Globally, an estimated 400,000 new oral cancer cases were reported during 2022. Oral cancer is the second most common malignancy in India. India reports approximately 79,979 deaths and 143,759 new cases each year. The incidence rate among Indian men is 14.7 per 100,000. Buccal mucosa cancer (BMC) is the most common oral cancer in the Indian subcontinent and has a poor 5-year survival rate of 43%. Long-term studies on BMC are limited. Alcohol contributes substantially to the risk of oral cancer, which accounts for 17.7% of new oral cancer cases in India throughout 2020. Evidence on alcohol-related risk mostly comes from non-Indian populations. A recent study published in BMJ Global Health aimed to evaluate the combined and independent effects of alcohol, like 30 locally brewed beverages (LBL) and 11 internationally recognized liquors (IRL), and tobacco on BMC risk in Indian men.
In this multicenter case-control study, a total of 1803 histologically confirmed BMC male cases (mean age = 46±9.9 years, duration of tobacco use = 20.56±10.74 years, alcohol consumption = 36.58±54.16 grams/day) and 1,903 frequency-matched male controls (mean age = 44±10.5 years, duration of tobacco use = 17.93±11.27 years, alcohol consumption = 28.79±51.09 grams/day) were recruited from six Tata Memorial Centre affiliated hospitals across India between 2010 and 2021. Cases and controls were matched by region and age. Exposure data were collected via in-person interviews using a validated questionnaire approach. Consumption of alcohol was quantified in terms of grams/day. The data on key confounders such as tobacco use, residence, age, and education were collected and adjusted for analysis. The combined effect of alcohol and tobacco on the risk of BMC was estimated through state-wise population attributable fraction (PAF) and the cases attributable fraction (AF). All statistical analyses were conducted using STATA 15.0.
Results demonstrated that alcohol consumption was associated with a significantly increased risk of BMC among Indian males. Ever-users had a 68% higher risk compared to never-users with an odds ratio (OR) of 1.68 (95% confidence interval [CI]: 1.44-1.97) and p <0.0001. Even low intake of alcohol (≤9 grams/day) also increased the BMC risk with an OR of 1.56 (95% CI: 1.27-1.91) and p < 0.0001. Similar results were also observed in men consuming more than 9 grams of alcohol per day with an OR of 1.81 (95% CI: 1.49-2.21) and p <0.0001. Furthermore, both LBL and IRL raised the risk of BMC. An increased risk of BMC was observed among alcohol users, including those consuming (OR: 3.09, 95% CI: 1.51-6.33), whisky (OR: 1.78, 95% CI: 1.48-2.15, p <0.0001), beer (OR: 1.91, 95% CI: 1.50-2.43, p <0.0001), and desi daru (OR: 1.84, 95% CI: 1.34-2.52) compared to never-users.
Tobacco and alcohol showed a strong joint effect, which nearly doubled the BMC risk with an OR of 4.86 (95% CI: 3.87-6.11, p = 0.0053). Moreover, AF for BMC due to chewing tobacco and alcohol was found to be 62.3%. Alcohol alone accounted for 11.3% of BMC cases in India, ranging from 0.3% in Lakshadweep to 26.3% in Arunachal Pradesh.
In conclusion, this study highlights that there is no safe alcohol level for BMC risk. Tobacco and alcohol act synergistically to increase BMC risk. Strong prevention policies are needed to target alcohol, tobacco, and informal local alcohols, which could substantially reduce the burden of BMC in India.
Reference: George GS, Patil A, Moirangthem R, et al. Association of alcohol and different types of alcoholic beverages with the risk of buccal mucosa cancer in Indian men: a multicentre case-control study. BMJ Glob Health. 2025;10:e017392. doi:10.1136/bmjgh-2024-017392
