Person:

Zavras, Athanasios I.

Background: In India, 72% of the population resides in rural areas and 30-40% of cancers are found in the oral cavity. The majority of Haryana residents live in villages where inadequate medical facilities, no proper primary care infrastructure or cancer screening tools and high levels of illiteracy all contribute to poor oral cancer (OC) outcomes. In this challenging environment, the objective of this study was to assess the association between various risk factors for OC among referrals for suscipious lesions and to design and pilot test a collaborative community-based effort to identify suspicious lesions for OC. Methods: Setting: Community-based cross sectional OC screening. Participants: With help from the Department of Health (DOH), Haryana and the local communities, we visited three villages and recruited 761 participants of ages 45-95 years. Participants received a visual oral cancer examination and were interviewed about their dental/medical history and personal habits. Pregnant women, children and males/females below 45 years old with history of OC were excluded. Main outcome: Presence of a suspicious oral lesion. Results: Out of 761 participants, 42 (5.5%) were referred to a local dentist for follow-up of suspicious lesions. Males were referred more than females. The referral group had more bidi and hookah smokers than non smokers as compared to non referral group. The logistic regression analysis revealed that smoking bidi and hookah (OR = 3.06 and 4.42) were statistically significant predictors for suspicious lesions. Conclusions: Tobacco use of various forms in rural, northern India was found to be quite high and a main risk factor for suspicious lesions. The influence of both the DOH and community participation was crucial in motivating people to seek care for OC.

Background: The main purpose of the study was to quantify the direct costs of oral cancer treatment to the healthcare system of Greece. Another aim was to identify factors that affect costs and potential cost reduction items. More specifically, we examined the relationship between stage of disease, modality of treatment and total direct costs. Methods: The medical records and clinic files of the Oral and Maxillofacial Clinic of the Athens General Hospital "Genimatas" were abstracted to investigate clinical treatment characteristics, including length of hospitalization, modes of treatment, stage of disease etc. Records of 95 patients with oral squamous cell carcinoma (OSSC), with at least six months of follow-up, were examined. The clinical data was then used to calculate actual direct costs, based on 2001 market values. Results: The mean total direct costs for OSSC treatment estimated at euro 8,450 or approximately US$ 7,450. Costs depended on the stage of the disease, with significant increases in stages III and IV, as compared with stages I and II (p < 0.05). Multi-modality treatment applied mainly to patients in stages III and IV was the factor that affected the cost. Disease stage was also associated with the total duration of hospitalization (p < 0.05). Conclusions: The clinical management of advanced oral cancer is strongly associated with higher costs. Although the ideal would be to prevent cancer, the combination of high-risk screening, early diagnosis and early treatment seems the most efficient way to reduce costs, and most importantly, prolong life.

Background: The aim of the present study was to evaluate temporal changes on oral health knowledge and attitudes among two populations of young Greek males (age 19–29 years) undergoing their military training. A secondary aim was to identify socioeconomic trends that may have influenced the above. Methods: A total of 2,764 healthy subjects (1511 in 1985, and 1253 in 1996) answered a standardized questionnaire of oral health issues. Respondents were stratified in 3 groups, according to their educational status (ES); their responses were compared using the chi-square statistic. The evaluation of socioeconomic indicators utilized longitudinal data from the national Household Expenditures Survey. Results: An overall improvement was noted in the majority of "Knowledge" and "Attitudes" variables in 1996, as compared to 1985. Education seems to play an important role in both knowledge and attitudes. These changes may also be partially attributed to a shift in consuming standards from the coverage of main needs to income disposal directed towards the achievement of better quality of life.

The worldwide prevalence of tobacco use is widespread, resulting in nearly 4.5 million deaths every year. Nicotine is addictive and has psychopharmacological effects that maintain the use of tobacco products. Several studies have documented a strong hereditary component to tobacco use. The present article reviews results from twin and adoption studies and proceeds to present association studies of specific genes that may be involved in tobacco use. Cholinergic receptor nicotinic beta polypeptide 2, serotonin receptor and transporter genes, dopamine receptor and transporter genes, and the cytochrome P450A6 gene are reviewed. Linkage studies help to identify regions of the genome that may be worth further investigation. The paper concludes with a discussion of the limitations of genetic research and the future of genetic epidemiology in this domain.