Disparities in Oral Cancer Stage at Presentation in a High HIV Prevalence Setting In Sub-Saharan Africa

PURPOSE

Oral cancer is the sixth most common cancer worldwide and is the seventh most common in Botswana. Lack of improvement in oral cancer survival despite the availability of multiple treatment options may be due to the high prevalence of advanced stage at presentation. We identified risk factors for presenting with oral cancer at an advanced stage to facilitate interventions to reduce mortality from oral cancers.

METHODS

A retrospective cohort analysis was conducted among individuals with biopsy-confirmed oral cancer at Princess Marina Hospital in Gaborone, Botswana, between 2010 and 2020. Data collected included age at diagnosis, sex, place of residence, HIV status, oral cancer stage, and oral subsite. Multivariable analyses were controlled for age, sex, district of residence, and oral subsite.

RESULTS

Of the 218 records analyzed, 79% were male, 58% were HIV-positive, the median age was 56 years (interquartile range: 47-63), and 67% presented with advanced-stage disease. Cancers from hidden oral sites were more likely to present at an advanced stage with an adjusted odds ratio (OR) of 2.98 (95% CI, 1.29 to 6.89; P = .01). Residence in socioeconomically disadvantaged districts was associated with higher likelihood (OR, 2.36; 95% CI, 1.28 to 4.39; P = .01) of advanced stage presentation compared with other districts. HIV infection was not associated with risk of advanced lesion presentation (OR, 1; 95% CI, 0.61 to 1.61; P = .97).

CONCLUSION

Hidden oral cancer sites and residence in districts with limited access to care were risk factors for advanced oral cancer at the time of diagnosis in Botswana. These findings support a need to increase efforts to improve access to care and increase oral cancer awareness to decrease the burden of advanced oral cancer.

Factors Associated With Oral Cancer Adverse Outcome at the Rwanda Military Hospital, a Retrospective Cross-Sectional Study

Oral cancer (OC) is one of the most common cancers that remain global public health concerns in low- and middle-income countries. The epidemiology of OC in Africa endures uncertain. Earlier reports suggested a relatively low incidence of OC among Africans. Acting on behavioral factors and setting early diagnosis and treatments of OC can tremendously reduce morbidity and mortality related to it. This study determined factors associated with the OC adverse outcome and death in the Rwanda Military Hospital. A cross-sectional study was conducted among 311 medical records of patients who consulted in the Oral and Maxilla Facial Department between January 1, 2007 and December 31, 2019. Associated factors were estimated by use of odds ratios (OR) with their 95% confidence intervals (CI) in bivariate and multivariate logistic regression analyses to estimate predictors of an OC adverse outcome and death. Almost three quarters of the participants were from rural areas (n = 229, 73.6%) and alcohol users (n = 247, 79.1%). Concerning primary site infection, 54.02% of the participants had the intra-oral cavity within the past 5 years. Muslims had greater odds to experience an OC adverse outcome and death [aOR = 6.7; 95% CI (3.8–11.9), p < 0.001] than the Catholics. Those with no formal education significantly had greater likelihoods to have an OC adverse outcome and death [aOR = 2.6; 95% CI (1.3–5.3), p = 0.005] than those with higher education or university. Those with primary education had greater likelihoods [aOR = 1.8; 95% CI (1.1–3.1), p = 0.03] to have an OC adverse outcome than those with higher or university education. Those with oral hygiene had less risk to have an OC adverse outcome and death [aOR = 0.2; 95% CI (0.0–0.9), p = 0.039] than their counterparts. Using multi-sectorial approaches, including policy makers, clinicians, and researchers from public and private institutions, may be of an added value to promote clinical research on OC for earning knowledge, contributing to combat risk behaviors and improve the population's information and education on OC prevention.

Re-Emphasizing the Roles of General Medical and Dental Practitioners Regarding Oral Cancer Eradication in Nigeria

The burden of oral cancer in Nigeria is largely under-reported. The available data on oral cancer etiology/risk factors, clinical features, disease burden, and literacy rate in Nigeria points towards a possible explosion in prevalence in the near future, which poses a serious public health concern. The general medical and dental practitioners (GMDPs) in Nigeria can salvage this looming problem through appropriate public health and clinical interventions. This narrative review article re-emphasizes the key roles of GMDPs towards oral cancer eradication in Nigeria. It also discusses oral cancer case definition, etiology, risk factors, and the epidemiological burden in the Nigerian context.

Prevalence of Oral Mucosal Lesions and Relation to Serum Cotinine Levels-Findings from a Cross-Sectional Study in South Africa

Oral mucosal lesions (OML) can decrease oral health-related quality of life and some have the potential to become malignant. The aim of the present study was to report the prevalence of OML in relation to age, sex, and serum cotinine levels in a population with mixed ancestry from South Africa. This study is part of the Cape Town Vascular and Metabolic Health (VHM) study, conducted between 2014-2016. Trained dental examiners assessed the oral mucosa for the presence of OML according to WHO criteria. In total, 1976 individuals were included in the study, being 1496 females (75.7%) and 480 males (24.3%) with average age of 49.5 years (SD = 15.3). In total, 262 lesions were detected in 252 participants (overall prevalence of 13%). Males had higher prevalence than females (14% vs. 9%, p = 0.008). Participants aged 25-34 had the highest prevalence rates (21%). Participants who had cotinine ≥15 ng/mL had higher prevalence of OML as compared to those with <15 ng/mL (15% vs. 5%, p < 0.001). Most common lesions were nicotine stomatitis (33%) and leukoplakia (19%). Age, male sex, and higher cotinine levels were associated with increased prevalence of OML.

Prevalence and incidence of oral cancer in low- and middle-income countries: A scoping review

INTRODUCTION

Oral cancer is common cancer in many low- and middle-income countries (LMICs) with a low five-year survival rate. It is among the four most common types of cancer in South East Asia region. In South-Central Asia, lip and oral cavity cancer is the second most common cancer according to the specific cancer types.

METHODS

This scoping review intended to investigate published studies on the current prevalence and incidence of oral cancer in LMICs. The review was conducted applying the search words "Oral Cancer" and "Mouth neoplasm" as the Medical Subject Heading (MeSH) major topic and "Epidemiology" and ("prevalence" OR "incidence") as the MeSH subheading; the search was supplemented by cross-references. Included studies met the following criteria: original studies, reporting of prevalence or incidence rates, population-based studies, studies in English language and studies involving humans.

RESULTS

The sample sizes ranged from 486 to 101,761 with 213,572 persons included. Buccal mucosa is one of the most common sites of oral cancer, associated with the widespread exposure to chewing tobacco. The incidence is likely to rise in the region where gutkha, pan masala, pan-tobacco and various other forms of chewing tobacco are popular.

CONCLUSION

This review contributes to useful information on prevalence and incidence estimates of oral cancer in LMICs.