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. The limited and contrasting evidence regarding the association of ABO blood groups with the different types of head and neck cancers in the Indian population warrants the need for the present study.
Aim and Objective: To assess the relative risk of various Head & Neck cancers among different blood groups.
Materials and Method: Three hundred sixty two diagnosed cases of different type of head and neck cancers and 400 controls were selected from four hospitals of New Delhi, India. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients regarding their socio demographic profile, dietary history using a structured performa. The information regarding type of cancer (cases only), ABO blood group was collected.
Statistical Tests: The data was analysed using the SPSS 19 version. Chi square test and odd ratios were calculated. The level of significance was fixed at 5%.
Results: The O blood group was found to be most prevalent followed by B, A and AB among the cases as well as the controls. Oral cancer patients showed maximum number in blood group O followed by B, A and AB. Significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p= 0.003, p=0.000 p=0.112 respectively.
Conclusion: The present study reveals that there is an inherited element in the susceptibility or protection against different types of head and neck cancers. Blood group A was found to be a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood group B was found to be a potential risk factor for laryngeal cancers.
Keywords: Blood Groups, Oral cancer, Esophageal cancers, Laryngeal cancer, Salivary gland cancers
Introduction
Cancer, known medically as a malignant neoplasm, is a broad group of diseases involving unregulated cell growth wherein cells divide and grow uncontrollably, forming malignant tumors, and invading nearby parts of the body. 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 18% of the deaths throughout the world [1].
In India, cancer has become one of the leading death causes. It is estimated that there are nearly 1.5 to 2 million cancer cases at any given point of time. Data from population-based registries under National Cancer Registry Programme indicate that the leading sites of cancer are oral cavity followed by lungs, oesophagus and stomach amongst men and cervix, breast and oral cavity amongst women. Cancers namely those of oral and lungs in males, and cervix and breast in females account for over 50% of all cancer deaths in India [2,3,4,5]. The increasing number of cancer related morbidity and mortality has been related to its multifactorial etiology, particularly lifestyle factors such as chronic use of tobacco, spicy food, alcohol and smoking [6,7].
In addition to these lifestyle factors, the role of genetics and heredity in the etiology of the cancer cannot be overemphasized. The ABO blood group is one of such genetic factor that has been hypothesized in the etiology of various chronic diseases. The possibility of association between ABO blood groups and malignancy was first explored by Anderson DE & Haas C [8]. Since then high incidence of blood Group A in various cancers, including neurologic tumours, salivary Gland, colon, uterus, ovary, pancreas, kidney, bladder and cervix and consistent relation to O blood group in skin and melanoma has been reported in many studies [9,10].
ABO blood group genes are mapped at 9q region in which genetic alteration is common in many cancers [11]. Thus, blood group antigen expression may be affected by genetic change of tumor. A correlation of blood group antigen expression in tumor has been reported for various human malignancies, such as colon, breast and prostate cancer as the blood group carbohydrates expressed on cell surface of metastatic cancer cells function as cell adhesion molecules [12,13].
In India, head and neck cancers are one of the leading causes of mortality, accounting for about 40% of all cancers of the body and affecting large number of population Along with the lifestyle related factors, the genetic and hereditary influences have been implicated in the etiology of head and neck cancers particularly oral cancer. The ABO blood groups is one such genetic factor that have been studied to be associated with the oral cancer [14]. Studies done by Gupta, Nayak, Baruah and Gogoi have shown that individuals with blood group A have predisposition for oral cancer [14–16]. Raghavan et al., 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 [17].Hakomori documented decreased expression of histo-blood-Group antigens A and B in the patients of oral carcinomas [18].
The documented association between blood groups and head and neck cancer have been limited to oral cancer particularly in India and there has been limited documentary evidence regarding association between other types of head and neck cancers viz salivary tumours, oesophageal tumours and blood groups. Hence, the present study aimed to assess the relative risk of various head and neck cancers among different blood groups of patients attending oncology department of multi-speciality hospitals in Delhi, India.
Materials and Method
The present analytical study was conducted in Oncology ward of four multi-specialty hospitals over a period of 6 months (January to June 2013), after obtaining ethical clearance from the institutional review board and permission from the concerned authorities of the various multispeciality hospitals in Delhi, India.
The city of Delhi was divided for the study purpose into four zones namely North, South, East and West and stratified random sampling method was employed to select one multispecialty hospital from each zone. A total of 362 head and neck cancer patients (cases) and 400 controls were included from the four selected hospitals based on following inclusion and exclusion criteria.
Inclusion Criterion
Subjects histopathologically diagnosed for head and neck cancer
Subjects who gave informed consent
Exclusion Criterion
Patients with in situ carcinoma but with no histopathological confirmation
Patients with some other type of carcinoma along with head and neck cancer
Patients with genetic disorder
The control group comprised of 400 healthy subjects who visited the oncology department along with the cancer patients. The information was collected from the study subjects (cases=362 and controls=400) regarding their socio demographic profile, dietary history and personal history using a structured Performa. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients. The blood group of the cases and controls was collected by a single trained and calibrated investigator using finger prick method and blood typing done by tube method.
Statistical Analysis
The data was entered in the Microsoft Excel and processed using the SPSS 19 version. The descriptive statistics included calculation of frequency of patients and healthy subjects with different type of blood groups. The association between different type of head and neck cancers and blood groups was analyzed using Chi-square test and calculation of Odds ratio. The level of significance was fixed at 5%.
Results
The present analytical study was conducted on a total of 762 study subjects, out of which 362 were head and neck cancer patients and 400 were controls in the age group of 20-65 years. The mean age for the patients was 53.97+13.65 and for controls was 46.01+8.01 irrespective of the blood groups. The analysis of the blood group distribution among the patients and controls has been shown in [Table/Fig-1] where the difference among the distribution between the cases and controls was statistically significant in blood group A(P=0.04).
[Table/Fig-1]:
Blood group distribution between cases and control
| Blood Group | A (%) | B (%) | AB (%) | O(%) |
|---|---|---|---|---|
| Cases | 75 (20.72) | 119 (32.87) | 31 (8.56) | 137 (37.85) |
| Controls | 51 (12.75) | 142 (35.5) | 47 (11.75) | 160 (40) |
| p-value | 0.04 | 0 .15 | 0.07 | 0 .18 |
The analysis of blood group distribution among the various types of head and neck cancer patients revealed that the most prevalent blood group among the patients was blood group O followed by B, A and AB(p=0.000). A similar significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p= 0.003, p=0.001 p=0.112 respectively) [Table/Fig-2].
[Table/Fig-2]:
Blood group and type of cancer
| Type of cancer | Blood Group A (%) | Blood Group B (%) | Blood Group AB (%) | Blood Group O (%) | Total N (%) | P-Value |
|---|---|---|---|---|---|---|
| Oral cancer | 46(21.49) | 70(32.71) | 19(8.87) | 79(36.93) | 214(59.11) | 0.000 |
| Esophageal cancer | 15(20.83) | 22(30.55) | 7(9.74) | 28(38.88) | 72(20) | 0.003 |
| Laryngeal cancer | 06(14.29) | 19(45.24) | 1(2.38) | 16(38.09) | 42(11.60) | 0.000 |
| Salivary gland cancer | 8(23.53) | 8(23.53) | 4(11.74) | 14(41.2) | 34(9.29) | 0.112 |
The strength of association between ABO blood groups and individual head and neck cancers was assessed by odds ratio [Table/Fig-3]. It was found that blood Group A had 1.84 times higher risk of developing oral cancer compared to people of other blood groups.
