Exp. Patho!. 1990; 40: 229- 23 \ Gustav Fischer Verlag Jena
1) 2)
Department of Dental Surgery/Ora l Surgery (North), Free University, Berlin , FRG Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Oral cancer in Northern Thailand' ) By P. A. REtCHART1) , A. SCHMIDT-WESTHAUSEN 1) and C. THEETRANONT2)
Address for correspondence: P. A. REICHART , Abteilung ftir zahnarztliche Chirurgie/Oralchirurgie (Nord), Freie Universitat Berlin, Fahrer Str. 15, W - 1000 Berlin 65 Key words: oral cancer ; betel quid ; Areca nut; tobacco habits; cancer, oral
Summary
Statistical material accumulated at the Faculty of Medicine, Chiang Mai University, Thailand, revealed that oral cancer ranked third in both sexes during 1975-1 984 and 1981 alone. In 1987 oral cancer had dropped to rank 7 of cancers of all sites. Since there is evide nce of disappearance of traditional chewing and smoking habits in Northern Thailand this may result in changing incidence of oral cancer in this province.
Introduction The high prevalence of oral cancer and precancer in South-East Asia has well been docu mented (4, 9, 10). In a descriptive study from Thailand published in 1924 47 % of all cancers involved oral structures (5). Another study from Thailand (1959) showed that 14. 1% of all cancers (n = 1100) were either cancers of the lip, tongue or oral cavity (6) . A review of 27,703 cases of cancer from a hospital in Bangkok (1955 to 1980) reveale d 4,260 (15.4 %) oral carcinoma cases; 63.4 % of them were chewers of Areca nut (12). In a recent report (1984) (I I), oral cancer was found to rank third when compared with total cancer incidence ; oral cancer represented 8 % of all cancers. The correlation between oral cancer and precanc er and tobacco habits as well as betel quid and Areca nut chewing has well been documented (2, 3). In addition, several epidemiologic studies from Northern Thail and have shown an association between oral mucosal lesions and specific smoking and chewing habits (7,8) . The purpose of the present article was to summarize and compare some statistics on the incidence of oral cancer in Northern Th ailand , based on material mainly published in the Thai language.
Materials and Methods Statistica l material was extracted from publications basically published at the Faculty of Medicine, Chiang Mai Hospital, Chiang Mai University, Thailand (I, 13, 14). The 10 leading sites of all cancers were recorded as well as the absolute number of cancer cases registered . In addition, the absolute number of oral cancers and the rank of oral cancer among the 10 leading I) Dedicated to Prof. MO HR on the occasion of his 60th birthday
Exp. Pathol. 40 (1990) 4
229
sites was recorded. Figures were compared to additional statistical material from central and Southern Thailand (I) .
Results All figures obtained from the original sources including the absolute number of cancers of all sites, the absolute number of oral cancers , the percentage of all oral cancers in relation to cancers of all sites as well as the rank of oral cancer of the IO leading cancer sites are summarized in table 1. From the accumulated material it appears that during the period from 1975 to 1985 7.98 %
Table I, Oral cancer in Chiang Mai province. Cancer all sites (n)
Oral cancer
Rank of 10 leading sites
(n)
(%)
14,166 6,201 7,915
1,126 673 453
7.98 10.85 5.72
3. 2. 4.
1981 (S2) males females
1,785 832 953
121 51 70
6.75 6.13 7.35
3. 5. 4.
1987 (53) males females
3,836 1,742 2,094
164 98 66
4.28 5.63 3.15
6. 3. 7.
1975-84 (SI) males females
SI, 2, 3=Source 1 (ref. I) ; Source 2 (ref. 13); Source 3 (ref. 14) of all cancers were oral cancers. While in 1981 alone 6. 75 % were oral cancers this figure dropped to 4.28 % in 1987. From 1975 to 1984 and in 1981 oral cancer ranked as the third most common cancer among the IO leading cancer sites. In 1987 it only ranked as the sixth most common tumour site . The most common sites in falling frequency were ( 1): I. cervix uteri 18.48 %),2. lung (9 .58% ), 3. oral cavity (7 .98 %) ,4. breast (6.6 %) , 5. skin (6.06 %),6. liver (5.44 %) ,7. larynx (5. 37 % ) , 8. stomach (4.46 %), 9. pharynx (4.43 % ), 10. lymph node (3.12 % ). If the most common female tumour of cervix uteri is not considered , oral carcinoma was the second most frequent cancer for males (10.85 % ). Statistical material from the period of 1975 to 1984 as well as from 1981 alone showed oral cancer to be the third most common cancer in both sexes and the second most common oral cancer in males (1975 to 1984). In a series of cancer patients from Ramathibodi Hospital in Bangkok (1974 to 1978) (n = 5,496) oral cancer occurred in 9.08 % of the cases and ranked second in the 10 leading sites. Similar findings were reported from Siriraj Hospital (1979 to 1980) (n = 6,670) with oral cancer occurring in 9 .54 % of the cases and also ranking second in the IO leading sites . In material from the southern part of Thailand (1976 to 1982) (n = 3,192) cancer of the oral cavity occurred in 11.18 % ranking third in the 10 leading sites of all cancers (1).
