Skip to main content

Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina

Abstract

Objectives

Oral squamous cell carcinoma (OSCC) is a multifactorial disease. The individual effect of each risk factor for OSCC may be conditioned by the frequency of other factors. The objective of this study was to identify the association between chronic mechanical irritation (CMI) and OSCC and to analyse the influence of CMI on other important risk factors for OSCC.

Materials and methods

A prospective and age/sex-matched case-control study was performed in two institutions from Argentina between 2009 and 2019, with consecutive and newly diagnosed OSCC. The frequencies of tobacco, alcohol, and CMI were analysed using conditional logistic regression. Cumulative tobacco consumption and the presence of CMI were analysed using the Mann-Whitney test.

Results

CMI and OSCC were associated with an OR of 7.02 (95% CI 3.57–13.78, p < 0.001). The combination of CMI and alcohol demonstrated the highest risk of OSCC (OR 53.83, CI 95% 8.04–360, p < 0.0001), followed by the combination of CMI, tobacco, and alcohol (OR 48.06, CI 95% 8.47–272, p < 0.0001). The combination of CMI and tobacco was also significant (OR 5.61, CI 95% 1.07–29.54, p = 0.042). Patients with CMI developed OSCC with less cumulative tobacco use compared with those without CMI.

Conclusion

CMI is an independent risk factor for OSCC, and it could act as a risk modifier among tobacco and alcohol users having an enhancing effect.

Clinical relevance

Elimination of CMI could decrease the risk of OSCC.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Hashibe M (2020) Risk factors for cancer of the mouth: tobacco, betel quid, and alcohol. In: Warnakulasuriya S, Greenspan JS (eds) In: Textbook on Oral Cancer. Springer Nature, Switzerland, pp 23–30. https://doi.org/10.1007/978-3-030-32316-5_3

    Chapter  Google Scholar 

  2. Kreimer AR, Clifford GM, Boyle P, Franceschi S (2005) Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomark Prev 14:467–475. https://doi.org/10.1158/1055-9965.EPI-04-0551

    Article  Google Scholar 

  3. Warnakulasuriya S (2020) Controversial factors on causation of oral cancer. In: Warnakulasuriya S, Greenspan JS (eds) In; Textbook on Oral Cancer. Springer Nature, Switzerland, pp 439–446. https://doi.org/10.1007/978-3-030-32316-5_31

    Chapter  Google Scholar 

  4. Martin HE, Munster H, Sugarbaker ED (1940) Cancer of the Tongue. Arch Surg 41:888–936. https://doi.org/10.1001/archsurg.1940.01210040077005

    Article  Google Scholar 

  5. Piemonte ED, Lazos JP, Brunotto M (2010) Relationship between chronic trauma of the oral mucosa, oral potentially malignant disorders and oral cancer. J Oral Pathol Med 39:513–517. https://doi.org/10.1111/j.1600-0714.2010.00901.x

    Article  PubMed  Google Scholar 

  6. Pérez MA, Raimondi AR, Itoiz ME (2005) An experimental model to demonstrate the carcinogenic action of oral chronic traumatic ulcer. J Oral Pathol Med 34:17–22. https://doi.org/10.1111/j.1600-0714.2004.00249.x

    Article  PubMed  Google Scholar 

  7. Manoharan S, Nagaraja V, Eslick GD (2014) Ill-fitting dentures and oral cancer: a meta-analysis. Oral Oncol 50:1058–1061. https://doi.org/10.1016/j.oraloncology.2014.08.002

    Article  PubMed  Google Scholar 

  8. Singhvi HR, Malik A, Chaturvedi P (2017) The role of chronic mucosal trauma in oral cancer: a review of literature. Indian J Med Paediatr Oncol 38:44–50. https://doi.org/10.4103/0971-5851.203510

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gupta AA, Kheur S, Varadarajan S et al (2021) Chronic mechanical irritation and oral squamous cell carcinoma: a systematic review and meta-analysis. Bosn J Basic Med Sci. https://doi.org/10.17305/bjbms.2021.5577

