|Year : 2021 | Volume
| Issue : 1 | Page : 76-79
Association between oral cancer and ABO blood groups
SR Ashwinirani1, Girish Suragimath2
1 Department of Oral Medicine and Radiology, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
|Date of Submission||29-Feb-2020|
|Date of Decision||17-Oct-2020|
|Date of Acceptance||08-Jan-2021|
|Date of Web Publication||29-Jul-2021|
Dr. Girish Suragimath
Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Satara, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Oral cancer (OC) in India accounts for about 40% of all cancers of the body. Since the majority of human cancers are derived from epithelial cell changes in blood group antigens, it is an important aspect of human malignancies. So the present study was designed to evaluate the association between ABO blood group type and OC. Materials and Methods: A total of 63 atients were included in the study after obtaining a written consent and ethical clearance from the Institution. Demographic information including name, age, gender, adverse habits were recorded in a predesigned proforma. The clinically confirmed cases of OC were included and ABO blood grouping was done by routine method using Eryscreen Plus kit. The data was entered in MS excel and subjected to statistical analysis. Results: Most common age group affected in OC was 50-59 years and more in males. The most common site affected by OC was buccal mucosa. Blood group A patients were more common in OC. Conclusion: Based on the results of our study males aged above 50-59 years with blood group A were more prone to develop OC.
Keywords: Blood groups, buccal mucosa, oral cancer, vestibule
|How to cite this article:|
Ashwinirani S R, Suragimath G. Association between oral cancer and ABO blood groups. J Datta Meghe Inst Med Sci Univ 2021;16:76-9
| Introduction|| |
In 1900, Karl Landsteiner discovered blood groups A, B, and O and blood group AB was discovered in 1902 by Pupils Von Decastallo and Sturli. There is a variation in ABO blood group in different geographic and ethnic groups. The major alloantigens in humans are blood group antigens which are present on the surface of red blood cells and various epithelial cells. Since a majority of human cancers are derived from the epithelial cells, changes in these blood group antigens are an important aspect of human malignancies.
Cancer prevalence is on the rise according to the international agency of research for cancer (IJRC), a 50% increase in cancer rate within the next 20 years is expected. Oral cancer (OC) in India accounts for about 40% of all cancers of the body. It is the third most common malignancy after the cervix and stomach in developing countries. Studies have shown increasing deaths due to pharyngeal and oral carcinoma as three to fourfold. The mortality rate in India is 7.2/100,000, while the world mortality rate is 2.9/100,000. Diagnosing these OCs in early stages would reduce the morbidity as well as mortality rates.
Alexander first studied the possibility of an association between ABO blood groups and malignancy in 1921. Later on, the association between gastric cancer and blood group A was reported by Aird et al. in 1953. Later on, various studies showed the relationship between ABO blood groups and OCs in different parts of the world. The data regarding the association between blood group and OC in the Maharashtra population are sparse; with this background, the present study is designed to evaluate the association between ABO blood groups and OC.
| Methodology|| |
The present study was conducted at the Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University (KIMSDU), Karad, Maharashtra, India. Institutional ethical clearance was obtained from KIMSDU (No. KIMSDU/IEC/04/2016, Dated 29/12/2016) before commencing the study. The objectives of the study were explained to the patients and written informed consent was obtained. Patients who were willing to participate in the study were included in the study. Patients suffering from any bleeding and clotting disorders were excluded from the study. The study was conducted for 1 year from December 2016 to November 2017.
A total of 63 patients were included in the study, but data of only 58 patients were considered, as five patients were not willing to undergo blood group investigation. Demographic information including name, age, gender, and adverse habits was recorded in a predesigned pro forma. The clinically confirmed cases of OCs were included in the study by a convenient sampling technique. ABO blood grouping was done by collecting 1 ml of blood from antecubital fossa by a routine method using Eryscreen Plus kit (Tulip Diagnostics Private Ltd., Verna, Goa, India). The data were entered into MS Excel and subjected to statistical analysis.
Statistical analysis was carried out using descriptive statistics (frequency and percentage) with SPSS software (version 20.0 Armonk, NY, USA: IBM Corp).
The present study was conducted at the Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University (KIMSDU), Karad, Maharashtra, India. Institutional ethical clearance was obtained from KIMSDU (No. KIMSDU/IEC/04/2016, Dated 29/12/2016) before commencing the study
| Results|| |
The most common age group affected was 50–59 years accounting for 39.6%, followed by least percentage in 70–79 years age group [Table 1]. Site-wise distribution showed the buccal mucosa as the most common site (36.3%) for OC and least common in the palate accounting for 1.7% [Table 2]. Association of habits with OC showed that a majority of OCs were associated with tobacco chewers, followed by patients with multiple habits [Table 3]. A majority of patients with blood Group A were affected by OC accounting for 50%, followed by blood Group B, O, and AB [Table 4].
| Discussion|| |
OC is a multifactorial disease due to the consumption of tobacco both in smoking and smokeless forms; alcohol; human papillomavirus 16 and 18; nutritional deficiencies which includes deficiency of Vitamin A, C, and E; spicy foods; and immunosuppression.,,
In our study, the most common age group affected by OC was 50–59 years accounting for 39.6%, followed by 40–49 years. The results of our study were in consistent with Singh et al., Sharma et al., Addala et al., and Shenoi et al.'s studies. This may be due to well-known factor that OC is an age-related process, even though tobacco consumption starts at early age OC progress slowly leading to cellular and structural changes of the mucosa. A study reported by Addala et al. showed only one case in 20-year age group.