[Table/Fig-3]:
Odds Ratio
| Type of cancer | Oral Cancer | Esophageal cancer | Laryngeal cancer | Salivary gland cancer |
|---|---|---|---|---|
| Blood Group A | 1.84 | 1.8 | 1.14 | 2.105 |
| Blood Group B | 1.81 | 0.79 | 1.50 | 0.55 |
| Blood Group AB | 0.73 | 0.80 | 0.18 | 1.00 |
| Blood Group O | 0.87 | 0.29 | 0.92 | 1.05 |
Discussion
The blood group is a genetic factor that has established correlation with different cancers particularly gastric and esophageal cancer although its role in oral cancer is still unclear.
Blood Group O was found to be maximum among the study population owing to the generalized prevalence of O blood group in Indian population followed by blood Group B, A and AB resulting in a similar pattern of blood group distribution among cancer patients as well. This is in agreement with the study done by Sharma G et al., [19].
Assessing the potential risks of the ABO blood groups for the development of various head and neck cancers through odds ratio, it was found that blood group A had highest potential of developing Oral cancer (OR=1.84 P<0.05). These findings are in agreement with the study conducted by Jaleel B [14]. The probable reason behind this could be that in people belonging to A and B blood Groups, the precursor H antigen is converted to A and B antigen increasing the risk for the development of oral cancer since H antigen have been found to be protective factor for oral cancer. In O blood group individuals, it remains in original form and thus, people with blood group O have highest amount of H antigen which affords protection against oral cancer. Another genetic factor found consistently associated with oral cancers is the p56 gene mutation [14]. The altered antigen pattern on the surface is a tumor- associated change resulting in malignancy. It is also possible that the observed associations are not due to the blood group antigens themselves, but to the effects of genes closely associated with them [20].
Esophageal cancer was also found more in patients of A blood Group which is similar to a study done by Guleria et al., 2005, Pinkston JA et al., Nozoe T et al., [21–23] whereas contradictory results were found by Aminien A et al., [24] which shows the presence of esophageal cancer more in blood group B followed by A (0.027). For salivary gland cancer patients also, blood group A was found in majority of the patients which is contrary to the results of Garrett JV et al., in which no significant relation was found between blood group and salivary cancer [25]. However, Laryngeal cancer was found to be more in blood Group B which is contradictory to the results by Adam SI et al., who showed a higher prevalence among patients with blood Group A [26]. No specific reason has been documented so far for the prevalence of specific blood groups among various head and neck cancers.
Hence, the present study reveals a strong association of Blood Group A with most of the head and neck cancer patients, though the actual reason of association of oral cancer with a particular blood group still remains unknown as H antigen is present in all the individuals irrespective of the blood group types. Additionally, it might have nothing to do with molecular mechanisms or genetics [27,28]. However, the limitation of the study lies in the lack of genetic mapping of the subjects. Genetic mapping is required to ascertain the proposed hypothesis. Thus, further longitudinal studies on blood groups in large series are needed to elucidate and confirm the relationship between blood groups and head and neck cancers.
Thus, study results indicate susceptibility of different blood groups for specific head and neck cancers which creates a need to spread awareness among the mass for the same. Early and regular Cancer screening should be advised to the patients of susceptible blood groups if any known etiologic factor like tobacco or alcohol abuse is noticed or if any sign or symptom of head and neck cancer is suspected. They should be trained for self examination and be encouraged for early referral of cancer screening if in doubt [29]. Public health professionals should work towards awareness, advocacy and action on health through tobacco cessation programmes, collaborating with other institutions and organizations and meeting the nutritional needs of patients of cancer, other diseases as well as malnourished/undernourished people which are all risk factors for development of cancer. Area Volunteers or health workers can be utilized as a part of various outreach programmes who can aid in bringing awareness about the cancer and its preventive methods to people at the local level within their areas, continuous self-monitoring and screening of susceptible individuals as well as regular health education can be reinforced as a preventive measure [30].
Blood donation camps can be utilized as a platform wherein when the blood is collected and blood group is recorded, the donors with susceptible blood groups can be counseled and regular cancer screening can be planned for such individuals. Oncology and dental teams should work hand in hand for early detection of cancers. Also, lifestyle modification for giving up tobacco habits and alcohol abuse, if present, needs to be initiated for these individuals. Hence, a comprehensive team effort is required to utilize the opportunities for prevention of the occurrence of cancer in susceptible blood groups [30].
