Oral Health, U.S. 2002 Annual Report
Section 13: ORAL AND PHARYNGEAL CANCER
It is estimated that in the United States approximately 30,000 people are being
diagnosed with and 8,000 deaths are occurring annually from oral and pharyngeal
cancer (Silverman, 2001). Oral cancers currently represent about 3% of all
cancer deaths. The 5-year survival rate for oral and pharyngeal cancers of 52%
is one of the lowest rates among all cancers and has not changed in three
decades (Ries et al., 2001). Oral cancer is one of the most debilitating of all
cancers, with extremely high morbidity resulting from the disease and its
treatment. Treatment modalities generally involve surgery, radiation, or a
combination of the two. Oral cancer therapy is frequently associated with
disfigurement, diminished speech fluency, and inability to eat and swallow,
often resulting in a substantial decrease in quality of life (Shiboski et al.,
2000).
Greater than 90% of oral cancer cases occur after age 45 years, with the average
age at diagnosis about 60 years (Silverman, 1998). In addition, recent
increases in incidence have been observed among individuals less than 40 years
of age, particularly for cancer of the tongue. These increases do not seem to
be associated with known risk factors such as tobacco or with immune
suppression (Shiboski et al., 2000; Silverman, 2001). Oral cancer occurs more
commonly in men than in women and is more frequent among black men than among
white men. Surveillance, Epidemiology, and End Results (SEER) statistics from
1994 to 1998 showed the incidence in males to be 2.6 times that in females
(14.8 per 100,000 compared to 5.8 per 100,000). The rate was highest for black
males (20.5 per 100,000). Among females the rates for whites and blacks were
comparable (6.1 per 100,000 compared to 5.8 per 100,000) (Silverman, 2001).
The vast majority of oral cancers (approximately 75%) are associated with
tobacco and alcohol use. Combined use of both agents significantly increases
the risk of developing oral and pharyngeal cancer. Neither SEER data nor that
of most State Cancer Registries currently track risk factors, such as tobacco
and alcohol use, in recently diagnosed patients, making examination and
monitoring of these factors more difficult.
The majority of oral cancers are squamous cell carcinomas. Cancer of the tongue
is the most frequent site, comprising more than one-fourth of oral cancers
reported to the SEER program from 1973 through 1996 (Shiboski et al., 2000).
Oral cancer survival is highly correlated with stage at diagnosis. Most oral
cancers are currently diagnosed in advanced stages, decreasing probability of
survival and increasing treatment morbidity. Oral cancer can frequently be
detected with a comprehensive oral exam performed by a trained clinician,
including intra-oral examination and external palpation. However, the frequency
of screening exams for oral cancer is low, even among those over 50 years of
age and among high-risk groups. This has been attributed in part to a need for
greater awareness and training among dental professionals and a lack of
knowledge on the part of the general population (Horowitz et al., 2001;
Yellowitz et al., 2000).
This section examines stage at diagnosis, screening, deaths, and sites of oral
and pharyngeal cancer.
REFERENCES
Horowitz AM, Siriphant P, Sheikh A, Child W. Perspectives of Maryland dentists
on oral cancer. J Am Dent Assoc 2001;132:65–72.
Ries LA, Eisner MP, Kosary CL, et al (eds). SEER Cancer Statistics Review,
1973–1998. Bethesda, MD: National Cancer Institute, 2001.
Shiboski CH, Shiboski SC, Silverman S Jr. Trends in oral cancer rates in the
United States, 1973-1996. Community Dent Oral Epidemiol 2000;28:249–56.
Silverman S Jr. Oral Cancer, 4th edition. American Cancer Society. Hamilton,
Ontario, Canada: Decker Inc., 1998.
Silverman S Jr. Demographics and occurrence of oral and pharyngeal cancers. The
outcomes, the trends, the challenge. J Am Dent Assoc 2001 Nov;132 Suppl:7S–11S.
Yellowitz JA, Horowitz AM, Drury T, Goodman HS. Survey of U.S. dentists'
knowledge and opinions about oral pharyngeal cancer.
J Am Dent Assoc
2000;131:653–61.
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