Disparities between Populations With Oral Cancer in Low and Middle Income and High Income Countries

 

Title: Disparities between Populations with Oral Cancer in Low and Middle Income and High Income Countries Abstract: Cancer affects people worldwide, but there are stark differences in prevalence, survival, etiologic risk factors, and type of cancers between the populations in the developed and less developed regions of the world. These differences affect the treatment outcomes, survival, morbidity, disability and quality of life of Individuals diagnosed with cancer. Recently, there has been a significant thrust in the development of technologies in HIC and transfer of these technologies to LMIC. In order to understand whether the technologies for screening, detection and treatment of cancer are appropriate for a particular population it is essential to evaluate the disease burden, the health care delivery model, and the economic resources of that region. Therefore, we proposed to review the literature to identify the disparities between individuals with oral cancer in High Income Countries (HIC) and Low and Middle Income Countries (LMIC). For this review, we used the United States of America (USA) as our representative HIC, and India as our LMIC. The Gross domestic Product (GDP), Human Development Index (HDI) and literacy rate for the two countries vary significantly. According to the United Nations Human Development Report, USA has a very high HDI and is ranked 3rd, in contrast India is ranked 136th with a medium HDI. The average population literacy rates in the US are 99% in comparison to average literacy rates in 78%. The results of our review showed that, for India, the annual incidence of new cases Lip and Oral Cavity Cancer (C00-08) was 77,003 with Age Standardized Rate (ASR) of 10.1 for males and 4.3 for females and 51,797 individuals diagnosed with oral cancer die each year. In comparison, the incidence of new cases in USA is 26, 000 and mortality is 4620 and 5-year prevalence data are 85,000. The Age standardized rates for males in USA is 7.5/100, 000 and females is 3.2/ 100,000 population. The 5-year prevalence for lip and oral cavity cancer is 118,902 for India in comparison to 85, 000 for USA (GLOBOCAN 2012). Oral cancer was diagnosed in a greater proportion of younger males between the ages of 30-69 years as opposed to 45-65 years in USA. Studies among tobacco users have shown the relative risk of developing oral cancer is 5.1 for Indian males, where as, it is slightly lower at 2.6 for males in the USA. In addition, there are differences in the type of tobacco used smokeless versus smoked tobacco between the populations in two regions. The overall observed survival of oral cancer patients (all stages) in USA is 55% in comparison to Indian patients, which is 30-35%. Lower survival in LMIC is mainly due to advanced stage at diagnosis, low health literacy and lack of awareness and limited access to healthcare. The data strongly suggests that for both HIC and LMIC that rural geographic areas, low health literacy, lack of access to healthcare and low socioeconomic status are risk factors for oral cancer. Our future direction is to propose health technological solutions for screening, and early detection of oral cancer appropriate for the populations in LMIC.

References: 1. Louise Davies and H. Gilbert Welch Epidemiology of head and neck cancer in the United States Otolaryngology -- Head and Neck Surgery September 2006 135: 451-457, 2. Projections of number of cancer cases in India (2010-2020) by cancer groups R Takiar, D Nadayil, A Nandakumar - Asian Pac J Cancer Prev, 2010