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ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 6  |  Page : 149-154

Oral cavity cancer incidence and mortality in China, 2010


1 Department of Head and Neck Surgical Oncology, Zhejiang Cancer Hospital, Beijing, China
2 Editorial Board of Journal of Chinese Oncology, Zhejiang Cancer Hospital, Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou, China
3 National Office for Cancer Prevention and Control, National Cancer Center, Beijing, China

Date of Web Publication26-Oct-2015

Correspondence Address:
Qing-Min Xia
Editorial Board of Journal of Chinese Oncology, Zhejiang Cancer Hospital, Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.168176

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 > Abstract 

Purpose: To analyze the incidence and mortality of oral cavity cancer in the cancer registration areas of China in 2010.
Materials and Methods: Until June 1, 2013, 219 population-based cancer registries submitted the data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 120 cancer registries were selected after the quality evaluation for this analysis. Oral cavity cancer cases were selected from the database according to the International Classification of Diseases-10 coded as "C00-C10, C11-C12." We calculated the crude incidence and mortality rates of oral cavity cancer by sex, age, and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age standardized rates.
Results: In 2010, it was estimated that there were 34,319 new cases diagnosed as oral cavity cancer in China, including 23,096 males and 11,223 females. The crude incidence rate of oral cavity cancer was 2.61/100,000 in 2010, accounting for 1.11% of overall new cancer cases, ranked the 20th in all cancer sites. The age standardized by China population (ASRcn) and by world population (ASRwld) were 2.06/100,000 and 2.02/100,000, respectively. Cumulative rate (0–74 years old) and truncated age standardized rate (35–64 years old) were 0.23% and 3.82/100 000, respectively. In 2010, it was estimated that there were 14,652 cases died in oral cavity cancer in China, including 10,363 males and 4289 females. The crude mortality rate of oral cavity cancer was 1.11/100,000 in 2010, accounting for 0.75% of overall cancer deaths, ranked the 20th in all cancer sites. The ASRcn and ASRwld were 0.86/100,000 and 0.85/100,000, respectively. Cumulative rate and truncated age standardized rates were 0.10% and 1.30/100,000, respectively.
Conclusions: Both the incidence and mortality of oral cavity cancer in China were still low in 2010. Primary prevention such as smoking control, reducing alcohol consumption, changing the habit of chewing betel nut, and chemical prevention should be enhanced in the general population.

Keywords: China, incidence, mortality, oral cavity cancer


How to cite this article:
Zheng CM, Ge MH, Zhang SS, Tan Z, Wang P, Zheng RS, Chen WQ, Xia QM. Oral cavity cancer incidence and mortality in China, 2010. J Can Res Ther 2015;11, Suppl S2:149-54

How to cite this URL:
Zheng CM, Ge MH, Zhang SS, Tan Z, Wang P, Zheng RS, Chen WQ, Xia QM. Oral cavity cancer incidence and mortality in China, 2010. J Can Res Ther [serial online] 2015 [cited 2019 Apr 21];11:149-54. Available from: http://www.cancerjournal.net/text.asp?2015/11/6/149/168176


 > Introduction Top


Oral cavity cancer is the sixth most common cancer in the world. It was reported that there were 263,000 new oral cavity cancer cases every year, and 130,000 deaths due to oral cavity cancer. Two-thirds occurred in young men aged from 40 to 60 years old. Two-thirds occurred in developing countries. The age standardized incidence rate for male and female was 12.8/100,000 and 3.9/100,000, respectively.[1] Although the incidence of oral cavity cancer in China is relatively low, the population of China is large, and the new case is nearly 46,500 cases per year.[2]

The Chinese Cancer Registry Annual Report has been published since 2008, which provided basic scientific data for Cancer Prevention and Control in China. The Chinese cancer registry annual report system was established by National Central Cancer Registry (NCCR) to promote the work in China. In 2013, the NCCR collected data for the calendar year 2010 from 219 cancer registries. After comprehensive quality evaluation, data from 120 cancer registries were selected as sources of this study, and the incidence and mortality for the registration areas in 2010 were calculated. In this study, we analyzed the incidence and mortality of oral cavity cancer in order to understand the epidemic distribution of oral cavity cancer in 2010 in China.


