title: Oral cancer incidence and survival rates in the Republic of Ireland, 1994-2009.
abstract: Oral cancer is a significant public health problem world-wide and exerts high economic, social, psychological, and physical burdens on patients, their families, and on their primary care providers. We set out to describe the changing trends in incidence and survival rates of oral cancer in Ireland between 1994 and 2009.
  
  
  
  National data on incident oral cancers [ICD 10 codes C01-C06] were obtained from the National Cancer Registry Ireland from 1994 to 2009. We estimated annual percentage change (APC) in oral cancer incidence during 1994-2009 using joinpoint regression software (version 4.2.0.2). The lifetime risk of oral cancer to age 79 was estimated using Irish incidence and population data from 2007 to 2009. Survival rates were also examined using Kaplan-Meier curves and Cox proportional hazard models to explore the influence of several demographic/lifestyle covariates with follow-up to end 2012.
  
  
  
  Data were obtained on 2,147 oral cancer incident cases. Men accounted for two-thirds of oral cancer cases (n = 1,430). Annual rates in men decreased significantly during 1994-2001 (APC = -4.8 %, 95 % CI: -8.7 to -0.7) and then increased moderately (APC = 2.3 %, 95 % CI: -0.9 to 5.6). In contrast, annual incidence increased significantly in women throughout the study period (APC = 3.2 %, 95 % CI: 1.9 to 4.6). There was an elevated risk of death among oral cancer patients who were: older than 60 years of age; smokers; unemployed or retired; those living in the most deprived areas; and those whose tumour was sited in the base of the tongue. Being married and diagnosed in more recent years were associated with reduced risk of death.
  
  
  
  Oral cancer increased significantly in both sexes between 1999 and 2009 in Ireland. Our analyses demonstrate the influence of measured factors such as smoking, time of diagnosis and age on observed trends. Unmeasured factors such as alcohol use, HPV and dietary factors may also be contributing to increased trends. Several of these are modifiable risk factors which are crucial for informing public health policies, and thus more research is needed.
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. hala.e.ali@gmail.com.
authors.forename: Hala
authors.identifier: 0000-0002-0032-1088
authors.initials: H
authors.lastname: Ali
authors.affiliation: Department of non-communicable disease epidemiology, London School of Hygiene and Tropical Medicine, Kepple St, London, WC1E 7HT, UK.
authors.forename: Sarah-Jo
authors.initials: SJ
authors.lastname: Sinnott
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.|Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.affiliation: National Cancer Registry, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Deady
authors.affiliation: Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Kabir
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate
keywords: Incidence rate; Joinpoint regression; Oral cancer; Survival rate; Time trend