The epidemiology of lip, oral cavity and pharyngeal cancers in Kuwait 1979-1988

Oral Health in the State of Kuwait: An Appraisal

BACKGROUND

Oral health issues have received significant attention from most global health agencies, which have integrated these issues into their noncommunicable disease, sustainable development, and universal health coverage objectives.

METHODS

This paper provides an update on the progress made in the last 2 decades and aims to highlight some of the challenges faced by the oral health care system in Kuwait.

RESULTS

Despite the nation's rising expenditure on oral health care, the prevalence of oral diseases remains high in Kuwait. The lack of reliable data on periodontitis and edentulism limits the ability of researchers to comment on the trends of these conditions. This emphasises the critical need for a nationwide household-level oral health survey in both pediatric and adult populations that would provide valuable information on the oral health status of these populations.

CONCLUSION

In the future, Kuwait must invest more in oral disease prevention programs, especially among children and the high-risk communities of the population.

Estimated projection of oral squamous cell carcinoma annual incidence from twenty years registry data: a retrospective cross-sectional study in Indonesia

Background

The incidence of oral squamous cell carcinoma (OSCC) has not been well documented in Indonesia. Thus, we aimed to analyze trends and clinicopathological profiles of OSCC cases in Indonesia, focusing on differences between age and sex groups.

Methods

A cross-sectional study was conducted in Indonesia's main referral hospital, analyzing 1,093 registered OSCC cases from 2001 to 2020. Trend analysis was performed using Joinpoint regression analysis to determine the annual percentage change (APC) for overall cases and each case group based on age, sex, and anatomical subsites. APC significance was assessed using a Monte Carlo permutation test. The projection of case numbers for the following 5 years (2021-2025) was estimated using linear/non-linear regression analysis and presented as a mathematical function. The significance of the trend slope was measured using an ANOVA test. Demographic and clinicopathological characteristics of OSCC were analyzed according to age and sex, and their comparative analysis was assessed using Chi-square and its alternatives.

Results

The incidence of OSCC in female patients and in the tongue and buccal mucosa showed a positive trend (APC 2.06%; 3.48%; 8.62%, respectively). Moreover, the incidence of OSCC overall, and in women with OSCC, is projected to increase significantly in the next 5 years following the quadratic model. The mean age of patients was 51.09 ± 14.36 years, with male patients being younger than female patients. The male-to-female ratio was 1.15, and 36.5% of these patients were categorized as young (≤45 years old). The tongue was the predominantly affected site. Prominent pathologic characteristics included well-differentiation, keratinization, and grade I of Bryne's (1992) cellular differentiation stage. Most patients presented with advanced staging, lymphovascular invasion, and uninvaded margins. Tumor sites and staging varied according to age, while age and tumor sites differed between sexes.

Conclusion

The rising incidence trends of OSCC among Indonesian patients, both in the past and projected future, are concerning and warrant attention. Further research into risk factors should be conducted as preventive measures.

Oral Cancer Knowledge, Attitudes and Practices among Primary Oral Health Care Dentists in Kuwait

Background: Oral cancer signifies a public health concern of international importance. Early detection of oral cancer can improve the prognosis and the 5-year survival rate. Objective: The aim of this study was to assess the level of oral cancer knowledge, opinion, attitudes and practices among dentists working at the primary oral health care centers in Kuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the dentists working at the primary oral health care centers in Kuwait. A total of 289 dentists participated in the present study. The questionnaire included 23- questions on oral cancer knowledge, opinion, attitudes and practices. Results: The mean age of the dentists was 35.2 ± 10.9 years. Approximately, all dentists (99.7%) were aware of the major risk factors that were most likely associated with oral cancer. Overall, majority of the participants knew the most common form of oral cancer (80.6%), most common site (80.3%) and the likely lesions associated with oral cancer occurrence (87.9%). A large number of dental practitioners (81%) would routinely refer a patient with a suspicious lesion to a specialist. Nearly one-third (32%) reviewed their patients’ oral cancer risk factors. Approximately two-thirds (62%) assessed the use of tobacco in their practice. Almost, all (92.4%) were interested in attending continuing education courses on oral cancer. Conclusions: Majority of the participants presented good knowledge about various aspects of oral cancer. More continuing education programs on risk factors and diagnosis of oral cancer should be organized to train the dentists. Oral cancer screening should be a routine procedure for the high risk patients at the primary oral health care centers in Kuwait.

