Racial Differences in Stage at Diagnosis of Screenable Oral Cancers in North Carolina

Objective : This study examined differences between blacks and whites in stage at diagnosis of screenable oral cancers. Methods : Data for 1,137 North Carolina residents with first primary tumors of the oral cavity (excluding the lip and salivary glands) or oropharynx diagnosed from 1990–92 were obtained from the North Carolina Central Cancer Registry. The outcome variable was stage at diagnosis dichotomized as localized and advanced. The explanatory variables were race, sex, age, year diagnosed, tumor site, and county-level socioeconomic and health care resource factors. Bivariate, stratified, and multiple regression analyses were conducted. Results : In the regression analysis, the odds of advanced stage was 2.1 (95% Cl=1.5, 2.9) times greater for blacks than whites. Other multivariable effects were sex [males compared to females: OR=1.5 (95% Cl=1.2, 2.0)] and tumor site [oropharynx compared to palate: OR=4.2 (95% Cl=2.5, 7.0)]. Conclusion : Among black and white residents of North Carolina diagnosed with cancer of the oral cavity or oropharynx, blacks had a greater odds of diagnosis at advanced stage.     

Trends in the incidence of oral cancer in Nova Scotia from 1983 to 1997

OBJECTIVE: The purpose of the study was to characterize the total burden of oral cancer in Nova Scotia over the 15-year period from 1983 to 1997 and to identify any trends in the number of cases or incidence rates at specific anatomic sites or within specific age or sex groups over this time period. STUDY DESIGN: All cases that had a diagnosis of invasive oral cancer (ICD-9 sites 140-146) during the study period were retrieved from the records of the Nova Scotia Cancer Registry, which theoretically includes all cancer cases in the province. Cases of in situ carcinoma, lymphoma, and leukemia were not included. All cases during the study period were categorized by tumor site and the age and sex of the patient. Tumors at ICD-9 sites 141 and 143-146 were analyzed separately as intraoral cancer. Trends were studied by grouping cases into three 5-year periods: period 1 (1983-1987), period 2 (1988-1992), and period 3 (1993-1997). Age-standardized incidence rates were calculated to the 1991 Canadian standard population. RESULTS: A total of 1,155 cases of oral cancer were registered in Nova Scotia for this 15-year study period, accounting for 2.0% of all cancer cases. There was an average of 57 cases in men and 20 cases in women per year. Overall, the most common site was the lip (26% of cases), followed by the tongue (20%), other mouth (16%), tonsil/oropharynx (12%), salivary gland (12%), floor of mouth (10%), and gum (4%). About 5% of cases occurred in patients 40 years and younger, and 53% occurred in patients 65 years and older. Lip cancer in men decreased by 38%, and the age-standardized incidence rate fell from 5.6 to 3.0 per 100,000 from period 1 to period 3. Intraoral cancers in men increased by 23% and the age-standardized incidence rate increased by 10% from period 1 to period 3. Both measures peaked in period 2. Intraoral cancer in women increased steadily by 84%, and the age-standardized incidence rate increased by 48% from period 1 to 3. The male-to-female ratio for intraoral cancer cases decreased from 2.9 to 2.5 to 1.9 over the 3 periods. CONCLUSION: Although there was a decreasing trend for lip cancer, the number of cases and the age-standardized incidence rate for intraoral cancer increased over the 15-year study period. Intraoral cancer increases in females were dramatic. Trends in the number of cases reflected changing risk and a growing, aging population. More oral cancers occurred each year than cancers of the uterine cervix, suggesting the need for more resource allocation in the areas of research, prevention, and early detection of oral cancer.     

