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Oral Cancer Prevention (PDQ®): Prevention - Health Professional Information [NCI] - 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.[1,2,3] 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.[4,5,6,7]

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 to 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.[8,9,10,11] 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.[12,13,14]

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

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