Systematic review| Volume 61, ISSUE 1, P39-48, January 2023

Download started.


Occupational exposure and risk of oral and oropharyngeal squamous cell carcinoma: systematic review and 25-year retrospective cohort study of patients

Published:November 04, 2022DOI:


      Social habits such as smoking and drinking alcohol are well-known causative agents for oral and oropharyngeal squamous cell carcinoma (OSCC/OPSCC). Human papillomavirus (HPV) is a known causative agent for OPSCC. However, we often encounter patients with no identifiable risk factors. There is growing evidence of the role of occupational carcinogens in the pathogenesis of oral cancer. The aim of this study therefore was to identify any occupational carcinogens linked to oral cancer. We carried out a systematic review of the literature using PubMed, EMBASE, and Medline, along with a retrospective review of patients treated in a regional unit over 25 years. Occupations were classified based on the UK Standard of Classification 2020. Data analysis was completed using the chi-squared test. A total of 17 papers met the inclusion criteria for review. In our retrospective study a total of 874 patients were identified of whom 31% were blue-collar workers, 32.8% were white-collar workers, 20.2% were unemployed/housewives, and 16% workers in other occupations. The majority of blue-collar workers were in the construction industry and had maximum exposure to hydrocarbons and exhaust fumes. The aetiology of oral and oropharyngeal SCC is multifactorial and there is no consensus on the role of occupational carcinogens. We showcase our patient cohort and discuss the occupational exposures that appear to make them susceptible to OSCC and OPSCC. Further multicentre studies are required to enable us to understand fully the pathogenesis of oral cancer and help us to inform relevant organisations, the aim being to reduce the incidence of occupation-related cancer.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Cancer today. International Agency for Research on Cancer; World Health Organization. Available from URL: (last assessed 8 November 2022).

      2. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum 2004;83:1–1438.

      3. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Human papillomaviruses. IARC Monogr Eval Carcinog Risks Hum 2007;90:1–636.

      4. Pott P. Chirurgical observations: relative to the cataract, the polypus of the nose, the cancer of the scrotum, the different kinds of ruptures, and the mortification of the toes and feet. London: TJ Carnegy for L Hawes, W Clarke, and R Collins; 1775.

      5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Some non-heterocyclic polycyclic aromatic hydrocarbons and some related exposures. IARC Monogr Eval Carcinog Risks Hum 2010;92:1–853.

        • Khetan P.
        • Boffetta P.
        • Luce D.
        • et al.
        Occupations and the risk of head and neck cancer: a pooled analysis of the International Head and Neck Cancer Epidemiology (INHANCE) Consortium.
        J Occup Environ Med. 2019; 61: 397-404
        • Awan K.H.
        • Hegde R.
        • Cheever V.J.
        • et al.
        Oral and pharyngeal cancer risk associated with occupational carcinogenic substances: systematic review.
        Head Neck. 2018; 40: 2724-2732
        • Barul C.
        • Carton M.
        • Radoï L.
        • et al.
        Occupational exposure to petroleum-based and oxygenated solvents and oral and oropharyngeal cancer risk in men: a population-based case-control study in France.
        Cancer Epidemiol. 2019; 59: 22-28
        • Barul C.
        • Matrat M.
        • Auguste A.
        • et al.
        Welding and the risk of head and neck cancer: the ICARE study.
        Occup Environ Med. 2020; 77: 293-300
        • Maschio F.
        • Lejuste P.
        • Ilankovan V.
        Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years.
        Br J Oral Maxillofac Surg. 2019; 57: 101-115
      6. Statistics Office for National Statistics. Standard Occupational Classification (SOC) 2020. Available from URL:∼:text=Standard%20Occupational%20Classification%202020%3A%20SOC,coding%20index%20for%20SOC%202020. (last assessed 8 November 2022).

