ORGAN
T sites varies strikingly in different geographic regions of the world and even in specific areas of a country. In India and the Philippine Islands oral and pharyngeal cancer is by far the most common neoplasm encountered.9 T h e Cancer Institute of Madras9 reported 48y0 of all neoplasms were oral or pharyngeal in origin. More specifically, 7 1 % of all oral cancers and 26% of all malignant tumors arose from the buccal mucosa. In contrast to this extremely high oral cancer-incidence rate, in the United States buccal-cavity cancers accounted for only 4.6% of all newly diagnosed cancers in male patients and 1.7% in female patients.2
Visitors to cancer clinics in the southeastern United States are impressed by the higher incidence of cancer of the buccal cavity and the fact that these cancers have a lower histological grade, fewer metastases, and better survival experience than in the northern sections of the country. Cancer morbidity studies suggest that oral cavity and pharynx cancers occur more frequently in low income than in high income groups.2 In both India and the Philippines, where the incidence of intraoral cancer is high and the economic status low, the use of tobacco with slaked lime and betel nut is associated with these cancers.4 I n the southeastern United States dipping snuff is a fairly common habit, especially among women of low income groups. It is suspected that this habit is associated with an increased incidence of intraoral cancer.
T h e accepted modern method of using consists Of placing a pinch Of the flavored powdered tobacco i n the gingival buccal gutter area and sucking on the quid most of the time the patient is awake. Snuff is