Search

Objectives: Over the past several decades, oral cancer has been the most common malignancy among Sri Lankan males and the top 10 cancer among females, disproportionately affecting low socio‐economic groups. Sri Lanka is a lower‐middle‐income developing country (LMIC), currently striking through an economic crisis, and social and political unrest. Occurring at an accessible body site and predominantly attributed to potentially modifiable health‐related behaviours, oral cancer should be preventable and controllable. Unfortunately, broader contextual factors that are socio‐cultural, environmental, economic, and political and mediated through social determinants of people's lives consistently hinder progress. Many LMICs with a high burden of oral cancer are now gripped by economic crises, consequent social and political unrest, all compounded by reduced public health investments. The aim of this review is to provide a critical commentary on key aspects of oral cancer epidemiology including inequalities, using Sri Lanka as a case study. Methods: The review synthesizes evidence from multiple data sources, such as published studies, web‐based national cancer incidence data, national surveys on smokeless tobacco (ST) and areca nut use, smoking and alcohol consumption, poverty headcount ratios, economic growth, and Gross Domestic Product (GDP) health expenditure. National trends in the oral cancer, ST use, smoking and alcohol consumption in Sri Lanka are identified alongside inequalities. Results: Using these evidence sources, we discuss 'where are we now?', together with the availability, accessibility and affordability of oral cancer treatment services, oral cancer prevention and control programmes, tobacco and alcohol control policies, and finally, outline macroeconomic perspectives of Sri Lanka. Conclusions: Finally, we speculate, 'where to next?' Our overarching goal of this review is to initiate a critical discourse on bridging the gaps and crossing the divides to tackle oral cancer inequalities in LMIC such as Sri Lanka. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of the oral cavity (OSCC) is the most common head‐and‐neck malignancy. Importantly, we are experiencing an alarming rise in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) globally. Oncogenic viruses, human papillomavirus (HPV) and Epstein‐Barr virus (EBV), are known to be co‐associated with OSCC and OPSCC cases. However, the reported incidence of HPV and EBV co‐infection in OSCCs and OPSCCs globally is unknown. To address this, we performed a formal meta‐analysis and systematic review on published studies that report the detection of both EBV and HPV in OSCCs and OPSCCs. Our analysis revealed 18 relevant studies out of a total of 1820 cases (1181 from the oral cavity and 639 from the oropharynx). Overall, HPV and EBV co‐infection was found in 11.9% of OSCC and OPSCC cases combined (95% CI: 8%–14.1%). Based on anatomical subsite, dual positivity estimates were 10.5% (95% CI: 6.7%–15.1%) for OSCC and 14.2% (95% CI: 9.1%–21.3%) for OPSCC. The highest dual positivity rates described were in European countries: for OSCC 34.7% (95% CI: 25.9%–44.6%) in Sweden and for OPSCC, 23.4% (95% CI: 16.9%–31.5%) in Poland. Given these substantive prevalence rates, the value of detecting dual infection in the diagnosis and prognosis of these cancers deserves careful longitudinal studies, as do implications for cancer prevention and therapy. We further proposed molecular mechanisms that could explain how HPV and EBV could co‐contribute to the aetiology of OSCCs and OPSCCs. [ABSTRACT FROM AUTHOR]

Objectives: Cancer of the oral cavity is the leading malignancy amongst males in Sri Lanka, and eighth amongst women. Almost all malignancies are developed from a clinically visible precursor stage called an oral potentially malignant disorder (OPMD). The objective of this study was to estimate costs of managing patients with OPMD in Sri Lanka for a 12‐month period from diagnosis. Methods: A hospital‐based costing study was conducted in Sri Lanka in the years 2016‐2017. Three selected treatment centres participated. For societal perspectives, healthcare, household and indirect costs were used. Costs to the healthcare system included clinic visits, diagnostic biopsy, consumables and drug costs. Capital costs included apportioned value of land, buildings, equipment and furniture. Household costs consisted of out‐of‐pocket expenditure and indirect costs of lost income. Results: Sixty‐two patients were recruited (39 male and 23 female). The majority had awareness of oral potentially malignant disorders (OPMDs). Total average cost of managing a single patient with an OPMD for 1 year was SLR 19 547 (US$ 140) which includes a health system cost of SLR 7320 (US$ 52) and household cost of SLR 12 227 (US$ 87). Travel loss and income loss were a substantial burden to patients and their families. Conclusions: Managing patients with an OPMD, even with annual monitoring, is less costly than managing patients with oral cancer. Out‐of‐pocket costs are very high, and these could be reduced by revising the National Management Guidelines to allow care closer to home. [ABSTRACT FROM AUTHOR]

