Ed, actually you have it backwards. The previous, and still correct number one risk factor is tobacco. Add alcohol (number 2 risk factor) to the equation and it's a cofactor double whammy. Alcohol alone was never number one, though by itself can be a significant risk factor. The most current thinking related to both tobacco and alcohol is that even in those whose risk factors were well known such as tobacco, a co factor in the mutanogenic ability of those two was HPV. We now know that for the 25% of us that didn't have the first two main risk factors this was a major player, but studies are finding that HPV is a facilitator even in those cancers, which are primarily tobacco related. Part of the puzzle of why some smokers get cancer and some do not.

I am up on this, since I have spent the past few weeks researching over the phone with the current thought leaders in all this at a variety of government and research facilities, the correct list of risk factors, since there is so much bad information out there, especially on the web. OCF is printing a "What you need to know about oral cancer" brochure for dentist office waiting rooms, and risk factors is the first chunk of it. The old wives tales of chronic irritation, poor hygiene, etc. having anything at all to do with oral cancer (which they do not), have got to be set straight. What I am saying in the brochure is that there are two types of risk factors, ones that you can control, and those that you cannot. In the cannot range are those that come from statistical issues, and those which are derived by socio-economic issues that lead to a distortion in the list of factors. For instance, blacks get it 2 to 1 over whites, and die from it 2 to 1 over whites. So lots of people say that being black is a risk factor. The truth is there is no biology / genetic issue or difference here; this is because of a list of things that are socio-economic and not biological. I won't go into it in length here, but if you are interested I can elaborate. Al this has to do with underserved populations in the US, both black and white and money/poverty, availability of healthcare, role models, and even education. Ditto the issue of age. As we age our immune system becomes incompetent, and older people get more diseases of all types than younger people. So age is a risk factor

Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.