Risk Of Advanced-stage Disease Research Articles

Disparities in Risk of Advanced-Stage Liver Cancer and Mortality by Race and Ethnicity.

In the United States, liver cancer is the fifth and seventh most common cause of cancer-related death among men and women, respectively. Compared with other racial or ethnic groups in the United States, Asian and Pacific Islander populations experience the highest incidence rates of liver cancer, but little is known about disparities in risk of advanced-stage disease or risk of liver cancer mortality across these heterogenous populations. In a population-based cohort of 60146 patients aged 20-79 years diagnosed with liver cancer from 2004 to 2018 identified through the Surveillance, Epidemiology, and End Results Program, we examined associations between race or ethnicity, including specific Asian and Pacific Islander subgroups, and risk of advanced-stage liver cancer and liver cancer-specific mortality. Compared with non-Hispanic White patients, non-Hispanic Black, Filipino, and Laotian patients had 30%-85% elevated odds of being diagnosed with stage IV liver cancer, whereas Hispanic, Vietnamese, and Chinese patients had 7%-33% lower odds of being diagnosed with stage IV liver cancer (all P <.05). Additionally, non-Hispanic Black, Kampuchean, and Laotian patients had 6%-22% elevated hazards of liver cancer-specific mortality, and Hispanic, Vietnamese, Chinese, and Korean patients had 3%-27% lower hazards of liver cancer-specific mortality (all P <.05). All statistical tests were 2-sided. Substantial variations in risk of advanced-stage liver cancer and risk of liver cancer mortality were observed by race and ethnicity, including considerable heterogeneity across individuals broadly defined as Asians and Pacific Islanders. Further efforts to understand the contributors to these disparities are needed to inform potential targeted screening and treatment interventions.

PD11-03 ACCURACY AND RACIAL/ETHNIC REPRESENTATION OF PROSTATE CANCER SCREENING VIDEOS ON YOUTUBE AND TIKTOK

You have accessJournal of UrologyCME1 May 2022PD11-03 ACCURACY AND RACIAL/ETHNIC REPRESENTATION OF PROSTATE CANCER SCREENING VIDEOS ON YOUTUBE AND TIKTOK Max Abramson, Nathan Feiertag, Darius Javidi, Stacy Loeb, and Kara Watts Max AbramsonMax Abramson More articles by this author , Nathan FeiertagNathan Feiertag More articles by this author , Darius JavidiDarius Javidi More articles by this author , Stacy LoebStacy Loeb More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Black men have higher incidence and mortality from prostate cancer than white men, and Hispanic men have an increased risk of advanced stage disease. Health-related videos on social media have increased markedly in recent years, and a vast majority of Black and Hispanic adults use social media. We investigated the content quality and racial/ethnic representation of prostate cancer screening videos on YouTube and TikTok. METHODS: The top 50 videos for the search term “prostate cancer screening” on both YouTube and TikTok were retrieved in a cache-cleared browser. Three reviewers analyzed all videos using validated criteria for the quality of consumer health information (DISCERN and PEMAT). High quality was defined as: DISCERN ≥4, PEMAT understandability ≥75%, and PEMAT actionability ≥75%. Additionally, a published Likert scale was used to demonstrate the level of misinformation compared to American Urological Association and National Comprehensive Cancer Network guidelines. Perceived race and ethnicity of people in the videos were assessed by consensus approach. RESULTS: Median number of views was lower on YouTube than TikTok (909, range: 12-221,003 vs 23,150, range: 640-13,900,000). Perceived Black and Hispanic representation was present in 10% and 6% of YouTube videos, and 20% and 12% of TikTok videos, respectively. High-risk racial/ethnic groups were explicitly discussed in 46% of YouTube videos and 8% of TikTok videos. 98% of YouTube videos and 100% of TikTok videos had low to moderate quality consumer health information, and 88% of YouTube videos and 100% of TikTok videos had moderate to high levels of misinformation based on screening guidelines. CONCLUSIONS: Social media videos about prostate cancer screening are widely viewed but do not provide quality consumer health information. Black and Hispanic men remain underrepresented on both platforms, and high-risk racial groups were not discussed in most videos despite the importance for screening criteria. The low understandability, low actionability, significant misinformation, and a lack of diversity in online videos may contribute to disparities in prostate cancer screening. Source of Funding: Funding for SL: Department of Defense Health Disparity Research Award, the Prostate Cancer Foundation and the Edward Blank and Sharon Cosloy-Blank Family Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e189 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Abramson More articles by this author Nathan Feiertag More articles by this author Darius Javidi More articles by this author Stacy Loeb More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF DownloadLoading ...