Oral cancer in Enugu, Nigeria, 1998-2003

Cancers of the oral cavity make up 3-4% of all cancers, being in eighth place in men and eleventh in women when the cancer is caused by smoking and alcohol misuse. In this study we recorded all oral cancers in Enugu, eastern Nigeria over the 6-year period from 1998 to 2003. We reviewed all patients who had a diagnosis of invasive oral cancer during this period from notes kept in the Records Department of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Carcinoma-in-situ, lymphoma, and leukaemia were not included. All cases were categorised by the site of the tumour and the age and sex of the patient. Eighty one cases of oral cancer were recorded during that period, accounting for 2.7% of all cancers. Forty-eight men and thirty-three women were affected, and the most common site was other sites of the oral cavity (28, 35%), followed by the tongue (24, 30%), floor of the mouth (17, 21%) and finally the lip (12, 15%). They were all advanced at the time of presentation. The patients gave no history of alcohol or tobacco misuse, and their conditions should be seen in terms of chronic illnesses, malnutrition, poverty, and ignorance. We need an urgent awareness campaign, and programmes for the prevention and early detection of oral cancer, in Nigeria.     

The epidemiology of lip, oral cavity and pharyngeal cancers in Kuwait 1979-1988

Of the 10 539 cases of cancer recorded in the Kuwait Cancer Registry in the 10 years 1979-1988, 784 (7.4%) involved the lip, oral cavity or pharynx. Nearly half of these were of the nasopharynx or salivary glands, and the incidence of salivary gland cancer appears to be increasing. The aetiology may be related to poor oral hygiene and tobacco-smoking.     

Declining oral cancer rates in Sri Lanka: are we winning the war after being at the top of the cancer league table?

Oral Diseases (2011) 17 , 636–641 Objectives: To investigate the age‐standardized incidence, demography, recent trends and patterns of incidence of oral cancer in Sri Lanka between 1985 and 2005. Materials and methods: Data on oral and oropharyngeal cancers were obtained from the published hospital‐based cancer registry reports in the years 1985, 1990, 1995, 2000, and 2005. The data were analyzed by gender, age (<40 or >40 years), and by site. A linear regression analysis was performed on the age‐standardized oral and oropharyngeal cancer incidence rates to examine the trends over a 20‐year period. Results: There was a steady decline in the age‐standardized incidence of lip and oral cavity cancers over the past 20 years in both men and women. A significant reduction of 1.9% per year is noted over this period. Contrary to this, cancers of the oropharynx (C09, C10, and C14) showed a slight increase over the same period. Conclusions: Reversal of betel quid use and smoking must be considered in accounting for declining trends for oral cancer. Increasing rates of oropharyngeal cancer raises the issue whether risk factors for the oropharynx are different to those of the oral cavity, and this may need further investigation.     

Oral cancer at a Tasmanian tertiary referral clinic, the Royal Hobart Hospital 1996-2002

Background : The Holman Clinic at the Royal Hobart Hospital includes a multi-disciplinary head and neck clinic which functions as a tertiary referral centre for Southern Tasmania and involves Ear Nose and Throat surgeons, Oral and Maxillofacial Surgeons, Plastic and Reconstructive Surgeons, Radiation Oncologists and Medical Oncologists.
Methods : The aim of this study was to examine retrospectively the number, gender distribution, age, site of lesion, histology, mortality and treatment modalities of the oral cancers referred to the Holman clinic at the Royal Hobart Hospital. The medical histories and a database of the Holman clinic were used as the sources of data for this study. A total of 101 patients were treated for oral cancer in the Holman clinic at the Royal Hobart Hospital from 1996 to 2002. There were 64 males and 37 females.
Results : The distribution of anatomical sites of the oral cancers in this study was as follows: 36 oral tongue lesions, 17 floor of mouth, 13 lip, five retromolar trigone, five mandibular alveolus, six buccal mucosa, nine palatal and 10 minor and major salivary gland cancers. The most common site of oral cancer was the tongue (35.6 per cent), followed by the floor of mouth (16.8 per cent) and lip (12.9 per cent).
Conclusions : The majority of oral cancers were squamous cell carcinoma, except for the salivary gland cancers. The incidence of squamous cell carcinoma was between 67 and 100 per cent, depending upon the site involved. The trends found in this study are similar to those previously documented over the past 20 years.     

