Relationship between Selected Socio-Demographic Factors and Cancer of Oral Cavity - A Case Control Study

Association of oral cancer site with addiction and sociodemographic characteristics: A cross-sectional study conducted at a tertiary health centre

Introduction

In contemporary epidemic scenarios, oral cancer ranks the top 3 cancer types afflicting the Indian population. The primary risk factors include alcohol consumption, tobacco usage in various forms, such as cigarettes and smokeless tobacco, betelnut chewing, and infection with the human papillomavirus. This article submitted in preprint in medRxiv on 20 February 2024.

Materials and Methods

This study, conducted at a tertiary healthcare center, adopted a hospital-based cross-sectional approach involving 233 oral cancer patients who sought medical care from January 1 to December 31, 2017.

Results

The findings indicate that males above the age of 60 (40.11%) and females aged between 41 and 50 years (45.45%) were the most affected groups. A statistically significant association (P < 0.05) was found. The primary sites for oral cancer were the cheek (40.36%) and tongue (31.78%). Remarkably, the majority of male patients exhibited a combination of addictions, including tobacco chewing, smoking, and alcohol use, whereas most female patients were exclusively involved in tobacco chewing.

Conclusion

To curb the increasing prevalence of oral cancer in India, it is imperative to implement comprehensive public education initiatives and health promotion strategies aimed at reducing both smoking and alcohol consumption.

Factors influencing the 5-year survival rate of oral cancer patients in the Mongolian population: a retrospective cohort study

Introduction

The high mortality rate of head and neck cancers, particularly oral cancer, poses a significant health challenge in developing nations such as Mongolia. This retrospective survival analysis study was conducted to identify factors influencing the 5-year survival rate of oral squamous cell carcinoma patients.

Methods

The study analyzed data from 173 patients diagnosed with oral squamous cell carcinoma, including multiple variables such as age, gender, residence, education, tobacco and alcohol consumption, oral health indicators, family history, precancerous conditions, cancer characteristics, treatment, rehabilitation, cancer recurrence, and 5-year survival. Survival analysis was conducted using the Kaplan-Meier method, and STATA was used for statistical analysis.

Results

The study revealed a 5-year survival rate of 50.3% for oral cancer patients, with a survival rate of 38% for tongue cancer patients. Age, residence, cancer stage, and cancer recurrence were identified as significant survival predictors. Compared to those aged 60 or younger, the hazard ratio (HR) for patients aged 61 or older was 1.52. Survival was associated with female gender (HR = 0.47, CI = 0.29-0.77). Urban residence was associated with decreased survival (HR = 1.92, CI = 1.22-3.05). Significantly worse survival was associated with the presence of cancer recurrence (HR = 1.99, CI = 1.15-3.04). Oral cancer patients in stage IV had a fourfold higher risk of mortality compared to those in stage I (HR = 4.08, CI = 1.2-13.84).

Conclusion

This research highlights the influence of age, urban habitation, and cancer recurrence on oral cancer survival. Age, urban residence, and cancer recurrence were all associated with decreased survival, whereas cancer at stage IV substantially increased the risk of death. The significance of early detection, treatment, and active surveillance to identify oral cancer at an early stage is highlighted by these findings. Compared to industrialized nations, Mongolia's lower oral cancer survival rates emphasize the need to increase public awareness and education. A comprehensive approach is required to improve oral cancer patient survival rates and quality of life, including emphasizing early detection through active surveillance, implementing preventive measures, and advancing cancer education initiatives.

Awareness of Oral Cancer Among Users of Smokeless Tobacco: A Cross-Sectional Study

INTRODUCTION

 Smokeless tobacco (SLT) stands out for its higher nicotine absorption and its role in preventable fatalities. The Global Adult Tobacco survey in Saudi Arabia revealed SLT usage, while past legislation restricted its use. Linking SLT consumption to oral cancer and oral mucosal ulcers, the study addresses its prevalence in head and neck malignancies.

METHODOLOGY

This study is cross-sectional and includes adult users of SLT. Raosoft (Raosoft Inc., Seattle, WA) was used to calculate the sample size. The data was analyzed using SPSS software (IBM Corp., Armonk, NY).

