Cancer By County
Oral Cancer3-6

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Risk Factors

Tobacco (cigarettes, cigars, pipes, chewing tobacco, and snuff) and alcohol use account for about 75 percent of all oral cancer in the U.S. Smoking and drinking together multiply the risk of oral cancer. A diet high in fresh fruits and vegetables (vitamins A, C, E, carotenoids) appears to protect against oral cancer. Poor dentition (development of teeth) and poor oral hygiene, trauma due to badly-fitting dentures or jagged teeth, and use of mouthwashes with high alcohol content may contribute to oral cancer. Iron deficiency anemia may predispose toward oral cancer. Skin diseases such as syphilis and erosive lichen planus may contribute to cancer of the tongue. Viruses such as human papilloma and herpes simplex have been suggested as risk factors, but this needs further study.

Occupational exposure to asbestos has been linked to oral cancer and outdoor work with exposure to sunlight such as farming and fishing is associated with lip cancer. Workers in other industries such as printing, leather, textiles, metal, and steel also may be at risk for oral cancer. Exposure to ionizing radiation has been associated with salivary gland cancer.

Prevention and Control

Oral cancer is preventable through avoidance of tobacco use and limited or no alcohol use. Protection against sunlight would also reduce the risk of oral cancer. Oral cancer can be detected at an early stage through routine examination by dentists and primary care physicians.

Incidence and Mortality in the U.S.

There is estimated to be 30,300 new cases of oral cancer (cancers of the lip, tongue, mouth, throat, salivary gland) in the U.S. in 1998. Oral cancer is two to three times more common in men than women and is more common in black men than white men. Most cases occur in people over age 45. The survival rate for one year is 81 percent and for five years is 53 percent. It is estimated that 8,000 people will die of oral cancer in 1998 in the U.S. Mortality rates have decreased since the early 1980s. As with oral cancer incidence rates, oral cancer mortality rates are nearly three times higher in men than women and almost twice as high among blacks as whites.

Incidence in New Jersey - 1986-1996

Tables 37 through 40 contain incidence data on oral cancer in New Jersey for the years 1986 through 1996. Figure 13 shows the trends statewide. Statewide, black men had higher rates than white men, and both black and white men had higher rates than black and white women whose rates were similar (see Figure 13). The counties followed this pattern except in Cumberland, Gloucester, and Middlesex counties white men had higher rates than black men (see Table 38). The rates among black men in Cumberland and Gloucester counties should be interpreted cautiously because they are based on small numbers. The oral cancer rates generally declined over the years statewide, although the rates increased in recent years among all the race/gender groups (see Figure 13).

Conclusion

The prevention of oral cancer through avoiding tobacco use, limited or no alcohol use, and protection against sunlight needs to occur in order to reverse the very recent trend of increased oral cancer. It is also important to detect oral cancer early through routine examination by dentists and primary care physicians.

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Table 37.
Oral Cancer Incidence
By County1, White Males, New Jersey - 1986-1996

COUNTY 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
(Prelim.)

