Racial disparity in survival of patients with squamous cell carcinoma of the oral cavity and pharynx

Community socioeconomic status and rural/racial disparities in HPV-/+ head and neck cancer

Background

Head and Neck Cancer (HNC) is a major cause of cancer morbidity and mortality in the United States, but the burden is not evenly distributed. Rural and racial disparities are obvious across the HNC continuum. Most HNC disparities research have emphasized individual factors perpetuating rural and racial disparities, ignoring the role of community-level factors.

Methods

We analyzed data from the Surveillance Epidemiology and End Results (SEER) program's "Specialized HNC-Human Papillomavirus (HPV) Census-Tract SES" datafile (2010-2016). In addition to cancer patient characteristics, this data includes a socioeconomic status (SES) quintile based on the patient's census-tract. Our outcome variables included whether the HNC patient 1) was diagnosed at a distant stage, 2) received initial treatment two or more months after diagnosis, 3) received radiation therapy, 4) survived two years after diagnosis. We tested for differences across SES quintiles, in the full sample and then within rural/racial categories. We then tested for differences between each rural/racial category conditional on SES quintile.

Results

For both HPV(-) and HPV + HNCs, patients in higher SES census-tracts have 8-10% lower rates of distant stage diagnoses and delayed treatment initiation, and 12.0-14.5% higher survival rates than patients in lower SES census-tracts. Radiation treatment only varied across SES quintiles in HPV + HNC patients. We find little evidence of rural-urban differences within each socioeconomic quintile. However, within lower SES quintiles, we found significant racial disparities in delayed detection and treatment. These differences were largest in the lowest SES quintile, as non-Hispanic Black patients reported 10-11% higher rates of delayed detection and treatment initiation than non-Hispanic White patients.

Conclusions

Our research illustrates the value and constraints in leveraging community-level factors in health disparities research that can ultimately assist in designing effective policies that address and achieve rural and racial cancer equity.

Effects of racial residential segregation on oral squamous cell carcinoma prognosis and survival

OBJECTIVES

The objective of this study is to evaluate the impact of racial residential segregation on disease prognosis and overall survival in Black patients diagnosed with oral squamous cell carcinoma (OSCC), relative to White patients.

MATERIALS AND METHODS

This retrospective cohort study identified individuals diagnosed with OSCC between 2005 and 2015 using the Surveillance, Epidemiology and End Results Database. Patients were included with cancers diagnosed in the following locations: lip, tongue, gum, floor of mouth, palate, and other/unspecified. Tumors located at the base of tongue, tonsils, and oropharynx were excluded. The primary predictor variable was the degree of residential segregation. The primary outcome was overall survival. A Kaplan Meier survival analysis and univariate/multivariate analyses were performed to account for potential confounders of survival.

RESULTS

A total of 35,769 patients met inclusion criteria. At the time of initial diagnosis, Black patients presented with OSCC of higher grades and more advanced stages (p < 0.001). A greater number of Black subjects were dead by the time of last follow-up compared to White subjects (p < 0.001). Across the entire spectrum of residential segregation, cumulative survival was worse among Black patients compared to Whites (p < 0.001). Multivariate analysis identified highly segregated counties, advanced age, higher grade/advanced stage at time of diagnosis, lack of surgery, and no chemotherapy treatment as poor prognostic factors for survival among Black individuals.

CONCLUSION

Racial residential segregation results in poorer long-term cancer survival among Black patients. Understanding the links between residential segregation and inequities in cancer outcomes will allow policymakers to better implement targeted, population-based interventions in treating various cancers.

Molecular docking data of E3 ubiquitin-protein ligase WWP1 with compounds from a medicinal plant Justicia adhatoda L

It is known that E3 ubiquitin-protein ligase WWP1 is linked to oral cancer. Therefore, it is of interest to document molecular docking data of E3 ubiquitin-protein ligase WWP1 with compounds ((Stigmasterol, Pyrazinamide, Vasicinone and Ethambutol)) from a medicinal plant Justicia adhatoda L for further consideration.

Prognostic factors associated with overall survival in patients with oral cavity squamous cell carcinoma

Background

Low socioeconomic status, increasing age, and poor lifestyle behaviors are associated with poor survival in patients with oral cavity squamous cell carcinoma (OCSCC). To determine the overall survival (OS) and the risk of OCSCC death by tumor subsite.

Material and Methods

A retrospective cohort study of OCSCC patients diagnosed from 2007 to 2009 and treated at a single cancer center in Rio de Janeiro, Brazil. Patient information was obtained from the Hospital Cancer Registry (HCR) database and complemented by individual search of physical and electronic medical records. Descriptive statistics of population characteristics were computed. OS was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analyses were used to estimate the risk of death by tumor subsite.

Results

Seven hundred and three patients with OCSCC were identified. Most patients were men (77.4%) with low levels of education (67.5%), who drank (73.9%) and smoked (79.7%). The most prevalent tumor site was the tongue (45.4%), 73.4% of patients had advanced (clinical stage III or IV) OCSCC at diagnosis and 74.1% died during follow-up. For the entire cohort, the OS was 39.1% at two years and 27.9% at five years. The median survival time was 1.4 years (95%CI: 1.2‒1.5). Non-operative treatment (HR: 3.11; 95%CI: 2.26‒4.29; p <0.001), advanced stage (HR 2.14; 95%CI 1.68-2.74; p <0.001), and age >60 years at diagnosis (HR: 1.37; 95%CI: 1.15‒1.64; p <0.001) were independently associated with the risk of death. However, these factors varied by tumour subsite.

Conclusions

Analysis of specific subsites of the oral cavity revealed substantial differences in prognostic factors associated with poor survival in OCSCC.

Key words:Squamous cell carcinoma, oral cavity cancer, survival, prognosis.

Association of Race/Ethnicity, Stage, and Survival in Oral Cavity Squamous Cell Carcinoma: A SEER Study

Objective

Survival differences in oral cancer between black and white patients have been reported, but the contributing factors, especially the role of stage, are incompletely understood. Furthermore, the outcomes for Hispanic and Asian patients have been scarcely examined.

Study Design

Retrospective, population-based national study.

Setting

Surveillance, Epidemiology, and End Results 18 Custom database (January 1, 2010, to December 31, 2014).

Subjects and Methods

In total, 7630 patients with primary squamous cell carcinoma in the oral cavity were classified as non-Hispanic white (white), non-Hispanic black (black), Hispanic, or Asian. Cox regression was used to obtain unadjusted and adjusted hazard ratios (HRs) of 5-year mortality for race/ethnicity with sequential adjustments for stage and other covariates. Logistic regression was used to examine the relationship between race/ethnicity and stage with adjusted odds ratios (aORs).

