1. Shu-Lin Chuang, PhD1; Sam Li-Sheng Chen, PhD2 ; Amy Ming-Fang Yen, PhD2; Jean Ching-Yuan Fann, PhD3; Sherry Yueh-Hsia Chiu, PhD4; Chiu-Wen Su, PhD5; Hsiu-Hsi Chen, PhD1
1. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
2. School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
3. Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan
4. Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
5. Department of Otolaryngology -Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
Applying Evidence of Translational Medicine to the Risk-Oriented Cancer Screening for Oral Neoplasm
FREE OF ORAL CANCER
ERYTHROLEUKOPLAKIA
BETEL QUID CHEWING
LEUKOPLAKIA
ORAL CANCER
CIGARETTE SMOKING
PAI-1 – 675
hOGG1 codon 326
ACE intron 16
TIMP-2 – 418
miR-137
p53

2. Introduction and Objective:
　　Since the dose-response effect of betel quid chewing and cigarette smoking on multistate progression between oral pre-malignancy and oral cancer has been elucidated and in addition, there are quite amount of researches emphasizing on genetic and epigenetic effect on the risk of oral squamous-cell carcinoma, we would like to combine those evidences mentioned earlier and computer stimulation to construct the risk stratified profile for individuals based on the evidence of translation medicine.
Methods:
　　We developed a risk assessment model on the ground of evidence from literature to incorporate important risk factors like betel quid chewing and cigarette smoking as well as genetic and epigenetic factors. A computer simulation was further applied to cohort with distribution of risk profiles the same as a high-risk group for oral screening in Taipei. We examined the results of screening program with different inter-screening interval combined, or not, with health education program for quitting betel quid chewing and cigarette smoking as attending the screening program to project the effectiveness when compared to a non-intervention control scenario. We simulated a hypothetical cohort of different inter-screening intervals combined with or without health education for quitting betel quid chewing and cigarette smoking.
Applying Evidence of Translational Medicine to the Risk-Oriented Cancer Screening for Oral Neoplasm
Shu-Lin Chuang, PhD1; Sam Li-Sheng Chen, PhD2 ; Amy Ming-Fang Yen, PhD2; Jean Ching-Yuan Fann, PhD3; Sherry Yueh-Hsia Chiu, PhD4; Chiu-Wen Su, PhD5; Hsiu-Hsi Chen, PhD1
1. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
2. School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
3. Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan
4. Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
5. Department of Otolaryngology -Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan

3. MST of from ELP to OC (year)
ACE intron 16
P53
TIMP-2 – 418
G/G vs. C/C and G/C: OR=26.33 (95% CI: )
Vairaktaris et al, Oral Oncology, 2009
Positive vs. Negative: OR=17.05 (95% CI: )
Chang et al, J Oral Pathol Med 2000
I/I vs. D/I or D/D: OR=9.16 (95% CI: )
hOGG1 codon 326
miR-137
PAI-1 – 675
4G/4G vs. 5G/4G or 5G/5G: OR=5.00 (95% CI: )
Vairaktaris et al, Oral Oncology, 2009
SCCHN vs. Control: OR=4.80 (95% CI: )
Langevin et al, Carcinogenesis 2010,
CG/GG vs . CC: OR=1.42 (95% CI: )
Tsou et al, Anticancer Research, 2010
Decile
Lifetime Risk
(per 105) RR
MST of from ELP to OC (year)
1st
278
0.16
33.96
2nd
551
0.33
31.13
3rd
611
0.36
29.68
4th
628
0.37
14.88
5th
1,692
1.00
18.62
6th
1,937
1.14
10.65
7th
2,148
1.27
8.23
8th
4,327
2.56
7.68
9th
7,283
4.30
5.10
10th
9,992
5.91
1.03
Applying Evidence of Translational Medicine to the Risk-Oriented Cancer Screening for Oral Neoplasm
Shu-Lin Chuang, PhD1; Sam Li-Sheng Chen, PhD2 ; Amy Ming-Fang Yen, PhD2; Jean Ching-Yuan Fann, PhD3; Sherry Yueh-Hsia Chiu, PhD4; Chiu-Wen Su, PhD5; Hsiu-Hsi Chen, PhD1
1. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
2. School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
3. Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan
4. Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
5. Department of Otolaryngology -Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan

4. Target Population
Demographic Feature (Age sex)
Competing Risks of Death
Individual Characteristic
(EX. BETEL QUID CHEWING, CIGARETTE SMOKING)
Screening Policy
Simulated Cycle (year=0)
FREE OF
ORAL CANCER
ERYTHROLEUKOPL
-AKIA
LEUKOPLAKIA
ORAL CANCER
Simulated Cycle (year+1)
Intervention & Treatment
YES
Death ?
Exit NO
YES NO
Normal ?
Applying Evidence of Translational Medicine to the Risk-Oriented Cancer Screening for Oral Neoplasm
Shu-Lin Chuang, PhD1; Sam Li-Sheng Chen, PhD2 ; Amy Ming-Fang Yen, PhD2; Jean Ching-Yuan Fann, PhD3; Sherry Yueh-Hsia Chiu, PhD4; Chiu-Wen Su, PhD5; Hsiu-Hsi Chen, PhD1
1. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
2. School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
3. Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan
4. Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
5. Department of Otolaryngology -Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan

5. Conclusions:
　　We developed a risk assessment model to stratify the risk of oral squamous-cell carcinoma for all age cohort considering unhealthy oral habits like betel quid chewing and cigarette smoking, genetic and epigenetic factors in a multistate progression model to demonstrate how different prevention programs has varying effectiveness across different risk groups.
Screening for Oral Neoplasma
+ Health Education
Screening for Oral Neoplasma
Applying Evidence of Translational Medicine to the Risk-Oriented Cancer Screening for Oral Neoplasm
Shu-Lin Chuang, PhD1; Sam Li-Sheng Chen, PhD2 ; Amy Ming-Fang Yen, PhD2; Jean Ching-Yuan Fann, PhD3; Sherry Yueh-Hsia Chiu, PhD4; Chiu-Wen Su, PhD5; Hsiu-Hsi Chen, PhD1
1. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
2. School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
3. Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan
4. Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
5. Department of Otolaryngology -Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan