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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 1  |  Page : 7-10
Relationship between ABO blood groups and oral cancer


1 Department of Community Dentistry, Al-Azhar Dental College, Thodupuzha, Kerala, India
2 Department of Community Dentistry, Pacific Dental College and Hospital, Udaipur, India

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Date of Submission12-Jul-2010
Date of Decision14-Aug-2010
Date of Acceptance09-Dec-2010
Date of Web Publication26-Jul-2012
 

   Abstract 

Background: Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. Oral cancer has multifactorial etiology and is significantly associated with risk factors of the individual's lifestyle, particularly, chronic use of tobacco, spicy food, alcohol and smoking. Many studies have indicated that genetic factors also have an influence on the etiology of cancer.
Aim: To evaluate if any of the ABO blood groups are associated with an increased risk for oral cancer.
Materials and Methods: The present study was conducted at Kidwai Memorial Institute of Oncology (KMIO), Bangalore, after obtaining permission from the Director of the institute. The study sample comprised 235 oral cancer patients and 812 controls. For statistical analysis, Chi-square test and odds ratio were used to assess the relationship between ABO blood groups and oral cancer. Probability level was fixed at ≤0.05.
Results: It was found that people with blood group A had 1.46 times higher risk of developing oral cancer compared to people of other blood groups.
Conclusion: By employing a simple blood grouping test during community field programs, people with blood group A in the age group of 40-59 years having tobacco chewing habits can be apprised that they are more at risk to develop oral cancer than people with other blood groups.

Keywords: ABO blood group, oral cancer, oral cancer risk

How to cite this article:
Jaleel BF, Nagarajappa R. Relationship between ABO blood groups and oral cancer. Indian J Dent Res 2012;23:7-10

How to cite this URL:
Jaleel BF, Nagarajappa R. Relationship between ABO blood groups and oral cancer. Indian J Dent Res [serial online] 2012 [cited 2019 Aug 24];23:7-10. Available from: http://www.ijdr.in/text.asp?2012/23/1/7/99029
Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. If the cancer has progressed beyond the stage that it can be successfully removed, it may even result in death of the individual. Cancer in all forms accounts for around 12% of the deaths throughout the world. [1]

The term oral cancer generally refers to carcinoma of oral mucosal origin. In India, oral cancer accounts for about 40% of all cancers of the body and is a major public health problem with sufficient morbidity and mortality, emerging as a killer disease. [2] Oral cancer has multifactorial etiology and is significantly associated with risk factors of the individual's lifestyle, particularly, chronic use of tobacco, spicy food, alcohol and smoking. Many studies have indicated that genetic factors also have an influence on the etiology of cancer as the genes have been implicated in development and progression of oral cancer. The p53 gene has been found to be mutated in majority of oral cancer patients. [3],[4],[5]

Blood has had a mysterious fascination for man since the dawn of time. A and B antigens are saccharide groups of glycoproteins present on RBC membrane. These antigens are not shared by all the members of the particular species and are called "iso-antigens". The alleles which determine the presence or absence of these antigens are called as "iso-alleles", which are located on chromosome number 9 and are inherited according to simple Mendelian principles. Based on the presence of these blood group antigens, individuals may be categorized to belong to one of the four blood groups, i.e. A, B, AB or O. [2]

Some researchers have studied the relationship between ABO blood groups and oral cancer. The possibility of association between ABO blood groups and malignancy was first explored by Alexander in 1921. Following a long gap thereafter, Aird et al. (1953) and Walter (1956) reported a close association between gastric cancer and blood group A. In India, studies done by Tyagi et al., [6] Mittal and Gupta, [7] Nayak, [8] and Baruah and Gogoi [9] have shown that individuals with blood group A have predisposition for oral cancer. Raghavan et al., [10] who studied the incidence of ABO blood groups in oral cancer cases of South Kanara district of India, found increased susceptibility of oral cancer among people with blood group A. Protection against oral cancer was greater for blood group O, followed by blood group AB and then B.

Hence, against this background, the present study was undertaken as a step in the field of research to assess the relationship between ABO blood groups and oral cancer, which might contribute to determine the susceptibility of an individual to oral cancer.

Aim

To evaluate if any of the ABO blood groups are associated with an increased risk for oral cancer.


   Materials and Methods Top


The present study was conducted at Kidwai Memorial Institute of Oncology (KMIO), Bangalore, after obtaining permission from the Director of the institute. 235 patients comprising 77 males and 158 females, who were histopathologically diagnosed of oral cancer and admitted in the institute during the 2-month period, constituted the cases. Data regarding the patient's personal details, blood groups and oral habits were obtained from their case sheets available in the hospital.

812 people, 716 males and 96 females, who had donated blood at KMIO, Bangalore, during the same 2-month period, comprised the controls.

For statistical analysis, Chi-square test and odds ratio were used to assess the relationship between ABO blood groups and oral cancer. Probability level was fixed at ≤0.05.