 > Materials and Methods Top


Data source

NCCR of China was responsible for cancer data collection, evaluation, analysis, and publication from population-based cancer registries located in the each province of China. Traditionally, new cancer cases reporting methods have been classified as active or passive. Active reporting involves registry personnel actually vesting the sources of data. Passive reporting relies on other health care workers to complete notification forms and forward them to the registry or to the send copies of abstracts from which the necessary data can be obtained. The mortality material often comes from population-based death database. The population data originate from census data, Departments of Statistics or Public Security.

In 2013, there were 219 cancer registries (92 cities and 127 counties) from 31 provinces submitted cancer data of 2010 to NCCR, covered about 207,229,403 population totally, accounting for 15.56% of the whole national population. The NCCR coded cases by the International Classification of Diseases-10 (ICD-10) and ICD-O-3, and the oral cavity cancer (ICD-10 code of C00-C10, C11-C12) was selected and analyzed.

Quality control

The value of cancer registry relies heavily on the underlying quality of data and quality control procedures. Based on "Guideline of Chinese Cancer Registration," each cancer registration data were evaluated by the quality indicators, including the proportion of morphological verification (MV%), percentage of death certificated only (DCO%), and mortality to incidence ratio (M/I). Generally, the quality indicators for all cancer sites with DCO% <15%, MV% more between 55% and 90%, and M/I between 0.55 and 0.95 were considered acceptable. Finally, a total of 120 cancer registries with qualified data were included in the final database for further analysis.

Statistical analysis

Softwares such as © SAS 9.3 version (SAS Institute Inc, Sas North Carolina, US),© MS-FoxPro 6.0 version (MS-FoxPro, Washington State, US), MS-Excel, IARC/IACR tools, and IARC-crg. Tools were used for data collection, sorting, check, and statistics. In our study, we calculated several variables including crude incidence rate, mortality, China age standardized rate (National Population Structure in 2000), world age standardized rate (world Segi's population), cumulative rate, age-specific rate, truncated rate, and so on. Cumulative rate expresses the probability of the onset of oral cavity cancer between birth and specific age (74 years old). Truncated rate is the calculation of rates over the truncated age of 35–64 years old, using WHO world standard population.


 > Results Top


Pooled data

A total of 120 population-based cancer registries were enrolled in this study after evaluation for each submitted data, covered about 124,652,935 populations including 63,076,221 males and 61,576,714 females, accounted for 9.29% of the whole national population. There were 55 cancer registries came from urban areas covering about 79,987,999 (64.17%) populations, and 65 cancer registries came from rural areas covering about 44,664,936 (35.83%) populations. The M/I, MV%, DCO%, and unknown basis (UB%) for the pooled data were 0.44%, 83.26%, 2.25%, and 0.48%, respectively. In urban areas, the M/I, MV%, DCO%, and UB% were 0.44%, 85.31%, 1.96%, and 0.51%, respectively, while in rural areas, they were 0.44%, 77.20%, 3.10%, and 0.40%, respectively. The detailed information for the quality control index of oral cavity cancer in 2010 in China was shown in [Table 1].
Table 1: The quality control index of oral cavity cancer in China in 2010

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Incidence

In 2010, it was estimated that there were 34,319 new cases diagnosed as oral cavity cancer in China, including 23,096 males and 11,223 females. Two-thirds of new cases occurred in urban areas and one-third in rural areas. Much more new cases came from the Eastern areas and the Middle areas, while less new cases from the Western areas [Table 2].
Table 2: Oral cavity cancer incidence in China in 2010

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The crude incidence rate of oral cavity cancer was 2.61/100,000 in 2010, accounting for 1.11% of overall new cancer cases, ranked the 20th in all cancer sites. The age standardized by China population (ASRcn) and by world population (ASRwld) were 2.06/100,000 and 2.02/100,000, respectively. Cumulative rate (0–74 years old) and truncated age standardized rate (35–64 years old) were 0.23% and 3.82/100,000, respectively.

