Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge

Oral cancer prevention and early detection: knowledge, practices, and opinions of oral health care providers in New York State

BACKGROUND

The purpose of this study was to assess the knowledge, practices, and opinions of dentists and dental hygienists in New York State regarding oral cancer prevention and early detection.

METHOD

We sent questionnaires to a stratified random sample of dentists and dental hygienists selected from a list of licensed oral health care providers in New York State. We analyzed responses to the questionnaires, and we derived descriptive statistics.

RESULTS

The effective response rate was 55% and 65% among dentists and dental hygienists, respectively. About 85% of dentists and 78% of dental hygienists reported providing annual oral cancer examination to their patients aged 40 and above. Although a majority assessed tobacco use, fewer practitioners assessed alcohol use. Both dentists and dental hygienists lacked knowledge in some aspects of risk factors, signs, and symptoms of oral cancer. However, dentists had significantly higher knowledge scores than dental hygienists.

CONCLUSION

Dentists and dental hygienists in New York State are knowledgeable about oral cancer, but there are gaps in the knowledge of certain risk factors and in the oral cancer examination technique.

North Carolina dental hygienists' oral cancer knowledge and opinions: implications for education

BACKGROUND

Appropriately trained dental hygienists can participate in oral cancer (OC) control.

METHOD

We assessed knowledge of risk factors, diagnostic procedures, and opinions regarding OC education among 651 dental hygienists practicing in North Carolina using a mail survey. We constructed regression models of factors influencing high knowledge levels.

RESULTS

Most correctly identified tobacco and alcohol use as OC risk factors, and 52% felt their knowledge of OC was current; however, we identified gaps. Diagnostic knowledge was highest for those who were recent graduates or received continuing education in the last 5 years; 96% were interested in future continuing education.

CONCLUSION

Increased OC education content in dental hygiene curricula and training programs for practicing hygienists is needed to enhance early detection of OC.

Clinical implications of continued alcohol consumption after diagnosis of upper aerodigestive tract cancer

AIMS

To examine clinical implications of findings on the relationship between continued alcohol consumption in patients after diagnosis and treatment of upper aerodigestive tract cancer.

METHODS

Clinical research literature on the prevalence and effects of alcohol consumption after oral cancer diagnosis was reviewed. Since limited research is currently available on this important clinical topic, all published studies were considered regardless of size and methodology.

RESULTS

Between 34 and 57% of oral cancer patients continue to drink alcohol after cancer diagnosis. Continued drinking increases complications from surgery, increases the likelihood of recurrent cancer, and reduces disease-specific survival. Older patients and those with a longer and heavier drinking pattern prior to diagnosis are more likely to continue drinking after diagnosis.

CONCLUSIONS

Findings indicate that routine alcohol screening of newly diagnosed oral cancer patients as well as brief intervention and/or treatment referral is warranted. Monitoring of alcohol consumption for the first year after diagnosis and treatment is recommended.

Phenotypic alterations in Rb pathway have more prognostic influence than p53 pathway proteins in oral carcinoma

The two well-defined pathways that are shown to be prominently altered in a variety of cancers are the cell cycle regulatory pathways led by either p53 or Rb genes. The present study is undertaken to find the pathway that is more altered in oral carcinoma at protein level, with special emphasis on its prognostic significance. The expression pattern of key molecules of the Rb and p53 pathways, such as Rb, cyclin D1, CDK4, p16, p53, p21 and Bcl-2 and the proliferative marker PCNA were analysed in 348 oral carcinoma specimens by immunohistochemical technique. The expression index of these molecules and various clinicopathological factors were statistically correlated with treatment end points to assess its prognostic efficacy after following up these patients up to a maximum of 48 months with a median of 23 months. Rb pathway proteins, Rb (P=0.016), cyclin D1 (P=0.0001) and p16 (P=0.012) showed significant association with disease-free survival, and p16 (P=0.041) and cyclin D1 (P=<0.0001) with the overall survival. Among p53 pathway proteins studied, only p53 expression index showed association with both disease-free survival and overall survival. Multivariate analyses confirmed that the biological variables, cyclin D1 and p16 and the clinical variable, 'stage of disease' were independent predictors of disease-free survival and overall survival. Subgrouping of the patients on the basis of p16 and cyclin D1 expression revealed that the subgroup having downregulation of p16 and overexpression of cyclin D1 exhibited the worst disease-free survival and overall survival compared to the other subgroups. The present data showed that disabling of the Rb and p53 pathways were frequent events in oral carcinoma. The study also demonstrated that the Rb pathway proteins are comparatively more important than p53 pathway proteins for the prognostication of oral carcinoma patients. The combined evaluation of p16 and cyclin D1 in oral carcinoma could identify a group of patients with the worst survival who might therefore need alternate or more intense treatment strategies.

