The International Agency for Research on Cancer (IARC)’s Handbook on oral cancer prevention has been launched. Key measures for significantly reducing the risk of oral cancer include avoiding or stopping tobacco smoking and the usage of areca nut including betel quid with or without tobacco, and reducing alcohol consumption.
The Handbook was developed by a working group of 25 scientists from 14 countries and marks the first assessment of oral cancer prevention through the IARC handbooks programme. The Handbook brings together, for the first time, current available evidence on both primary prevention, to prevent cancer before it develops, and secondary prevention, which covers interventions that detect precancerous lesions, or early-stage cancer, by early detection.
Oral cancers include cancers of the lips and oral cavity (tongue, gums, floor of the mouth, palate and other parts of the mouth). Oral cancer is the 13th most common cancer worldwide, with 377 713 new cases and 177 757 deaths in 2020. Tobacco smoking and alcohol consumption are the main drivers of oral cancer in most countries, although smokeless tobacco and chewing of areca nut products are the top causes in South and South-East Asia and in the Western Pacific islands.
“Drawing on an assessment of evidence from around the world, this IARC Handbook outlines how deaths from oral cancer can be prevented,” said Bente Mikkelsen, WHO’s Director of Noncommunicable Diseases. “It is a welcome consolidation of the scientific foundations for advancing policies on oral cancer prevention in countries where it is most needed.”
Worldwide, most patients with oral cancer present in advanced stages with a poor prognosis because of a lack of access to promotive, preventive and early detection programmes. Early detection programmes that target high-risk populations, in selected settings where incidence is quite high such as in South and South-East Asia and in the Western Pacific islands, may reduce oral cancer incidence and mortality, particularly of the advanced stages of cancer. The Handbook also provides an overview of emerging screening and diagnostic technologies, ranging from artificial intelligence to optical imaging. While the causal association between preventive intervention such as tobacco, alcohol cessation or use of areca nut and cancer is established, current body of evidence on the impact of some interventions on cancer incidence or death is not fully ascertained.
Some of the promising interventions to stop consuming smokeless tobacco include behavioural interventions using telephone counselling, self-help manuals and tip sheets, which show a significant impact among adult populations though current limited evidence is less conclusive among younger populations who are more susceptible to tobacco advertising and who do not perceive tobacco as harmful.
To reduce the global burden of oral cancer, the Handbook calls for increased public awareness around its risks and causes, along with increased research on oral cancer prevention, and improved early detection services.
The Handbook is part of ongoing efforts to implement WHO’s Global Oral Health Action Plan 2023–2030 and aims to serve as an important resource for regulating smokeless tobacco and areca nut use in the most affected countries.