Editorial: Incidence, Mortality, and Risk Factors for Oral Cancers

Juliana Lucena Schussel^1*Mariana Villarroel-Dorrego²Sven Eric Niklander³

• ¹Federal University of Paraná, Curitiba, Brazil
• ²Universidad Central de Venezuela, Caracas, Venezuela
• ³Universidad Andres Bello, Santiago, Chile

According to the most recent Global Burden of Disease (GBD) 2019 study, oral cancer presents a mulGfaceted epidemiological scenario. Age-standardized incidence rates (ASIR) have conGnued to increase globally, while age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) have shown a gradual decline, largely agributable to improvements in early diagnosis and treatment modaliGes (1). However, these advances are limited to high-income countries, revealing important dispariGes between regions and socioeconomic groups.One of the arGcles in this Research Topic explores the epidemiology of oral squamous cell carcinoma (OSCC) in Europe (Ghanem et al, 2024), idenGfying notable differences across regions, sex, and age groups. The arGcle emphasizes the need to address region-specific risk factors, enhance early diagnosis through public awareness and healthcare efficiency, and advance personalized treatment strategies, including targeted therapies and radioimmunotherapy. It also highlights the criGcal role of HPV in OSCC pathogenesis and calls for deeper invesGgaGon into the biological, behavioral, and social determinants of the disease to inform more effecGve prevenGon approaches.In contrast, a study from southwestern Iran found that demographic variablessuch as age, gender, marital status, and socioeconomic indicators-did not significantly affect the 5-year survival rate of OSCC paGents (Karimi et al. 2024). The authors advocate for future research to focus instead on pathological features like recurrence, metastasis, treatment type, and tumor characterisGcs to beger understand and improve paGent outcomes.Globally, men conGnue to represent the majority of oral cancer cases. However, a growing incidence among women suggests evolving exposure to tradiGonal risk factors such as tobacco and alcohol. This trend underscores the need for gender-sensiGve public health strategies (1). Low-and middle-income countries (LMICs), faces disproporGonate burdens due to late-stage diagnoses, limited treatment capacity, and preventable deaths (2). Low health literacy, restricted access to healthcare services, and a shortage of trained professionals for early detecGon are some of the obstacles encountered. The absence of specialized diagnosGc centers further delays Gmely intervenGon. Nonetheless, exisGng evidence confirms that trained clinicians can accurately assess the clinical risk of oral potenGally malignant disorders (OPMDs), making such training a cornerstone of successful screening efforts.From 1990 to 2019, oral cancer incidence, mortality, and DALYs increased with age. Among individuals under 20, high-income countries saw a paradoxical rise in incidence but a concurrent decline in deaths and DALYs. Conversely, LMICs reported rising mortality in this group, exposing serious deficiencies in healthcare infrastructure and our understanding of disease behavior in younger populaGons (3). Among the elderly-parGcularly those aged 70 to 79-mortality from some head and neck cancers has risen substanGally. While men showed a higher number of deaths before age 35, DALY trends aner age 70 revealed a marked decline in males and a stabilizaGon in females, suggesGng sex-based dispariGes in survival and healthcare access (1).Tobacco and alcohol remain the principal risk factors for oral cancer. High-income countries have successfully implemented tobacco control measures, whereas LMICs conGnue to struggle with the influence of tobacco industries. The rise in e-cigarege use, especially among adolescents, adds a layer of complexity. These products are aggressively marketed using appealing flavors and misleading health claims, which can give a false sense of safety. Alcohol companies similarly exploit weak regulaGons in LMICs, saturaGng markets with inexpensive, high-alcohol-content beverages that sGmulates consumpGon behaviors.A study from this Research Topic focusing on rural women who use hookah, highlighted low to average scores in knowledge, aptudes, and prevenGon behaviors related to oral cancer (Mohammadkhah et al., 2024). NicoGne dependence was high and significantly associated with reduced prevenGve behaviors. The findings, grounded in the Theory of Planned Behavior, call for tailored health educaGon programs, parGcularly in underserved communiGes. Using mass media and social plaqorms may enhance outreach, while addressing nicoGne addicGon remains a criGcal barrier to effecGve prevenGon.HPV vaccinaGon-a proven strategy in reducing oropharyngeal cancer-faces implementaGon barriers, especially in resource-limited sepngs. Access to HPV vaccines is a mager of deep concern and reflects a marked inequity in global health. In resourcelimited countries, health systems onen must prioriGze combaGng infecGous diseases and infant mortality, which can relegate HPV vaccinaGon to a secondary priority.At the same Gme, advancements in genomics and proteomics have the potenGal to improve risk straGficaGon and guide individualized surveillance approaches. However, the cost of proteomic analysis, reagents, and highly trained personnel is an insurmountable barrier for most research centers and hospitals. This severely limits the possibility of conducGng genomic and proteomic studies locally or incorporaGng these techniques into clinical pracGce.On the other hand, oral cancer screening campaigns in LMICs face significant challenges that limit their impact on disease incidence. While early detecGon is crucial for improving treatment outcomes and survival, several socioeconomic and infrastructure factors hinder the effecGveness of these campaigns in resource-limited sepngs. When healthcare infrastructure is precarious, with few trained health professionals and few health centers equipped to conduct screening and follow-up, it makes it difficult for campaigns to reach the target populaGon and for detected cases to receive Gmely treatment.It is important also to understand that cancer survivors onen face life-altering consequences, including disfigurement from radical surgeries and lack of access to rehabilitaGon services. Addressing these human costs requires resolute acGon, prioriGzing equitable access to care, and integraGng oral cancer control into broader public health frameworks.While progress has been made, dispariGes persist. Only through innovaGon, global collaboraGon, and a steadfast commitment to health equity can we achieve meaningful reducGons in the global burden of oral cancer.