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Oral Cancer Prevention (PDQ®)

Overview

Note: Separate PDQ summaries on Oral Cancer Screening; Lip and Oral Cavity Cancer Treatment; and Cigarette Smoking: Health Risks and How to Quit are also available.

Who is at Risk?

People who use tobacco in any of the commonly available forms (cigarettes, cigars, pipes, and smokeless tobacco) or have high alcohol intake are at elevated risk of oral cancer; and they are at particularly high risk if they use both tobacco and alcohol. People who chew betel quid (whether mixed with tobacco or not)—a common practice in south central Asia and Melanesia—are also at high risk. Individuals with persistent oral infection by carcinogenic strains of human papillomavirus (HPV) are also at increased risk. People with chronic sun exposure are at elevated risk of lip cancer, particularly on the lower lip.

Factors associated with increased risk of oral cancer

Tobacco use

Based on solid evidence from numerous observational studies, tobacco use causes cancers of the lip, oral cavity, and oropharynx.[1-3] Smoking avoidance and smoking cessation result in decreased incidence and mortality from oral cancer.

Magnitude of Effect: Large (most cancers of the oral cavity are attributable to the use of tobacco products).

  • Study Design: Numerous observational case-control and cohort studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.
Alcohol use

Based on solid evidence, alcohol use is an independent risk factor for the development of oral cancer.[4-7]

Magnitude of Effect: Lower than the risk associated with tobacco use, but the risk is approximately doubled for people who drink three to four alcoholic beverages per day compared with nondrinkers, and is dose related.

  • Study Design: Case-control and cohort studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Oral cancer risk is highest in persons using both alcohol and tobacco compared with those using one or the other.

HPV infection

Based on solid evidence, there is a strong association between oral HPV infection and oral cancer, particularly HPV type 16.[8-11] Given the known causal association between HPV infections and cancer of the cervix, the established strong association between infection by carcinogenic strains of HPV and oral cancer may also be causal.

Magnitude of Effect: Not well quantified. It accounts for a small but increasing proportion of oral cancers.

  • Study Design: Case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.
Sun exposure

Based on fair evidence, carcinoma of the lip, predominantly the lower lip, is associated with sun exposure.[12-14]

Magnitude of Effect: Not well quantified due to wide confidence intervals.

  • Study Design: Case-control studies.
  • Internal Validity: Fair.
  • Consistency: Small number of studies make consistency difficult to assess.
  • External Validity: Fair.

Interventions Associated With a Decreased Risk of Oral Cancer

Avoidance of tobacco

Based on solid evidence, avoidance or cessation of exposure to tobacco (e.g., cigarettes, pipes, cigars, and smokeless tobacco) would lead to a decrease in oral cancer.

Magnitude of Effect: Decreased risk, moderate to large magnitude.

  • Study Design: Cohort or case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Interventions With Inadequate Evidence as to Whether They Reduce the Risk of Oral Cancer

Avoidance of alcohol

Although alcohol use is a risk factor for oral cancer and, by inference, its avoidance would lead to fewer cases, there is inadequate empiric evidence that cessation of alcohol use decreases the risk of oral cancer.

Magnitude of Effect: Decreased risk, moderate magnitude.

  • Study Design: Evidence of association only, from cohort or case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Avoidance of HPV infection

Although infection with specific carcinogenic strains of HPV is a risk factor for (and likely causes) a subset of oral cancers and, by inference, its avoidance would lead to fewer cases, there is inadequate empiric evidence that strategies to avoid infection decrease the risk of oral cancer.

Magnitude of Effect: Not defined.

  • Study Design: Evidence of association only, based on case-control studies.
  • Internal Validity: Good.
  • Consistency: Good.
  • External Validity: Good.

Dietary factors

There is inadequate evidence to determine whether a change in diet would decrease the risk of oral cancer.

Magnitude of Effect: Not applicable (N/A).

  • Study Design: Evidence of association only, obtained from cohort or case-control studies.
  • Internal Validity: Inadequate.
  • Consistency: N/A.
  • External Validity: N/A.

Sun avoidance and sunscreen use

There is inadequate evidence to determine whether reducing sun exposure or use of sunscreens would prevent lip cancer. (Refer to the PDQ summary on Skin Cancer Prevention for more information about sun avoidance and sunscreen use for prevention of skin cancer.)

Magnitude of Effect: N/A.

  • Study Design: Evidence of association only, from cohort or case-control studies.
  • Internal Validity: Inadequate.
  • Consistency: N/A.
  • External Validity: N/A.

References

  1. U.S. Department of Health and Human Services: The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Ga: U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available online. Last accessed September 19, 2014.
  2. National Cancer Institute: Cigars: Health Effects and Trends. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, [1998]. Smoking and Tobacco Control Monograph 9. Available online. Last accessed July 2, 2014.
  3. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: Smokeless tobacco and some tobacco-specific N-nitrosamines. IARC Monogr Eval Carcinog Risks Hum 89: 1-592, 2007. [PUBMED Abstract]
  4. Blot WJ, McLaughlin JK, Winn DM, et al.: Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48 (11): 3282-7, 1988. [PUBMED Abstract]
  5. Altieri A, Bosetti C, Gallus S, et al.: Wine, beer and spirits and risk of oral and pharyngeal cancer: a case-control study from Italy and Switzerland. Oral Oncol 40 (9): 904-9, 2004. [PUBMED Abstract]
  6. Talamini R, La Vecchia C, Levi F, et al.: Cancer of the oral cavity and pharynx in nonsmokers who drink alcohol and in nondrinkers who smoke tobacco. J Natl Cancer Inst 90 (24): 1901-3, 1998. [PUBMED Abstract]
  7. Talamini R, Franceschi S, Barra S, et al.: The role of alcohol in oral and pharyngeal cancer in non-smokers, and of tobacco in non-drinkers. Int J Cancer 46 (3): 391-3, 1990. [PUBMED Abstract]
  8. Schwartz SM, Daling JR, Doody DR, et al.: Oral cancer risk in relation to sexual history and evidence of human papillomavirus infection. J Natl Cancer Inst 90 (21): 1626-36, 1998. [PUBMED Abstract]
  9. Mork J, Lie AK, Glattre E, et al.: Human papillomavirus infection as a risk factor for squamous-cell carcinoma of the head and neck. N Engl J Med 344 (15): 1125-31, 2001. [PUBMED Abstract]
  10. D'Souza G, Kreimer AR, Viscidi R, et al.: Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 356 (19): 1944-56, 2007. [PUBMED Abstract]
  11. Franceschi S, Muñoz N, Bosch XF, et al.: Human papillomavirus and cancers of the upper aerodigestive tract: a review of epidemiological and experimental evidence. Cancer Epidemiol Biomarkers Prev 5 (7): 567-75, 1996. [PUBMED Abstract]
  12. Pogoda JM, Preston-Martin S: Solar radiation, lip protection, and lip cancer risk in Los Angeles County women (California, United States). Cancer Causes Control 7 (4): 458-63, 1996. [PUBMED Abstract]
  13. Silverman S Jr, ed.: Oral Cancer. 4th ed. Hamilton, Canada: BC Decker, 1998.
  14. Perea-Milla López E, Miñarro-Del Moral RM, Martínez-García C, et al.: Lifestyles, environmental and phenotypic factors associated with lip cancer: a case-control study in southern Spain. Br J Cancer 88 (11): 1702-7, 2003. [PUBMED Abstract]
  • Updated: July 2, 2014