口腔癌流行病學

吳建遠國民健康局癌症防治組

97 年 6 月

檳榔造成之醫藥衛生問題

「同時有吸菸與嚼檳榔習慣」是人類第一類致癌物，造成口腔、咽、喉及食道等部位癌症（ 1992 ，IARC ）

「單純檳榔子」是人類第一類致癌物（ 2003 ， IARC ）

造成口腔病變，如口腔黏膜纖維化、白斑症等可能與糖尿病、懷孕併發症及肝癌等疾病有關

Age-Adjusted Incidence Rates of Oral Cancer in Asian-Oceania Selected Regions

30

0510152025

22.3

22.2

21.5

20.5

20.0

17.1

14.8

10.6

8.6

8.3

7.5

6.4

6.3

6.3

5.7

5.6

5.2

4.4

3.6

3.0

1.6Male

Female

*Adapted from Cancer Incidence in Five Continents, Volume VIII, 2002.*Lip, Oral Cavity, Oropharynx and Hypopharynx are included.

Age-adjusted Incidence Rates (per 100,000)

Age-adjusted incidence and mortality for the past 10 years

83 84 85 86 87 88 89 90 91 92 93 94 95

發生年代

0

10

20

30

40

()

年齡標準化率

每十萬人口

男性發生率男性死亡率女性發生率女性死亡率

Definition of Oral Cancer :ICD-9-CM (140-149, exclude 142 and 147)

Year

Rate(/105)

Male incidenceMale mortalityFemale incidenceFemale mortality

CancerIncidence(2004) Mortality(2006)

Number Crude Incidence

Median

Age

Number Crude Mortality

Median

Age

Liver Cancer

6,958 60.5 62 5,383 46.5 65

Lung Cancer

5,442 47.2 72 5,149 44.5 72

Colorectal Cancer

5,416 46.9 67 2,485 21.5 72

Oral cancer 4,338 37.6 51 2,044 17.7 54

Stomach cancer

2,658 20.5 71 1,571 13.6 75

Male Incidence and Mortality of the leading Five cancers in Taiwan

(unit: per 105 men)

Stage at diagnosis

Stage Case Number %

I 749 19.7

II 670 17.6

III 523 13.8

IV 1,534 40.4

Source: Taiwan Cancer Data Bank,2004

22.74

22.55

15.53

13.14

12.35

0.07

-0.09

-1.13

-4.65

-7.82

4.37

口腔癌

食道癌

皮膚癌

攝護腺癌

結直腸癌

肺癌

肝癌

膀胱癌

鼻咽癌

胃癌

全癌症

0 5 10 15 20 25 30 35 40 45 50-5-10-15-20-25-30-35-40-45-50

(%)五年變化率

, 男性十大癌症年齡標準化發生率之五年變化率 民國89-93 年

21.92

7.71

5.86

4.27

3.48

3.09

-2.93

-5.43

-12.88

-15.97

-1.42

口腔癌

食道癌

攝護腺癌

非何杰金淋巴癌

胰臟癌

結腸直腸癌

肺癌

肝癌

鼻咽癌

胃癌

全癌症0 5 10 15 20 25 30 35 40 45 50-5-10-15-20-25-30-35-40-45-50

(%)增減率

, 男性十大癌症年齡標準化死亡率之增減率 民國91-95 年

Topography

Subsites of oral cavityYear

C00Lip

C01-C02Tongue

C03Gum

C04Floor of mouse

C06.0Buccal

C09-C10Oro-

pharynx

C12-C13Hypo-

pharynx

2004 3% 28% 5% 2% 22% 10% 13%

2003 3 ％ 29 ％ 6 ％ 2 ％ 22 ％ 10 ％ 12 ％

2002 4 ％ 27 ％ 6 ％ 2 ％ 23 ％ 9 ％ 13 ％

2001 4 ％ 28 ％ 7 ％ 2 ％ 21 ％ 10 ％ 12 ％

2000 5 ％ 27 ％ 7 ％ 3 ％ 23 ％ 9 ％ 11 ％

Histopathology

Pattern Squamous cell Carcinoma

Verucous carcinoma

Others

85 90% 4% 6%

86 91% 4% 5%

87 91% 4% 5%

88 90% 5% 5%

89 91% 5% 4%

90 91% 5% 4%

91 90% 4% 6%

92 90% 4% 6%

N.B. Above 95% cases were microscopically varified.

Source ： http://www.doh.gov.tw/statistic/medical annual report/92.htm

Medical Expenditure, 2003

Site Expenditure(billion $NT)

Percentage（％）

Colon-rectum 2.8 12.7

Oral 2.7 12.3

Lung 2.3 10.5

Liver 2.3 10.2

Breast 2.2 9.8

All sites 22.3 100.0

Prevalence of Chewing Betel Quid Among Taiwanese Adults

Gender 19961 19992 20023 20054

Men - 17.7 16.6 15.9

Women - 1.0 1.2 1.0

All 10.9 9.0 9.1 8.5

Source: 1 、 Lee-Lan Yen,1996,   Study on Taiwanese Adolescents and Adults’ Knowledge and Behavior of Betel Nut Chewing.2 、 Lee-Lan Yen,1999 ; Study of The Behavior of Chewing Betel Quid Among Taiwanese Adults. 3 、 Tien-yu shieh,2001 Prevalence of Areca/Betel Quids Chewing and Smoking, and a Study of Cognition of Health Hazards Caused by Chewing Areca/Betel Quids.  4 、 KAP Study on Health Promotion ,BHP,2002

Consumption v.s. mortality

Source: Statistical Year Book (2003) & Department of Health (2003)

Per capita consumption

Age-standardized mortality rate

0

2

4

6

8

10

1219

71

1974

1977

1980

1983

1986

1989

1992

1995

1998

2001

Year

Kg (per

cap

ita

consu

mption o

f bet

el

quid

, ag

e 15 a

nd o

ver

)

0

2

4

6

8

10

12

Mal

e ora

l ca

nce

r: a

ge-

stan

dar

diz

e

mortal

ity rat

e (1

/100,0

00)

per capita betel quid consumption

standardized oral cancer mortality

一、辦理宣導教育 大眾傳媒：建立不嚼檳榔社會常模 小眾宣導：於特定場域建立不嚼檳榔支持環境 （如：學校、軍隊、社區、職場、公務體系等）

二、落實現有法令（兒少法）三、協助民眾戒嚼檳榔四、減少檳榔供應、協助檳榔農轉作五、以價制量，評估徵檳榔健康捐可行性六、辦理口腔癌篩檢，早期發現早期治療

口腔癌防治策略口腔癌防治策略

Result of Screening （ 2004-2005 ）

Numberscreene

d

Positive rate

Referrate

Confirmed diagnosis

Number

％ Number ％ Oral cancer

others

Smoke

r

463,74

0

2,31

8

0.5 2,060 88.

9

215(0.05%) 1,160

Chewe

r

72,881 1,22

5

1.7 1,118 91.

3

146(0.20%) 632

Both 386,47

2

7,41

4

1.9 6,736 90.

9

1,073(0.27%) 3,522

Thank you for your attention.