Risk Factors

  • More common in men than women
  • More common in blacks than whites
  • Age (90% over age 45)
  • Tobacco (smoking, chewing, dipping snuff and second-hand smoke)—primary risk factor
  • Alcohol
  • Ethanol and tobacco together are much worse than either one individually
  • Asbestos, nickel, and polyvinyl chloride exposure
  • Mustard gas exposure
  • Defoliating agents exposure
  • Poor oral hygiene (ill-fitting bridgework, broken teeth, mucosa irritated by sharp or jagged teeth)


  • Sun exposure
  • Chronic irritation
  • Direct contact with tobacco
  • Contact with stem of a pipe


  • Chinese/Asian ancestry
  • Epstein-Barr virus exposure
  • Familial clusters

Salivary glands

  • Prior radiation to the head and neck

Thyroid gland

  • More common in women than men
  • Most common between ages 25 and 65
  • Prior radiation to head and neck in infancy or childhood
  • Familial association for medullary carcinoma