Inflammatory tongue conditions increase the risk of oral cancer

In a study published in the Journal of Clinical Oncology, researchers found that Inflammatory tongue conditions raised oral tongue cancer risks and preceded diagnosis by years, emphasizing the importance of increased clinical surveillance for patients with apparently benign conditions.

A team of researchers conducted a case-control study using the SEER-Medicare dataset (1992-2013) comprising 2,534 oral tongue cancers, 6,832 other oral cavity cancers, 9,373 oropharyngeal cancers, and 200,000 controls.

Medicare data was used to identify patients with clinically diagnosed inflammatory tongue conditions (glossitis, benign migratory glossitis, median rhomboid glossitis, atrophic glossitis, glossodynia, other specified conditions [e.g., atrophy and hypertrophy], and other unspecified conditions) and oral precancer (leukoplakia/erythroplakia). Only conditions preceding cancer/control selection by more than 12 months were included.

Key findings from the study are:

• Compared to controls, the prevalence of inflammatory tongue conditions was higher in tongue cancer patients (6.0% vs. 0.6%).
• The odds ratio was 5.8.
• The overall association primarily arose from glossitis (5.6), other specified conditions (9.1), and unspecified conditions (13.7).
• These associations were elevated for >5 years preceding tongue cancer, diagnosed by specialists, and among patients who received an oral biopsy, arguing against reverse causation, misclassification, and missed cancer, respectively.

 In 2013, 1 in 11 oral tongue cancer patients had a prior inflammatory tongue condition diagnosis. The association between inflammatory tongue conditions and other oral cavity cancers and oropharyngeal cancer were weak and observed only near cancer diagnosis.

Concluding further, they said that inflammatory tongue conditions, including glossitis, atrophy, hypertrophy, and other unspecified conditions, were found to increase the risk of oral tongue cancer among US individuals aged 65 or older. The risk associations ranged from 6-fold to 15-fold, and inflammatory tongue conditions often preceded tongue cancer diagnosis by at least five years. Approximately one in 11 tongue cancers had a preceding diagnosis of inflammatory tongue condition. As such, clinicians should consider referring patients with glossitis to specialists (like oral medicine, oral surgeons) for oral cancer surveillance.

Reference:

Tota et al. Inflammatory tongue conditions and risk of oral tongue cancer among the US elderly individuals. Journal of Clinical Oncology.