Oral Cancer Screening among Smokers and Nonsmokers

Aims and Objectives:

The aim of visual systematic screening is early identification of oral cancer (OC) precursor lesion. OC mortality improves when cancer is identified at early stages. This is important in patients whose lifestyle choices render them at higher risk of developing OC. This study described the prevalence of OC screening among smokers and nonsmokers in Kuwait and ascertained demographic predictors.

Materials and Methods:

This cross-sectional study utilized a self-administered online survey in English and Arabic through Survey Monkey^® and disseminated using the social networking app “WhatsApp.” The survey included 21 questions on demographics, smoking status, and knowledge of OC. Screening questions were adopted from the Maryland Cancer Screening and Risk Behavior Survey. Data were analyzed using the computer software “Statistical Package for Social Sciences, SPSS version 24.0” (IBM Corp, Armonk, NY, USA).

Results:

The study included 404 Kuwaiti respondents, 311 (77%) nonsmokers and 93 (23%) smokers. Prevalence of OC screening was 7.2, 7.7% among nonsmokers and 5.4% in smokers. Only 36.6% were aware of OC, with more nonsmokers (38.9%) than smokers (29%). Logistic regression revealed twice more males likely to go for screening than females and with the likelihood of those being in the age group of 25–44 years four times more (P < 0.012) than other age groups.

Conclusion:

There was low prevalence of screening and poor awareness of OC among sampled. Increased efforts are needed by health professionals to spread awareness and improve knowledge on OC and demand the inclusion of screening during their routine and opportunistic oral examinations.

Awareness of Mouth Cancer Among Adult Dental Patients Attending the Kuwait University Dental School Clinic

In Kuwait, the age-standardized incidence rate (per 100,000) for oral cancer is 1.5 and the mortality rate is 0.4. Early detection of oral cancer combined with appropriate treatment greatly improves the chances of cure and the quality of life. However, little is known about patient awareness of this disease and the ability to identify early signs, particularly among high-risk groups. Hence, the aim of this study is to assess dental patients' awareness and knowledge of mouth cancer and beliefs and perceptions about risk factors. A self-administered questionnaire was used to collect information from a convenience sample of outpatients attending the dental admission clinic. The questionnaire included questions to ascertain information on socio-demographic characteristics, knowledge of risk factors, and signs of oral cancer as well as sources of information regarding the same. Data were analyzed using the Statistical Package for the Social Sciences for Windows 19.0. A total of 160 questionnaires were distributed out of which 136 completed questionnaires were returned and used for the study. The mean knowledge score for oral cancer risk factors was found to be 5.2 ± 2.7 out of ten while that of signs and symptoms was 3.4 ± 2.7 out of eight. When the knowledge of risk factors of oral cancer was taken into consideration along with variables, significant difference was seen only in sex with women having better knowledge (p = 0.03). Knowledge about signs and symptoms of oral cancer revealed a highly significant difference with the level of education (p = 0.03). Family, friends, and colleagues were mentioned as the main source of information regarding oral cancer. Our findings suggest that knowledge regarding oral cancer risk factors, signs, and symptoms was found to be lacking among the dental patients which emphasizes the need for patient education at the dental centers as well as public awareness programs.

Malignant Tumors of Tongue in Iranian Population

BACKGROUND

The incidence of oral cancers varies from one country to another, which can be clarified by the difference in the distribution of the risk factors and the possible etiologies. Tongue is a main segment of oral cavity and malignant lesions of this region accounts for nearly 30% of all oral cancers.

OBJECTIVES

In the present study, we evaluated the pattern of tongue cancer in Iranian population and compared these findings with those previously reported in the other countries.

METHODS

In this multicenter, retrospective cross-sectional study recorded cases of the malignant tongue tumors in the cancer research center (CRC) of Shahid Beheshti University of Medical Sciences were extracted. The patient records and their microscopic reports were retrieved from the archives and age, sex and microscopic types were evaluated. It is to be noted that the CRC has been serving as a cancer registry center for major hospitals all over the country since the year of 2003. Thus, the obtained statistics are highly reliable.