Introduction: Smoked, and especially smokeless, tobacco are major causes of oral cancer globally. Here, we examine the oral bacteriome of smokers and of smokeless tobacco users, in comparison to healthy controls, using 16S rRNA gene sequencing. Methods: Oral swab samples were collected from smokers, smokeless tobacco users, and healthy controls (n = 44). Microbial DNA was extracted and the 16S rRNA gene profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Differentially abundant taxa were identified using DESeq2, while functional metagenomes based on KEGG orthology abundance were inferred using LIMMA. Results: A significantly higher microbial diversity was observed in smokeless tobacco users and smokers relative to controls (P < 0.05). Compositional differences in microbial communities were observed in all comparisons with healthy controls (PERMANOVA P < 0.05) but not between smokers and smokeless tobacco users. Levels of Fusobacterium spp., Saccharibacterium spp., and members of Shuttleworthia were elevated in smokers when compared to controls (BH adj P < 0.01). In addition, the relative abundance of three bacterial taxa belonging to genera Fusobacterium spp., Catonella, and Fretibacterium spp. was significantly increased in smokeless tobacco users relative to controls (BH adj P < 0.01). Major functional pathways significantly increased in smokeless tobacco users relative to both controls, and smokers were similar and involved amino acid metabolism including glutamate and aspartate biosynthesis and degradation (log FC > 1.5; BH adj P < 0.01). Conclusions: A distinct taxonomic and functional profile of oral microbiome in smokers and smokeless tobacco users as compared to healthy controls implicates a significant role of microbes and their metabolites in diseases associated with tobacco use including oral cancer. Clinical relevance: Future efforts in preventive, diagnostic, curative, and prognostic strategies for diseases associated with tobacco use in smokers and smokeless tobacco users could incorporate the oral microbiome. [ABSTRACT FROM AUTHOR]

Objective: While some oral carcinomas appear to arise de novo, others develop within long-standing conditions of the oral cavity that have malignant potential, now known as oral potentially malignant disorders (OPMDs). The oral bacteriome associated with OPMD has been studied to a lesser extent than that associated with oral cancer. To characterize the association in detail we compared the bacteriome in whole mouth fluid (WMF) in patients with oral leukoplakia, oral cancer and healthy controls. Methods: WMF bacteriome from 20 leukoplakia patients, 31 patients with oral cancer and 23 healthy controls were profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Sparse Partial Least Squares Regression Discriminant Analysis model was used to identify bacterial taxa that best discriminate the studied groups. Results: We found considerable overlap between the WMF bacteriome of leukoplakia and oral cancer while a clearer separation between healthy controls and the former two disorders was observed. Specifically, the separation was attributed to 14 taxa belonging to the genera Megaspheara, unclassified enterobacteria, Prevotella, Porphyromonas, Rothia and Salmonella, Streptococcus, and Fusobacterium. The most discriminative bacterial genera between leukoplakia and oral cancer were Megasphaera, unclassified Enterobacteriae, Salmonella and Prevotella. Conclusion: Oral bacteria may play a role in the early stages of oral carcinogenesis as a dysbiotic bacteriome is associated with oral leukoplakia and this resembles that of oral cancer more than healthy controls. Our findings may have implications for developing oral cancer prevention strategies targeting early microbial drivers of oral carcinogenesis. [ABSTRACT FROM AUTHOR]

The present study evaluated a national social marketing campaign (SMC) conducted in 2008, with the ultimate aim of improving control of oral cancer in Sri Lanka. The approach was based on our published Risk Factor Model (RFM). Social marketing tools were developed to educate the public on the major risk factors for oral cancer. A cross-sectional community-based cluster survey was carried out in 2013 by interviewing 491 citizens >25 years of age to assess any improvements to the level of disease awareness in the community. Changes in the number of case presentations were obtained from registrations at Government Hospital Dental Clinics (GHDC) from the year 2008–2015. A random sample of 491 members of the public was interviewed in 2013. Most (93%) were aware of oral cancer; but only 45.4% of oral potentially malignant disorders (OPMD). Statistically significant improvements were observed on awareness of oral cancer and OPMD and of the risk factors for oral cancer. A marked increase in the detection of oral leukoplakia and of oral cancer occurred in the GHDC surveillance system in the years 2012 and 2013, at the time the SMC campaign was implemented. The improvement in public awareness of oral cancer and of its major risk factors, and the changed public behavior seen in the increased attendance at healthcare facilities for mouth examination, may be attributed, at least in part, to our SMC. Such Risk Factor-based approaches to social marketing are proposed for control of oral cancer. [ABSTRACT FROM AUTHOR]

