Unequal burden of head and neck cancer in the United States

Goodwin, W. Jarrard; Thomas, Giovana R.; Parker, Dorothy F.; Joseph, Debbie; Levis, Silvina; Franzmann, Elizabeth; Anello, Charles; Hu, Jennifer J.

doi:10.1002/hed.20710

Cited by 121 publications

(134 citation statements)

References 38 publications

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“…These results support the findings of racial disparities that have been previously demonstrated for several other malignancies. [3][4][5][6][7] In the cohort reported herein, AA patients are diagnosed at a younger age and present with more advanced disease. Although they are more likely than whites to undergo chemotherapy and radiotherapy, they are less likely to be operated on for their tumors.…”

Section: Discussionmentioning

confidence: 92%

African American and poor patients have a dramatically worse prognosis for head and neck cancer

Molina

Cheung

Pérez

et al. 2008

Cancer

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190

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BACKGROUND.Differences in cancer survival based on race, ethnicity, and socioeconomic status (SES) are a major issue. To identify points of intervention and improve survival, the authors sought to determine the impact of race, ethnicity, and socioeconomic status for patients with cancers of the head and neck (HN).METHODS.HN cancer patients diagnosed between 1998 and 2002 were examined using a linked Florida Cancer Data System and Florida Agency for Health Care Administration data set.RESULTS.A total of 20,915 patients with HN cancers were identified, predominantly in the oral cavity and larynx. Overall, 72% of patients were male, 89.7% were white, 8.4% were African American (AA), and 10.6% were Hispanic. The median survival time (MST) was 37 months. MST varied significantly by race (white, 40 months vs AA, 21 months; P < .001), sex (men, 36 months vs women, 41 months; P = .001), and area poverty level (lowest, 27 months vs highest, 34 months; P < .0001). Only 32% of AA patients underwent surgery in comparison with 45% of white patients (P < .001). On multivariate analysis, independent predictors of poorer outcomes were race, poverty, age, sex, tumor site, stage, grade, treatment modality, and a history of smoking and alcohol consumption.CONCLUSIONS.Carcinomas of the HN have an overall high mortality with a disproportionate impact on AA patients and the poor. Dramatic disparities by race and SES are not explained completely by demographics, comorbid conditions, or undertreatment. Earlier diagnosis and greater access to surgery and adjuvant therapies in these patients would likely yield significant improvement in outcomes. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 92%

African American and poor patients have a dramatically worse prognosis for head and neck cancer

Molina

Cheung

Pérez

et al. 2008

Cancer

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190

256

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“…In contrast, the mean age among the three Black patients was 53 years. Interestingly, Goodwin et al recently reported that head and neck cancer incidence and mortality remains greater in Black Americans compared with Whites and peaks at an earlier age (25). Several reasons have been postulated to contribute to the incidence, mortality, survival, and age disparity between Blacks and Whites in terms of head and neck cancer (reviewed in ref.…”

Section: Resultsmentioning

confidence: 99%

“…Several reasons have been postulated to contribute to the incidence, mortality, survival, and age disparity between Blacks and Whites in terms of head and neck cancer (reviewed in ref. 25), but information is scarce pertaining to genetic or epigenetic differences, which may contribute in part to the unequal burden of oral cancer among Blacks. Herein, we report that deletion …”

Section: Resultsmentioning

confidence: 99%

Frequent Alterations of p16INK4a and p14ARF in Oral Proliferative Verrucous Leukoplakia

Kresty

Mallery²,

Knobloch

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Proliferative verrucous leukoplakia (PVL) represents a rare but highly aggressive form of oral leukoplakia with >70% progressing to malignancy. Yet, PVL remains biologically and genetically poorly understood. This study evaluated the cell cycle regulatory genes, p16 INK4aand p14 ARF , for homozygous deletion, loss of heterozygosity, and mutation events in 20 PVL cases. Deletion of exon 1B, 1A, or 2 was detected in 40%, 35%, and 0% of patients, respectively. Deletions of exons 1A and 1B markedly exceed levels reported in non-PVL dysplasias and approximate or exceed levels reported in oral squamous cell carcinomas. Allelic imbalance was assessed for markers reported to be highly polymorphic in squamous cell carcinomas and in oral dysplasias. Loss of heterozygosity was detected in 35.3%, 26.3%, and 45.5% of PVLs for the markers IFNa, D9S1748, and D9S171, respectively. INK4a and ARF sequence alterations were detected in 20% and 10% of PVL lesions, accordingly. These data show, for the first time, that both p16INK4a and p14 ARF aberrations are common in oral verrucous leukoplakia; however, the mode and incidence of inactivation events differ considerably from those reported in non-PVL oral premalignancy. Specifically, concomitant loss of p16INK4a and p14 ARF occurred in 45% of PVL patients greatly exceeding loss reported in non-PVL dysplastic oral epithelium (15%). In addition, p14 ARF exon 1B deletions were highly elevated in PVLs compared with non-PVL dysplasias. These data illustrate that molecular alterations, even within a specific genetic region, are associated with distinct histologic types of oral premalignancy, which may affect disease progression, treatment strategies, and ultimately patient prognosis. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3179 -87)

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“…HNSCC is a multifactorial disease marked by racial, gender and SES disparities [17]. Biomarker levels may differ based on certain demographic or risk variables [15].…”

Section: Discussionmentioning

confidence: 99%

Salivary markers and risk factor data: A multivariate modeling approach for head and neck squamous cell carcinoma detection

Pereira

Adebisi

Perez

et al. 2012

CBM

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Abstract.Background: Head and neck squamous cell carcinoma (HNSCC) is a debilitating and deadly disease largely due to late stage diagnosis. Prior work indicates that soluble CD44 (solCD44) and total protein may be useful diagnostic markers for HNSCC. In this study we combine the markers solCD44, IL-8, HA, and total protein with demographic and risk factor data to derive a multivariate logistic model that improves HNSCC detection as compared to our previous data using biomarkers alone. Methods: We performed the solCD44, IL-8, HA, and total protein assays on oral rinses from 40 HNSCC patients and 39 controls using ELISA assays. Controls had benign diseases of the upper aerodigestive tract and a history of tobacco or alcohol use. All subjects completed a questionnaire including demographic and risk factor data. Results: Depending on cancer subsite, differences between cases and controls were found for all markers. A multivariate logistic model including solCD44, total protein and variables related to smoking, oral health and education offered a significant improvement over the univariate models with an AUC of 0.853. Sensitivity ranged from 75-82.5% and specificity from 69.2-82.1% depending on predictive probability cut points. Conclusion: A multivariate model, including simple and inexpensive molecular tests in combination with risk factors, results in a promising tool for distinguishing HNSCC patients from controls. Impact: In this case-control study, the resulting observations led to an unprecedented multivariate model that distinguished HNSCC cases from controls with better accuracy than the current gold standard which includes oral examination followed by tissue biopsy. Since the components are simple, noninvasive, and inexpensive to obtain, this model combining biomarkers, risk factor and demographic data serves as a promising prototype for future cancer detection tests.

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Unequal burden of head and neck cancer in the United States

Cited by 121 publications

References 38 publications

African American and poor patients have a dramatically worse prognosis for head and neck cancer

African American and poor patients have a dramatically worse prognosis for head and neck cancer

Frequent Alterations of p16INK4a and p14ARF in Oral Proliferative Verrucous Leukoplakia

Salivary markers and risk factor data: A multivariate modeling approach for head and neck squamous cell carcinoma detection

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