Oral squamous cell carcinoma among Yemenis: Onset in young age and presentation at advanced stage

Oral cancer knowledge, attitudes, and practices among senior dental students in Yemen: a multi-institution study

BACKGROUND

The "Knowledge, attitude, and practice (KAP)" approach is crucial in health system. Appreciating the current KAP status will reveal the extent of the efficiency of applied health strategies, and subsequently help to determine the appropriate health policy to be employed for improving the health indicators of a given disease/condition, including Oral Cancer (OC). This large-scale cross-sectional study aimed to assess knowledge, attitude, and practice on OC among senior dental students in Yemen.

METHODS

A pre-validated online questionnaire was used for data collection. It consisted of a series of close-ended questions on knowledge, attitudes and practices related to OC. Yemeni dental students in clinical levels (4th and 5th years) from nine dental schools based in four major cities were invited to complete the survey. The SPSS Version 28.0 was used for data analysis. Differences by different grouping factors were assessed by Chi-squared and Mann Whitney-U tests, as appropriate.

RESULTS

A total of 927 students completed the questionnaire: a response rate of 43%. While the majority identified smoking (93.8%), and smokeless tobacco (92.1%) as potential risk factors of OC, only 76.2% recognized sun exposure as a risk factor for lip cancer and only 50% were aware of old age as a risk factor of OC. Regarding clinical signs of OC, 84.1% reported that OC can present as non-healing ulcer, but only two thirds of the participants recognized that OC can present as a white and/or red lesion. With respect to practices, although 92.1% reported asking their patients regarding oral habits, only 78% reported they regularly carry out a soft tissue examination. Only 54.5% of the participants considered themselves to be well-trained to provide smoking cessation advice, and 21% were confident regarding their knowledge on OC. The 5th year students showed significantly better knowledge and practices than the 4th year students did (p < 0.01).

CONCLUSION

The study suggests significant gaps in knowledge, attitudes, and practices of senior dental students in Yemen regarding OC. The findings also underscore the urgent need to improve OC teaching and training of undergraduate dental students, and to provide periodic well-structured continuing professional development activities for dental professionals.

Head and neck squamous cell carcinoma in young patients: a 26-year clinicopathologic retrospective study in a Brazilian specialized center

BACKGROUND

To describe the clinicopathologic profile of young patients with head and neck squamous cell carcinoma (HNSCC) and compare to middle-aged and elderly adults.

MATERIAL AND METHODS

Patients' individual records were reviewed for clinicopathologic data. Eighty-nine patients with age 18-45 years old met the inclusion criteria of the study. Two additional groups of middle-aged (n=89) and old (n=89) adults were set to comparative analysis.

RESULTS

Young patients represented 11.9% of all patients diagnosed with HNSCC. Women were more affected by HNSCC in the young and elder groups (p= 0.04), and young patients were more prone to be non-smokers (p= 0.01) and have lymph node metastasis at the time of diagnosis (p=0.04). In the young group, patients diagnosed with the disease in advanced stages were more prone to have a positive familial history of cancer (p= 0.04), a positive status of alcohol consumption (p= 0.03), and to be heavy drinkers (p= 0.01). Survival was not different for the young group in comparison to the other groups.

CONCLUSIONS

HNSCC in young patients had a different profile when compared to older patients, especially regarding sex and exposure to the classic risk factors for this disease. The survival of the young group is similar to the older groups and advanced clinical stage is predictor of worse survival.

A retrospective institutional study of histopathologic pattern of Oral Squamous Cell Carcinoma (OSCC) in Tehran, Iran during 2006-2015

Background:

Despite the available data on demographic information of oral squamous cell carcinoma (OSCC), the changing trend of histopathologic pattern of OSCC has not conducted yet, in Iran. The aim was to investigate the pattern of histopathologic features of OSCC in Iran by analyzing the patients referred to Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, during 2006-2015.

Materials and Methods:

The study was a retrospective institutional study. The pathology records with the diagnosis of OSCC were retrieved from Iran National Tumor Bank, Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran, during 2006-2015. The demographic characteristics and histopathologic features were recorded and analyzed for possible trend. Descriptive analysis was used for statistical interpretation.

Results:

The data showed an increasing number of moderately and poorly differentiated OSCC. Accordingly, higher increasing rate in tumor size and vascular, perineural invasion was detected.

Conclusion:

On the basis of histopathologic features, moderately differentiated OSCC with increasing rate of tumor size and vascular, perineural invasion was indicated in recent decade. Based on the findings, lower differentiation potentially is compatible with worsen prognosis.

Retrospective analysis of biopsied oral and maxillofacial lesions in South-Western Saudi Arabia

Objectives:

To report the prevalence and types of biopsied oral and maxillofacial lesions (OMLs) in South-Western (Jazan Province) region, Kingdom of Saudi Arabia (KSA).

Methods:

This retrospective study was based on the retrieval of clinicopathological data for a period of 6 years between January 2009 and December 2014. These data were obtained between October 2014 and June 2015 from the histopathology records of King Fahad Central Hospital, Jazan, KSA, which is the only referral center for biopsy services.