Results

The cohort consisted of 75.0% whites, 7.6% blacks, 9.1% Hispanics, and 8.3% Asians. Compared to whites, the unadjusted HR for all-cause mortality for blacks was 1.68 (P < .001), which attenuated to 1.15 (P = .039) after adjusting for stage and became insignificant after including insurance. The unadjusted HRs for all-cause mortality were not significant for Hispanics and Asians vs whites. Compared to whites, blacks and Hispanics were more likely to present at later stages (aORs of 2.63 and 1.42, P < .001, respectively).

Conclusion

The greater mortality for blacks vs whites was largely attributable to the higher prevalence of later stages at presentation and being uninsured among blacks. There was no statistically significant difference in mortality for Hispanics vs whites or Asians vs whites.

Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States

OBJECTIVES

To quantify head and neck cancer (HNC) mortality rates and identify racial and socioeconomic factors associated with 90-day mortality.

METHODS

The National Cancer Database (2004-2014) was queried for eligible HNC cases (n = 260,011) among adults treated with curative intent. Outcome of interest was any-cause 90-day mortality. Kaplan-Meier curves (Log-rank tests) estimated crude survival differences. A Cox proportional hazards model with further adjustments using the Šidák multiple comparison method adjusted for racial, socioeconomic and clinical factors.

RESULTS

There were 9771 deaths (90-day mortality rate = 3.8%). There were crude differences in sex, race/ethnicity, comorbidity, distance, income, and insurance (Log-rank p-value < 0.0001). In the final model, blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) had greater 90-day mortality hazard, as did those uninsured (aHR = 1.72; 95% CI 1.48, 1.99), covered by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53). Residence in lower median income zip code was associated with greater 90-day mortality [(aHR <$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000-$34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000-$45,999 = 1.18; 95% CI 1.08, 1.27)]; and farther travel distance for treatment was associated with decreased 90-day mortality [(aHR 50-249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR > 250 miles = 0.70; 95% CI 50, 0.99)].

CONCLUSIONS

There are significant race and socioeconomic disparities among patients with HNC, and these disparities impact mortality within 90 days of treatment.

Genetic determinants in head and neck squamous cell carcinoma and their influence on global personalized medicine

While sequencing studies have provided an improved understanding of the genetic landscape of head and neck squamous cell carcinomas (HNSCC), there remains a significant lack of genetic data derived from non-Caucasian cohorts. Additionally, there is wide variation in HNSCC incidence and mortality worldwide both between and within various geographic regions. These epidemiologic differences are in part accounted for by varying exposure to environmental risk factors such as tobacco, alcohol, high risk human papilloma viruses and betel quid. However, inherent genetic factors may also play an important role in this variability. As limited sequencing data is available for many populations, the involvement of unique genetic factors in HNSCC pathogenesis from epidemiologically diverse groups is unknown. Here, we review current knowledge about the epidemiologic, environmental, and genetic variation in HNSCC cohorts globally and discuss future studies necessary to further our understanding of these differences. Long-term, a more complete understanding of the genetic drivers found in diverse HNSCC cohorts may help the development of personalized medicine protocols for patients with rare or complex genetic events.

Racial Disparities in Histology and Short-Term Renal Functional Outcomes Following Robotic Nephron-Sparing Surgery

PURPOSE

To identify variations in renal function and histology between Caucasian Americans (CA) and African Americans (AA) undergoing robotic nephron-sparing surgery (NSS).

METHODS

A retrospective chart review was performed on patients who underwent NSS. Multivariate analysis identified factors affecting postoperative estimated glomerular filtration rate (eGFR). Histology was re-reviewed by pathology to confirm papillary type.

RESULTS

A total of 331 patients underwent NSS: CA (n = 212), AA (n = 105), Hispanic (n = 10), and other (n = 4). AA average age (60.1 years) was lower than CA (62.3 years) (P < .001), with a higher proportion of AA women (46%) than CA (37%) (P = .021). AA had a higher incidence of diabetes (58.2%) and hypertension (93.9%). Preoperative average eGFR was similar: 70.35 mL/min for AA versus 69.06 mL/min for CA. Average postoperative eGFR was 50.59 mL/min for AA and 57.85 mL/min for CA. Postoperative creatinine increased more in AA (0.44 mg/dL) versus CA (0.33 mg/dL) (P < .001) even when stratified by pathological stage. Clear cell renal cell carcinoma (RCC) was the most common histology with AA (45%) and CA (60%). A greater than 2-fold higher incidence of papillary RCC was observed in AA (31%) versus CA (13%). AA exhibited a greater proportion of high-grade or type 2 papillary RCC (40% and 30%) versus CA (25% and 13%).

CONCLUSIONS

AA patients were treated at a younger age, with a larger proportion of women. Postoperatively, AA experienced a greater increase in serum creatinine. Final histology demonstrated greater papillary RCC incidence in AA and increased likelihood for type 2 papillary RCC, a more aggressive histology.

Race and sex disparities in long-term survival of oral and oropharyngeal cancer in the United States

PURPOSE

To investigate the effect of race and sex on long-term survival of oral and oropharyngeal cancer.

METHODS

The Surveillance, Epidemiology and End Results database was queried for adult oral and oropharyngeal cancer patients with at least 25-year follow-up. Kaplan-Meier survival curves and cox proportional hazards model were used to identify differences.

RESULTS

Of the 22,162 patients identified, 70.3% were males. Only 8.9% were alive at 25 years post-diagnosis. Black males show the poorest overall and disease-specific survival rates (p < 0.001). After controlling for covariates, Blacks had a 40% higher hazard of mortality compared with Whites (HR 1.40, 95% CI 1.35-1.46), while females had a 9% reduction in mortality risk (HR 0.91, 95% CI 0.88-0.94).

CONCLUSIONS

Overall and disease-specific survival is poor for oral and oropharyngeal cancer patients, and Black men fare worst. This illustrates the need for long-term cancer survival plans incorporating disparity effects in overall cancer outcomes.

Oropharyngeal cancer as a driver of racial outcome disparities in squamous cell carcinoma of the head and neck: 10-year experience at the University of Maryland Greenebaum Cancer Center

BACKGROUND

Racial outcome disparities have been observed in head and neck squamous cell carcinoma (HNSCC) with diminished survival for black patients compared with white patients.

METHODS

We retrospectively analyzed 1318 patients with primary HNSCC treated at the University of Maryland Greenebaum Cancer Center (UMGCC) from 2000 to 2010.