   Results Top


[Table 1] shows the distribution of ABO blood groups among cases and controls. Out of 235 oral cancer cases, 68 (29%) had blood group A, 63 (27%) had B, 11 (5%) had AB and 93 (39%) had blood group O. Among the controls, 177 (22%) had blood group A, 191 (23%) had B, 42 (5%) had AB and 402 (50%) had blood group O. When the cases and controls were compared, a significant relationship was found between blood group A and oral cancer. The relative frequency (%) of blood group A was higher in the oral cancer group than in the control group and the difference was statistically significant (P<0.05).

[Table 2] shows that when the strength of association between ABO blood groups and oral cancer was assessed by odds ratio, it was found that people with blood group A had 1.46 times higher risk of developing oral cancer compared to people of other blood groups. The relative risk was 1.19 for people with blood group B and 0.90 for those with blood group AB. The relative risk for people with blood group O was 0.66, which was statistically significant.
Table 1: Blood group characteristics among cases and controls

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Table 2: Odds ratio showing the strength of association between ABO blood groups and oral cancer

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The distribution of ABO blood groups among oral cancer cases and controls according to sex shows that out of 77 male oral cancer cases, 34% had blood group A, 26% had B, 1% had AB and 39% had blood group O, whereas among the controls, there were 22%, 21%, 6% and 51% people with the four blood groups, respectively. Among 158 female cases, 27% had blood group A, 27% had B, 6% had AB and 40% had O, and among the controls, 27%, 19%, 7% and 47% had the four blood groups, respectively. Oral cancer was found to be significantly higher among females compared to males (P`lt;0.05).

Majority of the oral cancer cases (54%) were found in the age group of 40-59 years, irrespective of the blood group they had. Very few cases were seen in the other age groups, i.e. 21-39 years and 60+ years.

When the different types of habits were compared, majority of the oral cancer cases (i.e. 80%) had the habit of chewing tobacco. Smoking and alcohol consumption were comparatively less. No significant relation was found between the habits and blood groups in relation to oral cancer.

When the distribution of oral cancer cases was studied, it was seen that buccal mucosa was affected in most of the cases (68%), followed by tongue (12%), palate (11%), alveolus (12%), floor of the mouth (3%) and lip (1%).


   Discussion Top


Human genetics is much more than the study of mere hereditary diseases. It has emerged as a basic biological science for understanding the endogenous factors in health and disease and the complex interaction between nature and nurture.

Blood groups A, B and O were discovered by Karl Landsteinner in 1900 and the 4 th group AB was later described by his pupils, Von Decastallo and Sturli, in 1902. [2] The knowledge of association between blood groups and disease frequencies evolved in the early part of the last century. Since then, we have come a long way in the study of association between blood groups and specific diseases, i.e. both systemic and oral diseases.

This study clearly demonstrates that there exists a relationship between ABO blood groups and oral cancer. People having blood group A were found to have a greater tendency to develop oral cancer. This can be explained by the fact that blood group antigens, in addition to being present on red blood cell membranes are also found on epithelial cells of various other tissues, including the oral mucosa. The relative downregulation of glycosyl transferase that is involved in the biosynthesis of A and B antigens is seen in association with tumor development (Mendel et al., Orntoft). [11] The partial or complete deletion of epithelial blood group antigens due to aberrations in their synthesis brings about changes in their cell surface. It has been indicated that the altered antigen pattern on cell surface is a tumor-associated change resulting in malignancy. [12]

H antigen is a blood group antigen present in all the individuals irrespective of blood group types. It is the precursor for the formation of A and B antigens. In people belonging to A and B blood groups, the precursor H antigen is converted to A and B antigens, respectively, whereas in O blood group individuals, it remains in its original form. People with O blood group have the highest amount of H antigen which affords protection against oral cancer. Hence, O blood group people were least susceptible to develop oral cancer. [13]

The main objective of this study was to assess the relationship between ABO blood groups and oral cancer, and to determine which blood group is genetically more susceptible to oral cancer, but since this was a retrospective study, other details about the patients like their age, sex, habits and site of oral cancer were available and these data were also analyzed.

In this study, among the oral cancer cases, male:female ratio was almost around 1:2. This may be due to the fact that in southern parts of India, people consume more spicy food and, in addition to this, females have the habit of keeping tobacco in their oral cavity for a longer duration of time compared to males, thus resulting in higher incidence of oral cancer among females. This finding is supported by the report of National Cancer Registry Program conducted by Indian Council of Medical Research, [14] FDI World report 1996 and epidemiological data of Moore et al.[15]

In this study, the highest frequency of oral cancer cases irrespective of blood groups was seen in the age group of 40-59 years. This is in accordance with the well-proven fact that most cancers of the body occur after the 4 th decade of life. [1] Very few cases were seen in the 20-39 years age group. This may be due to shorter duration of exposure to the carcinogens.

Tobacco chewing is generally considered as the primary local etiological factor for oral cancer. Smoking and alcohol merely act as co-factors. The same was reflected in this study, wherein the frequency of the oral cancer was highest among those who had the habit of chewing tobacco. Also, in the present study, it was seen that though patients of all blood groups had tobacco chewing habit, oral cancer was seen more in patients with blood group A.

