Risk factors associated with head and neck cancer in former smokers: A Brazilian multicentric study.

BACKGROUND: Reduced tobacco consumption in the population has not been associated with reduced incidence rates of head and neck cancer in several countries. OBJECTIVE: To explore the associations between HNC and sociodemographic characteristics and lifestyle of former smokers from three Brazilian cancer centers. METHODS: A multicenter case-control study was conducted with 229 former smokers diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, larynx, and 318 controls (former smokers without head and neck cancer). Bivariate and multiple logistic regression analyses were conducted to estimate odds ratios (ORs) with a 95% confidence interval (CI). RESULTS: 11-20 years after smoking cessation showed significant impact on HNC reduction (OR 0.22, 95% CI, 0.12-0.39), which reached 82% (95% CI, 0.09-0.35) among 20 + former smokers when compared to individuals who had stopped smoking for up to 5 years. A history of high-intensity smoking (>40 pack-years) increased HNC risk by 2.09 times (95% CI 1.13-3.89) when compared to subjects who smoked up to 20 pack-years. Past alcohol consumption (OR 1.99, 95% CI, 1.06-3.82) was also associated with head and neck cancer risk in former smokers when compared to no alcohol consumption. There was a decreased head and neck cancer risk in former smokers who had high school level of education (OR 0.38, 95% CI, 0.16-0.91) compared to illiterate former smokers; and former smokers with moderate intake of vegetables (OR 0.49, 95% CI, 0.28-0.85) and fruits (OR 0.43, 95% CI, 0.25-0.73) compared to those with low intake. CONCLUSION: Head and neck cancer risk in former smokers decreases after 11 years after smoking cessation, former smokers with past alcohol consumption showed an increased risk of HNC. High school level of education and moderate intake of vegetables and fruits reduced HNC risk among former smokers.

Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The InterCHANGE Study.

PURPOSE: Head and neck squamous cell carcinoma (HNSCC) incidence is high in South America, where recent data on survival are sparse. We investigated the main predictors of HNSCC survival in Brazil, Argentina, Uruguay, and Colombia. METHODS: Sociodemographic and lifestyle information was obtained from standardized interviews, and clinicopathologic data were extracted from medical records and pathologic reports. The Kaplan-Meier method and Cox regression were used for statistical analyses. RESULTS: Of 1,463 patients, 378 had a larynx cancer (LC), 78 hypopharynx cancer (HC), 599 oral cavity cancer (OC), and 408 oropharynx cancer (OPC). Most patients (55.5%) were diagnosed with stage IV disease, ranging from 47.6% for LC to 70.8% for OPC. Three-year survival rates were 56.0% for LC, 54.7% for OC, 48.0% for OPC, and 37.8% for HC. In multivariable models, patients with stage IV disease had approximately 7.6 (LC/HC), 11.7 (OC), and 3.5 (OPC) times higher mortality than patients with stage I disease. Current and former drinkers with LC or HC had approximately 2 times higher mortality than never-drinkers. In addition, older age at diagnosis was independently associated with worse survival for all sites. In a subset analysis of 198 patients with OPC with available human papillomavirus (HPV) type 16 data, those with HPV-unrelated OPC had a significantly worse 3-year survival compared with those with HPV-related OPC (44.6% v 75.6%, respectively), corresponding to a 3.4 times higher mortality. CONCLUSION: Late stage at diagnosis was the strongest predictor of lower HNSCC survival. Early cancer detection and reduction of harmful alcohol use are fundamental to decrease the high burden of HNSCC in South America.

Relação entre condição bucal precária e carcinoma de células escamosas oral e orofaríngeo / Relationship between poor oral health and oral and oropharyngeal squamous cell carcinoma

Introdução: Condição bucal precária tem sido relacionada aorisco de desenvolvimento de câncer, no entanto os critérios paradeterminar esta relação ainda não estão bem estabelecidos.Objetivo: O objetivo deste estudo foi avaliar a condição bucale sua relação com o desenvolvimento do carcinoma de célulasescamosas oral e orofaríngeo. Método: Trata-se de estudotransversal descritivo de perfil epidemiológico, onde foram obtidosdados de 150 pacientes sobre gênero, faixa etária, etnia e históriado uso de tabaco e consumo de álcool. A condição bucal foideterminada utilizando os índices de número de dentes perdidos,restaurados e cariados (CPO-D), Perda de Inserção Periodontal(PIP) e Índice Periodontal Comunitário (CPI). Resultados: Aavaliação da condição bucal mostrou que 98,67% dos indivíduosapresentaram grande número de dentes perdidos (média 23,11dentes). Na análise do CPO-D foi observada diferença na faixaetária acima de 50 anos (p< 0.01). Não foram observadasdiferenças significativas relacionadas à quantidade de tabaco ouálcool consumida, bem como ao tempo de consumo de bebidasalcoólicas. O uso do tabaco mostrou relação somente com o índiceCPO-D associado ao tempo de uso superior a 30 anos (p< 0.05).Na análise dos índices CPI e PIP, 74% dos sextantes foramexcluídos devido ao grande número de perdas dentárias. Foramobservados presença de sangramento, cálculo e profundidadede sondagem maior que 4 mm na maioria dos sextantesanalisados. Conclusão: Relação entre condição bucal precária edesenvolvimento de câncer oral e orofaríngeo foi observada nesteestudo, considerando CPO-D, CPI e PIP indicadores relevantespara determinar a condição bucal de pacientes oncológicos.