Microbial dysbiosis has been implicated in the pathogenesis of oral cancer. We analyzed the compositional and metabolic profile of the bacteriome in three specific niches in oral cancer patients along with controls using 16SrRNA sequencing (Illumina Miseq) and DADA2 software. We found major differences between patients and control subjects. Bacterial communities associated with the tumor surface and deep paired tumor tissue differed significantly. Tumor surfaces carried elevated abundances of taxa belonging to genera Porphyromonas, Enterobacteriae, Neisseria, Streptococcus and Fusobacteria, whereas Prevotella, Treponema, Sphingomonas, Meiothermus and Mycoplasma genera were significantly more abundant in deep tissue. The most abundant microbial metabolic pathways were those related to fatty-acid biosynthesis, carbon metabolism and amino-acid metabolism on the tumor surface: carbohydrate metabolism and organic polymer degradation were elevated in tumor tissues. The bacteriome of saliva from patients with oral cancer differed significantly from paired tumor tissue in terms of community structure, however remained similar at taxonomic and metabolic levels except for elevated abundances of Streptococcus, Lactobacillus and Bacteroides, and acetoin-biosynthesis, respectively. These shifts to a pro-inflammatory profile are consistent with other studies suggesting oncogenic properties. Importantly, selection of the principal source of microbial DNA is key to ensure reliable, reproducible and comparable results in microbiome studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of Oral Potentially Malignant Disorders (OPMD) on daily life activities. Materials and methods: Patients diagnosed with Oral Leukoplakia, Oral submucous fibrosis and Oral Lichen Planus attending the Oral Medicine clinic of Panineeya Institute of Dental Sciences & Research Centre, Hyderabad, India were invited to participate. Eighteen interviews and three focus groups were conducted in a non-clinical setting. Voice recordings were transcribed and translated from Telugu to English. Data coding was performed using the NVivo software. Results: Sample size for this qualitative study comprised 32 patients. Four main themes emerged: (1) difficulties with diagnosis and knowledge about the condition, (2) physical impairment and functional limitations, (3) psychological and social wellbeing and (4) effects of treatment on daily life. In a majority of the patients, most of the interview time was spent discussing physical impairment and functional limitations. Patients also reported their mouth condition having a debilitating effect on their psychological well-being and social interactions. Conclusions: ‘Physical impairment and functional limitations’ was the most important theme for many of the patients. However, the impacts of OPMD also extended beyond physical impairment and functional limitations to aspects of daily living, notably psychological and social wellbeing. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that the EQ-5D-3 L preference-based measure of health outcome lacks sensitivity to discriminate between health states in cancer patients. An alternative approach is to use a disease (cancer) specific preference-based measure, such as the EORTC-8D. A limited number of comparisons have been made between generic and disease specific preference-based measures. The aim of this study was to compare the utility scores from the EQ-5D-3 L and the EORTC-8D in a group of patients with oral cancer or with oral potentially malignant disorders (OPMD).Methods: Patients (n = 151) with OPMD or oral cancer were recruited consecutively from six hospitals in Sri Lanka. All participants completed both the EQ-5D-3 L and the EORTC's QLQC-30 instrument. The Sri Lankan EQ-5D-3 L and EORTC-8D scoring algorithms were employed to estimate utility scores. The utility scores from the two instruments were compared for discrimination, responsiveness and correlation.Results: There were significant differences across the two utility scores. The EQ-5D-3 L showed better discrimination than EORTC-8D with higher effect sizes. There were higher ceiling effects observed in the EQ-5D-3 L. There was poor correlation between the dimensions of the two instruments except for the mobility and physical functions.Conclusion: The two instruments captured different aspects of quality of life. The EQ-5D-3 L demonstrated better discrimination than the EORTC-8D. In mild conditions EORTC-8D was more responsive and we recommend further validation of this instrument in diverse cancer conditions. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancers (HNCs) continue to remain a significant public health burden worldwide, causing significant mortality and morbidity despite significant clinical advances enabling their early diagnosis and treatment. Methods: We used data from the GLOBOCAN 2012, Cancer Incidence in Five Continents, World Health Organization Mortality Database and Surveillance, Epidemiology, and End Results programmes to describe the current epidemiology of HNCs. Results: Estimated age-standardised incidence/ mortality rates for cancers of the lip and oral cavity among males and females (7.0/2.3 and 2.6/0.6 per 100,000 per annum) in more developed regions are higher compared to those in less developed regions (5.0/2.8 and 2.5/1.4 per 100,000 per annum). Similarly, the estimated rates for cancers of the tonsils and pharynx among males (7.5/2.5 per 100,000 per annum) and females (2.7/0.5 per 100,000 per annum) are reported to be the highest in Western Europe, whereas these rates for cancer of the larynx among males (7.9/4.0 per 100,000 per annum) and females (0.9/0.5 per 100,000 per annum) are reported to be the highest in the Caribbean. Cancer of the nasopharynx represents a significant HNC burden in the Asia-Pacific region and Northern Africa. Conclusion: The current and future estimated burden of HNCs is shifting to less developed regions which may be ill equipped to deal with this increasing burden. This needs urgent attention of policy makers through effective cancer control policy implementation with population-based interventions. [ABSTRACT FROM AUTHOR]