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

Atlantic

16

16.4

10

11.8

15

15.0

16

17.4

12

11.4

13

12.9

19

19.3

12

11.7

14

14.6

20

19.8

13

12.6

Bergen

64

13.7

54

12.0

36

7.8

53

11.3

52

11.4

51

11.2

50

10.8

43

9.1

56

12.9

45

9.8

43

9.2

Burlington

17

11.8

11

7.1

15

9.3

16

10.5

27

16.5

19

12.5

21

12.9

24

14.8

17

9.6

26

15.3

26

15.4

Camden

19

9.0

32

15.7

22

10.9

25

12.5

24

11.9

27

12.9

35

16.5

28

13.9

30

14.7

23

11.8

27

13.7

Cape May

9

16.6

14

26.4

10

17.5

12

21.2

7

12.4

8

11.4

8

11.6

11

17.5

11

15.3

12

19.6

11

16.3

Cumberland

10

18.3

7

12.1

14

24.4

8

14.0

15

23.7

---

---

---

---

6

10.6

10

18.4

12

21.7

9

14.2

Essex

42

15.0

48

17.8

42

16.0

41

16.2

33

13.0

31

11.9

32

13.2

33

13.0

24

10.9

33

14.1

32

13.3

Gloucester

11

13.1

8

9.4

13

14.3

22

23.9

10

9.3

11

11.3

15

16.0

13

13.4

6

5.9

9

8.4

11

10.9

Hudson

45

18.5

41

17.5

44

19.0

52

23.1

40

17.8

37

16.5

41

18.5

35

15.7

49

21.6

31

14.2

33

14.5

Hunterdon

5

12.6

8

17.7

5

9.6

6

12.4

---

---

5

8.5

8

15.9

---

---

---

---

10

18.1

7

12.2

Mercer

20

14.7

30

22.4

22

16.1

18

12.7

13

9.5

13

9.9

28

20.7

23

17.1

21

14.9

19

13.7

21

16.2

Middlesex

48

16.1

46

15.4

35

12.2

35

12.2

60

20.5

27

8.9

40

13.4

37

12.2

36

11.7

38

12.0

35

11.6

Monmouth

34

13.7

36

14.3

34

13.4

33

12.9

32

12.8

26

10.1

32

12.0

32

12.4

31

11.5

29

10.6

42

15.1

Morris

26

14.4

25

12.5

20

10.4

27

14.4

16

8.2

27

14.0

20

9.8

26

13.2

17

8.3

26

12.7

24

11.4

Ocean

36

13.5

28

11.3

38

14.9

43

14.2

41

14.5

35

12.7

35

11.4

43

13.5

54

18.2

49

16.6

36

12.7

Passaic

34

16.9

21

10.2

40

20.4

37

18.9

35

18.0

28

15.0

26

13.6

38

19.9

31

15.4

33

16.9

31

16.1

Somerset

10

9.7

16

15.8

13

11.3

16

15.2

11

9.9

10

8.5

14

11.8

11

8.9

12

10.5

11

8.8

12

10.0

Sussex

9

14.8

7

13.5

10

19.7

6

12.1

6

12.6

7

13.6

7

11.4

12

23.4

10

16.2

8

12.7

---

---

Union

38

15.1

35

14.7

35

15.9

24

10.1

27

11.7

36

14.8

24

10.3

31

13.7

31

13.9

35

15.5

23

10.2

Warren

7

14.9

9

22.5

10

21.7

---

---

6

13.1

11

22.5

---

---

6

12.1

7

12.5

7

13.7

---

---

STATE

504

14.4

486

14.0

478

13.7

498

14.3

479

13.6

429

12.2

463

13.0

469

13.1

472

13.1

484

13.4

448

12.4


1Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Salem county. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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Table 38.
Oral Cancer Incidence
By County1, White Females, New Jersey - 1986-19961

COUNTY 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
(Prelim.)

