Prognostic value of non-smoking, non-alcohol drinking status in oral cavity cancer.

OBJECTIVES: To compare the treatment response and prognosis of oral cavity cancer between non-smoking and non-alcohol-drinking (NSND) patients and smoking and alcohol-drinking (SD) patients. METHODS: A total of 313 consecutively treated patients from 2000 to 2019 were included. Demographic, clinicopathologic, treatment, and prognosis information were obtained. Relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were compared between NSND and SD groups using Kaplan-Meier plots, log-rank test, and multivariate Cox regression analysis. RESULTS: Sample prevalence of NSND patients was 54.6%. These patients were predominantly females in their eighth decade with lower prevalence of floor of the mouth cancers compared to SD patients (1.8% vs 14.8%). No difference in the RFS and DSS between both groups was found following multivariable analysis; however, NSND patients had better OS (HR (95% CI) - 0.47 (0.29-0.75); p = 0.002). Extracapsular extension was associated with significantly poorer OS, DSS, and RFS in this oral cavity cancer cohort. CONCLUSION: Treatment response and disease-specific prognosis are comparable between NSND and SD patients with oral cavity cancer. However, NSND patients have better OS. CLINICAL RELEVANCE: This study shows that oral cavity cancer in NSND is not less or more aggressive compared to SD patients. Although better survival is expected for NSND than SD patients, this is likely due to the reduced incidence of other chronic diseases in the NSND group.

A novel environmental exposure index and its interaction with familial susceptibility on oral cancer in non-smokers and non-drinkers: a case-control study.

The objective of this study was to explore the collective effect of environmental factors and its interaction with familial susceptibility on oral cancer among non-smokers and non-drinkers (NSND). A hospital-based case-control study, including 319 oral cancer patients and 994 frequency-matched controls, was conducted in Fujian, China. We raised a weighed environmental exposure index according to nine significant environmental factors obtained from multivariable logistic regression model. And then, the index was classified into three categories according to the tertiles of controls (<1.34, 1.34-2.43, and >2.43). Multiplicative and additive interactions were evaluated between environmental exposure index and family cancer history. Our results showed that environmental exposure index was associated with an increased risk of oral cancer especially for those with family cancer history. Compared to subjects with low environmental exposure index and without family cancer history, those with high index and family cancer history showed the highest magnitude of OR in oral cancer risk (OR 10.40, 95% CI 5.46-19.80). Moreover, there was a multiplicative interaction between environmental exposure index and family cancer history for the risk of oral cancer (P < 0.001). This study puts forward a novel environmental exposure index, which enables a comprehensive evaluation on the overall effect of environmental risk factors on oral cancer among NSND and may interact with family cancer history. Further studies are warranted to explore the underlying mechanisms.

Drinker's own drinking, experience of alcohol-related harms, and concern for drinking predict drinker's attitudes towards non-drinkers.

OBJECTIVE: While the stigma experienced by non-drinkers is well-documented, little is known about the factors that influence it. This study aims to test a sequential mediation model in which the amount of alcohol consumed by a drinker, predicts their experienced alcohol-related harm, which in turn predicts the concern they have for drinking and their negative attitudes towards non-drinkers. METHODS: A sample of 787 Australian drinkers (Mage = 38.4 years, SD = 11.4) completed online measures of alcohol consumption, alcohol-related harms, concern for drinking and the Cheers Attitudes towards Non-drinker Scale (CANS): a scale that measures the negative attitudes toward non-drinkers via three threats non-drinkers are perceived to pose to drinkers (Threat to Fun, Connection, and Self). RESULTS: The model was shown to be a good fit and demonstrated a sequential mediation with significant indirect effects from alcohol consumption via experienced alcohol-related harms and concern, to each CANS subscale: Threat to Self (ß = 0.402, p < 0.001), Fun (ß = 0.096, p = 0.006) and Connection (ß = 0.165, p < 0.001). CONCLUSION: The findings suggest that the stigma directed at non-drinkers may be enacted as a defence against an unwanted self-reflection from a drinker's concern for their own drinking.

Oral cavity cancer in young, non-smoking, and non-drinking patients: A contemporary review.

