Non-Cochrane · aetiology · PM42174468
Evaluation of dose-response relationships between smoking tobacco, alcohol consumption and oral cancer: a systematic review and meta-analysis.
Aswathi G, Carvalho Andre, Palaniraja Sathishrajaa, et al. · BMC public health · 2026 · PubMed · doi:10.1186/s12889-026-27796-1
Findings
Population People in observational studies of oral cancer; current or combined current/ever users of the exposure
26 findings
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 10 units/day | RR 2.19 [1.75, 2.74] GRADE not reported 27 studies |
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 20 units/day | RR 4.54 [2.74, 7.54] GRADE not reported 27 studies |
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 30 units/day | RR 5.98 [3.37, 10.60] GRADE not reported 27 studies |
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 50 units/day | RR 3.84 [2.41, 6.13] GRADE not reported 27 studies |
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 40 units/day | RR 4.98 [3.49, 7.13] GRADE not reported 27 studies |
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 5 units/day | RR 1.46 [1.01, 2.10] GRADE not reported 27 studies |
| Smoking frequency (units of tobacco smoked per day) | Never users (reference) | Oral cancer risk Exposure level: 0 units/day | RR 0.97 [0.53, 1.60] GRADE not reported 27 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 30 years | RR 2.11 [1.60, 2.79] GRADE not reported 22 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 40 years | RR 2.19 [1.48, 3.23] GRADE not reported 22 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 50 years | RR 2.16 [0.79, 5.90] GRADE not reported 22 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 0 years | RR 0.47 [0.26, 0.84] GRADE not reported 22 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 5 years | RR 0.64 [0.44, 0.94] GRADE not reported 22 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 20 years | RR 1.56 [1.08, 2.25] GRADE not reported 22 studies |
| Smoking duration (years) | Never users (reference) | Oral cancer risk Exposure level: 10 years | RR 0.88 [0.69, 1.12] GRADE not reported 22 studies |
| Duration of alcohol consumption (years) | Never drinkers (reference) | Oral cancer risk Exposure level: 30 years | RR 2.31 [1.80, 2.96] GRADE not reported 11 studies |
| Duration of alcohol consumption (years) | Never drinkers (reference) | Oral cancer risk Exposure level: 40 years | RR 2.67 [1.97, 3.63] GRADE not reported 11 studies |
| Duration of alcohol consumption (years) | Never drinkers (reference) | Oral cancer risk Exposure level: 10 years | RR 2.01 [1.56, 2.58] GRADE not reported 11 studies |
| Duration of alcohol consumption (years) | Never drinkers (reference) | Oral cancer risk Exposure level: 50 years | RR 3.13 [1.40, 6.97] GRADE not reported 11 studies |
| Duration of alcohol consumption (years) | Never drinkers (reference) | Oral cancer risk Exposure level: 0 years | RR 1.94 [1.04, 3.62] GRADE not reported 11 studies |
| Duration of alcohol consumption (years) | Never drinkers (reference) | Oral cancer risk Exposure level: 20 years | RR 2.10 [1.56, 2.81] GRADE not reported 11 studies |
| Age at smoking initiation (years) | Never users (reference) | Oral cancer risk Exposure level: age 20 years | RR 0.82 [0.11, 6.01] GRADE not reported 11 studies |
| Age at smoking initiation (years) | Never users (reference) | Oral cancer risk Exposure level: age 25 years | RR 0.51 [0.03, 8.68] GRADE not reported 11 studies |
| Age at smoking initiation (years) | Never users (reference) | Oral cancer risk Exposure level: age 15 years | RR 1.37 [0.45, 4.16] GRADE not reported 11 studies |
| Age at smoking initiation (years) | Never users (reference) | Oral cancer risk Exposure level: age 40 years | RR 0.53 [0.02, 9.63] GRADE not reported 11 studies |
| Age at smoking initiation (years) | Never users (reference) | Oral cancer risk Exposure level: age 35 years | RR 0.46 [0.02, 10.02] GRADE not reported 11 studies |
| Age at smoking initiation (years) | Never users (reference) | Oral cancer risk Exposure level: age 30 years | RR 0.42 [0.01, 10.28] GRADE not reported 11 studies |
Included primary studies 68
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Edirisinghe et al., 2023 [Analysis of the nucleotide sequence of DNA]. PMID:202344 | 1977 | 2 other reviews | not stated | not extracted yet |
