Oral cancer risk factors: tobacco, alcohol, HPV and the signs to report

What counts as oral cancer

Oral cancer includes cancers of the mouth and the back of the throat. It can start on the tongue, the lining of the mouth and gums, under the tongue, at the base of the tongue and in the throat at the back of the mouth (NIDCR). Most are squamous cell cancers, which begin in the flat cells covering the mouth, tongue and lips (MedlinePlus).

Oral cancer makes up roughly 3% of cancers diagnosed each year in the US, about 54,000 new cases in 2022. It most often occurs in people over 40 and affects more than twice as many men as women (NIDCR).

Risk factors

A risk factor raises the chance of getting a cancer. Avoiding risk factors may lower your risk, but it does not mean you will not get cancer (NCI PDQ).

• Tobacco of any kind. Tobacco is the most common cause of these cancers. Cigarettes, pipes, cigars and smokeless tobacco (snuff and chewing tobacco) can all cause them (NCI PDQ), and the NIDCR also lists electronic cigarette smoking (NIDCR). Current smokers have about 5 to 10 times the risk of people who never smoked, and the risk grows with how much and how long a person has smoked (NCI PDQ).
• Alcohol. Risk rises with the number of drinks a day. People who have 2 or more drinks a day have 2 to 6 times the risk of people who do not drink (NCI PDQ).
• Tobacco and alcohol together. Using both raises the risk further than either one alone (NIDCR). People who both smoke and drink heavily have about 5 to 14 times the risk of mouth and throat cancer of people who never smoke or drink (NCI PDQ).
• HPV infection. Infection with certain types of human papillomavirus, especially HPV-16, raises the risk of cancer at the back of the throat (oropharyngeal cancer) and may raise the risk of some mouth cancers. HPV spreads mainly through sexual contact (NCI PDQ). The NIDCR says most throat cancers are caused by HPV and that HPV-positive oral cancer has become more common in recent years (NIDCR).
• Age over 40. Risk increases with age, and these cancers most often occur after 40 (NIDCR) (MedlinePlus).
• Being male. Men are more than twice as likely as women to get mouth or throat cancer and to die from it (NCI PDQ).
• Sun on the lips. Frequent sun exposure can cause cancer of the lip (NIDCR) (MedlinePlus).
• A past head or neck cancer. A personal history of head and neck cancer raises the risk (NCI PDQ) (MedlinePlus).
• Betel quid chewing. Betel quid contains areca nut, a cancer-causing substance. Risk rises with how long and how often it is chewed, and is higher when it is chewed with tobacco (NCI PDQ).
• Diet and genes. A diet low in fruits and vegetables has been linked with a higher risk, and people with inherited defects in certain genes have a high risk of mouth and middle throat cancer (NIDCR).

Signs to show a dentist or doctor

See a dentist or doctor if any of these lasts more than two weeks (NIDCR) (MedlinePlus):

• a sore, irritation, lump or thick patch in the mouth, lip or throat, or a lip or mouth sore that will not heal
• a white or red patch in the mouth
• pain, bleeding or numbness in the mouth, lip or tongue
• a sore throat that does not go away, a feeling that something is caught in the throat, or hoarseness
• a lump in the neck
• trouble chewing, swallowing or speaking, or moving the jaw or tongue
• swelling of the jaw, loose teeth, or dentures that no longer fit well
• ear pain

Oral cancer can spread quickly, so finding it early matters (MedlinePlus). During a regular dental checkup, the dentist or hygienist can check your face, neck, lips, whole mouth and the back of the throat. The exam is painless and takes a few minutes (NIDCR).

Screening: what the USPSTF says

For adults without symptoms, the USPSTF found the evidence insufficient to weigh the benefits and harms of oral cancer screening by a primary care clinician (an I statement, 2013). The recommendation does not cover dentists or ear, nose and throat specialists, who may examine the mouth and throat during a visit (USPSTF 2013). The oral cancer screening check walks through the USPSTF statement for your age and risk factors.

What can lower the risk

• Quitting smoking. After people stop smoking cigarettes, their risk of these cancers falls by half within 5 to 9 years. Within 20 years of quitting, it is the same as for someone who never smoked (NCI PDQ). The quit smoking help check covers what works for quitting.
• Drinking less. The NCI says it is not clear whether avoiding alcohol lowers the risk, but some studies show the risk of mouth cancer falls within about 20 years of stopping drinking (NCI PDQ). The AUDIT-C alcohol check scores your drinking, and the guide to alcohol and cancer risk covers the other cancers alcohol is linked to.
• HPV vaccine. The HPV vaccine greatly lowers the risk of oral HPV infection. It is not yet known whether getting it at any age lowers the risk of HPV-related throat cancer (NCI PDQ). The HPV vaccine age check shows whether it is recommended at your age.

Common questions

I have never smoked. Can I still get mouth cancer?

Yes. HPV infection, age, being male, sun on the lips and a past head or neck cancer also raise the risk (MedlinePlus). Most throat cancers are caused by HPV (NIDCR).

Does vaping count?

The NIDCR lists electronic cigarette smoking alongside cigarettes, pipes, cigars, chewing tobacco and snuff as putting you at risk of oral cancer (NIDCR).

Should I ask for a mouth cancer screening?

The USPSTF has not found enough evidence to recommend for or against screening by a primary care clinician in adults without symptoms (USPSTF 2013). Your regular dental checkup is a good time for a mouth exam (NIDCR), and any sign that lasts more than two weeks should be checked (MedlinePlus).