Abstract 34: High urinary thromboxane B2 associates with lethal prostate cancer in African American men and inversely correlates with aspirin use

Abstract Background: Systemic low-grade inflammation is a candidate risk factor for prostate cancer (PC) in African American (AA) men, potentially contributing to lethal PC development. We previously reported that regular aspirin use is associated with a decreased risk of advanced stage disease and disease recurrence in AA patients with PC. The cancer-preventive benefits of aspirin have been attributed to inhibition of the cyclooxygenase (COX) pathway. Thromboxane A2 (TXA2) is an eicosanoid produced by the COX1 enzyme in platelets. Aspirin can inhibit metastasis by inhibiting COX1 activity and TXA2 synthesis. Hence, we assessed the role of TXA2 in the development of lethal PC. Because TXA2 is unstable, we measured its corresponding primary metabolite, urinary thromboxane B2 (TXB2), to examine the relationship of TXA2 with PC. Method: TXB2 was measured in cases (977) and controls (1022) from the NCI-MD PC Case-Control study using a mass-spectrometry-based assay. TXB2 levels were modeled into low (≤median) and high (&amp;gt;median) levels. We calculated risk factor-adjusted odds ratios (ORs) and 95% confidence intervals (CI) using unconditional logistic regression, adjusted hazard ratios (HR) using Cox regression and sub hazard ratios (SHR) using the Fine-Gray model. Results: We observed increased TXB2 levels in cases and an inverse relationship between levels of TXB2 and aspirin use in both cases and controls. For cases who used aspirin, the odds of having high TXB2 were reduced when compared to non-users (OR 0.46 95%CI, 0.34-0.61). This observation remained significant when stratified by race/ethnicity (AA: OR 0.36 95%CI, 0.23-0.54; EA: OR 0.58 95%CI, 0.38-0.88), indicating significant inhibition of TXB2 formation by aspirin, most notably in AA men. Further analysis showed that high TXB2 is associated with a PC case status in AA men (OR 1.44 95%CI, 1.08-1.93) but not EA men (OR 1.07 95%CI, 0.83-1.93), indicating increased TXA2 synthesis in AA men with PC compared to AA men without the disease. Also, men with high TXB2 were more likely to be diagnosed with metastasis compared to men with low TXB2 (OR 4.27 95%CI, 1.48-12.29), indicating more aggressive disease for cases with high TXB2. Furthermore, high TXB2 was associated with all-cause mortality (HR 1.56 95%CI, 1.05-2.33) and PC mortality (HR 4.02 95%CI, 1.46-11.07; SHR 2.89 95%CI, 1.03-8.11) in AA men only. Our findings indicate a distinct association between TXA2 and PC outcomes in AA men. Conclusion: Aspirin use inversely associates with high TXB2. This is of clinical interest as we report that increased TXB2 associates with PC in AA men, with aggressive PC, and with PC death which disproportionally affects AA men. This is consistent with our previous findings that aspirin may reduce lethal PC in AA men and highlights the potential benefit of aspirin for prevention of lethal PC in this high-risk group of men through inhibition of TXA2 synthesis. Citation Format: Maeve Bailey-Whyte, Ginger Milne, Tsion Z. Minas, Tiffany H. Dorsey, Wei Tang, Cheryl J. Smith, Michael B. Cook, Clayton Yates, Stefan Ambs. High urinary thromboxane B2 associates with lethal prostate cancer in African American men and inversely correlates with aspirin use [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 34.

An observational study and randomized trial of stress reactivity in cancer disparities.

