Not just tobacco, alcohol too top driver of oral cancer: New research

Aditi Tandon

New Delhi, October 18

A group of international experts convened by the International Agency for Research on Cancer (IARC), in the first evaluation of oral cancer prevention strategies worldwide, has found that tobacco smoking and alcohol consumption were the main drivers of oral cancer in most countries but the use of smokeless tobacco and chewing of areca nut products were the top causes of oral cancer in many countries, mainly in South and Southeast Asia.

A special report by experts, published today in the New England Journal of Medicine, calls for screening of high risk populations by clinical oral examination to reduce mortality from oral cancer.

In 2020, cancer of the lip and oral cavity was estimated to rank 16th in incidence and mortality worldwide and was the common cause of death in men across much of South and SouthEast Asia and the Western Pacific.

“Risk factors for oral cancer are dominated by tobacco, both smoked and smokeless, and alcohol consumption,” the paper says.

It says cessation of tobacco smoking and alcohol consumption has a preventive effect on the incidence of oral cancer and probably also decreases the risk of oral potentially malignant disorders.

Given that the combined effect of tobacco smoking and alcohol consumption is greater than multiplicative, smoking cessation reduces the risk of oral cancer in persons who continue drinking alcohol.

“Similarly, the benefits of cessation in the use of areca nut products with or without tobacco have been established,” the group said, asking nations to consider these prevention strategies.

Leading epidemiologist Ravi Mehrotra was part of the expert group.

Commenting on the work, Béatrice Lauby-Secretan, Deputy Head of the Evidence Synthesis and Classification Branch at IARC and a co-author of the report said, “This IARC Handbook provides a first-time evaluation of primary and secondary prevention of oral cancer. The Working Group evaluated: interventions for quitting use of smokeless tobacco and areca nut products; the benefits of quitting use of these products, quitting tobacco smoking, and quitting alcohol consumption; and the effectiveness of current oral cancer screening methods. The Working Group also reviewed the implementation of bans on sale and other policies to control the use of smokeless tobacco and areca nut products. This work thus contributes to IARC’s mission to serve low- and middle-income countries.”