RESULTS

Of all the patients, 65.9% were white, 30.7% were black, and 3.3% were of other races. Black patients were less likely to present with oral cavity cancer, and more likely to present with laryngeal or hypopharyngeal cancers. White patients were more likely to have early stage disease, especially in the oral cavity. Black race was independently associated with worse overall survival (OS) in the entire cohort. Black patients had a significantly worse OS among oral cavity and oropharyngeal cancers, with the largest disparity in oropharyngeal cancer. However, in multivariate analysis, race was only still significant in oropharyngeal cancer.

CONCLUSION

We observed differences by race in distribution of disease site, stage, and OS. Survival disparity in the entire cohort was driven mostly by differences among oropharyngeal cancer.

Impact of African-American race on presentation, treatment, and survival of head and neck cancer

OBJECTIVES

To determine the associations between African American race and stage at diagnosis, receipt of definitive therapy, and cancer-specific mortality among patients with head and neck cancer.

MATERIALS AND METHODS

The Surveillance, Epidemiology and End Results (SEER) database was used to conduct a retrospective study on 34,437 patients diagnosed with head and neck cancer from 2007 to 2010. Multivariable logistic regression analyses were applied to determine the impact of race on cancer stage at presentation (metastatic vs. non-metastatic) and receipt of definitive treatment. Fine and Gray competing-risks regression modeled the association between race and head and neck cancer-specific mortality.

RESULTS

African Americans were more likely to present with metastatic cancer compared to non-African Americans (Adjusted Odds Ratio [AOR] 1.76; CI 1.50-2.07; P<0.001). Among patients with non-metastatic disease, African Americans were less likely to receive definitive treatment (AOR 0.63; CI 0.55-0.72; P<0.001). After a median follow-up of 19months, African Americans with non-metastatic disease were found to have a higher risk of head and neck cancer specific mortality (AHR 1.19; 95% CI 1.09-1.29; P<0.001).

CONCLUSION

African Americans with head and neck cancer are more likely to present with metastatic disease, less likely to be treated definitively, and are more likely to die from head and neck cancer. The unacceptably high rates of disparity found in this study should serve as immediate targets for urgent healthcare policy intervention.

Race disparities attributed to volumetric tumor burden in patients with head and neck cancer treated with radiotherapy

BACKGROUND

The purpose of this study was to evaluate how gross tumor volume (GTV) affects treatment outcome among different race/ethnic groups in patients with head and neck cancer receiving definitive radiotherapy (RT).

METHODS

Ninety-one patients with head and neck cancer were treated to a median RT dose of 69.96 Gy in 33 fractions. The patient's self-reported race/ethnicity, primary tumor, and nodal GTV were obtained. Two-year actuarial local, nodal, and distant control, and overall and disease-free survival were calculated.

RESULTS

The patients were categorized as white (n = 43) or non-white (n = 48), which included 29 African Americans, 11 Hispanics, 5 Asians, and 3 others. The mean primary GTV was 21.0 cc and 39.9 cc for whites and non-whites, respectively (p = .011). White patients reported improved overall survival of 85.4% compared to non-whites (65.8%; p = .006). Improvements in local and nodal control and disease-free survival rates were also observed.

CONCLUSION

White patients demonstrated improved treatment outcomes compared with non-whites, which may be reflective of tumor volume.

Cancers of upper gingivobuccal sulcus, hard palate and maxilla: A tertiary care centre study in North India

Introduction:

Oral cancer is the sixth most common malignancy in the world, and the third most common in southeast Asia. Cancers of the upper gingivo-buccal complex are uncommon and reported infrequently. In this article, we have assessed the clinicopathological features of such cancers and their optimal management.

Materials and Methods:

We studied 64 patients with cancer of the upper gingivobuccal sulcus (GBS), hard palate, and maxilla seen between February 2009 and 2013 over a span of 4 years.

Results:

Of the 64 patients studied, 45 were male. The mean age at presentation was 50.59 years (24-80 years). Of the 64, 48 patients (75%) had a history of substance abuse in the form of tobacco chewing, smoking or alcohol. On presentation, 48 of the 64 patients (75%) had T4 disease, eight had T3, six had T2 lesion, one had T1 lesion, and 1 patient had a neck recurrence with distant metastatic disease (Tx). Out of the 64 patients, 31 had clinically palpable neck disease and two patients had distant metastatic disease. Of the 64 patients, 58 had squamous cell carcinoma, two had adenoid cystic carcinoma of the hard palate and one patient each had melanoma, sarcoma, neuroendocrine tumor, and mucoepidermoid carcinoma. Following imaging, 18 patients (28.13%) underwent upfront surgery and six following neoadjuvant chemotherapy. 14 of the 24 patients operated had simultaneous neck dissection. 2 patients with distant metastasis and 1 with cavernous sinus thrombosis received palliative chemotherapy. Out of the 64 patients, the other 24 who were inoperable were referred to radiotherapy.

Conclusion:

Upper GBS, hard palate and maxilla cancers are uncommon and are diagnosed at an advanced stage due to delay in presentation and ignorance of our population. Surgery offers the best form of treatment. NACT may be tried to downstage the disease in selected patients with borderline operable disease. However, generous margins should be taken post chemotherapy with concomitant neck dissection. Adjuvant radiotherapy is recommended in selected patients after surgery.

Racial parities in outcomes after radiotherapy for head and neck cancer

BACKGROUND

Although black patients experience worse outcomes after treatment for squamous cell carcinoma of the head and neck (HNSCC), these conclusions were based on populations in which blacks comprised a minority of patients. The objective of the current study was to determine the impact of race on outcomes in patients with HNSCC who received radiotherapy at an institution in which blacks comprised the majority of patients.

METHODS

In this retrospective cohort study, the authors reviewed 366 black patients and 236 white patients who had nonmetastatic HNSCC for which they received radiotherapy between 1990 and 2012. The primary study outcome measures were locoregional control, freedom from distant metastasis, progression-free survival, and overall survival.

RESULTS

The median follow-up was 18.3 months for all patients. The 2-year locoregional control rate was 71.9% for black patients compared with 64.2% for white patients (hazard ratio, 0.72; P=.03). There was no difference between blacks and whites regarding 2-year freedom from distant metastasis, progression-free survival, or overall survival. Among the patients who had stage III through IVB disease, blacks and whites had similar outcomes. On multivariate analysis, race was not statistically significant for locoregional control, freedom from distant metastasis, progression-free survival, or overall survival. Despite these similar outcomes, black patients had worse socioeconomic factors and increased comorbidities but had similar treatment compliance compared with white patients.

