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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 676-677

Hygiene and cancer: A perspective

1 Tata Memorial Center, Mumbai, Maharashtra, India
2 Department of Surgical Oncology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Date of Submission15-May-2020
Date of Decision25-May-2020
Date of Acceptance27-May-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
T S Shylasree
Tata Memorial Center, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_198_20

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How to cite this article:
Shylasree T S, Kattepur AK. Hygiene and cancer: A perspective. Cancer Res Stat Treat 2020;3:676-7

How to cite this URL:
Shylasree T S, Kattepur AK. Hygiene and cancer: A perspective. Cancer Res Stat Treat [serial online] 2020 [cited 2021 May 5];3:676-7. Available from: https://www.crstonline.com/text.asp?2020/3/4/676/304947

Two of the important causes of cancer, especially in the developing world, are infection and chronic inflammation. Both lead to the upregulation of various pro-inflammatory pathways that have been linked to carcinogenesis. Conversely, certain anti-inflammatory effects of the commensals or “good” bacteria in the body can lead to regression of cancer cells. This “cancer hygiene” hypothesis is based on the role of certain microbiota and helminths in the human body in the downregulation of inflammation and the ability of pathogens and/or their products to enhance the anticancer immunity.[1],[2] One way to maintain a healthy microbiome is to maintain good personal hygiene.

The important components of hygiene include oral, genital, and sexual hygiene. Oral hygiene is important not only in the prevention of dental ailments but also in the prevention of cancer. Poor oral hygiene has been implicated in the causation of oral cavity, lung, pancreatic, and colorectal cancers. Poor oral health can manifest clinically as loss of teeth, decay or caries, and periodontal disease. Tobacco smoking and chewing result in chronic mucosal inflammation, periodontitis, and impaired mucosal defense barriers that can worsen oral health. In a study involving 403 patients with lung cancer and 1612 matched controls, loss of tooth/teeth and tooth decay were significantly related to an increased risk of lung cancer with an odds ratio of 1.64 and 1.65 when >10 and ≥6 teeth were lost, respectively.[3] Oral anaerobic microflora (Bacteroides and Fusobacterium spp.) have been associated with the development of colorectal cancers. This is related to the formation of a biofilm on the surface of these pathogens. Nonsteroidal anti-inflammatory drugs such as aspirin, by inhibiting this biofilm formation and reducing mucosal and periodontal inflammation, serve as one of the methods in the prevention of colorectal carcinogenesis.[4] Poor oral hygiene is often associated with oral squamous cell carcinomas and may very well be one of its plausible causative factors. One study[5] reported that poor oral hygiene was strongly associated with oral cancers, and those with poor hygiene were at an increased risk of developing oral cancers, even when other causative factors such as smoking and alcohol were adjusted for. Another study[6] involving 740 patients demonstrated that oral hygiene was an important prognostic factor in head-and-neck cancers and was associated with poor survival. Others have reported that periodontitis and self-reported poor oral health are associated with an increased risk of gastrointestinal cancers such as pancreatic cancer (64% increased risk)[7] and liver cancer (75% increased risk, with an even higher risk in patients with hepatitis/cirrhosis).[8]

Genital and sexual hygiene are the important parameters linked to the causation of genital cancers in both men and women. Genital hygiene generally refers to the physical hygiene of the genitalia, while sexual hygiene has a broader perspective that includes safe sex practices in addition to physical hygiene. Genital hygiene in men involves, but is not limited to, cleaning of the foreskin so as to clear off the accumulated smegma. In women, however, the concept of genital hygiene is more controversial. Practices such as vaginal douching, use of tampons, sprays/wipes, and powders have in fact been implicated in carcinogenesis through volatile organic compounds (e.g., 1,4-dichlorobenzene and ethyl-benzene) that are present in the blood at levels higher (ranging from 18% with occasional use to 81% with frequent usage) than controls.[9] Hence, genital hygiene in women involves allowing the vagina to cleanse itself naturally.

In a case–control study evaluating various risk factors for cervical cancer in high-risk women, the authors reported that although there was no increased risk from various douching or hygiene practices, poor hygiene (infrequent washing of genitalia) during menstruation was associated with a heightened risk for cervical cancer.[10] However, an overuse of soaps/cleansers/bubble baths has been associated with chronic irritation and dermatitis of the vulvar skin, especially in the older women.[11] An increased risk of sexually transmitted infections, such as human immunodeficiency virus (HIV), human papillomavirus (HPV), and trichomoniasis, may be attributable to poor genital/sexual hygiene, which is often compounded by unsafe sexual practices in both men and women. These, in turn, are risk factors for anogenital cancers in both the sexes. The various mechanisms, leading to an increased risk of infection and carcinogenesis in the cervix, include alterations in the vaginal pH, repeated microtrauma to the cervix that allows viral entry through the breached mucosa, and immunosuppression by HIV. These changes lead to persistent and recurrent infections, increased viral load, changes in the vaginal microbiota, and integration of the viral DNA into the cervical and genital tract mucosae.[12] Similarly, HPV carcinogenesis is associated with anal cancers, in individuals who indulge in anoreceptive intercourse.

The practice of circumcision in preadolescence has been associated with a reduced risk of penile cancer during later stages of life. This is related to better genital hygiene and reduction in the accumulation of smegma beneath the foreskin, which is common in uncircumcised males.[13] The association between circumcision and the development of cervical cancers is controversial. The low incidence of cervical cancers among the Jewish women may be related to the neonatal circumcision practices followed by the Jewish men. Circumcision also reduces the risk of sexually transmitted infections such as HPV that are involved in cervical carcinogenesis.[13]

In conclusion, the various hygiene practices not only prevent infectious diseases but also contribute to the reduction in the development of several types of cancers. Therefore, the association between hygiene and cancer should be emphasized in various cancer prevention programs. Moreover, sensitizing people about cancer prevention with the practice of personal hygiene during the COVID-19 era could be more effective as they are currently very receptive to hygiene etiquettes.

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  References Top

Fernandes R, Alves H, Botelho MC. The cancer hygiene hypothesis: From theory to therapeutic helminths. Curr Cancer Ther Rev 2019;15:248-50.  Back to cited text no. 1
Oikonomopoulou K, Brinc D, Kyriacou K, Diamandis EP. Infection and cancer: Revaluation of the hygiene hypothesis. Clin Cancer Res 2013;19:2834-41.  Back to cited text no. 2
Yoon HS, Wen W, Long J, Zheng W, Blot WJ, Cai Q. Association of oral health with lung cancer risk in a low-income population of African Americans and European Americans in the South Eastern United States. Lung Cancer 2019;127:90-5.  Back to cited text no. 3
Cordero OJ, Varela-Calviño R. Oral hygiene might prevent cancer. Heliyon 2018;4:e00879.  Back to cited text no. 4
Mathur R, Singhavi HR, Malik A, Nair S, Chaturvedi P. Role of poor oral hygiene in causation of oral cancer-a review of literature. Indian J Surg Oncol 2019;10:184-95.  Back to cited text no. 5
Chang CC, Lee WT, Hsiao JR, Ou CY, Huang CC, Tsai ST, et al. Oral hygiene and the overall survival of head and neck cancer patients. Cancer Med 2019;8:1854-64.  Back to cited text no. 6
Michaud DS, Joshipura K, Giovannucci E, Fuchs CS. A prospective study of periodontal disease and pancreatic cancer in US male health professionals. J Natl Cancer Inst 2007;99:171-5.  Back to cited text no. 7
Jordão HW, McKenna G, McMenamin ÚC, Kunzmann AT, Murray LJ, Coleman HG. The association between self-reported poor oral health and gastrointestinal cancer risk in the UK Biobank: A large prospective cohort study. United European Gastroenterol J 2019;7:1241-9.  Back to cited text no. 8
Ding N, Batterman S, Park SK. Exposure to volatile organic compounds and use of feminine hygiene products among reproductive-aged women in the United States. J Womens Health (Larchmt) 2020;29:65-73.  Back to cited text no. 9
Herrero R, Brinton LA, Reeves WC, Gaitan E, Garcia M, Rawls WE, et al. Sexual behaviour, venereal diseases, hygiene practices, and invasive cervical cancer in a high-risk population. Cancer 1990;65380-386.  Back to cited text no. 10
Lambert J. Pruritus in female patients. Biomed Res Int 2014;2014:541867.  Back to cited text no. 11
Kyrgiou M, Mitra A, Moscicki AB. Does the vaginal microbiota play a role in the development of cervical cancer? Transl Res 2017;179:168-82.  Back to cited text no. 12
Warner E, Strashin E. Benefits and risks of circumcision. Can Med Assoc J 1981;125:967-92.  Back to cited text no. 13


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