Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers

Shu Lin Chuang, William Wang Yu Su, Sam Li Sheng Chen, Amy Ming Fang Yen, Cheng Ping Wang, Jean Ching Yuan Fann, Sherry Yueh Hsia Chiu, Yi Chia Lee, Han Mo Chiu, Dun Cheng Chang, Yann Yuh Jou, Chien Yuan Wu, Hsiu Hsi Chen, Mu Kuan Chen, Shu Ti Chiou

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. METHODS: A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged≥18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. RESULTS: The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. CONCLUSIONS: An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer.

Original languageEnglish
JournalCancer
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Mouth Neoplasms
Tobacco Products
Mortality
Population
Confidence Intervals
Selection Bias
Mastication
Early Detection of Cancer
Habits
Smoking
Intention to Treat Analysis
Incidence
Program Evaluation

Keywords

  • Betel quid chewing
  • Cigarette smoking
  • Mortality
  • Oral cancer
  • Population-based screening

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers. / Chuang, Shu Lin; Su, William Wang Yu; Chen, Sam Li Sheng; Yen, Amy Ming Fang; Wang, Cheng Ping; Fann, Jean Ching Yuan; Chiu, Sherry Yueh Hsia; Lee, Yi Chia; Chiu, Han Mo; Chang, Dun Cheng; Jou, Yann Yuh; Wu, Chien Yuan; Chen, Hsiu Hsi; Chen, Mu Kuan; Chiou, Shu Ti.

In: Cancer, 2017.

Research output: Contribution to journalArticle

Chuang, SL, Su, WWY, Chen, SLS, Yen, AMF, Wang, CP, Fann, JCY, Chiu, SYH, Lee, YC, Chiu, HM, Chang, DC, Jou, YY, Wu, CY, Chen, HH, Chen, MK & Chiou, ST 2017, 'Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers', Cancer. https://doi.org/10.1002/cncr.30517
Chuang, Shu Lin ; Su, William Wang Yu ; Chen, Sam Li Sheng ; Yen, Amy Ming Fang ; Wang, Cheng Ping ; Fann, Jean Ching Yuan ; Chiu, Sherry Yueh Hsia ; Lee, Yi Chia ; Chiu, Han Mo ; Chang, Dun Cheng ; Jou, Yann Yuh ; Wu, Chien Yuan ; Chen, Hsiu Hsi ; Chen, Mu Kuan ; Chiou, Shu Ti. / Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers. In: Cancer. 2017.
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abstract = "BACKGROUND: To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. METHODS: A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged≥18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. RESULTS: The overall screening rate was 55.1{\%}. The relative risk of death from oral cancer was 0.53 (95{\%} confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95{\%} CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95{\%} CI, 0.59-0.64), which increased to 0.79 (95{\%} CI, 0.76-0.82) after adjustment for self-selection bias. CONCLUSIONS: An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer.",
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author = "Chuang, {Shu Lin} and Su, {William Wang Yu} and Chen, {Sam Li Sheng} and Yen, {Amy Ming Fang} and Wang, {Cheng Ping} and Fann, {Jean Ching Yuan} and Chiu, {Sherry Yueh Hsia} and Lee, {Yi Chia} and Chiu, {Han Mo} and Chang, {Dun Cheng} and Jou, {Yann Yuh} and Wu, {Chien Yuan} and Chen, {Hsiu Hsi} and Chen, {Mu Kuan} and Chiou, {Shu Ti}",
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T1 - Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers

AU - Chuang, Shu Lin

AU - Su, William Wang Yu

AU - Chen, Sam Li Sheng

AU - Yen, Amy Ming Fang

AU - Wang, Cheng Ping

AU - Fann, Jean Ching Yuan

AU - Chiu, Sherry Yueh Hsia

AU - Lee, Yi Chia

AU - Chiu, Han Mo

AU - Chang, Dun Cheng

AU - Jou, Yann Yuh

AU - Wu, Chien Yuan

AU - Chen, Hsiu Hsi

AU - Chen, Mu Kuan

AU - Chiou, Shu Ti

PY - 2017

Y1 - 2017

N2 - BACKGROUND: To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. METHODS: A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged≥18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. RESULTS: The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. CONCLUSIONS: An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer.

AB - BACKGROUND: To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. METHODS: A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged≥18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. RESULTS: The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. CONCLUSIONS: An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer.

KW - Betel quid chewing

KW - Cigarette smoking

KW - Mortality

KW - Oral cancer

KW - Population-based screening

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