  10. Pentenero M, Azzi L, Lodi G et al (2021) Chronic mechanical trauma/irritation and oral carcinoma: a systematic review showing low evidence to support an association. Oral Dis. https://doi.org/10.1111/odi.14049

  11. Piemonte ED, Lazos J (2018) Evidence for chronic mechanical irritation as a causative factor in oral cancer: application of Bradford Hill criteria. Transl Res Oral Oncol 3:2057178X18791034. https://doi.org/10.1177/2057178X18791034

    Article  Google Scholar 

  12. Di Credico G, Edefonti V, Polesel J et al (2019) Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: a bivariate spline model approach. Oral Oncol 94:47–57. https://doi.org/10.1016/j.oraloncology.2019.05.006

    Article  PubMed  PubMed Central  Google Scholar 

  13. Vineis P, Kriebel D (2006) Causal models in epidemiology: past inheritance and genetic future. Environ Health Glob Access Sci Source 5:21. https://doi.org/10.1186/1476-069X-5-21

    Article  Google Scholar 

  14. Lissoni A, Agliardi E, Peri A et al (2020) Oral microbiome and mucosal trauma as risk factors for oral cancer: beyond alcohol and tobacco. A literature review. J Biol Regul Homeost Agents 34:11–18

    PubMed  Google Scholar 

  15. Piemonte E, Lazos J, Belardinelli P et al (2018) Oral cancer associated with chronic mechanical irritation of the oral mucosa. Med Oral Patol Oral Cir Bucal 23:e151–e160. https://doi.org/10.4317/medoral.22017

    Article  PubMed  PubMed Central  Google Scholar 

  16. Velly AM, Franco EL, Schlecht N et al (1998) Relationship between dental factors and risk of upper aerodigestive tract cancer. Oral Oncol 34:284–291

    Article  Google Scholar 

  17. Lockhart PB, Norris CM, Pulliam C (1998) Dental factors in the genesis of squamous cell carcinoma of the oral cavity. Oral Oncol 34:133–139. https://doi.org/10.1016/s1368-8375(97)00086-9

    Article  PubMed  Google Scholar 

  18. Rosenquist K, Wennerberg J, Schildt E-B et al (2005) Oral status, oral infections and some lifestyle factors as risk factors for oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden. Acta Otolaryngol (Stockh) 125:1327–1336. https://doi.org/10.1080/00016480510012273

    Article  Google Scholar 

  19. Vaccarezza GF, Antunes JLF, Michaluart-Júnior P (2010) Recurrent sores by ill-fitting dentures and intra-oral squamous cell carcinoma in smokers. J Public Health Dent 70:52–57. https://doi.org/10.1111/j.1752-7325.2009.00143.x

    Article  PubMed  Google Scholar 

  20. Bektas-Kayhan K, Karagoz G, Kesimli MC et al (2014) Carcinoma of the tongue: a case-control study on etiologic factors and dental trauma. Asian Pac J Cancer Prev 15:2225–2229. https://doi.org/10.7314/apjcp.2014.15.5.2225

    Article  PubMed  Google Scholar 

  21. Huang J, He B, Chen F et al (2015) Association between oral hygiene, chronic diseases, and oral squamous cell carcinoma. Zhonghua Yu Fang Yi Xue Za Zhi 49:688–692

    PubMed  Google Scholar 

  22. Li S, Lee YA, Li Q et al (2015) Oral lesions, chronic diseases and the risk of head and neck cancer. Oral Oncol 51:1082–1087. https://doi.org/10.1016/j.oraloncology.2015.10.014

    Article  PubMed  Google Scholar 

  23. Chen F, Lin L, Yan L et al (2018) Nomograms and risk scores for predicting the risk of oral cancer in different sexes: a large-scale case-control study. J Cancer 9:2543–2548. https://doi.org/10.7150/jca.24431

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hashim D, Sartori S, Brennan P et al (2016) The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol 27:1619–1625. https://doi.org/10.1093/annonc/mdw224

