Cancer Causes & Control

, Volume 18, Issue 9, pp 919–929 | Cite as

Smoking and drinking in relation to oral cancer and oral epithelial dysplasia

  • Douglas E. MorseEmail author
  • Walter J. Psoter
  • Deborah Cleveland
  • Donald Cohen
  • Mireseyed Mohit-Tabatabai
  • Diane L. Kosis
  • Ellen Eisenberg
Original Paper



Risks associated with smoking and drinking are not necessarily constant over the multistage pathway to oral cancer. We investigated whether smoking and drinking patterns differ for persons with oral cancer (OC) relative to those with oral epithelial dysplasia (OED), a precancerous condition.


Incident cases of OC and OED were interviewed using a questionnaire containing questions on smoking and drinking. Odds ratios (ORs) compared the odds of smoking and drinking among persons with OC relative to OED.


No adjusted ORs for smoking achieved statistical significance; however, most were <1.0. The odds of OC relative to OED increased with drinking level; the adjusted OR for 19+ drinks/week was 3.03 (1.56–5.87). Age drinking began and years of drinking were not notably different for OC and OED cases; a higher proportion of OC cases reported discontinuing alcohol for 9+ years before diagnosis.


The relationship between smoking and OED was at least as strong as that for smoking and OC, suggesting that smoking may have its greatest impact on oral carcinogenesis prior to malignant transformation. Drinking was more strongly associated with OC than OED, particularly at elevated consumption levels; the role of alcohol does not appear limited to a late-stage effect.


Tobacco smoking Alcohol drinking Oral cancer Oral dysplasia Mouth neoplasms 



The authors thank the healthcare practitioners and study subjects who participated in the investigation. The study was supported by the New York University Oral Cancer Research for Adolescent and Adult Health Promotion Center, which is funded by the National Institutes of Health/National Institute of Dental and Craniofacial Research grant U54 DE14257 and NIH/NIDCR grant P50 DE10592.