Oral cavity cancer occurred more often among men than women. In the male, the crude incidence rate, ASRcn, and ASRwld were 3.43/100,000, 2.77/100,000, and 2.74/100,000, respectively, while in the female, the crude incidence rate, ASRcn, and ASRwld were 1.75/100,000, 1.36/100,000, and 1.32/100,000, respectively. The crude incidence rate, ASRcn, and ASRwld were higher in urban areas than those in rural areas. In the Western areas, the crude incidence rate, ASRcn, and ASRwld were the highest (2.72/100,000, 2.18/100,000, and 2.15/100,000), followed by Eastern areas (2.64/100,000, 2.07/100,000, and 2.03/100,000), and lowest in Middle areas (2.48/100,000, 1.97/100,000, and 1.91/100,000) [Table 2].

The age-specific incidence rate of oral cavity cancer was relatively low before 35 years old, and dramatically increased after 35 years old both for all populations, male and female, reached peak at the age group of 75 years old, 85+ years old, and 75− years old, respectively. Compared the age-specific incidence of oral cavity cancer for different locations, the incidence rates were generally higher in urban areas than those in rural areas for male and female [Table 3] and [Figure 1].
Table 3: Age specific incidence rate of oral cavity cancer in China in 2010 (1/100,000)

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Figure 1: Oral cavity cancer incidence in China in 2010

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Mortality

In 2010, it was estimated that there were 14,652 cases died in oral cavity cancer in China, including 10,363 males and 4289 females. The number of deaths were much more in urban areas (8662 deaths) than that in rural areas (5990 deaths). The Eastern areas had 6259 oral cavity cancer deaths, followed by the Middle areas (4311 deaths) and the Western areas (4082 deaths) [Table 4].
Table 4: Oral cavity cancer mortality in China in 2010

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The crude mortality rate of oral cavity cancer was 1.11/100,000 in 2010, accounting for 0.75% of overall cancer deaths, ranked the 20th in all cancer sites. The ASRcn and by ASRwld were 0.86/100,000 and 0.85/100,000, respectively. Cumulative rate (0–74 years old) and truncated age standardized rate (35–64 years old) were 0.10% and 1.30/100,000, respectively.

The mortality of oral cavity cancer was higher in male than that in the female. In the male, the crude mortality rate, ASRcn, and ASRwld were 1.54/100,000, 1.23/100,000, and 1.23/100,000, respectively, while in the female, the crude mortality rate, ASRcn, and ASRwld were 0.67/100,000, 0.49/100,000, and 0.48/100,000, respectively. The crude mortality rate, ASRcn, and ASRwld were higher in urban areas than those in rural areas. In the Western areas, the crude mortality rate, ASRcn, and ASRwld were the highest (1.19/100,000, 0.94/100,000, and 0.93/100,000), followed by the Eastern areas (1.14/100,000, 0.85/100,000, and 0.84/100,000), and lowest in the Middle areas (1.02/100,000, 0.78/100,000, and 0.79/100,000) [Table 4].

The age-specific mortality rate of oral cavity cancer was relatively low before 40 years old and dramatically increased after 40 years old both for all populations, male and female, both reached the peak at age group of 85+ years old, respectively. Compared the age-specific mortality of oral cavity cancer for different locations, the mortality rates were generally higher in urban areas than those in rural areas for a male. For a female, the curves were, especially similar before 65 years old, while in older years groups (65–85 years old) [Table 5] and [Figure 2].
Table 5: Age specific mortality of oral cavity cancer in China in 2010 (1/100,000)

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Figure 2: Oral cavity cancer mortality in China in 2010

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 > Discussion Top


Epidemiology of oral cavity cancer

The incidence of oral cavity cancer varies widely around the world. High risk areas are mainly distributed in the Southern Asia (India, Bangladesh, Bhutan, Maldives, Pakistan, and Sri Lanka) and the Southeastern (Brunei, Taiwan), the Western Europe (France, Luxembourg) and the Eastern Europe (Slovakia, Hungary) and the Pacific region (Papua New Guinea), and China belongs to the low risk areas.[3]

