Intended for healthcare professionals

Practice Clinical updates

Tobacco related oral cancer

BMJ 2019; 365 doi: (Published 05 June 2019) Cite this as: BMJ 2019;365:l2142
  1. Pankaj Chaturvedi, professor1,
  2. Arjun Singh, fellow, head and neck oncology1,
  3. Chih-Yen Chien, professor2,
  4. Saman Warnakulasuriya, professor3
  1. 1Tata Memorial Hospital, Mumbai, India
  2. 2Kaohsiung Chang Gung Memorial Hospital, Taiwan
  3. 3King’s College, London
  1. Correspondence to: P Chaturvedi chaturvedi.pankaj{at}

What you need to know

  • Smoking and use of chewed forms of tobacco are the most common causes of oral cancer

  • Patients present with a persistent non-healing ulcer in the mouth or a growth, and may have impaired speech and chewing as a result

  • Encourage those who use tobacco to attend an annual oral visual examination to detect early lesions such as white or red patches in the mouth or fibrosis limiting opening of the mouth

  • Immediately refer patients with a suspicious lesion and history of tobacco use to a specialist for imaging and biopsy to confirm diagnosis

  • Surgical excision of the tumour is warranted in most patients, and reconstructive surgery can minimise disruption of facial features and function to an extent

Oral cancer accounts for over 140 000 deaths annually across the world. Over 300 000 people are diagnosed with oral cancer each year.1 The incidence of oral cancer in the United Kingdom has increased by 68% over the past 20 years.2 Most oral cancers result from tobacco smoking or using tobacco in other forms.34 In the developed world, oral cancers linked to human papillomavirus (HPV) infection are on the rise.56 Tobacco related oral cancer is an important contributor to lost productivity in developing countries from premature deaths.7

General practitioners (GPs) can play an important role in prevention and in early recognition of signs and prompt referral of patients. In this clinical update, we review the presentation of tobacco related oral cancers and provide guidance for GPs, dentists, and nurses on how to spot oral cancer and further management.

How is it caused?

Tobacco use, alcohol consumption, and poor diet together possibly explain about 90% of head and neck cancers.3 Smoking accounts for 75% of oral cancers in the United States,4 with higher risk for cancers of the larynx than for …

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