Oral leukoplakia and oral cavity cancer risk among elderly adults in the United States 2002-2009

Tuesday, September 23, 2014 — Poster Session III
12:00 p.m. – 2:00 p.m.	FAES Academic Center	NCI	EPIG-12

Authors

• E.L. Yanik
• E.A. Engels
• H.A. Katki
• A.K. Chaturvedi

Abstract

The progression rate of leukoplakia, a cancer precursor, to oral cavity cancer (OCC) and the benefits of leukoplakia screening for early OCC detection are unclear. We conducted a case-cohort study in SEER-Medicare, a linkage between cancer registries and Medicare that includes SEER cancer cases and a 5% subcohort of Medicare recipients. Weighted Cox regression was used to estimate leukoplakia associations with OCC incidence and cumulative OCC incidence following leukoplakia diagnosis. Among OCC cases, we estimated leukoplakia associations with cancer stage at diagnosis. Among 449,969 Medicare recipients in the subcohort, 0.5% had a leukoplakia diagnosis. Among those with leukoplakia, the cumulative OCC incidence was 0.4% at 3 months and 2.4% at 5 years. Individuals with leukoplakia had 29.7 times higher OCC incidence than individuals without leukoplakia (95%CI=26.5-33.3). Risk was most increased <3 months after leukoplakia diagnosis, but was also significantly increased in subsequent follow-up. Among OCC cases (N=9,239), a prior leukoplakia claim was associated with lower cancer stage (odds ratio for regional/distant vs. localized=0.4, 95%CI=0.3-0.5). In conclusion, leukoplakia indicates substantially higher OCC risk. The many diagnoses made shortly after leukoplakia identification may reflect increased diagnostic work-up. Leukoplakia associations with OCC down-staging imply that leukoplakia identification often leads to earlier OCC detection.

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