In China, the incidence rate of oral cavity cancer was 3.15/100,000 during 2003 to 2007, accounting for 1.19% of all the new cancer cases and ranked 21st of all new cancer cases. The incidence rate of oral cavity cancer for male and female were 3.95/100,000 and 2.34/100,000, respectively. The incidence rate for a male was 0.69 times higher than that for a female. In urban areas, the incidence rate of oral cavity cancer was 3.57/100,000, while in rural areas it was 1.72/100,000. The mortality rate of oral cavity cancer was 1.37/100,000 in China, 2003–2007, accounting for 0.80% of all cancer deaths, and ranked 18th of all cancer deaths. The mortality rate of oral cavity cancer for male and female were 1.84/100,000 and 0.89/100,000. The mortality rate for a male was 1.07 times higher than that for a female. In urban areas, the mortality rate of oral cavity cancer was 1.47/100,000, while in rural areas it was 1.01/100,000. The incidence and mortality of oral cavity cancer increased with age, especially in older groups.[4]

In our study, the crude incidence rate of oral cavity cancer was 2.61/100,000 in 2010, accounting for 1.11% of overall new cancer cases. Oral cavity cancer occurred more often among men than women. In the male, the crude incidence rate, ASRcn, and ASRwld were 3.43/100,000, 2.77/100,000, and 2.74/100,000, respectively, while in the female, the crude incidence rate, ASRcn, and ASRwld were 1.75/100,000, 1.36/100,000, and 1.32/100,000, respectively. The crude incidence rate, ASRcn, and ASRwld were higher in urban areas than those in rural areas. The crude mortality rate of oral cavity cancer was 1.11/100,000 in 2010, accounting for 0.75% of overall cancer deaths. The mortality of oral cavity cancer was higher in male than that in the female. In the male, the crude mortality rate, ASRcn, and ASRwld were 1.54/100,000, 1.23/100,000, and 1.23/100,000, respectively, while in the female, the crude mortality rate, ASRcn, and ASRwld were 0.67/100,000, 0.49/100,000, and 0.48/100,000, respectively. The crude mortality rate, ASRcn, and ASRwld were higher in urban areas than those in rural areas.

Risk factors of oral cavity cancer

Tobacco (including smoking, snuff and chewing tobacco, and chewing betel and other forms of smoking) and drinking are important pathogenic factors of oral cavity cancer. There is a positive correlation between the risk of oral cavity cancer and smoking and alcohol consumption. Smoking and drinking can also play a synergistic effect. All these lead to the higher risk of oral cavity cancer for male than that for a female. Fu et al., analyzed the smoking status and the risk of oral cavity cancer, and found that smoking was the risk factor of oral cavity cancer (odds ratio [OR] =2.92, P = 0.004). Compared with nonsmokers, the OR of smokers who began to smoke <20 years old was 3.57 (P = 0.002); the OR of smokers daily smoking amount more than 20 branches was 2.99 (P < 0.05); and the OR of smokers having filter nozzle was 2.99 (P = 0.003).[5] Most people think that the filter can reduce the harm of tobacco. Studies have proved that the carcinogenicity of smokeless tobacco was not less than tobacco smoke, which means filter does not reduce the risk of cancer caused by tobacco.[6],[7],[8] The results of this study are not widely known in China.

Alcohol is considered as one of the risk factors of oral cavity cancer in the long term. Epidemiology supports the hypothesis that alcohol causes the oral cavity cancer, but it has not been confirmed by animal experiments that ethanol can induce oral cavity cancer. Supports for the ethanol carcinogenic hypothesis are mainly included: (i) Ethanol contains substances or contaminants that can cause cancer; (ii) ethanol can produce metabolites that are carcinogenic to humans; (iii) ethanol as a solvent to enhance the penetration of other carcinogens, can increase the nutritional deficiencies of patients, hinder the degradation of carcinogens, and prompt some substances into carcinogens; (iv) ethanol can enhance the cell's exposure to oxidant and inhibit the immune function.[9] Lissowska et al., through the study showed that ethanol was positively associated with the incidence of oral cavity cancer, especially for people drinking more than 21 cups per week.[9] Franceschi et al., found that the weekly 1–20 cups of moderate alcohol consumption does not increase the risk of oral cavity cancer, but the OR of heavy drinkers with weekly over 91 cup was 11.6, the risk increased nearly 12 times.[10] Merletti et al., found that drinkers with an average of more than 120 g/day had a higher risk of oral cavity cancer, and the risk increased along with the alcohol consumption.[11] Mashberg et al., found that after adjusted the factor of smoking, the incidence rate of oral cavity cancer increased along with the alcohol consumption.[12] Therefore, the alcohol drinkers need to pay attention to the proper amount of alcohol in order to prevent the incidence of oral cavity cancer. Blot et al., reported that almost all oral cavity cancer patients had drinking habits, almost all drinking oral cancer patients accompanied by smoking and about 2/3 smoking and drinking related to oral cancer patients had severe smoking and alcohol habits (smoking history of more than 20 years, smoking over 2 packs every day and drinking wine more than 30 cup a week).[13] The risk of oral cavity cancer is rising while smoking combined with drinking. The risk of heavy smoking and heavy drinking is higher than nonsmokers and nondrinkers. The effects of tobacco can be enhanced by ethanol.