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.

Immunohistochemical analysis of EGFR and HER-2 in patients with metastatic squamous cell carcinoma of the skin

BACKGROUND

Metastatic squamous cell carcinoma (SCC) of the skin often raise difficult therapeutic problems. Few data are available about the expression of EGFR and HER-2 in SCC of the skin. Overexpression of EGFR and of HER-2 proteins has been reported. The purpose of this study was to investigate the expression of EGFR and HER-2 in a series of metastatic SCC of the skin.

PATIENTS AND METHODS

EGFR and HER-2 expression was studied by immunochemistry on 13 specimens of metastatic recurrence and on 2 primary lesions of these tumours.

RESULTS

EGFR had a strong membranous expression in all specimens. HER-2 was weakly expressed in 4 specimens, with a membrane expression in 2 cases.

CONCLUSION

In the present study, EGFR was overexpressed in all samples of metastatic SCCs of the skin. Therefore, these metastatic tumours appear to be suitable targets for treatment with tyrosine kinase inhibitors. Additional studies are warranted to establish whether or not HER-2 is expressed in SCC of the skin.

Tobacco attitudes, practices, and behaviors: A survey of dentists participating in managed care

Tobacco cessation knowledge, attitudes, and behaviors of dentists participating in a large national managed care dental plan were assessed using a mailed survey. The survey was administered to dentists recruited to participate in an evaluation of a CD-ROM and supportive electronic detailing to promote increased tobacco cessation activities. General dentists who met specific technological criteria, had an active E-mail account, and at least 200 adult patients were eligible to participate in this study. A total of 184 dentists, located in 29 states, agreed to participate. The survey instrument included questions that addressed (a) Ask, Advise, Assess, Assist, and Arrange behaviors, (b) self-efficacy including knowledge, confidence, and success regarding tobacco cessation, (c) success of various tobacco cessation strategies, (d) barriers to tobacco cessation, and (e) demographics including year of graduation, gender, and race/ethnicity. Self-reported baseline tobacco intervention-related behaviors were low, with 28% of dentists reporting that they asked their patients about tobacco or recorded tobacco use in their patients' charts at least 41% of the time. For Advise behavior, approximately half of the dentists advised tobacco-using patients to quit at least 41% of the time. Although self-reported lack of knowledge was high, 71% of respondents indicated that their lack of knowledge was either not a barrier or a slight barrier to incorporating tobacco cessation into their practices. The survey revealed that dentists do not routinely incorporate tobacco cessation into their practices. Newer information-transfer technologies may serve as vehicles for increased smoking cessation activities by dentists.

Oral cancer: leukoplakia and squamous cell carcinoma

This article reviews the epidemiology, etiologic risk factors, clinical presentation, recognition, and diagnosis of oral precancer and cancer. The actual treatment and complications from treatment of oral cancer are discussed only briefly.

