Risk factors for tongue cancer without tobacco or alcohol use
Tongue cancer can develop in people with no history of tobacco smoking and no history of alcohol consumption due to other established carcinogenic exposures and host factors. [1][2] The most important non–tobacco and non–alcohol causes/risk factors include oncogenic human papillomavirus (HPV) infection, betel quid (areca nut/paan) exposure, and immunosuppression. [1][3][4]
Oncogenic human papillomavirus infection
High-risk HPV types can cause cancers in the head and neck region, including cancers involving the base of tongue. [1][5] HPV is transmitted through sexual contact, including oral sex. [3]
Betel quid (paan) and areca nut chewing
Chewing betel quid (including areca nut products, with or without added tobacco) increases the risk of oral cavity cancers. [1][5] Betel quid exposure is specifically associated with increased risk of mouth cancers in populations where it is used. [1]
Immunosuppression and reduced immune control
Immunosuppression increases the risk of tongue/oral cancers, including immunosuppression from medicines that suppress the immune system (for example after solid-organ transplant). [6] HIV infection is associated with higher risk of HPV-related head and neck cancers through increased risk of HPV infection. [4][3]
Secondhand smoke and other tobacco exposures
Secondhand smoke can contribute to head and neck cancer risk, even without personal tobacco use. [7] Smokeless tobacco exposure (chewing tobacco/snuff) also increases risk for oral cancers and can occur without alcohol use. [7][2]
Genetic susceptibility and inherited predisposition
Rare genetic disorders that impair DNA repair and tumor suppression can increase susceptibility to head and neck squamous cell carcinoma. [8]
Carcinogenic radiation and other high-risk exposures
Prior radiation exposure is associated with increased risk of some head and neck cancers, including oral cavity sites. [6]
Clinical implications of “no tobacco and no alcohol” presentation
A tongue cancer presentation in the absence of tobacco and alcohol use warrants evaluation for HPV-associated disease and for exposure histories such as betel quid/areca nut chewing and immunosuppression. [1][3][4][6]