Chewing betel nut is another major risk factor for oral cavity cancer. Betel nut products contain a variety of betel nut, which will lead to oral submucous fibrosis, and may be converted to the oral cavity cancer. Papua New Guinea, India, Sri Lanka, Guangdong, and Taiwan have the custom of chewing betel nut, and these areas are the high incidence of oral cavity cancer. In addition, studies have shown that viral infections can cause oral cavity cancer. For example, human immunodeficiency virus was associated with the occurrence of Kaposi sarcoma. Human papillomavirus (HPV) was associated with squamous cell carcinoma of the mouth and throat. Other risk factors include exposure to ultraviolet radiation, tooth damage, and oral infections, lack of vitamin A, trace element zinc and so on.

Prevention

Smoking cessation and drinking control are important measures to prevent oral cavity cancer and also can reduce the risk of other cancers and chronic diseases. In the areas of chewing betel nut people should be suggested to get rid of betel nut, which is also very important for reducing the incidence of oral cavity cancer. The successful development and listing of HPV prophylactic vaccine will reduce the oral cavity cancer caused by HPV infection. In addition, complementary fruits and vegetables have also proven to reduce the risk of oral cancer.

In a word, although oral cavity cancer is not the major cancer in China, the incidence of oral cavity cancer showed a slowly rising trend. Many patients have been found in the advanced stage. Therefore, it is necessary to improve the health awareness of the masses. People should seek medical treatment in time when the oral mucosal ulcer is not healing for a long time, earache, sore throat, difficulty swallowing and so on. At the same time a series of measures are urgent needed, such as smoking control, reducing alcohol consumption, changing the habit of chewing betel nut, chemical prevention and so on, in order to prevent and control oral cavity cancer.

Acknowledgments

All staff from each local cancer registries that have made a great contribution for providing their cancer registration database is acknowledged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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Fu JY, Gao J, Zheng JW, Zhang ZY, Zhong LP, Xiang YB. Epidemiology study of risk factors of oral cancer. China J Oral Maxillofac Surg 2011;9:316-22.  Back to cited text no. 5
    
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Rodu B, Jansson C. Smokeless tobacco and oral cancer: A review of the risks and determinants. Crit Rev Oral Biol Med 2004;15:252-63.  Back to cited text no. 8
    
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Lissowska J, Pilarska A, Pilarski P, Samolczyk-Wanyura D, Piekarczyk J, Bardin-Mikollajczak A, et al. Smoking, alcohol, diet, dentition and sexual practices in the epidemiology of oral cancer in Poland. Eur J Cancer Prev 2003;12:25-33.  Back to cited text no. 9
    
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Franceschi S, Levi F, Dal Maso L, Talamini R, Conti E, Negri E, et al. Cessation of alcohol drinking and risk of cancer of the oral cavity and pharynx. Int J Cancer 2000;85:787-90.  Back to cited text no. 10
    
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Merletti F, Boffetta P, Ciccone G, Mashberg A, Terracini B. Role of tobacco and alcoholic beverages in the etiology of cancer of the oral cavity/oropharynx in Torino, Italy. Cancer Res 1989;49:4919-24.  Back to cited text no. 11
    
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Mashberg A, Garfinkel L, Harris S. Alcohol as a primary risk factor in oral squamous carcinoma. CA Cancer J Clin 1981;31:146-55.  Back to cited text no. 12
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Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.  Back to cited text no. 13
    


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