| Fu et al., 2013 Hydrolysis of triphosphoinositides in developing central and peripheral nervous systems of the chicken. PMID:201341 | 1977 | 2 other reviews | not stated | not extracted yet |
| Amtha et al., 2014 [Gonadotropin receptors]. PMID:201442 | 1977 | 1 other review | not stated | not extracted yet |
| C J 2018 Possibility of EB virus preferentially transforming a subpopulation of human B lymphocytes. PMID:201868 | 1977 | 1 other review | Oral cancer risk | not extracted yet |
| Castellsague et al., 2004 Regulation of noradrenaline release in the rat pineal through a negative feedback mechanism mediated by presynaptic alpha-adrenoceptors. PMID:200438 | 1977 | 1 other review | not stated | not extracted yet |
| De Stefani et al., 2007 Microwave fixation of brain tissue as a neurochemical technique- a review. PMID:200753 | 1977 | 1 other review | not stated | not extracted yet |
| Gholap et al., 2023 An EEG sleep study of a bipolar (manic-depressive) patient with a nocturnal switch process. PMID:202345 | 1977 | 1 other review | not stated | not extracted yet |
| Sankarnarayanan et al., 1990 Adenosine in rat cerebral cortex: its determination, normal values, and correlation to AMP and cyclic AMP during shortlasting ischemia. PMID:199047 | 1977 | 1 other review | not stated | not extracted yet |
| Siddiqui et al., 2024 Changes in enzyme activities during the artificially stimulated transition from follicular to luteal cell types in rat ovary. PMID:202454 | 1977 | 1 other review | not stated | not extracted yet |
| Zheng et al., 1997 Herpes simplex virus DNA polymerase as the site of phosphonoacetate sensitivity: temperature-sensitive mutants. PMID:199734 | 1977 | 1 other review | not stated | not extracted yet |
| Amtha 2014 Tobacco (kretek) smoking, betel quid chewing and risk of oral cancer in a selected Jakarta population. PMID:25374188 | 2014 | this review only | Oral cancer risk | not extracted yet |
| Balaram 2002 Oral cancer in southern India: the influence of smoking, drinking, paan-chewing and oral hygiene. PMID:11920597 | 2002 | this review only | Oral cancer risk | not extracted yet |
| Balaram et al., 2002 Reduced nuclear triiodothyronine receptors in starvation-induced hypothyroidism. PMID:200237 | 1977 | this review only | not stated | not extracted yet |
| Bundgaard 1995 Case-control study of squamous cell cancer of the oral cavity in Denmark. PMID:7718736 | 1995 | this review only | Oral cancer risk | not extracted yet |
| Bundgard et al., 1995 [The mechanism of action of histamine on the myocardium and the smooth vascular muscles]. PMID:199533 | 1977 | this review only | not stated | not extracted yet |
| C. J et al., 2018 Increased growth after long-term oral 1alpha,25-vitamin D3 in childhood renal osteodystrophy. PMID:201843 | 1978 | this review only | not stated | not extracted yet |
| Castellsague 2004 The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis. PMID:14696101 | 2004 | this review only | Oral cancer risk | not extracted yet |
| Day 1993 Racial differences in risk of oral and pharyngeal cancer: alcohol, tobacco, and other determinants. PMID:8445674 | 1993 | this review only | Oral cancer risk | not extracted yet |
| Day et al., 1993 Calcitonin heterogeneity: in vivo and in vitro studies. PMID:199331 | 1977 | this review only | not stated | not extracted yet |
| De Stefani 1998 Smoking patterns and cancer of the oral cavity and pharynx: a case-control study in Uruguay. PMID:9861338 | 1998 | this review only | Oral cancer risk | not extracted yet |
| De Stefani 2007 The effect of smoking and drinking in oral and pharyngeal cancers: a case-control study in Uruguay. PMID:16624486 | 2007 | this review only | Oral cancer risk | not extracted yet |
| De Stefani et al., 1998 Augmentation of PGE1 sensitivity in macrophages by concanavalin A. PMID:199835 | 1977 | this review only | not stated | not extracted yet |
| Dikshit 2000 Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer: a population-based case-control study in Bhopal, India. PMID:10922335 | 2000 | this review only | Oral cancer risk | not extracted yet |
| Dikshit et al., 2000 Calcium ion control of cyclic nucleotide phosphodiesterase and its activating factor in human platelets. PMID:200050 | 1977 | this review only | not stated | not extracted yet |
| Edirisinghe 2023 Risk Assessment of Alcohol Consumption for Oral Cancer: A Case-Control Study in Patients Attending the National Cancer Institute (Apeksha… PMID:37116139 | 2023 | this review only | Oral cancer risk | not extracted yet |