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gilligan GM, Costa MFFG, Moine L et al (2017) Could chronic mechanical irritation facilitate entry of human papillomavirus (HPV) facilitating oral HPV infection? Transl Res Oral Oncol 2:2057178X17746799. https://doi.org/10.1177/2057178X17746799

    Article  Google Scholar 

  26. Gopinath D, Kunnath Menon R, Veettil K, George S et al (2020) Periodontal diseases as putative risk factors for head and neck cancer: systematic review and meta-analysis. Cancers 12:1893. https://doi.org/10.3390/cancers12071893

    Article  PubMed Central  Google Scholar 

  27. Herrera-Serna BY, Lara-Carrillo E, Toral-Rizo VH, do Amaral RC (2020) Efecto de las políticas de control de factores de riesgo sobre la mortalidad por cáncer oral en América Latina. Rev Esp Salud Pública 93:e201907050

    Google Scholar 

  28. Serna BYH, Lara-Carrillo E, Toral-Rizo VH, do Amaral RC (2020) Comparación entre incidencia y factores de riesgo de cáncer oral en diferentes países de América Latina. Rev Salud Pública 24:49–63. https://doi.org/10.31052/1853.1180.v24.n2.24336

    Article  Google Scholar 

  29. Fishbein A, Hammock BD, Serhan CN, Panigrahy D (2021) Carcinogenesis: failure of resolution of inflammation? Pharmacol Ther 218:107670. https://doi.org/10.1016/j.pharmthera.2020.107670

    Article  PubMed  Google Scholar 

  30. Chuang S-L, Wang C-P, Chen M-K et al (2018) Malignant transformation to oral cancer by subtype of oral potentially malignant disorder: a prospective cohort study of Taiwanese nationwide oral cancer screening program. Oral Oncol 87:58–63. https://doi.org/10.1016/j.oraloncology.2018.10.021

    Article  PubMed  Google Scholar 

  31. Speight PM, Khurram SA, Kujan O (2018) Oral potentially malignant disorders: risk of progression to malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol 125:612–627. https://doi.org/10.1016/j.oooo.2017.12.011

    Article  PubMed  Google Scholar 

  32. Gasparoni L-M, Alves F-A, Holzhausen M et al (2020) Periodontitis as a risk factor for head and neck cancer. Med Oral Patol Oral Cir Bucal. https://doi.org/10.4317/medoral.24270

  33. Warnakulasuriya S, Diz-Dios P, Lanfranchi H et al (2016) Understanding gaps in the oral cancer continuum and developing strategies to improve outcomes. The Global Oral Cancer Forum, New York 2016. http://www.globaloralcancerforum.org/img/White-Paper-Group-2.pdf.php. Accessed 28 Feb 2021

Download references

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: EDP and SW. Methodology: EDP and SW. Formal analysis and investigation: EDP, JPL, GMG, RLP, LCW, Y-HY, and SW. Writing — original draft preparation: EDP, JPL, GMG, and SW. Writing — review and editing: EDP, JPL, GMG, RLP, LCW, Y-HY, and SW. Funding acquisition: EDP and GMG. Resources: EDP, JPL, and GMG. Supervision: SW.

Corresponding author

Correspondence to Eduardo David Piemonte.

Ethics declarations

Ethics approval

This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Council of Ethical Evaluation of Health Research under the Ministry of Health of the Province of Córdoba (N° 1378), by the Institutional Committee of Ethics in Health Research of the Faculty of Dentistry of the University of Córdoba (11T/2016), and by the Research Ethics Committee of the Hospital Alemán, Buenos Aires, Argentina (registration code 3674).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Piemonte, E.D., Lazos, J.P., Gilligan, G.M. et al. Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina. Clin Oral Invest (2022). https://doi.org/10.1007/s00784-022-04584-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00784-022-04584-w

Keywords

  • Tobacco
  • Alcohol
  • Chronic mechanical irritation
  • Oral squamous cell carcinoma
  • Risk factors
  • Case-control study