Discussion From the figures extracted from statistical material accumulated at the Faculty of Medicine, Chiang Mai University, it clearly appears that oral cancer excluding nasa-pharyngeal carcinoma in still one of the most common cancers of the body had in this northern province and other parts of Thailand. Of some interest , however, is that in the statistical report from 1987 (14) the incidence of oral cancer in relation to all cancers of the body dropped to 4.28 %, now representing the sixth most common cancer in the 10 leading sites . While in males this figure dropped to 5.6 % (rank 3), in females it had dropped to 3.15 % (rank 7) . In an estimation of cancer incidence (10 230
Exp. Palho!. 40 ( 1990) 4
leading sites) in the Chiang Mai province based on a rate per 100,000 of the total population of this province oral cancer figured with 4.2 % (rank 7 for both sexes), 5.3 % (rank 5 for males and rank 10 for females) (14). It was interesting to note that in these estimations cancers appeared, e. g. colorectal cancer, which did not appear in the 10 leading sites from figures accumulated during the years 1975 to 1984 (I). At present it may be.too early to speculate on an indication of a decrease of oral cancer in Northern Thailand, however, a change of habit patterns concerning smoking and chewing has to be noted (7, 8). In particular, traditional habits such as betel nut chewing and smoking of cigars such as Khi Yo have been given up by young people. Thus, epidemiological studies have shown that the chewing of betel and miang was more prevalent among older Thai people and that these habits seem to have lost their attraction for the younger generation. Instead, cigarette smoking was more prevalent among younger and middle-aged individuals (7). It will be of extreme interest to see whether in the future the prevalence of oral cancer in Northern Thailand will decrease with the disappearance of traditional chewing and smoking habits.
References 1. CHAIWAN, B., SINCHAISRI, T., RANGDAENG, S., THEETRANONT, c., MENAKANIT, W.: Cancer in North Thailand. Chiang Mai Med. Bull. 1986; 25: 280-289. 2. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, vol. 37. IARC, Lyon, France 1985. 3. KOONTONGKAEW, S.: Betel quid chewing and oral cancer. J. Sci. Soc. Thailand 1986; 83-95. 4. KWAN, H. W.: A statistical study on oral carcinomas in Taiwan with emphasis on the relationship with betel nut chewing: a preliminary report. J. Formosan Med. Assoc. 1976; 75: 497-505. 5. MENDELSON, R. W., ELLIS, A. G.: Cancer as a public health problem in Siam. J. Trop. Med. Hyg. 1924; 27: 274-278. 6. PlYARATN, P.: Relative incidence of malignant neoplasms in Thailand. Cancer 1959; U: 693-696. 7. REICHART, P. A., MOHR, U., SRlSUWAN, S., GEERLINGS, H., THEETRANoNT, C., KANGWANPONG, T.: Precancerous and other oral mucosal lesions related to chewing, smoking and drinking habits in Thailand. Community Dent. Oral Epidemiol. 1987; 15: 152-160. 8. - PHILlPSEN, H. P., MOHR, U., GEERLlNGS, H., SRISUWAN, S.: Miang chewing in Northern Thai villagers. Trop. Geogr. Med. 1988; 40: 39-44. 9. SENEWIRATNE, B., URAGODA, C. G.: Betel chewing in Ceylon. Am. J. Trop. Med. Hyg. 1973; 22: 418-422. 10. SIMARAK, S., JONG, U. W. DE, BRESLOW, N. et al.: Cancer of the oral cavity, pharynxllarynx and lung in North Thailand: Case control study and analysis of cigar smoke. Br. J. Cancer 1977; 36: 130-140. 11. SONTJPONG, S., SOMBOONCHAROEN, S.: Oral cancer in Thailand. Thai Cancer J. 1984; 10: 11-16. 12. TEPMONGKOL, P., SKULCHAN, Y., PESEE, M., THANsAKuL, A., PRlJYANONDA, B.: Betelnut chewing and oral cancers. Siriraj Hosp. Gaz. 1981; 33: 797-803. ' 13. Tumor Registry. Cancer Unit. Chiang Mai Hospital. Statistical Report, vol. 4, 1981. 14. Tumor Registry. Cancer Unit. Maharaj Nakorn Chiang Mai Hospital. Statistical Report, vol. 10, 1987.