The most common site for occurrence of oral cancer was buccal mucosa. This is because majority of the people have a tendency to keep the quid in buccal vestibule, which, over a period of time, causes chronic irritation to buccal mucosa ultimately resulting in cancer. [16] Other common sites involved were tongue and palate, since they are also actively involved in the process of chewing.

One of the important causes for lip cancer is smoking. In this study, very few cases had smoking habit and consequently the involvement of lip was also very less. [17]

Dabelsteen and Pindborg (1973) conducted extensive research comparing the presence of blood group A antigens in normal epithelium and oral carcinomas and concluded that in carcinomas, the blood group A substance decreases in amount or completely disappears. [12]

Raghavan et al. (1986) studied the incidence of ABO blood groups in oral cancer cases in South Kanara district, India, and reported increased susceptibility of blood group A to oral cancer. [10] The results of the present study are also in full conformity with the results of Toto and Nadimi (1990). [17]


   Conclusion Top


This study demonstrates that people with blood group A are 1.46 times at a greater risk to develop oral cancer, followed by those with blood group B, AB and O. Oral cancer is amenable to primary and secondary prevention. A randomized trial of screening for oral cancer and premalignant lesions in 192,053 subjects in Kerala showed a 20% reduction in mortality from oral cancer among the screened group compared to the controls. [18] By employing a simple blood grouping test during community field programs, we can target the people with blood group A in the age group of 40-59 years having tobacco chewing habits and educate them that they are more at risk to develop oral cancer than people with other blood groups.

But since this was a retrospective study based on hospital records, it may not be truly representative of all oral cancer cases in the community. Hence, further study in this regard is recommended.

 
   References Top

1.Park K. Epidemiology of Communicable diseases. In: Park's text book of Preventive and Social Medicine. 15 th ed. Jabalpur, India: Banarasidas Bhanot Publishers; 1997. p. 281.  Back to cited text no. 1
    
2.Ananthanarayanan R. Immunohematology. In: Text Book of Microbiology, 3 rd Ed. New Delhi: Orient Longman Limited; 1996. p. 170-1.  Back to cited text no. 2
    
3.Mao L, Hong WK, Papadimitrakopoulou VA. Focus on head and neck cancer. Cancer Cell 2004;4:311-6.  Back to cited text no. 3
    
4.Jefferies S, Foulkes WD. Genetic mechanisms in squamous cell carcinoma of the head and neck. Oral Oncol 2005;37:115-26.  Back to cited text no. 4
    
5.Scully C, Field JK, Tanzawa H. Genetic aberrations in Oral or head and neck squamous cell carcinoma. Oral Oncol 2000;36:311-27.  Back to cited text no. 5
[PUBMED]    
6.Tyagi SP, Pradhan S, Agarwal P. Blood groups in malignant diseases. J Indian Med Assoc 1965;45:645-50.  Back to cited text no. 6
    
7.Mittal VP, Gupta S. The study of ABO blood groups in oral cancer. J Cancer 1969;6:34-7.  Back to cited text no. 7
    
8.Nayak SK. ABO blood groups in different diseases. J Indian Med Assoc 1971;57:449-52.  Back to cited text no. 8
[PUBMED]    
9.Baruah BD, Gogoi BC. Blood groups in cancer in Assam, India. Indian J Cancer 1977;14:6-9.  Back to cited text no. 9
    
10.Raaghavan VM, Bailoor DN, Jhansirani P. Incidence of ABO Blood groups in oral cancer in south kanara district. J Indian Dent Assoc 1986;58:305-8.  Back to cited text no. 10
    
11.Dabelsten E, Gao S. ABO Blood group antigens in oral cancer. J Dent Res 2004;84:21-8.  Back to cited text no. 11
    
12.Dabelsten E, Pindborg JJ. Loss of epithelial blood group substance in oral carcinoma. Acta Path Microbial Scand 1973;81:435-44.  Back to cited text no. 12
    
13.Auclair CL. Altered H-antigen reactivity as an early indicator of malignant transformation in oral epithelium. J Oral Pathol 1984;13:401-11.  Back to cited text no. 13
    
14.Consolidated report of population based cancer registry: Biennial report 1996-97, Indian council of medical research.  Back to cited text no. 14
    
15.Moore SR, Johnson NW, Pierre AM, Wilson DF. The epidemiology of mouth cancer- A review of global incidence. Oral Dis 2000;6:65-74.  Back to cited text no. 15
    
16.Blomquist G, Hirsch JM, Alberius P. Association between development of lower lip cancer and tobacco habits. J Oral Maxillofac Surg 1991;49:1044-7.  Back to cited text no. 16
    
17.Toto PD, Nadimi H. Co-expression of cytokeratins, involucrin and blood group antigens in oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol 1990:70:75-80.  Back to cited text no. 17
[PUBMED]    
18.Shankaranarayanana R, Dinshaw K, Nene BM, Ramadas K, Esmy PO, Jayant K, et al. Cervical and oral cancer screening in India. J Med Screen 2006;13 Suppl 1:S35-8.  Back to cited text no. 18
    

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Correspondence Address:
Bushranaaz Fathima Jaleel
Department of Community Dentistry, Al-Azhar Dental College, Thodupuzha, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.99029

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    Tables

  [Table 1], [Table 2]

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