Definite risks for mouth and oropharyngeal cancer
This page is about the factors that are known to play a part in causing mouth and oropharyngeal cancers. There is information below about
Definite risks for mouth and oropharyngeal cancer
Cancers of the mouth and oropharynx are relatively rare. They are more common in older people and in men but the number of young and middle aged people developing them is increasing. We don’t know exactly what causes them, but we do know that several things affect your risk.
Main risk factors
Smoking tobacco (cigarettes, cigars and pipes) and drinking a lot of alcohol are the main risk factors for mouth and oropharyngeal cancers in the western world. Mouth cancer is much more common in parts of the world where people chew tobacco or betel quid (gutkha) with tobacco (also called paan).
Other risk factors
Poor diet is common in heavy drinkers and may increase mouth cancer risk. Other factors include human papilloma virus (HPV) infection and sun exposure. People who have had previous mouth or squamous cell skin cancers are more at risk. Women who have had cervical, anal or genital cancers and men who have had cancer of the back passage (rectum) are also at higher than average risk.
About 1 in 3 people diagnosed with lip cancer work outdoors and so have been exposed to the sun for long periods of time.
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Cancers of the mouth and oropharynx are relatively rare. Including cancers of the lip, tongue, mouth and oropharynx, there are about 6,500 people diagnosed in the UK each year. Overall, about 2 out of every 100 cancers diagnosed (2%) are mouth or oropharynx cancers.
As with most cancers, mouth and oropharyngeal cancers are more common in older people. There are few cases in people under 50 but the number of young and middle aged people developing them is increasing. They are twice as common in men than in women. But rates of these cancers in women have been increasing in recent years. This is because women took up smoking in large numbers much later than men and we are now seeing the delayed effects of that.
Smoking tobacco (cigarettes, cigars and pipes) and drinking a lot of alcohol are the main risk factors for mouth and oropharyngeal cancers in the western world. If you smoke you are at a higher than average risk of developing these types of cancers. A study in 2011 estimated that more than half of mouth and throat cancers in the UK are caused by smoking. Pipe smokers or people who hold the cigarette for a long time on the lip have an increased risk of cancer of the lip. People exposed to secondhand smoke at home or in the workplace have a small increase in their risk of mouth or oropharyngeal cancer.
Smokeless tobacco can also increase cancer risk and may not be a safe alternative to cigarettes. The amount of risk varies according to the type of smokeless tobacco used in different countries. In the UK and Europe (except for Sweden) smokeless tobacco is rarely used except in minority ethnic groups.
Drinking alcohol increases the risk of oropharyngeal cancer and may increase mouth cancer risk when combined with smoking. A large Cancer Research UK study looking at lifestyle factors that cause cancer found that about a third of cancers of the mouth and throat (30%) were caused by drinking alcohol. Current guidelines in the UK suggest that people should drink no more than 21 units of alcohol per week for men, and 14 units per week for women.
Cigarettes and alcohol contain nitrosamines and other chemicals that are known to cause cancer. The nitrosamines in alcohol pass over the mouth, throat and top of the larynx (the epiglottis) as you swallow. When you smoke, the smoke passes through your mouth, throat and the larynx on its way to your lungs. Your risk increases the longer you smoke.
Remember that if you smoke, you are much more likely to develop cancer of the mouth or oropharynx. If you smoke and regularly drink more than the recommended amounts your risk is especially high. Cancers of the mouth or oropharynx do sometimes occur in people who have never smoked or drunk much but this is rare.
Chewing tobacco or betel quid (gutkha) is known to cause mouth cancer and oropharyngeal cancer. It is very common in parts of Asia. It is also popular in some immigrant groups in Europe, North America and Australia.
The term quid means a substance or mixture of substances put in the mouth and chewed, usually for long periods. It usually contains tobacco, either on its own or mixed with areca nut (from the Areca catechu tree) and slaked lime and sometimes spices. You wrap the mixture in a leaf called a betel leaf, which is where the name betel quid (also called paan) comes from.
The harmful substances in tobacco and betel quid can cause cancer if they are in contact with your gums and tongue over long periods. Chewing betel quid without tobacco increases the risk of mouth cancer but chewing mixtures containing tobacco increases the risk even more.