RESULTS

The research study investigated various sociodemographic characteristics and prevalence of SLT use among participants. All participants reported using SLT, with toombak (33.2%) and shamma (36.0%) being the most prevalent. Notably, reasons for initiating SLT included influence from peer pressure (33.6%), alternatives to smoking (32.0%), and influence from relatives (19.0%). While 75.1% intended to quit within a year, awareness of SLT's harmfulness varied: 40.3% believed it was less harmful than smoking, and 57.7% recognized its link to oral cancer. Additionally, 62.2% believed SLT could lead to dependence. Sociodemographic factors generally did not significantly affect awareness of SLT causing oral cancer.

CONCLUSION

The findings indicate a significant prevalence of SLT use, with toombak and shamma being the most common types consumed. Awareness of the potential harm of SLT use in relation to oral cancer varied among participants, with a notable proportion misunderstanding its harmfulness compared to smoking tobacco.

Outcomes of Oral and Oropharyngeal Squamous Cell Carcinoma Related to Healthcare Coverage: A Retrospective Cohort Study in Brazil

We investigated the differences in prognosis according to the type of healthcare coverage of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). This study included 875 medical records. Patients covered by the publicly funded Unified Health System (SUS) had a low educational level, with advanced T stage and delayed treatment initiation. Multivariate analyses revealed an association between T stage (p = .035) and poor prognosis in oral squamous cell carcinoma, and age (p = .029) in oropharyngeal squamous cell carcinoma. Surgical treatment (p = .036) and marital status (p = .015) were considered predictors of better prognosis in OOSCC. Exclusive SUS-dependency can be considered an indirect prognostic factor for OOSCC.

Opportunistic Screening of Oral Potentially Malignant Disorders: A Public Health Need for India

PURPOSE

Oral cancer (OC) is the leading cancer in 25% of Indian cancer registries, and 80% of OCs are diagnosed in advanced stages. OC screening is a topic of debate. Studies from other countries have used a variety of study designs as OC screening strategies. There are not many studies from India on strategic screening, and there is a need to review the literature to provide insights and knowledge about screening programs. The purpose of this narrative review is to present broad epidemiologic evidence on the OC burden in India, to discuss and summarize the currently available evidence for OC screening strategies, and to highlight a feasible opportunistic screening strategy for addressing OC burden in India.

METHODS

Medline and EMBASE were used to identify articles. Data from GLOBOCAN and government reports were obtained from websites. As many key concepts and divergent views cannot be addressed with a single research question, a narrative review was considered appropriate, but to ensure a comprehensive literature search, a systematic review search strategy was used.

RESULTS

OC rates are rising more rapidly in India than projected. Wide variations in OC incidence within India reflect regional diversity of risk factors. Studies abroad have demonstrated the feasibility of opportunistic screening of oral potentially malignant disorders by dentists; however, although recommendations exist in India, no studies of opportunistic screening by dentists have been reported.

CONCLUSION

The projected major increases in the OC burden necessitate an OC screening program; opportunistic screening of high-risk groups by dentists using oral visual examination is recommended as a cost-effective strategy. As a way forward, a pilot project to assess the feasibility of regional opportunistic screening is in progress.

Oral cancer histopathological subtypes in association with risk factors: a 5-year retrospective study

Background: Oral cancer is a worldwide public health problem, being the sixth most common neoplasm. The high mortality rate of this type of cancer is due to a delayed diagnosis, a fast evolution and metastasis, no primary symptomatology, the multitude of risk factors and the lack of awareness among the population concerning oral malignancy. Aim: The aim of this 5-year retrospective study was to evaluate the incidence of oral cancer patients in the Clinic of Maxillo-Facial Surgery, Emergency County Hospital, Timişoara, Romania and quantify the histopathological (HP) subtypes, localization, age, gender, tumor staging and differentiation, positive loco-regional lymph nodes and risk factors. Patients, Materials and Methods: A number of 129 patients diagnosed with oral cancer were included in the study and their medical records were analyzed. A statistical analysis was performed that included the variables gender, age, tumor staging, differentiation grade, HP subtype, lymph nodes, localization, and risk factors. Results: Our results outlined a high prevalence of oral cancer among males (65.9%), squamous cell carcinoma (SCC) being the most common HP subtype. Tumor staging revealed the fact that the majority of were T3 and T4 tumors with dissemination in the loco-regional lymph nodes. In 52% of the cases, tobacco was identified as a risk factor, and the association of tobacco and alcohol was present in 28.3% of the cases. Conclusions: The early diagnosis is crucial for the improvement of oral cancer survival rate. The oral cavity is permanently exposed to carcinogenic substances that associated with other risk factors have an influence upon the incidence of oral malignancies.