Sri Lanka’s Veddas/ Vanniya- laeto, are a small Indigenous group today with little information on their oral health status. This report is to provide an overview on oral health status of Veddas. Oral health status was recorded by the principal investigator after obtaining consent, using World Health Organization criteria, at an initial screening point before sending the person for any necessary treatment. Total participants were 194: 78% were males>35 years. Mean decayed, missing, filled teeth was 0.9 and 3% had pockets <3.5mm. Three had oral potentially malignant disorders (OPMDs), while three were treated for oral cancer. While the prevalence of dental caries and periodontal conditions was low, oral cancer and OPMDs is a serious concern. The Veddas have a culturally specific health system based on herbal medicinal knowledge. Thus, it is challenging to introduce and implement a preventive and curative oral health care system that would be culturally acceptable to this community. [ABSTRACT FROM AUTHOR]

Brief Background India has the highest number of cases of oral cancer in the world and this is increasing. This burden is not fully appreciated even within India, despite the high incidence and poor survival associated with this disease. Because the aetiology of oral cancer is predominantly tobacco-related, the immense public health challenge can be ameliorated through habit intervention. Methods We reviewed current rates of incidence, mortality and survival, and investigated the determinants of disease and current prevention strategies. Results In addition to tobacco smoking and the myriad other forms of tobacco use prevalent in India, risk factors include areca nut consumption, alcohol consumption, human papilloma virus, increasing age, male gender and socioeconomic factors. Although India has world-leading cancer treatment centres, access to these is limited. Further, the focus of healthcare services remains clinical and is either curative or palliative. Summary and Conclusions: Although the efforts of agencies such as the Ministry of Health and Family Welfare and the Indian Dental Association are laudable, enhanced strategies should be based on common risk factors, focusing on primary prevention, health education, early detection and the earliest possible therapeutic intervention. A multi-agency approach is required. [ABSTRACT FROM AUTHOR]