Physiological stress responses have been suggested as a mechanism through which social and biological factors contribute to racial disparities in breast cancer outcomes. Many African Americans experience stressful life events and circumstances. These social factors may contribute to an increased risk of advanced stage disease at diagnosis and/or faster progression, but not all African American women exposed to adverse social factors develop advanced stage disease. Similarly, women who have a limited number of stressors can develop advanced stage breast cancer. Highly individualized stress reactivity may account for these inconsistent associations. This report describes the rationale, design, and methods for an exploratory study that uses the experimental medicine approach to: (a) characterize the nature and distribution of stress reactivity among African American breast cancer survivors based on socioeconomic, clinical, and social stressors; (b) examine the impact of stress reactivity on temporal discounting; and (c) determine the extent to which stress reactivity and temporal discounting are associated with adherence to recommendations for cancer control behaviors and treatment compliance as part of the Science of Behavior Change Network. This study addresses several empirical gaps about the most effective ways to develop behavior change interventions for a medically underserved population that continues to experience disparities in cancer morbidity and mortality. Results from this research will provide the empirical and conceptual basis for future intervention protocols that target mechanisms that are critical to disparities in African American breast cancer survivors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The effect of distance from cancer facility on advanced clinical stage at diagnosis in patients with cervical cancer

Purpose/ObjectivesIn the United States, cervical cancer remains a significant cause of morbidity and mortality. The effect of distance has a complicated relationship with disease characteristics and outcomes in other cancers. The purpose of this study is to investigate the relationship between distance from cancer facility on clinical stage at diagnosis in women with cervical cancer. Materials/MethodsData were obtained from the National Cancer Database which include patient demographics, disease characteristics, and treatment details. Persons diagnosed with cervical cancer from 2004 to 2015 were included. Subjects were excluded if they had missing information, variant histology, or lived >1,000 miles from their facility resulting in 51,413 persons. Disease was classified as localized (stage 1a-2a) or advanced (stage 2b-4b). Univariate comparisons were performed using analysis of variance and chi-square test. Multivariable logistic regression was used to investigate the effect of distance quartiles on advanced stage while adjusting for other significant variables. ResultsMean age was 51.0 years, 16.9% of women were black, 14.7% were Hispanic, 45.0% had private insurance, and 10.7% were uninsured. Overall, 50.9% of women presented with advanced disease. In multivariable analysis, greater distance demonstrated a stepwise risk reduction of advanced disease where those in the farthest quartile had odds ratio of 0.73 (p<0.001) relative to the closest. Additionally, age, race, income, and insurance status significantly affected risk of advanced disease. ConclusionsDistance from cancer facility resulted in lower risk of advanced stage disease at diagnosis. Additional research could elucidate the nuanced relationship between distance, disease characteristics and outcomes in cervical cancer.

The Effect of Distance from Cancer Facility on Advanced Clinical Stage at Diagnosis in Cervical Cancer

In the United States, cervical cancer remains a significant cause of mortality especially among young women. The effect of distance from cancer facility is not well understood in cervical cancer and has been shown to have a complicated relationship with disease characteristics and outcomes in other cancers. The purpose of this study is to investigate the relationship between distance from cancer facility on clinical stage at diagnosis in patients with cervical cancer. Data were obtained from the National Cancer Database which includes patient demographics, disease characteristics, and first course treatment decisions. Patients diagnosed with cervical cancer between 2004 and 2015 were included. Patients were excluded if they had missing demographic or disease information, variant histology, or lived >1000 miles from their facility resulting in 51,413 patients. Distance was categorized by quartiles. Univariate comparisons were performed using analysis of variance and chi-square. Disease was classified as localized (surgically curable, stage 1a-2a) or advanced (not surgically curable, stage 2b-4b). A multivariable binomial logistic regression model was used to investigate the effect of distance on stage at diagnosis while adjusting for age, insurance status, race and ethnicity, income quartile, education, urbanization, Charlson Comorbidity Score, and year of diagnosis. The mean age was 51.0 years, 16.9% of patients were black, 14.7% were Hispanic, 45.0% of patients had private insurance, 10.7% were uninsured, 15.7% were in the highest education quartile nationally, and 98.4% of patients lived in urban or metro counties. Overall, 50.9% of patients presented with advanced disease. On multivariable analysis, patients living in the 2nd (OR 0.96, p=0.098), 3rd (OR 0.90, p<0.001) and 4th distance quartile (OR 0.66, p<0.001) demonstrated a stepwise reduction in risk of advanced disease by increasing distance compared to those living closest to their facility. Black patients had increased risk of advanced disease (OR 1.18; p<0.001) while Hispanic patients had decreased risk (OR 0.81; p<0.001) compared to white patients; patients with Medicaid (OR 1.98; p<0.001), Medicare (OR 1.14; p<0.001), and who were uninsured (OR 2.31; p<0.001) experienced increased rates of higher stage disease relative to patients with private insurance. To our knowledge this is the first study to analyze the effect of distance on cervical cancer stage at diagnosis in a nationally representative cohort. Greater distance from cancer facility resulted in lower risk of advanced stage disease at diagnosis. Intuitively, greater distance might pose a barrier to care, yet has demonstrated a protective effect among patients in other disease sites. Additional research is needed to understand the nuanced relationship between distance, disease characteristics, and outcomes in cervical cancer.