People chew tobacco and betel quid for many reasons. It can make you feel good, prevent hunger and sweeten your breath. But more important is that it is a cultural and social habit in many parts of Asia. Mouth cancer is much more common in parts of the world where people chew betel quid. Of the estimated 400,000 cases of oral cancer worldwide each year, around two thirds occur in developing countries. In some parts of India, it is the most common type of cancer.
A poor diet may increase your risk of certain types of mouth and oropharyngeal cancer. This may be due to a lack of zinc, or other vitamins and minerals. If you eat a well balanced diet, with plenty of protein, you are unlikely to be short of zinc.
A diet high in fresh fruit and vegetables seems to reduce the risk of developing cancer of the mouth. This may be because these foods contain a lot of antioxidant vitamins and other substances that help prevent damage to body cells.
Vitamin A deficiency increases your risk of developing cancer of the mouth and oropharynx. Poor eating patterns are common in people who drink a lot of alcohol. Poor diet in people who drink heavily may help to explain why alcohol increases the risk of some cancers.
Viruses can help to cause some cancers. But this doesn't mean that you can catch these cancers like an infection. The virus can cause genetic changes in cells that make them more likely to become cancerous in the future.
Mouth and oropharyngeal cancers have been linked to the human papilloma virus (HPV), especially type 16. There are more than 100 different types of (HPV). Some types are called the wart virus, because they cause warts on the genital area or skin. Other types of HPV are known to increase the risk of some types of cancer. These include cancer of the cervix, vaginal cancer, vulval cancer and anal cancer.
HPV can be passed on during sexual contact. Most sexually active adults will be infected with at least one type of HPV at some time during their life. For many people, the virus causes no harm and goes away without treatment. Only a very small percentage of people with HPV develop oropharyngeal cancer. HPV infection of the mouth is more common in men than in women. The risk of HPV infection in the mouth and throat is linked to certain sexual behaviours, such as open mouth kissing and oral sex. The risk increases with the number of sexual partners a person has. Smoking also increases the risk of HPV infection in the mouth.
Research has found that people have an increased risk of mouth cancer if they have a reduced immunity due to HIV or AIDS. Taking medicines to suppress immunity after organ transplants also gives a higher risk of mouth cancer than in the general population.
Skin cancers are relatively common on the face and neck, as these areas are often exposed to ultraviolet light (UV). Both the sun and tanning beds give off UV rays. These rays can cause skin cancers in unprotected skin. Some studies have shown an increase of skin cancer in people who regularly use sunbeds. Melanoma is the most serious type of skin cancer and can occur on the lip. More than 30 out of every 100 people (30%) diagnosed with cancer of the lip work outdoors and have been exposed to the sun for long periods.
People who have had mouth or oropharyngeal cancer have an increased risk of getting a second one. Women have a higher risk of a second oral cancer than men.
People who have had some other types of cancer also have an increased risk of mouth cancer. These include
- Cancer of the food pipe (oesophagus)
- Squamous cell skin cancer
- Cervical, anal or genital cancer in women
- Cancer of the back passage (rectum) in men
People often worry that they are at a higher risk of cancer because someone in their family has it. There does seem to be a slightly higher risk of getting mouth cancer if you have a close relative (a parent, brother, sister or child) who has had mouth cancer. We don't know the reason for this.
Sometimes changes can happen in the cells of the lining of the mouth and they cause red or white patches to appear. These changes are called leukoplakia and erythroplakia. In some people these changes may develop into cancer over some years. Dentists can see these changes during dental checks so it is important to have regular dental appointments to find these changes early.
People with certain syndromes caused by inherited changes (mutations) in particular genes have a high risk of mouth and throat cancer. These include
- Fanconi anaemia – a genetic disorder that can affect children and adults from any ethnic background. It is also called Fanconi's syndrome. People with Fanconi anaemia are short, have bone changes, and are at risk of developing cancers, leukaemia, and bone marrow failure (aplastic anemia)
- Dyskeratosis congenita – a genetic syndrome that can cause aplastic anaemia, skin rashes, and abnormally shaped fingernails and toenails. People with this syndrome have a high risk of developing cancer of the mouth and throat when they are young
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