Toxicity of Saffron Extracts on Cancer and Normal Cells: A Review Article

BACKGROUND AND AIM

Medicinal plants have played an important role in human health since the Stone Age. According to WHO, 80% of Asian and African people rely on traditional medicine and medicinal plants to conserve their health. Saffron has received much attention among the herbal compounds related to cancer treatment.

METHODS

This review aims to provide an overview of in-vitro and in-vivo evaluation molecule mechanism for anti-tumor activity, cancer preventing and protective effects of saffron extract. The review is based on the available data accessible in PubMed, Science Direct, Google Scholar, Magiran.ir, and SID.ir databases.

RESULTS

Saffron has selective toxic and preventive effects on cancerous cells and without adverse effects on normal cells and prevents tumor formation. Saffron appears to reduce the toxic effects of anticancer drugs. Saffron has toxicity effects when used in high amounts, which are far greater than those  are used in human food culture.

CONCLUSIONS

Considering the observed effects of saffron on the removal of cancer cells, saffron extract can be used in the treatment and prevention of cancer after confirmation in human clinical trials. According to the high IC50 of saffron extracts in normal cells, its toxicity against non-cancerous cells is low and its use is safe. Besides, the studies suggested the cytotoxic effects of saffron on some of the  more cancers, including nervous system cancer and common cancers. Further studies are required to determine the effective dose and influence of mechanism of saffron in various animal type of cancers.

Smoking History Decreases Survival in Patients with Squamous Cell Carcinoma of the Mouth: A Retrospective Study with 15 Years of Follow-up

Background:

The purpose of this study was to evaluate the influence of smoking history on the clinical-pathological, sociodemographic and prognostic characteristics of patients with oral squamous cell carcinoma (SCC).

Materials and Methods:

A retrospective cohort study was carried out with the records of 136 smokers with SCC and 68 nonsmokers with oral SCC who were diagnosed and treated at Haroldo Juaçaba Hospital (2000-2014). Data on patient sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, treatment type, marital status, method of health care access (public or private health systems) and overall survival (15 years) were analyzed by the X² test, Mantel-Cox tests and multinomial and Cox logistic regression models (SPSS 20.0, p <0.05).

Results:

Smoking history was directly associated with male sex (p <0.001), low levels of education (p = 0.001), tumors of the mouth and palate (p = 0.001), stage T3/4 tumors (p = 0.014), lymph node metastasis (N+) (p = 0.024), palliative treatment (p = 0.024) and receiving health care through the public health system (p = 0.006), with education level being the only independently associated factor (p = 0.039). Lower survival was observed in patients who were smokers (p = 0,002), with low levels of education (p = 0.001), who had stage T3/4 tumors (p = 0.004), with N+ (p = 0.021), and had received palliative treatment (p = 0.002). Age (>65 years old, p = 0.015) and T staging (T3/4, p = 0.033) decreased the survival of SCC patients regardless of the other factors.

Conclusions:

Smoking history had an independent association with low education level and a history of alcoholism, and survival was negatively associated with older age and larger tumor size, which were more prevalent in smokers.

Oral squamous cell carcinoma profile in North-Eastern regions of India from habits to histopathology: A hospital-based study

Background

Head and neck cancers constitute about 5%-8% of total body cancers in Europe, America, but in India, this figure is somewhat higher. The aim of this study is to evaluate the current burden of oral cancers in India, particularly North-East India.

Materials and Methods

A full-length study starting from patient counseling to clinical and histopathological examination and grading was planned. The study was conducted under the guidance of clinician, oral surgeon, oral pathologists, and statistician.

Results

In the 3 years study, all the patients with oral lesions are examined clinically, out of them suspected oral cancer patients were histopathologically confirmed as oral squamous cell carcinoma patient. The socioeconomic profile of oral cancer patients in relation to all examined patients was summarized, and results are drawn.

Conclusion

The studied population is heavily indulgent tobacco consumption. Education for cancer prevention, early detection, and treatment is needed.