CONCLUSIONS

With more adverse prognostic factors, black patients experienced oncologic outcomes similar to the outcomes of white patients after receiving radiotherapy for HNSCC. The current data suggest that centers that treat large percentages of minority patients who receive radiotherapy for HNSCCs may overcome existing health care disparities through improved treatment compliance.

A survey of barriers to screening for oral cancer among rural Black Americans

OBJECTIVE

Research documents a disparity between Black and White Americans in mortality for oral cancer that appears to result in part from behaviors such as lower oral cancer screening among Black Americans. We examined barriers to oral cancer screening among Black Americans.

METHODS

We surveyed Black Americans (N = 366) living in rural Florida to identify barriers to getting screened for oral cancer.

RESULTS

Low knowledge/social attention, lack of resources, and fear/defensive avoidance predicted screening intentions, with lack of resources emerging as the largest barrier. Participants also reported that a recommendation from their provider was most likely to increase screening intentions, whereas encountering financial barriers was most likely to decrease screening intentions.

CONCLUSIONS

Low knowledge/social attention, lack of resources, and fear/defensive avoidance emerged as independent barriers to oral cancer screening, with the latter two barriers accounting for the most variance in intentions to get screened.

WWP1 gene is a potential molecular target of human oral cancer

OBJECTIVE

This study investigates the oncogenic role of WWP1, an ubiquitin ligase linked to tumor promotion, in oral cancer.

STUDY DESIGN

An array-based comparative genomic hybridization was used to detect chromosomal changes in 10 oral cancer specimens. An additional 59 specimens and 6 cultured oral cancer cells were further examined to evaluate changes in the DNA copy number and messenger RNA (mRNA) and protein expression of WWP1.

RESULTS

The copy number of the WWP1 gene and its mRNA levels were significantly increased in the oral cancer specimens. An elevated WWP1 gene expression was observed in 6 cultured oral cancer cell lines. Knockdown of the endogenous WWP1 using small hairpin RNA further showed that deficiency of WWP1 suppressed cell growth and caused apoptosis in oral cancer cells.

CONCLUSION

Our results reveal that WWP1 might play an oncogenic role in oral cancer cells.

Cyclin D1 polymorphism and oral cancer: a meta-analysis

Cyclin D1 (CCND1) plays a critical role in the G1 to S-phase cell cycle transition. Data on the association between the CCND1 A870G polymorphism and oral cancer are conflicting. To assess the relationship between the CCND1 A870G genotype and the risk of developing oral cancer, we performed a meta-analysis. We searched PubMed to December 1, 2011, for studies on this topic that had been published in the English. For each study, we calculated odds ratios (ORs) and 95 % confidence intervals (CIs), assuming the frequency of allele comparison, homozygote comparison, recessive and dominant genetic models. We then calculated pooled ORs and 95 % CIs. Seven studies were included in the meta-analysis. The CCND1 G allele was not associated with oral cancer in the frequency of allele comparison (G vs. A: OR = 0.882; 95 % CI = 0.684-1.137; p = 0.001 for heterogeneity). In the subgroup analysis, the CCND1 G allele was associated with a borderline significantly decreased risk of developing oral cancer in Asians in the frequency of allele comparison (G vs. A: OR = 0.800; 95 % CI = 0.636-1.006; p = 0.089 for heterogeneity), and the association between the GG genotype and oral cancer was significant in Asians with respect to both the homozygote comparison (GG vs. AA: OR = 0.644; 95 % CI = 0.491-0.843; p = 0.186 for heterogeneity) and the dominant genetic model (GG + AG vs. AA: OR = 0.713; 95 % CI = 0.584-0.870; p = 0.293 for heterogeneity). Our analysis provides evidence that genotypes for the CCND1 A870G polymorphism may be associated with an increased risk of developing oral cancer in the Asian population.

Barriers to oral cancer screening: a focus group study of rural Black American adults

OBJECTIVE

Mortality from mouth and throat cancer (MTC) is higher among Black Americans than White Americans partially because of late stage detection through screening. The disparity in mortality is particularly problematic among Black Americans living in rural areas who have limited access to preventative resources. Our study explored barriers to screening for MTC among Black Americans.

METHODS

We conducted nine focus groups among rural Black Americans age 40 years and older (N = 80).

RESULTS

Content coding of the transcripts of the focus groups revealed three primary barriers to screening. Lack of knowledge (e.g., not knowing about MTC and not knowing MTC symptoms) accounted for 31.8% of all barriers mentioned, lack of resources (e.g., lack of money and health insurance) accounted for 25.0% of all barriers mentioned, and fear (e.g., fear of screening and diagnosis) accounted for 22.9% of all barriers mentioned.

CONCLUSIONS

We placed these barriers within the Theory of Planned Behavior and conclude that interventions aimed at increasing MTC screening among rural Black Americans should first focus on changing people's attitudes about screening by increasing knowledge about MTC and reducing fear.

A review of the epidemiology of oral and pharyngeal carcinoma: update

Oral and pharyngeal cancers are the sixth most common cancers internationally. In the United States, there are about 30,000 new cases of oral and pharyngeal cancers diagnosed each year. Furthermore, survival rates for oral and pharyngeal cancers have not significantly improved over the last three decades. This review examines the scientific literature surrounding the epidemiology of oral and pharyngeal cancers, including but not limited to risk factors, disparities, preventative factors, and the epidemiology in countries outside the United States. The literature review revealed that much of the research in this field has been focused on alcohol, tobacco, and their combined effects on oral and pharyngeal cancers. The literature on oral and pharyngeal cancer disparities among racial groups also appears to be growing. However, less literature is available on the influence of dietary factors on these cancers. Finally, effective interventions for the reduction of oral and pharyngeal cancers are discussed.

Association of alpha B-crystallin genotypes with oral cancer susceptibility, survival, and recurrence in Taiwan

Background

Alpha B-crystallin (CRYAB) is a protein that functions as “molecular chaperone” in preserving intracellular architecture and cell membrane. Also, CRYAB is highly antiapoptotic. Abnormal CRYAB expression is a prognostic biomarker for oral cancer, while its genomic variations and the association with carcinogenesis have never been studied.

