Mouth cancer For whom the bell tolls
Hatton Senior Clinical Research Prize winner David Conway was invited to speak at the Houses of Parliament on the launch of Mouth Cancer Action Month 2010. Here’s what he said to the politicians…
T
hank you for this opportunity to speak at the launch of Mouth Cancer Action Month 2010.
On my way here I was thinking, as I heard Big Ben’s bell ringing, that my research chimes with the location here in the Houses of Parliament. It also chimes with the current economic and social climate that we live in. My research on mouth cancer inequalities is a subject that is inherently political. Our research at the University of Glasgow Dental School is focused on understanding and ultimately tackling socioeco- nomic inequalities in oral health. Mouth cancer is a horrible, insidious disease. Horrible, as John Diamond – the respected journalist who so vividly docu- mented his suffering and death from oral cancer – described it as “like being on death row”. Insidious, because it hides under the radar of public and research attention, casting a dark shadow of devastating and often fatal consequences for individuals, families, and com- munities, while also stretching limited healthcare resources.
The research which I am
going to talk about today is a European collaborative with 14 centres across 11 countries – including our own in Glasgow; Manchester and Newcastle were the other UK centres. The research was well funded by the EU framework grant. We studied mouth cancer alongside pharynx/throat, lar- ynx and oesophagus/gullet – grouped together as upper aerodigestive tract cancers. Collectively, they are among the most common in the world, especially in developing coun- tries, but increasingly in Europe and North America. Globally there are about
550,000 cases a year, in Europe, about 180,000 cases every year and in the UK, we observe more than 10,000 cases, 1,000 in Scotland. Socioeconomic inequalities – with the poorest bearing the greatest burden – are increas- ingly being recognised. In Scotland there is a two-fold greater incidence in the most deprived compared to the least deprived areas. Traditional risk factors for mouth cancer are well known
and described. There is plenty of evidence that smoking and alcohol increase risk. And there is moderate level evidence that diets low in fresh fruit and vegetables, and human papilloma virus (HPV) infec- tion, also increase risk. Our systematic review of the
world literature has also shown definitively that low socioeco- nomic status by income, education and occupational social class increases risk for mouth cancer significantly. However, the components and nature of this socioeconomic risk are not well understood – with lifestyle risk factors (smok- ing, and alcohol) being the accepted explanation. So, in our European study, we aimed to assess socioeconomic factors associated with upper aerodigestive tract cancer risk, both independently and through their influence on known lifestyle behaviours. We employed a case-control
study design with robust meth- ods. This involved hour-long face-to-face interviews by trained research nurses follow- ing a detailed standardised script. We investigated full life
histories of patients recently diagnosed with cancer and the control group were recruited to the study matched on age and sex only – in that they were broadly identical, but didn’t have cancer. Data collected included
demographics, full-time occu- pation history, very detailed information on smoking, alco- hol and diet behaviours. Socioeconomic status was measured in several ways: edu- cation, occupational social class and unemployment experience. We managed to recruit large numbers due to the multi-cen- tre collaboration and the good funding arrangements. Some 2,200 people with cancer and a similar number of controls par- ticipated – making this the largest study of its kind in the world. More than half the cases were those with mouth cancer. What were our findings?
• low occupational social class – manual workers – had a 50 per cent increase risk rel- ative to non-manual workers.
• unemployed experience conferred a 60 per cent increase risk
• low educational attainment
54 Scottish Dental magazine
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