A new review was published in Volume 13 of Oncoscience, titled “Cultural carcinogens in oral squamous cell carcinoma risk across global populations.”

The article was led by Nicole C. Nowak from Rush Medical College, who also serves as the corresponding author.

Rather than presenting new experimental findings, the review brings together epidemiological, mechanistic, and public health evidence describing how culturally rooted practices contribute to the global burden of oral squamous cell carcinoma (OSCC).

The authors also discuss culturally sensitive prevention strategies that combine education, harm reduction, and community engagement while respecting cultural identity.

OSCC is the most common form of head and neck squamous cell carcinoma and remains a major cause of cancer-related illness and death worldwide, particularly in low- and middle-income countries.

Although tobacco, alcohol, and human papillomavirus (HPV) are well-established risk factors, the authors emphasise that several culturally embedded practices—including areca nut chewing, toombak use, khat chewing, reverse smoking, and drinking very hot yerba mate—remain underrecognized contributors to disease risk in many populations.

These practices help explain important geographic differences in the global burden of oral cancer.

The review examines how these exposures promote oral carcinogenesis through distinct but overlapping biological mechanisms.

Depending on the exposure, carcinogenic effects include nitrosamine-induced DNA damage, oxidative stress, chronic inflammation, thermal injury, fibrosis, and disruption of normal cellular signalling pathways.

Areca nut and toombak have the strongest epidemiological and mechanistic evidence linking them to OSCC, while reverse smoking and very hot mate consumption are linked to thermal injury and exposure to carcinogenic compounds, including polycyclic aromatic hydrocarbons.

Khat chewing is associated with oxidative and cytogenetic damage, although the review notes that current human evidence directly linking khat to OSCC remains limited and inconsistent.

Beyond summarising biological mechanisms, the authors highlight the cultural context in which these practices occur.

Many have been practiced for generations and are closely connected to social identity, community life, and local economies.

Because of this, the review argues that prevention efforts based solely on prohibition are unlikely to succeed.

Instead, culturally tailored education, community engagement, harm-reduction approaches, and collaboration with local leaders are presented as more practical strategies for reducing cancer risk while respecting cultural heritage.

A major focus of the review is the role of dermatologists in early cancer prevention.

Dermatologists frequently examine the skin and oral mucosa and may be among the first clinicians to recognise potentially malignant oral lesions such as leukoplakia, erythroplakia, and oral submucous fibrosis.

Incorporating routine oral mucosal examinations into dermatology practice, particularly for patients from high-risk or immigrant populations, could improve early detection and facilitate timely biopsy, referral, and culturally sensitive counselling.

The authors note that this represents an effective, low-cost strategy that could help reduce disparities in oral cancer outcomes.

The review also discusses challenges that complicate prevention efforts.

Public awareness of these culturally associated carcinogens remains limited in many high-prevalence regions, while healthcare providers may under-recognise these exposures and their clinical significance.

Additional barriers include limited access to oral cancer screening, insufficient biopsy services, inconsistent enforcement of existing regulations, and the need for more robust epidemiological and mechanistic research to clarify dose-response relationships and exposure-specific risks.

“By embedding culturally sensitive education and screening programmes within dermatology and public health frameworks, global efforts can reduce OSCC incidence, narrow health disparities, and preserve community identity.”

Overall, this review emphasises that reducing the global burden of oral squamous cell carcinoma requires more than identifying carcinogenic exposures.

Effective prevention should combine biomedical evidence with cultural understanding, community engagement, early clinical recognition, and practical harm-reduction strategies.

By integrating culturally sensitive oral cancer screening and education into dermatology and public health practice, the authors suggest that healthcare systems can improve prevention while respecting the traditions and identities of the communities they serve.

Source: Impact Journals LLC