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Population‐based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers
Author(s) -
Chuang ShuLin,
Su William WangYu,
Chen Sam LiSheng,
Yen Amy MingFang,
Wang ChengPing,
Fann Jean ChingYuan,
Chiu Sherry YuehHsia,
Lee YiChia,
Chiu HanMo,
Chang DunCheng,
Jou YannYuh,
Wu ChienYuan,
Chen HsiuHsi,
Chen MuKuan,
Chiou ShuTi
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30517
Subject(s) - medicine , cancer , betel , relative risk , population , confidence interval , incidence (geometry) , epidemiology , mortality rate , environmental health , physics , structural engineering , optics , nut , engineering
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. Cancer 2017;123:1597–1609. © 2017 American Cancer Society .