Assessing the impact of race and sex on oral squamous cell carcinoma clinical presentation.

Abstract

e18066 Background: Oral squamous cell carcinoma (OSCC) is the seventh most common cancer worldwide, accounting for 4.5% of new cases. Risk factors include smoking, alcohol, chewing tobacco, areca nut, and HPV. Despite adjusting for these modifiable risk factors, racial disparities persist in incidence, stage at diagnosis, and outcomes in many cancers. Healthcare barriers contribute to differences in presentation, treatment recommendations, and adherence. Hypothesis: We hypothesized that non-Hispanic Black and Hispanic patients present with more advanced OSCC, independent of smoking and alcohol consumption. Methods: A retrospective analysis of 409 OSCC patients from Zuckerberg Cancer Center (2010–2020) was conducted. Data on demographics, smoking, alcohol use, tumor location, staging, pathology, and treatment history were collected. The cohort included 11 Black, 42 Hispanic/Latino, and 27 Asian patients. Chi-square analysis assessed differences in clinical presentation by race, with adjusted residuals and two-sided p-values calculated using the standard normal distribution. Results: Black patients had significantly higher rates of node-positive disease (p = 0.019), Stage IVB OSCC (p = 0.0004), and Stage IVC OSCC (p = 0.091). Hispanic patients had significantly higher rates of node-positive disease (p = 0.047) and were more likely to be diagnosed at age ≤ 50 years (p = 0.0076). No significant racial differences were observed in smoking or alcohol use. Women with OSCC are significantly more likely to have a history of not smoking (p = 0.013) and to report lower alcohol consumption (p = 0.100), yet exhibit similar rates of node positivity and disease incidence. Conclusions: This study highlights significant racial disparities in OSCC, with Black and Hispanic patients more often presenting with advanced-stage disease. Likely contributors include healthcare access barriers, delayed diagnosis, follow-up disparities, and tumor biology factors. These findings emphasize the urgent need for targeted screening, education, and early interventions to enhance detection and reduce disparities. Additionally, the lack of differences in OSCC incidence and node-positive disease among women, despite lower smoking and alcohol use, suggests alternative risk factors warrant further investigation. Limitations: Given the retrospective design, much of the analysis was post hoc, which may limit causal inferences. Future prospective studies with larger, more diverse cohorts are needed to further elucidate the impact of socioeconomic factors, healthcare access, and biologic differences on OSCC disparities.