Methodology/Finding

Therefore, we hypothesized that CRYAB single nucleotide polymorphisms may be associated with oral cancer risk. In this hospital-based study, the association of CRYAB A-1215G (rs2228387), C-802G (rs14133) and intron2 (rs2070894) polymorphisms with oral cancer in a Taiwan population was investigated. In total, 496 oral cancer patients and 992 age- and gender-matched healthy controls were genotyped and analyzed. A significantly different frequency distribution was found in CRYAB C-802G genotypes, but not in A-1215G and intron2 genotypes, between the oral cancer and control groups. The CRYAB C-802G G allele conferred an increased risk of oral cancer (P = 1.49×10⁻⁵). Patients carrying CG/GG at CRYAB C-802G were of lower 5-year survival and higher recurrence rate than those of CC (P<0.05).

Conclusion/Significance

Our results provide the first evidence that the G allele of CRYAB C-802G is correlated with oral cancer risk and this polymorphism may be a useful marker for oral cancer recurrence and survival prediction for clinical reference.

Determinants of head and neck cancer survival by race

BACKGROUND

Several factors contribute to the documented racial disparity in head and neck cancer, among which are socioeconomic status, access to care, and biologic factors.

METHODS

Clinical characteristics of 87 African-American patients with head and neck cancer and a random sample of 261 white patients matched on age and smoking dose were associated with outcome.

RESULTS

Black patients with cancers of the oral cavity and larynx were more likely diagnosed with advanced stages than whites, after adjusting for socioeconomic and insurance status and other confounding factors. There was a significant difference in relapse-free survival between blacks and whites with tumors of the larynx (hazard ratio [HR] = 3.36, 95% confidence interval [CI]: 1.62-7.00), but not with tumors of the oral cavity or pharynx.

CONCLUSIONS

Differences in disease outcome may be attributed to a combination of tumor stage, socioeconomic status, and access to health care. The inclusion of biologic markers such as human papillomavirus (HPV) status is needed in future studies to further evaluate racial disparities in head and neck cancer outcomes.

Barriers to early detection and treatment of head and neck squamous cell carcinoma in African American men

BACKGROUND

African Amercians afflicted with head and neck squamous cell carcinoma (HNSCC) have a strikingly worse survival than do whites. One apparent cause is an advanced stage of presentation in African Americans. This study was designed to identify barriers to early treatment among African American men.

METHODS

Twenty-four African American male HNSCC survivors completed structured interviews. Interviewers elicited the participants' experiences from symptom recognition to receiving definitive care.

RESULTS

Most participants were seen with advanced-stage HNSCC. Overall, 10% experienced barriers to obtaining early medical care, though 30% were hesitant to seek care due to perceived barriers. Definitive treatment began for 81% within 3 months of initial care seeking.

CONCLUSION

Once participants sought care, most of them received definitive treatment within a reasonable time frame. To explain the advanced stage at presentation, either tumor growth rate was extremely rapid or participants sought care when the tumor was quite advanced. The themes suggested by this elicitation study require further validation.

Matched-pair analysis of race or ethnicity in outcomes of head and neck cancer patients receiving similar multidisciplinary care

It is unknown whether population-level racial or ethnic disparities in mortality from squamous cell carcinoma of the head and neck (SCCHN) also occur in the setting of standardized multidisciplinary-team directed care. Therefore, we conducted a matched-pair study that controlled for several potentially confounding prognostic variables to assess whether a difference in survival exists for African American or Hispanic American compared with non-Hispanic white American SCCHN patients receiving similar care. Matched pairs were 81 African American case and 81 non-Hispanic white control patients and 100 Hispanic American cases and 100 matched non-Hispanic white controls selected from 1,833 patients of a prospective epidemiologic study of incident SCCHN within a single, large multidisciplinary cancer center. Matching variables included age (+/-10 years), sex, smoking status (never versus ever), site, tumor stage (T(1-2) versus T(3-4)), nodal status (negative versus positive), and treatment. Cases and controls were not significantly different in proportions of comorbidity score, alcohol use, subsite distribution, overall stage, or tumor grade. Matched-pair and log-rank analyses showed no significant differences between cases and controls in recurrence-free, disease-specific, or overall survival. Site-specific analyses suggested that more aggressive oropharyngeal cancers occurred more frequently in minority than in non-Hispanic white patients. We conclude that minority and non-Hispanic white SCCHN patients receiving similar multidisciplinary-team directed care at a tertiary cancer center have similar survival results overall. These results encourage reducing health disparities in SCCHN through public-health efforts to improve access to multidisciplinary oncologic care (and to preventive measures) and through individual clinician efforts to make the best multidisciplinary cancer treatment choices available for their minority patients. The subgroup finding suggests a biologically based racial/ethnic disparity among oropharyngeal patients and that prevention and treatment strategies should be tailored to different populations of these patients.

Interaction of Exo1 genotypes and smoking habit in oral cancer in Taiwan

Exonuclease 1 (Exo1) is an important nuclease involved in the mismatch repair system that helps to maintain genomic stability, to modulate DNA recombination, and to mediate cell cycle arrest. Potential polymorphisms in Exo1 may alter cancer risks by influencing the repair activity of Exo1. Therefore, we hypothesized that single-nucleotide polymorphisms in Exo1 were associated with the risk of oral cancer. In this hospital-based study, the associations of Exo1 A-1419G (rs3754093), C-908G (rs10802996), A238G (rs1776177), C498T (rs1635517), K589E (rs1047840), G670E (rs1776148), C723R (rs1635498), L757P (rs9350) and C3114T (rs851797) polymorphisms with oral cancer risk in a central Taiwan population were investigated. In total, 680 patients with oral cancer and 680 age- and gender-matched healthy controls recruited from the China Medical University Hospital were genotyped. A significantly different distribution is found in the frequency of the Exo1 K589E genotype, but not the other genotypes, between the oral cancer and control groups. The A allele Exo1 K589E conferred a significant (P=6.18E-8) increased risk of oral cancer. Gene-environment interactions with smoking were significant for Exo1 K589E polymorphism (OR=2.509, 95% CI=1.914-3.287). Our results provide evidence that the A allele of the Exo1 K589E may be associated with the development of oral cancer.

Determinants of outcome following surgery for oral squamous cell carcinoma

The recent changes in incidence and prevalence of oral squamous cell carcinoma in relation to gender and age mirror the changing patterns of exposure to tobacco and alcohol, the main etiological agents. Most cases of oral cancer are managed by surgery, often combined with radiotherapy. Histopathological assessment of the resection specimen provides information vital for postoperative management and prognosis. This review considers the full range of histological determinants of outcome in relation to the primary oral tumor and any metastatic involvement of the cervical lymphatic system, together with an outline of more general patient factors that may also impact on morbidity and mortality rates.

