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DOI: 10.1055/s-0042-1756479
Trend Analysis of Global Web Searches (2004–2022) on Oral Cancer and Its Major Risk Factors
Abstract
Background Oral cancer is the 15th leading cause of mortality globally. The Internet is an online source of information pertaining to oral cancer and its major risk factors. This study aims to analyze the trend of global online interest on oral cancer and its major risk factors through an analysis of web searches of oral cancer.
Materials and Methods This study analyzed the web searches conducted, from 2004 to January 2022, on oral cancer and its major risk factors (tobacco use, harmful alcohol use, and human papillomavirus [HPV] infection) using data obtained from Google Trends.
Results Within the time frame under study, oral cancer had multiple peak search periods, with the highest relative search volume index (SVI) for a period being 1; the peak search period for alcohol was March 2020 (SVI = 100); the peak search periods for tobacco were March to April 2004 (SVI = 17); and the peak search period of HPV was April 2004 (SVI = 1). Globally, alcohol was the most common searched term among these four terms (oral cancer, alcohol, tobacco, and HPV) except in Turkey where tobacco was the most common (55%) searched term. The top 25 search queries for oral cancer, HPV, tobacco, and alcohol had SVI ranges of 22 to 100, 12 to 100, 28 to 100, and 18 to 100, respectively. From these search queries, it was observed that people have interest in oral cancer symptomatology, and the adverse effects of tobacco, alcohol, and HPV.
Conclusion This study revealed an overall decline in the online interest on oral cancer and its major risk factors on a global scale.
#
Introduction
Oral cancer is the commonest malignancy affecting the head and neck region, the 16th commonest malignancy, and the 15th leading cause of mortality globally.[1] [2] Oral cancer is a very notorious public health problem with a 5-year survival rate among 40 to 50% of patients diagnosed with the disease.[3] The incidence of oral cancer increases with age and majority of cases occur among people in their fifth or older decade.[1] However, reports have also shown an increased incidence of oral cancer cases among young people under the age of 40 years and human papillomavirus (HPV) infection has been strongly implicated in these cases.[4] [5]
Oral cancer is a preventable disease with various associated risk factors including tobacco use, harmful alcohol use, HPV infection, nutritional deficiency, genetic predisposition, sunlight exposure.[4] [6] [7] Of all these risk factors, the three commonly associated ones are tobacco use, harmful alcohol use, and HPV infection.[4] [6] [7] [8] The common clinical features (symptoms and signs) of oral cancer include chronic nonhealing oral ulceration, enlargement of the lymph nodes, intraoral bleeding episodes, and teeth mobility.[9] [10] [11]
The lack of adequate knowledge and awareness concerning oral cancer is a factor contributing to the delay in oral cancer presentation and diagnosis among patients, leading to poor prognosis[12] [13] [14]; hence, the need for public education about the risk factors, symptomatology of the disease cannot be over-emphasized.[11] [15] [16]
The Internet has been a source of health information for patients and its use for this purpose is growing daily.[17] [18] [19] The Internet is also found to provide important information and support systems for oral cancer patients by improving awareness, facilitating treatment adherence, and enhancing professional–patient interaction even when there are concerns about the quality, validity, and patient's understanding of these information.[17] [18]
Globally, there are over 2.5 billion Internet and social media users, and this population is expected to continue to rise.[20] [21] Therefore, Internet-based sources of information, such as YouTube, Instagram, Twitter, Facebook, and search engines (e.g., Google), have been used as channels for accessing, sharing, and disseminating information to disseminate health information and health promotion, including those about oral cancer.[22] [23] [24]
Google is a leading Internet-based search engine used for seeking diverse information, including those pertaining to health.[25] [26] [27] Pertinently, populations' health information-seeking behavior has been evaluated by analyzing online interests using Google Trends.[25] [26] For example, Google Trends analysis has been used to evaluate online interest dynamics on coronavirus disease 2019 (COVID-19), salmonellosis, and mental health.[27] [28] [29] [30] After extensive literature, it was observed that no know study has analyzed the global online interest on oral cancer. This study therefore aims to analyze the trend of global online interest on oral cancer and its major risk factors through an analysis of web searches of oral cancer from 2004 to 2022. The outcome of this study will provide deep insights on the global trend of information-seeking patterns on oral cancer.
#
Materials and Methods
This study was an infodemiological study that measured the global online search interest on oral cancer and its major risk factors (tobacco use, harmful alcohol use, and HPV infection)[4] [6] [7] [8]) through the analysis of global web searches on Google Trends (http://trends.google.com). Google Trends is a web site, owned by Google, which analyzes the degree of popularity of top search queries in Google Search across various periods (times), languages, and regions. On Google Trends, search trends are measured in the unit of search volume index (SVI). An SVI of 0 depicts insufficient data on the popularity of a search term, an SVI of 100 refers to the peak popularity of a search term, and an SVI of 50 means half popularity of a search term.
On February 16, 2022, we did a comparative search of “oral cancer,” “alcohol,” “tobacco,” and “human papillomavirus” using the “all categories,” “2004–present,” “worldwide,” and “web search” filters on the Explore page on Google Trends (https://trends.google.co.uk/trends/explore). The SVIs, related queries, and maps generated from the search were extracted from the search outcomes for trend analysis. The results were presented in texts, maps, charts, and table.
