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Mouth Cancer Epidemiology

Mouth Cancer Epidemiology. Emma O’Donnell. Contents . Mouth cancer an overview Risk groups and Aetiology Geographical locations Changing epidemiology Survival rates Role of GDP Signs and Symptoms Referral Summary. Mouth Cancer – An Overview.

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Mouth Cancer Epidemiology

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  1. Mouth Cancer Epidemiology Emma O’Donnell

  2. Contents • Mouth cancer an overview • Risk groups and Aetiology • Geographical locations • Changing epidemiology • Survival rates • Role of GDP • Signs and Symptoms • Referral • Summary

  3. Mouth Cancer – An Overview • 2% of all cancers and 6th leading cancer in the world • Any cancer of the oral cavity and oropharynx • Most common type of head and neck cancers • Mainly oral squamous cell carcinomas – less common are adenocarcinomas, sarcomas, malignant melanomas or lymphomas • 3/4 of cases found in resource-poor countries • High risk groups we may see are migrants from the Indian subcontinent, East Asia, Eastern European and Latin America • Most common areas: • Side of tongue (60%) • Lip (6%)

  4. Risk Groups and Aetiology • Lifestyle modifiable risk factors such as tobacco and alcohol (already discussed) • Age – more common in >45 years old. Althougth increasing in younger people especially females • More common in men – attributed to heavier indulgence of risk habits (tobacco and alcohol) and exposure to sunlight as part of outdoor occuptaions. • Social class – more prevalent in lower SES, especially males • Traditional risk groups remain – older males with habits of alcohol, tobacco or betel use. • Increasing oropharyngeal cancers in younger people associated to HPV virus

  5. Mouth Cancer differences by geographical location • In resource rich populations • Higher incidence in ethnic minorities and immigrants – South Asian Women and new migrants from Eastern European Union • UK • high relative mortality and incidences rising by 1/3 in last decade • Lip cancer uncommon • Highest rates found in Scotland, Northern Ireland and north of England • Males more common • In resource poor populations i.e. Sri Lanka, India, Pakistan, Brazil, Puerto Rico etc Mouth Cancer can be 50% of all cancers reported. • Poor reporting on incidences, mortality, prevalence • Likely to involve exposure to salted fish consumption (nitrosamines) and viruses (EBV)

  6. Epidemiology changing? • Younger people - 1 in 10 cases diagnosed <50 years old • Europe: • Increasing rates, males dominating • As much as 76% increase between 1975-77 and 2008-10 for males and 83% for females • Biggest increase found in males between 50-59 years old and females <49 years old • USA: • Rates rise with age, more rapid rise >50 years old and peaks 60-70years. • Higher incidences found in Hispanic and Black males • HPV exposure and infection increase risk of oropharyngeal cancer independent of tobacco and alcohol • 60% increase of <45 years old between 1973 – 2009

  7. UK • Increasing rates except for over 80s • Dip of incidences between 1980-1990s due to public health efforts against tobacco • Rose again from 1990s • 2011 – 6,800 diagnosed – expected to risk to 9,200 every year by 2030 • 2015 when paper published – 14 cases per 100,000 males and 7 per 100,000 females

  8. Survival? • 90% survival at 5 years for lip cancer patients – attributed to early diagnosis as visible site • Mouth cancer higher death rate than cervical cancers and malignant melanoma • Mouth cancer around 50-60% 5 year survival rate (2015) – has been improving slightly. Similar survival rates when comparing Black and White patients if given same care • Prognosis reduces by: • Advanced disease, low SES, advanced age, continuing risky lifestyles • Earlier found and treated the better the outcome – ST screening by GDPs. • In theory mouth cancer is preventable and detectable. This is influenced by patients delaying seeking professional advice for on average ~3 months after being aware of an oral symptom. • After successful treatment patient need regular surveillance to detect recurrences. In 20-30% second primary cancers of H+N may arise for up to 20 years due to clonal evolution.

  9. Role of GDP • Soft tissue screening 6 monthly in dentate patient and 12 monthly in edentulous • Pre treatment dental assessments – 1 month before cancer treatment. ID disease and risk of potential disease, remove infection, establish good OH. Allow 3 weeks healing time after extractions before cancer treatments • Radiotherapy: mucositis, dry mouth, pain, loss of taste, osteoradionecrosis, trismus, radiation caries • Chemotherapy – immunosuppression, mucositis, dry mouth, swelling, pain, altered taste

  10. Symptoms • Early: nothing, non-healing ulcer, red patch, white patch, lump or rough area, change in existing lump or patch, crusted or non-healing lesion on the lip, persistent soreness, earache • Late: numbness, difficulty speaking/swallowing, dentures not fitting, loosening of the teeth, non-healing extraction site, lump in the neck, bleeding, friable, pain.

  11. Urgent Referral • The Scottish Referral Guidelines for Suspected Cancer recommend urgent referral for patients meeting the following criteria: • with red or red and white patches of the oral mucosa which persist for more than three • ulceration of oral mucosa or oropharynx which persists for more than three weeks • oral swellings which persist for more than three weeks • unexplained tooth mobility not associated with periodontal disease • persistent, particularly unilateral, discomfort in the throat for more than four week • pain on swallowing persisting for three weeks that does not resolve with antibiotic • dysphagia which persists for more than three weeks • hoarseness which persists for more than three weeks • stridor (requires same day referral) • unresolved head or neck mass which persists for more than three weeks • unilateral serosanguineous nasal discharge which persists for more than three weeks, particularly with associated symptoms • facial palsy, weakness or severe facial pain or numbness • orbital masses • ear pain without evidence of local ear abnormalities.

  12. Summary • Rates of mouth cancer rising for males and females in all age groups • More <50 years old than every before – still a predominantly older patient disease • Lip cancer prevalence in UK decreasing • Gender gap is narrowing (1.5:1 for mouth and 2.8:1 for oropharynx) • Reasons for change: • Ageing population • Changing demographics and lifestyles – potential reduction of heavy smoking and alcohol consumption and increase infection by HPV • UK most common found in UK Asians including Bangladeshi men • Racial/ethnic disparity in oral cancer rates attributed to lifestyle – particularly chewing tobacco, areca nut and waterpipe use • Mainly in low socio-economic groups (130% higher incidences in males between most an least deprived areas and 74% in women)

  13. References • Mouth Cancer for Clinicians part 2: Epidemiology • SIGN 90 Diagnosis and management of head and neck cancer • NHS choices website – mouth cancer • Symposium on Oral Cancer (12/12/14) Presented at GDH+S by Prof. J Gibosn, Dr P Sweeney, Mrs Z. Makki and Dr N. Beacher

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