Loss of heterozygosity at 9q33 and hypermethylation of the DBCCR1 gene in oral squamous cell carcinoma

The DBCCR1 gene at chromosome 9q33 has been identified as a candidate tumour suppressor, which is frequently targeted by promoter hypermethylation in bladder cancer. Here, we studied the possible involvement of DBCCR1 in the development of oral squamous cell carcinoma. DNA from 34 tumours was examined for loss of heterozygosity (LOH) at three markers surrounding DBCCR1 and for hypermethylation of the DBCCR1 promoter, using methylation-specific PCR and methylation-specific melting-curve analysis. LOH was found in 10 of 31 cases (32%), and DBCCR1 hypermethylation was present in 15 of 34 cases (44%). Hypermethylation of DBCCR1 was also present in three of seven epithelial tissues adjacent to the tumours, including two hyperplastic and one histologically normal epithelia. Furthermore, of four oral leukoplakias with dysplasia, one showed LOH at 9q33 and two showed DBCCR1 hypermethylation. These data suggest that LOH at 9q33 and hypermethylation of the DBCCR1 promoter are frequent and possibly early events in oral malignant development.

Analysis of 587 cases of oral squamous cell carcinoma in northern Thailand with a focus on young people

The increasing incidence of oral squamous cell carcinoma (SCC) especially among younger people has been observed in many parts of the world. The objective of this study was to delineate the profile of patients with oral SCC with an emphasis on younger people in northern Thailand between 1991-2000. The medical records of 587 (median age 65, male-to-female ratio 1:3:1) patients presenting oral SCC were reviewed, with details of demographic data, staging, histological grading, treatment modality and risk factor profile being collated in detail. Seventy-five patients (12.8%) were 45 years of age or below (median age, 39 years). Most patients regardless of age had stage IV disease (56.2%). The most common histological gradings were well or moderately differentiated SCC (79.4%). The most common site regardless was tongue (42.8%). Most patients (79.4%) received treatments with either radiotherapy alone or a combination of surgery and radiotherapy. 64.4% of patients (87.2%) did not have a familial history of cancer. Collectively this data indicates that oral SCC remains a constant problem to the northern Thai population. In addition, the occurrence of oral SCC in young people is relatively high. Therefore, it is recommended that prevention of oral SCC with early detection, early treatment intervention, and withdrawal from risk habits are important factors for improving the wellbeing of these people.

Assessment of reading level and content adequacy of oral cancer educational materials from USAF dental clinics

BACKGROUND

The threat of oral cancer has generated growing concern among the military health community that its beneficiaries have access to appropriate printed health materials. This study addresses the reading level and content adequacy of printed oral cancer literature collected from 82 United States Air Force (USAF) dental clinics.

METHODS

Materials were subjected to a readability formula and information content analysis.

RESULTS

Readability ranged from 7th to 13th grade, consistent with the lowest grade level (high school) required for USAF personnel. Adequacy of the content of materials was highly variable.

CONCLUSION

Few oral cancer items were retrieved, most were old, and many included misleading or incorrect information.

Oral cancer information in health education textbooks

BACKGROUND

Previous studies have reported a lack of knowledge and misinformation about oral cancer, its risk factors, and preventive methods among the general public. This study evaluated the quality, completeness, and accuracy of oral cancer information in 26 health education (elementary to high school) textbooks.

METHODS

Twenty-six health education textbooks were purchased and evaluated.

RESULTS

A deficiency in the amount, accuracy, and quality of oral cancer information in grade school and high school textbooks was evident.

CONCLUSION

Current health texts do not provide adequate information to educate future adults about oral cancer prevention and early detection.

Coverage and quality of oral cancer information in selected popular press: May 1998 to July 2003

OBJECTIVES

A 1998 study demonstrated a lack of coverage about oral cancer in the popular press between April 1987 and April 1997. Since that study, several oral cancer-related activities took place, many of which could have increased the media's attention to oral cancer. Therefore, this study analyzed coverage and quality of oral cancer information in selected popular press between May 1998 and July 2003.

METHODS

Articles from magazines and newspapers were retrieved from three databases and were analyzed by specific topics and subtopics for adequacy of content and accuracy of information. Articles were categorized as either "primarily oral cancer-related" or "primarily tobacco-related."

RESULTS

Sixty articles were identified, 39 of which were included in the analysis (14 magazines; 25 newspapers). Seventeen articles were "primarily oral cancer-related," and 22 were "primarily tobacco-related." Seventy-two percent of the articles mentioned at least one risk factor for oral cancer, the most common being tobacco use (69%). Far fewer articles noted alcohol (10%) or the combined use of tobacco and alcohol (5%) as risk factors. Only 8 percent of the articles recommended an oral cancer examination.