RESULTS

During the years 2003 to 2008, a total number of 952 new cases of the tongue cancer were recorded in the CRC. Most cases are diagnosed in the sixth and seventh decades of life. 450 cases (47.2%) occurred in men and 489 cases (51.36%) in women. Four different types of malignant lesions (epithelial, salivary gland, hematopoietic and mesenchymal) were diagnosed. Epithelial tumors were the most prevalent malignancies (93%) of which squamous cell carcinoma (SCC) made up 87.39% of all lesions. Salivary gland tumors had the second place with 3.15% of the total lesions.

CONCLUSIONS

In Iranian population, squamous cell carcinoma is the most prevalent malignancy of tongue and it is notable that the ratio of female to male population was equal. These lesions were prevalent in the sixth and seventh decades of life. Thus screening examination of tongue by dentist especially in elderly patients is necessary for early detection of cancerous lesions.

Oral cancer awareness among dentists in Kuwait

OBJECTIVES

The aim of this study was to assess oral cancer awareness among dentists in Kuwait.

SUBJECTS AND METHODS

A cross-sectional survey was conducted among 200 dentists working at the Ministry of Health Dental Centers and Kuwait University Dental Center using a structured questionnaire. Dentists' knowledge about risk factors of oral cancer and about diagnostic concepts, current practices and opinions, preferred point of referral as well as interest in continuing education were assessed and the responses were analyzed.

RESULTS

Of the 200 dentists surveyed, 153 responded (76.5% response rate). The mean knowledge score of the respondents was 20.6 ± 4.0 out of a total score of 30. Thirty-five (22.9%) dentists had consistently high knowledge scores for both risk factors and diagnostic concepts. Of the 153 dentists, 132 (86.3%) were interested in obtaining further information about oral cancer.

CONCLUSION

This study highlighted the need for improved knowledge and education of dental practitioners on oral cancer.

Primary malignant tumors of orofacial region at Benghazi, Libya: a 17 years review

The aim of this study was to systematically analyze the clinical presentations of orofacial malignant tumors in a Libyan population over a period of 17 years and compare the results with the reports from other countries. During the study period, tumors of epithelial origin were found in 160 patients (82%), followed by tumors of immune system, 22 (11%) and tumors of mesenchymal origin, 14 (7%). Of the total malignant tumors, 115 were men and 81 were women and the male to female ratio was 1.41:1. Malignant non-odontogenic tumors were seen in 194 patients (99%) and malignant odontogenic tumors were seen in 2 patients (1%). Among the epithelial tumors, squamous cell carcinoma (50.6%) was the most common neoplasm, followed by mucoepidermoid carcinoma (15%) and adenoid cystic carcinoma (8.7%). The incidence of oral malignancy is impressively low with respect to the corresponding levels in other countries in Africa and some European countries.

Sociodemographic and etiologic differences of malignant orofacial tumors in Iran

Oral malignant tumors are the sixth most common malignancy in the world, and there is a recent trend of rising incidence of these tumors in young patients. The aim of this study was to compare demographic and etiologic data from young and old patients with orofacial malignant tumors. Data were obtained by retrospective analysis of files of patients with malignant orofacial tumors, who were categorized into 2 groups: the young group (< or = 40 years old) an the older group (> 60 years old). Both younger and older groups showed male predilection (male-female ratio was 1.05:1 and 2.4:1 in the younger and older groups, respectively). Consumption of tobacco and alcohol was reported by 13 young patients (31.7%) and by 45 older patients (62.5%). Tongue was the most common site for older group (37.5%), whereas that for the younger group was the parotid (29.3%). We found that the pattern of malignant orofacial tumors in the young age group was changed, and these tumors can occur in young patients who report no tobacco or alcohol use.

