Non-smokers with oral epithelial dysplasia (OED) — a precancerous lesion of the mouth — have a greater likelihood of progressing to cancer than smokers with OED, according to a study published in Oral Oncology.1

For this prospective study, researchers enrolled 445 patients with primary mild or moderate OED, of whom 306 were smokers and 139 were non-smokers. Investigators collected detailed data regarding tobacco and alcohol history, as well as clinicopathologic data including lesion site, size, appearance, and characteristics. Clinical follow-up was performed once every 6 months, and the median follow-up was 55.4 months.

The majority of patients with OED were smokers; these patients were more likely to be male, non-white, and heavy drinkers.

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There was a significantly greater number of OEDs on the tongue in non-smokers and a significantly greater number of OEDs on the floor of the mouth in smokers.

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Non-smokers with OED were twice as likely as smokers to progress to cancer, and were 38 times more likely to develop oral cancer if the OED was located on the floor of the mouth.

The authors hypothesized that while OED develops at higher rates in smokers, some non-smokers may have a genetic predisposition to OED and oral cancer. They concluded that “this information is critical to the evolution of precision medicine in this subgroup by allowing for medical decisions, practices, and interventions to be tailored to the individual patient based on their predicted risk of disease.”


  1. Rock LD, Rosin MP, Zhang L, Chan B, Shariati B, Laronde DM. Characterization of epithelial oral dysplasia in non-smokers: first steps towards precision medicine. Oral Oncol. 2018;78:119-25. doi: 10.1016/j.oraloncology.2018.01.028