes for major cancers, such as breast and cervical cancer have effectively decreased the mortality rate and helped to reduce the incidence of these cancers. Although oral cancer is a global health problem with increasing incidence and mortality rates, no national population‐based screening programmes for oral cancer have been implemented. To date there is debate on whether to employ screening methods for oral cancer in the daily routine work of health providers.Objectives: To assess the effectiveness of current screening methods in decreasing oral cancer mortality.Search strategy: Electronic databases (MEDLINE, CANCERLIT, EMBASE (1966 to July 2005) and CENTRAL (The Cochrane Library 2005, Issue 3), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data.Selection criteria: Randomized controlled trials of screening for oral cancer or precursor oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy.Data collection and analysis: The search found 112 citations and these have been reviewed. One randomized controlled trial of screening strategies for oral cancer was identified as meeting the review’s inclusion criteria. Validity assessment, data extraction and statistics evaluation were undertaken by two independent review authors.Main results: One 10‐year randomized controlled trial has been included (n = 13 clusters: 191 873 participants). There was no difference in the age‐standardized oral cancer mortality rates for the screened group (16.4/100 000 person‐years) and the control group (20.7/100 000 person‐years). Interestingly, a significant 34% reduction in mortality was recorded in high‐risk subjects between the intervention cohort (29.9/100 000 person‐years) and the control arm (45.4/100 000). However, this study has some methodological weaknesses. Additionally, the study did not provide any information related to costs, quality of life or even harms of screening from false‐positive or false‐negative findings.Authors’ conclusions: Given the limitation of evidence (only one included randomized controlled trial) and the potential methodological weakness of the included study, it is valid to say that there is insufficient evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest that other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Future high quality studies to assess the efficacy, effectiveness and costs of screening are required for the best use of public health resources. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed. Future studies on improved treatment modalities for oral cancer and precancer are also required.Plain language summary: Screening programmes for the early detection and prevention of oral cancer. More evidence needed to find out whether screening programmes could detect oral cancer earlier and reduce the number of deaths from this disease. Cancer of the mouth and back of the throat (oral cancer) has a low survival rate, largely because the disease is often not diagnosed until it is advanced. Screening the general population for oral cancer might make it possible to detect cases of the disease earlier. The most common method is visual inspection by a clinician, but other techniques include the use of a special blue “dye” and an imaging technique. The review found that there is not enough evidence to decide whether screening by visual inspection reduces the death rate for oral cancer, and no evidence for other screening methods.

Mortalidade por câncer de boca e condição sócio-econômica no Brasil

Chronic non-communicable diseases represent a major public health problem, requiring more effective investigation and control by government agencies. The aim of this study was to correlate the mortality rate for oral cancer in Brazilian State capitals from 1998 to 2002 with socioeconomic factors collected in the 2000 census, using an ecological study design. Data were obtained from the Mortality Information System from 1998 to 2002. Social factors were taken from the Brazilian Human Development Atlases. After data collection, statistical analysis was performed using Pearson's correlation index. The findings included positive and significant correlations among the socioeconomic indicators (Municipal Human Development Index-- MHDI, MHDI-income, MHDI-education, MHDI-life expectancy, and per capita income), and negative and significant correlations with the socioeconomic indicators Gini Index and infant mortality. Despite the study's limitations and probable underreporting in less developed State capitals, the study found significant statistic correlations between the selected socioeconomic indicators and the oral cancer mortality rate.

Oral Cancer in Appalachia

Oral cancer accounts for 2.3% of malignancies in the U.S. and has one of the lowest five-year survival rates. An examination of oral cancer in Appalachia was motivated by the high incidence of lung and bronchial cancers in Appalachian states, the risk factors for which overlap with those for oral cancer. The incidence and mortality rates for oral cancer in 13 Appalachian states and the relative frequency of presumptive risk factors were examined and compared with national rates, using data from the National Program of Cancer Registries, Surveillance Epidemiology and End Results, Behavioral Risk Factor Surveillance System, the Appalachian Regional Commission, and the National Health Interview Survey. Combined incidence rates for oral cancer were higher in six of 12 Appalachian states, and mortality rates higher in 10 of 13, compared with the national average. Smoking was more prevalent than the national average in nine of 13 states, whereas alcohol consumption was the same or less in 11 Appalachian states. Only five of 13 states averaged fewer than the recommended five or more servings per day of fruits and vegetables.

