Cancer Res Treat.  2022 Jul;54(3):709-718. 10.4143/crt.2021.834.

Effect of National Oral Health Screening Program on the Risk of Head and Neck Cancer: A Korean National Population-Based Study

• Wee CW
• Lee HJ
• Lee JR
• Lee H
• Kwoen MJ
• Jeong WJ
• Eom KY

• KMID: 2531317
• DOI: http://doi.org/10.4143/crt.2021.834

Abstract

Purpose
Poor oral health is associated with head and neck cancer (HNC). We evaluated whether a national oral health screening program (OHSP) could reduce the risk of HNC.
Materials and Methods
Data from 408,247 healthy individuals aged ≥ 40 years from the National Health Insurance System-National Health Screening program during 2003 and 2004 in Korea were analyzed. The risk of HNC was compared between subjects who underwent OHSP (HEALS-Dental+, n=165,292) and routine health check-ups only (HEALS-Dental‒, n=242,955). The impact of individual oral health-related factors on HNC risk was evaluated in HEALS-Dental+.
Results
A total of 1,650 HNC cases were diagnosed. The 10-year HNC-free rate was 99.684% with a median follow-up of 11 years. The risk of all HNC (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.03 to 1.29; p=0.011) and oropharyngeal cancer (HR, 1.48; 95% CI, 1.13 to 1.94; p=0.005) was significantly higher in HEALS-Dental‒ than in HEALS-Dental+. In HEALS-Dental+, oral cavity cancer was marginally reduced (p=0.085), and missing teeth was a significant factor for HNC (HR, 1.24; 95% CI, 1.02 to 1.50; p=0.032). Toothbrushing was a significant factor in univariate analysis (p=0.028), but not in multivariate analysis (p=0.877).
Conclusion
The National OHSP significantly reduced the long-term HNC risk, particularly the incidence of oropharyngeal cancer. Routine OHSP should be considered at the population level.

Keyword

Head and neck neoplasms; Oral health; Dental health; Epidemiology; Oropharyngeal neoplasms; Oral health screening program

Figure

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  Fig. 1 Crude summary of the oral health screening protocol.

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  Fig. 2 Kaplan-Meier curves of cancer-free rates for head and neck cancers (A), oropharyngeal cancers (B), and oral cavity cancers (C) depending on the receipt of national oral health screening program.

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  Fig. 3 Kaplan-Meier curves of head and neck cancer–free rates depending on number of missing teeth (A) and toothbrushing in individuals receiving the national oral health screening program (B).

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  Fig. 4 Summary of the proposed effect of national oral health screening program in reducing head and neck cancer. HPV, human papillomavirus.

Reference

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