Oral squamous cell carcinoma (OSCC) in non-smoking and non-drinking (NSND) individuals appears to be distinct from the traditional head and neck squamous cell carcinoma (HNSCC). The incidence of this subset is increasing, as are the number of studies examining its characteristics. NSND OSCC individuals tend to be younger (<45 years) compared to traditional HNSCC patients. The proportion of females in the NSND OSCC cohort is also higher. The tongue is the predominantly affected subsite. Studies have revealed several gene mutations and unique epigenomic profiles but no definitive genetic etiology. Transcriptomic analysis has not found any causative viral agents. Other proposed etiologies include chronic dental trauma, microbiome abnormalities, marijuana consumption, and genetic disorders. There are international efforts to determine the relative prognostic outcome of this unique cohort, but no consensus has been reached. Here, we review the incidence, demographics, subsite, possible etiologies, prognosis, and therapy implications of the NSND OSCC cohort.

Differential characteristics of patients with squamous cell carcinoma of the head and neck with no history of tobacco or alcohol use.

OBJECTIVE: The present study aims to analyse the differential characteristics of patients with head and neck squamous cell carcinoma (HNSCC) without a history of consumption of toxic substances such as tobacco and alcohol. MATERIAL AND METHODS: We carried out a retrospective study of 4694 patients with HNSCC located in the oral cavity, oropharynx, hypopharynx or larynx treated in our centre during the period 1985-2019. RESULT: 7.7% of the patients (n = 363) did not report a history of consumption of toxic substances. The group of patients with no toxic history was older, had a higher proportion of women, a higher frequency of cases located in the oral cavity, a higher proportion of cases diagnosed in early stages, and a lower incidence of second neoplasms. The percentage of patients with no history of consumption of toxic substances increased significantly over the study period. The overall survival of patients with no history of consumption of toxic substances was significantly higher than that of patients with toxic substances use. Specific survival for patients with tumours located in the oral cavity without a history of consumption of toxic substances was significantly lower than that of patients with toxic substances use, whereas for patients with oropharyngeal carcinomas the absence of a history of consumption of toxic substances was associated with a better prognosis. CONCLUSIONS: There were differences in the epidemiological and prognostic characteristics of patients with HNSCC according to the history of consumption of toxic substances such as tobacco and alcohol.

The 'sober eye': examining attitudes towards non-drinkers in Australia.

BACKGROUND: The proportion of Australians who choose not to drink alcohol has increased in recent years; yet, non-drinkers report experiences of stigma and judgement from peers for this choice. This study aimed to explore the attitudes that exist towards non-drinkers and examine what drives this stigma. METHOD: Thematic analysis of four focus groups was undertaken, comprising 37 drinking and non-drinking Australian adults. RESULTS: Three themes were identified that elucidate the stigma, with non-drinkers being perceived as a: (1) threat to fun, a judgemental 'sober eye' disrupting the desired hedonistic environment created by alcohol, (2) threat to connection, described as difficult to initiate and maintain a social connection with and (3) threat to self, with the presence of a non-drinker described by drinkers as encouraging an unwanted reflection on the problematic aspects of their own drinking. Participant responses also suggested that the gender of the non-drinker influenced these perceptions. CONCLUSION: Through the lens of Integrated Threat Theory, this study proposes that the stigma experienced by non-drinkers may be understood as a response to threats non-drinkers are perceived to pose to drinkers' group values (e.g. hedonism) and self-esteem. This study offers new direction for health promotion efforts to challenge negative perceptions of non-drinkers.

Relationships of Alcohol Consumption with Coronary Risk Factors and Macro- and Micro-Nutrient Intake in Japanese People: The INTERLIPID Study.

Several studies have reported a J-shaped relationship between alcohol consumption and coronary heart disease (CHD) risk. However, the mechanisms of this relationship remain unclear. This study aimed to evaluate the relationships of alcohol consumption with established CHD risk factors and with macro-/micro-nutrient intake among Japanese people. Participants were 1,090 Japanese men and women aged 40-59 y enrolled in the INTERLIPID study, excluding former drinkers. Based on two 7-d alcohol records, participants were classified as non-drinkers (0 g/wk), light-drinkers (<100 g/wk), moderate-drinkers (100-299 g/wk), or heavy-drinkers (≥300 g/wk). Detailed macro-/micro-nutrient intake was evaluated using four in-depth 24-h dietary recalls and adjusted for total energy intake excluding alcohol. We analyzed the associations of CHD risk factors and nutrient intake with alcohol consumption. Serum high-density lipoprotein cholesterol and blood pressure were higher and low-density lipoprotein cholesterol was lower among those with higher alcohol consumption. J-shaped relationships with alcohol consumption were observed for the proportion of current smokers, number of cigarettes smoked, and prevalence of hypertension; these risk factors were lowest among light-drinkers. Carbohydrate and total fiber intakes were lower and protein and dietary cholesterol intakes were higher among those with higher alcohol consumption. These associations were similar for men and women. Alcohol consumption was related to nutrient intake as well as established CHD risk factors. Non-drinkers were higher on some CHD risk factors than were light-drinkers. These findings may influence the J-shaped relationship between alcohol consumption and CHD risk.