The role of vegetable and fruit consumption and other habits on survival following the diagnosis of oral cancer: a prospective study in Spain

The authors carried out a hospital-based prospective study to evaluate the role of behavioral and clinical risk factors, occurring before and after diagnosis, on the prognosis of 146 patients with newly diagnosed oral cancer using Cox models. High weekly intake of vegetables before and after diagnosis were both associated with lower recurrence rates, longer overall survival and longer oral cancer survival. Diagnostic delay was associated with an increased risk of recurrence and oral cancer mortality. Patients presenting with pharyngeal pain or a mucosal lesion had a longer oral cancer survival than patients presenting with other symptoms. Quitting tobacco and alcohol consumption before and after diagnosis were both associated with a lower recurrence and/or better survival, but the effects were not statistically significant. This study suggests that high consumption of vegetables before and after diagnosis of oral cancer may reduce the risk of recurrence, overall mortality and cancer mortality in oral cancer patients.

Incidence and mortality of oral cancer in the West Midlands

Incidence and mortality of oral cancer in the West Midlands

Analysis of oral cancer epidemiology in the US reveals state-specific trends: implications for oral cancer prevention

BackgroundDownward trends have been observed in oral cancer incidence and mortality in the US over the past 30 years; however, these declines are not uniform within this population. Several studies have now demonstrated an increase in the incidence and mortality from oral cancers among certain demographic groups, which may have resulted from increased risks or risk behaviors. This study examines the underlying data that comprise these trends, to identify specific populations that may be at greater risk for morbidity and mortality from oral cancers.MethodsOral cancer incidence and mortality data analyzed for this study were generated using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program.ResultsWhile oral cancer incidence and mortality rates have been declining over the past thirty years, these declines have reversed in the past five years among some demographic groups, including black females and white males. Sorting of these data by state revealed that eight states exhibited increasing rates of oral cancer deaths, Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming, in stark contrast to the national downward trend. Furthermore, a detailed analysis of data from these states revealed increasing rates of oral cancer among older white males, also contrary to the overall trends observed at the national level.ConclusionThese results signify that, despite the declining long-term trends in oral cancer incidence and mortality nationally, localized geographic areas exist where the incidence and mortality from oral cancers have been increasing. These areas represent sites where public health education and prevention efforts may be focused to target these specific populations in an effort to improve health outcomes and reduce disparities within these populations.

Perspectives of African Americans and dentists concerning dentist–patient communication on oral cancer screening

Objective Mortality rates for oral cancer have not improved appreciably in decades, with Blacks less likely than others to survive 5-years post-treatment. Oral cancer is the fifth most common cancer among African American males, representing a pressing public health concern. This study compared how dentists and African American adults view the current state of dentist–patient communication regarding oral cancer and its detection. Methods Five focus groups with 56 African American adults and two focus groups with 17 dentists were conducted in order to compare responses regarding oral cancer information needs and dentist–patient communication on oral cancer screening. Results African American adults showed little knowledge about oral cancer and cancer screening, and great need for information. However, dentists reported rarely engaging in information exchange with their patients even while performing the examination. Conclusion African Americans’ request for screening information and dentists’ reticence about performing the screening and initiating communication with patients indicate a need for both public education on oral cancer and improved continuing education courses for dentists. Practice implications The dental care community should develop clear guidelines for communicating with patients about oral cancer and engage in continuing education on oral cancer screening procedure. Increased public health efforts aimed at increasing oral cancer awareness and knowledge among the public are warranted.

Which socio-demographic factors are associated with participation in oral cancer screening in the developing world? Results from a population-based screening project in India

Background: This study examines socio-demographic determinants of participation in a population-based randomized controlled trial that proved that oral visual inspection was effective in reducing oral cancer mortality in high-risk individuals in India. Methods: Multivariate logistic regression was used to establish socio-demographic characteristics of participants versus non-participants in the intervention arm. Compliance with referral was analysed according to the socio-demographic characteristics of screen-positives. Results: Of 96,517 eligible subjects, 87,655 were screened, 8688 individuals never received the invitation and 174 refused screening. Compared to the non-screened, a higher proportion of screened individuals were women (OR = 4.51; CI: 4.28–4.75), lived in better housing (OR = 1.35; CI: 1.25–1.41), had television/radio (OR = 1.50; CI: 1.43–1.58) and were tobacco and alcohol users (OR = 2.75; CI: 2.57–2.95). Being 65 and older decreased the chances of screening (OR = 0.39; CI: 0.37–0.42), as well as living in high-size households (OR = 0.73; CI: 0.68–0.78). Sixty-three percent of 5143 screen-positives complied with referral. Controlling for all other factors, individuals older than 44, and those with more advanced lesions were more likely to comply with referral ( p < 0.001). Individuals living in better housing were less likely to comply with referral (OR = 0.79; CI: 0.65–0.95). Conclusions: In summary, adequate coverage can be obtained in population-based oral screening in developing countries. The study underscores the important role of patient-provider communication in assuring high compliance with referral.