| Evstifeeva 1992 Nass use, cigarette smoking, alcohol consumption and risk of oral and oesophageal precancer. PMID:1422467 | 1992 | this review only | Oral cancer risk | not extracted yet |
| Evstifeeva et al., 1992 Regulation of DNA chain elongation in SV3T3 cells in relation to growth rate. PMID:199257 | 1977 | this review only | not stated | not extracted yet |
| Franceschi 1990 Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. PMID:2208109 | 1990 | this review only | Oral cancer risk | not extracted yet |
| Franceschi et al., 1990 [The liver and oral contraceptives]. PMID:199028 | 1977 | this review only | not stated | not extracted yet |
| Fu 2013 Role of cigarette filter on the risk of oral cancer: a case-control study in a Chinese population. PMID:22779984 | 2013 | this review only | Oral cancer risk | not extracted yet |
| Gholap 2023 Exclusive use of different types of tobacco products, exposure to secondhand tobacco smoke and risk of subtypes of head and neck cancer… PMID:36054453 | 2023 | this review only | Oral cancer risk | not extracted yet |
| Guneri 2005 Primary oral cancer in a Turkish population sample: association with sociodemographic features, smoking, alcohol, diet and dentition. PMID:16139559 | 2005 | this review only | Oral cancer risk | not extracted yet |
| Guneri et al., 2005 Prevalence of cytomegalovirus antibody in young children in Vellore. PMID:200552 | 1977 | this review only | not stated | not extracted yet |
| Hayes 1999 Tobacco and alcohol use and oral cancer in Puerto Rico. PMID:10334639 | 1999 | this review only | Oral cancer risk | not extracted yet |
| Hayes et al., 1999 [Bifocal bronchial granulocellular myoblastoma (Abrikosov's tumor)]. PMID:199936 | 1977 | this review only | not stated | not extracted yet |
| Idris 1995 Toombak dipping and cancer of the oral cavity in the Sudan: a case-control study. PMID:7591252 | 1995 | this review only | Oral cancer risk | not extracted yet |
| Idris et al., 1995 Development of a congeneic line of the GR mouse strain without early mammary tumours. PMID:199548 | 1977 | this review only | not stated | not extracted yet |
| Jayalekshmi 2011 Oral cavity cancer risk in relation to tobacco chewing and bidi smoking among men in Karunagappally, Kerala, India: Karunagappally cohort… PMID:21129124 | 2011 | this review only | Oral cancer risk | not extracted yet |
| Jayalekshmi et al., 2011 Immunhistological observations on the "hypophysiotrophic" area of the hypothalamus. PMID:201155 | 1976 | this review only | not stated | not extracted yet |
| Kabat 1994 The role of tobacco, alcohol use, and body mass index in oral and pharyngeal cancer. PMID:7721514 | 1994 | this review only | Oral cancer risk | not extracted yet |
| Kabat et al., 1994 Protein kinases and proteins binding adenosine 3':5'-monophosphate in subcellular fractions of calf ovaries. Effect of trypsin and… PMID:199432 | 1977 | this review only | not stated | not extracted yet |
| Llewellyn 2004 An analysis of risk factors for oral cancer in young people: a case-control study. PMID:14747062 | 2004 | this review only | Oral cancer risk | not extracted yet |
| Llewellyn et al., 2004 Properties of the peripheral opiate receptors in the cat nictitating membrane. PMID:200439 | 1977 | this review only | not stated | not extracted yet |
| Maasland 2014 Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study. PMID:24629046 | 2014 | this review only | Oral cancer risk | not extracted yet |
| Maasland et al., 2014 Theophylline stimulation of binding of radioiodinated rat prolactin to murine mammary gland. PMID:201456 | 1977 | this review only | not stated | not extracted yet |
| Mashberg 1981 Alcohol as a primary risk factor in oral squamous carcinoma. PMID:6784891 | 1981 | this review only | Oral cancer risk | not extracted yet |
| Mashberg 1993 Tobacco smoking, alcohol drinking, and cancer of the oral cavity and oropharynx among U.S. veterans. PMID:8339227 | 1993 | this review only | Oral cancer risk | not extracted yet |
| Mashberg et al., 1981 Increased cyclic nucleotide phosphodiesterase activity associated with proliferation and cancer in human and murine lymphoid cells. PMID:198126 | 1977 | this review only | not stated | not extracted yet |
| Mashberg et al., 1993 25-Hydroxyvitamin D3 regulation. PMID:199330 | 1977 | this review only | not stated | not extracted yet |
