Oral cancer, a type of head and neck cancer, involves malignancies that develop in the tissues of the mouth or throat. This includes the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx. While oral cancer affects both men and women, its causes and contributing factors can vary between genders due to differences in lifestyle, biology, hormonal influences, and environmental exposures. In recent decades, the incidence of oral cancer in women has shown a concerning rise, underscoring the importance of understanding its causes specifically within this demographic.
1. Tobacco Use
Tobacco use is the most significant and well-established cause of oral cancer in both men and women. It includes both smoked forms—such as cigarettes, cigars, and pipes—and smokeless forms like chewing tobacco and snuff.
a. Smoking in Women
Although historically smoking rates were higher in men, smoking among women has increased in certain populations due to targeted marketing, changing social norms, and stress-related coping strategies. Tobacco smoke contains over 70 known carcinogens, including polycyclic aromatic hydrocarbons and nitrosamines, which can damage the DNA of cells in the mouth and lead to malignant transformations.
b. Smokeless Tobacco
In many cultures, particularly in South and Southeast Asia, smokeless tobacco use is common among women. Chewing betel quid, often mixed with tobacco, areca nut, and slaked lime, has been strongly linked with the development of oral submucous fibrosis—a precancerous condition—and oral squamous cell carcinoma.
2. Alcohol Consumption
Excessive alcohol consumption is the second most significant risk factor for oral cancer. Alcohol acts as a solvent, enhancing the penetration of carcinogens such as those found in tobacco smoke into the mucosal lining of the mouth.
a. Gender Differences in Alcohol Metabolism
Women are more susceptible to alcohol-related health risks due to differences in body composition and metabolism. Alcohol dehydrogenase (ADH), the enzyme that metabolizes alcohol, is generally less active in women, leading to higher concentrations of acetaldehyde—a known carcinogen—being present in their tissues.
b. Combined Effect with Tobacco
The synergistic effect of alcohol and tobacco significantly increases the risk of oral cancer. Women who consume alcohol and use tobacco are at an exponentially higher risk compared to those exposed to just one of these factors.
3. Human Papillomavirus (HPV) Infection
HPV, particularly the high-risk strains such as HPV-16, has emerged as a major etiological factor in oropharyngeal cancers, which include parts of the throat at the back of the mouth.
a. Sexual Behavior and HPV Transmission
HPV is primarily transmitted through oral sex and intimate contact. Increased awareness and changing sexual practices have led to higher exposure rates in women, contributing to a rise in HPV-related oral cancers.
b. Gender-Specific Immune Response
Some research suggests that women may have a different immune response to HPV infections than men, potentially affecting how long the virus persists and the likelihood of developing cancer.
4. Poor Oral Hygiene and Dental Health
Chronic irritation from broken teeth, ill-fitting dentures, or poor oral hygiene can contribute to persistent inflammation and cellular changes in the oral cavity.
a. Periodontal Disease
Studies have shown a link between chronic periodontal disease and oral cancer. Periodontitis involves the prolonged presence of inflammation and bacterial infection, which may promote carcinogenesis. Women with limited access to dental care due to financial or social constraints may be particularly vulnerable.
b. Sociocultural Influences
In certain societies, women may prioritize the health needs of other family members over their own, leading to delayed or infrequent dental checkups. This delay can allow precancerous lesions to go unnoticed until they have developed into malignancies.
5. Diet and Nutritional Deficiencies
A poor diet, particularly one low in fruits and vegetables, can increase the risk of oral cancer. These foods are rich in antioxidants and micronutrients like vitamins A, C, and E, which help protect cells from oxidative damage.
a. Iron Deficiency
Iron-deficiency anemia, more common in women due to menstruation and pregnancy, has been associated with Plummer-Vinson syndrome—a condition linked to an increased risk of esophageal and oral cancers. This syndrome is characterized by iron deficiency, dysphagia, and esophageal webs.
b. Folate Deficiency
Folate plays a critical role in DNA synthesis and repair. Low levels of folate have been associated with an increased risk of developing cancers, including oral cancer, particularly when combined with other risk factors such as smoking and alcohol use.
6. Genetic and Hormonal Factors
While lifestyle factors contribute significantly to cancer risk, genetic predisposition and hormonal influences also play a role in the development of oral cancer in women.
a. Genetic Susceptibility
Variants in genes that regulate cell cycle control, DNA repair, and detoxification of carcinogens can influence cancer risk. Polymorphisms in genes like p53, CYP1A1, and GSTM1 have been studied for their roles in oral carcinogenesis, with some variations showing gender-specific patterns.
b. Hormonal Influences
Estrogen and progesterone may affect the development of oral cancers. Estrogen receptors have been found in oral epithelial cells, suggesting that hormonal changes—such as those occurring during menopause, pregnancy, or hormone replacement therapy—could influence the behavior of oral tissues and potentially their susceptibility to cancer.
7. Occupational and Environmental Exposures
Women working in certain environments may be exposed to carcinogenic substances such as formaldehyde, asbestos, or heavy metals.
a. Industrial and Agricultural Work
Exposure to pesticides and industrial chemicals has been implicated in increased cancer risk. Women involved in agriculture or factories may unknowingly be at higher risk if proper protective measures are not in place.
b. Indoor Air Pollution
In low- and middle-income countries, women often spend more time cooking with biomass fuels (such as wood or charcoal) in poorly ventilated spaces. Prolonged exposure to smoke and particulate matter can damage oral tissues and increase the risk of cancer.
8. Chronic Infections and Autoimmune Conditions
Certain chronic infections and autoimmune diseases more common in women can predispose them to oral malignancies.
a. Lichen Planus
Oral lichen planus is an inflammatory condition more prevalent in women and is considered a potentially malignant disorder. While most cases do not become cancerous, long-standing erosive forms carry a small but significant risk of malignant transformation.
b. Candida Infections
Chronic candidiasis, particularly when associated with immunosuppression or poorly managed diabetes (more common in women over 40), may contribute to the development of oral leukoplakia and subsequent cancer.
9. Socioeconomic and Educational Disparities
Women in lower socioeconomic groups often face barriers to healthcare access, cancer screening, and education about risk factors.
a. Delayed Diagnosis
Lack of awareness about early signs and symptoms of oral cancer, such as persistent mouth sores or unexplained lumps, leads to late-stage diagnoses and poorer outcomes. Women from marginalized communities are especially at risk of such delays.
b. Cultural Taboos and Stigma
In some cultures, discussing health issues—especially those related to habits like tobacco or sexual activity—can be taboo for women, preventing them from seeking timely medical advice or screening.
10. Psychological Stress and Mental Health
Although not a direct cause of cancer, chronic stress has been shown to weaken immune function, promote inflammation, and lead to unhealthy coping behaviors such as smoking or alcohol use.
a. Women and Caregiver Stress
Many women face the dual burden of professional responsibilities and caregiving for children or elderly relatives. Chronic stress without proper outlets may result in behavioral patterns that increase cancer risk.
Conclusion
The causes of oral cancer in women are multifactorial and deeply intertwined with behavioral, biological, environmental, and social factors. While traditional risk factors like tobacco and alcohol continue to play a significant role, emerging contributors such as HPV infection, hormonal changes, and socioeconomic barriers are becoming increasingly relevant.
Efforts to prevent and reduce the burden of oral cancer in women must be multi-pronged: increasing awareness, promoting regular dental checkups, encouraging healthy lifestyle choices, and addressing the social determinants of health. Culturally sensitive public health campaigns, improved access to education and screening, and further research into gender-specific mechanisms of oral carcinogenesis are essential for reversing the upward trend of this preventable disease in women.