ASPO Abstracts
Factors associated with the development of early onset oral tongue cancer
Category: Electronic Health Records (EHRs), Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
While many types of head and neck cancer are declining in the US due to decreased tobacco use, incidence of oral tongue carcinoma (OTC) is rising among those under age 50. The underlying cause is unknown. The purpose of this study was to identify factors associated with early (< age 50) vs. traditional onset OTC and to evaluate patient outcomes. 567 OTCs diagnosed and/or treated at Vanderbilt between 2000 and 2016 were identified using the Research Derivative, a searchable database containing clinical data from more than 3.5 million electronic health records (EHRs) and cancer registry data (ex: cancer site, stage, date/age of diagnosis, race, gender). All confirmed incident cases without a prior history of cancer (N=417) underwent manual EHR review to obtain data not amenable for automated extraction: alcohol and tobacco use (cigarette, cigar, pipe, snuff, chewing tobacco), treatment, and outcome (recurrence/survival). Of the 417 patients, median age was 59 (interquartile range: 48-67), the majority were male (59.5%), white (95.4%), tobacco (64.8%) and alcohol users (61.2%), stage 0-II (52.5%), and treated with surgical resection only (59.5%). 118 (28.3%) cases were early onset. Compared to traditional onset cases, patients with early onset OTC were less likely to be heavy alcohol users (adjusted odds ratio [aOR]:0.2, 95% confidence interval [CI]:0.1-0.8) and more likely to receive combined modality treatment (surgery & radiation; aOR:2.8, 95%CI:1.1-7.0), and to report snuff use (aOR:4.8, 95%CI:1.6-14.7). Early onset patients had significantly better overall survival (adjusted hazard ratio [aHR]: 0.5, 95%CI:0.3-0.9). In stratified analyses, the association between early onset and improved survival was strongest among tobacco users (aHR:0.3, 95%CI:0.1-0.8); reduced risk of recurrence was only observed among early onset patients with no history of tobacco use (aHR:0.4, 95% CI:0.1-0.9). This is the largest study to evaluate factors associated with early onset OTC and the first to report an association with snuff — a smokeless tobacco increasing in popularity among younger birth cohorts. Yet, only 55% of early onset cases reported tobacco use and only 12% reported snuff use, suggesting the presence of additional, unknown factors contributing to the rise in OTC.
Keywords: oral tongue cancer; early onset; tobacco; snuff; survival