title: Smoking and drinking in relation to oral cancer and oral epithelial dysplasia.
abstract: OBJECTIVE
  Risks associated with smoking and drinking are not necessarily constant over the multistage pathway to oral cancer. We investigated whether smoking and drinking patterns differ for persons with oral cancer (OC) relative to those with oral epithelial dysplasia (OED), a precancerous condition.
  
  
  METHODS
  Incident cases of OC and OED were interviewed using a questionnaire containing questions on smoking and drinking. Odds ratios (ORs) compared the odds of smoking and drinking among persons with OC relative to OED.
  
  
  RESULTS
  No adjusted ORs for smoking achieved statistical significance; however, most were <1.0. The odds of OC relative to OED increased with drinking level; the adjusted OR for 19+ drinks/week was 3.03 (1.56-5.87). Age drinking began and years of drinking were not notably different for OC and OED cases; a higher proportion of OC cases reported discontinuing alcohol for 9+ years before diagnosis.
  
  
  CONCLUSIONS
  The relationship between smoking and OED was at least as strong as that for smoking and OC, suggesting that smoking may have its greatest impact on oral carcinogenesis prior to malignant transformation. Drinking was more strongly associated with OC than OED, particularly at elevated consumption levels; the role of alcohol does not appear limited to a late-stage effect.
authors.affiliation: Department of Epidemiology & Health Promotion, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA. dem5@nyu.edu
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Morse
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Psoter
authors.forename: Deborah
authors.initials: D
authors.lastname: Cleveland
authors.forename: Donald
authors.initials: D
authors.lastname: Cohen
authors.forename: Mireseyed
authors.initials: M
authors.lastname: Mohit-Tabatabai
authors.forename: Diane L
authors.initials: DL
authors.lastname: Kosis
authors.forename: Ellen
authors.initials: E
authors.lastname: Eisenberg
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology*; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires