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



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.

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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.

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Correspondence to Douglas E. Morse.

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Morse, D.E., Psoter, W.J., Cleveland, D. et al. Smoking and drinking in relation to oral cancer and oral epithelial dysplasia. Cancer Causes Control 18, 919–929 (2007).

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  • Tobacco smoking
  • Alcohol drinking
  • Oral cancer
  • Oral dysplasia
  • Mouth neoplasms