Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Christopher (Kim) Buttery


Background: Forty percent of all head and neck cancers occur in the oral cavity. According to ICD-O (International classification of diseases for oncology) C00-C14 includes cancers of the lip, oral cavity and pharynx. Studies have indicated that increased population density or Metro living have increased oral cancer incidence. The objectives of this study are to look at the distribution of Oral and Oro pharyngeal Cancers in Virginia from 2001-2005 The study aims to determine if there is an association between metro living (beale code 3) and advanced Oral Cancers. This study is also being done to determine if Metro living is a predictor of Oral Cancer after adjusting for gender. Methods: The data for this study was obtained from the Virginia Cancer Registry. Cancer counts were obtained based on gender, beale code distribution and stage at diagnosis. The counts were collected for the years 2001-2005 based on the ICD-O codes C00-C14. Analysis of this secondary data was done using SAS 9.1. Descriptive statistics presents the distribution of oral cancer according to the stage, gender and urbanity level of the patient. A log-linear model was done to look for association between metro living and Oral Cancers in Virginia after adjusting for gender and stage. This model was fit using a Poisson’s regression to observe if the cancer counts are influenced by the urban beale code 3. Results: During the five year period of 2001- 2005 the Virginia Cancer registry received a total of 3,390 reported cases of oral and pharyngeal cancers. Out of the 3,390 cases 67.35% (2283) of the cases were diagnosed in males and the rest 32.65% were females (1107). Based on the stage at diagnosis, 34.45% (1168) of Oro-pharyngeal cancers were diagnosed to have localized staging as compared to 50.18% (1701) regional and 11.03% (374) distant. 4.34% of the cancers were unstaged (N=147). 82% of all Oro-pharyngeal cancers were seen amongst whites. Majority of oral cancers were seen amongst age groups 35-74 years (78.41%). While looking at the distribution of oral cancers reported from the urban populations; 82.3% (2790) were reported from beale code1. Only 9.73% (330) cases were reported from beale code 2 and 7.96% (270) cases were reported from beale code 3 (population fewer than 250,000 people). More than 50% of cancers were diagnosed at an advanced stage in the urban populations; we did not see a significant relation between advanced oral cancers and metro living. (p =0.2878). After performing a scaled deviance Poisson regression model indicated that there was a stable trend in counts of advanced oral cancer after adjusting for race, age and gender.(θ=-0.04 p-value =0.617). Conclusions: With a linear trend between increased population density and advanced oral cancers, our study observed a stable trend within the metro populations. Due to lack of a clear understanding of all the possible contributing factors further research is recommended to observe the various etiological differences within the urban populations and advanced oral cancers.


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Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2008

Included in

Epidemiology Commons