Relative Frequency of Oral Malignancies and Oral Precancer in the Biopsy Service of Jazan Province, 2009-2014

Abstract

Background: The objective of this study was to report the types and relative frequency of oral malignancies and precancer in the Jazan region of Saudi Arabia during the period 2009-2014. Materials and Methods: Pathology reports were retrieved from the archives of Histopathology Department, King Fahd hospital in Jazan. Demographic data on tobacco habits, clinical presentation and histologic grading of oral precancer and cancer cases were transcribed from the files. Results: 303 (42.7%) oral pre-malignant and malignant cases were found out of 714 oral biopsy lesions. A pathology diagnosis of squamous cell carcinoma (85.1%) was most frequent, followed by premalignant lesions/epithelial dysplasia (8.6%), verrucous carcinoma (3.3%) and malignancy of other histological types (3%) such as ameloblastic carcinoma, salivary gland malignancy and sarcomas. Oral squamous cell carcinoma was predominant in females with a male to female ratio of 1:1.9. Patient age ranged from 22 to 100 years with a mean of 65±13.9. Almost 44.6% of oral cancer had occurred after 65 years of age. Only 16.3% cases were reported in patients younger than 50 years, predominantly females. The majority of female patients had the habit of using shammah with a long duration of usage for more than 45 years. Buccoalveolar mucosa (52.3%) was the common site of involvement followed by tongue/ floor of the mouth (47.7%) and clinically presented mostly as ulceration/swelling clinically. Moderately differentiated tumours (53.9%) were common followed by well differentiated (32.2%) and poorly differentiated tumours (5.8%). The prevalence of oral verrucous carcinoma (3.3%) was comparatively low with an equal distribution in both males and females. Both bucco-alveolar mucosa and tongue were predominantly affected. Oral precancer/epithelial dysplasia (8.6%) was common in females with a shammah habit. Bucco-alveolar mucosa was commonly involved and clinically presented mostly as white/red patches. Most cases were mild followed by moderate and severe dysplasia. Tumours of other histological types (3%) include 1 ameloblastic carcinoma, 3 malignant salivary gland tumours and 5 sarcomas. Conclusions: In this study, it was found that oral cancers reported in the pathology service to be a common occurrence. This study reconfirms previous reports of the high burden of oral cancer in this population This indicates that conventional preventive programs focused on oral cancer are in need of revision. In addition, further research into identifying new risk factors and molecular markers for oral cancer are needed for screening high risk individuals.

Prevalence of oral potentially malignant disorders: A systematic review and meta‐analysis

“…In phase‐2, 313 studies were excluded (Appendix ). In the final review, 22 studies were included for qualitative and quantitative evaluation (Figure ).…”

“…Among the 22 studies selected, 7 studies were performed in South America's or Caribbean countries, 5 in Asia, 5 in Europe, 2 in the Middle East, and 2 in North America . Six of the included studies had a sample size lower than 1000 individuals, and 4 studies had their sample size larger than 50 000 …”

“…Seven studies were classified to have high RoB, 12 had moderate RoB, and 3 had low RoB . For most studies, the response to questions “Was the sample representative of the target population?” and “Were study participants recruited in an appropriate way?” was scored as “high‐risk of bias” because the participants in the sample were not from a population screening samples and were not selected randomly.…”

The relationship of shammah (Arabian snuff) chewing to the risk of oral cancer and oral potentially malignant disorders

“…Four studies reported the duration of shammah use among the study groups and ranged from 10 to 45 years and 1 to 12.5 minutes per serving. The reported odds ratio was 6.91 (95% CI: 2.66‐17.95) for an average duration of shammah use of >5 minutes and 1.07 (95% CI: 0.98‐1.17) for the duration of being a shammah user of more than 1 year.…”

“…While assessing the quality of included studies using NOS score, only three were classified as good‐quality studies . These reported cancer cases that were confirmed either through histological analysis or hospital records and adjusted their risk estimates for other confounding factors including smoking.…”