Oral tongue squamous cell carcinomas in young patients according to their smoking status: a GETTEC study

Abstract

Background Incidence of oral tongue squamous cell carcinoma (OTSCC) is increasing, especially in young adults, despite decreasing tobacco and alcohol consumption. Methods This multicentric retrospective study of 185 young adults with OTSCC (median follow-up 43 months), investigated risk factors, tumour characteristics and oncological outcomes according to the smoking status. Results Overall, 38% of patients were smokers (S). Non-smokers (NS) were significantly younger than S. Sex ratios were 1.1 for N and 1.8 for S. NS patients were less frequently cannabis or alcohol users than S, but were more likely to have a history of leukoplakia. Second primaries were observed in NS (4.4%) and in S (12.7%). Despite more frequent local relapse in NS (p = 0.018), there was no difference in diagnostic stage and overall survival between groups. Conclusion OTSCC affects differently young S and NS patients suggesting the existence of a specific clinical entity of OTSCC in non-smoking young adults.

Oral cavity squamous cell carcinomas in patients with no identified risk factors: Feeling like an outsider

“…First, they perceived themselves as being different from the negative HNSCC stereotypes regarding the absence of an identified cause of the disease and their socio‐cultural status. While HNSCC patients with behavioural risk factors (alcohol consumption, smoking) are predominantly men, the sex ration tends to be different among NIRF with a much higher proportion of women (Deneuve et al, 2021; Ortholan et al, 2009). Given that the large majority of the participants in this study were women, we can assume that gender—along with behaviour (drinking, smoking)—also plays a role in this distancing process; this hypothesis should be the subject of further investigation.…”

“…This increase in incidence mainly affect younger patients with tongue cancers or older patients with gum cancers, who are more likely to be women (Kruse et al, 2010; Ng et al, 2017; Wiseman et al, 2003). Most of them do not present the traditional alcohol/tobacco risk factors (Deneuve et al, 2021; Ortholan et al, 2009). No consistent association with HPV (Nauta et al, 2021), herpes simplex virus (Sand & Jalouli, 2014) or Epstein–Barr virus (Sand & Jalouli, 2014) has been shown for OCSCC.…”

Influence of site and smoking on malignant transformation in the oral cavity: Is the microbiome the missing link?

“…Tobacco and alcohol are known to act synergistically, increasing the risk of oral cancer up to 15-fold, particularly in the floor of the mouth ( 18 , 20 ). However, up to 15% of OSCCs in older adults and up to 26% of OSCCs in younger adults have little to no exposure to tobacco or alcohol ( 21 , 22 ), with Deneuve et al also finding that their non-smoking tongue cancer cohort had a significantly higher prevalence of oral leukoplakia (OLK) than their smoking cohort ( 21 ). OLK is the most common OPMD with a global estimated incidence of 4.1% and malignant transformation rate of 9.8% ( 23 ).…”

Diverging incidence trends of oral tongue cancer compared to other head and neck cancers in young adults in France

“…This has been attributed to an increasing incidence of HPV related‐HNC and changes in tobacco and alcohol consumption 18 . Also, young adults with OTC in France have been reported to be mostly nonsmokers, and nonsmoking patients with OTC to be significantly younger than smokers with OTC 10 . However, little is known about the evolution of the incidence of OTC in young patients in this country.…”

“…Second, oral tongue cancer (OTC) has been described as increasing by several authors 4,7 especially among young White people 8 and more particularly among white women 7,9 . Although the medical literature provides no uniform definition for the upper age limit for young adults, studies usually chose 40 years as the threshold age 10 . Among these young patients with OTC, nonsmokers are more frequent than smokers, 11 and the attributable fraction of cigarette smoking as well as of alcohol drinking in young adults has been estimated to be lower than in older adults 12 .…”