Non-smoking, non-drinking, oral squamous cell carcinoma patients are a distinct and clinically significant group

Carcinogenesis of oral squamous cell carcinoma (OSCC) has long been associated with exposure to tobacco smoke and alcohol consumption. Some centres have reported that non-smoking non-drinking (NSND) patients represent a significant and increasing proportion of OSCC cases with reports of poorer outcomes. Demographic characteristics are variably reported for this group and carcinogenesis is not fully understood. We present the largest cohort study to date in this subject area and sought to better understand demographics and survival.

We interrogated 541 OSCC patients by retrospective analysis to assess risk factor status, disease characteristics and survival. Patients were categorised according to smoking and alcohol exposure with non-smoker (NS) status defined as less than five cigarettes per week with no history of use greater than this. Non-drinker (ND) status was defined as less than three standard drinks per week with no history of alcohol consumption greater than this. Those both NS and ND were categorised as NSND. Subsite, tumour stage and treatment were recorded along with evidence of cervical nodal and distant metastasis.

These patients were more likely to be female, older and present with early-stage disease. Tumour site was tongue, maxillary alveolus and buccal mucosa, at variance with the smoker drinker groups.

NSNDs comprise a significant proportion our OSCC population. These patients were more likely to be female, older and present with early-stage disease. Tumour site was tongue, maxillary alveolus and buccal mucosa, at variance with the smoker drinker groups. Thus, NSNDs are a clinically distinct and significant group in oral cavity cancer management.