title: Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions.
abstract: The mouth and oropharynx are among the ten most common sites affected by cancer worldwide, but global incidence varies widely. Five-year survival rates exceed 50% in only the best treatment centers. Causes are predominantly lifestyle-related: Tobacco, areca nut, alcohol, poor diet, viral infections, and pollution are all important etiological factors. Oral cancer is a disease of the poor and dispossessed, and reducing social inequalities requires national policies co-ordinated with wider health and social initiatives - the common risk factor approach: control of the environment; safe water; adequate food; public and professional education about early signs and symptoms; early diagnosis and intervention; evidence-based treatments appropriate to available resources; and thoughtful rehabilitation and palliative care. Reductions in inequalities, both within and between countries, are more likely to accrue from the application of existing knowledge in a whole-of-society approach. Basic research aimed at determining individual predisposition and acquired genetic determinants of carcinogenesis and tumor progression, thus allowing for targeted therapies, should be pursued opportunistically.
authors.affiliation: Griffith Health Institute, Griffith University, Queensland, Australia. n.johnson@griffith.edu.au
authors.forename: N W
authors.initials: NW
authors.lastname: Johnson
authors.forename: S
authors.initials: S
authors.lastname: Warnakulasuriya
authors.forename: P C
authors.initials: PC
authors.lastname: Gupta
authors.forename: E
authors.initials: E
authors.lastname: Dimba
authors.forename: M
authors.initials: M
authors.lastname: Chindia
authors.forename: E C
authors.initials: EC
authors.lastname: Otoh
authors.forename: R
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: J
authors.initials: J
authors.lastname: Califano
authors.forename: L
authors.initials: L
authors.lastname: Kowalski
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D001114:Areca / Q000009:adverse effects; D018865:Dental Research; D014943:Global Health; D006266:Health Education; D006291:Health Policy; D006292:Health Priorities; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D009909:Oral Health; D011230:Precancerous Conditions; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D062789:Tobacco Products