Oral Oncology 50 (2014) e7–e8
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the Editor Oral potentially individuals
malignant
disorders/
The WHO working group on oral cancer and precancer met in 2005 to discuss current concepts, nomenclature, classifications, the natural history, and pathology to critically analyse the evolution of knowledge and practice concerning the diagnosis and management of oral precancerous lesions and conditions. In precancerous lesions, the cancer may arise and would correspond to the site (oral mucosa) of the disorder and in precancerous conditions; the cancer may arise in any anatomical site of the oral mucosa. The consensus from the working group is that even the clinically normal appearing mucosa in patient harboring a precancerous lesion may have dysplasia on the contralateral anatomic site or genetic aberrations in other oral mucosal sites suggestive of a pathway to malignant transformation, and that cancer could subsequently arise in apparently normal mucosa. The working group, therefore, did not favour subdividing precancer to lesions and conditions and proposed the term ‘‘potentially malignant disorders’’ (PMD) to all clinical presentations that carry some risk and/or predispose the oral mucosa to cancer. The PMD conveys (1) All lesions and conditions described under this term may not transfer to cancer, rather that there is a family of morphological alterations amongst which some may have an increased potential for malignant transformation. (2) Oral mucosa is also indicator of risk of likely further malignancies elsewhere in (clinically normal appearing) oral mucosa and not only site specific predictors [1]. Current scientific knowledge shows, malignant changes can develop even in clinically and histomorphologically normal epithelium with no known acquired and/or hereditary predisposing disorders. This could be attributed to the mutagen associated, spontaneous or hereditary alterations or mutations in the genetic material of the oral epithelial cells [2]. It has been proven and widely accepted that the following PMD group of individuals (as independent variables) with no known predisposing disorders and any clinically evident lesion are susceptible to oral cancer [3]. 1. 2. 3. 4. 5. 6. 7. 8. 9.
Age above 70 yrs [4]. Low socioeconomic status [5]. First degree family history of cancer [6]. Chronic unprotected exposure to sunlight [7]. Tobacco smoking/betel quid chewing [8,9]. Excessive consumption of alcohol [9]. Blood group A [10]. Chronic chromium exposure from farm soil [11]. Nutritional deficiency (low consumption of fruits and vegetables) [9,12].
The above enlisted group of individuals with known genetic aberrations can be classified under PMD [2]. On the other hand, 1368-8375/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.oraloncology.2013.10.021
individuals with no known genetic aberrations should be considered as healthy ‘‘individuals,’’ presently carry no risk and/or predispose the oral mucosa to cancer. These healthy ‘‘individuals’’ may cause future genetic aberrations carry risk and/or predispose the oral mucosa to cancer. In medical context ‘‘disorder’’ is described as a disturbance of function, structure, or both, resulting from a genetic or embryonic failure in development or from exogenous factors such as poison, or trauma or disease [13]. It will be inappropriate to use the term ‘‘disorder’’ for the healthy ‘‘individuals’’ of the above enlisted group as they doesn’t show disturbance of function and/or structure resulting from genetic, development, or exogenous factors. At present there are no biological markers available that would detect genetic aberrations to differentiate between healthy ‘‘individual’’ and PMD [14]. Looking at the understanding of the current concept of PMD and above mentioned points, it will be inappropriate to include normal ‘‘individuals’’ and PMD under one roof of ‘‘PMD.’’ I personally propose and appear apt; the term potentially malignant disorders/individuals (PMDI) for the individuals with no known predisposing disorders and any clinically evident lesion but oral mucosa may susceptible to cancer. The inclusion of term ‘‘individual’’ to PMD will reflect future risk and wide population in addition to present precancerous state. This might benefit in screening larger high risk or future risk individuals for oral cancer in order to detect in a relatively early clinical stage. Such earlier diagnosis will result in less treatment morbidity and true long survival. The proposed terminology is based on the author’s opinion with the hope of further suggestions from the readers. Conflict of interest statement None declared. References [1] Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 2007;36:575–80. [2] Sarode SC, Sarode GS, Tupkari JV. Oral potentially malignant disorders: precising the definition. Oral Oncol 2012;48:759–60. [3] Manne RK. Comment on the article ‘‘A new classification for potentially malignant disorders of the oral cavity’’ by Sachin C. Sarode et al. published in Oral Oncology 47 (2011) 920–921. Oral Oncol 2013;49:e39–40. [4] Kruse AL, Bredell M, Grätz KW. Oral squamous cell carcinoma in non-smoking and non-drinking patients. Head Neck Oncol 2010;2:24. [5] Warnakulasuriya S. Significant oral cancer risk associated with low socioeconomic status. Evid Based Dent 2009;10:4–5. [6] Turati F, Edefonti V, Bosetti C, Ferraroni M, Malvezzi M, Franceschi S, et al. Family history of cancer and the risk of cancer: a network of case-control studies. Ann Oncol 2013;00:1–6. [7] Piñera-Marques K, Lorenço SV, Silva LF, Sotto MN, Carneiro PC. Actinic lesions in fishermen’s lower lip: clinical, cytopathological and histopathologic analysis. Clinics (Sao Paulo) 2010;65:363–7.
