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Review
. 2022 Aug:8:e2100439.
doi: 10.1200/GO.21.00439.

Disparities in Oral Cancer Stage at Presentation in a High HIV Prevalence Setting In Sub-Saharan Africa

Precious K Motlokwa  1   2 , Billy M Tsima  1   3 , Yehoda M Martei  1   3 , Tlotlo Ralefala  2 , Faith Galebole  2 , Alisa J Stephens-Shields  1 , Surbhi Grover  1   3 , Robert Gross  1   3
Affiliations
Review

Disparities in Oral Cancer Stage at Presentation in a High HIV Prevalence Setting In Sub-Saharan Africa

Precious K Motlokwa et al. JCO Glob Oncol. 2022 Aug.

Abstract

Purpose: Oral cancer is the sixth most common cancer worldwide and is the seventh most common in Botswana. Lack of improvement in oral cancer survival despite the availability of multiple treatment options may be due to the high prevalence of advanced stage at presentation. We identified risk factors for presenting with oral cancer at an advanced stage to facilitate interventions to reduce mortality from oral cancers.

Methods: A retrospective cohort analysis was conducted among individuals with biopsy-confirmed oral cancer at Princess Marina Hospital in Gaborone, Botswana, between 2010 and 2020. Data collected included age at diagnosis, sex, place of residence, HIV status, oral cancer stage, and oral subsite. Multivariable analyses were controlled for age, sex, district of residence, and oral subsite.

Results: Of the 218 records analyzed, 79% were male, 58% were HIV-positive, the median age was 56 years (interquartile range: 47-63), and 67% presented with advanced-stage disease. Cancers from hidden oral sites were more likely to present at an advanced stage with an adjusted odds ratio (OR) of 2.98 (95% CI, 1.29 to 6.89; P = .01). Residence in socioeconomically disadvantaged districts was associated with higher likelihood (OR, 2.36; 95% CI, 1.28 to 4.39; P = .01) of advanced stage presentation compared with other districts. HIV infection was not associated with risk of advanced lesion presentation (OR, 1; 95% CI, 0.61 to 1.61; P = .97).

Conclusion: Hidden oral cancer sites and residence in districts with limited access to care were risk factors for advanced oral cancer at the time of diagnosis in Botswana. These findings support a need to increase efforts to improve access to care and increase oral cancer awareness to decrease the burden of advanced oral cancer.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Alisa J. Stephens-Shields

Research Funding: AbbVie (Inst)

Expert Testimony: Gilead Sciences

Surbhi Grover

Honoraria: Varian Medical Systems

Consulting or Advisory Role: GenesisCare

Research Funding: Varian Medical Systems

Robert Gross

Consulting or Advisory Role: Pfizer

Research Funding: Merck (Inst)

No other potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Distribution of oral cancer stages at presentation by district of residence.
FIG 2
FIG 2
Stage distribution of oral cancer subsite at presentation.
See this image and copyright information in PMC

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