Primary malignant tumors of orofacial origin in Iran

Orofacial malignant tumors are the sixth most common malignancy in the world and, with pharyngeal malignancies, the third most common one in the developing world. This study was carried out to determine the malignant oral primary tumors in Shiraz, southern Iran. From April 2002 to March 2007, all (181) malignant tumors of the orofacial region recorded in Fars Cancer Registry Center of Shiraz University of Medical Sciences in Shiraz, southern Iran, were enrolled. Age range of patients was 4 to 91 years (53.7 +/- 18.6 years), whereas 40% of cases were older than 60 years. Ninety percent were epithelial tumors, 6% sarcomas, and 4% lymphomas. The most common sites were tongue (34.3%) and major salivary glands (32.5%). Squamous cell carcinoma (50.8%) was the most common malignant orofacial tumor. Oral malignant tumors were more common in males than females with an older aged preponderance. The tongue was the most commonly affected site, and squamous cell carcinoma was the most common malignant orofacial tumor. There is an urgent need for a national program focusing on early detection of these tumors. Oral health professionals in Iran should be educated on oral cavity comprehensive examination because of the important role of dentists in early detection of malignant oral tumors.

[Malignant tumors of the oral cavity and neck in clinic of maxillo-facial surgery in Poznań from 2002-2004]

Increasing number of malignant neoplasms of the oral cavity and facial region as well as lower age of the patients hospitalized were the interest of the authors.

MATERIAL AND METHODS

Clinical data from the years 2002-2004 were analysed in this paper. In this study the factors as: sex and age of patients, tumor localization, histological examinations, surgical treatment of the tumor and lymph nodes are reported.

RESULTS

During the 3 years period there were 346 tumors of the oral cavity treated in Clinic of Maxillofacial Surgery in Poznań. Epidemiologic studies have revealed a increased number of squamous cell carcinomas and other malignant tumors as lymphomas, adenoid cystic carcinomas and sarcomas of the oro-facial region. The staging of the tumors is similar as in previous years.

CONCLUSIONS

The study shows better knowledge about oral malignancies in dentists and general praticioners. The tumor patients are surgically treated earlyer as in previous years.

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included chi and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age </=40, 42% in ages 41-64 and 48% >/= age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.

Squamous cell carcinoma of the oral cavity, maxillary antrum and lip in a Zimbabwean population: A descriptive epidemiological study

Squamous cell carcinoma accounts for approximately 90% of oral malignancies. The objective of this study was to document the gender, age, sub-site distribution and histologic differentiation of squamous cell carcinoma of the oral cavity, maxillary antrum and lip in a Zimbabwean population. Hospital records of patients with a histologic diagnosis of squamous cell carcinoma of the oral cavity, maxillary antrum and lip seen at Harare Central Hospital and Parirenyatwa Hospital in Zimbabwe during the period January 1982-December 1991 were reviewed. 20.8% (n = 358/1723) were squamous cell carcinoma of the oral cavity, maxillary antrum and lip. Age ranged from 3 to 70years with a 2:1 male:female ratio. Peak incidence in both sexes were in the 41-50 and 51-60years age groups. Sub-site distribution was mandibular gingiva 18.4%, tongue 17.9%, floor of the mouth 16.2%, maxillary gingiva 9.2%, buccal mucosa 9.2%, maxillary antrum 12.6%, hard palate 7.8%, soft palate 4.8%, lower lip 2.8% and upper lip 1.1%. 64.8% were well differentiated, 24.8% moderately differentiated and 10.4% poorly differentiated. The mandibular gingiva, floor of the mouth and tongue were most commonly affected. Lip squamous cell carcinoma was uncommon. Well-differentiated squamous cell carcinoma was most common in the 41-60 years age group.