CONCLUSION

Despite local and limited national efforts and activities aimed at increasing public awareness of oral cancer, the popular press coverage of those activities was minimal or nonexistent.

Development of the Bowman-Birk inhibitor for oral cancer chemoprevention and analysis of Neu immunohistochemical staining intensity with Bowman-Birk inhibitor concentrate treatment

OBJECTIVES/HYPOTHESIS

Cancer chemoprevention is a rapidly evolving approach to reverse or inhibit carcinogenesis, and there is active interest in development of effective chemopreventive agents against head and neck cancers. The retinoids are archetypal chemopreventive agents for oral premalignant lesions. They have significant clinical effect, but widespread use is limited by significant clinical toxicity. The Bowman-Birk Inhibitor is one of several nontoxic compounds exhibiting both potent anticarcinogenic activity and minimal toxicity. The purposes of the study were to summarize the preclinical and clinical development of Bowman-Birk Inhibitor and a Bowman-Birk Inhibitor concentrate against oral premalignant lesions and to evaluate Neu immunohistochemical staining intensity for lesions and simultaneously obtained biopsy specimens of normal-appearing mucosa from the Phase IIa Bowman-Birk Inhibitor concentrate oral leukoplakia chemoprevention trial.

STUDY DESIGN

Part I is a selected literature review. Part II is a retrospective analysis of pathological specimens prospectively obtained from the Phase IIa clinical trial of Bowman-Birk Inhibitor concentrate.

METHODS

Thirty-two sets of biopsy specimens from lesions and uninvolved oral mucosa before and after treatment with Bowman-Birk Inhibitor concentrate in doses ranging from 200 to 1066 chymotrypsin inhibitory units were examined in blinded fashion for Neu immunohistochemical staining intensity using the 3B-5 monoclonal antibody. Staining intensity scores among the lesion and control biopsy specimens before and after Bowman-Birk Inhibitor concentrate treatment were analyzed and compared with previously obtained values for serum Neu, oral mucosal cell Neu, protease activity, and clinical response to treatment.

RESULTS

Mean Neu staining score was significantly higher in lesions compared with uninvolved mucosa (P <.001). Pretreatment staining scores for biopsy specimens of lesions and control biopsy specimens of normal-appearing tissues were correlated (Spearman correlation coefficient [r] = 0.375, P =.045), but no correlation between lesion and control biopsy specimen scores was evident after treatment. The change in Neu staining score with Bowman-Birk Inhibitor concentrate treatment in control site biopsy specimens demonstrated an inverse relationship of change in lesion area with Bowman-Birk Inhibitor concentrate treatment (Spearman r = -0.493, P <.007).

CONCLUSION

Bowman-Birk Inhibitor concentrate shows promise to become an effective nontoxic chemopreventive agent based on results of extensive preclinical studies, and Phase I and Phase IIa clinical trials. Bowman-Birk Inhibitor concentrate has dose-related clinical activity against oral leukoplakia and modulates levels of Neu and protease activity. The current investigation identified increased Neu staining intensity in hyperplastic lesions compared with simultaneously obtained biopsy specimens of normal-appearing mucosa both before and after Bowman-Birk Inhibitor concentrate treatment. This finding supports prior observations that increased Neu expression is present in a subset of oral premalignant lesions and head and neck cancers. The trend of increased Neu staining score in control biopsy tissues of subjects exhibiting decreased lesion area following Bowman-Birk Inhibitor concentrate treatment raises questions about the mechanisms of Bowman-Birk Inhibitor concentrate action. One possible explanation is that Bowman-Birk Inhibitor stabilizes the extracellular domain of Neu, thereby preventing receptor truncation and internalization. Further study of modulation of Neu and protease activity by Bowman-Birk Inhibitor concentrate treatment may provide insights into the role of proteases and protease inhibitors in oral premalignant lesions and the mechanisms underlying Bowman-Birk Inhibitor concentrate effects. A Phase IIb randomized, placebo-controlled clinical trial to determine the clinical effectiveness of Bowman-Birk Inhibitor concentrate and further evaluate these candidate biomarkers is under way.