Re-configured pleasures: How young people feel good through abstaining or moderating their drinking.

BACKGROUND: Alcohol use has strong associations with the pursuit of pleasure, yet trends in young people's drinking have been declining in Australia for more than 15 years. Therefore, it is important to examine how the increasing number of young people who drink lightly or abstain think about pleasure and alcohol, and how this might reflect changing practices around drinking for pleasure. METHODS: Semi-structured interviews were conducted with 50 young people aged 16-19 from Melbourne who abstained from alcohol or drank within Australian guidelines for risky drinking. Participants reflected on how they socialised whilst drinking lightly or without drinking at all, and how they experienced pleasure in this context. These responses were analysed thematically. RESULTS: Four key themes emerged; authenticity, intimacy, control, and vicarious pleasure. Some participants felt that by not drinking, they were enacting authentic or better versions of themselves, whilst developing a stronger sense of intimacy with their sober friends. Others described the displeasure of potentially losing control of their emotions and bodies in social situations and were able to instead experience enjoyment vicariously through their friends' drinking. CONCLUSION: Drinking has long been regarded as a way to build a connection with others, relax and feel a sense of pleasure. However, it is important to recognise that avoiding drinking and drunkenness provides an alternative means by which some young people pursue feelings of pleasure and enjoyment. In a time of declining drinking rates, participants here drew on notions of authenticity, intimacy, self-control, and vicarious enjoyment to construct light or non-drinking as a pleasurable pursuit, and a positive part of selfhood.

'I feel like I have to become part of that identity': Negotiating femininities and friendships through alcohol consumption in Newcastle, UK.

Whilst women's excessive alcohol consumption has traditionally been regarded as a potential threat to health, safety and even femininity, recent research highlights the important role that alcohol plays in many young women's lives. Drawing on data from semi-structured interviews with women aged 18-25 in Newcastle, UK, this paper will consider the role that alcohol can play in the negotiation of female friendships in the Night Time Economy, highlighting the ways in which young women may regard alcohol as a tool to enhance socialising, trust and intimacy (both when pre-drinking and in bars, pubs and clubs). The role of alcohol in 'doing' gender and femininity will also be explored, as young women collectively display feminine identities through particular drinking choices and practices that may include heavy drinking and drunkenness. Finally, I will consider the implications for young women who do not engage in these collective practices of alcohol consumption and suggest avenues for future work on the under-researched topic of the experiences of non-drinkers.

Presence of Human Papillomavirus and Epstein-Barr Virus, but Absence of Merkel Cell Polyomavirus, in Head and Neck Cancer of Non-Smokers and Non-Drinkers.

OBJECTIVE: Determine the presence and prognostic value of human papillomavirus (HPV), Epstein-Barr virus (EBV), Merkel cell polyomavirus (MCPyV), and cell cycle proteins in head and neck squamous cell carcinoma (HNSCC) of non-smokers and non-drinkers (NSND). METHODS: Clinical characteristics and tumors of 119 NSND with HNSCC were retrospectively collected and analyzed on tissue microarrays. RNAscope in situ hybridization (ISH) was used to screen for the presence of HPV and MCPyV mRNA. Immunohistochemistry was performed for expression of p16 as surrogate marker for HPV, Large T-antigen for MCPyV, and cell cycle proteins p53 and pRb. Positive virus results were confirmed with polymerase chain reaction. For EBV, EBV encoded RNA ISH was performed. Differences in 5-year survival between virus positive and negative tumors were determined by log rank analysis. RESULTS: All oropharyngeal tumors (OPSCC) (n = 10) were HPV-positive, in addition to one oral (OSCC) and one nasopharyngeal tumor (NPSCC). The other three NPSCC were EBV-positive. MCPyV was not detected. Patients with HPV or EBV positive tumors did not have a significantly better 5-year disease free or overall survival. Over 70% of virus negative OSCC showed mutant-type p53 expression. CONCLUSION: In this cohort, all OPSCC and NPSCC showed HPV or EBV presence. Besides one OSCC, all other oral (n = 94), hypopharyngeal (n = 1), and laryngeal (n = 9) tumors were HPV, EBV, and MCPyV negative. This argues against a central role of these viruses in the ethiopathogenesis of tumors outside the oro- and nasopharynx in NSND. So, for the majority of NSND with virus negative OSCC, more research is needed to understand the carcinogenic mechanisms in order to consider targeted therapeutic options.

