Fatima Dost

Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading

OBJECTIVE This study describes the predictive value of oral epithelial dysplasia (OED) grading as an indicator for malignant transformation and progression. STUDY DESIGN The records of an Australian-based pathology laboratory were searched for oral mucosal biopsies with a dysplastic or malignant diagnosis. Examination for an association with progression and malignant transformation without reinterpretation was performed. Analysis was undertaken using hazard ratios and the Fisher exact test. RESULTS A total of 368 patients with a diagnosis of OED were included. Twenty-six patients (7.1%) underwent progression or malignant transformation; the annual malignant transformation rate was 1%. No other characteristics were associated with a heightened risk of progression or transformation. CONCLUSIONS The severity of OED was not associated with risk of malignant transformation, suggesting that the current OED grading system is not useful for predicting patient outcomes or for determining management strategies. Definitive treatment of all OED is recommended, until a more reliable progression/transformation system is developed.

A retrospective analysis of clinical features of oral malignant and potentially malignant disorders with and without oral epithelial dysplasia

OBJECTIVE Clinical identification of underlying histopathology of oral mucosal lesions (OMLs) remains difficult. The study aims to identify clinical indicators of underlying histopathology of oral malignant and potentially malignant disorders. STUDY DESIGN All clinical patient records of an oral medicine and pathology clinic over a 12-year period were manually searched. Cases of OMLs with a histopathologic diagnosis of dysplasia (n = 124) and malignancy (n = 27) and a sample of nondysplastic OMLs (n = 109) were analyzed using both univariate and multivariate analysis and odds ratios for an association with clinical characteristics. RESULTS A nonhomogeneous clinical appearance was strongly associated with underlying dysplasia in both univariate and multivariate analysis (P < .001; odds ratio, 4.4). For lesions with homogeneous appearance, dysplasia was associated with lesion location (P = .005; odds ratio, 2.6) and smoking history (P = .04). CONCLUSIONS These findings suggest that a nonhomogeneous mucosal lesion is a significant independent indicator for underlying oral epithelial dysplasia, with location, size, and color as additional contributing factors.

Oral cancer in Australia 1982–2008: a growing need for opportunistic screening and prevention

BACKGROUND Globally, a decline in the incidence of oral cancer has been noted, while the mortality rates have remained relatively stable. The aim of this study was to provide an update on the incidence and mortality of oral cancer in Australia on a national and state level. METHODS Data regarding new cases and deaths associated with cancer of the lip, oral cavity and oropharynx were obtained from the Australian Institute of Health and Welfare for the period 1982-2008. Crude- and age-standardized incidence and mortality rates were calculated for all of Australia and for each state and territory. RESULTS A total of 60 826 cases of lip, oral cavity and oropharyngeal cancer were diagnosed in Australia. Between 1992 and 2008, a decline in the annual percentage change of age-standardized incidence was noted. The lip, followed by the tongue, continue to represent the most common sites of new oral cancer cases. There was no significant change in the rates of mortality for oral cancer over the time period. CONCLUSIONS These findings show that the oral cancer mortality rate remains high despite a decline in incidence over the past three decades, highlighting a greater need for dental practitioners to undertake preventive strategies and opportunistic screening for patients.

A retrospective analysis of oral and maxillofacial pathology in an Australian paediatric population.

BACKGROUND The prevalence of oral and maxillofacial pathology has not previously been reported in the Australian paediatric population. This study aimed to audit a large pathology service to provide insight into the prevalence of oral and maxillofacial pathology. METHODS Written records of a major Australian oral pathology service were imported into an electronic database. Age, gender and histological diagnosis were assessed. Prevalence of histological diagnoses as a percentage of the major diagnostic categories and of the whole sample were calculated, as well as gender predilections and mean age of presentation of disease. RESULTS A total of 1305 oral pathology specimens, collected from paediatric patients aged 16 and under were included in the analysis. The most common pathology was dental pathology (24.4%), followed by odontogenic cysts (18.5%) and mucosal pathology (17.0%). The most frequently encountered lesion was the dentigerous cyst (9.4%), followed by fibrous hyperplasia (8.3%), radicular cyst (5.2%) and chronic periapical granuloma (5.2%). CONCLUSIONS In the paediatric population, dental pathology and specifically, the dentigerous cyst is the most common pathology type sent for histopathology, suggesting a high prevalence of pathology of dental origin occurring in Australian children.

Oral mucosal lesions: findings from the Australian National Survey of Adult Oral Health.

BACKGROUND The prevalence of oral mucosal lesions (OMLs) and factors associated with these has not previously been reported in the Australian population. This study aimed to report on the prevalence of OMLs in Australian adults and to evaluate their association with socio-demographic factors. METHODS This study utilized data from the Australian National Survey of Adult Oral Health 2004-06, which employs a multi-stage, stratified random sample selection procedure. Information on socio-demographics, smoking and presence of OMLs were collected using telephone interview, self-reported questionnaires and comprehensive oral examination. A multivariate regression model was generated to estimate effect of factors on the prevalence of non-ulcerated OMLs. RESULTS A total of 3551 dentate adult Australians had complete data for this analysis. Over 20% of study participants presented with an OML on the day of examination. The prevalence of suspected malignancy was less than 1% and over 17% for non-ulcerated OMLs. Prevalence of non-ulcerated OMLs was associated with age, gender, residential location, household income and smoking. CONCLUSIONS The study reported that epidemiological survey can provide useful information on OMLs. Certain population groups had a higher risk of having the condition. Preventing smoking uptake and smoking cessation can reduce the prevalence of OMLs in the population.

Heightened risk of second primary carcinoma of the head and neck following cervical neoplasia

Cervical cancers have been shown to increase the risk of cancers at distant sites, including the head and neck region. This study investigated the relative risk of developing head and neck cancer subsequent to cervical cancer in an Australian population.

Knowledge of oral cancer risk factors amongst high-risk Australians: findings from the LESIONS programme

BACKGROUND Patient awareness of risk factors associated with cancer has been shown to increase patient presentation for screening and early detection. This study aimed to identify the level of awareness of oral cancer risk factors in a high risk Australian population. METHODS Participants were recruited from the LESIONS programme between April 2012 and April 2014. Demographics were collected via semi-structured interview. A self-administered questionnaire was provided, listing a number of possible oral cancer risk factors. Participants were requested to indicate their level of agreement on a three-point scale. Bivariate and multivariable analysis was performed. RESULTS A total of 1498 participants took part in the LESIONS programme and were invited to complete the questionnaire. The most common risk factors thought to be associated with oral cancer were smoking (87.5%), poor oral hygiene (67.9%) and family history (61.1%). Only 50.2% of respondents were aware of alcohol consumption as a risk factor. CONCLUSIONS While most participants were aware of the association between smoking and oral cancer, only half were aware of the significant risk alcohol consumption poses. A significant portion of participants also held a number of inaccurate beliefs in relation to oral cancer risk. These findings can benefit both clinicians and public health policy makers in targeting oral cancer education.