By 1950, 50 per cent of people in industrialised countries smoked. It was an accepted behaviour, glamourised by film stars and the wealthy. Smoking is now one of the most preventable causes of illness and death in the world.
The UK plans to be ‘smoke-free’ by 2030 but researchers believe this target will be missed as one of the impacts of the pandemic was a growth in new smokers. Hospital admissions due to smoking increased by five per cent in 2023.
Smoking causes 25 per cent of mouth and oropharyngeal cancers. Acetone, tar, nicotine and carbon monoxide are some of the unsafe substances found in cigarettes – there are over 600 ingredients in a cigarette and at least 69 of these are carcinogenic. The intake of these into the mouth promotes the build-up of malignant cells, increasing the risk of cancer developing in the mouth or the back of the throat.
Oral cancer is common and aggressive. It has a high morbidity, mortality and recurrence rate across the world. In the UK, the number of people dying from oral cancer has increased every year since 2014. Identifying early stages of oral cancer can help reduce mortality and it is also vital to understand how smoking cessation can decrease the risk of developing it.
The risk among men
Oral cancer affects twice as many men as it does women. Furthermore, in the UK, men are 35 per cent more likely to die from cancer than women. When comparing only non-sex-specific cancers, like oral cancer, this grows to 67 per cent. The disproportionate number of male victims may be connected to the fact that more men smoke than women, with 14.6 per cent of the male population smoking against 11.2 per cent of the female population.
More worryingly, men are less likely than women to have a regular dental check-up and more likely to have never been to a dentist, meaning that there is a greater chance for oral cancer to develop undetected. Similarly, studies have noted that men seemingly go missing in global cancer policy as they are underrepresented and underfunded. Being the most susceptible demographic to oral cancer, it is crucial for practices to keep up patient recall for male patients, especially those over 40 and who may be known smokers.
Paying attention to the growing number of women, particularly among the middle-class, who have started smoking is just as important. There has been a 25 per cent jump in the last decade for young middle-class women smoking, with the pandemic years contributing to this. The long-term effects will soon start to materialise. Unlike lung cancer, no direct causality has been established between second-hand smoking and oral cancer.
The rise of vaping
The use of e-cigarettes in younger adults and teenagers has tripled in recent years. Marketed as a better alternative to smoking cigarettes, e-cigarettes, or vapes, are misconceived as being safe. The direct causality between e-cigarette use and oral cancer remains unclear because the long-term effects of vaping have yet to be fully realised and studied. Chemically analysed e-cigarettes have been found to contain organic compounds with the potential for carcinogenicity, but this has not led to a direct risk increase in oral cancer.
However, case reports of oral cancer in heavy e-cigarette users without other traditional risk factors, such as alcohol consumption and weakened immunity, do exist. E-cigarettes remain recommendable as a cessation aid as they are lower risk than the more damaging traditional cigarette. However, keeping updated on any breakthroughs regarding the long-term implications of e-cigarettes is imperative.
Finding oral cancer early
To fight oral cancer in its early stages, there is a need for early identification. This starts with making sure that all patients who are smokers are educated on the health impacts, are encouraged to quit, and maintain regular check-ups. Unusual lesions and symptoms such as sore throats and ear pain may give dentists grounds to suspect oral cancer.
Testing methods like tissue biopsies, CT scans, endoscopies and MRI scans have lengthy waiting times to confirm the results. Using a newly emerging and non-invasive pre-diagnostics test can efficiently test for cancer risks in patients to ensure this referral pathway is optimised.
The BeVigilant OraFusion System from Vigilant Biosciences offers the solution to more confident testing. It identifies the presence of biomarkers associated with oral cancer in 15 minutes or less. With or without symptoms you can use the system’s non-invasive saliva test to accurately report a low, moderate or elevated risk of oral cancer for that patient. The BeVigilant OraFusion will empower clinicians to make assured assessments and confident referrals for cancer tests.
The future of smoking in the UK is at a crossroads, with increases in some demographics offsetting the ‘smoke-free’ goal and the long-term impacts of e-cigarettes needing for more research. Staying alert and ensuring high-risk patients maintain regular check-ups is integral to battling oral cancer.
References available on request.
For more information visit www.vigilantbiosciences.com