The increased trend of non-drinking in adolescence: The role of parental monitoring and attitudes toward offspring drinking.

INTRODUCTIONS AND AIMS: The proportion of adolescents who do not drink alcohol has increased during the last decade in many European countries, the USA and Australia. Few studies have addressed why this positive trend has occurred. The aim of the present study is to examine associations between parenting factors, peers' alcohol use and non-drinking among 15- to 16-year-old adolescents over time, from 2003 to 2015, and to evaluate potential gender differences. DESIGN AND METHODS: Data from the Swedish subsample of European School Survey Project on Alcohol and Other Drugs were used. Data were available for 2003, 2007, 2011 and 2015 in nation-based samples with responses from 11 531 adolescents in total. RESULTS: The proportion of non-drinkers increased from 23.2% in 2003 to 48.7% in 2015. For each year, indicators of especially restrictive attitudes toward offspring drinking were robustly associated with an increased probability of non-drinking. However, neither indicators of parental monitoring nor parental attitudes toward offspring drinking were associated with the increase in the proportion of non-drinkers that occurred from 2003 to 2015. Two indicators of parental monitoring were more strongly associated with non-drinking among girls than among boys, while paternal restrictive attitudes toward offspring drinking were more strongly associated with non-drinking among boys than girls. DISCUSSION AND CONCLUSIONS: Parenting characteristics are important for adolescents who do not use alcohol, which has implications for prevention strategies. However, the increased trend of non-drinkers could not be attributed to parental factors.

Adolescent non-drinkers: Who are they? Social relations, school performance, lifestyle factors and health behaviours.

INTRODUCTION AND AIMS: Traditionally, non-drinking adults or young adults have been associated with health deficits rather than health benefits. However, as the proportion of Swedish non-drinking adolescents has doubled since 2000, their health profiles are of interest. The aim of the present study is to examine whether social relations, school characteristics, lifestyle factors or health behaviours distinguish adolescent non-drinkers from adolescent drinkers, and if their health profiles have changed from 2004 to 2012. DESIGN AND METHODS: Data from the Survey of Adolescent Life in Vestmanland, a health survey biennially distributed to all 9th graders (15-16 years) in a medium-sized Swedish county, was used. In total, 2872 students in 2004 and 2045 students in 2012 were included. RESULTS: Non-drinkers were distinguished from drinkers in both 2004 and 2012 by elevated parental supervision, a lower rate of school truancy and lower rates of cannabis use, use of other illicit drugs, daily smoking and lower scores on antisocial behaviour, but more problems of getting new friends. No differences between 2004 and 2012 were found. DISCUSSION AND CONCLUSIONS: Non-drinkers presented more adaptive and healthier behaviours than their drinking peers, but it is difficult to determine whether their health benefits were related to their improved alcohol status or to the more general trend towards adaptation that occurred from 2004 to 2012 among adolescents.

Características diferenciales de los pacientes con carcinoma escamoso de cabeza y cuello sin antecedentes de consumo de tabaco ni alcohol / Differential characteristics of patients with squamous cell carcinoma of the head and neck with no history of tobacco or alcohol use

Objetivo: El objetivo del presente estudio es analizar las características diferenciales de los pacientes con un carcinoma escamoso de cabeza y cuello (CECC) sin antecedentes de consumo de tóxicos, como el tabaco y el alcohol.Material y métodosSe llevó a cabo un estudio retrospectivo de 4.694 pacientes con un CECC localizado en la cavidad oral, orofaringe, hipofaringe o laringe tratados en nuestro centro durante el periodo 1985-2019.ResultadoUn 7,7% de los pacientes (n=363) no refirieron el antecedente de consumo de tóxicos. El grupo de pacientes sin antecedentes tóxicos tenía mayor edad, una mayor proporción de mujeres, una mayor frecuencia de casos localizados en la cavidad oral, una mayor proporción de casos diagnosticados en estadios iniciales y una menor incidencia de segundas neoplasias. El porcentaje de pacientes sin antecedentes de consumo de tóxicos aumentó de forma significativa a lo largo del periodo de estudio. La supervivencia global de los pacientes sin antecedentes de consumo de tóxicos fue significativamente más elevada que la de los pacientes con antecedentes tóxicos. La supervivencia específica para los pacientes con tumores localizados en la cavidad oral sin antecedentes tóxicos fue significativamente inferior, en tanto que para los pacientes con carcinomas de orofaringe la ausencia de antecedentes de consumo de tóxicos se asoció a un mejor pronóstico.ConclusionesExistieron diferencias en las características epidemiológicas y pronósticas de los pacientes con CECC en función del antecedente de consumo de tóxicos como el tabaco o el alcohol. (AU)

