Factors related to late stage diagnosis of oral squamous cell carcinoma

Aims: To identify factors related to advanced-stage diagnosis of oral cancer to disclose high-risk groups and facilitate early detection strategies. Study design: An ambispective cohort study on 88 consecutive patients treated from January 1998 to December 2003. Inclusion criteria: pathological diagnosis of OSCC (primary tumour) at any oral site and suffering from a tumour at any TNM stage. Variables considered: age, gender, smoking history, alcohol usage, tumour site, macroscopic pattern of the lesion, co-existing precancerous lesion, degree of differentiation, diagnostic delay and TNM stage. Results: A total of 88 patients (mean age 60 +/- 11.3; 65.9% males) entered the study. Most patients (54.5%) suffered no delayed diagnosis and 45.5% of the carcinomas were diagnosed at early stages (I-II). The most frequent clinical lesions were ulcers (70.5%). Most cases were well- and moderately-differentiated (91%). Univariate analyses revealed strong associations between advanced stages and moderate-poor differentiation (OR=4.2; 95% CI=1.6-10.9) or tumour site (floor of the mouth (OR=3.6; 95% CI=1.2-11.1); gingivae (OR=8.8; 95% CI=2.0-38.2); and retromolar trigone (OR=8.8; 95% CI=1.5-49.1)). Regression analysis recognised the site of the tumour and the degree of differentiation as significantly associated to high risk of late-stage diagnosis. Conclusions: Screening programmes designed to detect asymptomatic oral cancers should be prioritized. Educational interventions on the population and on the professionals should include a sound knowledge of the disease presentation, specifically on sites like floor of the mouth, gingivae and retromolar trigone. More studies are needed in order to analyse the part of tumour biology on the extension of the disease at the time of diagnosis.