Is the incidence of oral and pharyngeal cancer increasing in Finland? An epidemiological study of 17 383 cases in 1953–1999

OBJECTIVE: The aim of this study was to describe the occurrence of oral and pharyngeal cancer in Finland over the last half century. MATERIALS AND METHODS: The study included all lip, oral and pharyngeal cancer cases diagnosed in Finland and reported to the nation-wide Finnish Cancer Registry between 1953 and 1999. RESULTS: The study comprised 17,383 new cancer cases: 11,666 in males and 5717 in females. Of these, 83% were squamous cell carcinomas. By the end of the study, 1999, the mean age at diagnosis had increased to 63 years for males and 67 for females. The age-adjusted incidence of oral and pharyngeal cancer decreased in males from 12.5 per 10(5) to 8.4 per 10(5) while it increased in females from 3.0 per 10(5) to 3.9 per 10(5). This was because of a decrease in lip cancer incidence in males, while the incidence of tongue, mouth and salivary gland cancers increased in both genders. The annual number of new oral cancer cases increased, however, in both genders. CONCLUSION: The incidence of lip cancer decreased in males, probably because of a decrease in smoking and in outdoor work. The incidence of intra-oral cancers increased in both genders, possibly because of increased alcohol consumption.     

Tumors of the intraoral minor salivary glands: a demographic and histologic study of 426 cases

In a demographic and histologic study of 426 oral minor salivary gland tumors, 57.5% were classified as benign and 42.5% were classified as malignant or potentially malignant. There was an overall female preponderance (1.59/1). The mean age for females was 53.1 years and for males was 50.6 years. The mean age for patients with malignant tumors was 5.4 years greater than for patients with benign tumors and was statistically significant. The palate was the most common site for oral minor salivary gland tumors followed by the upper lip and the buccal mucosa. These three sites accounted for 76.1% of all cases. Pleomorphic adenoma was the most common benign tumor (41% of all cases and 71% of benign tumors) followed by monomorphic adenoma of the canalicular and basal cell subtypes (10% of all tumors and 18.9% of benign lesions). Mucoepidermoid carcinoma was the most commonly encountered malignant tumor, accounting for 15.2% of all tumors and 35.9% of malignant lesions. Low-grade (terminal duct, lobular, polymorphous) adenocarcinoma was the most second most common type, making up 11% of all tumors and 26.4% of all malignant tumors. The results of this study are compared with other recent studies.     

Racial disparity in stage at diagnosis and survival among adults with oral cancer in the US

OBJECTIVES: To explore distribution of stage at diagnosis and relative survival rates among US adults with oral cavity cancer in relation to race, and over time. METHODS: We obtained 1973-2002 oral cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program, and computed proportions for each oral cavity site by stage at diagnosis, tumor size, and 5-year relative survival rates among Whites and Blacks. RESULTS: A total of 46 855 cases of oral cavity cancer were reported to the SEER registry among adults > or =20 years between 1973 and 2002. African-Americans had a significantly higher proportion of cancer, mainly in the tongue, that had spread to a regional node or to a distant site at diagnosis than Whites: 67% versus 49% of tongue cancers reported from 1973 to 1987 (P < 0.001), and 70% versus 53% of those reported from 1988 to 2002 (P < 0.001). They had a significantly higher proportion of tongue cancer that were >4 cm in diameter at time of diagnosis (59% versus 44%; P < 0.001), and black men in particular experienced lower 5-year relative survival rates than white men, in particular, for tongue cancer (25% versus 43% from 1973 to 1987, and 31% versus 53% from 1988 to 2002). CONCLUSION: There are significant racial disparities with respect to stage at diagnosis and survival among adults with oral cancer reported to the SEER registry from 1973 to 2002. One possible explanation for the lower survival among Blacks may be a difference in access to, and utilization of, healthcare services.     

