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International Journal of Epidemiology, Vol 26, 264-271, Copyright © 1997 by International Epidemiological Association
T Zheng, TR Holford, Y Chen, B Ward, W Liu, J Flannery and P Boyle
BACKGROUND: Recent studies indicate that cancers of the salivary gland are
increasing, and the factors responsible for the increase are unknown.
Artefactual changes, such as shift in classifying cancers of the floor of
the mouth to cancers of the salivary gland, could affect the time trend for
salivary gland cancer. METHODS: The current study examined the time trends
for cancers of the salivary gland and for cancers of the floor of the mouth
and lower gum by using Connecticut Tumor Registry data for the time period
1935-1992. A regression model was used to identify the components of birth
cohort, period and age as determinants of the observed time trend. RESULTS:
Cancers of the salivary gland have recently increased in Connecticut, with
a relative risk of 1.48 (95% CI: 1.06-2.08) for females in 1990-1992
compared to 1980-1984, and a comparable relative risk of 1.60 (95% CI:
1.16-2.22) for males. The increase was found in all age groups 40 and over,
particularly among those aged 70 and over. The results from age-period-
cohort modelling show a recent upturn in the trend for period slopes, with
no clear increase from recent birth cohorts, which is consistent with the
results from univariate analyses suggesting no clear increase among those
under 40 years of age. CONCLUSION: Our results suggest that artifactual
changes, such as a shift in designation of cancer sites, increasing use of
the needle aspirate biopsies, and greater access to medical care for the
elderly, may have largely contributed to the rising trend. The known risk
factors, radiation exposure and a history of a prior cancer, can hardly
explain the observed increase. The Epstein-Barr virus infection has only
been associated with certain types of rare squamous cell carcinomas of the
salivary gland in the Eskimo population. The AIDS epidemic also cannot
explain why older age groups have accounted for most of the increase in
incidence of the disease. An examination of the incidence rates for cancers
of the salivary gland from other populations may help to clarify the issue.
ARTICLES
Are cancers of the salivary gland increasing? Experience from Connecticut, USA
Yale School of Medicine, Yale Cancer Center, New Haven, CT 06520-8034, USA.
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