Aim: This systematic review and meta-analysis aimed to critically appraised data from comparable studies leading to quantitative assessment of any independent association between use of oral smokeless tobacco in any form, of betel quid without tobacco and of areca nut with incidence of oral cancer in South Asia and the Pacific. Methods: Studies (case control and/or cohort) were identified by searching Pub Med, CINAHL and Cochrane databases through June 2013 using the keywords oral cancer: chewing tobacco; smokeless tobacco; betel quid; betel quid without tobacco; areca nut; Asia, the Pacific and the reference lists of retrieved articles. A random effects model was used to compute adjusted summary ORRE for the main effect of these habits along with their corresponding 95% confidence intervals. To quantify the impact of between-study heterogeneity on adjusted main-effect summary ORRE, Higgins' H and I2 statistics along with their 95% uncertainty intervals were used. Funnel plots and Egger's test were used to evaluate publication bias. Results: Meta-analysis of fifteen case–control studies (4,553 cases; 8,632 controls) and four cohort studies (15,342) which met our inclusion criteria showed that chewing tobacco is significantly and independently associated with an increased risk of squamous-cell carcinoma of the oral cavity (adjusted main-effect summary for case- control studies ORRE = 7.46; 95% CI = 5.86–9.50, P<0.001), (adjusted main-effect summary for cohort studies RR = 5.48; 95% CI = 2.56–11.71, P<0.001). Furthermore, meta-analysis of fifteen case control studies (4,648 cases; 7,847 controls) has shown betel quid without tobacco to have an independent positive association with oral cancer, with OR = 2.82 (95% CI = 2.35–3.40, P<0.001). This is presumably due to the carcinogenicity of areca nut. There was no significant publication bias. Conclusion: There is convincing evidence that smokeless (aka chewing) tobacco, often used as a component of betel quid, and betel quid without tobacco, are both strong and independent risk factors for oral cancer in these populations. However, studies with better separation of the types of tobacco and the ways in which it is used, and studies with sufficient power to quantify dose-response relationships are still needed. [ABSTRACT FROM AUTHOR]

Background While the protective role of antioxidant nutrients against cancer is well established, data on Asian diets in patients with oral cancer are meagre. Methods A total of 1029 subjects over 30 years of age were investigated on their dietary practices in the Sabaragamuwa province (Sri Lanka) in 2006-07. Data collection tools were an interviewer-administered questionnaire, a three-day food diary and an examination of the oral cavity. Subjects identified with Oral Potentially Malignant Disorders ( OPMD) and disease-free controls were analysed in a case-control fashion. Among the OPMDs, those with leukoplakia were separately considered. A further subgroup analysis was undertaken for β-carotene-rich foods. The analysis was stratified by portions of fruit/vegetables consumed as five or more portions and two or more portions daily. Results A low BMI (<18.5) was a significant independent risk factor for the development of OPMD. More than half of both cases and controls consumed less than two portions of fruit/vegetables per day and only 20 subjects consumed more than five portions per day. Intake of more than two portions per day of β-carotene-containing fruits/vegetables significantly reduced the risk of having an OPMD and leukoplakia ( OR = 0.5; 95% CI, 0.3-0.9). The significant differences observed with BMI and fruits/vegetables were attenuated when adjusted for betel quid chewing, smoking and alcohol use. Conclusions This study discloses prevailing under-nutrition in this rural population with very low daily consumption of fruit/vegetables. Cancer preventive properties in their diets are limited and are swamped by the known carcinogenic agents associated with use of betel quid, tobacco and alcohol. [ABSTRACT FROM AUTHOR]

Background: Considerable global variation in the incidence of lip, of oral cavity and of pharyngeal cancers exists. Whilst this reflects regional or population differences in risk, interpretation is uncertain due to heterogeneity of definitions of sites and of sub-sites within this anatomically diverse region. For Australia, limited data on sub-sites have been published. This study examines age-standardised incidence trends and demography from 1982 to 2008, the latest data available.Methods: Numbers of cases within ICD10:C00-C14 were obtained from the Australian Institute of Health and Welfare, recorded by sex, age, and sub-site. Raw data were re-analysed to calculate crude, age-specific and age-standardised incidence using Segi's world-standard population. Time-trends were analysed using Joinpoint regression.Results: Lip, Oral Cavity and Pharyngeal (excluding nasopharynx) cancers, considered together, show a biphasic trend: in men rising 0.9% pa from 1982 to 1992, and declining 1.6% pa between 1992 and 2008. For females: rises of 2.0% pa 1982-1997; declines of 2.8% pa 1997-2008. Lip cancer is declining especially significantly. When the Oropharynx is considered separately, steadily increasing trends of 1.2% pa for men and 0.8% pa for women were observed from 1982 to 2008.Conclusions: Although overall rates of lip/oral/oropharyngeal cancer are declining in Australia, these are still high. This study revealed steady increases in cancers of the oropharynx, beginning in the late 1990s. Continued efforts to reduce the burden of these cancers are needed, focused on reduction of the traditional risk factors of alcohol and tobacco, and with special emphasis on the possible role of human papillomavirus and sexual hygiene for cancers of the oropharynx. [ABSTRACT FROM AUTHOR]

The article offers information on the epidemiology and aetiology of squamous cell carcinoma and precursor lesions in the oral cavity. It says that oral cancer is the eight most common cause of cancer-related deaths throughout the world wherein more than 90% of these cancers are squamous cell carcinomas arising in the mucous membranes of the mouth and oropharynx. Moreover, majority of oral squamous cell carcinomas are associated with dietary micronutrient deficiency and heavy alcohol drinking.

