Oral Cancer in Australia - Rising Incidence and Worsening Mortality.

BACKGROUND: Oral cancer, predominantly squamous cell carcinoma (SCC), is a lethal and deforming disease of rising incidence. Although largely preventable by eliminating harmful tobacco and alcohol risk factor behaviour, five-year survival rates remain around 50%, primarily due to late presentation of advanced stage disease. Whilst low socio-economic status, regional and remote location and Indigenous status are associated with head and neck cancer in general, detailed incidence and demographic data for oral SCC in Australia are limited. This study aimed to characterize the Queensland population at risk of oral SCC development.

METHODS: Following ethical approval, the Queensland Cancer Register (QCR) dataset was analyzed to determine patterns of incidence, anonymized patient demographics, clinical presentation and outcome data for oral SCC cases diagnosed between 1982 and 2018.

RESULTS: Data from 9887 patients were obtained. Mean age at diagnosis was 64.55yrs, with a male to female ratio of 2.51:1; males were diagnosed at a younger age (p<0.001). At study census date, 59% of patients had died, with females demonstrating longer mean survival (p<0.001). Clinico-pathological data confirmed that SCC most commonly arose from tongue sites (49%) and, whilst tumours were predominantly moderately differentiated in nature (63%), patients with poorly differentiated carcinomas exhibited shortest survival times (p<0.05). Over the 36-year study period, the number of diagnoses increased 4.49-fold, whilst the number of deaths increased 19.14-fold.

CONCLUSION: Oral SCC poses a significant and growing healthcare problem in Queensland. In the absence of national screening, characterizing the high-risk oral SCC population facilitates pragmatic opportunities to raise disease awareness, to deliver targeted screening and effective primary prevention strategies, and to provide early interventional treatment intervention to reduce disease mortality and morbidity. This article is protected by copyright. All rights reserved.