Exp. Pathol. 40 (1990) 4
231
1) 2)
Department of Dental Surgery/Ora l Surgery (North), Free University, Berlin , FRG Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Oral cancer in Northern Thailand' ) By P. A. REtCHART1) , A. SCHMIDT-WESTHAUSEN 1) and C. THEETRANONT2)
Address for correspondence: P. A. REICHART , Abteilung ftir zahnarztliche Chirurgie/Oralchirurgie (Nord), Freie Universitat Berlin, Fahrer Str. 15, W - 1000 Berlin 65 Key words: oral cancer ; betel quid ; Areca nut; tobacco habits; cancer, oral
Summary
Statistical material accumulated at the Faculty of Medicine, Chiang Mai University, Thailand, revealed that oral cancer ranked third in both sexes during 1975-1 984 and 1981 alone. In 1987 oral cancer had dropped to rank 7 of cancers of all sites. Since there is evide nce of disappearance of traditional chewing and smoking habits in Northern Thailand this may result in changing incidence of oral cancer in this province.
Introduction The high prevalence of oral cancer and precancer in South-East Asia has well been docu mented (4, 9, 10). In a descriptive study from Thailand published in 1924 47 % of all cancers involved oral structures (5). Another study from Thailand (1959) showed that 14. 1% of all cancers (n = 1100) were either cancers of the lip, tongue or oral cavity (6) . A review of 27,703 cases of cancer from a hospital in Bangkok (1955 to 1980) reveale d 4,260 (15.4 %) oral carcinoma cases; 63.4 % of them were chewers of Areca nut (12). In a recent report (1984) (I I), oral cancer was found to rank third when compared with total cancer incidence ; oral cancer represented 8 % of all cancers. The correlation between oral cancer and precanc er and tobacco habits as well as betel quid and Areca nut chewing has well been documented (2, 3). In addition, several epidemiologic studies from Northern Thail and have shown an association between oral mucosal lesions and specific smoking and chewing habits (7,8) . The purpose of the present article was to summarize and compare some statistics on the incidence of oral cancer in Northern Th ailand , based on material mainly published in the Thai language.
Materials and Methods Statistica l material was extracted from publications basically published at the Faculty of Medicine, Chiang Mai Hospital, Chiang Mai University, Thailand (I, 13, 14). The 10 leading sites of all cancers were recorded as well as the absolute number of cancer cases registered . In addition, the absolute number of oral cancers and the rank of oral cancer among the 10 leading I) Dedicated to Prof. MO HR on the occasion of his 60th birthday
Exp. Pathol. 40 (1990) 4
229
sites was recorded. Figures were compared to additional statistical material from central and Southern Thailand (I) .
Results All figures obtained from the original sources including the absolute number of cancers of all sites, the absolute number of oral cancers , the percentage of all oral cancers in relation to cancers of all sites as well as the rank of oral cancer of the IO leading cancer sites are summarized in table 1. From the accumulated material it appears that during the period from 1975 to 1985 7.98 %
Table I, Oral cancer in Chiang Mai province. Cancer all sites (n)
Oral cancer
Rank of 10 leading sites
(n)
(%)
14,166 6,201 7,915
1,126 673 453
7.98 10.85 5.72
3. 2. 4.
1981 (S2) males females
1,785 832 953
121 51 70
6.75 6.13 7.35
3. 5. 4.
1987 (53) males females
3,836 1,742 2,094
164 98 66
4.28 5.63 3.15
6. 3. 7.
1975-84 (SI) males females
SI, 2, 3=Source 1 (ref. I) ; Source 2 (ref. 13); Source 3 (ref. 14) of all cancers were oral cancers. While in 1981 alone 6. 75 % were oral cancers this figure dropped to 4.28 % in 1987. From 1975 to 1984 and in 1981 oral cancer ranked as the third most common cancer among the IO leading cancer sites. In 1987 it only ranked as the sixth most common tumour site . The most common sites in falling frequency were ( 1): I. cervix uteri 18.48 %),2. lung (9 .58% ), 3. oral cavity (7 .98 %) ,4. breast (6.6 %) , 5. skin (6.06 %),6. liver (5.44 %) ,7. larynx (5. 37 % ) , 8. stomach (4.46 %), 9. pharynx (4.43 % ), 10. lymph node (3.12 % ). If the most common female tumour of cervix uteri is not considered , oral carcinoma was the second most frequent cancer for males (10.85 % ). Statistical material from the period of 1975 to 1984 as well as from 1981 alone showed oral cancer to be the third most common cancer in both sexes and the second most common oral cancer in males (1975 to 1984). In a series of cancer patients from Ramathibodi Hospital in Bangkok (1974 to 1978) (n = 5,496) oral cancer occurred in 9.08 % of the cases and ranked second in the 10 leading sites. Similar findings were reported from Siriraj Hospital (1979 to 1980) (n = 6,670) with oral cancer occurring in 9 .54 % of the cases and also ranking second in the IO leading sites . In material from the southern part of Thailand (1976 to 1982) (n = 3,192) cancer of the oral cavity occurred in 11.18 % ranking third in the 10 leading sites of all cancers (1).