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Letter to the Editor / Oral Oncology 50 (2014) e7–e8
[8] Muwonge R, Ramadas K, Sankila R, Thara S, Thomas G, Vinoda J, et al. Role of tobacco smoking, chewing and alcohol drinking in the risk of oral cancer in Trivandrum, India: a nested case-control design using incident cancer cases. Oral Oncol 2008;44:446–54. [9] Petti S. Lifestyle risk factors for oral cancer. Oral Oncol 2009;45:340–50. [10] Jaleel BF, Nagarajappa R. Relationship between ABO blood groups and oral cancer. Indian J Dent Res 2012;23:7–10. [11] Su CC, Tsai KY, Hsu YY, Lin YY, Lian IeB. Chronic exposure to heavy metals and risk of oral cancer in Taiwanese males. Oral Oncol 2010;46:586–90. [12] Amtha R, Zain R, Razak IA, Basuki B, Roeslan BO, Gautama W, et al. Dietary patterns and risk of oral cancer: a factor analysis study of a population in Jakarta, Indonesia. Oral Oncol 2009;45:e49–53. [13] Filardo TW. Disorder. Stedman’s medical dictionary. 28th ed. Lippincott Williams and Wilkins; 2006. p. 567. [14] Mydlarz WK, Hennessey PT, Califano JA. Advances and perspectives in the molecular diagnosis of head and neck cancer. Expert Opin Med Diagn 2010;4:53–65.
Associate Professor Rakesh Kumar Manne Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Chintareddypalem, Nellore 524003, Andhra Pradesh, India Tel.: +91 861 2313841x2411/2337, mobile: +91 9704014747; fax: +91 861 2305092. E-mail addresses: [email protected], drmrakeshkumar@ yahoo.co.in Available online 20 November 2013
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the Editor Oral potentially individuals
malignant
disorders/
The WHO working group on oral cancer and precancer met in 2005 to discuss current concepts, nomenclature, classifications, the natural history, and pathology to critically analyse the evolution of knowledge and practice concerning the diagnosis and management of oral precancerous lesions and conditions. In precancerous lesions, the cancer may arise and would correspond to the site (oral mucosa) of the disorder and in precancerous conditions; the cancer may arise in any anatomical site of the oral mucosa. The consensus from the working group is that even the clinically normal appearing mucosa in patient harboring a precancerous lesion may have dysplasia on the contralateral anatomic site or genetic aberrations in other oral mucosal sites suggestive of a pathway to malignant transformation, and that cancer could subsequently arise in apparently normal mucosa. The working group, therefore, did not favour subdividing precancer to lesions and conditions and proposed the term ‘‘potentially malignant disorders’’ (PMD) to all clinical presentations that carry some risk and/or predispose the oral mucosa to cancer. The PMD conveys (1) All lesions and conditions described under this term may not transfer to cancer, rather that there is a family of morphological alterations amongst which some may have an increased potential for malignant transformation. (2) Oral mucosa is also indicator of risk of likely further malignancies elsewhere in (clinically normal appearing) oral mucosa and not only site specific predictors [1]. Current scientific knowledge shows, malignant changes can develop even in clinically and histomorphologically normal epithelium with no known acquired and/or hereditary predisposing disorders. This could be attributed to the mutagen associated, spontaneous or hereditary alterations or mutations in the genetic material of the oral epithelial cells [2]. It has been proven and widely accepted that the following PMD group of individuals (as independent variables) with no known predisposing disorders and any clinically evident lesion are susceptible to oral cancer [3]. 1. 2. 3. 4. 5. 6. 7. 8. 9.
Age above 70 yrs [4]. Low socioeconomic status [5]. First degree family history of cancer [6]. Chronic unprotected exposure to sunlight [7]. Tobacco smoking/betel quid chewing [8,9]. Excessive consumption of alcohol [9]. Blood group A [10]. Chronic chromium exposure from farm soil [11]. Nutritional deficiency (low consumption of fruits and vegetables) [9,12].
