Dysplasia and Oral Cancer Epidemiology

Question 1

What are the 2 distinct patterns of disease in Oral Cancer?

Answer 1

Oral Cavity Cancer

Oro-pharyngeal cancer

Question 2

What was the aim of the INHANCE report?
(International Head and Neck Cancer Epidemiology Consortium)

Answer 2

Investigating the risk factors for head and neck cancer including (separately) oral cavity and oropharyngeal cancer subsites

Question 3

What is the incidence of OCC?

Answer 3

2.5 per 100,000

Male to female 2:1

Question 4

Why is the incidence of OCC decreasing in men and increasing in females?

Answer 4

Due to reduction in smoking in men

Question 5

What are the risk sites for OCC?

Answer 5

Floor of the mouth
Lateral border of the tongue
Retromolar regions
Soft and hard palate
Gingivae
Buccal mucosa

-> most common in tongue/tonsillar area but can occur anywhere in the oral cavity so do not ignore areas

Question 6

Which sites are more predisposed to developing squamous cell carcinoma in people who smoke and drink?

Answer 6

Floor of the mouth

Lateral border of tongue

Soft palate

Question 7

What is the incidence of OPC?

Answer 7

1.4 per 100,000

Male to female 4.8:1

Question 8

What are the rising rates of OPC thought to be linked to?

Answer 8

HPV epidemic

Question 9

What are the risk factors for Oral Cancer

Answer 9

Smoking- 2x risk

Drinking (3-4 drinks per day)- 2x risk

Smoking and drinking in combination- 5x risk
-> risk increases with frequency and duration

Betel quid- 3x risk

Low socio-economic status- 2x risk

Question 10

What aspects of the smoking habit have an impact on oral cancer risk?

Answer 10

Increases with quantity, duration and frequency of tobacco use

Fewer cigarettes for longer duration worse than high number, short term

Question 11

What cancer does smoking carrying a greater risk for?

Answer 11

Laryngeal Cancer

Question 12

Why is drinks per day measured when analysing alcohol use as a risk for oral cancer?

Answer 12

As frequency is more of a risk than duration

Question 13

What are the reasons for socioeconomic status increasing risk of Oral cancer?

Answer 13

More likely to smoke and drink

Poor diet

Low educational attainment

Question 14

What are examples of risk factors thought to be linked to oral cancer but not yet proven?

Answer 14

Family Hx

Sexual Activity- slight increased risk for oropharyngeal cancer with:
-> six or more lifetime sexual partners
-> four or more lifetime oral sex partners (HPV)
-> early age (<18 years) of sexual debut (INHANCE)

Poor OH

Question 15

When do people who smoke start to see benefits or their risk of Oral cancer reduce?

Answer 15

Benefits start to occur 1-4 years later

-> It takes 20 years of quitting to reach same level of cancer risk as someone who has never smoked

Question 16

How long does it take to see benefits of quitting heavy alcohol consumption take to reveal themselves?

Answer 16

Benefits emerge 20 years later

Question 17

If patient willing to give up smoking or drinking, what should be encouraged most and why?

Answer 17

In short term if patient prepared to quit smoking or drinking- oral cancer risk reduced quickest by stopping smoking
 Still encourage both
 Smoking prevention is more important when only limited health education message can be conveyed

Question 18

What dietary factors reduce the risk of Oral Cancer?

Answer 18

Increasing intake of fresh fruit and veg can reduce risk of oral cancer by half

Question 19

What is interesting about the link between obesity and oral cancer?

Answer 19

Obesity was not associated with an increased oral cancer risk
-> in young people (aged 30-years or less) oral cancer was more likely in those who self-reported a low body mass index (BMI)

Question 20

How can the risk of oral cancer in low socioeconomic status be mediated?

Answer 20

Fixed by policy not medicine
 Be aware when considering public health
 Policy is best way to improve poverty