Oral cancer in South Australia—incidence and case survival

A bstract — South Australian cancer registry data for the 1977–80 period indicated that 3.2 per cent of malignant neoplasms occurred in the mouth, over half of them on the lip. The male to female incidence ratio was 3.3:1 for all oral cancers and 6.3:1 for lip cases. The incidence of lip cancer was higher in country areas than in metropolitan Adelaide, and lower for migrants from England and Ireland than among other South Australians. Approximately 85 per cent of oral cancers were squamous cell carcinomas, with mucoepidermoid carcinomas being the next most prevalent type, constituting about four per cent of all cases and 29 per cent of salivary gland tumours. The four-year survival rate was 69 per cent for all oral cancers, and 84 per cent for lip cases, compared with 41 per cent for all other cancers combined.     

Epidemiology and survival outcomes of lip,oral cavity,and oropharyngeal squamous cell carcinoma in a southeast Brazilian population

Background Lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC) represent a major health problem in the global scenario. In South America, the highest incidence rates are seen in Brazil. Therefore, the epidemiological and clinical profile and survival outcomes of lip, oral cavity, and oropharyngeal SCC was studied in São Paulo State, Brazil.Material and Methods The clinicopathological data of 12,099 patients with lip, oral cavity, and oropharyngeal SCC were obtained from hospital cancer registries of the Fundação Oncocentro de São Paulo, Brazil (2010–2015). Survival rates and other analyses were performed using SPSS software.Results A clear male predominance was observed, particularly for patients with oropharyngeal SCC (88.3%). The average age of patients was higher for lip cases (65 ± 13.5 years) compared to other sites. The schooling level was low for most patients, especially in lip cases (87.9%). Most of the patients with oral cavity (71.8%) and oropharyngeal (86.3%) SCC had advanced-stage (III–IV) disease. However, the majority of lip cases (83.3%) were at an early stage (I–II). Surgical excision was the main treatment for lip (72%) and oral cavity SCC (23.5%), and chemoradiotherapy was the main treatment for oropharyngeal SCC (40.2%). The 5-year overall survival (OS) for patients with lip, oral cavity, and oropharyngeal SCC were 66.3, 30.9, and 22.6%, respectively. Multivariate analysis revealed that the determinants of OS were different for lip, oral cavity, and oropharyngeal SCC, except for those at the clinical stage, which was an independent predictor for all sites.Conclusions OS-independent determinants varied according to the affected site. Oral cavity and oropharyngeal SCC presented worse survival rates than those for lip SCC. Key words:Squamous cell carcinoma of head and neck, lip neoplasms, mouth neoplasms, oropharyngeal neoplasms, survival analysis.     

Basic issues in screening for oral cancer among male subpopulation

The value of population screening for oral cancer among male adults as a method of oral cancer control is an issue of great controversy. Screening programs have different objectives, varying costs, undocumented benefits, and some may have harmful effects. Consequently, these programs are not unanimously accepted and with the many constraints in evaluating these programs, the future of screening as oral cancer prevention strategy is questionable. Basic issues in the prevalence of oral cancer include factors affecting the patient such as age, sex, exposure to carcinogens, plus the site or the type of the neoplasm. Oral cancer afflicts primarily middle-aged and older adults, particularly heavy users of tobacco and alcohol; long-term exposure to ultraviolet radiation may also be important in the initiation of the disease. Eighty percent of oral cancer patients are over 45 years of age. Exposure to tobacco and/or alcohol seems to be a critical factor in the transformation of normal cells to cancer-producing cells. In the U.S.A., 70-80 percent of oral cancers detected occurred in men. 27,000 new cases of oral cancer are found annually in the United States and at least 9,000 of the cases will result in death. Squamous cell carcinomas represent 90 percent of all oral soft tissue cancers. The most common sites are the floor of the mouth, and soft palate complex. Cancers of the lip and tongue show the greatest association with age while major salivary gland cancers show the least. An inexpensive test should be developed in the near future and subjects should be followed carefully.     