#
Results
This study analyzed the web searches on oral cancer, alcohol, tobacco, and HPV across 218 countries. Between the time frame from 2004 to January, 2022, oral cancer had multiple peak search periods, with the highest relative SVI in a period being 1; the peak search period for alcohol was March 2020 (SVI = 100); the peak search periods for tobacco were March to April 2004 (SVI = 17); and the peak search period of HPV was April 2004 (SVI = 1) ([Fig. 1]).
![](https://www.thieme-connect.de/media/10.1055-s-00045654/202303/thumbnails/10-1055-s-0042-1756479-i2230567-1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
[Fig. 2] (Data source: Google Trends [ https://www.google.com/trends]) is an analytic geo-map developed from the comparative analysis of searches, from 2004 to January, 2022, on web searches per country on oral cancer, tobacco, alcohol, and HPV. In this figure, all countries, including countries with low SVIs (n = 178), were included. In the geo-map, the most prominent search term in a country has the color indicating the search term. It is noteworthy that oral cancer was not the most prominent search term in any of these countries. However, in all these countries, alcohol was the most common searched term, except for Turkey where tobacco was the most common (55%) searched term.
![](https://www.thieme-connect.de/media/10.1055-s-00045654/202303/thumbnails/10-1055-s-0042-1756479-i2230567-2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
After excluding the countries with low SVIs, countries with high and moderate SVIs (n = 40) were subjected to further analysis. Brazil had the highest proportion (0.04%) of searches-per-country on oral cancer, Argentina had the highest proportion (99%) of searches-per-country on alcohol, Turkey had the highest proportion (55%) of searches-per-country on tobacco, and Kenya (1%) and Nigeria (1%) had the highest proportions of searches-per-country on HPV ([Fig. 3]).
![](https://www.thieme-connect.de/media/10.1055-s-00045654/202303/thumbnails/10-1055-s-0042-1756479-i2230567-3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
[Table 1] shows the list of top 25 search queries used on Google Trends to search for oral cancer, HPV, tobacco, and alcohol, from 2004 to January 2002. The top 25 search queries for oral cancer, HPV, tobacco, and alcohol had SVI ranges of 22 to 100, 12 to 100, 28 to 100, and 18 to 100, respectively. From these search queries, it was observed that people have interest in oral cancer symptomatology, and the adverse effects of tobacco, alcohol, and HPV.
Abbreviations: HPV, human papillomavirus; SQ, search query; STD, sexually transmitted disease; SVI, search volume index.
#
Discussion
The findings obtained in this study were noteworthy. From the results obtained, it was observed that while the global search interest in alcohol and tobacco was more varied over time with an overall decrease in the use of these search terms, web search interests in HPV and oral cancer appeared to be more stable maintaining a rough plateau over this 18-year time frame under study.
Of particular interest was the sudden spike in the SVI of global web search of alcohol in March 2020. Coincidentally, March 2020 was the period when several nations started announcing/implementing lockdowns to deter COVID-19 outbreak.[31] [32] [33] [34] [35] Over a period of approximately 3 months (March 2020–June 2020), the SVI spike gradually declined to its previous level. From the juxtaposition of this decline with the timeline of multinational COVID-19 lockdown experience, it was observed that May/June 2020 was the period when countries started easing lockdowns.[35] [36] Pertinently, because of the lockdown—as human movement was massively restricted—many people used online markets to purchase alcoholic beverages. This can be confirmed by a reported two-digit increase (36%) in alcohol use observed in several countries during the COVID-19 lockdown.[37] On the other hand, the peak periods of tobacco and HPV web searches were about two decades ago (year 2004), while that of oral cancer was multiple; these suggested that COVID-19 lockdown had no obvious effect on the rate of their web searches.
It is interesting to note that the overall volume of global searches on oral cancer, alcohol, tobacco, and HPV was unequal. Out of these four terms, alcohol and tobacco were the most searched, while HPV and oral cancer were less searched. The low relative SVIs of oral cancer and HPV is probably a reflection of the low level of lay public knowledge recorded in multiple surveys concerning these two terms.[16] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] Based on this finding, evidence-based educational interventions are recommended to encourage public online interests and information-seeking behavior concerning these health terms, particularly on oral cancer, and HPV. Furthermore, it is recommended that these interventions are country-specific interventions to reduce the existing inequalities in the search volumes on these terms across countries. For example, the proportion of searches on oral cancer in India was very low. However, in India, unlike in Brazil and several other countries, oral cancer forms over 30% of its cancer cases and, also, about one-third of global oral cancer cases are from India.[49] [50] In addition, only two countries—Nigeria and Kenya—had appreciable search proportions on HPV. With the current explosion in the global burden of HPV-induced oropharyngeal cancers and low web searches on HPV, it becomes imperative for all countries to start focusing more on interventions that will enhance digital health literacy and improve HPV understanding.[21] [51] [52] [53]
As earlier noted, alcohol and tobacco were the two most searched terms out of the four investigated search terms. Some search queries, such as “alcohol near me,” “tobacco shops,” and “tobacco near me,” suggest that some of these web searches were for sourcing alcohol and tobacco. It is pertinent that the forms of online information concerning these two substances are diverse, many of which were commercial-, policy-, or health-related.[19] [54] [55] [56] [57] However, research had identified that some of those web-based sources encouraging the use of alcohol and tobacco are highly promoted, more engaging, more accessible, and more enticing, while those discouraging alcohol and tobacco use are difficult to access by the public, and less engaging.[16] [21] [54] [55] [56] [57] Hence, it is recommended that all relevant public health organizations should intensify the optimization, promotion, reachability, and regular update of their web pages on health information pertaining to tobacco and harmful alcohol use prevention, to ensure that Internet surfers can easily access credible information on health and alcohol and tobacco use prevention.
