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Risk factors for multiple oral premalignant lesions
Gigi Thomas1, Mia Hashibe, Binu J Jacob
1Regional Cancer Centre, Trivandrum, India.
International Journal of Cancer
|September 2, 2003
Summary
Tobacco chewing significantly increases the risk of developing multiple oral premalignant lesions, such as oral leukoplakia and submucous fibrosis. This habit is identified as a primary driver of field cancerization in the oral epithelium.
Area of Science:
- Oral Medicine
- Oncology
- Epidemiology
Background:
- Oral premalignant lesions, including oral leukoplakia, oral submucous fibrosis, and erythroplakia, pose a significant risk for oral cancer.
- Field cancerization, characterized by widespread genetic defects in the upper aerodigestive tract epithelium due to carcinogen exposure, is hypothesized to underlie the development of multiple oral premalignant lesions.
- Epidemiological data on risk and protective factors for multiple oral premalignant lesions were previously lacking.
Purpose of the Study:
- To investigate the risk and protective factors associated with multiple oral premalignant lesions.
- To explore the association between tobacco chewing, alcohol consumption, smoking, and the development of multiple oral premalignant lesions.
- To identify the primary risk factor contributing to field cancerization of the oral epithelium in the Indian population.
Main Methods:
- A case-control study was conducted using data from the baseline screening of a randomized oral cancer screening trial in Kerala, India.
- 115 subjects with multiple oral premalignant lesions (combinations of oral leukoplakia, oral submucous fibrosis, and erythroplakia) were compared with 47,773 controls without oral lesions.
- Statistical analysis included adjusted odds ratios (OR) to assess the risk associated with tobacco chewing, alcohol consumption, and smoking, controlling for covariates.
Main Results:
- Ever tobacco chewing showed a highly significant odds ratio of 37.8 (95% CI=16.2-88.1) for multiple oral premalignant lesions, even after adjusting for other factors.
- A significant dose-response relationship was observed for both the frequency (p<0.0001) and duration (p<0.0001) of tobacco chewing.
- While alcohol consumption may be a potential risk factor, smoking was not found to be significantly associated with an increased risk (OR=0.9, 95%CI=0.5-1.7).
Conclusions:
- Tobacco chewing is identified as the most significant risk factor for multiple oral premalignant lesions.
- Tobacco chewing appears to be a major contributor to field cancerization of the oral epithelium, particularly in the Indian population.
- Further research into preventive strategies targeting tobacco cessation is warranted.