A longitudinal cohort study has found that high consumption of sugar-sweetened beverages may be associated with an increased risk of oral cavity cancer in female patients, regardless of their smoking or drinking habits.
In the study, published in JAMA Otolaryngology–Head & Neck Surgery, investigators analyzed data from 162,602 female patients participating in the Nurses' Health Study (NHS) and NHS II, documenting 124 invasive oral cavity cancer (OCC) cases during 30 years of follow-up. The findings revealed that patients consuming one or more sugar-sweetened beverages (SSB) daily had nearly a five times higher risk of developing OCC compared with those consuming less than one SSB monthly.
"In multivariable-adjusted models, participants consuming one or more SSB daily (5 [individuals] per 100,000 population) had a 4.87 times (95% confidence interval [CI] = 2.47–9.60) higher risk of OCC compared with those consuming less than one SSB monthly (2 [individuals] per 100,000 population), increasing the rate of OCC to 3 more [individuals] per 100,000 population," the study authors reported.
The association persisted even when limiting the analysis to those without traditional risk factors. Among nonsmokers or light smokers and nondrinkers or light drinkers, the risk was 5.46 times higher (95% CI = 1.75–17.07) for daily SSB consumers compared with those who rarely consumed SSBs.
The investigators, led by Luis Gomez-Castillo, BA, at the University of Washington and Fred Hutch Cancer Center, noted that while the relative risk increase appeared substantial, the absolute baseline risk remained low, with an increase of only 3 cases per 100,000 population.
The research addressed a knowledge gap concerning the etiology of OCC in nonsmokers, which has been increasingly observed worldwide, particularly among White female patients. The investigators explained their rationale: "The incidence of OCC is increasing among nonsmokers and young individuals without traditional risk factors worldwide. High SSB intake is associated with various gastrointestinal cancers, but its association with OCC has not been explored."
The study adjusted for multiple potential confounding factors, including age, caloric intake, tobacco use, alcohol consumption, body mass index, and glycemic load. Subsite analyses showed elevated risk for both tongue and nontongue OCC locations among high SSB consumers.
Several potential mechanisms might explain the findings. Previous research has linked high intake of high fructose corn syrup (HFCS), a common SSB component, with periodontitis, which is associated with OCC. Additionally, HFCS consumption can cause rapid increases in blood glucose and insulin levels, potentially promoting carcinogenesis through the insulin–insulin-like growth factor 1 axis. HFCS also exhibits proinflammatory properties that may cause oral dysbiosis, another emerging risk factor for OCC.
The investigators acknowledged study limitations, including the precision of estimates caused by the small number of OCC cases, the exclusively female cohort, and the predominantly European descent of participants.
"Additional studies are needed in larger cohorts, including male [patients], to validate the impact of these findings," the study authors concluded.
The authors declared having no competing interests.