The above enlisted group of individuals with known genetic aberrations can be classified under PMD [2]. On the other hand, 1368-8375/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.oraloncology.2013.10.021
individuals with no known genetic aberrations should be considered as healthy ‘‘individuals,’’ presently carry no risk and/or predispose the oral mucosa to cancer. These healthy ‘‘individuals’’ may cause future genetic aberrations carry risk and/or predispose the oral mucosa to cancer. In medical context ‘‘disorder’’ is described as a disturbance of function, structure, or both, resulting from a genetic or embryonic failure in development or from exogenous factors such as poison, or trauma or disease [13]. It will be inappropriate to use the term ‘‘disorder’’ for the healthy ‘‘individuals’’ of the above enlisted group as they doesn’t show disturbance of function and/or structure resulting from genetic, development, or exogenous factors. At present there are no biological markers available that would detect genetic aberrations to differentiate between healthy ‘‘individual’’ and PMD [14]. Looking at the understanding of the current concept of PMD and above mentioned points, it will be inappropriate to include normal ‘‘individuals’’ and PMD under one roof of ‘‘PMD.’’ I personally propose and appear apt; the term potentially malignant disorders/individuals (PMDI) for the individuals with no known predisposing disorders and any clinically evident lesion but oral mucosa may susceptible to cancer. The inclusion of term ‘‘individual’’ to PMD will reflect future risk and wide population in addition to present precancerous state. This might benefit in screening larger high risk or future risk individuals for oral cancer in order to detect in a relatively early clinical stage. Such earlier diagnosis will result in less treatment morbidity and true long survival. The proposed terminology is based on the author’s opinion with the hope of further suggestions from the readers. Conflict of interest statement None declared. References [1] Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 2007;36:575–80. [2] Sarode SC, Sarode GS, Tupkari JV. Oral potentially malignant disorders: precising the definition. Oral Oncol 2012;48:759–60. [3] Manne RK. Comment on the article ‘‘A new classification for potentially malignant disorders of the oral cavity’’ by Sachin C. Sarode et al. published in Oral Oncology 47 (2011) 920–921. Oral Oncol 2013;49:e39–40. [4] Kruse AL, Bredell M, Grätz KW. Oral squamous cell carcinoma in non-smoking and non-drinking patients. Head Neck Oncol 2010;2:24. [5] Warnakulasuriya S. Significant oral cancer risk associated with low socioeconomic status. Evid Based Dent 2009;10:4–5. [6] Turati F, Edefonti V, Bosetti C, Ferraroni M, Malvezzi M, Franceschi S, et al. Family history of cancer and the risk of cancer: a network of case-control studies. Ann Oncol 2013;00:1–6. [7] Piñera-Marques K, Lorenço SV, Silva LF, Sotto MN, Carneiro PC. Actinic lesions in fishermen’s lower lip: clinical, cytopathological and histopathologic analysis. Clinics (Sao Paulo) 2010;65:363–7.
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Letter to the Editor / Oral Oncology 50 (2014) e7–e8
[8] Muwonge R, Ramadas K, Sankila R, Thara S, Thomas G, Vinoda J, et al. Role of tobacco smoking, chewing and alcohol drinking in the risk of oral cancer in Trivandrum, India: a nested case-control design using incident cancer cases. Oral Oncol 2008;44:446–54. [9] Petti S. Lifestyle risk factors for oral cancer. Oral Oncol 2009;45:340–50. [10] Jaleel BF, Nagarajappa R. Relationship between ABO blood groups and oral cancer. Indian J Dent Res 2012;23:7–10. [11] Su CC, Tsai KY, Hsu YY, Lin YY, Lian IeB. Chronic exposure to heavy metals and risk of oral cancer in Taiwanese males. Oral Oncol 2010;46:586–90. [12] Amtha R, Zain R, Razak IA, Basuki B, Roeslan BO, Gautama W, et al. Dietary patterns and risk of oral cancer: a factor analysis study of a population in Jakarta, Indonesia. Oral Oncol 2009;45:e49–53. [13] Filardo TW. Disorder. Stedman’s medical dictionary. 28th ed. Lippincott Williams and Wilkins; 2006. p. 567. [14] Mydlarz WK, Hennessey PT, Califano JA. Advances and perspectives in the molecular diagnosis of head and neck cancer. Expert Opin Med Diagn 2010;4:53–65.
Associate Professor Rakesh Kumar Manne Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Chintareddypalem, Nellore 524003, Andhra Pradesh, India Tel.: +91 861 2313841x2411/2337, mobile: +91 9704014747; fax: +91 861 2305092. E-mail addresses: [email protected], drmrakeshkumar@ yahoo.co.in Available online 20 November 2013
