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Risk Factors
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BrianOCF posted:
Age is frequently named as a risk factor for oral cancer, as historically it occurs in those over the age of 40. The age of diagnosed patients may indicate a time component in the biochemical or biophysical processes of aging cells that allows malignant transformation, or perhaps, immune system competence diminishes with age. Very recent data lead us to believe that the fastest growing segment of the oral cancer population are non smokers under the age of fifty, which would indicate a paradigm shift in the cause of the disease, and in the locations where it most frequently occurs in the oral environment.
However, it is likely that the accumulative damage from other factors, such as tobacco use, alcohol consumption, and persistent viral infections such as HPV, are the real culprits. It may take several decades of smoking for instance, to precipitate the development of a cancer. Having said that, tobacco use in all its forms is number one on the list of risk factors in individuals over 50. Historically at least 75% of those diagnosed at 50 and older are tobacco users. This percentage is now changing, and exact percentages are yet to be definitively determined and published, as new data related to viral causes are changing the demographics very rapidly. When you combine tobacco with heavy use of alcohol, your risk is significantly increased, as the two act synergistically. Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others. It does not appear that the HPV16 viral causes act synergistically with tobacco or alcohol, and represent a completely unique disease process.
Tobacco and alcohol are essentially chemical factors, but they can also be considered lifestyle factors, since we have some control over them. Besides these, there are physical factors such as exposure to ultraviolet radiation. This is a causative agent in cancers of the lip, as well as other skin cancers. Another physical factor is exposure to x-rays. Radiographs regularly taken during examinations, and at the dental office, are safe, but remember that radiation exposure is accumulative over a lifetime. It has been implicated in several head and neck cancers.
Biological factors include viruses and fungi, which have been found in association with oral cancers. The human papilloma virus, particularly HPV16, has been definitively implicated in oral cancers, particularly those that occur in the back of the mouth. (Oropharynx, base of tongue, tonsillar pillars and crypt, as well as the tonsils themselves.) HPV is a common, sexually transmitted virus, which infects about 40 million Americans today. There are over 120 strains of HPV, most thought to be harmless. But approximately 1% of those infected, have the HPV16 strain which is a primary causative agent in cervical cancer (with HPV18), cancers of the anus and penis, and now is a known cause of oral cancer as well. It is likely that the changes in sexual behaviors of young adults over the last few decades, and which are continuing today, are increasing the spread of HPV, and the oncogenic versions of it. There are other minor risk factors which have been associated with oral cancers, but have not yet been definitively shown to participate in their development. These include lichen planus, an inflammatory disease of the oral soft tissues, and genetic predispositions.


There are studies which indicate a diet low in fruits and vegetables could be a risk factor, and that conversely, one high in these foods may have a protective value against many types of cancer. Clearly cancer is a very complex group of diseases, and diet alone should not be considered a stand alone causative factor for initiation of the cascade of cellular events that changes a cell from normal to malignant.

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