Oral cancer in Western Australia, 1982–2006: a retrospective epidemiological study

J Oral Pathol Med (2010) 39 : 376–381 Objective: To report differences and trends in oral cancer incidence by gender, age, indigenous status and area of residence and on mortality in Western Australia. Methods: Data were provided by Western Australian Cancer Registry. Oral cancer definition included ICD‐O‐3 codes C00C08. Age‐specific, direct age‐standardized rates and mortality:incidence ratios were computed with 95% confidence intervals. Results: The incidence and death rates of oral cancer accounted for 2.3% and 1.3% of all cancers respectively. Over 25 years, the male:female incidence ratio was 2.4:1. Eighty‐eight percent of new cases were over the age of 40, peaking in the sixth decade of life. The incidence rates were 14.6 and 6.2 per 100 000 per annum in men and women respectively. Over 17 years, standardized mortality rates were less than 1 per 100 000 per year, with double the deaths in men. Mortality:incidence ratios for oral cancer were between 0.4 and 0.6 with the exception of lip. Conclusions: Cancer registries are the only reliable source of data for epidemiologic surveillance of cancer incidence and mortality. Results from this study are comparable with studies on oral cancer in Australia and globally.     

The epidemiology of tongue cancer: a review of global incidence

The tongue (141 ICD-9) is the most common intraoral site for cancer in most countries, however its global epidemiology shows significant geographic variation. This review paper summarises the global incidence of cancer of the tongue using cancer maps and references to recent studies from various locations. Tongue cancer remains a serious health problem in many countries including India (male incidence rates up to 6.5 per 100,000 per annum) and parts of Europe (male incidence rates in France up to 8.0 per 100,000 per annum). It is noted that as with other forms of oral cancer the majority of population-based data for tongue cancer comes from the Western world with a paucity of reliable data from the so-called developing countries. The tongue remains the most common intraoral site for oral cancer worldwide and in a number of countries it is a serious public health problem with significant morbidity and mortality. While the incidence of tongue cancer appears to be stable or falling in some regions of the world, in other areas it is rising, particularly among younger people.     

Oral cancer in Ireland, 1984–1988

Age standardised oral cancer incidence rates were calculated for the Republic of Ireland from data collected by the Southern Tumour Registry for the years 1984–1988. The annual incidence rates (per 100 000) for men were lip 3.8, tongue 1.2 and mouth 1.8 while the corresponding rates for women were lip 0.2, tongue 0.7 and mouth 0.5. The incidence of lip cancer is shown to be much lower than indicated by previously published Irish rates. In general, oral cancer incidence rates in Ireland are comparable to those reported for Denmark. The vast majority (94%) of cases were histologically verified. The results, along with recent findings on mortality, contradict the view that Ireland has a very high rate of oral cancer by west European standards.     

The epidemiology of mouth cancer: a review of global incidence

Mouth cancer (143-145 ICD-9) is a major health problem in many parts of the world. While its incidence is relatively low in most western countries there are some important exceptions to this trend: on the Indian subcontinent and in other parts of Asia it remains one of the most common forms of cancer. This review article summarises the global incidence of mouth cancer using cancer maps. Data have been compiled from the latest edition of Cancer Incidence in Five Continents and recent studies from various locations around the world. Significant geographic variation is noted in the incidence of mouth cancer, with high rates reported for the Indian subcontinent and parts of Asia (male incidence rates in excess of 10 per 100,000 per annum). It is also noted that as with other forms of oral cancer, the majority of population-based data for mouth cancer comes from the Western world with a paucity of reliable data from the so-called developing countries. Mouth cancer remains a serious health problem in many parts of the world with many regions reporting increasing incidence rates particularly in males. Ongoing research into the aetiologic risk factors associated with this disease must remain a very high priority if the causes of mouth cancer are to be established and disease control protocols introduced widely.     

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.     

Lip cancer in Western Australia, 1982–2006: a 25-year retrospective epidemiological study

Background:  The aim of this study was to report on the epidemiological trends in incidence and mortality rates of lip cancer in Western Australia from 1982–2006.
Methods:  Incidence and mortality data were provided by the Western Australian Cancer Registry. Analysis of demographic distribution by gender, age, metro-rural residence and Indigenous status and by sub-site of lip cancer was undertaken. Percentages, crude, age-specific and direct age-standardized rates were computed with 95% confidence intervals.
Results:  In Western Australia, lip cancer represents 49 per cent of all oral cancer cases. A total of 2152 new cases and 31 deaths due to lip cancer were reported. Eighty-one per cent of new cases occurred on the lower lip. The incidence rate ratio of males to females was 2.5-3:1, with non-Indigenous people suffering 98 per cent of lip cancer. Rural dwellers have higher standardized incidence rates when compared to people living in metropolitan areas. An increasing trend with older age is consistent throughout the study period.
Conclusions:  Over the 25 years, on average 90–100 people are diagnosed with lip cancer but only 1–2 people die each year. These mortality rates are very low indeed and are the reason for its good prognosis.     

