Evidence map›Paper›PMID 42174468›Full record

SynthesisBMC public health2026

Evaluation of dose-response relationships between smoking tobacco, alcohol consumption and oral cancer: a systematic review and meta-analysis.

G Aswathi, Andre Carvalho, Sathishrajaa Palaniraja, M Shivacharan, Bhukya Nom Kumar Naik, Saman Warnakulasuriya, Kishore Chaudhry, Muralidhar Kulkarni, Ranjitha S Shetty, Shirley Lewis and 5 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

G AswathiDepartment of Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Andre CarvalhoEarly Detection, Prevention, and Infections Branch (EPR), International Agency for Research on Cancer [IARC/WHO], Lyon, France.
Sathishrajaa PalanirajaInternational Agency for Research on Cancer [IARC/WHO], Lyon, France.
M ShivacharanDepartment of Radiation Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Bhukya Nom Kumar NaikDepartment of Anatomy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Saman WarnakulasuriyaDepartment of Oral Medicine & Experimental Pathology, King's College London, London, UK.
Kishore Chaudhry, Las Vegas, Nevada, USA.
Muralidhar KulkarniDepartment of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Ranjitha S ShettyDepartment of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Shirley LewisDepartment of Radiation Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Vijay Shree DhyaniKasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Suzanne Tanya NethanEarly Detection, Prevention, and Infections Branch (EPR), International Agency for Research on Cancer [IARC/WHO], Lyon, France.
Ravivarman LakshmanasamyEarly Detection, Prevention, and Infections Branch (EPR), International Agency for Research on Cancer [IARC/WHO], Lyon, France.
Vasudeva GuddattuDepartment of Applied Statistics and Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
K DevarajaDepartment of Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India. devaraja.k@manipal.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTobacco smoking and alcohol consumption are established independent risk factors for oral carcinogenesis, yet the quantitative dose-response relationships for key exposure variables remain unclear.

methodsA systematic review and dose-response meta-analysis (PROSPERO registration number: CRD42024531040) was conducted following the PRISMA 2020 guidelines. Cohort, case-control, and cross-sectional studies reporting relative risks (RRs) or odds ratios for at least one of the exposure variables, such as smoking frequency, smoking duration, alcohol duration, and age at smoking initiation were included. Random-effects dose-response models with restricted cubic splines were applied. Quality of the included studies was assessed using the Newcastle-Ottawa Scale.

resultsData from 34 eligible studies (27 on smoking frequency, 22 on smoking duration, 11 on alcohol duration, and 11 on age at smoking initiation) were analysed. Smoking frequency showed a strong non-linear association, peaking at 30 smoking units/day (RR: 5.98; 95% CI: 3.37-10.60). Smoking duration was positively associated with risk, reaching a maximum at 40 years (RR: 2.19; 95% CI: 1.48-3.23). Duration of alcohol consumption showed a positive but weaker association, with the highest risk occurring at 50 years (RR: 3.13; 95% CI: 1.40-6.97). Age at smoking initiation was not independently associated with risk.

conclusionsSmoking frequency and duration each exhibit strong and independent dose-response relationships with oral cancer, while alcohol duration independently confers moderate risk. These findings highlight exposure-specific risk thresholds that can inform targeted prevention and screening strategies, particularly in populations with high incidence rates.

Indexed as

Alcohol DrinkingMouth NeoplasmsSmokingTobacco SmokingHumansRisk FactorsAlcohol consumptionDose-responseMeta-analysisOral cancerRisk factorsTobacco smoking

Identifiers

PMID42174468
PMCPMC13371301

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.