Analysis of Oral Cancer Epidemiology in the US Reveals State-specific Trends: Implications for Oral Cancer Prevention

Karl Kingsley; Susan O'Malley; Marcia Ditmyer; Michelle Chino

Disclosures

BMC Public Health 

In This Article

Abstract and Background

Abstract

Background: Downward trends have been observed in oral cancer incidence and mortality in the US over the past 30 years; however, these declines are not uniform within this population. Several studies have now demonstrated an increase in the incidence and mortality from oral cancers among certain demographic groups, which may have resulted from increased risks or risk behaviors. This study examines the underlying data that comprise these trends, to identify specific populations that may be at greater risk for morbidity and mortality from oral cancers.
Methods: Oral cancer incidence and mortality data analyzed for this study were generated using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program.
Results: While oral cancer incidence and mortality rates have been declining over the past thirty years, these declines have reversed in the past five years among some demographic groups, including black females and white males. Sorting of these data by state revealed that eight states exhibited increasing rates of oral cancer deaths, Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming, in stark contrast to the national downward trend. Furthermore, a detailed analysis of data from these states revealed increasing rates of oral cancer among older white males, also contrary to the overall trends observed at the national level.
Conclusion: These results signify that, despite the declining long-term trends in oral cancer incidence and mortality nationally, localized geographic areas exist where the incidence and mortality from oral cancers have been increasing. These areas represent sites where public health education and prevention efforts may be focused to target these specific populations in an effort to improve health outcomes and reduce disparities within these populations.

Background

Although rates of oral cancer incidence and mortality in the US have declined over the past few decades, these declines have not been consistent or uniform within this population.[1,2,3,4] Collaborative reports using data from the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC) and the American Cancer Society (ACS) have found increases in the incidence of oral cancer among specific segments of the population, including minorities.[5,6,7] While many advances in treatment and diagnosis have been made over the past three decades, oral cancer remains the eighth leading cause of cancer death among US males [8] and the five-year survival rate has remained low and relatively unchanged.[9,10] Cancer remains the second leading cause of death in the US,[11] and these observed increases in oral cancer provide compelling rationale for this study examining data underlying the general declining trends to elucidate which specific subsets of the population, as well as specific states or regions, that face increasing oral cancer rates.

Recently, studies of oral cancer epidemiology demonstrated statistically significant differences in oral cancer rates among population subgroups, including minorities and various age groups, and between genders.[12] One such study demonstrated that although incidence rates of oral cancer have been steadily decreasing among white males, incidence rates among older black males (>65 years old) have been increasing.[13] In addition, this study demonstrated that oral cancer rates among females, in particular, have increased.[13] Although these data provide some evidence of the disparities in oral cancer rates between these populations, a more detailed examination may identify states, metropolitan areas or communities, as well as additional population sub-groups within these areas, which are experiencing increases in oral cancer incidence or mortality.

This study will examine the underlying data that comprise the general trends, to identify specific populations within the US that may be at greater risk for morbidity and mortality from oral cancers. Epidemiology studies of oral cancer in Europe have found incidence and mortality rates have been declining steadily over the past few decades, similar to the trends found in the US, although more detailed analyses of the underlying data revealed that persistent upward trends were still present in a small subset of eastern European countries.[14,15,16,17,18] To perform a similar analysis for specific US states and counties, the NCI Surveillance, Epidemiology and End Results (SEER) website,[19] a collaborative effort between the NCI and CDC, in conjunction with all US state registries, provides an interface for epidemiologists and other researchers to access and generate oral cancer statistics.[20] Due to the recently observed increases in oral cancer among particular segments of the US population, a more detailed analysis of the underlying data which comprise these general, long-term declining trends provides valuable information about significant short-term increases in specific geographic areas and among specific demographic groups.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....