  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRefGoogle Scholar
  2. 2.
    Mayne ST, Morse DE, Winn DM (2006) Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, pp 674–696Google Scholar
  3. 3.
    Melrose RJ (2001) Premalignant oral mucosal diseases. J Calif Dent Assoc 29:593–600PubMedGoogle Scholar
  4. 4.
    Pindborg JJ, Reichart PA, Smith CJ, van der Waal I (1997) in collaboration with Sobin LH (eds) Histological typing of cancer and precancer of the oral mucosa. Springer, New YorkGoogle Scholar
  5. 5.
    Silverman S Jr, Gorsky M, Lozada F (1984) Oral leukoplakia and malignant transformation. A follow-up study of 257 patients. Cancer 53:563–568PubMedCrossRefGoogle Scholar
  6. 6.
    Castellsague X, Quintana MJ, Martinez MC et al (2004) The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis. Int J Cancer 108:741–749PubMedCrossRefGoogle Scholar
  7. 7.
    Franceschi S, Talamini R, Barra S et al (1990) Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. Cancer Res 50:6502–6507PubMedGoogle Scholar
  8. 8.
    Blot WJ, McLaughlin JK, Winn DM et al (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48:3282–3287PubMedGoogle Scholar
  9. 9.
    Morse DE, Katz RV, Pendrys DG et al (1996) Smoking and drinking in relation to oral epithelial dysplasia. Cancer Epidemiol Biomarkers Prev 5:769–777PubMedGoogle Scholar
  10. 10.
    Banoczy J, Gintner Z, Dombi C (2001) Tobacco use and oral leukoplakia. J Dent Educ 65:322–327PubMedGoogle Scholar
  11. 11.
    Hashibe M, Sankaranarayanan R, Thomas G et al (2000) Alcohol drinking, body mass index and the risk of oral leukoplakia in an Indian population. Int J Cancer 88:129–134PubMedCrossRefGoogle Scholar
  12. 12.
    Evstifeeva TV, Zaridze DG (1992) Nass use, cigarette smoking, alcohol consumption and risk of oral and oesophageal precancer. Eur J Cancer B Oral Oncol 28B:29–35PubMedCrossRefGoogle Scholar
  13. 13.
    Lee CH, Ko YC, Huang HL et al (2003) The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan. Br J Cancer 88:366–372PubMedCrossRefGoogle Scholar
  14. 14.
    Loftus ER, Baric JM, Kapur KK, Chauncey HH (1981) Cigarette smoking and oral leukoplakia in healthy males. Spec Care Dentist 1:206–210PubMedGoogle Scholar
  15. 15.
    Dietrich T, Reichart PA, Scheifele C (2004) Clinical risk factors of oral leukoplakia in a representative sample of the US population. Oral Oncol 40:158–163PubMedCrossRefGoogle Scholar
  16. 16.
    Schepman KP, van der Meij EH, Smeele LE, van der Waal I (1998) Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. Oral Oncol 34:270–275PubMedGoogle Scholar
  17. 17.
    Roed-Petersen B (1971) Cancer development in oral leukoplakia. Follow-up of 331 patients. J Dent Res 50:711Google Scholar
  18. 18.
    Einhorn J, Wersall J (1967) Incidence or oral carcinoma in patients with leukoplakia of the oral mucosa. Cancer 20:2189–2193PubMedCrossRefGoogle Scholar
  19. 19.
    Macigo FG, Mwaniki DL, Guthua SW (1995) The association between oral leukoplakia and use of tobacco, alcohol and khat based on relative risks assessment in Kenya. Eur J Oral Sci 103:268–273PubMedGoogle Scholar
  20. 20.
    Gupta PC (1984) Epidemiologic study of the association between alcohol habits and oral leukoplakia. Community Dent Oral Epidemiol 12:47–50PubMedCrossRefGoogle Scholar
  21. 21.
    Shiu MN, Chen TH (2004) Impact of betel quid, tobacco and alcohol on three-stage disease natural history of oral leukoplakia and cancer: implication for prevention of oral cancer. Eur J Cancer Prev 13:39–45PubMedCrossRefGoogle Scholar
  22. 22.
    Fritz A, Percy C, Jack A et al (2000) International classification of diseases for oncology, 3rd edn. WHO, Geneva, pp 45–46Google Scholar
  23. 23.
    Graham S, Dayal H, Rohrer T et al (1977) Dentition, diet, tobacco, and alcohol in the epidemiology of oral cancer. J Natl Cancer Inst 59:1611–1618PubMedGoogle Scholar
  24. 24.
    Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. John Wiley & Sons, Inc., New YorkGoogle Scholar
  25. 25.
    Lumerman H, Freedman P, Kerpel S (1995) Oral epithelial dysplasia and the development of invasive squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79:321–329PubMedCrossRefGoogle Scholar
  26. 26.
    Chen YK, Hsue SS, Lin LM (2004) p73 Expression for human buccal epithelial dysplasia and squamous cell carcinoma: does it correlate with nodal status of carcinoma and is there a relationship with malignant change of epithelial dysplasia? Head Neck 26:945–952PubMedCrossRefGoogle Scholar
  27. 27.
    Soni S, Kaur J, Kumar A et al (2005) Alterations of rb pathway components are frequent events in patients with oral epithelial dysplasia and predict clinical outcome in patients with squamous cell carcinoma. Oncology 68:314–325PubMedCrossRefGoogle Scholar
  28. 28.
    Lo Muzio L, Pannone G, Leonardi R et al (2003) Survivin, a potential early predictor of tumor progression in the oral mucosa. J Dent Res 82:923–928PubMedGoogle Scholar
  29. 29.
