Risk factors for advanced-stage oral cavity cancer

To assess the association between risk factors for inadequate surveillance of oral cavity cancer and stage of disease (localized, T1, T2/N0 vs advanced, T1, T2/N1-3, T3, T4/N0 or N1-3).

Convenience sample from a case series.

Otolaryngology clinic in a tertiary care hospital.

Fifty-three patients with cancer of the oral cavity who were treated at The University of Iowa, Iowa City, from October 1990 through March 1994, participated in the study. Selection criteria included pathologic confirmation of squamous cell carcinoma (SCC) of the oral cavity, the capacity to retrieve data regarding tumor characteristics at initial presentation, and completion of a 30-item questionnaire by the patient.

Administration of questionnaire identifying factors contributing to inadequate surveillance of cancer of the oral cavity.

Advanced-stage cancer of the oral cavity was identified by the presence of large tumors (T3, T4) and cancer metastatic to the neck lymph nodes (N1, N2, N3). Comparison groups were built to determine the relationship between these two dependent variables and multiple independent variables. Descriptive statistics and tests of association were used to assess relationships.

Two of the 53 patients performed self oral examinations specifically designed to screen for cancer prior to finding cancer of the oral cavity. Knowledge of the warning signs of cancer of the oral cavity was denied by 87%. The rate of cancer growth in the oral cavity was variable from first discovery by the patient to the time of tumor staging by otolaryngologists. The interval from discovery of the tumor to tumor staging (delay in diagnosis) was greatest for floor of the mouth cancers and shortest for those cancers located on the tongue. Thirty-seven percent of the patients younger than age 64 years were edentulous in contrast to 62% edentulism in patients older than 65 years. There was a significant, inverse relationship between time since last dental visit and late-stage disease.

Patients with advanced-stage cancer of the oral cavity tended to be elderly, more often wore dentures, and seldom visited the dentist. Treatment of cancer of the oral cavity as localized disease, with an associated decrease in morbidity and mortality, is likely to result by targeting this population as one in need of more intense surveillance.