Oral malignant neoplasia: a survey of 428 cases in two Zimbabwean hospitals

A review of oral malignant neoplasms biopsies accessioned in the pathology services of Harare Central Hospital and Parirenyatwa Hospital, Harare, Zimbabwe, during the 10year period January 1982 to December 1991 was carried out. Clinical records of 428 patients with histologically diagnosed oral malignant neoplasms by ICD-O type and site (COO.O-CO6.9) were retrieved and analyzed for gender, age, history of tobacco and alcohol usage, neoplastic type and histologic differentiation of squamous cell carcinoma (8000/3). Oral malignant neoplasms constituted 24.8% (n = 428) of the 1723 biopsies accessioned in the department during this period. There was a male to female ratio of 1.9:1, with lesions being most common in the 41-60 year age group. Squamous cell carcinoma, (8070/3) 73.1%, was the predominant oral malignancy most common in the 61-70 year age group with 21.1% on the mandibular gingivae (CO3.1), 20.5% on the tongue (CO1.9-CO2.9), 18.5% on the floor of the mouth (CO4.9) and 10.5% each on the maxillary gingivae (CO3.O) and buccal mucosa (CO6.O). The hard palate (CO5.9) had 9% of the lesions. Lip malignancy (COO-COO.9 and C44.0), inclusive of mucosa of lip, vermilion and skin, constituted 3.3% and minor salivary gland (CO6.9) malignancy (M-8940/3) 4.9%. The remaining oral malignancies, 11%, included Burkitt's lymphoma (M-9687/3) 4.7%; Kaposi's sarcoma (M-9140/3) 3.7%; osteosarcoma (M-9180/3) 2.6% and malignant melanoma (M-8720/3) 1.9%. Fourty five percent of the patients admitted tobacco and alcohol consumption, of whom 95% were males. Oral malignant neoplasms were more common in males than females and occurred in a relatively young age group. Well-differentiated squamous cell carcinoma (M-8070/31) was the most common oral malignant neoplasm and was most frequently found on the mandibular gingivae (CO3.1), tongue (CO1.9-CO2.9) and floor of the mouth (CO4.9). The lip (COO-COO.9) was least affected with a high palatal (CO5.9) involvement.

Nasopharyngeal cancer in the Middle East: experience of the American University of Beirut Medical Center

PURPOSE

To review the data of nasopharyngeal carcinoma (NPC) treated at the American University of Beirut Medical Center and reflect on the characteristics and treatment outcome of NPC in the Middle East compared with those of Western countries and countries in which NPC is endemic.

METHODS AND MATERIALS

Between 1966 and 1998, 151 patients with the diagnosis of NPC received definitive radiotherapy at the American University of Beirut Medical Center. Of the 151 patients, 111 were males (gender ratio, 2.78); the median age was 45 years (range, 11-75 years). Most (95%) patients (n = 144) were Lebanese, 4 were Syrians, and 3 were from the Gulf countries. Most (60%) patients (n = 91) had Stage IV disease, 27% had Stage III, and 13% had Stage I or II disease; nodal disease was present in 117 patients (77%). The pathologic type was predominantly lymphoepithelioma or World Health Organization type III (95 patients, 63%). Treatment consisted of definitive radiotherapy alone for 116 patients (77%). All others received induction chemotherapy, primarily with cisplatin-containing regimens. The median radiation dose was 66 Gy (range, 47-73 Gy) to the primary and 67 Gy (range, 49-85 Gy) to involved neck nodes given at 2 Gy/fraction. The average follow-up was 3.02 years (range, 0.1-24.5 years).

RESULTS

The 5-year and 10-year disease-free survival (DFS) rate was 46%. Using univariate analyses, the following factors significantly affected DFS: node size (<3 vs. 3-6 vs. >6 cm; p = 0.01), node level (upper vs. mid vs. lower neck; p = 0.004), and duration of radiotherapy (p = 0.002). However, T stage, age, gender, radiation dose, use of chemotherapy, and histologic features had no statistically significant influence on DFS. The actuarial rate of local control at 5 and 10 years was 81% and 73%. T stage, N stage, and histologic features were statistically significant variables for local control in the univariate analyses. Using a Cox regression model, N stage (N1-N2 vs. N3; relative risk 2.09, p = 0.004) was identified as an independent variable for DFS, and N stage and pathologic features were identified as independent variables for local control. The actuarial rate of distant metastases was 32% at both 5 and 10 years. Distant metastases were only affected by N stage (upper-mid vs. lower neck; p = 0.004). Six patients (4%) were reported to have Grade 4 late complications.

CONCLUSION

Our results indicate that the characteristics of NPC patients in Lebanon and their parameters of outcome are comparable to those reported in Western series, particularly for the relative frequency and effect of lymphoepithelial histologic type. Because of potential confounding factors, no definite conclusions about induction chemotherapy could be drawn from this retrospective study.

Oral health in Kuwait

This paper reviews oral health in Kuwait, based on all the surveys conducted in the country. In the global perspective, the prevalence of dental caries in Kuwait is high and there is no indication of a decrease, contrary to that observed in most industrialised countries. The periodontal diseases are common, affecting the majority of the population. Oral health promotion needs to be strengthened and a defined strategy should be developed and implemented for the improvement of the quality of life of individuals. Children and disadvantaged groups of the population should be given the priority when focusing on national oral health care efforts.