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THE question of the effects of tobacco smoking on the oral tissues has been one of the most perplexing in the research, over the last 20 years, into the effects of smoking on mortality. In three successive reviews13 the Public Health Service has steadily increased its assessment of the causal significance of tobacco smoking in the carcinogenesis of oral cancer. The earliest of these reviews, the 1964 Report to the Surgeon-General, concludes that, "although there are suggestions of relationships between cancer of the specific sites of the oral cavity and the several forms of tobacco use, the causal implications cannot at present be stated." 1, P. 205 It was clear that the study of the effects of tobacco upon the oral cavity would require: increased attention to the experimental prodluction of oral cancer, the separation of the oral cancer category (ICD code 140-148) into more specific sitcs, more detailed information about the smoking practice of subjects, and greater attention to other personal practice variables-e.g., alcohol consumptioni-which are involved in oral carcinogenesis and tend to covary with smoking practice. These concerns require detailed attention in the early planning stages of research, and result in increasingly complicated problems of data collection and analysis. While the time since publication of the report has been too short to allow the execution and publication of a large number of new studies, there have been new reports of older data and some reports of newer data which reflect an awareness of the special problems of oral cancer study. Time and space require that this report ignore the literature on the experimental production of oral lesions in laboratory animals, and clinical studies of tobacco's basic effects on the tissue of the mouth. Instead, concern will be with the recent epidemiological literature on smoking and oral cancer and the presentation of some new prospective study data on smokers' risk of death due to cancer from specific oral sites.

Smoking and oral cancer: epidemiological data, educational responses.