Association between DNA double strand break gene Ku80 polymorphisms and oral cancer susceptibility

The DNA double strand break repair gene Ku80 is thought to play a major role in the caretaking of the overall genome stability. It is very possible that defective in double strand break repair capacity can lead to human carcinogenesis. Thus, the polymorphic variants of Ku80 were firstly investigated regarding their association with oral cancer susceptibility. In this hospital-based case-control study, the association of Ku80 promoter G-1401T (rs828907), promoter C-319T (rs11685387), and intron19 (rs9288518) polymorphisms with oral cancer risk in a Taiwanese population was investigated. 600 patients with oral cancer and 600 age- and gender-matched healthy controls recruited were genotyped and analyzed by PCR-RFLP method. There were significant differences between oral cancer and control groups in the distributions of their genotypes (P=0.0038) and allelic frequencies (P=0.0044) in the Ku80 promoter G-1401T polymorphism. In the other two polymorphisms, there was no difference between both groups in the distribution of either genotype or allelic frequency. There is a synergistic gene-environmental interaction between Ku80 and areca chewing. Compared with G/G genotype in Ku80 promoter G-1401T, the G/T plus T/T significantly enhanced the risk only in the areca chewers (odds ratio=1.603; 95% confidence interval=1.053-2.011), not in the non-areca chewers. In conclusion, the Ku80 promoter G-1401T is correlated with oral cancer susceptibility and this polymorphism may be a useful marker for oral cancer prevention and early detection.

Unequal burden of head and neck cancer in the United States

BACKGROUND

Black Americans are adversely affected by many types of malignancies.

METHODS

We reviewed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to evaluate racial disparities in head and neck cancer incidence, mortality, and survival.

RESULTS

Head and neck cancer incidence is greater in the black population and peaks at a younger age. The incidence disparity is decreasing over time and is less for cancers of the oral cavity/pharynx (OCP) than for cancers of the larynx. The disparity in survival after diagnosis is substantial for both sites and is increasing over time because of improvement in survival for the white population, but not for the black population. Some, but not all, of the survival disparity is due to more advanced stage at the time of diagnosis within the black population. The age-adjusted mortality rate for black men is approximately twice the rate for white men.

CONCLUSION

Black Americans clearly bear a greater burden from head and neck cancer. The underlying causes are largely unknown, but are most likely due to a complex interplay of differences in access to health care, quality of medical care, biologic/genetic factors, incidence of comorbid conditions, exposure to carcinogens, diet, and cultural beliefs. Prospective studies are needed to define the relative importance of these factors and to inform intervention strategies.

Oral cancer and genetic polymorphism of DNA double strand break gene Ku70 in Taiwan

The DNA repair gene Ku70, an important caretaker of the overall genome stability, is thought to play a major role in the DNA double strand break repair system. It is known that defects in double strand break repair capacity can lead to irreversible genomic instability. However, the polymorphic variants of Ku70 and their association with oral cancer susceptibility has never been reported on. In this hospital-based case-control study, the association of Ku70 promoter T-991C (rs5751129), promoter G-57C (rs2267437), promoter A-31G (rs132770), and intron3 (rs132774) polymorphisms with oral cancer risk in a Taiwanese population was investigated. In total, 318 patients with oral cancer and 318 age- and gender-matched healthy controls recruited from the China Medical Hospital in Taiwan were genotyped. The results showed that there were significant differences between the oral cancer and control groups in the distribution of their genotypes (P=0.0031) and allelic frequency (P=0.0009) in the Ku70 promoter T-991C polymorphism. Individuals who carried at least one C allele (T/C or C/C) had a 2.15-fold increased risk of developing oral cancer compared to those who carried the T/T wild-type genotype (95% CI: 1.37-3.36). In the other three polymorphisms, there was no difference between both groups in the distribution of either genotype or allelic frequency. In conclusion, the Ku70 promoter T-991C, but not the Ku70 promoter C-57G, promoter A-31G or intron3, is connected to oral cancer susceptibility. This polymorphism may be a novel useful marker for primary prevention and anticancer intervention.

A novel single nucleotide polymorphism in XRCC4 gene is associated with oral cancer susceptibility in Taiwanese patients

The DNA double strand break repair gene XRCC4, an important caretaker of genome stability, is suggested to play a role in the development of human carcinogenesis. However, no evidence has been provided showing that XRCC4 was associated with oral oncology. In this hospital-based case-control study, the association of XRCC4 G-1394T (rs6869366), intron 3 (rs28360071), intron 7 (rs28360317), and intron 7 (rs1805377) polymorphisms with oral cancer risk in a Taiwanese population was first investigated. In total, 318 patients with oral cancer and 318 age- and gender-matched healthy controls were genotyped. We found a significant different distribution in the frequency of the XRCC4 intron 3 genotype, but not the XRCC4 G-1394T or intron 7 genotypes, between the oral cancer and control groups. Those who had heterozygous del/ins at XRCC4 intron 3 showed a 1.57-fold (95% confidence interval=1.12-2.21) increased risk of oral cancer compared to those with ins/ins. As for XRCC4 G-1394T or intron 7 polymorphisms, there was no difference in the distribution between the oral cancer and control groups. There were significant gene-environment interactions between XRCC4 intron 3 genotype with smoking and with betel quid chewing, but not with alcoholism. In smoker and betel quid chewer groups, the XRCC4 intron 3 del variants exhibited 2.57- and 3.03-fold higher risks than the ins genotype, respectively. Our results firstly suggest that the XRCC4 intron 3 del genotype may be associated with oral oncology and may be a novel useful marker for primary prevention and anticancer intervention.

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.

Prognostic factors associated with the survival of oral and pharyngeal carcinoma in Taiwan

Background

In Taiwan, a distinct ethnic group variation in incidence and mortality rates has been suggested for most carcinomas. Our aim is to identify the role of prognostic factors associated with the survival of oral and pharyngeal carcinoma in Taiwan.

Methods

Taiwan Cancer Registry records of 9039 subjects diagnosed with oral and pharyngeal carcinoma were analyzed. The population was divided into three ethnic groups by residence, which were Taiwanese aborigines, Hakka and Hokkien communities. Five-year survival rates were estimated by Kaplan-Meier methods. Ethnic curves differed significantly by log-rank test; therefore separate models for Taiwanese aborigines, Hakka and Hokkien were carried out. The Cox multivariate proportional hazards model was used to examine the role of prognostic factors on ethnic survival.

