Hindle, Ian; (1996) The epidemiology of oral cancer in England and Wales 1901-1991. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The aim of this study was to examine the temporal and spatial epidemiology of oral cancer and relate this to selected major risk factors, using published data. Oral cancer was defined as lip (ICD 140) and intra-oral (ICD 141, 143-146). The major risk factors chosen were tobacco and alcohol. Figures for mortality, incidence and population estimates were obtained from the Office of Population Censuses and Surveys. For temporal trends age-specific and age-standardised rates were calculated for both genders. Spatial distribution was examined by preparing standardised incidence ratios for the Regional Health Authorities in England and Wales. In order to assess the completeness of modern oral cancer registration, a postal survey of pathology departments in England and Wales was undertaken. Figures for tobacco and alcohol consumption proved to be imprecise. Other body diseases were therefore used as surrogate markers of these factors; lung cancer for cigarette consumption, liver cirrhosis mortality for alcohol. Analysis revealed a progressive and sustained reduction for lip cancer in both genders during this century. However, despite overall reductions for intra-oral cancer, especially in men, significant increases occurred in younger males during the last thirty years. These were associated with birth cohorts born subsequent to 1911-12. Similar trends, though far less pronounced were found in females. Differences were found in the geographic distribution of lip and intra-oral cancer. Correlation of intra-oral cancer with the other body diseases revealed significant negative correlations with lung cancer in all age groups, for both genders. Conversely, in males, significant positive correlations were found with liver cirrhosis, the closest being for those aged 35-64. Positive correlations, though less pronounced, were also found for females of this age group. These results suggest that alcohol is now a more important major risk factor for intra-oral cancer in England and Wales than tobacco.

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