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Determinants of oral cancer at the national level: just a question of smoking and alcohol drinking prevalence?

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Abstract

In addition to individual-based prevention strategies, the burden of oral cancer could be decreased by controlling its national level determinants. Population-based studies have found smoking, drinking, and wealth to be associated with oral cancer incidence and mortality rates. However, these studies merely reported trends, or did not account for confounders or for intercorrelation between predictor variables. This ecologic study sought to investigate oral cancer determinants at the country level. The male, age-standardized mortality rate was the dependent variable. The explanatory variables, obtained from reliable international agencies, were life expectancy, frequency of physicians, gross national product (GNP), expenditure on health, literacy rate, human immunodeficiency virus (HIV) prevalence, smoking prevalence, alcohol drinking prevalence, drinking modality, average daily calorie consumption, and average calorie intake from fruit and vegetables. Common factor analysis was used to generate a new dimension that incorporated all of the strongly intercorrelated variables. These were life expectancy, physician frequency, GNP, expenditure on health, literacy rate, calorie consumption, smoking prevalence, and drinking modality. According to this dimension, arbitrarily called the country development level (CDL), countries were split into quartiles. The ecologic risk for high mortality from oral cancer, estimated using logistic regression analysis, was three to five times higher among the second, third, and fourth CDL quartiles than among the first CDL quartile, which included the highest-income countries. HIV, drinking prevalence, and fruit and vegetable intake did not affect significantly mortality. These results suggest that it might be possible to improve oral cancer mortality by modifying country-based determinants related to aberrant lifestyles (not only smoking and drinking prevalence) and improving healthcare system efficiency, approximately estimated by CDL, as well as general socioeconomic and cultural conditions.

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References

  1. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: cancer incidence, mortality and prevalence worldwide, version 2.0. IARC Cancer Base Number 5. Lyon: IARC Press; 2004.

    Google Scholar 

  2. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009;45:309–316.

    Article  PubMed  Google Scholar 

  3. Petti S. Lifestyle risk factors for oral cancer. Oral Oncol 2009;45:340–350.

    Article  PubMed  Google Scholar 

  4. Hashibe M, Brennan P, Chuang SC, Boccia S, Castellsague X, Chen C, Curado MP, Dal Maso L, Daudt AW, Fabianova E, Fernandez L, Wünsch-Filho V, Franceschi S, Hayes RB, Herrero R, Kelsey K, Koifman S, La Vecchia C, Lazarus P, Levi F, Lence JJ, Mates D, Matos E, Menezes A, McClean MD, Muscat J, Eluf-Neto J, Olshan AF, Purdue M, Rudnai P, Schwartz SM, Smith E, Sturgis EM, Szeszenia-Dabrowska N, Talamini R, Wei Q, Winn DM, Shangina O, Pilarska A, Zhang ZF, Ferro G, Berthiller J, Boffetta P. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev 2009;18:541–550.

    Article  PubMed  Google Scholar 

  5. Rahman M, Sakamoto J, Fukui T. Calculation of population attributable risk for bidi smoking and oral cancer in south Asia. Prev Med 2005;40:510–514.

    Article  PubMed  Google Scholar 

  6. Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol 2008;9:667–675.

    Article  PubMed  Google Scholar 

  7. Room R, Babor T, Rehm J. Alcohol and Public Health. Lancet 2005;365:519–530.

    PubMed  Google Scholar 

  8. Brunner EJ, Rees K, Ward K, Burke M, Thorogood M. Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev 2007;4:CD002128.

    PubMed  Google Scholar 

  9. Bala M, Strzeszynski L, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev 2008;23:CD004704.

    Google Scholar 

  10. Prokhorov AV, Winickoff JP, Ahluwalia JS, Ossip-Klein D, Tanski S, Lando HA, Moolchan ET, Muramoto M, Klein JD, Weitzman M, Ford KH, Tobacco Consortium, American Academy of Pediatrics Center for Child Health Research. Youth tobacco use: a global perspective for child health care clinicians. Pediatrics 2006;118:e890–e903.

    Article  PubMed  Google Scholar 

  11. Peterson AV Jr, Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention — results on smoking. J Natl Cancer Inst 2000;92:1979–1991.

    Article  PubMed  Google Scholar 

  12. de Vries H, Dijk F, Wetzels J, Mudde A, Kremers S, Ariza C, Vitoria PD, Fielder A, Holm K, Janssen K, Lehtovuori R, Candel M. The European Smoking Prevention Framework Approach (ESFA): effects after 24 and 30 months. Health Educ Res 2006;21:116–132.

