Environmental heavy metal as a potential risk factor for the progression of oral potentially malignant disorders in central Taiwan |
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| Affiliation: | 1. Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan;2. Department of Internal Medicine, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan;3. Green Energy and Environment Research Laboratories, Industrial Technology Research Institute, No. 195, Section 4, Chung Hsing Road, Chutung, Hsinchu 310, Taiwan;4. Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan;1. Department of Epidemiology, Fielding School of Public Health, University of California, CA, USA;2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;3. Division of Pediatric Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA;1. Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;2. School of Pharmacy, Queen’s University Belfast, Northern Ireland, United Kingdom;3. Centre of Excellence for Public Health (NI), Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;1. College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331;2. Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX 78714;1. Cancer Prevention Institute of California, Fremont, CA, United States;2. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, United States;3. Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, United States;1. Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, Suite 202, San Bernardino, CA 92408, USA;2. School of Public Health, Center for Community Resilience, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA 92350, USA;3. School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA 92350, USA;1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA;2. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA |
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| Abstract: | ObjectiveOral cancer (OC) is a leading cause of death from cancer in men between the ages of 25 and 44 years in Taiwan. The overall 5-year survival rates for the four OC stages (I–IV) in Taiwan are approximately 70%, 30%, 20%, and 10%, respectively, indicating the importance of the early diagnosis of oral potentially malignant disorders (OPMDs). Previous studies indicated an association between the OC incidence and certain environmental heavy metal concentrations. If these associations do exist for OC, they may also be observed for OPMD. The purpose of this study is to explore the association between the development of OPMD to OC and environmental heavy metals. Oral submucous fibrosis (OSF) and oral leukoplakia (OL) are two major types of OPMD in Taiwan.Materials and methodsA retrospective cohort study was conducted by Changhua Christian Hospital, the sole medical center in Changhua County, where 2725 male adult patients diagnosed with either OSF or OL between 2000 and 2014 were recruited. Data were analyzed by Cox regression and adjusted for smoking and betel-quid chewing.Results and discussionOPMD patients who resided in areas with high nickel concentrations (polluted levels) exhibited hazard ratios of 1.8–2 for OC relative to those who lived in areas with low nickel levels (P < 0.01). Meanwhile, smokers with OPMDs had a hazard ratio of 2.8–2.9 relative to non-smokers. Betel-quid chewers had a 2.2–2.3 hazard ratio relative to non-chewers. Smoking, betel-quid chewing, and environmental nickel exposure are associated with an increased risk of OC development in OPMD patients. This study provides valuable findings on the environmental effects of heavy metals on human health. Enhanced surveillance of the condition of OPMD patients who have been exposed to high nickel concentrations may be crucial for OC prevention. |
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| Keywords: | OPMD Oral cancer Heavy metal Mixture cure model |
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