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

Atlantic

6

4.5

10

7.3

---

---

7

7.3

12

9.5

11

7.1

7

3.8

8

6.0

8

6.0

12

9.2

10

8.4

Bergen

25

4.5

36

6.2

31

5.2

39

6.2

43

7.3

39

6.9

27

4.4

33

5.2

23

3.5

35

5.3

26

4.3

Burlington

11

5.8

10

4.9

11

5.3

13

6.0

13

5.7

12

5.8

10

5.7

19

10.2

8

4.2

10

5.0

15

8.3

Camden

15

5.9

9

3.1

19

6.8

14

5.5

21

7.9

13

5.0

12

3.8

14

5.5

16

6.0

18

6.3

14

5.7

Cape May

7

10.8

5

5.1

5

6.2

7

10.8

6

6.8

6

9.2

---

---

7

5.8

---

---

9

10.8

5

6.1

Essex

23

6.2

26

6.5

20

4.9

27

7.8

19

5.2

23

8.0

19

5.7

21

5.8

18

5.6

24

6.5

16

4.3

Gloucester

6

5.9

6

5.0

10

9.5

8

7.6

10

9.7

6

5.8

5

3.9

---

---

---

---

7

6.5

9

7.0

Hudson

21

6.2

13

4.2

22

7.4

17

4.8

12

3.9

17

5.6

14

3.9

21

6.1

19

5.5

25

7.5

24

8.6

Mercer

8

4.6

11

5.7

14

7.9

16

9.8

14

8.6

7

2.8

12

6.1

11

6.2

12

5.8

13

7.7

10

5.7

Middlesex

18

5.3

15

4.2

23

6.4

21

5.9

19

5.0

19

5.1

10

2.4

15

3.9

16

3.9

19

4.4

25

6.2

Monmouth

18

5.9

28

9.4

25

7.8

26

7.5

28

8.8

20

5.8

28

9.3

25

7.1

25

7.0

25

7.5

23

6.8

Morris

9

3.6

10

3.9

11

4.9

23

9.5

11

4.3

13

5.5

11

4.8

10

4.1

10

4.0

11

4.1

14

5.4

Ocean

20

6.6

13

2.8

24

6.4

19

4.4

17

3.8

18

5.5

19

5.4

28

7.6

24

6.2

28

6.9

13

3.9

Passaic

15

5.0

13

5.5

17

6.6

11

4.1

11

3.3

13

4.5

18

6.0

15

5.6

15

5.7

9

3.3

13

5.3

Somerset

8

6.7

9

7.1

6

4.9

5

3.9

---

---

---

---

10

6.4

7

5.0

9

6.8

---

---

6

5.1

Union

15

4.3

14

4.5

17

5.6

22

8.1

20

5.7

21

6.9

11

3.6

13

4.3

20

5.8

17

5.2

16

5.5

STATE

243

5.5

242

5.3

280

6.3

298

6.6

278

6.0

254

5.7

232

4.8

269

5.6

246

5.1

286

6.0

253

5.5


1Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Cumberland, Hunterdon, Salem, Sussex, Warren. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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Table 39.
Oral Cancer Incidence
By County, Blacks By Gender, New Jersey - 1986-1990 and 1991-19961

COUNTY

1986-1990

1991-1996

Male

Female

Male

Female

Number

Rate2

Number

Rate2

Number

Rate2

Number

Rate2

Atlantic

18

24.1

7

7.0

26

23.7

10

6.4

Bergen

10

12.3

3

2.5

16

14.5

6

4.1

Burlington

17

16.8

6

6.8

21

16.6

5

2.8

Camden

23

16.7

14

7.8

26

14.1

18

7.5

Cumberland

---

---

---

---

11

22.5

---

---

Essex

194

33.4

77

9.9

195

27.9

79

8.0

Gloucester

---

---

---

---

8

12.9

---

---

Hudson

46

37.5

9

4.7

32

18.7

13

5.8

Mercer

32

28.3

8

5.2

41

27.7

17

8.9

Middlesex

13

14.8

6

6.4

10

7.5

10

6.4

Monmouth

25

26.0

9

7.0

27

20.5

14

8.0

Morris

8

35.6

---

---

7

19.9

---

---

Ocean

9

44.6

---

---

6

19.8

---

---

Passaic

40

33.7

9

6.2

38

23.2

8

4.3

Somerset

---

---

---

---

7

16.8

---

---

Union

30

16.3

12

5.1

42

17.7

17

5.4

STATE

481

25.3

169

6.9

524

20.9

212

6.5


1Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with fewer than five cases for each gender in each time period were removed from the table - Cape May, Hunterdon, Salem, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.
2Average annual rate.

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Table 40.
Oral Cancer Incidence
By County, Race And Gender, New Jersey - 1986-1996 Combined1

COUNTY

MALE

FEMALE

WHITE

BLACK

WHITE

BLACK

Number

Rate2

Number

Rate2

Number

Rate2

Number

Rate2

Atlantic

160

14.9

44

23.9

94

6.6

17

6.6

Bergen

547

10.9

26

13.6

357

5.4

9

3.4

Burlington

219

12.4

38

16.7

132

6.0

11

4.4

Camden

292

13.1

49

15.2

165

5.6

32

7.6

Cape May

113

16.9

7

27.0

65

7.3

---

---

Cumberland

97

15.2

13

14.9

52

6.3

---

---

Essex

391

14.0

389

30.4

236

6.1

156

8.9

Gloucester

129

12.2

12

11.8

73

5.9

---

---

Hudson

448

17.9

78

26.8

205

5.8

22

5.3

Hunterdon

64

11.7

---

---

22

3.4

---

---

Mercer

228

15.3

73

28.0

128

6.5

25

7.4

Middlesex

437

13.3

23

10.3

200

4.8

16

6.5

Monmouth

361

12.6

52

22.8

271

7.5

23

7.5

Morris

254

11.7

15

26.6

133

4.9

---

---

Ocean

438

13.9

15

29.6

223

5.4

---

---

Passaic

354

16.4

78

27.8

150

5.0

17

5.1

Salem

36

10.8

6

11.2

25

6.3

---

---

Somerset

136

10.9

9

12.5

68

4.7

---

---

Sussex

86

14.4

---

---

46

6.3

---

---

Union

339

13.3

72

17.1

186

5.4

29

5.3

Warren

72

13.8

---

---

47

7.0

---

---

STATE

5210

13.4

1005

22.8

2881

5.7

381

6.7


1Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.
2Average annual rate.

Figure 13.

Figure 13

*1996 data are preliminary. Source: New Jersey State Cancer Registry.