Current Disparities in Oral Cancer Research and Survival

Oral squamous cell carcinoma (OSCC) significantly trails behind other cancers in research funding and, as a result, in survival. Survival is worse in racially and socioeconomically disadvantaged groups. Completion of the human genome project in 2001 ushered in an era of personalized medicine. The hope was that genome-wide approaches would facilitate the development of highly effective biomarkers to determine risk in cancer patients. Some cancers have had significantly improved outcomes from substantial research funding to develop biomarkers for risk prediction.^1,2 For example, commercially available genomic tests predict the risk of recurrence in breast cancer patients and are currently used to guide treatment decisions.^3-5 These and other advances in breast cancer treatment fueled by biomarker research have resulted in improvement in survival over the past two decades, particularly in young women with metastatic disease.²

In contrast, OSCC survival has remained stagnant. OSCC research funding lags significantly behind that of other cancers. OSCC incidence is on the rise, affecting 400,000 people globally each year, with the largest increase in young patients.⁶ Aside from high mortality, OSCC patients suffer from significantly higher morbidity than other cancers, due to the cosmetic and functional deformities resulting from treatment that affect their ability to eat, taste, speak, and relate to others.⁷ In the U.S. alone, 30,000 people are diagnosed with OSCC annually, of which about half will die of their disease, accounting for approximately one death per hour.⁸ Socioeconomic and racial disparities are augmented in this particular cancer, with black patients and patients with lack of access to care suffering from delays in diagnosis that portend worse survival.⁹

OSCC survival also falls behind other head and neck cancer sub-sites. OSCC is a subset of head and neck cancers that is distinct from oropharyngeal SCC (OPSCC). The two diseases have divergent clinical behavior. More than 70% of newly-diagnosed OPSCC is caused by human papilloma virus (HPV) infection.¹⁰ HPV status serves as a reliable biomarker for survival. HPV-positive OPSCC has significantly better survival than HPV-negative disease. A concerted research effort and research funding support for clinical trials targeting HPV-positive OPSCC has improved the survival rate to as high as 90%.^11,12 Conversely, HPV does not play a significant role in OSCC.¹³ Fifty percent  of newly diagnosed OSCC cases are early stage I or II.¹⁴ These early stage patients still have 40% risk of 5-year mortality. The largest increase in oral cancer incidence has been in young patients without smoking or drinking history.^15,16 Unfortunately even these young patients have poor survival.

Due to disparate research funding, oral cancer research to develop novel treatments falls behind that of other cancers. The amount of governmental and foundation research funding for different cancers have little to do with how common the cancer is or how many people it kills. Rather, cancers surrounded by stigma receive significantly less funding. Unfortunately, oral cancer falls in this category, as it is falsely perceived to be a result of heavy tobacco and alcohol use. We know from recent epidemiologic studies that young patients without these traditional risk factors are still susceptible to developing oral cancer dying of the disease. There needs to be a focus on equalizing cancer research funding to address these disparities in survival, which are a direct result of lack of rigorous research that would lead to treatment advancements.

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References:

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