Results

The five-year survival rates of oral and pharyngeal carcinoma were significantly poorer for Hokkien community (53.9%) and Taiwanese aborigines community (58.1%) compared with Hakka community (60.5%). The adjusted hazard ratio of Taiwanese aborigines versus Hakka was 1.07 (95%CI, 0.86–1.33) for oral and pharyngeal carcinoma mortality, and 1.16 (95%CI, 1.01–1.33) for Hokkien versus Hakka. Males had significantly poor prognosis than females. Subjects with tongue and/or mouth carcinoma presented the worst prognosis, whereas lip carcinoma had the best prognosis. Subjects with verrucous carcinoma had better survival than squamous cell carcinoma. Prognosis was the worst in elderly subjects, and subjects who underwent surgery had the highest survival rate.

Conclusion

Our study presented that predictive variables in oral and pharyngeal carcinoma survival have been: ethnic groups, period of diagnosis, gender, diagnostic age, anatomic site, morphologic type, and therapy.

Racial disparities in patients with head and neck squamous cell carcinoma

OBJECTIVES/HYPOTHESIS

Black patients are reported to have a higher incidence of advanced disease and increased mortality from head and neck squamous cell carcinoma (HNSCC) but constitute the minority of patients in large-scale studies investigating the effect of race on outcome. This study sought to determine if racial disparities exist between black and white patients with HNSCC treated at a single large institution in the South with a high proportion of black patients.

STUDY DESIGN

The authors conducted a nonrandomized retrospective cohort analysis.

METHODS

The tumor registry was used to identify patients diagnosed with HNSCC from 1985 to 2002. The medical records of non-Hispanic white and black adult patients were retrospectively reviewed. Median household income, percentage of population below poverty level, and education level based on census tract and block information were obtained from U.S. Census 2000 data. Standard statistical analysis, including Kaplan-Meier survival curve analysis and Cox proportional hazards models, was used to analyze the effects of covariables on survival.

RESULTS

A total of 1,128 patients met study criteria (478 black, 650 white). Compared with white patients, black patients were significantly younger (mean age, 53.9 vs. 56.4 years, P<.0001), male (81.2% vs. 72.3%, P=.0005), more commonly abused alcohol (88.0% vs. 74.3%, P<.0001), and were significantly less likely to have insurance (8.6% vs. 21.7%, P<.0001). There was no difference in the incidence of tobacco use (91.7%), advanced comorbidity (35.9%), or primary tumor site. Black patients had a significantly greater incidence of stage IV disease (65.7% vs. 46.6%, P<.0001) and nonoperative treatment (48.7% vs. 30.8%, P<.0001), which was performed for inoperable disease in 57.1% of black compared with 31.0% of white patients (P<.0001). Black patients resided in census block groups with significantly lower mean education level, median income, and a higher percentage of population below poverty compared with white patients. The 5-year disease-specific survival differed significantly between black (29.3%) and white (54.7%) patients (P<.0001). Cox proportional hazards models revealed that alcohol abuse, advanced TNM stage, high tumor grade, nodal disease, extracapsular spread, advanced comorbidity, and regional or distant metastatic disease were associated with poorer survival for all patients. An interaction with race was found for insurance status, nonoperative treatment, and extracapsular spread. Stepwise variable selection adjusting for patient, tumor, and treatment characteristics showed a significant effect only for race by payor status on disease-specific survival (P=.0228).

CONCLUSIONS

Insurance status, treatment, and extracapsular spread differentially affected the survival of black patients compared with white patients. Only insurance status had a significant effect on survival in black patients after controlling for other variables. These data suggest that racial differences in HNSCC outcomes are primarily related to differences in access to health care.

Disparities in oral and pharyngeal cancer incidence, mortality and survival among black and white Americans

BACKGROUND

The authors present statistics and long-term trends in oral and pharyngeal cancer (OPC) incidence, mortality and survival among U.S. blacks and whites.

METHODS

The authors obtained incidence, mortality and five-year relative survival rates via the Surveillance, Epidemiology and End Results (SEER) Program Web site. Current rates and time trends for 1975 through 2002 are presented.

RESULTS

From 1975 through 2002, age-adjusted incidence rates (AAIRs) and mortality rates (AAMRs) were higher among males than among females and highest for black males. By the mid-1980s, incidence and mortality rates were declining for black and white males and females; however, disparities persisted. During the period 1998-2002, AAIRs were more than 20 percent higher for black males compared with white males, while the difference in rates for black and white females was small. AAMRs were 82 percent higher for black males compared with white males, but rates were similar for black and white females. Five-year relative survival rates for patients diagnosed during the period 1995-2001 were higher for whites than for blacks and lowest for black males.

CONCLUSIONS

Despite recent declines in OPC incidence and mortality rates, disparities persist. Disparities in survival also exist. Black males bear the brunt of these disparities.

PRACTICE IMPLICATIONS

Dentists can aid in reducing OPC incidence and mortality by assisting patients in the prevention and cessation of tobacco use and alcohol abuse. Five-year relative survival may be improved through early detection.

Is there disparity in the care of minority patients with upper aerodigestive tract malignancy?

The data presently available indicate that there is unequal (disparate) care in patients with head and neck cancer. The reasons for this are likely multifactorial and require further study. Complicating such work is the need for subgroup analysis. For example, Hispanics are not a homogeneous ethnic group; hence, differences in social perception, cultural mores, and available medical resources can be demonstrated that can directly impact care and outcome. Appropriate epidemiologic studies are needed with more underserved minority patients to analyze these differences further and to address such differences.

The salivary microbiota as a diagnostic indicator of oral cancer: a descriptive, non-randomized study of cancer-free and oral squamous cell carcinoma subjects

Background

The purpose of the present investigation was to determine if the salivary counts of 40 common oral bacteria in subjects with an oral squamous cell carcinoma (OSCC) lesion would differ from those found in cancer-free (OSCC-free) controls.

Methods

Unstimulated saliva samples were collected from 229 OSCC-free and 45 OSCC subjects and evaluated for their content of 40 common oral bacteria using checkerboard DNA-DNA hybridization. DNA counts per ml saliva were determined for each species, averaged across subjects in the 2 subject groups, and significance of differences between groups determined using the Mann-Whitney test and adjusted for multiple comparisons. Diagnostic sensitivity and specificity in detection of OSCC by levels of salivary organisms were computed and comparisons made separately between a non-matched group of 45 OSCC subjects and 229 controls and a group of 45 OSCC subjects and 45 controls matched by age, gender and smoking history.

Results

Counts of 3 of the 40 species tested, Capnocytophaga gingivalis, Prevotella melaninogenica and Streptococcus mitis, were elevated in the saliva of individuals with OSCC (p < 0.001). When tested as diagnostic markers the 3 species were found to predict 80% of cancer cases (sensitivity) while excluding 83% of controls (specificity) in the non-matched group. Diagnostic sensitivity and specificity in the matched group were 80% and 82% respectively.