Low-cost, multimodal, portable screening system for early detection of oral cancer

Oral cancer is an important global health problem. There is an urgent need for improved methods to detect oral cancer and its precursors, because early detection is the best way to reduce oral cancer mortality and morbidity. In this work, we describe simple modifications to a surgical headlight system that enables direct visualization and digital image acquisition from oral tissue in multiple imaging modalities including fluorescence, white-light reflectance, and orthogonal polarization reflectance. Images obtained with the system in-vivo demonstrate that it is an attractive technology to explore for oral cancer screening in low-resource environments where clinical expertise is often unavailable.

Trends in the incidence, mortality, and survival rates of oral and pharyngeal cancer in a high‐risk area in Michigan, USA

The aim of this analysis was to analyze the incidence, mortality and survival rates for the city of Detroit and Wayne County, Michigan. In Detroit, about four out of the five residents are African-Americans. Rates and standard errors on oral cancer incidence, survival, and mortality by county of residence, race, gender, stage of diagnosis were provided by the Michigan Cancer Surveillance Program, which is maintained by the Michigan Department of Community Health. Rates were expressed per 100,000 individuals and age adjusted to reflect the distribution of the USA population in 2000. Analysis for trends was conducted by the authors using the National Cancer Institutes' joinpoint regression program (version 3.0). In 1993-2002, the incidence rate of oral cancer in Michigan (one of the 50 states in the USA) was 11.3 per 100,000, and in the city of Detroit, it was 16.6. In African-American males in Michigan the incidence rate was 24.3 per 100,000, one of the highest among all American males. The city of Detroit, with 9% of the total state population, had 13.1% of all new cases. Between 1993 and 2002, there was a drop in incidence rates in Michigan and Detroit. However, there was an increase in mortality rates in Michigan and Detroit between 2000 and 2002. In Detroit, the incidence and mortality rates of 'white' and African-American males were not different and the highest incidence rates were found in adults between the ages of 50 and 74 years. In the state, the peak incidence rates were found in adults 75 years or older. In 2000-2002, residents of Detroit had the lowest percentage (28.3%) of cases detected at early cancerous stage (in situ or localized) compared with rates in Michigan. African-Americans in Michigan had a 5-year survival rate of 34.9% compared with the state average of 54.6%. African-American males in Detroit accounted for a larger proportion of the oral cancer cases relative to their population size. There was surprising similarity between the incidence and mortality rates of African and 'white' Americans in Detroit. While the incidence rates have declined in Michigan and Detroit, mortality rates have increased between 2000 and 2002. This finding is contrary to national trends. In order to target programs to prevent oral cancer, oral cancer statistics for in small areas or high-risk populations should be evaluated separately.

Cigarette smoking, alcohol drinking, and oral and pharyngeal cancer mortality in Japan

To prospectively examine the association of cigarette smoking and alcohol drinking with oral and pharyngeal carcinogenesis, we analyzed data from a nation-wide large-scale cohort study in Japan. A total of 34 136 men and 43 711 women aged 40-79 years were included in the study. The Cox proportional hazard model was used to estimate the relative risk (RR) and 95% confidence interval (95% CI) of oral and pharyngeal cancer for smoking and drinking by sex, while adjusting for age, consumption of green tea, preference for salty foods, and consumption of green yellow vegetables. Current smokers were found to have a higher risk of death caused by oral and pharyngeal cancer compared with non-smokers in both sexes: the RR was 2.6 (95% CI: 1.0-6.7) in men and 8.2 (95% CI: 2.1-32.1) in women. Men who drank more than 46 g ethanol per day had an approximately threefold increased risk of oral and pharyngeal cancer. Simultaneous exposure to both factors was significantly associated with an elevated risk of oral and pharyngeal cancer (RR: 3.3, 95% CI: 1.1-9.6). The result supports the carcinogenic effect of cigarette smoking and alcohol drinking on the oral cavity and pharynx.

