Is Oral Biopsy Associated With Change in Tobacco or Alcohol Use?

Purpose: Tobacco and alcohol remain the predominant risk factors for oral cancer, but the relation between having an oral biopsy and cessation of these risk factors is unknown. Therefore, this investigation examined whether there might be an association between oral biopsy and change in risk factor use.

Materials And Methods: A survey was sent to a cohort consisting of a consecutive sample of subjects identified in the University of North Carolina Oral Pathology database. The predictor variable was oral biopsy diagnosis, with 3 levels consisting of hyperkeratosis, dysplasia, or carcinoma. The outcome variable was change in risk factor use, coded as "no change in usage," "decreased usage" or "quit." Other study variables included age, gender, and race. The proportional odds model was used to assess the effect of explanatory variables on change in use, and the P value was set at .05.

Results: The response rate was 37.4% for a total sample of 605 subjects. White non-Hispanics composed 85% of respondents and women composed 49.5%, with no significant difference among diagnostic categories. The global test for change in cigarette use was significant, with age contributing to variability in behavioral change. Although not statistically significant, larger percentages of patients with more severe diagnoses quit cigarettes and alcohol following biopsy. The youngest respondents were 3.7 times more likely not to quit before biopsy or to continue to smoke following biopsy (95% confidence interval, 1.98-6.91).

Conclusion: The results of this study suggest that oral biopsy provides an ideal opportunity to focus on risk factor cessation. Different diagnoses provide objective data on which to base a discussion about carcinogenesis and the roles played by the risk factors in this process. Differences in risk factor cessation associated with demographics emphasize the need for all clinicians to address cessation with all patients.