J Bell

King's College London, Londinium, England, United Kingdom

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Publications (3)10.47 Total impact

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    ABSTRACT: there is, currently, much anecdotal and some epidemiological evidence for a rise in oral cancer rates amongst younger individuals, many of whom have had no exposure to traditional risk factors such as tobacco and heavy alcohol use, or at least not the exposure over decades usually associated with this disease. The probity of this assertion and the presence or absence of traditional risk factors needs further evidence. this paper describes the demography and the exposure to potential risk factors amongst a cohort aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the South East of England. eligible patients registered with a cancer registry were included in this retrospective study. Information was accessed from the database and by a postal questionnaire survey. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco; alcohol; diet; frequency of dental visits and familial cancer. this is the largest UK epidemiological study so far to be undertaken on young subjects diagnosed with oral cancer. One-hundred and sixteen cases were recruited representing a response rate of 59%. Slightly over 90% of this cohort were classified as white European. A large proportion of cases (40%) were from social classes I & II suggesting either a true social class difference in young cases versus older oral cancer cases or a possible bias in responders or survivors. Risk factors of tobacco use and excessive alcohol consumption were present in the majority (75%) of patients. Significant differences in the pattern of alcohol consumption were found in female subjects, who were less likely to consume over the recommended amounts of alcohol compared with male subjects. Daily regular fresh fruit and vegetable consumption during the ten year period before cancer diagnosis was recorded to be low. There was a distinct subgroup of cases, 26% of the group, that showed little, if any, exposure to any major risk factors.
    Oral Oncology 02/2003; 39(2):106-14. · 2.70 Impact Factor
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    ABSTRACT: Studies on migrants can generate important clues on the etiology of cancer. The purpose of the present study was to determine the relationship between ethnic origin and the incidence of oral and pharyngeal cancers among residents of the Thames regions in southern England. Records from the Thames Cancer Registry during the period 1986-91 were examined and south Asians and Chinese ethnic immigrants flagged using their place of birth and names. Computation of relative incidence among head and neck cancers (n = 7222) showed that oral cancer was significantly higher among Asians (95/232 = 40.9%) and nasopharyngeal cancer among Chinese (45/67 = 67.2%). Some differences in the intra-oral site of cancer and ethnic origin were noted. The ethnic migrants were significantly younger (Asians 51.6 +/- 34.8 years, Chinese 47.6 +/- 14.8 years) compared to the rest of the population (64.8 +/- 15.6 years) at the time of cancer diagnosis (p = 0.0) but no significant differences were found for the stage of presentation. The mean survival period for a cancer of the head and neck was 2.2 years and significant differences in cumulative rates of survival were noted among the three groups studied (p = 0.003). A strong correlation was noted between the incidence of oral cancer and local authorities with a high percentage of Asian residents. The south Asian and Chinese ethnic minorities constitute important high risk groups for oral and nasopharyngeal cancer, for whom targeted prevention is indicated.
    Oral Oncology 10/1999; 35(5):471-5. · 2.70 Impact Factor
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    ABSTRACT: Our objective was to examine the accuracy of reporting oral cancer cases to the cancer registry system. We examined a series of 583 patients with oral malignancies treated at several institutions and reported by our laboratory during 1971-87. Using patient details and pathology diagnosis, we traced the entries for these patients in the Thames Cancer Registry (TCR). Of the 583 patients identified 351 were eligible for entry in TCR. Of these, 255 were traced in the Registry and 96 were not (27%). The data, when separated for the period 1971-80 and post-1980, showed that for the earlier period under-reporting was 21% and for the later period 36%: Underascertainment was particularly marked in the mid-1980s while regional registration in the North Thames Regions was being discontinued and taken over by TCR. The major factors contributing to under-reporting are thought to be the fact that many specialised dental units and oral pathology laboratories may fail to be included in the cancer registration process and possible inconsistencies in death-initiated registrations related to this site. Similar levels of under-reporting were observed in another regional registry (South Western), suggesting that this may be a national problem. If this is the case, national incidence rates for mouth cancer may have been underestimated by about 25% during this period. This contrasts with over 90% completeness of registration for cancers as a whole.
    British Journal of Cancer 11/1994; 70(4):736-8. · 5.08 Impact Factor