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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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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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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