Exploring the risk factors for oral cancer in Pakistan: a systematic literature review

Background: Oral cancer is one of the major public health issues in Pakistan and is the second most common malignancy in the country. This is mainly attributed to the widespread use of smokeless tobacco products, cigarettes, and paan without tobacco. This review aims to go beyond commonly discussed factors and, consequently, to provide a comprehensive picture of all the multi-faceted contributors to the high prevalence of the carcinoma of the oral cavity, including the role of human papillomavirus and genetic predisposition. The aim is to synthesise all available evidence on the predisposing factors of oral carcinoma in Pakistan. Methods: This is a comprehensive systematic review of all observational studies investigating the contributing factors of malignancy of the oral cavity in Pakistan, and it strictly follows the PRISMA guidelines. Multiple databases, such as PubMed, EBSCO CINAHL Plus, SCOPUS, and Ovid Medline, were used to find studies, and the Cochrane Database of Systematic Reviews was searched for existing/ongoing reviews carried out on the same topic. A meta-synthesis of selected studies was carried out to create robust and statistically valid conclusions. Results: ST and cigarette smoking were found to be the major contributors to the burden of carcinoma of the lip and oral cavity. The included studies indicated that genetic predisposition and human papillomavirus could be major risk factors for the disease in the Pakistani population, but not enough research has been carried out to find their true impact. Conclusions: Smokeless tobacco, cigarette smoking, genetic predisposition, and human papillomavirus can be considered significant risk factors for oral cancer in Pakistan.