    Mao L, Lee JS, Fan YH et al (1996) Frequent microsatellite alterations at chromosomes 9p21 and 3p14 in oral premalignant lesions and their value in cancer risk assessment. Nat Med 2:682–685PubMedCrossRefGoogle Scholar
  30. 30.
    Rosin MP, Cheng X, Poh C et al (2000) Use of allelic loss to predict malignant risk for low-grade oral epithelial dysplasia. Clin Cancer Res 6:357–362PubMedGoogle Scholar
  31. 31.
    Hayes RB, Bravo-Otero E, Kleinman DV et al (1999) Tobacco and alcohol use and oral cancer in Puerto Rico. Cancer Causes Control 10:27–33PubMedCrossRefGoogle Scholar
  32. 32.
    Maserejian NN, Joshipura KJ, Rosner BA, Giovannucci E, Zavras AI (2006) Prospective study of alcohol consumption and risk of oral premalignant lesions in men. Cancer Epidemiol Biomarkers Prev 15:774–781PubMedCrossRefGoogle Scholar
  33. 33.
    Banoczy J, Sugar L (1972) Longitudinal studies in oral leukoplakias. J Oral Pathol 1:265–272PubMedCrossRefGoogle Scholar
  34. 34.
    Kabat GC, Chang CJ, Wynder EL (1994) The role of tobacco, alcohol use, and body mass index in oral and pharyngeal cancer. Int J Epidemiol 23:1137–1144PubMedCrossRefGoogle Scholar
  35. 35.
    Mashberg A, Garfinkel L, Harris S (1981) Alcohol as a primary risk factor in oral squamous carcinoma. CA Cancer J Clin 31:146–155PubMedCrossRefGoogle Scholar
  36. 36.
    Wight AJ, Ogden GR (1998) Possible mechanisms by which alcohol may influence the development of oral cancer—a review. Oral Oncol 34:441–447PubMedCrossRefGoogle Scholar
  37. 37.
    Howie NM, Trigkas TK, Cruchley AT, Wertz PW, Squier CA, Williams DM (2001) Short-term exposure to alcohol increases the permeability of human oral mucosa. Oral Dis 7:349–354PubMedCrossRefGoogle Scholar
  38. 38.
    Blot WJ (1992) Alcohol and cancer. Cancer Res 52:2119s–2123sPubMedGoogle Scholar
  39. 39.
    Blot WJ (1999) Invited commentary: more evidence of increased risks of cancer among alcohol drinkers. Am J Epidemiol 150:1138–1140PubMedGoogle Scholar
  40. 40.
    Altieri A, Bosetti C, Gallus S et al (2004) Wine, beer and spirits and risk of oral and pharyngeal cancer: a case–control study from Italy and Switzerland. Oral Oncol 40:904–909PubMedCrossRefGoogle Scholar
  41. 41.
    Dal Maso L, La Vecchia C, Polesel J et al (2002) Alcohol drinking outside meals and cancers of the upper aero-digestive tract. Int J Cancer 102:435–437PubMedCrossRefGoogle Scholar
  42. 42.
    Schlecht NF, Franco EL, Pintos J et al (1999) Interaction between tobacco and alcohol consumption and the risk of cancers of the upper aero-digestive tract in Brazil. Am J Epidemiol 150:1129–1137PubMedGoogle Scholar
  43. 43.
    McCann SE, Sempos C, Freudenheim JL et al (2003) Alcoholic beverage preference and characteristics of drinkers and nondrinkers in western New York (United States). Nutr Metab Cardiovasc Dis 13:2–11PubMedCrossRefGoogle Scholar
  44. 44.
    Barefoot JC, Gronbaek M, Feaganes JR, McPherson RS, Williams RB, Siegler IC (2002) Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study. Am J Clin Nutr 76:466–472PubMedGoogle Scholar
  45. 45.
    Merletti F, Boffetta P, Ciccone G, Mashberg A, Terracini B (1989) Role of tobacco and alcoholic beverages in the etiology of cancer of the oral cavity/oropharynx in Torino, Italy. Cancer Res 49:4919–4924PubMedGoogle Scholar
  46. 46.
    Franceschi S, Levi F, Dal Maso L et al (2000) Cessation of alcohol drinking and risk of cancer of the oral cavity and pharynx. Int J Cancer 85:787–790PubMedCrossRefGoogle Scholar
  47. 47.
    Day NE, Brown CC (1980) Multistage models and primary prevention of cancer. J Natl Cancer Inst 64:977–989PubMedGoogle Scholar
  48. 48.
    Holmes JD, Dierks EJ, Homer LD, Potter BE (2003) Is detection of oral and oropharyngeal squamous cancer by a dental health care provider associated with a lower stage at diagnosis? J Oral Maxillofac Surg 61:285–291PubMedCrossRefGoogle Scholar
  49. 49.
    Cowan CG, Gregg TA, Napier SS, McKenna SM, Kee F (2001) Potentially malignant oral lesions in northern Ireland: a 20-year population-based perspective of malignant transformation. Oral Dis 7:18–24PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Douglas E. Morse
    • 1
    Email author
  • Walter J. Psoter
    • 1
  • Deborah Cleveland
    • 2
  • Donald Cohen
    • 3
  • Mireseyed Mohit-Tabatabai
    • 4
  • Diane L. Kosis
    • 5
  • Ellen Eisenberg
    • 6
  1. 1.Department of Epidemiology & Health PromotionNew York University College of DentistryNew YorkUSA
  2. 2.Department of Diagnostic SciencesUniversity of Medicine and Dentistry of New JerseyNewarkUSA
  3. 3.Department of Oral and Maxillofacial Surgery and Diagnostic ServicesUniversity of Florida College of DentistryGainesvilleUSA
  4. 4.Department of Veterans AffairsNew Jersey Health Care System, Department of General SurgeryEast OrangeUSA
  5. 5.Formerly University of Connecticut School of Dental MedicineFarmingtonUSA
  6. 6.Department of Oral DiagnosisUniversity of Connecticut School of Dental MedicineFarmingtonUSA

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