Bridging the Gap: Transforming Knowledge into Action
July 8-12, 2006, Washington, DC, USA
Tuesday, 11 July 2006 - 4:30 PM 220-5
A Rapid Increase in Oral Cancer Among Men in Taiwan: An Urgent and Preventable Epidemic
Chi Pang Wen, MD, DrPH1, Michael P. Eriksen, Sc.D.2, Paul Chiang1, Wen-Shen Isabella Chung, MSc3, Ting Yuan David Cheng, MS4, Shan Pou Tsai, PhD5, and Shon Yu1. (1) Health Policy Division, National Health Research Institutes, Taiwan, 35 Keyan Rd., Zhunan Town, Maioli County, Taiwan, (2) Institute of Public Health, Georgia State University, 140 Decatur Street, Suite 849, Atlanta, GA 30302, (3) Centre for Health Policy Research and Development/Division of Health Policy Research, National Health Research Institutes, 35 Keyan Rd., Zhunan Town, Maioli County, Taiwan, (4) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21215, (5) School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
Objective: Methods: Results: Global cancer incidence and mortality rates are remarkably stable, and most rates change gradually if at all, except for tobacco-related cancers. One disturbing exception was observed in Taiwan, where within a period of 20 years, a sharp increase occurred in oral cancer among males. The age-adjusted incidence increased more than five fold, from 5.4 in 1981 to 26.9 in 2001(per 100,000), and mortality more than tripled, from 4.2 in 1984 to 14.7 in 2004, with nearly eight fold increase in deaths (from 386 to 3,230). Oral cancer accounts for one out of every ten new cancer cases, is the fourth leading cancer site, and second among men aged 35-59. During the same time period, per capita consumption of cigarettes and betel quid increased by 15% and 240%, respectively. Nearly 20 percent of Taiwanese men chew betel quid, particularly among those with low socio-economic status and among those smoking. Betel quid in Taiwan does not contain tobacco, and yet, smoking and its combination with chewing is doubly deadly for oral cancer, with relative risks showing dose response increase and synergistic interaction between the two. By occurring among young males (age peak 35-50), having a short latency (3-7 years) and poor survival, Taiwan is faced with a devastating epidemic that requires immediate attention. Similar to tobacco control, efforts to reduce production or taxing the consumers face strong resistance. Furthermore, efforts to export betel quid to mainland China will have serious public health consequences.