Oral Cancer Screening

The term “oral cancer” includes a diverse group of tumors arising from the
oral cavity. Usually included are cancers of the lip, tongue, pharynx, and
oral cavity. The annual incidence of oral cancer in the U.S. is about
11/100,000 population, with a male/female ratio greater than 2:1.1 Oral
cancer is responsible for 2% of all cancer deaths in the U.S., and it is projected
to account for over 28,000 new cases and about 8,400 deaths in
1995.

Fifty-three percent of oral cancers have spread to regional or distant
structures at the time of diagnosis.1 Overall 5-year survival is 52%, but it
ranges from 79% for localized disease to 19% if distant metastases are present.
1 The natural history of each type of cancer can be quite different.
Cancer of the lip accounts for 11% of new cases of oral cancer but only 1%
of deaths. In contrast, cancer of the pharynx accounts for 31% of new cases
of oral cancer but 50% of deaths.1 The median age at diagnosis of oral cancers
is 64 years, and 95% occur in persons over age 40. About half of all
oropharyngeal cancers and the majority of deaths from this disease occur
in persons over age 65.

Use of tobacco in all forms and, to a lesser extent, alcohol abuse are the
major risk factors for the development of oral cancer. The risk of oral cancer
is increased 6–28 times in current smokers,4 and the effects of tobacco
and alcohol account for 90% of oral cancer in the U.S.In parts of India
and Asia where chewing tobacco or betel nut is very common, the incidence
of oral cancer is 3 times higher than in the U.S.5 In several areas of
India, oral cancer accounts for 40% of all female cancer deaths.5 Other
risk factors for oral cancer include occupational exposures, solar radiation
(for cancer of the lip), and the presence of premalignant lesions such as
leukoplakia or erythroplakia. virus are at increased risk of oral cancers, most commonly
Kaposi’s sarcoma and non-Hodgkin’s lymphoma.

Depending on the degree of histologic
abnormality, up to 18% of cases of leukoplakia may develop into invasive
cancers over long-term follow-up.5 Patients infected with human immunodeficiency
virus are at increased risk of oral cancers, most commonly
Kaposi’s sarcoma and non-Hodgkin’s lymphoma.