Gender-related hormonal risk factors for oral cancer

Abstract

Oral cancer (OC) is a neoplasm with fairly high male to female ratio in most populations. The conspicuously lower incidence of this tumor among women than man is suggestive of certain endocrine involvement in its development. The aim of the present case-control study was to clarify the origin of this gender-specific risk of OC incidence. 2660 inpatients (530 females and 2130 males) with squamous cell OC at the Department of Oral and Maxillofacial Surgery were included in a case-control study. Smoking, alcohol consumption, elevated fasting serum glucose level and menopausal histories of female cases were registered. Smoking and excessive alcohol intake proved to be strong risk factors for OC both in the male and female group. However, moderate alcohol consumption was a weaker risk factor for male patients, and it presented no risk for female cases. Elevated fasting glucose level was not a demonstrable OC risk factor among males, however, it proved to be strong risk factor for OC among female patients, especially in gingival cancer cases. The almost exclusively postmenopausal state of female OC patients and the long mean interval (17 years) between their menopause and OC diagnosis suggested an important role of estrogen deficiency in OC epidemiology. The significantly younger mean age at menopause and the significantly higher rate of hysterectomy among female OC cases in comparison with their controls also support the estrogen deficiency hypothesis. This novel hypothesis of estrogen deficiency and elevated fasting glucose as risk factors for OC in postmenopausal women may provide new insights into the etiology of oral malignancies.

Oral squamous cell carcinoma in a South African sample: Race/ethnicity, age, gender, and degree of histopathological differentiation

“…This suggests that estrogen deficiency may play a role in the pathogenesis of OSCC in some women. [27] The results of this study support previous findings from South Africa [16,28] and from the USA [24] that there are significant differences between black and white persons with OSCC with regard to clinical, epidemiological, and histopathological features of the disease; that black persons are diagnosed with OSCC at a younger age than white persons; [28] and that OSCC affects black males, white males, white females, and black females in a declining order of frequency [ Table 1]. …”

Global Epidemiology of Head and Neck Cancers: A Continuing Challenge

“…The incidence rates for cancer of the lip, oral cavity and pharynx (C00-14, excluding C11) as well as the larynx (C32) are increasing among women globally, which could be due to access to better diagnostic aids or changes in the socially acceptable behaviour pattern among women in many other parts of the world such as India [32,33] . Apart from the traditional risk factors discussed above, it has been suggested that oestrogen deficiency may influence susceptibility to oral cancer (C00-06) in women; significantly younger mean age at menopause and higher rates of hysterectomy may influence the high rates of oral cancer reported among younger females [34] .…”

Identification of Tumor Cell- and Stroma Derived Biomarkers of Treatment Response in Head and Neck Cancer

“…Indeed, estrogen deficiency has been shown to increase the risk for oral cancer among women. 8,9 The typical HNSCC patient is a 65 year old male with low socioeconomic status and heavy alcohol and smoking habits. However, an alarming trend has been noticed the past years with an increasing number of individuals younger than 45 years of age developing HNSCC.…”

“…[14][15][16] This group calls for further studies but genetic susceptibility 17 and younger mean age at menopause, leading to estrogen deficiency, have been suggested as risk factors. 8,9 In recent years, the human papillomavirus (HPV) type 16 has been associated with cancer in the tonsils and base of tongue in a subset of younger patients with no other reported risk factors.…”