Epidemiology

More than 90% of malignant neoplasms of the oral cavity and oropharynx are squamous cell carcinomas of the lining mucosae with relatively rare neoplasms arising in minor salivary glands and soft tissues. It is important to specify which anatomical sites are included in epidemiological data. Separate assessment of incidence rates for the oral cavity and oropharynx is complicated by the difficulty of assigning a site of origin to tumours that are often advanced. Males are affected more often than females because of heavier indulgence in both tobacco and alcohol habits in most countries: in India the highest rates of intraoral cancer may be found in women who chew tobacco heavily. The male to female ratio is, however, globally lower for cancer of the oral cavity than for cancer of the oropharynx, perhaps suggesting that higher exposure to tobacco smoking and alcohol drinking are required to induce oropharyngeal than oral cancer {796}.

Globally some 389,650 cases occurred in the year 2000; 266,672 for the oral cavity (ICD-9 140-5) and 122,978 for the oropharynx (ICD-9 146,8-9) {1981}. This represents 5% of all cancers for men and 2% for women.

In males, the country with the highest rate in the western world is currently France, with extremely elevated rates also in French-speaking Switzerland, Northern Italy, Central and Eastern Europe (especially Hungary) and parts of Latin America. Rates are elevated amongst both men and women throughout South Asia. In the USA incidence rates are two-fold higher in Black men than White men {1981}. Very high rates in the IARC database for Melanesia, presumably associated with areca nut and tobacco habits, are based on small numbers and need confirmation {730,1981}. The high incidence rates in Australasia are explained by lip cancer in fair-skinned races which has a comparatively low mortality rate.

Much of Europe and Japan is experiencing alarming rises in incidence, with a strong cohort effect, those born from approximately 1930 onwards showing significantly increased incidence and mortality. In North America there are statistically significant falls in Whites, but Blacks continue to show worse outcomes. Globally, with the exception of the most highly specialized treatment centres, survival rates have not improved for decades.

Significant increases in incidence in younger subjects, particularly males, have been reported from many western countries in recent decades {1534,2259}.

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