Squamous cell carcinoma of the oral cavity: a case series analysis of clinical presentation and histological grading of 1,425 cases from Iraq

Peoples in Iraq face a mixture of health hazards associated with poverty. Oral cancer is a major public health issue worldwide; it remains a highly lethal and disfiguring disease. It is primarily a disease of epithelial origin. A total of 1,425 cases of histologically diagnosed squamous cell carcinoma collected from the main centers of pathology in Iraq were analyzed according to age, sex, site, patient complaints at the time of presentation, and histological grading. Patients at their fifth decade of life were the most commonly affected with a male-to-female ratio of 2:1. The lower lip was the most commonly affected site followed by the tongue. The most common clinical complain was ulceration and swelling. More than 70% of the cases were well-differentiated squamous cell carcinoma. Oral cancer is increasingly seen as a major health problem-In line with general trend in the region, the need for interprofessional health care delivery approaches for reducing oral cancer mortality and improving patient's quality of life.

Oral and pharyngeal cancer mortality rates in Mexico, 1979–2003

In Mexico, information on oral and pharyngeal cancer (OPC) is scarce. The purpose of this study was to explore the trends in OPC mortality rates in Mexico from 1979 through 2003 and to describe the distribution of OPC deaths for selected socio-demographic variables for the period of 2001-2003. Annual crude and age-adjusted mortality rates were obtained by gender and site of lesion, using the 2003 WHO World standard million population. The Poisson regression model was used to detect a trend in the mortality rates, testing the hypothesis beta(1) = 0. Also, the annual percentage change (APC) was computed over the age-adjusted rates. The total number of OPC deaths during the period 1979-2003 was 15,576. The age-adjusted mortality rate was 1.13/100,000 in 1979 and 1.08/100,000 in 2003. Oral cancer was more frequently found than salivary gland and pharyngeal cancer (41.5% vs. 13.4% and 17.1%). The tongue (19%) was the most frequent oral affected site. The Poisson regression analysis indicated a stationary trend in cancer mortality rate; also, the APC regression model showed no increase or decrease in OPC from 1979 to 2003. Oral and pharyngeal cancer mortality rates in Mexico were low compared to most countries, and remained stable in the past two decades.

The Association of Nation-Based Alcohol-Drinking Profiles and Oral Cancer Mortality Remains Unclear

Oral Cancer: The Association between Nation-based Alcohol-Drinking Profiles and Oral Cancer Mortality. Petti, S. and C. Scully (2005). Oral Oncol 41(8): 828-34. 4 To study the association between per capita consumption of alcohol among selected countries with age standardized oral cancer mortality among males. Information not available Ecologic

O173 Oral visual screening reduces oral cancer mortality: evidence from a randomised trial

O173 Oral visual screening reduces oral cancer mortality: evidence from a randomised trial

O63 Oral cancer mortality: Alcohol consumption impact at nation level

O63 Oral cancer mortality: Alcohol consumption impact at nation level

Tendências de mortalidade por câncer de boca e orofaringe no Município de São Paulo, Brasil, 1980/2002

The current study assessed trends in oral cancer mortality in the city of São Paulo, Brazil, from 1980 to 2002. The official mortality information system supplied data on deaths whose underlying cause was classified as oral cancer, stratified by sex, age, and anatomic site. Death rates were estimated and adjusted by the direct method, using population data supplied by national censuses from 1980, 1991, and 2000 and a population count performed in 1996. There was an upward trend in overall cancer mortality, at a yearly rate of 0.72%. Accounting for more than one third of these deaths, tongue cancer was the main mortality category. Labial, gengival, and retromolar cancer showed a downward trend, while oropharyngeal cancer and cancer in unspecified parts of the mouth and oropharynx showed increasing mortality. Monitoring the magnitude and trends in cancer mortality can assist the planning of health initiatives aimed at reducing the disease burden from oral cancer in Brazil.

Direct fluorescence visualization of clinically occult high‐risk oral premalignant disease using a simple hand‐held device

A considerable proportion of oral cancer and precancer is not clinically apparent and could contribute significantly to the late diagnosis and high mortality of oral cancer. A simple method to identify such occult change is needed. Patients in the Oral Dysplasia Clinics at British Columbia are currently being examined with a simple hand-held device that permits the direct visualization of alterations to autofluorescence in the oral cavity. Tissue showing loss of autofluorescence is biopsied. We present 3 representative cases in which occult lesions were identified with fluorescence visualization during longitudinal follow-up, resulting in the diagnosis of a primary dysplasia in case 1, a second primary cancer in case 2, and cancer recurrence in case 3. This is the first report of the diagnosis of occult oral disease using a simple noninvasive device. These early examples indicate the potential value of this technology to guide the management of patients with oral lesions, facilitating the detection of high-risk changes not apparent with white-light visualization.