Racial differences in risk of oral and pharyngeal cancer: alcohol, tobacco, and other determinants.

BACKGROUND: In the United States, Blacks have increasingly higher rates of oral and pharyngeal cancer (oral cancer) than Whites, but determinants of the racial disparity have not been clear. PURPOSE: The purpose of this study was to explore reasons for the higher incidence of oral cancer among Blacks than Whites. METHODS: We used data from a large, population-based case-control study of oral cancer risk factors conducted in four areas of the United States. On the basis of interviews that ascertained characteristics of 1065 oral cancer patients (871 Whites and 194 Blacks) and 1182 controls (979 Whites and 203 Blacks), we examined racial differences in exposure prevalences and relative risks for a number of known etiologic factors, including tobacco and alcohol consumption, diet, and socioeconomic and other variables. To evaluate the extent to which the major risk factors explained the excess risk of oral cancer among Blacks, population-attributable risks were calculated. RESULTS: Differences with respect to alcohol consumption, especially among current smokers, emerged as the most important explanatory variables. After adjusting for smoking, heavy drinking (> or = 30 drinks/week) resulted in a 17-fold increased risk among Blacks and a ninefold increase among Whites. Among drinkers, Blacks tended to drink more than Whites. Also, a higher (P = .01) percentage of Blacks (37%) than Whites (28%) were current smokers, although there were little or no racial differences in relative risks or patterns of use for other smoking variables, including number of cigarettes smoked per day, years of smoking, and age started smoking. From population-attributable risk calculations, we estimated that differences in alcohol and tobacco use account for the bulk of the higher incidence of oral cancer among Blacks in the United States and that, in the absence of alcohol and tobacco, the rates of this cancer according to race (Black, White) and gender would be nearly equal. With regard to other potential etiologic factors, protective effects provided by higher dietary intake of fruits and vitamin C were more pronounced for Whites, while Blacks more often tended to be in sociodemographic and medical or dental health categories associated with increased risk. CONCLUSIONS: These analyses provide evidence that various environmental or lifestyle determinants of oral cancer may contribute to the higher oral cancer rates in Blacks than in Whites in the United States, but that patterns and risks associated with alcohol consumption, particularly among current smokers, are the most important contributors to the excess risk in Blacks. IMPLICATIONS: These findings suggest that the key to prevention of oral and pharyngeal cancers among both Blacks and Whites is reduced intake of alcoholic beverages and, because of strong interactive effects, the cessation of smoking.

Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer.

Interviews with 866 patients with cancer of the oral cavity and pharynx and 1249 controls of similar age and sex from the general population in four areas of the United States revealed increased risks associated with the regular use of mouthwash. Risks of oral cancer were elevated by 40% among male and 60% among female mouthwash users, after adjusting for tobacco and alcohol consumption. Risks among both sexes generally increased in proportion to duration and frequency of mouthwash use. The increased risks were confined to users of mouthwash high in alcohol content, consistent with the elevated risks associated with drinking alcoholic beverages. Except for a higher prevalence of leukoplakia among cases, little relationship was found with oral or dental conditions, although denture wearing was reported more often by patients with cancer of the gums. These findings, together with other studies, provide further incentive for clarifying the association between mouthwash use and oral cancer.

Endolymphatic fistulization.

Three previous papers have detailed my experience with various methods of surgical treatment of Meniere's disease: 1) surgery for all patients; 2) surgery for only those patients who demonstrated patency of the vestibular aqueduct as seen on tomographic examination; and 3) prognostic tests to determine which patients were most suitable for endolymphatic sac surgery. This paper details the results of endolymphatic shunt surgery performed on 43 patients over a 3-year period, restudying my prior conclusions. All patients were operated using a new method of capillary endolymph dispersement regardless of tomographic findings. The results are compared to the results of the prior studies to determine whether the findings of tomography are correlated with success or failure of shunt operations, a conclusion that others have questioned. This study clearly shows that the present technique affords better results than prior methods regardless of the x-ray findings. In addition, the tomographic findings correlate closely to the clinical pattern of the disease and to the success or failure of the operation.

Columellar tympanoplasty.

This article discusses the problem that ossicular reconstruction presents when the malleus handle has been destroyed and a columella must be used. The technical problems and failures of the past twenty-five years are exposed in an effort to glean the lessons of this experience. A comparison of three types of columella currently used--bone, ceramic, and polyethylene--is presented. Since there have been disadvantages and excessive failure rates with each type of columella, other techniques have been attempted and are described. Many of the questions posed by the efforts to develop adequate solutions to the problems of columellar tympanoplasty are restated here in the hope that cooperative research and development between surgeon and manufacturer will continue and prosper.

The off--centered TORP.

Refinement of the techniques of ossicular reconstruction has provided satisfactory hearing results for a majority of patients with chronic ear disease. As documented in 1976, 16% of patients, those requiring a columneller type of ossiculoplasty because of absence of the malleus, did not realize the same degree of hearing improvement as with other types of reconstruction. These procedures, short and long "L-shaped" assemblies, used for patients without a malleus, resulted in a mean 27 dB bone-air gap postoperatively. The conclusion reached after comparison with the results obtained with other types of reconstruction was "... the L-shaped conductive system is less efficient than normal by the amount observed (27 dB). If these results are to be improved, a change in the method of reconstruction resulting in a more normal system may be required." Following duplication of the aforecited report a change in the method of reconstruction used for patients with the malleus absent was instituted, but perversely creating a less normal conductive system. This paper will present the one year results of those patients in which a Plastipore prosthesis has been used as a replacement of the previously described method and will compare these results with those of the past technique.