Is there a role for for minnelide in uterine serous cancers?

Objectives: Most women with uterine serous carcinoma (USC) have a high risk of advanced stage disease and/or recurrence, and in these settings, there are few effective therapies. There is a need for effective therapy in the recurrent USC. Minnelide is bioavailable prodrug of Triptolide, which was isolated in the Chinese herb, Thunder god vine (Tripterygium wilfordii). Minnelide is currently in phase II clinical trials for pancreatic and GI cancers. The purpose of this study was to explore the effect of Minnelide on USC in preclinical models.

Intake of individual fatty acids and risk of prostate cancer in the European prospective investigation into cancer and nutrition.

The associations of individual dietary fatty acids with prostate cancer risk have not been examined comprehensively. We examined the prospective association of individual dietary fatty acids with prostate cancer risk overall, by tumor subtypes, and prostate cancer death. 142,239 men from the European Prospective Investigation into Cancer and Nutrition who were free from cancer at recruitment were included. Dietary intakes of individual fatty acids were estimated using center‐specific validated dietary questionnaires at baseline and calibrated with 24‐h recalls. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average follow‐up of 13.9 years, 7,036 prostate cancer cases and 936 prostate cancer deaths were ascertained. Intakes of individual fatty acids were not related to overall prostate cancer risk. There was evidence of heterogeneity in the association of some short chain saturated fatty acids with prostate cancer risk by tumor stage (p heterogeneity < 0.015), with a positive association with risk of advanced stage disease for butyric acid (4:0; HR1SD = 1.08; 95%CI = 1.01–1.15; p‐trend = 0.026). There were no associations with fatal prostate cancer, with the exception of a slightly higher risk for those who consumed more eicosenoic acid (22:1n‐9c; HR1SD = 1.05; 1.00–1.11; p‐trend = 0.048) and eicosapentaenoic acid (20:5n‐3c; HR1SD = 1.07; 1.00–1.14; p‐trend = 0.045). There was no evidence that dietary intakes of individual fatty acids were associated with overall prostate cancer risk. However, a higher intake of butyric acid might be associated with a higher risk of advanced, whereas intakes of eicosenoic and eicosapentaenoic acids might be positively associated with fatal prostate cancer risk.

Advanced cancer risk similar with biennial vs. annual mammography in women aged 50 to 74

A study comparing the benefits and harms of the frequency of screening mammography indicates that women aged 50 to 74 years who are screened every other year have a similar risk of advanced stage disease and a lower cumulative risk of falsepositive results than those who are screened annually. The study was led by Karla Kerlikowske, MD, of the University of California at San Francisco.1 She and her colleagues attempted to determine whether the benefits and harms of annual versus biennial screening mammography vary according to age, breast density, and postmenopausal hormone therapy (HT) use. The study was prompted by the 2009 recommendation by the US Preventive Services Task Force that women aged 50 years to 74 years receive biennial screening mammography versus the previous recommendation of every 1 to 2 years. Dr. Kerlikowske and her colleagues analyzed data from January 1994 to December 2008 from community mammography facilities that participate in the Breast Cancer Surveillance Consortium mammography registries. The data included information gathered from 11,474 women with breast cancer and 922,624 women without the disease. Researchers found that biennial screening mammography was not associated with an increased risk of advanced stage disease or large tumors regardless of a woman's breast density or HT use. However, researchers did find that women aged 40 to 49 years with extremely dense breasts had an increased risk of advanced stage cancer (odds ratio, 1.89) and large tumors (odds ratio, 2.39) with the use of biennial screening mammography compared with annual screening. The cumulative probability of a false-positive result also was high for women with extremely dense breasts who were either aged 40 years to 49 years or who used estrogen plus progestogen and underwent annual screening mammography. Those rates were 65.5% and 65.8%, respectively. Conversely, it was lower among women aged 50 to 74 years with scattered fibroglandular densities or fatty breasts who underwent biennial or triennial screening mammography. Researchers concluded that women aged 50 years to 74 years can undergo biennial rather than annual screening mammography, regardless of breast density or HT use, because the former does not increase the risk of advanced disease but substantially reduces the cumulative risk of false-positive results and biopsy recommendations. Meanwhile, women with extremely dense breasts who are aged 40 to 49 years should consider annual screening mammography to decrease the risk of advanced stage disease; however, they should be aware of the higher probability of false-positive results.

