Women who eat less-healthy diets may have an increased risk of developing oral cavity cancer (OCC) affecting the lips, tongue, and mouth. Further, the risk was heightened among women who reported little or no alcohol or tobacco use, whereas no parallel risk increase was seen among men, according to a May 26 University of Washington (UW) Medicine news release.
“It seems that, globally for women, if you have a poor diet, you're at higher risk for getting oral cavity cancer. Counterintuitively, that risk increase appears higher for women who don’t smoke or drink alcohol,” said Dr. Brittany Barber, a head and neck surgeon and an associate professor at the UW School of Medicine, who is the lead author of the study published in the Journal of the Sciences and Specialties of the Head and Neck.
The prospective cohort study is the largest of its kind, using data from the Nurses’ Health Study, the Nurses’ Healthy Study II, and the Health Professionals Follow-up Study, for a total of nearly 211,00 individuals (162,602 women and 47,923 men) who did not have OCC at baseline. Two dietary patterns and a dietary measure were evaluated, specifically:
- The Western diet, a diet higher in red and processed meats, refined grains, and high-sugar beverages
- The prudent diet, which was higher in vegetables and fruit, legumes, fish, and whole grains
- The Alternative Healthy Eating Index-2019 diet (AHEI), a scoring tool that rated the quality of participants’ food intake
Dietary intake was evaluated every four years using validated food frequency questionnaires. After 30 years of follow-up, 226 OCC cancers were identified (124 in women, 102 in men).
Among the women, those with lower adherence to the prudent diet and ADEI dietary patterns had nearly twice the OCC risk (hazard ratio [HR] for lowest vs. highest quartile: 1.86; 95% confidence interval [CI]: 1.03 to 3.35; and HR: 2.17; 95% CI: 1.24 to 3.77, respectively). And for women who were nonsmokers or light smokers and nondrinkers or light drinkers, low adherence to the prudent diet had nearly three times the OCC risk as women with high adherence to the prudent diet (HR for lowest vs. highest quartile 2.94; 95% CI: 1.06 to 8.10).
No such association for men
But for the male participants, no such associations were observed, which surprised the researchers. Why? Because men “… typically eat more processed meats than women,” Barber added.
For women, the study’s findings suggest that diet may be an OCC risk factor independent of tobacco and alcohol consumption. The authors added, though, that “these results are best considered hypothesis-generating, underscoring the need for larger collaborative studies to confirm these findings and further elucidate the biological and behavioral mechanisms linking dietary quality to oral carcinogenesis.”
OCC prevalence is rare, the researchers noted, which during this study resulted in two additional OCC cases per 100,000 people -- a limitation the study’s authors acknowledged, which restricted the “statistical power” throughout the study, they wrote.
Takeaway for dental hygienists, clinicians
OCC is the sixth most common cancer globally. And OCC disproportionately strikes more men than women, with 1 in 59 men having a lifetime risk of developing OCC and 1 in 139 women developing OCC.
For dentists and dental hygienists, the study’s findings give food for thought for discussing a patient’s dietary history and touching on the importance of eating a well-balanced diet that emphasizes whole foods with patients, especially women patients who report no history of using alcohol or tobacco.
