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Mouth cancer for clinicians part 3: risk factors (traditional: tobacco)

From Volume 42, Issue 5, June 2015 | Pages 476-483

Authors

Nicholas Kalavrezos

FRCS, FFD RCSI, MD

Consultant in Head and Neck/Reconstructive Surgery, Head and Neck Centre, University College London Hospitals, London, UK

Articles by Nicholas Kalavrezos

Crispian Scully

CBE, DSc, DChD, DMed (HC), Dhc(multi), MD, PhD, PhD (HC), FMedSci, MDS, MRCS, BSc, FDS RCS, FDS RCPS, FFD RCSI, FDS RCSEd, FRCPath, FHEA

Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Crispian Scully

Abstract

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team, in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.

CPD/Clinical Relevance: This article offers the dental team an overview of the main cancer risk factors, tobacco and alcohol, betel and other chewing habits, and environmental factors.

Article

Mouth cancer arises out of DNA mutations (Article 1) which can affect various genes and are increased by various risk factors. The main known definitive risk factors for mouth cancer are using tobacco and drinking alcohol: it is thought that about 3 out of 4 head and neck cancers (75%) are linked to these habits (Figure 1). Other risk factors include betel use and similar chewing habits (Article 4). Radiation (eg sunlight, ionizing), which is implicated in lip cancer, and infection with the virus human papillomavirus (HPV), which plays a role in oropharyngeal cancer, are discussed in Article 5. This article discusses tobacco.

The cause of cancer in most people is unclear but risk depends on a combination of genes, environment and aspects of living (Figure 2).

Anything that increases DNA mutations increases a person's chances of developing cancer and is called a ‘cancer risk factor’. A risk factor is something that increases the chances of developing cancer, but having a risk factor for cancer does not mean necessarily that cancer will develop: some people with risk factors never develop cancer, and yet other people without known risk factors can still develop cancer. It is impossible to control fundamental mouth cancer risk factors such as gender and age.

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