Discussion From the figures extracted from statistical material accumulated at the Faculty of Medicine, Chiang Mai University, it clearly appears that oral cancer excluding nasa-pharyngeal carcinoma in still one of the most common cancers of the body had in this northern province and other parts of Thailand. Of some interest , however, is that in the statistical report from 1987 (14) the incidence of oral cancer in relation to all cancers of the body dropped to 4.28 %, now representing the sixth most common cancer in the 10 leading sites . While in males this figure dropped to 5.6 % (rank 3), in females it had dropped to 3.15 % (rank 7) . In an estimation of cancer incidence (10 230
Exp. Palho!. 40 ( 1990) 4
leading sites) in the Chiang Mai province based on a rate per 100,000 of the total population of this province oral cancer figured with 4.2 % (rank 7 for both sexes), 5.3 % (rank 5 for males and rank 10 for females) (14). It was interesting to note that in these estimations cancers appeared, e. g. colorectal cancer, which did not appear in the 10 leading sites from figures accumulated during the years 1975 to 1984 (I). At present it may be.too early to speculate on an indication of a decrease of oral cancer in Northern Thailand, however, a change of habit patterns concerning smoking and chewing has to be noted (7, 8). In particular, traditional habits such as betel nut chewing and smoking of cigars such as Khi Yo have been given up by young people. Thus, epidemiological studies have shown that the chewing of betel and miang was more prevalent among older Thai people and that these habits seem to have lost their attraction for the younger generation. Instead, cigarette smoking was more prevalent among younger and middle-aged individuals (7). It will be of extreme interest to see whether in the future the prevalence of oral cancer in Northern Thailand will decrease with the disappearance of traditional chewing and smoking habits.
References 1. CHAIWAN, B., SINCHAISRI, T., RANGDAENG, S., THEETRANONT, c., MENAKANIT, W.: Cancer in North Thailand. Chiang Mai Med. Bull. 1986; 25: 280-289. 2. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, vol. 37. IARC, Lyon, France 1985. 3. KOONTONGKAEW, S.: Betel quid chewing and oral cancer. J. Sci. Soc. Thailand 1986; 83-95. 4. KWAN, H. W.: A statistical study on oral carcinomas in Taiwan with emphasis on the relationship with betel nut chewing: a preliminary report. J. Formosan Med. Assoc. 1976; 75: 497-505. 5. MENDELSON, R. W., ELLIS, A. G.: Cancer as a public health problem in Siam. J. Trop. Med. Hyg. 1924; 27: 274-278. 6. PlYARATN, P.: Relative incidence of malignant neoplasms in Thailand. Cancer 1959; U: 693-696. 7. REICHART, P. A., MOHR, U., SRlSUWAN, S., GEERLINGS, H., THEETRANoNT, C., KANGWANPONG, T.: Precancerous and other oral mucosal lesions related to chewing, smoking and drinking habits in Thailand. Community Dent. Oral Epidemiol. 1987; 15: 152-160. 8. - PHILlPSEN, H. P., MOHR, U., GEERLlNGS, H., SRISUWAN, S.: Miang chewing in Northern Thai villagers. Trop. Geogr. Med. 1988; 40: 39-44. 9. SENEWIRATNE, B., URAGODA, C. G.: Betel chewing in Ceylon. Am. J. Trop. Med. Hyg. 1973; 22: 418-422. 10. SIMARAK, S., JONG, U. W. DE, BRESLOW, N. et al.: Cancer of the oral cavity, pharynxllarynx and lung in North Thailand: Case control study and analysis of cigar smoke. Br. J. Cancer 1977; 36: 130-140. 11. SONTJPONG, S., SOMBOONCHAROEN, S.: Oral cancer in Thailand. Thai Cancer J. 1984; 10: 11-16. 12. TEPMONGKOL, P., SKULCHAN, Y., PESEE, M., THANsAKuL, A., PRlJYANONDA, B.: Betelnut chewing and oral cancers. Siriraj Hosp. Gaz. 1981; 33: 797-803. ' 13. Tumor Registry. Cancer Unit. Chiang Mai Hospital. Statistical Report, vol. 4, 1981. 14. Tumor Registry. Cancer Unit. Maharaj Nakorn Chiang Mai Hospital. Statistical Report, vol. 10, 1987.
Exp. Pathol. 40 (1990) 4
231
