Oral cancer risk

Question 1

What areas are involved in oral cavity cancer

Answer 1

• lip
• gum
• floor of mouth
• palate
• anterior 2/3 of tongue

Question 2

What areas are involved with oropharyngeal cancer

Answer 2

• base of tongue
• lingual tonsil
• tonsil
• oropharynx
• pharynx
• waldeyer ring

Question 3

What factor of smoking has biggest impact for cancer risk

Answer 3

duration
* smoking less for longer is worse than smoking more for a shorter period of time

Question 4

What factor of alcohol has the biggest impact

Answer 4

• binge drinking worsens risk
• higher intake for short time > lower intake for longer time
  frequency

Question 5

What is the effect of smokeless tobacco on oral cancer risk

Answer 5

snuff = 3x risk
tobacco chewing = 2 x risk

Question 6

When do the benefits of quitting smoking emerge

Answer 6

• get immediate risk reduction within 1-4 years
• by 20+ years of quitting, risks come back to normal

Question 7

When do the benefits of quitting alcohol emerge

Answer 7

after 20y

Question 8

How much does a first degree relative having oral cancer increase your risk by

Answer 8

1.7x

Question 9

What are the genetic variations that may increase risk of OC

Answer 9

• alcohol metabolism - the alcohol dehydrogenase gene is effected and so alcohol metabolism is not normal
• nicotine metabolism and addiction - possible genetic link
• dna repair genes possibly effected

Question 10

What is the impact of diet/bmi on OC risk

Answer 10

• not major risk factor
• high intake of fruit slightly reduces risk
• high intake of red meat or processed meat slightly increases risk
• low BMI increased risk

Question 11

What is the impact of oral health and dental care on oral cancer risk

Answer 11

• poor dental care = 2x risk
• excessive mouthwash containing alcohol can hypothetically increase risk

Question 12

What is the impact of socioeconomic status on oral cancer risk

Answer 12

• 2.5x increased risk for low education and impacted
• 1/3 of these not explained by tobacco or alcohol
• risk is 1.61x in those who never drink or smoke

Question 13

What features of sexual history increase OC risk

Answer 13

> 6 or more sexual partners
4 or more lifetime oral sex partners
early age (<18) of sexual debut

Question 14

How much does HPV increase risk by

Answer 14

14.6 x

Question 15

What are the oncogenic types of HPV

Answer 15

16 18

Question 16

Which type of cancer is HPV implicated in

Answer 16

oropharyngeal

Question 17

What is the prevention strategy for OPC

Answer 17

• HPV driven
• vaccination - males and females
• safer sex

Question 18

What are possible ways to screen for OPC

Answer 18

HPV16 test
higher risk if you have the antibody
usually present 6 years before diagnosis

Question 19

What are the prevention principles of OCC

Answer 19

• oral health assessments
• teachable moments - OCC risk reduction
• signposting to specialist services
• tailored advice

Question 20

What are upstream factors that drive health inequality

Answer 20

affect patient behaviors such as smoking, poor nutrition, low physical activity, violence, alcohol and substance use, and sexual behavior

Question 21

What are downstream factors that drive health inequality

Answer 21

Further downstream are disease and injury such as communicable disease, chronic disease and intentional and unintentional injury.