Coefficients of relationship by isonymy among oral cancer registrations in Scottish males

The role of inherited susceptibility to oral cancers was studied by comparing groups of cancer patients and controls in terms of the coefficient of relationship by isonymy (Ri), both within and between Regions of mainland Scotland. Surname distributions for 3658 male cancer cases were derived from the Scottish Cancer Register for the years 1959-85. Control distributions were derived from a total of 32,468 male deaths in Scotland for 1976. For cancer of the floor of mouth, there was no evidence for increased isonymy in patients compared to controls and therefore no indication that familial factors contribute to cancer at this site. For cancer of the tongue there was a suggestion of increased isonymy within but not between Regions, perhaps reflecting environmental risk factors common to members of the same family. For cancers of the lip and salivary gland there was evidence of increased isonymy both within and to a lesser extent between Regions, suggesting a genetic contribution. There is corroborative evidence from other sources for a heritable component in salivary gland cancer but the reasons for the similar pattern of results in cancer of the lip are less clear.     

Trends of oral and pharyngeal cancer in Israel,by gender,age, ethnic group,and country of origin: 1970–2006

Background: Oral and pharyngeal cancer is one of the few life‐threatening oral diseases. Israel is recognized as a developed country, characterized by a heterogeneous population, a high level of sun exposure, and a large proportion of faired skinned inhabitants. The purpose of this study was to describe trends in incidence and survival rates of oral and pharyngeal cancer between 1970 and 2006. Methods: The incidence and survival data were derived from the Israel National Cancer Registry between 1970 and 2006. Oral and pharyngeal cancer included cancers of the lips, tongue, oral mucosa, floor of the mouth, major salivary glands and pharynx. Results indicated trends, survival rates and associations by ethnicity, country of origin, age, and gender. Results: The average age‐world‐standardized incidence rate, ASR(W), per 100 000, in 2001–2006 was 5.77 and 3.75 for Jews, and 5.99 and 2.30 for Arabs (males and females, respectively). The lip was the most common oral cancer site (36.8%). Over time, the rate (per 100 total cancer cases) decreased from 3.1 to 2.0, and male:female ratio decreased from 1.7 to 1.3. Kaplan–Meier survival plots demonstrated that patients under the age of 20 years had almost half the survival rate of older groups and lip cancer had almost twice the survival rate than other sites. Conclusions: Israel represents a developed country with relatively low percentage of alcohol consumption and high sun exposure. Data from this region demonstrated dissimilar distributions in comparison with other ‘Westernized’ countries. Public health programs need to utilize the present data in order to implement preventive strategies. Potential focus on specific high‐risk populations should be investigated.     

Cancers of the lip and oropharynx in different social and occupational groups in Finland

Social status and occupation-specific risks of cancers of the lip, tongue, mouth and pharynx were studied in a nationwide series of 2369 men and 809 women diagnosed in Finland in 1971–1985 and recorded in the files of the Finnish Cancer Registry. Codes for social status (four classes) and occupation (336 categories) were drawn from the files of the 1970 Population Census. The standardised incidence rates (SIR) were defined as the ratios of observed and expected numbers of cases, the expected ones being based on the sex, age, site and calendar period-specific incidence rates in the Finnish population. The SIR of lip cancer in the lowest social class was five times that of the highest one, thus indicating the effects of social class differences in smoking habits. The effect of outdoor work on the development of lip cancer was also strongly supported by this study. The social class-adjusted SIR for fishermen was 2.7 (95% C.I. 1.3–5.0), for forestry managers 2.2 (1.2–3.6), for timber workers 1.9 (1.2-2.9) and for farmers 1.8 (1.2-2.6). For cancers of the oral cavity and pharynx there was no clear correlation with social class. However, the SIR for these cancers among farmers was significantly reduced. The occupation-specific SIRs pointed more to alcohol than smoking aetiology. In the case of cancer of the tongue, no aetiological clues whatsoever could be found. The role of direct occupational factors in the aetiology of any of these cancers seemed to be minimal.     

