ReviewRisk factors for squamous cell carcinoma of the oral cavity in young people — a comprehensive literature review
Introduction
Squamous cell carcinoma (SCC) of the oral cavity and oropharynx is rare in patients of age 50 and younger, being primarily a disease that occurs in males in their 6th and 7th decade. Younger patients (arbitrarily aged less than 45 years) account for approximately 6% of all oral cancers [1].
‘Oral Cancer’ includes malignant neoplasms of the lip (ICD-9 latest available for incidence figures; site 140), intra-oral sites (ICD 141, 143–145) and the oro-pharynx (ICD 146.3–146.9). The nasopharynx (ICD 147), hypopharynx (ICD 148) and salivary glands (ICD 142) are not normally included in the term. If facial skin is excluded, the majority of malignant neoplasms of the orofacial region (over 80%) are squamous cell carcinomas of the oral mucosa, tongue and lip [2].
The relative rarity of these tumours occurring in young adults and the diversity in reporting age criteria, sites, stages and possible aetiology, make comparisons problematic. This in turn makes the determination of contributing factors and the development of appropriate preventative health messages difficult for this population. It has even been suggested that oral cancer in the young may be a disease distinct from that occurring in older patients with a different aetiology and disease progression [2].
The primary aim of this review is to examine the risk factors associated with oral cancer in young people using the existing literature. Studies examining potential aetiological agents will be critically discussed, to assess the relative contribution research to date has made towards recognising and understanding the potential risk factors associated with oral cancer in this particular population.
Section snippets
Search terms
The following databases were searched: Medline; CancerLit; the Institute for Scientific Information (ISI) databases of: SCI-expanded and Social Sciences Citation Index (SciSearch) and Embase (1980–present) and International Bibliography of the Social Sciences (IBSS) both via BIDS. Search terms of ‘Squamous Cell Carcinoma’; ‘Oral’; ‘Oral Cavity’; ‘Oropharynx’; ‘Oral and Cancer’ and ‘Oral and Carcinoma’; ‘Young’; ‘Young Adult’; in various combinations including and/or were used. The search was
Epidemiology
The highest rates of oral cancer in people of all ages occur in developing countries such as south and south-east Asia [3] where oral cancer is often the first or second most common site for malignancy [4], [5], [6].
Whilst several past studies in the early 1970s have indicated that the occurrence of oral cancer has been decreasing [7], [8], [9], in the last few decades it has been suggested that the incidence of oral cancer in all age groups may be rising worldwide [10].
The institutional
Prognosis/survival rates amongst young people
There is little agreement in the literature regarding the outcome of younger patients diagnosed with SCC of the oral cavity and oropharynx as compared with the outcome of older patients. Several authors [12], [37], [45], [46] have reported that age is related to prognosis concluding that diagnosis at a younger age is associated with a decreased survival rate. It would be prudent to add however, that the majority of these results are based on very small sample sizes. For example, Son et al. [12]
Conclusions
The increasing incidence of SCC of the oral cavity in the younger population, together with an estimated failure to improve survival rates and the evidence that traditional risk factors may not be responsible for a proportion of oral cancer cases in the young, demonstrate the importance of a better understanding of oral cancer epidemiology.
From this review it is clear that contrasting evidence exists in the literature as to the status of alcohol and tobacco as risk factors for oral carcinoma in
Acknowledgements
We would like to thank Dr. Alison Giles who contributed to the development of our databases, the literature searches and collection of data for information on case studies listed in Table 1, Table 2. CL is funded by a grant from the NHS Executive London (NHSE-LRO), Research and Development Responsive Funding Programme and from monies received from The Ben Walton Trust.
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