Objective: The present study aims to analyze the differential characteristics of patients with head and neck squamous cell carcinoma (HNSCC) without a history of consumption of toxic substances such as tobacco and alcohol.Material and methodsWe carried out a retrospective study of 4,694 patients with HNSCC located in the oral cavity, oropharynx, hypopharynx or larynx treated in our center during the period 1985-2019.ResultThe 7.7% of the patients (n=363) did not report a history of consumption of toxic substances. The group of patients with no toxic history was older, had a higher proportion of women, a higher frequency of cases located in the oral cavity, a higher proportion of cases diagnosed in early stages, and a lower incidence of second neoplasms. The percentage of patients with no history of consumption of toxic substances increased significantly over the study period. The overall survival of patients with no history of consumption of toxic substances was significantly higher than that of patients with toxic substances use. Specific survival for patients with tumors located in the oral cavity without a history of consumption of toxic substances was significantly lower than that of patients with toxic substances use, whereas for patients with oropharyngeal carcinomas the absence of a history of consumption of toxic substances was associated with a better prognosis.ConclusionsThere were differences in the epidemiological and prognostic characteristics of patients with HNSCC according to the history of consumption of toxic substances such as tobacco and alcohol. (AU)

Marchiafava-Bignami disease with rare etiology: A case report.

A male, 62-year-old patient was admitted to hospital due to dizziness and gait disturbance for 10 days. The patient had fallen a few times due to the gait instability, which was associated with stiffness and memory loss. The patient had undergone cardiac carcinoma surgery three years previously and had no drinking history. Physical examination revealed that the patient was lucid when conscious but exhibited slurred speech, apathy and cognitive impairment. The finger-to-nose and rapid alternating movement tests showed the patient to be slightly clumsy. Magnetic resonance imaging revealed symmetric abnormal signals in the splenium of the corpus callosum, and the diagnosis was Marchiafava-Bignami disease (MBD). The patient recovered following the administration of vitamin B and other treatments. The patient had long-term appetite loss. A brain myelin metabolism disorder caused by long-term malnutrition and leading to demyelinating changes in the brain may have been the cause of the MBD of this patient. Clinicians should increase awareness of this disease and should not ignore the diagnosis of it, even when the patient lacks a drinking history. Early diagnosis and treatment can improve the prognosis of the patient.

Do high-risk human papillomaviruses cause oral cavity squamous cell carcinoma?

High-risk human papillomaviruses (HR-HPV) are an established etiologic factor for a growing number of oropharyngeal cancers. However, their potential role in other upper aerodigestive tract locations is still a matter of debate, particularly in the oral cavity. This is of paramount importance as in the future diagnosis, treatment and follow up in head and neck squamous cell carcinoma may vary according to HPV status. This article reviews the recent published data and highlights some of the pitfalls that have hampered the accurate assessment of HR-HPV oncological role outside the oropharynx. We demonstrate that, in contrast to the oropharynx, only a small fraction of cancers located in the oral cavity seem to be HPV-related even in young non-smoking non-drinking patients. We emphasize several relevant factors to consider in assumed HPV-induced oral cavity cancers and discuss the current theories that explain why HPV-induced cancers arise preferentially in the oropharynx.

Adolescents' negative attitudes towards non-drinkers: a novel predictor of risky drinking.

The Regan Attitudes towards Non-Drinkers Scale was developed to address the concept that consumption of alcohol may serve as a means of avoiding social costs associated with being a non-drinker. This study sought to examine the Regan Attitudes towards Non-Drinkers Scale within a sample of Irish school-age adolescents. Results indicated that the Regan Attitudes towards Non-Drinkers Scale was a statistically significant predictor of self-reported problematic drinking. The findings of this study underscore the importance of this newly identified construct and highlight the necessity of further empirical tests of the Regan Attitudes towards Non-Drinkers Scale.