Changes in smoking and alcohol use following the diagnosis of an oral potentially malignant disorder: a retrospective pilot study

TL;DR

This study examines how a diagnosis of an oral potentially malignant disorder affects smoking and alcohol use, finding limited behavioral change.

Contribution

The study provides new insights into behavioral changes following an OPMD diagnosis, highlighting differences in smoking and alcohol cessation rates.

Findings

Smoking prevalence decreased slightly but not significantly after diagnosis.

Alcohol use remained largely unchanged post-diagnosis.

Younger patients were less likely to quit smoking, while lower socioeconomic status was linked to reduced alcohol use.

Abstract

Smoking and alcohol consumption are major risk factors for oral potentially malignant disorders (OPMDs), yet the extent to which an OPMD diagnosis prompts behavioral change remains unclear. This study aimed to describe the changes in smoking and alcohol consumption in patients after an OPMD diagnosis and explore the role of demographic and clinical factors in these behavioral changes.

A retrospective cohort study was conducted in the Department of Oral and Maxillofacial Surgery at the McGill University Health Centre, including OPMD patients from 2018 to 2023. Eligible patients had a confirmed OPMD diagnosis, no prior history of head and neck cancer, and at least six months of follow-up. Those without smoking or alcohol data were excluded. Descriptive statistics, McNemar’s and Wilcoxon signed-rank tests to assess behavioral changes, and logistic regression to identify factors associated with continued smoking and alcohol use were used.

The sample composed of 82 patients, 30 (36.6%) were female, with a mean age at diagnosis of 64 years. Leukoplakia (82.9%) was the most common OPMD, and the tongue was the most affected site (42.7%). Median follow-up was 29 months. Most patients (76.8%) had a histologic diagnosis of either mild or moderate dysplasia. At the time of diagnosis, about one-third were active smokers or moderate-to-heavy drinkers. Smoking prevalence decreased from 30.5% at diagnosis to 22.5% post-diagnosis, although this reduction did not reach statistical significance (p = 0.06), while moderate-to-heavy alcohol use remained largely unchanged (31.7% vs. 30.5%, p = 1.00). Younger patients were less likely to change smoking habits (OR = 0.96, 95% CI 0.91–1.00; p = 0.042). Patients from lower socioeconomic backgrounds had lower odds of alcohol use post-diagnosis (OR = 0.26, 95% CI 0.08–0.82; p = 0.021).

The findings suggest that smoking cessation is achievable post-diagnosis, whereas reducing alcohol intake may require more targeted interventions. Resistance to behavior change among younger patients may explain rising oral cancer rates in this population.