Elsevier

Oral Oncology

Volume 37, Issue 5, July 2001, Pages 401-418
Oral Oncology

Review
Risk factors for squamous cell carcinoma of the oral cavity in young people — a comprehensive literature review

https://doi.org/10.1016/S1368-8375(00)00135-4Get rights and content

Abstract

There have been several reports of a rising incidence of oral cancer from many parts of the world. Although it is well known that oral cancer increases with age, recent trends for a rising incidence particularly relates to cancer of the tongue and mouth in young males. This review critically examines 46 publications devoted to oral cancer in the young adult. Most studies suggest that 4–6% of oral cancers now occur at ages younger than 40 years. Several studies examining risk factors for oral cancer in the young provide evidence that many younger patients have never smoked or consumed alcohol, which are recognised risk factors in older groups, or that duration of exposure may be too short for malignant transformation to occur. Information on many aspects of aetiology for this disease in the young implicating occupational, familial risk, immune deficits and virus infection are meagre. The spectrum of genetic abnormality disclosed is similar to older patients, there is paucity of specific studies involving younger cohorts, but predisposition to genetic instability has been hypothesised as a likely cause. Conflicting evidence is also reported on the sex distribution and outcome compared with older patients. Much work is required to understand the caveats related to global demography, risk factors and their diagnostic and prognostic markers for this disease which might be considered a disease distinct from that occurring in older patients.

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.

References (170)

  • A.K.E. Hart et al.

    Oral and oropharyngeal squamous cell carcinoma in young adults: a report on 13 cases and review of the literature

    Otolaryngology Head and Neck Surgery

    (1999)
  • R. Martin-Granizo et al.

    Squamous cell carcinoma of the oral cavity in patients younger than 40 years

    Otolaryngology Head and Neck Surgery

    (1997)
  • G.R. Ogden et al.

    Aetiology of oral cancer: alcohol

    British Journal of Oral and Maxillofacial Surgery

    (1998)
  • J. Mackenzie et al.

    Increasing incidence of oral cancer amongst young persons: what is the aetiology?

    Oral Oncology, European Journal of Cancer

    (2000)
  • N.J. Burzynski et al.

    Squamous cell carcinoma of the upper aerodigestive tract in patients 40 years of age and younger

    Oral Surgery, Oral Medicine and Oral Pathology

    (1992)
  • S. Thomas et al.

    A quantitative evaluation of the aetiological role of betel-quid in oral carcinogenesis

    Oral Oncology, European Journal of Cancer

    (1993)
  • W.J. Blot et al.

    Geographic patterns of oral cancer in the United States: etiologic implications

    Journal of Chronic Diseases

    (1977)
  • Opportunistic oral cancer screening

    Occasional paper No

    (2000)
  • S. Atula et al.

    Cancer of the tongue in patients younger than 40 years

    Archives of Otolaryngology and Head and Neck Surgery

    (1996)
  • J.J. Pindborg

    Oral cancer and precancer

    (1980)
  • D.K. Daftary et al.

    Risk factors and risk markers for oral cancer in high risk areas of the world

  • ICMR. National Cancer Registry of the Indian Council for Medical Research Annual report 1984. ICMR,New Delhi,...
  • The Cancer Research Campaign. CRC CancerStats: Oral UK....
  • Binnie WH, Cawson RA, Hill GB, Soaper AE. Oral Cancer in England and Wales. A national study of morbidity, mortality,...
  • C.A. Szpak et al.

    Some observations concerning the demographic and geographic incidence of carcinoma of the lip and buccal cavity

    Cancer

    (1977)
  • K.N. Tan

    Oral cancer in Australia

    Australian Dental Journal

    (1969)
  • P. Boyle et al.

    Epidemiology of mouth cancer in 1989: a review

    Journal of the Royal Society of Medicine

    (1990)
  • R.J. Cusumano et al.

    Squamous cell carcinoma of the oral cavity and oropharynx in young adults

    Head and Neck Surgery

    (1988)
  • Y.H. Son et al.

    Oral cavity and oropharyngeal cancer in a younger population

    Cancer

    (1985)
  • K.A.A.S. Warnakulasuriya et al.

    Incompleteness of oral cancer registration in south-east England, 1971–87

    British Journal of Cancer

    (1994)
  • N.W. Johnson et al.

    Epidemiology and aetiology of oral cancer in the United Kingdom

    Community Dental Health

    (1993)
  • G.J. Macfarlane et al.

    Oral cancer in Scotland: changing incidence and mortality

    British Medical Journal

    (1992)
  • G.J. Macfarlane et al.

    Rising trends of oral cancer mortality among males worldwide: the return of an old public health problem

    Cancer Causes and Control

    (1994)
  • C.G. Cowan et al.

    Trends in the incidence of histologically diagnosed intra-oral squamous cell carcinoma in Northern Ireland, 1975–89

    British Dental Journal

    (1992)
  • F. Levi et al.

    Cancer incidence and mortality in young adults in Vaud, Switzerland, 1974–1992

    International Journal of Cancer

    (1995)
  • I. Plesko et al.

    Oral and pharyngeal cancer incidence in Slovakia

    International Journal of Cancer

    (1994)
  • R.T. Greenlee et al.

    Cancer statistics 2000

    CA Cancer J Clin

    (2000)
  • R.H. Depue

    Rising mortality from cancer of the tongue in young white males

    The New England Journal of Medicine

    (1986)
  • L.J. Shemen et al.

    Increase of tongue cancer in young men

    Journal of the American Medical Association

    (1984)
  • D. Fleming et al.

    Intraoral squamous cell carcinoma in South Africa

    Journal of the Dental Association of South Africa

    (1982)
  • G.J. Slotman et al.

    Head and neck cancer in a young age group: high incidence in black patients

    Head and Neck Surgery

    (1983)
  • S.J.Jr Arbes et al.

    Factors contributing to the poorer survival of black Americans diagnosed with oral cancer (United States)

    Cancer Causes and Control

    (1999)
  • National Cancer Registry. Annual report 1985. Indian Council of Medical Research, New Delhi,...
  • D.M. Parkin et al.

    Estimates of the worldwide incidence of eighteen major cancers in 1985

    International Journal of Cancer

    (1993)
  • P.C. Gupta

    Mouth cancer in India: a new epidemic?

    Journal of the Indian Medical Association

    (1999)
  • T.K. Padmanabhan et al.

    Evaluation of local control, survival and pattern of failure with radiotherapy in cancer of the tongue

    Oncology

    (1990)
  • D.D. Patel et al.

    Carcinoma of the anterior tongue in adolescence

    Cancer

    (1976)
  • J.B. Jones et al.

    Carcinoma of the tongue in young patients

    The Journal of Otolaryngology

    (1989)
  • C.W. Venables et al.

    Carcinoma of the tongue in early adult life

    British Journal of Cancer

    (1967)
  • R.W. Clarke et al.

    Squamous carcinoma of the head and neck in the young adult

    Clinical Otolaryngology

    (1992)
  • Cited by (0)

    View full text