Nutrition and Oral Medicine (Nutrition and Health)

Chapter 12 / Oral and Pharyngeal Cancer 20512 Oral and Pharyngeal CancerDouglas E. Morse1. INTRODUCTIONWorldwide, in the year 2000, there were approx 450,000 new cases of and 240,000deaths attributable to cancer of the lip, oral cavity, pharynx, and salivary glands (ICD-9140–149) (1). A diagnosis of cancer at these sites is important because it can result infacial disfigurement, speech impairment, chewing and/or swallowing difficulties, mentalanguish, a decreased quality of life, and reduced survival.In the United States, approx 75% of all newly diagnosed oral and pharyngeal cancers(OPCs) are attributable to tobacco and alcohol consumption (2); however, other modifiableexposures, including diet and nutrition, mouthwash use, socioeconomic status,occupation, and oral hygiene, have also been evaluated as potential risk or preventivefactors. This chapter reviews findings from studies that have investigated diet and nutritionin relation to OPC risk.2. NUTRITIONAL EPIDEMIOLOGYBefore presenting the relevant findings, a brief description of the methodologicalapproach utilized in epidemiological studies of diet and nutrition is provided. Most suchinvestigations employ a case–control study design. Using this approach, investigatorsidentify persons with the disease of interest (cases) and persons without the disease(controls). In a case–control study of OPC, the case group is made up of persons withOPC, whereas the control group is composed of persons without such a history.Information on past exposures of interest (e.g., tobacco use, alcoholic beverage consumption,and diet/nutrition) is then obtained from the cases and controls, with foodfrequencyquestionnaires often used to procure information on previous dietary habits.Typically, food-frequency questionnaires include questions on numerous food items andask the study participants to estimate how many times a day, week, or month they ate, onaverage, certain foods (e.g., apples) during their adult life or during a specified timeperiod. The specific food items included in such questionnaires can and do vary acrossstudies.In some instances, the investigators focus on a particular food item (e.g., tomatoes),whereas in other situations, the researchers define a food group for investigation (e.g.,From: Nutrition and Oral MedicineEdited by: R. Touger-Decker, D. A. Sirois, and C. C. Mobley © Humana Press Inc., Totowa, NJ205