        • Gustavsson P.
        • Jakobsson R.
        • Johansson H.
        • et al.
        Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: a case-control study in Sweden.
        Occup Environ Med. 1998; 55: 393-400
        • Purdue M.P.
        • Järvholm B.
        • Bergdahl I.A.
        • et al.
        Occupational exposures and head and neck cancers among Swedish construction workers.
        Scand J Work Environ Health. 2006; 32: 270-275
        • Offermans N.S.
        • Vermeulen R.
        • Burdorf A.
        • et al.
        Occupational asbestos exposure and risk of oral cavity and pharyngeal cancer in the prospective Netherlands Cohort Study.
        Scand J Work Environ Health. 2014; 40: 420-427
        • Langevin S.M.
        • O'Sullivan M.H.
        • Valerio J.L.
        • et al.
        Occupational asbestos exposure is associated with pharyngeal squamous cell carcinoma in men from the greater Boston area.
        Occup Environ Med. 2013; 70: 858-863
        • Cauvin J.M.
        • Guénel P.
        • Luce D.
        • et al.
        Occupational exposure and head and neck carcinoma.
        Clin Otolaryngol Allied Sci. 1990; 15: 439-445
        • Huebner W.W.
        • Schoenberg J.B.
        • Kelsey J.L.
        • et al.
        Oral and pharyngeal cancer and occupation: a case-control study.
        Epidemiology. 1992; 3: 300-309
        • Escribano Uzcudun A.
        • Rabanal Retolaza I.
        • García Grande A.
        • et al.
        Pharyngeal cancer prevention: evidence from a case–control study involving 232 consecutive patients.
        J Laryngol Otol. 2002; 116: 523-531
        • Vlajinac H.D.
        • Marinkovic J.M.
        • Sipetic S.B.
        • et al.
        Case-control study of oropharyngeal cancer.
        Cancer Detect Prev. 2006; 30: 152-157
        • Winn D.M.
        • Blot W.J.
        • Shy C.M.
        • et al.
        Occupation and oral cancer among women in the South.
        Am J Ind Med. 1982; 3: 161-167
        • Young T.B.
        • Ford C.N.
        • Brandenburg J.H.
        An epidemiologic study of oral cancer in a statewide network.
        Am J Otolaryngol. 1986; 7: 200-208
        • Schildt E.B.
        • Eriksson M.
        • Hardell L.
        • et al.
        Occupational exposures as risk factors for oral cancer evaluated in a Swedish case-control study.
        Oncol Rep. 1999; 6: 317-320
        • Radoï L.
        • Sylla F.
        • Matrat M.
        • et al.
        Head and neck cancer and occupational exposure to leather dust: results from the ICARE study, a French case-control study.
        Environ Health. 2019; 18: 27
        • Nagao T.
        • Warnakulasuriya S.
        • Gelbier S.
        • et al.
        Oral pre-cancer and the associated risk factors among industrial workers in Japan's overseas enterprises in the UK.
        J Oral Pathol Med. 2003; 32: 257-264
        • Coble J.B.
        • Brown L.M.
        • Hayes R.B.
        • et al.
        Sugarcane farming, occupational solvent exposures, and the risk of oral cancer in Puerto Rico.
        J Occup Environ Med. 2003; 45: 869-874
        • Reijula J.
        • Kjaerheim K.
        • Lynge E.
        • et al.
        Cancer incidence among waiters: 45 years of follow-up in five Nordic countries.
        Scand J Public Health. 2015; 43: 204-211
        • Khan M.R.
        • Sudha S.
        Evaluation of genotoxicity in automobile mechanics occupationally exposed to polycyclic aromatic hydrocarbons using micronuclei and other nuclear abnormalities.
        Iran J Cancer Prev. 2012; 5: 87-92
      7. Health and Safety Executive. Construction health risks: key points. 2022. Available from URL: (last assessed 8 November 2022).

        • Mishra G.A.
        • Pimple S.
        • Singal A.
        • et al.
        O8C.6 Tobacco control and oral cancer screening among public transport bus drivers, conductors and other staff in Mumbai, India.
        BMJ J Occup Environ Med. 2019; 76: A75