Cancers of the oral cavity and pharynx include cancers of the lip, tongue, salivary glands, mouth, tonsil and pharynx. In the SRRHIS region, 392 invasive cancers of the oral cavity and pharynx were reported diagnosed during 1991 through 1993. Figure 19 shows the distribution of primary sites by gender. Tumors of the tongue occurred most often in men, while mouth and gum were more common oral cancer sites in women. Oral cancers are the fifth most common cancer among men in this population.

Incidence rates in the SRRHIS population are highest for black males, with white males 25% lower (SRRHIS black males 20.0 per 100,000; white males 15.3). Incidence rates for black and white females are less than half those for males (black females 7.1; white females 6.2). Rates for all groups are fairly similar to those reported for the Atlanta and SEER populations (Figure 20).

The major risk factors for oral and pharyngeal cancer are alcohol consumption and tobacco use. Together these two factors account for about 75 percent of the cases in the United States (Miller, 93). Since these risk factors act synergistically to dramatically increase risk of oral cancer, persons who use both are at greatest risk. In addition to cigarette smoking, use of smokeless tobacco, especially snuff, greatly increases risk for cancers of the cheek and gums.

Other factors that have been associated with oral cancers include use of mouthwashes with high alcohol content, poor dentition and certain viruses.

Dietary factors, especially consumption of fresh fruits and vegetables, have been shown to reduce risk of oral cancer. Persons taking Vitamin E supplements have been reported to be at lower risk, and the nutrients Vitamin C and beta-carotene are suspected to be involved in the protective effect of fruits and vegetables.

Prevention strategies for oral cancers should include cessation of tobacco use, abstinence or moderation in alcohol consumption, and increasing one's intake of fresh fruits and vegetables. Early detection strategies should emphasize regular oral exams by dentists or primary care physicians to detect abnormal tissue changes and early stage cancers.

Relative survival rates for persons (all stages) with oral and pharyngeal cancers are about 52 percent five years after diagnosis. Persons with early, localized disease at diagnosis have an 81 percent five year relative survival rate (Kosary, 95).