| Moreno-Lopez 2000 Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain. PMID:10745168 | 2000 | this review only | Oral cancer risk | not extracted yet |
| Morenzo-Lopez et al., 2000 An autopsy case of agnogenic myeloid metaplasia complicated by hepatic cell carcinoma. PMID:200049 | 1977 | this review only | not stated | not extracted yet |
| Muwonge 2008 Role of tobacco smoking, chewing and alcohol drinking in the risk of oral cancer in Trivandrum, India: a nested case-control design using… PMID:17933578 | 2008 | this review only | Oral cancer risk | not extracted yet |
| Muwonge et al., 2008 Effects of cholera toxin on supersensitive and subsensitive rat pineal glands: regulation of sensitivity at multiple sites. PMID:200812 | 1977 | this review only | not stated | not extracted yet |
| Nandakumar 1990 A population-based case-control investigation on cancers of the oral cavity in Bangalore, India. PMID:2245179 | 1990 | this review only | Oral cancer risk | not extracted yet |
| Nandakumar et al., 1990 Herpes simplex virus-IgM specific antibodies in Guillain-Barré syndrome and encephalitis. PMID:199029 | 1977 | this review only | not stated | not extracted yet |
| Polesel 2008 Tobacco smoking and the risk of upper aero-digestive tract cancers: A reanalysis of case-control studies using spline models. PMID:18224689 | 2008 | this review only | Oral cancer risk | not extracted yet |
| Polosel et al., 2008 [Operative possibilities for tumors in single kidneys with particular reference to in situ perfusion (author's transl)]. PMID:200840 | 1977 | this review only | not stated | not extracted yet |
| Sankaranarayanan 1989 (1) Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India. PMID:2803939 | 1989 | this review only | Oral cancer risk | not extracted yet |
| Sankaranarayanan 1989 (2) A case-control investigation of cancer of the oral tongue and the floor of the mouth in southern India. PMID:2793234 | 1989 | this review only | Oral cancer risk | not extracted yet |
| Sankaranarayanan 1990 Risk factors for cancer of the buccal and labial mucosa in Kerala, southern India. PMID:2277249 | 1990 | this review only | Oral cancer risk | not extracted yet |
| Sankarnarayanan et al., 1989 Improved results with combined donor-specific transfusion (DST) and sequential therapy protocol. PMID:1989146 | 1991 | this review only | not stated | not extracted yet |
| Sankarnarayanan et al., 1989 The fate of paired kidneys: recipient immunologic risk factors profoundly influence immediate posttransplant renal function. PMID:1989227 | 1991 | this review only | not stated | not extracted yet |
| Siddiqui 2024 matched by author and year (probable) | NR | this review only | Oral cancer risk | not extracted yet |
| Winn 1981 Snuff dipping and oral cancer among women in the southern United States. PMID:7193288 | 1981 | this review only | Oral cancer risk | not extracted yet |
| Winn et al., 1981 Inhibition of normal lymphocyte mitogenic reactivity by serum from feline leukemia virus-infected cats. PMID:198125 | 1977 | this review only | not stated | not extracted yet |
| Zheng 1997 Risk of tongue cancer associated with tobacco smoking and alcohol consumption: a case-control study. PMID:9231164 | 1997 | this review only | Oral cancer risk | not extracted yet |
| Znaor 2003 Independent and combined effects of tobacco smoking, chewing and alcohol drinking on the risk of oral, pharyngeal and esophageal cancers… PMID:12740918 | 2003 | this review only | Oral cancer risk | not extracted yet |
| Znaor et al., 2003 alpha-Lactalbumin levels in human mammary tumors, sera, and mammary cell culture lines. PMID:200351 | 1977 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People exposed to smoked tobacco or alcohol; oral cancer outcome (observational studies) | Adults in studies from India, USA, Europe, Asia and elsewhere (n=34 studies) |
| Intervention | Quantitative exposure levels: smoking frequency (units/day), smoking duration (years), alcohol duration (years), age at smoking initiation | Smoking frequency (n=27), smoking duration (n=22), alcohol duration (n=11), age at smoking initiation (n=11) |
| Comparison | Never users (reference category) | Never users |
| Outcomes | Oral cancer risk (RR or OR) | Oral cancer risk (RR) |
| Study designs | Case-control, cohort and cross-sectional studies published in English | 31 case-control, 2 cohort, 1 cross-sectional study |
| Timing | Not specified | Not specified |