Conclusion

High salivary counts of C. gingivalis, P. melaninogenica and S. mitis may be diagnostic indicators of OSCC.

Important prognostic factors of long-term oropharyngeal carcinoma survivors in Taiwan

In Taiwan, a clear gender difference emerges for rates of oropharyngeal carcinoma incidence. The purpose of this study was to identify the gender differences and clinical factors associated with oropharyngeal carcinoma survival rates in Taiwan. We analyzed the 5-year survival rates of 8114 subjects diagnosed with oropharyngeal carcinoma between 1987 and 1994. The Cox proportional-hazards model identified clinical characteristics for gender according to oropharyngeal carcinoma death and all-cause death outcomes. The 5-year survival rates were significantly lower for males than females (p < 0.0001). The adjusted hazard ratio of males versus females was 1.54 (95% CI: 1.36-1.74) for oropharyngeal carcinoma death and 1.44 (95% CI: 1.31-1.58) for all-cause death. Gender and other clinical characteristics (i.e. diagnostic age, anatomic site, morphologic type, and treatment modality) play important roles in oropharyngeal carcinoma survival. We suggested that Taiwanese males have high proportion of betel quid chewing and that this is associated with the gender differences.

Racial disparity in incidence patterns and outcome of kidney cancer

OBJECTIVES

To identify the subgroups that primarily contribute to the greater incidence and mortality of renal cancer in black Americans compared with white Americans.

METHODS

We analyzed age, stage, and race-related differences in the incidence and survival among patients with renal cancer using the national Surveillance, Epidemiology, and End Results (SEER) registry database. White and black patients with renal cell carcinoma who were older than 19 years of age and had been diagnosed between 1975 and 1998 were included. Incidence trends were analyzed by joinpoint regression with the statistical significance level at P <0.05. The Cox proportional hazards model was used to determine the overall survival of patients with renal cell carcinoma by race (white versus black), age (20 to 59 versus 60+ years), and stage (local versus regional/distant).

RESULTS

Localized disease predominantly accounted for the rise in incidence. Both black age groups with localized disease had a greater estimated annual percentage of incidence increase (4.46% for 20 to 59 years and 4.35% for 60+ years) compared with their white counterparts (2.87% and 3.06%, respectively). The magnitude of survival difference was largest between black versus white patients younger than 60 years of age who had local stage disease, with a median survival time of 190 and 259 months, respectively (P <0.0001).

CONCLUSIONS

Young black patients with localized renal cancer appear to have had a greater rise in incidence and a poorer outcome than white patients of the same age and disease stage. Additional investigation is warranted to define the role of these race, stage, and age-related disparities in the etiology, prognosis, treatment, and follow-up of kidney cancer.

Impact of race on outcome after definitive radiotherapy for squamous cell carcinoma of the head and neck

BACKGROUND

The objective of the current study was to evaluate the impact of race (black vs. white) on the outcome of patients with invasive squamous cell carcinoma of the head and neck.

METHODS

Between 1983 and 1997, 686 patients completed definitive, twice-daily radiotherapy (RT) alone or combined with a planned neck dissection; no patients received adjuvant chemotherapy. The minimum follow-up was 2 years, and median follow-up was 7 years for living patients. No patients were lost to follow-up. Fifty-five patients were black (8%).

RESULTS

Although the two groups had similar 5-year local-regional control rates (black patients vs. white patients: 70% vs. 76%, respectively; P = 0.275), black patients had double the risk for distant recurrence compared with white patients (27% vs. 13%; P = 0.012). The 5-year cause-specific and absolute survival rates were lower for black patients (52% vs. 74% [P = 0.001] and 29% vs. 52% [P < 0.001], respectively). Multivariate analyses revealed that race was an independent predictor of freedom from distant metastasis (P = 0.013), cause-specific survival (P = 0.005), and absolute survival (P < 0.001).

CONCLUSIONS

Although equal local-regional control rates can be achieved in black patients and white patients with squamous cell carcinoma of the head and neck, the risk of distant recurrence was significantly higher in black patients and resulted in decreased survival. Reevaluation of current strategies for pretreatment metastatic work-ups and development of more effective systemic therapy will be key to improving the survival disparity in this group.

Opportunities for oral cancer screening among older African-American women

BACKGROUND

Older persons with smoking histories are important targets for oral cancer screening. Although older persons in low-income communities often lack regular dental care, little is known about the characteristics of groups at greatest risk for poor screening.

METHODS

Survey data from 576 African-American women aged 45-93 were used to identify predictors of smoking and recency and type of dental care.

RESULTS

Fifty-nine percent of respondents were current or former smokers, and 62% reported dental care within the past 3 years. Among smokers, no recent dental care was associated with older age, worse health, not working, no regular medical provider, and no recent mammography.

CONCLUSIONS

These results suggest that episodic visits to non dentist providers offer opportunities for oral screening in high-risk populations.

The epidemiology of oral and pharynx cancer in Brazil

A study was carried out on the occurrence of oral and pharynx cancer among populations living in five Brazilian geographic regions, by using incidence and mortality rates and trends. Information on survival was also analyzed. Complementary information regarding prevalence of the disease risk factors has been supplied in the attempt to establish some etiological connections with the incidence and mortality observed. Two clear patterns for the occurrence of oral and pharyngeal cancer have been detected: a pattern for the north (including the northern, northeastern and midwestern regions, which are the poorest ones) and a pattern for the south (including the southern and southeastern regions). The southern pattern revealed incidence rates higher than 15 per 100,000 among males, and the northern pattern displayed lower rate levels. Similarly, mortality rates in the south were higher than three per 100,000 and the northern pattern was characterized by lower rates. Other cancers linked to tobacco smoking, such as esophagus, larynx, lung and bladder cancer kept the same pattern of incidence and mortality rates related to oral and pharyngeal cancer in males per region. Information on survival of patients with oral and pharyngeal cancer was very restricted in Brazil, thus hindering the survival analysis per region, but the studies conducted allowed to conclude that the majority of diagnoses were conducted in advanced stages of the disease and implied the low 5-year survival rate observed in Brazil. Tongue tumors displayed the worst survival rates. The southern region shares specific risk factors involved in the oral and pharyngeal cancer present in the Argentinean and Uruguayan populations, namely heavy tobacco smoking and alcohol consumption, as well as high intake of charcoal-grilled red meat and mate. In addition to these risks, part of the oral and pharyngeal cancer registered in Brazil might be linked to a few factors present among people with low life standards, including poor oral hygiene and nutrition.