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.     

International variation in the incidence of oral and pharyngeal cancer

OBJECTIVE: An accurate epidemiological profile is a crucial component of any cancer strategy. The ongoing development of population-based cancer registries provides an invaluable information resource in this regard. Examination of international incidence levels indicates substantial geographical variation. This study assesses the precise extent of such variation. BASIC RESEARCH DESIGN: The age-standardised rates (ASRs) for oral and pharyngeal cancer (OPC) were analysed for 183 registries in the IARC/WHO publication CIFC-Volume VII. RESULTS: The median annual age-standardised incidence rates were mouth (2.3 per 100,000), tongue (2.0), lip (1.2), and salivary gland (0.6); the corresponding female rates were mouth (0.8), tongue (0.7), salivary gland (0.4) and lip (0.2). A substantial level of heterogeneity existed between registries in most instances. In the case of males, the highest ASR and the inter-quartile range of ASRs were as follows--mouth (highest rate of 12.4 per 100,000; IQR 1.4 to 3.6), tongue (max. 8.0; IQR 1.1 to 2.9), lip (max. 13.5; IQR 0.3 to 2.4) and salivary gland (max. 4.2; IQR 0.4 to 0.8). Corresponding statistics for females were also recorded. Comb graphs are used to highlight the significance of specific geographical-based trends and putative aetiological factors explored. CONCLUSIONS: This study reveals substantial international variation in the incidence rates of OPC, with up to 20-fold variation between countries in annual incidence rates for individual sites. The novel presentational technique makes this information readily accessible to non-specialists and highlights the need for disaggregation in future OPC studies.     

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.     

Epidemiological analysis of tongue cancer in South Australia for the 24-year period, 1977-2001

BACKGROUND: Tongue cancer (141 ICD-9) is the most common intra-oral malignancy in Western countries. In recent decades, reported tongue cancer incidence and mortality rates have increased both in Europe and in the United States, whilst survival has not improved. This study aimed to determine the epidemiology and survival trends of tongue cancer in South Australia over the 24-year period from 1977 to 2001. METHODS: Population-based data for tongue cancer were provided by the Central Cancer Registry Unit of the Epidemiology Branch of the South Australian Department of Health. Age-standardized incidence and mortality rates for males and females were calculated. Kaplan-Meier survival analysis was conducted according to time periods, age, sex and tongue sub-sites. Cox regression analysis was used to determine factors that influenced survival. RESULTS: During this 24-year period, 611 cases of tongue cancer (398 males, 213 females) were reported, the majority of which were squamous cell carcinomas. The most common age of diagnosis was 65-69 years in males and 60-64 years in females. Fifty cases (8.18 per cent of all tongue cancer cases) occurred in patients 40 years or younger. The most common cancer sub-sites reported were 'unspecified site' (48.45 per cent), lateral border (25.53 per cent) and base (18.49 per cent) of the tongue. The age-standardized incidence and mortality rates for males and females in South Australia were relatively low and stable, and there was no significant improvement in survival of tongue cancer over this period. Significant predictors for survival were sex, age and tongue sub-sites, with male, advanced age and base of tongue associated with poorer survival. CONCLUSIONS: Tongue cancer is an important health issue associated with poor survival. Early detection and diagnosis is important in order to improve survival rate for this malignancy.     

1996～2002年大连地区先天性唇腭裂的调查研究

目的：了解大连地区唇腭裂发生情况,比较综合征性唇腭裂与非综合征性唇腭裂的流行病学差异。方法：对大连地区38家县级以上助产医院1996～2002年期间的新生儿的出生缺陷资料进行整理,对263例非综合征性及38例综合征性唇腭裂病例进行回顾性分析：结果：1996～2002年大连地区非综合征性唇腭裂发病率为12．0／万;综合征性唇腭裂发病率为1．7／万：在66例总唇裂患儿中．有4例伴发全身其它畸形．占6．1％;在53例总腭裂患儿中,有8例伴发全身其它畸形,占15．1％：结论：腭裂伴发其它畸形的发生率要高于唇裂伴发其它畸形;腭裂伴发其它畸形,男性发病多于女性;非综合征性与综合征性唇腭裂在患儿体重及转归上有显著性差异。     

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.     