Prospective study on factors affecting the prognosis of oral cancer in a Chinese population

This study was performed to identify the factors affecting prognosis of oral cancer patients. 1240 pathologically confirmed oral cancer patients were included. The sociodemographic and clinical characteristics of all patients were collected. Univariate and multivariate Cox proportional hazards models were used to assess potential prognostic factors for survival. 1240 oral cancer patients were followed up for 49235.00 person months, and the 5-year overall survival rate was 64.38%. Both univariate and multivariate Cox regression analysis indicated that Body Mass Index < 18.5 kg/m2 (vs 18.5-23.9 kg/m2), age ≥ 55 years (vs < 55 years), clinical stages of II-IV (vs stage I), and poor differentiation (vs well differentiation) were associated with worse survival of oral cancer patients. While surgery (vs non-surgery) and origin of urban area (vs rural area) were protective factors. However, no significant association was found between adjuvant therapy and survival in oral cancer patients.

Descriptive study of 896 Oral squamous cell carcinomas from the only University based Oral Pathology Diagnostic Service in Sri Lanka

Background

The main objective of this study was to describe selected clinico-pathological characteristics of Oral Squamous Cell Carcinoma (OSCC) in Sri-Lanka.

Materials & methods

The study sample comprised of eight hundred and ninety six biopsies diagnosed as OSCC. The clinical and histopathological features were analyzed using the Chi-square test.

Results

Of the 896 biopsies, 801 were primary OSCCs, while 95 were recurrent OSCCs. Majority of the patients (78 %) were in the 5^th to 7^th decades of life and showed a male predilection. The buccal mucosa was the commonest site of primary OSCC comprising of 43 % of the sample. Of the primary OSCCs, with known TNM stage, 86 % were in stage 3&4 and majority (59 %) of stage 4 tumours showed tumour at one or more excision margins. Of the recurrent OSCC, 46 % developed their recurrences within one year of the excision of the primary tumour.

Conclusion

In Sri-Lanka, OSCC is a major problem. Only half the patients had completely excised tumours (with clearance of >5 mm at all excision margins) at operation, and recurrences appeared early. This data should be considered in the future management policy of OSCC in Sri-Lanka.

Influence of Educational Level, Stage, and Histological Type on Survival of Oral Cancer in a Brazilian Population: A Retrospective Study of 10 Years Observation

The mortality rate associated with oral cancer is estimated at approximately 12,300 deaths per year, and the survival rate is only 40% to 50% for diagnosed patients and is closely related to the duration of time between disease perception and its diagnosis and treatment. Socioeconomic risk factors are determinants of the incidence and mortality related to oral cancer. We conducted a retrospective, cross-sectional study of 573 records of patients with oral cancer at Haroldo Juaçaba Hospital - Cancer Institute of Ceará from 2000 to 2009 to evaluate the influence of socioeconomic factors on survival and epidemiological behavior of this neoplasia in a Brazilian population. In this study, patients with oral cancer were males greater than 60 years of age, presented squamous cell carcinoma in the floor of mouth and were characterized by low education levels. A total of 573 lesions were found in oral cavities. Cox proportional hazards regression model showed that the histological type, tumor stage, and low degree of education significantly influenced survival. A lower patient survival rate was correlated with a more advanced stage of disease and a worse prognosis. Squamous cell carcinoma is associated with a higher mortality when compared with other histological types of malign neoplasia.

Etiologic factors associated with oral squamous cell carcinoma in non-smokers and non-alcoholic drinkers: a brief approach

Oral squamous cell carcinoma (OSCC) is the fifth most common type of cancer in the world. The effect of some etiological factors is well established in the literature, such as consumption of tobacco and alcohol. However, approximately 15 to 20% of all oral cancer cases occur in patients without the traditional risk factors, reflecting in numerous cases of OSCC in non-smokers and non-alcoholic drinkers. Also, several studies have suggested a possible association between human papillomavirus and OSCC. Under these aspects, the purpose of this study is to address cases of oral cancer in non-smokers and non-drinkers focusing on the role of HPV, thus contributing to improve the diagnosis and monitoring of OSCC. A computer database search was performed using the Pubmed database. The search key words were: epidemiology, oral squamous cell carcinoma, risk factors and human papillomavirus. It is important to assess patients without the potential risk factors, since this knowledge may help identifying other features associated with the occurrence of oral cancer, enabling an appropriate clinical management and monitoring.