Gender-wise distribution in our study showed male predominance with a male-to-female ratio of 2:1. This may be due to easy access of tobacco and alcohol to males than females in the society. The results of our study were in accordance with Motazav and et al. Ajay et al.'s studies but contradictory to Fazeli et al. and Jaleel and Nagarajappa studies where they observed female predominance.
Regarding site distribution, buccal mucosa was the most common site for OC in both males and females, constituting 38.5% and 32.6%, respectively. The second most common site was the vestibule, followed by the alveolus (27.6% and 22.4%, respectively). The least prevalent site was the palate. The results of our study with respect to site distribution were in consistent with studies reported by Nayak Sharma et al., and Addala et al. which were done in different populations. Ajay et al. carried out a retrospective study to see the prevalence of OC in the same Maharashtra population also showed the buccal mucosa as the most common site. Compared to Western countries in India, the buccal mucosa, vestibule, and alveolus are the most common sites affected due to the use of smokless form of tobacco such as gutka and betel quid.
The usage of tobacco occurs in all parts of the world, but the mode of usage differs in different parts like in India; it is more of smokeless form of tobacco, but in western countries, smoking and alcohol are more prominent. However, education, occupation, and gender influence the use of tobacco. A majority of patients in our study were tobacco chewers followed by patients with multiple habits. The results of our study were consistent with previous Ajay et al.'s study done in the same population.
The risk of OC increases with quantity, frequency, and duration of usage of tobacco and alcohol. Tobacco contains multiple carcinogens, namely polycyclic aromatic hydrocarbons, nitrosoproline, and polonium. Longer exposure to these carcinogens enhances the risk for the development of OC.
Red blood cell membranes contain blood group antigens in addition to epithelial cells of various other tissues, including the oral mucosa. Therefore, certain blood group is considered more prone to develop premalignancy and subsequently convert to malignancy. The relative downregulation of glycosyltransferase that is involved in the biosynthesis of A and B antigen is observed in involvement with tumor development.
The precursor for the formation of A and B antigen is H antigen which is present in all the individuals irrespective of blood group types. In A and B blood group people, H antigen is converted into A and B antigens, whereas H antigen remains in its original form in O blood group individuals. People with O blood groups have the highest amount of H antigen which affords protection, hence the least susceptible to develop OC.
In our study, blood group A patients were more commonly affected by OC which accounts for 50% of cases, followed by blood group B and least common was blood group AB. The results of our study were in consistent with studies done by Tyagi et al., Nayak Baruah and Gogoi Mittal and Gupta Raghavan et al. in different parts of India.
The results were also consistent with the study done in other parts of the world by Dabelsten and Pindborg et al. In a study done by Singh et al., blood group A had 1.84 times higher risk for OC. Blood group A had increased risk for esophageal and salivary gland cancer and blood group B for laryngeal cancers.
Jaleel and Nagarajappa conducted a study to evaluate whether ABO blood groups are associated with an increased risk for OC. The results showed that people with blood group A had 1.46 times higher risk of developing OC compared to people of other blood groups.
Whereas studies conducted by Motazavi et al. in the Iranian population, Akhtar et al. in the North Indian population concluded that blood group B patients were most commonly affected in OC, followed by blood group A. The association between ABO blood groups and risk of cancer varies among different geographic locations, races, and ethnicities.
Very few studies have reported the relationship between the Rh factor and malignancies. In our study, there was no relationship between the Rh factor and OC; the results were accordance with Motazavi et al.'s study.
The treatment of OC includes radiotherapy, surgery, chemotherapy, immunotherapy, and combinations of treatment depending on the stage of OC. Since prevention is better than cure, early detection of potentially malignant disorders and OC reduces the morbidity and mortality rate of patients [Figure 1], [Figure 2], [Figure 3], [Figure 4].
|Figure 1: Malignancy of the mandibular anterior alveolar mucosa and vestibule|
Click here to view
| Conclusion|| |
Based on the results of our study, males aged >50–59 years with blood group A were more prone to develop OC. Regular tobacco counseling and oral health checkups in screening camps during blood donations help to reduce the chances of development of OC.
The authors would like to acknowledge Krishna Institute of Medical Sciences, Karad, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]