Results:

Out of the 32149 biopsies received, 714 (2.2%) were OMLs. The age ranged from 0 (neonatal) to 100 years, with a mean age of 46.8±23.4 and a male-to-female ratio of 1:1.3. The tongue was the most common site for OMLs and for malignant neoplasms, in particular. The most common category was malignant neoplasm (38.7%), followed by inflammatory lesions (16.5%). Oral malignancies accounted for 15.8% of all malignancies. Oral squamous cell carcinoma (OSCC) (36.1%) was the most frequent type, followed by pyogenic granuloma and mucocele (7% each). Shammah-associated OSCC and epithelial dysplasia were twice as common in females.

Conclusion:

The number of non-malignant OMLs was much lower than expected in comparison to oral malignancies. This difference can likely be explained by the fact that the biopsies were taken only when malignancy was suspected. The higher rate of OSCC reported from this region is attributed to shammah usage. This study emphasizes the importance of biopsy services for all OMLs and the prevention of shammah use.

Global incidence of oral and oropharynx cancer in patients younger than 45 years versus older patients: A systematic review

Head and neck squamous cell carcinoma (HNSCC) is typically regarded as a disease of elderly people. However, increasing numbers of patients worldwide with HNSCC at younger age (defined as <45 years old) have been reported in recent years. To assess geographical variations and trends worldwide in incidence of oral and oropharyngeal cancer in young patients, a systematic review was conducted in PubMed and Google scholar databases from 1975 to June 2016. Seventy-eight studies were selected for further study. Nineteen population-based studies on incidence rate were available from 13 countries, showing a prominent increase over time except for the Netherlands. A notable rise of oral (mobile) tongue cancer among white women and oropharyngeal cancer in white men was observed. Data suggest that cancer in young patients may be a distinct clinical entity and characterised by different aetiology and pathogenesis. Additionally, the relative proportion of oral and oropharyngeal cancer in young patients to total incidence revealed a significant difference between estimates from North America (5.5%) and both Africa (17.2%) and Middle East (14.5%). It is concluded that (i) a rising trend in oral and oropharynx cancers is observed in young patients worldwide; (ii) incidence studies should properly define outcomes in age cohorts and use a consensus cut-off for young patients; (iii) more population-based studies should be performed in non-Western regions to get accurate global measures of incidence for these cancers in young subpopulations and (iv) there is an urge to identify new aetiological factors in these young patients.

Epidemiology of oral cancer in Arab countries

Objectives:

To review the oral cancer (OC) studies that were conducted in Arab countries with regard to epidemiology, risk factors, and prognosis.

Methods:

A computer-based PubMed literature search was performed to retrieve studies conducted in the Arab world on epidemiology of OC. After screening for exclusion criteria, cross-referencing, and searching local journals, a total of 19 articles were included.

Results:

Eight prevalence studies found an OC prevalence ranging from 1.8 to 2.13 per 100,000 persons. Oral cancer patients were mostly in their fifth to sixth decade of life, and the incidence in younger age was reported in some Arab countries. Yemenis have an alarming high prevalence of OC among people younger than 45 years. Eleven studies explored determinants or prognosis of OC. Behavioral determinants such as smokeless tobacco (Shamma and Qat), and cigarette smoking were strongly associated with OC. Alcohol drinking and solar radiation exposures were cited as possible risk factors. The most affected sites were tongue, floor of the mouth, and lower lip variations in the affected site were attributed to the socio-cultural behavior of the populations under study. Squamous cell carcinoma was the most frequently detected cancer, and usually patients were in late stages (III and IV) at the time of diagnosis.

Conclusion:

No solid evidence exists regarding the true OC prevalence/incidence in most Arab countries due to the lack of national cancer registries and population-based studies.

Oral cancer in the UAE: a multicenter, retrospective study

AIM

To determine the prevalence of various malignant oral lesions in the UAE and correlate cases of squamous cell carcinomas with age, gender, site, grade, clinical presentations at the time of diagnosis, and the prevalence of neck metastasis.

MATERIALS AND METHODS

A multicenter, retrospective study was conducted at four major hospitals in the UAE. The study was based on histopathology reports of biopsies of oral tissues.

RESULTS

Of the 992 oral biopsy reports retrieved, 147 cases of malignant tumors were found which accounted for 14.9% of the total biopsies. Fifteen different types of malignant lesions were diagnosed, of which oral squamous cell carcinoma (OSCC) was the most prevalent and made up 11.4% of the overall oral biopsies retrieved. The commonest presentation of cancer was ulceration (31.17%), followed by lumps and white lesions. The most common site where the lesions were diagnosed was the tongue (51.9%), followed by the cheeks and lips. OSCC accounted for 77% of all malignancies reported. Neck dissections were conducted in only 20.8% of all OSCC cases diagnosed at Mafraq and Tawam hospitals, of which 43.75% showed evidence of neck metastasis.

CONCLUSION

Oral cancer is not an uncommon disease in the UAE. This may mandate more awareness campaigning, including screening procedures for early detection of cancerous lesions and other potentially malignant oral diseases. Elective neck dissections to detect lymph node metastasis should be more routinely performed, in particular for tongue carcinomas because of the early neck involvement potential.