Conclusion
The results of the present study conducted in various hospitals in Delhi indicated that Blood Group A is a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood Group B was a potential risk factor for laryngeal cancers. It appears that different blood groups are associated with different manifestations of the disease. From this correlation of blood groups and various cancers, it follows that there is an inherited element in the susceptibility or protection against different types of cancers; and the racial and ethnic distribution of blood groups is an important factor for predicting the cancer risk. The identification of genetic and environmental factors among racial and ethnic groups should offer some insights into the observed epidemiological data and advance opportunities to better understand the control and development of cancer.
Financial or Other Competing Interests
None.
References
- [1].Park Park K. Textbook of Preventive and Social Medicine. 21st ed. Jabalpur: Banarsidas Bhanot Publishers; 1997. pp. 353–5. [Google Scholar]
- [2].Nand KA. Consolidated report of population based Cancer Registeries. Indian council of Medical Research. 2001;1:212. [Google Scholar]
- [3].Kishore J. National Policies and Legislations Related to the Health. 12th ed. New Delhi: Century Publications; 2012. National Health Programmes of India; pp. 230–40. [Google Scholar]
- [4].Loddenkemper R, Minks T, Nitz M, Otte F, Koch M. ABO blood groups as a genetic host factors of lung cancer risks. Vol. 20. Berlin: Institute for Klinische Pharmokologie, Freie Universitat; 2002. pp. 114–7. [Google Scholar]
- [5].Merhrazin M. ABO blood group frequency and brain tumors. Sur Oncol. 2002;13:110–4. [PubMed] [Google Scholar]
- [6].Ghavamzadeh A, Moussavi M, Jahani M, Rastegarpanah, Iravani M. Esophageal Cancer in Iran. Semin Oncol. 2001;28:153–7. doi: 10.1016/s0093-7754(01)90086-7. [DOI] [PubMed] [Google Scholar]
- [7].Gholipour CR, Shalchi A, Abaasi MA. Histopathological study of Esophageal Cancer on the Western side of the Caspian Littoral from 1994-2003. Dis Esophgus. 2008;21:322–7. doi: 10.1111/j.1442-2050.2007.00776.x. [DOI] [PubMed] [Google Scholar]
- [8].Anderson DE, Haas C. Blood Type A and Familial Breast Cancer. Cancer. 1984;54:1845–9. doi: 10.1002/1097-0142(19841101)54:9<1845::aid-cncr2820540913>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
- [9].Shankaranayanana R, Dinshaw K, Nene BM, Ramdas K, Esmy P O, Jayant K, et al. Cervical and Oral Cancer screening in India. J Med Screen. 2006;13:35–8. [PubMed] [Google Scholar]
- [10].Bhasin M K, Walter H, Danker HH. The distribution of Genetical, morphological and Behavioural Traits among the Peoples of Indian Region. New Delhi: Raj Publisher; 1992. pp. 51–5. [Google Scholar]
- [11].Henderson J, Seagrott V, Goldacre M. Ovarian cancer and ABO blood groups. J. Epidemiol. Comm. Health. 1993;47:287–9. doi: 10.1136/jech.47.4.287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12].Karakousis CP, Evlogimenos E, Sun O. Blood groups and malignant melanoma. J. Surg. Oncol. 1986;33:24–6. doi: 10.1002/jso.2930330107. [DOI] [PubMed] [Google Scholar]
- [13].Sharma G, Choudhary R, Bharti D. Studies Showing the Relationship between ABO Blood Groups and Major Types of Cancers. Asian J. Exp. Sci. 2007;21(1):129–32. [Google Scholar]
- [14].Jaleel B, Nagarajrappa R. Relationship between ABO blood groups and oral Cancer. Ind J Dent Res. 2012;23(1):7–10. doi: 10.4103/0970-9290.99029. [DOI] [PubMed] [Google Scholar]
- [15].Nayak SK. ABO blood groups in different diseases. J Indian Med Assoc. 1971;57:449–52. [PubMed] [Google Scholar]
- [16].Baruah BD, Gogoi BC. Blood groups in cancer in Assam, India. Indian J Cancer. 1977;14:6–9. [PubMed] [Google Scholar]
- [17].Raaghvan VM, Baloor DN, Jhansirani P. Incidence of ABO blood groups in oral cancer in South Knanara District. J Ind Dent Assoc. 1986;58:305–8. [Google Scholar]
- [18].Hokomori S. antigen structure and genetic basis of histo-blood groups AB and O; their changes associated with human cancer. Biochim Biophys Acta. 1999 6;1473(1):247–66. doi: 10.1016/s0304-4165(99)00183-x. [DOI] [PubMed] [Google Scholar]
- [19].Sharma G, Choudhary R, Bharti D. Studies Showing the Relationship between ABO Blood Groups and Major Types of Cancers. Asian J. Exp. Sci. 2007;20(1):129–32. [Google Scholar]
- [20].Hu N, Roth MJ, Polymeropolous M, Tang ZZ, Emmert Buck MR, Wang QH. Identification of novel regions of allelic loss from a genome wide scan of oesophageal squamous cell carcinoma in a high risk Chinese population. Genes Chrom Cancer. 2000;27:217–8. doi: 10.1002/(sici)1098-2264(200003)27:3<217::aid-gcc1>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
- [21].Guleria K, Singh PS, Kaur H, Sambya V. ABO Blood Groups in Gastrointestinal Tract (GIT) and Breast Carcinoma Patients. Anthropologist. 2005;7(3):189–92. [Google Scholar]
- [22].Pinkston JA, Cole P. ABO blood groups and Salivary Gland Tumours (Alabana, United Staes) Cancer Causes Control. 1996;7:572–4. doi: 10.1007/BF00051698. [DOI] [PubMed] [Google Scholar]
- [23].Nozoe TT, Ezaki H, Bada Y, Machara Kakeji. Correlation of ABO blood group with clinicopathologic characteristics of patients with Esophgeal squamous cell Carcinoma. Dis Esophagus. 2004;17:146–9. doi: 10.1111/j.1442-2050.2004.00392.x. [DOI] [PubMed] [Google Scholar]
- [24].Aminian A, Rasul M, Alibkshi A, Khorgami Z, Habibula D, Sharareh M. Relationship between Esophageal Cancer and Blood Group. World Appl Sci J. 2010;8(4):503–8. [Google Scholar]
- [25].Garrett JV, Whittaker JS, Nicholson A, Ridway JC, Bowman CM. Blood-Groups And Secretor Status In Patients With Salivary-Gland Tumours. The Lancet. 1971;298(7735):1177–9. doi: 10.1016/s0140-6736(71)90490-9. [DOI] [PubMed] [Google Scholar]
- [26].Adam SI, Wilson KM, Overholser SM, Khabbaz E, Moreno K, Patil YJ. Are laryngeal squamous cell carcinoma incidence and patient mortality a function of ABO blood grouping? A retrospective study. J Laryngol Otol. 2012;2:180–4. doi: 10.1017/S0022215111002507. [DOI] [PubMed] [Google Scholar]
- [27].Jayant K. Relationship of ABO blood group to certain types of Cancers in Western India. Indian J Cancer. 1971;8:185–8. [PubMed] [Google Scholar]
- [28].Akhtar K, Mehdi G, Sherwani R, Sofi L. Relationship Between Various Cancers And ABO Blood Groups – A Northern India Experience. Int J Pathol. 2010;13(1):3–7. [Google Scholar]
- [29]. http://www.epi.grants.cancers.gov/workshops/century-trends/. Page last updated on 13 September 2013. [Accessed on 1st Jan 2014]
- [30]. http://www.canceraid.org/index.php/future-projects/ page last updated on December 2013. Page. [accessed on 1st Jan.2014]