Original article
Oral cancer. Risk factors and change in epidemiological trend
Introduction: Oral cancer continues to be one of the causes of increased morbidity and mortality in the world. With an incidence of approximately 377 thousand cases and a mortality of 177 thousand in 2020, being oral squamous cell carcinoma (OSCC) the most frequent. This neoplasia predominantly affects men and its incidence increases with age. Up to age 80, men have a 40.9% risk of developing cancer and women 27.0%. At age 85, this risk is increased to 49.1% in men and 31.8% in women.
Objective: To know the profile of the patient with oral cancer related to sex and age, and to identify the possible etiopathogenic factors related to the appearance of this neoplastic process.
Material and method: An observational, descriptive and retrospective study is carried out in the Oral and Maxillofacial Surgery Service of the Ramon y Cajal University Hospital in the period between 2004 and 2020. This study has been approved by the research ethics committee of the aforementioned hospital.
Results: Our sample has been made up of 46 men and 40 women. All of them suffer OSCC and have an average age of 66 years ± 14.0 years (66.37; 95% CI). Most of the patients in the sample have been from 60 to 80 years. The most relevant risk factors as predictors of this disease have been tobacco and alcohol. The most common places for oral carcinoma have been the tongue, the jugal mucosa and the floor of the mouth, in women the most frequent localization is in the tongue (57.14% vs 42.85%), the alveolar ridge (54.54% vs 45.45%) and maxillary tuberosity (100% vs 0%).
Conclusions: The profile of the patient suffering from oral cancer is beginning to change toward younger populations, finding it more often in women. The youngest patient with OSCC was 35 years old. Men continue to present more OSCC cases (53.5%), but women are approaching OSCC prevalence, and in some locations, they are already ahead. Risk factors such as tobacco and alcohol are shown to be positive predictors of oral cancer risk.
Oral cancer involves all topographic areas of the oral cavity as well as the lip. According to the World Health Organization (WHO) the global incidence is 4 cases per 100,000 inhabitants1, oral squamous cell carcinoma (OSCC) being the most common cancer of malignant tumours of the oral cavity2. representing 90% of cancers of the maxillofacial area. Cancers of the oral2 cavity and oropharynx are ranked sixth worldwide4, with Asian countries having the highest incidence of this type of tumours5. In Spain, the Spanish Network of Cancer Registries (REDECAN) estimates that approximately 277,394 new cancer cases have been diagnosed in 2020, with values very close to those of 2019. In the case of oral cavity and pharyngeal cancers incidence in Spain (2020) it has been 8.6 thousand cases6.
Oral and lip carcinoma presents a multifactorial etiology, being considered, among others, abusive alcohol and tobacco habits, areca nut consumption and human papillomavirus (HPV) infection, as risk factors for suffering OSCC3. Other factors that have been proposed as possible OSCC etiology are poor oral hygiene, genetic predisposition, nutritional deficiency, greater genomic alteration and chronic inflammation7. The most frequent OSCC locations are the oropharynx and the oral cavity8, with the tongue being the most frequent sublocalization in the oral cavity4.
The objective of this study was to review the profile of the patient presenting oral cancer related to sex and age, and to study the possible etiopathogenic factors related to its appearance.
Suarez Beke, Ana Paula
Master of Advanced Oral Implantology. PhD student in Biomedicine and Health Sciences, European University of Madrid.
Somacarrera Pérez, Maria Luisa
Dentistry Professor. European University of Madrid.
Martin Carreras-Presas, Carmen
Dentistry Professor. European University of Madrid.
Cardenas Serres, Cristina
Intern. Oral and Maxillofacial Surgery Service, University Hospital Ramon y Cajal, Madrid
Acero Sanz, Julio
Head of Services Oral and Maxillofacial Surgery Service, Ramon y Cajal University Hospitals and Puerta de Hierro. Professor, University of Alcala, Madrid.