    Article  PubMed  Google Scholar 

  13. Hammond D. Smoking behaviour among young adults: beyond youth prevention. Tob Control 2005;14:181–185.

    Article  PubMed  Google Scholar 

  14. Rose G. Sick individuals and sick populations. Int J Epidemiol 1985;14:32–38.

    Article  PubMed  Google Scholar 

  15. Petti S, Scully C. Oral cancer: the association between nation-based alcohol-drinking profiles and oral cancer mortality. Oral Oncol 2005:41:828–834.

    Article  PubMed  Google Scholar 

  16. Chen DT, Chou YF, Wu HP, Hsu LP, Wen IS, Lee CF, Chen PR. Income and the incidence of oral cavity cancer: cross-national study. J Otolaryngol Head Neck Surg 2009;38:208–211.

    PubMed  Google Scholar 

  17. Macfarlane GJ, Macfarlane TV, Lowenfels AB. The influence of alcohol consumption on worldwide trends in mortality from upper aerodigestive tract cancers in men. J Epidemiol Community Health 1996;50:636–639.

    Article  PubMed  Google Scholar 

  18. Kurumatani N, Kirita T, Zheng Y, Sugimura M, Yonemasu K. Time trends in the mortality rates for tobacco- and alcohol-related cancers within the oral cavity and pharynx in Japan, 1950–94. J Epidemiol 1999;9:46–52.

    PubMed  Google Scholar 

  19. Hindle I, Downer MC, Moles DR, Speight PM. Is alcohol responsible for more intra-oral cancer? Oral Oncol 2000;36:328–333.

    Article  PubMed  Google Scholar 

  20. Nieto A, Ramos MR. Raising trends in oral cancer mortality in Spain, 1975–94. J Oral Pathol Med 2002;31:147–152.

    Article  PubMed  Google Scholar 

  21. La Vecchia C, Lucchini F, Negri E, Levi F. Trends in oral cancer mortality in Europe. Oral Oncol 2004;40:433–439.

    Article  PubMed  Google Scholar 

  22. Lizzy S, Yeole BB, Hakama M, Shiri R, Sastry PSRK, Mathews S, Advani SH. Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk. Asian Pac J Cancer Prev 2004;5:294–300.

    Google Scholar 

  23. Wunsch-Filho V. The epidemiology of oral and pharynx cancer in Brazil. Oral Oncol 2002;38:737–746.

    Article  PubMed  Google Scholar 

  24. Wakefield J. Ecologic studies revisited. Annu Rev Public Health 2008;29:75–90.

    Article  PubMed  Google Scholar 

  25. World Health Organization. World health statistics 2008. Geneva: World Health Organization; 2008.

    Google Scholar 

  26. World Health Organization. The world health report 2004. Changing history. Geneva: World Health Organization; 2004.

    Google Scholar 

  27. Rehm J, Rehn N, Room R, Monteiro M, Gmel G, Jernigan D, Frick U. The global distribution of average volume of alcohol consumption and patterns of drinking. Eur Addict Res 2003;9:147–156.

    Article  PubMed  Google Scholar 

  28. Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, Sempos CT, Frick U, Jernigan D. Alcohol use. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative quantification of health risks. Volume 1. Global and Regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004. p. 959–1108.

    Google Scholar 

  29. Food and Agriculture Organization. Statistics Division. FAO statistical yearbook 2004. Rome: Food and Agriculture Organization; 2004.

    Google Scholar 

  30. Food and Agriculture Organization. FAO Statistical Data Quality Framework: a multi-layered approach to monitoring and assessment. Rome: Food and Agriculture Organization; 2004.

    Google Scholar 

  31. Ho R. Factor Analysis. In: Ho R, editor. Handbook of univariate and multivariate data analysis and interpretation with SPSS. Boca Raton: Taylor & Francis; 2006. p. 203–238.

    Chapter  Google Scholar 

  32. Hait JF, Black B, Babin B, Anderson RE, Tatham RL. Multivariate data analysis, 6th ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2006.

    Google Scholar 

  33. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74–108.

    Article  PubMed  Google Scholar 

  34. Silverman S. Demographics and occurrence of oral an pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc 2001;132Suppl:7S–11S.

    PubMed  Google Scholar 

  35. Berrino F, Verdecchia A, Lutz JM, Lombardo C, Micheli A, Capocaccia R, Eurocare Working Group. Comparative cancer survival information in Europe. Eur J Cancer 2009;45:901–908.

    Article  PubMed  Google Scholar 

  36. Tandon A, Murray CJL, Lauer J, Evans D. Measuring overall health system performance for 191 countries. Geneva: World Health Organization; 2000.

    Google Scholar 

  37. Evans DB, Tandon A, Murray CJL, Lauer JA. Comparative efficiency of national health systems: cross national econometric analysis. Br Med J 2001;323:307–310.