Abstract B75: Association of insurance status and age with stage at diagnosis among cervical cancer patients, National Cancer Database 2000–2007

Abstract Introduction: Late stage cervical cancer at diagnosis is associated with greater morbidity and mortality and higher treatment costs. Few studies have examined the association between insurance status and cervical cancer stage at diagnosis. Existing studies have been either state-specific or limited to elderly Medicare recipients. This study aims to examine the relationship between patient characteristics, with a particular focus on age at diagnosis and insurance status, and stage in a large number of cervical cancer patients aged 21–85 in the National Cancer Database (NCDB). Methods: Women diagnosed with their first primary invasive cervical cancer between 2000 and 2007 were selected from the NCDB. We evaluated the association between late stage (stage III/IV) and insurance and age while adjusting for race/ethnicity and other socio-demographic and clinical factors. Multivariate log binomial models were used to estimate risk ratios (RR) and 95% confidence intervals (CIs), respectively. Results: Among the 69,739 evaluable patients, the rate of late stage disease increased from 16.53% in 21–34 year olds to 42.44% in women ≥70. The adjusted risk of advanced stage of disease among women 50 years and older was 2.2 to 2.5 times that of patients aged 21–34. Uninsured (RR=1.44, 95% CI 1.40–1.49), Medicaid (RR=1.37, 95% CI 1.34–1.41), Younger Medicare (RR=1.12, 95% CI 1.06–1.19), and Older Medicare (RR=1.20, 95% CI 1.15–1.26) patients had a higher risk of late stage disease compared to privately insured patients. African Americans (RR=1.05, 95%CI 1.02–1.08) had slightly higher risks of advanced stage disease while Hispanics (RR=0.86, 95%CI 0.83–0.89) and other race/ethnicities (RR=0.88, 95%CI 0.84–0.92) had a lower risks compared to whites. Conclusion: In a large national sample of women diagnosed with cervical cancer, the strongest predictor of late stage at diagnosis was age. Patients without private insurance were also more likely to be diagnosed at later stages, particularly uninsured and Medicaid insured patients. Screening should be encouraged for those women for whom it is recommended, especially those at higher risk of advanced stage disease. Consideration of these findings in developing future guidelines for cervical cancer screening among older women is recommended. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B75.

Genetic variation in RNASEL associated with prostate cancer risk and progression

Variation in genes contributing to the host immune response may mediate the relationship between inflammation and prostate carcinogenesis. RNASEL at chromosome 1q25 encodes ribonuclease L, part of the interferon-mediated immune response to viral infection. We therefore investigated the association between variation in RNASEL and prostate cancer risk and progression in a study of 1286 cases and 1264 controls nested within the prospective Physicians' Health Study. Eleven single-nucleotide polymorphisms (SNPs) were selected using the web-based 'Tagger' in the HapMap CEPH panel (Utah residents of Northern and Western European Ancestry). Unconditional logistic regression models assessed the relationship between each SNP and incident advanced stage (T(3)/T(4), T(0)-T(4)/M(1) and lethal disease) and high Gleason grade (>/=7) prostate cancer. Further analyses were stratified by calendar year of diagnosis. Cox proportional hazards models examined the relationship between genotype and prostate cancer-specific survival. We also explored associations between genotype and serum inflammatory biomarkers interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-alpha receptor 2 using linear regression. Individuals homozygous for the variant allele of rs12757998 had an increased risk of prostate cancer [AA versus GG; odds ratio (OR): 1.63, 95% confidence interval (CI): 1.18-2.25), and more specifically, high-grade tumors (OR: 1.90, 95% CI: 1.25-2.89). The same genotype was associated with increased CRP (P = 0.02) and IL-6 (P = 0.05) levels. Missense mutations R462Q and D541E were associated with an increased risk of advanced stage disease only in the pre-prostate-specific antigen era. There were no significant associations with survival. The results of this study support a link between RNASEL and prostate cancer and suggest that the association may be mediated through inflammation. These novel findings warrant replication in future studies.

