Method: Interrogations of national and international databases, especially Globocan 2012. Knowledge of major risk factors from published surveys and suggestions for changes in Government policies at national and international levels.
Result: Age-standardised incidence rates, both sexes combined, for lip+oral cavity cancer range from 25.0 cases per 100,000 population pa in Papua New Guinea [the highest in the world], to less than 2, eg in much of central and northern Africa. In Australia and New Zealand the rates are 6.3 and 4.0 respectively. Mortality rates range from <1 in parts of Africa to 16/100,000 pa in PNG. ANZ rates are 1.0 in both countries.
Cancer of the oropharynx is a different disease: Australian incidence/mortality rates/100,000 pa are 2.0/0.7 & for NZ, 1.4/0.6.
In Australia rates are falling for cancers of the mouth and lip but rising in the oropharynx.
These ~30-fold variations in incidence are mostly explained by differences in behavioural risk factors: abuse of alcohol, tobacco use, poor diet and dentition and, for cancers of the oropharynx, exposure to high-risk human papillomaviruses. Limitations in access to care influence mortality rates in poorly resourced countries and in lower SES groups the world over.
Conclusion: Intense efforts are required to introduce policies which reduce abuse of risk factors; in health education and promotion; and in access to early diagnosis and care for all sectors of the population. Modern surgery, radiotherapy and cytotoxic chemotherapy have improved outcomes in specialised centres. Biotherapies and individualised patient treatment so far rely on monoclonal antibodies to block overexpression of epidermal growth factor receptors but many others are under study. Personalised medicine is clearly the way of the future.