Use of skin and oral cancer examinations in the United States, 1998

BACKGROUND

Findings from previous surveys suggest low utilization of oral cancer examinations, even though this examination is noninvasive. The purpose of this analysis is to compare the use of an oral cancer examination (OCE) and a skin cancer examination (SCE) in the past 12 months within the United States. Both exams are noninvasive and include a visual component.

METHODS

Weighted data from the Adult Prevention Supplement of the 1998 National Health Interview Survey (NHIS) for adults 40 years of age or older were analyzed using SAS and SUDAAN. A ratio compared the percentage reporting an OCE (%OCE) with the percentage reporting a SCE (%SCE).

RESULTS

The percentage having an OCE in the past year (13.8%) was very similar to the percentage having a SCE (13.5%) during that same period. With increasing age group, the %OCE/%SCE ratio varied inversely from 1.60 (C.I. 1.42-1.78) among persons 40-49 years to 0.62 (C.I. 0.55-0.69) among persons 70+ years. The ratio was similar in whites and blacks, males and females, and Hispanics and non-Hispanics. There was a positive gradient in the ratio by education and family income.

CONCLUSIONS

Overall, less than 15% of the population is receiving either of these examinations, although the American Cancer Society recommends both of them on an annual basis for individuals 40 years of age and older. To increase detection of these cancers at early stages, extensive educational and media campaigns for the public and providers identifying risk factors and the availability of and the need for these examinations are required.

Disparities in risk of and survival from oropharyngeal squamous cell carcinoma

BACKGROUND

Oropharyngeal cancer has a low 5-year survival rate in the United States, indicating that much remains to be learned about risk and survival factors. The purpose of this research was to identify factors that contribute to risk of and survival from this disease in a region associated with high tobacco use.

METHODS

A retrospective chart review of 221 subjects with diagnosis of head and neck cancer at a regional University Medical Center during a 10-year period (1986 to 1995) was performed to identify relationships between risk and survival factors of oropharyngeal squamous cell carcinoma (OSCC). Data from 92 records met the inclusion criteria and were analyzed with the chi(2) test of association, the Fisher exact test, and the log-rank test for comparison of survival distributions. The software used was SAS for Windows, release 8.2.

RESULTS

Most study subjects were white men between the ages of 50 and 75 years who chronically used tobacco and alcohol. The overall median survival period of the group was 18.1 months. The percentage of subjects surviving to 3 years was 35.6%. Disparities were identified in risk and survival by sex, race, age, dwelling, anatomic site, and exposure to carcinogenic substances. In particular, the disease more adversely affected minorities and those who chronically used tobacco or alcohol.

CONCLUSIONS

Our results show that, in the examined regional population, a high prevalence of tobacco use correlated with alcohol use and a lower rate of survival from OSCC than the national rate. Also, risk of and survival from OSCC are affected by demographic, geographic, and behavioral factors. This information is useful for the design and implementation of more effective preventive and intervention strategies.

Oral cancer examinations among U.S. Hispanics in 1998

BACKGROUND

An oral cancer examination (OCE) is crucial for early detection of oral and pharyngeal cancers. The objectives of this study were: 1) to estimate the percentages of Hispanics and Hispanic subgroups who reported having an OCE in the past 12 months; 2) to compare these groups with various Non-Hispanics; and 3) to evaluate the extents to which having an OCE might be explained by age, gender, education, family income, a recent visit to a dentist, and edentulism.

METHODS

Descriptive and logistic regression analyses using data from the 1998 National Health Interview Survey.

RESULTS

6.4% of Hispanics and 14.5% of non-Hispanics had had an OCE in the past 12 months. After adjusting for age, gender, education, income, a dental visit, and edentulism, Hispanics were 1.7 times less likely than non-Hispanics to have had an OCE in the past 12 months.

CONCLUSIONS

Fewer Hispanics are receiving OCEs relative to Non-Hispanics.