Association of Insurance Status and Ethnicity With Cancer Stage at Diagnosis for 12 Cancer Sites: A Retrospective Analysis

ABSTRACT Persons living in the United States who lack private medical insurance are less likely to have access to medical care and to take part in cancer screening programs. Regional studies suggest that uninsured and Medicaid-insured individuals are likelier than those who are privately insured to present with advanced-stage cancer, but this has not been confirmed using contemporary national-level information. Complicating the problem is the observation that cancer patients from ethnic minorities are likelier than non-Hispanic whites to be uninsured or Medicaid insured. This study sought relationships between insurance status and disease stage at the time of diagnosis for twelve cancer sites (breast, colorectal, kidney, lung, melanoma, non-Hodgkin lymphoma, ovary, pancreas, prostate, urinary bladder, uterus, thyroid). The study population included 3,742,407 patients whose characteristics resembled those of the U.S. population not included in the analysis. The patients, diagnosed in the years 1998–2004, were enrolled in the U.S. National Cancer Database, a hospital-based registry with patient information from approximately 1430 facilities. Uninsured and Medicaid-insured patients were significantly more likely than privately insured patients to present with advanced-stage (stage III or stage IV) cancer. The relationship was most evident for patients whose cancers can potentially be detected at an early stage by symptom assessment or screening. They include breast and colorectal cancers, lung cancer, and melanoma. Compared with privately insured patients, the odds ratios (ORs) for advanced-stage disease at diagnosis for uninsured and Medicaid-insured patients with colorectal cancer were 2.0 (95% confidence interval, 1.9–2.1) and 1.6 (1.5–1.7), respectively. For advanced-stage melanoma, the OR was 2.3 (2.1–2.5) for uninsured patients and 3.3 (3.0–3.6) for Medicaid-insured patients compared to privately insured patients. Compared with white patients, blacks and Hispanics had an increased risk of advanced-stage disease at diagnosis independently of insurance status. The investigators conclude that cancer patients residing in the United States who are uninsured or have Medicaid insurance are at a considerably increased risk of having more advanced disease when diagnosed than are privately insured patients.

Factors related to advanced stage oral squamous cell carcinoma in southern Thailand.

A critical factor that indicates a poor prognosis of oral squamous cell carcinoma (OSCC) is advanced stage disease. This study, therefore, aimed to identify the factors related to advanced stage (TNM staging III, IV) OSCC in Thailand. There were 161 patients with squamous cell carcinoma of the oral cavity and lip (ICD-9 140, 141, 143-5), included in the study. Sixty-two per cent of the patients presented with advanced stage disease. Information on demographic characteristics, risk habits, health-seeking behaviour prior to health care professional (HCP) consultation, tumour characteristics and patient and professional delay was obtained by questionnaire-based interview of the patients. These variables were included as initial variables in a logistic regression to calculate the odds ratio (OR) of advanced versus early stage OSCC. Having traditional herbal medication before HCP consultation significantly increased the risk of advanced stage OSCC (OR 5.77; 95% C.I. 1.25-26.62). Floor of mouth location of tumour was associated with a lower risk of advanced stage disease (OR 0.27; 95% C.I. 0.09-0.82) as was having an ulcer (OR 0.43, 95% C.I. 0.02-0.89). The findings indicate that having traditional herbal medication before HCP consultation increased the risk of advanced stage disease. The lower risk of advanced stage OSCC associated with ulcerative tumours and those on the floor of the mouth may be due to their being more readily detected by the patients.