Douglas R Farquhar1, Kimon Divaris2, Angela L Mazul3, Mark C Weissler4, Jose P Zevallos5, Andrew F Olshan3. 1. Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine; 170 Manning Drive, Chapel Hill, NC 27599-7070, USA. Electronic address: Douglas.Farquhar@unchealth.unc.edu. 2. Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA. 3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA. 4. Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine; 170 Manning Drive, Chapel Hill, NC 27599-7070, USA. 5. Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine; 170 Manning Drive, Chapel Hill, NC 27599-7070, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Abstract
INTRODUCTION: Poor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort. MATERIALS AND METHODS: Cases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Routine dental visits during the preceding 10years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4-0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer-(e.g., >10 visits: HR=0.4, 95% CI=0.2-0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival. CONCLUSION: We found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.
INTRODUCTION: Poor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort. MATERIALS AND METHODS: Cases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Routine dental visits during the preceding 10years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4-0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer-(e.g., >10 visits: HR=0.4, 95% CI=0.2-0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival. CONCLUSION: We found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.
Authors: Douglas R Farquhar; Andrew J Coniglio; Maheer M Masood; Nicholas Lenze; Paul Brennan; Devasena Anantharaman; Behnoush Abedi-Ardekani; Adam M Zanation; Mark C Weissler; Andrew F Olshan; Siddharth Sheth; Trevor G Hackman Journal: Oral Oncol Date: 2020-05-31 Impact factor: 5.337
Authors: Douglas R Farquhar; Maheer M Masood; Nicholas R Lenze; Philip McDaniel; Angela Mazul; Siddharth Sheth; Adam M Zanation; Trevor G Hackman; Mark Weissler; Jose P Zevallos; Andrew F Olshan Journal: Oral Oncol Date: 2019-01-02 Impact factor: 5.337
Authors: Nicholas R Lenze; Douglas Farquhar; Siddharth Sheth; Jose P Zevallos; Jeffrey Blumberg; Catherine Lumley; Samip Patel; Trevor Hackman; Mark C Weissler; Wendell G Yarbrough; Adam M Zanation; Andrew F Olshan Journal: Laryngoscope Date: 2020-11-10 Impact factor: 3.325
Authors: Marc A Emerson; Douglas R Farquhar; Nicholas R Lenze; Siddharth Sheth; Angela L Mazul; Adam M Zanation; Trevor G Hackman; Mark C Weissler; Jose P Zevallos; Wendell G Yarbrough; Paul Brennan; Behnoush Abedi-Ardekani; Andrew F Olshan Journal: Head Neck Date: 2022-01-19 Impact factor: 3.147
Authors: Dustin A Silverman; Chen Lin; Akina Tamaki; Sidharth V Puram; Ricardo L Carrau; Nolan B Seim; Antoine Eskander; James W Rocco; Matthew O Old; Stephen Y Kang Journal: Head Neck Date: 2020-04-30 Impact factor: 3.147
Authors: Anwar E Ahmed; Alhanouf N Albalawi; Eiman T Qureshey; Aisha T Qureshey; Nagarajkumar Yenugadhati; Hamdan Al-Jahdali; Abdul Rahman Jazieh Journal: Breast Cancer (Dove Med Press) Date: 2018-10-03
Authors: Nicholas R Lenze; Douglas R Farquhar; Siddharth Sheth; Jose P Zevallos; Catherine Lumley; Jeffrey Blumberg; Samip Patel; Trevor Hackman; Mark C Weissler; Wendell G Yarbrough; Andrew F Olshan; Adam M Zanation Journal: Oral Oncol Date: 2021-06-20 Impact factor: 5.972