Oral cancer in Australia: 1983-1996

BACKGROUND: The aims of this study were to identify differences in oral cancer incidence and mortality between sexes, age groups, oral sites and Australian States and Territories and recent trends in oral cancer incidence, mortality and age-profile over time. METHODS: Data were obtained from the Australian Institute for Health and Welfare and were age-standardized to the Australian 1991 Population Standard. Differences and trends were assessed with the Wilcoxon matched-pairs signed-ranks test and the Spearman correlation test, respectively. RESULTS: In Australia in 1996, there were 2173 new oral cancers and 400 deaths due to oral cancer, the majority of oral cancers were in the 60+ age group, oral cancer affected men more than women (>2:1), lip cancer accounted for more than 50 per cent of oral cancers and the oral cancer mortality-to-incidence (M:I) ratio was greatest in ACT and NSW and least in QLD and SA. From 1983 to 1996, the annual incidence of lip cancer increased while the M:I ratio of lip cancer decreased. The annual incidence of cervical cancer decreased whereas the annual incidence of intra-oral cancer remained constant. The M:I ratio of cervical cancer was consistently lower than the M:I ratio of intra-oral cancer. CONCLUSIONS: Reducing exposure to environmental carcinogens, increasing public awareness and population screening may reduce the incidence and mortality of oral cancer in Australia.     

Gastrointestinal cancer-associated antigen (GICA) in oral carcinoma

Gastrointestinal cancer-associated antigen (GICA) is detected by means of a monoclonal antibody in the serum and pathologic tissues of patients with gastrointestinal tumors. This article compares serum and salivary GICA and carcinoembryonic antigen (CEA) levels in 19 healthy control subjects, 17 patients with benign oral cavity lesions, and 11 patients with squamous cell carcinoma of the oral cavity. Serum CEA levels were similar in all three groups, whereas salivary CEA levels were higher in patients with squamous cell carcinoma than in the control subjects (p less than 0.001) and the patients with benign lesions (p less than 0.025). Serum GICA levels gave the opposite result and were significantly lower in squamous cell cancer when compared with control subjects (p less than 0.0001) and patients with benign lesions (p less than 0.02). Values of GICA in saliva of patients with oral cancer were also lower than in the control subjects (p less than 0.02). The possible significance of this difference between the two antigens is discussed.     

The unequal burden related to the risk of oral cancer in the different regions of the Kingdom of Saudi Arabia

OBJECTIVES: To estimate the burden and risk of oral cancer in Saudi Arabia and highlight differences between regions. METHODS: Using the National Cancer Registry Saudi Arabia, data was collated on numbers of cases of oral cancer (1996-1998) by site, age group, gender and region, plus relative frequencies of all cancer cases. Using Globocan, age-standardised rate (ASR) of oral cancer in Saudi Arabia was compared with five other neighbouring countries in the region. RESULTS: A total of 208 lip, mouth and tongue cancers for men and 209 for women were reported to the registry during this period. ASR of oral cancer was 1.81/100,000 for males and 2.13/100,000 for females. It was ranked 15th most common cancer for males and 11th for females, with a ratio of 1:1 and median age at diagnosis of 62 years. Very wide regional disparities in the incidence of oral cancer were found, with an almost thirty-fold difference in ASR between the regions with the lowest and highest rates. Jizan Region had the highest ASR (6.2/100,000 for males and 9.82/100,000 for females). Here oral cancer was ranked 2nd for males and 1st for females, with a ratio of 0.73:1 and the median age at diagnosis for females was lower. The third highest ASR (4.48/100,000) was found in females in Najran. In these two high incidence regions oral cancer was commonly reported on the gingiva. CONCLUSIONS: Overall the burden and risk of oral cancer in Saudi Arabia are not large. However, cancer of the oral cavity is a significant public health problem for the residents of Jizan and the women of Najran. Saudi females in both these regions have a higher burden of oral cancer.     

Epidemiologic and demographic update in oral cancer: California and national data--1973 to 1985

The number of new oral cancers diagnosed in the United States increases each year, with 31,000 cases reported in 1989. Unfortunately, in spite of advances in surgery, radiation, and chemotherapy, only about 50% of patients with oral cancer will survive their disease. During the past 12 years in which information is available, there have been no decided changes in age (mean 63), gender (males slightly outnumber females two to one), or sites (tongue most common). The lip is the only oral site showing an interval-decreased incidence. There is a slight trend toward an improvement in earlier detection; however, about two-thirds of all oral cancers are advanced (Stage III and IV) at the time of diagnosis.