However, this study has its limitation. This study was based on the data obtained from Google Trends while only 92.47% of all global Internet searches are conducted using Google search[58] hence, not all search engines were included in this study. Notwithstanding this limitation, this study is believed to be the first to explore the online search interests on oral cancer and its major risk factors, from 2004 till date.
In conclusion, this study provided credible evidence, with logical explanations, about the overall declining online interest on oral cancer and its major risk factors on a global scale.
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Conflict of Interest
None declared.
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Publication History
Article published online:
06 October 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Ren ZH, Hu CY, He HR, Li YJ, Lyu J. Global and regional burdens of oral cancer from 1990 to 2017: Results from the global burden of disease study. Cancer Commun (Lond) 2020; 40 (2-3): 81-92
- 2 International Agency for Research on Cancer. Lip, oral cavity. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/1-Lip-oral-cavity-fact-sheet.pdf
- 3 Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65 (02) 87-108
- 4 Menezes FDS, Latorre MDRDO, Conceição GMS, Curado MP, Antunes JLF, Toporcov TN. The emerging risk of oropharyngeal and oral cavity cancer in HPV-related subsites in young people in Brazil. PLoS One 2020; 15 (05) e0232871
- 5 Llewellyn CD, Johnson NW, Warnakulasuriya KAAS. Risk factors for squamous cell carcinoma of the oral cavity in young people–a comprehensive literature review. Oral Oncol 2001; 37 (05) 401-418
- 6 Joseph BK. Oral cancer: prevention and detection. Med Princ Pract 2002; 11 (Suppl. 01) 32-35
- 7 Conway DI, Purkayastha M, Chestnutt IG. The changing epidemiology of oral cancer: definitions, trends, and risk factors. Br Dent J 2018; 225 (09) 867-873
- 8 Yakin M, Gavidi RO, Cox B, Rich A. Oral cancer risk factors in New Zealand. N Z Med J 2017; 130 (1451): 30-38
- 9 Bagan J, Sarrion G, Jimenez Y. Oral cancer: clinical features. Oral Oncol 2010; 46 (06) 414-417
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- 11 Salami A, Kanmodi K, Nnyanzi L. Re-emphasizing the roles of general medical and dental practitioners regarding oral cancer eradication in Nigeria. Acta Medica Martiniana. 2021; 21 (03) 90-102
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- 16 Kanmodi K, Kanmodi P, Ogbeide M, Nwafor J. Head and neck cancer literacy in Nigeria: a systematic review of the literature. Annals of Public Health Issues. 2021; 1 (01) 25-49
- 17 Rogers SN, Rozek A, Aleyaasin N, Promod P, Lowe D. Internet use among head and neck cancer survivors in the North West of England. Br J Oral Maxillofac Surg 2012; 50 (03) 208-214
- 18 Varela-Centelles P, Ledesma-Ludi Y, Seoane-Romero JM, Seoane J. Information about oral cancer on the Internet: our patients cannot understand it. Br J Oral Maxillofac Surg 2015; 53 (04) 393-395
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- 22 Lister C, Royne M, Payne HE, Cannon B, Hanson C, Barnes M. The laugh model: reframing and rebranding public health through social media. Am J Public Health 2015; 105 (11) 2245-2251
- 23 Neiger BL, Thackeray R, Burton SH, Giraud-Carrier CG, Fagen MC. Evaluating social media's capacity to develop engaged audiences in health promotion settings: use of Twitter metrics as a case study. Health Promot Pract 2013; 14 (02) 157-162
- 24 López-Jornet P, Camacho-Alonso F. The quality of internet sites providing information relating to oral cancer. Oral Oncol 2009; 45 (09) e95-e98
- 25 Dalanon J, Esguerra R, Diano LM, Matsuka Y. Analysis of the Filipinos' interest in searching online for oral cancer. Asian Pac J Cancer Prev 2020; 21 (04) 1121-1127
- 26 Havelka EM, Mallen CD, Shepherd TA. Using Google Trends to assess the impact of global public health days on online health information seeking behaviour in Central and South America. J Glob Health 2020; 10 (01) 010403 DOI: 10.7189/jogh.
- 27 Nuti SV, Wayda B, Ranasinghe I. et al. The use of Google Trends in health care research: a systematic review. PLoS One 2014; 9 (10) e109583
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