Amarasinghe HK, Usgodaarachchi US, Johnson NW, Lalloo R, Warnakulasuriya S. Public awareness of oral cancer, of oral potentially malignant disorders and of their risk factors in some rural populations in Sri Lanka. Community Dent Oral Epidemiol 2010; 38: 540-548. © 2010 John Wiley & Sons A/S The aim of this study was to investigate the level of public awareness of oral cancer, of oral potentially malignant disorders (OPMD) and of risk factors for developing these diseases in a province of Sri Lanka, a country with one of the highest incidences of these diseases in the world. A cross-sectional community-based survey was carried out in Sabaragamuwa province by interviewing 1029 subjects above 30 years of age, over a 1-year period from November 2006. The level of public awareness of oral cancer was 84%, but only 23% for OPMD. Awareness was especially poor in low socioeconomic groups. The majority of subjects were not aware of the symptoms of oral cancer and of OPMD. Thirty-two percent were unaware that chewing betel quid was a risk factor for these diseases, as were 65% for tobacco smoking and 81% for heavy consumption of alcohol. Overall, 76% were not aware of any of the dangers inherent in the frequent use of areca nut. The majority of smokers, betel quid chewers and alcohol consumers were not aware that their lifestyles were placing their long-term health at serious risk. Knowledge of oral cancer, OPMD and their associated risk factors was poor among this population, indicating an urgent need to implement public health education and promotion strategies. [ABSTRACT FROM AUTHOR]

p53 is a nuclear phosphoprotein recognised as important in the regulation of normal cell growth and proliferation, the wild-type protein suppressing cell division. Expression of presumptive mutant protein, detected by immunohistochemistry, is used increasingly as a diagnostic and prognostic marker in human neoplasms. A question arises as to whether or not p53 (over)expression in a lesion is any more or less informative than other markers of cell proliferation. Twenty well-differentiated oral squamous cell carcinomas which had earlier been examined for immunoreactivity against a panel of p53 antibodies were examined for the status of cell proliferation--both in islands of invading neoplastic cells and in the non-malignant epithelial margins. The status of epithelial cell proliferation was found to be significantly higher in p53-positive tumours when enumerated by Ki-67 antibody, both within the tumour as well as its margins. This may confer a growth advantage to these neoplasms and reflect a status of inactivated p53 protein, although the actual cause of the rapid proliferation may lie in activation/inactivation of other genes. The PCNA labelling indices, on the other hand, were closely similar in both p53-positive and -negative groups, suggesting that stabilisation of p53 protein does not influence the proliferative advantage in these carcinomas via a deregulation step of PCNA-related gene products. [ABSTRACT FROM AUTHOR]

The efficacy of 1% toluidine blue in the identification of oral malignancies and potentially malignant oral lesions was evaluated among a group of Asian patients (n = 102) with undiagnosed oral mucosal lesions and conditions (n=145). The trial, utilising a ready-to-use kit, was controlled by histopathologic evaluation of a total of 87 dye-retained or dye-negative lesions. Eighteen oral carcinomas all retained the dye and there were no false negatives, yielding a test sensitivity of 100%. Eight of 39 oral epithelial dysplasias were toluidine blue-negative, giving a false negative rate of 20.5% and a sensitivity of 79.5% for oral epithelial dysplasias. The specificity of the technique was low (62%). Five dysplastic lesions were detected solely by the kit and this suggests that the method is valuable for surveillance of high-risk subjects in addition to its remarkable sensitivity in the detection of invasive carcinoma. [ABSTRACT FROM AUTHOR]

Whether "periodontal disease" can be considered as an independent risk factor for head and neck cancer (HNC) remains controversial. The aim of the current meta-analysis was to quantitatively assess this relationship in order to determine whether this represents a true risk factor, with implications for cancer prevention and management. PubMed, Scopus, and Embase databases were systematically searched. Selective studies were reviewed, and meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CIs) on eligible studies using a random effects model. In total, 21 eligible observational studies (4 cohorts and 17 case-controls) were identified for qualitative synthesis after a review of 1051 articles. Significant heterogeneity could be identified in measures utilized for reporting of periodontal disease. Meta-analysis performed on nine studies that employed objective measures for reporting periodontal disease demonstrated a significant association between periodontal disease and HNC [OR 3.17, 95% CI, 1.78–5.64]. A diseased periodontium represents an independent risk marker, and a putative risk factor, for HNC. Prospective studies with standardized measures of periodontal disease severity and extent, integrated with microbiological and host susceptibility facets, are needed to elucidate the mechanisms of this positive association and whether treatment of the former influences the incidence and outcomes for HNC. [ABSTRACT FROM AUTHOR]

Summary: We investigated the prevalence of, and risk factors for, oral potentially malignant disorders (OPMDs) in rural Sri Lanka. A cross-sectional community-based study was conducted by interview and oral examination of 1029 subjects aged over 30years. A community-based nested case-control study then took those with OPMDs as ‘cases’, “controls” being those with no oral abnormalities at time of initial screening. The prevalence of OPMD was 11.3% (95% CI: 9.4–13.2), after weighting for place of residence and gender. Risk factors were betel-quid (BQ) chewing daily [OR=10.6 (95% CI: 3.6–31.0)] and alcohol drinking daily or weekly [OR=3.55 (1.6–8.0)]. A significant dose–response relationship existed for BQ chewing. Smoking did not emerge when adjusted for covariates. A synergistic effect of chewing and alcohol consumption existed. The attributable risk (AR) of daily BQ chewing was 90.6%, the population AR 84%. This study demonstrates high prevalence of OPMD, betel-quid chewing with or without tobacco being the major risk factor. [Copyright &y& Elsevier]

Imbalance within the resident bacterial community (dysbiosis), rather than the presence and activity of a single organism, has been proposed to be associated with, and to influence, the development and progression of various diseases; however, the existence and significance of dysbiosis in oral/oropharyngeal cancer is yet to be clearly established. A systematic search (conducted on 25/01/2018 and updated on 25/05/2018) was performed on three databases (Pubmed, Web of Science & Scopus) to identify studies employing culture-independent methods which investigated the bacterial community in oral/oropharyngeal cancer patients compared to control subjects. Of the 1546 texts screened, only fifteen publications met the pre-determined selection criteria. Data extracted from 731 cases and 809 controls overall, could not identify consistent enrichment of any particular taxon in oral/oropharyngeal cancers, although common taxa could be identified between studies. Six studies reported the enrichment of Fusobacteria in cancer at different taxonomic levels whereas four studies reported an increase in Parvimonas. Changes in microbial diversity remained inconclusive, with four studies showing a higher diversity in controls, three studies showing a higher diversity in tumors and three additional studies showing no difference between tumors and controls. Even though most studies identified a component of dysbiosis in oral/oropharyngeal cancer, methodological and analytical variations prevented a standardized summary, which highlights the necessity for studies of superior quality and magnitude employing standardized methodology and reporting. Indeed an holistic metagenomic approach is likely to be more meaningful, as is understanding of the overall metabolome, rather than a mere enumeration of the organisms present. [ABSTRACT FROM AUTHOR]

The incidence of oral cancer amongst young adults is increasing in many European and high incidence countries. The aim of this study was to evaluate the major risk factors for oral cancer in young adults using a case-control design. A sample of 116 patients aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the south east of England were included. Two-hundred and seven controls who had never had cancer, matched for age, sex and area of residence, were recruited. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco products, cannabis, alcohol and diet. Conditional logistic analyses were conducted adjusting for social class, ethnicity, tobacco and alcohol habits. All tests for statistical significance were two-sided. The majority of oral cancer patients reported exposure to the major risk factors of tobacco and alcohol even at this younger age. The estimated risks associated with tobacco or alcohol were low (OR range: 0.6–2.5) among both males and females. Only smoking for 21 years or more produced significantly elevated odds ratios (OR=2.1; 95% CI: 1.1–4.0). Exposure associated with other major risk factors did not produce significant risks in this sample. Long term consumption of fresh fruits and vegetables in the diet appeared to be protective for both males and females. The results suggest that although this younger sample exhibit similar behavioural risk factors to older oral cancer patients, the low odds produced in addition to the relatively short duration of exposure, suggest that factors other than tobacco and alcohol may be implicated in the development of oral cancer in these younger patients. [Copyright &y& Elsevier]