1988～1992年中国非综合征性唇腭裂发生率的动态变化

目的　了解我国 1988～ 1992年非综合征性唇腭裂发生率的动态变化趋势及流行病学特征。方法　采用以医院为单位的整群抽样方法 ,对 1988～ 1992年期间我国 5 0 0多所医院孕 2 8周至产后 7天的 3 2 46 40 8例围产儿 ,4349例非综合征性唇腭裂病例进行回顾性分析。结果　我国 5年非综合征性唇腭裂发生率无显著性差异 ,城乡发生率也无显著性差异。男性发生率为 14.9/万 ,女性发生率为 11.7/万 ,差异有显著性 ,非综合征性唇腭裂的性别比为 1.3∶ 1。三类非综合征性唇腭裂各自的发生率为 :CL± P:7.8/万 ,CL:3.8/万 ,CP:1.8/万。结论　我国非综合征性唇腭裂发生率无变化趋势 ,城乡无差异。男性高于女性 ,唇裂合并腭裂为最常见类型。     

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

Objective: 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. Methods: 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). Results: 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%. Conclusions: 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.     

Second primary cancers in patients with carcinoma of the lip

The occurrence of second primary cancers in patients with lip cancer was evaluated in order to test certain etiologic hypotheses. All cases of lip cancer reported to the Finnish Cancer Registry in 1953-74 (3303 men, 320 women) were followed up for a second (or third) primary cancer through the files of the Registry either to death or to 31 December 1974 (a total of 25 510 person-years). The expected numbers of cases were calculated on the basis of the incidence rates specific for sex, age, time and residence (urban or rural) in Finland. A higher than expected risk of cancer was found among both urban and rural male lip cancer patients; among women the observed number of new primary cancers did not differ from that expected. A significant excess risk among males was noted for cancers of the lung and larynx (rural patients) and for non-melanomatous skin cancer in locations other than the head and neck (urban patients). The association of cancers of the lip, lung and larynx found earlier on a geographic level supports the hypothesis that tobacco smoking is a common risk factor in these cancers. The differences in the relative risks between urban and rural patients, however, suggest that the risk factors in lip cancer in urban areas might be partially different from those prevalent in the rural population. The results do not support the hypothesis that sunlight is an important risk factor in lip cancer.     

Screening programmes for the early detection and prevention of oral cancer

Background: 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.     

Changing trends in oral cancer in the United States, 1935 to 1985: a Connecticut study

An extensive epidemiologic study was undertaken in an attempt to analyze patterns of oral cancer distribution and demography in Connecticut between 1935 and 1985. Sources of data for the investigation included both the Connecticut Tumor Registry (CTR) and the University of Connecticut Oral Pathology Biopsy Service. During the 51-year study period, 9,708 cases of primary oral cancer were reported to the CTR. Male age-adjusted incidence rates for overall oral cancer remained stable between 1935 and 1964 (14.5 to 14.8 per 100,000), with a gradual decline to 10.9 per 100,000 in the early 1980s. In contrast, age-adjusted rates for females advanced approximately threefold, from 1.4 per 100,000 in the 1930s to 4.1 per 100,000 in the early 1980s. There was a decrease in age-specific rates of oral cancer in males aged 70 and older; in contrast, age-specific incidence rates in females increased steadily over the same period. It was also found that female birth cohorts born in 1900 and later exhibited higher oral cancer incidence rates than those of previous cohorts. Between the 1960s and the present, male patients 30 to 39 years of age exhibited a nearly fourfold increase in oral cancer incidence; this was not observed among similarly aged females. Connecticut counties with highest oral cancer incidence rates in both sexes were the more densely populated Hartford and New Haven counties. In general, the picture of oral cancer, as revealed through analysis of cases accessioned by the University biopsy service between 1975 and 1986, exhibited similar trends to those disclosed by analysis of CTR data.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of cleft lip and palate in a hospital-based population in the Sudan

Cleft lip and palate represents one of the most common developmental deformities seen in oral surgery clinics. It is usually associated with problems which include not only cosmetic and dental abnormalities, but also speech, hearing and facial growth difficulties. OBJECTIVES: The purpose of the present study was to determine the prevalence of cleft lip and palate in births taking place in hospitals in the Sudan. METHODS: The records of 15,890 Sudanese new-borns delivered at three hospitals during the period from 1997 to 2000 were examined. RESULTS: Thirteen cases of cleft lip and palate were found, demonstrating a prevalence of 0.9 per 1000. There were more girls than boys, with a male:female ratio of 3:10. Fifty-four per cent of the cases had cleft lip with cleft palate, 30% had only cleft palate and the remaining 16% had cleft lip alone. CONCLUSIONS: The present study was confined to hospital-based births in one city, and the true incidence of cleft lip and/or palate in the Sudan is not yet known. Findings differ from reports from other countries in terms of suggesting a higher incidence in girls.     

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.