    Article  Google Scholar 

  38. Reinhardt UE, Hussey PS, Anderson GF. Cross-national comparisons of health systems using OECD data, 1999. Health Aff (Millwood) 2002;21:169–181.

    Article  Google Scholar 

  39. Kelley E. Health, spending and the effort to improve quality in OECD countries: a review of the data. J R Soc Promot Health 2007;127:64–71.

    Article  PubMed  Google Scholar 

  40. Zalmanovitch Y, Vashdi DR. Shrinking budgets, improving care: trade-offs are unavoidable. Br Med J 2010;340:c1259.

    Article  Google Scholar 

  41. Greenberg A, Angus H, Sullivan T, Brown AD. Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada. Int J Qual Health Care 2005;17:107–114.

    Article  PubMed  Google Scholar 

  42. Tawfik-Shukor AR, Klazinga NS, Arah OA. Comparing health system performance assessment and management approaches in the Netherlands and Ontario, Canada. BMC Health Serv Res 2007;7:25.

    Article  PubMed  Google Scholar 

  43. Warnakulasuriya KAAS, Harris CK, Scarrott DM, Watt R, Gelbier RS, Peters TJ, Johnson NW. An alarming lack of public awareness towards oral cancer. Br Dent J 1999;187:319–322.

    PubMed  Google Scholar 

  44. Netuveli G, Sheiham A, Watt RG. Does the “inverse screening law” apply to oral cancer screening and regular dental check-ups? J Med Screen 2006;13:47–50.

    Article  PubMed  Google Scholar 

  45. Thomson CS, Forman D. Cancer survival in England and the influence of early diagnosis: what can we learn from recent Eurocare results? Br J Cancer 2009;101:S102–S109.

    Article  PubMed  Google Scholar 

  46. Molina MA, Cheung MC, Perez EA, Byrne MM, Franceschi D, Moffat FL, Livingstone AS, Goodwin WJ, Gutierrez JC, Koniaris LG. African American and poor patients have a dramatically worse prognosis for head and neck cancer. An examination of 20,915 patients. Cancer 2008;113:2797–2806.

    Article  PubMed  Google Scholar 

  47. Bhurgri Y. Cancer of the oral cavity: trends in Karachi South (1995–2002). Asian Pac J Cancer Prev 2005;6:22–26.

    PubMed  Google Scholar 

  48. Stahl S, Meskin LH, Brown JL. The American Dental Association’s oral cancer campaign. The impact on consumers and dentists. J Am Dent Assoc 2004;135:1261–1267.

    PubMed  Google Scholar 

  49. Scott S, Mc Gurk M. At risk individuals. Br Dent J 2005;199:585.

    Article  PubMed  Google Scholar 

  50. Petti S, Scully C. Oral cancer knowledge and awareness: primary and secondary effects of an information leaflet. Oral Oncol 2007;43:408–415.

    Article  PubMed  Google Scholar 

  51. Mackay G, Eriksen M. The tobacco atlas. Geneva: World Health Organization; 2002.

    Google Scholar 

  52. World Health Organization. Regional Office for Europe. WHO European country profiles on tobacco control 2003. Copenhagen: World Health Organization Regional Office for Europe; 2003.

    Google Scholar 

  53. Siahpush M, Mc Neill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tob Control 2006;15(Suppl III):III65–III70.

    Article  PubMed  Google Scholar 

  54. Fong GT, Cummings KM, Shopland DR. Building the evidence base for effective tobacco control policies: the International Tobacco Control Policy Evaluation Project (the ITC Project). Tob Control 2006;15(Suppl III):III1–III2.

    Article  PubMed  Google Scholar 

  55. Powe BD, Finnie R. Cancer fatalism: the state of the science. Cancer Nurs 2003;26:454–465.

    Article  PubMed  Google Scholar 

  56. Powe BD, Ross L, Cooper DL. Attitudes and beliefs about smoking among African-American college students at historically black colleges and universities. J Natl Med Assoc 2007;99:338–344.

    PubMed  Google Scholar 

  57. World Health Organization. Ottawa Charter for Health Promotion. Geneva: World Health Organization; 1986.

    Google Scholar 

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Authors and Affiliations

  1. Department of Public Health and Infectious Diseases, Sanarelli Hygiene building, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy

    Stefano Petti

  2. Eastman Dental Institute, University College London, London, UK

    Crispian Scully

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  1. Stefano Petti
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Correspondence to Stefano Petti.

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Petti, S., Scully, C. Determinants of oral cancer at the national level: just a question of smoking and alcohol drinking prevalence?. Odontology 98, 144–152 (2010). https://doi.org/10.1007/s10266-010-0133-4

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  • DOI: https://doi.org/10.1007/s10266-010-0133-4

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