title: A deficit in biopsying potentially premalignant oral lesions in Puerto Rico.
abstract: BACKGROUND
  Intraoral lesions clinically suspicious for cancer/precancer should be biopsied and diagnosed histopathologically. We evaluated whether the frequency of oral cancer (OC) cases diagnosed in Puerto Rico (PR) is disproportionately high relative to the frequency of persons with histopathologic diagnoses that would have appeared clinically suspicious for OC/precancer at biopsy.
  
  
  METHODS
  All pathology reports for oral (ICD-O-3 C01-C06) soft tissue biopsies generated during 1/2004-5/2005 by seven PR and two New York City (NYC) pathology laboratories were reviewed. The analysis was restricted to persons diagnosed with invasive oral squamous cell carcinoma (OSCC), epithelial dysplasia, or hyperkeratosis/epithelial hyperplasia (HK/EH), i.e., diagnoses associated with lesions clinically suspicious for OC/precancer. The OC relative frequency measured the percentage of persons diagnosed with OSCC among persons with OSCC, dysplasia, or HK/EH. OC relative frequencies for PR and NYC laboratories were compared.
  
  
  RESULTS
  Overall, the OC relative frequency was 67% in PR and 40% and 4% in the NYC general and oral pathology laboratories, respectively (each p<0.001). In PR, the OC relative frequency was highest for males (80%). When OC relative frequencies were stratified by pathology laboratory type (general/oral) and compared across PR and NYC, age/gender-specific OC relative frequencies were always higher in PR; however, differences were consistently statistically significant for males only.
  
  
  CONCLUSIONS
  A disparity in the OC relative frequency exists in PR vs. NYC indicating a shortfall in biopsying potentially precancerous oral lesions in PR. PR residents with intraoral lesions suspicious for oral cancer/precancer are most likely to be biopsied only after developing an invasive OC.
authors.affiliation: New York University College of Dentistry, Department of Epidemiology & Health Promotion, New York, NY 10003-1402, USA. dem5@nyu.edu
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Morse
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Psoter
authors.forename: Lumarie
authors.initials: L
authors.lastname: Cuadrado
authors.forename: Yves A
authors.initials: YA
authors.lastname: Jean
authors.forename: Joan
authors.initials: J
authors.lastname: Phelan
authors.forename: Khush
authors.initials: K
authors.lastname: Mittal
authors.forename: Carmen J
authors.initials: CJ
authors.lastname: Buxó
authors.forename: Gustavo D
authors.initials: GD
authors.lastname: Cruz
authors.forename: Augusto
authors.initials: A
authors.lastname: Elias
mesh_terms: D000367:Age Factors; D001706:Biopsy / Q000706:statistics & numerical data*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007753:Laboratories / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D009519:New York City / Q000453:epidemiology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D011647:Puerto Rico / Q000453:epidemiology; D012737:Sex Factors; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*