File # 02em

J Vet Intern Med 2003;17:557–562

Environmental and Lifestyle Risk Factors for Oral Squamous Cell

Carcinoma in Domestic Cats
Elizabeth R. Bertone, Laura A. Snyder, and Antony S. Moore

Oral squamous cell carcinoma (SCC) is a common malignancy in cats, but little currently is known about its etiology. We examined
the relationship between risk of oral SCC and factors such as environmental tobacco smoke, flea control products, and diet in 36
domestic cats with histologically confirmed oral SCC and 112 renal disease control cats presented to a large veterinary referral
hospital between 1994 and 2000. Questionnaires were mailed to owners of all study and control cats to assess demographic
characteristics, lifestyle factors, and level of chemical exposures 2 years before diagnosis. Multivariate relative risks (RR) were
used to estimate the relationships between the various factors and the risk of oral SCC. Flea control product use and diet were
significantly associated with risk of oral SCC. Cats that wore a flea collar had 5 times the risk of oral SCC as nonusers, after
adjustment for other factors (RR 5 5.3; P 5 .002). In contrast, use of flea shampoo substantially reduced risk. Compared to cats
eating mostly dry food, those with high canned food intake had a 3-fold increase in risk (RR 5 3.6; P 5 .014); canned tuna fish
intake was independently associated with risk (RR 5 4.7; P 5 .004). Exposure to household environmental tobacco smoke was
associated with a nonsignificant 2-fold increase in risk (P 5 .11). Results of this study suggest that flea control products, diet, and
perhaps environmental tobacco smoke might be associated with risk of oral SCC and indicate that further investigation into these
relationships is warranted.
Key words: Diet; Environmental tobacco smoke; Epidemiology; Flea control; Oral cancer.

C ancer of the oral cavity is the 4th most common tumor

of the domestic cat.1,2 As in humans, oral cancer in
cats occurs most frequently as squamous cell carcinoma
(SCC), with tumors developing on the tongue, gingiva, lips,
and oropharynx. Cats with SCC can experience a variety
of clinical signs, including oral pain, difficulty in swallow-
ing, excessive salivation, anorexia, and loosening or loss of
teeth. On diagnosis, tumors often are ulcerated and accom-
panied by secondary bacterial infection. Oral tumors are
extremely invasive locally, but rarely metastasize to distant
locations, although regional lymph nodes can be affected.3,4
Even with treatment options of surgery, radiation, and che-
motherapy, cats diagnosed with oral SCC have a poor prog-
nosis, with a 1-year survival rate of less than 10%.4 Al-
though some data suggest that the incidence of oral SCC
in cats might increase with age, few other risk factors for
the disease have been identified.1,2,5
Numerous epidemiologic studies in humans suggest that
use of cigarettes and smokeless tobacco products increases
the risk of oral SCC.6–8 More than 40 mutagens and carcin-
ogens have been identified in tobacco smoke, several of
which have been implicated in human carcinogenesis.9–12 In
experimental studies, oral tumors have been induced in ro-
dents by exposure of their oral mucosa to carcinogens
From the Department of Biostatistics and Epidemiology, School of
Public Health and Health Sciences, University of Massachusetts, Am-
herst, MA (Bertone); and the Department of Clinical Sciences (Ber-
tone) and the Harrington Oncology Program (Snyder, Moore), Tufts
University School of Veterinary Medicine, North Grafton, MA. A brief
synopsis of elements of this research were presented at the American
College of Veterinary Internal Medicine Forum, 2002, and Health
Ecosystems Health People, 2002.
Reprint requests: Dr Elizabeth Bertone, ScD, Department of Bio-
statistics and Epidemiology, 409 Arnold House, University of Mas-
sachusetts, 715 North Pleasant Street, Amherst, MA 01003-9304; e-
mail: ebertone@schoolph.umass.edu.
Submitted June 20, 2002; Revised October 23, 2002; Accepted De-
cember 30, 2002.
Copyright q 2003 by the American College of Veterinary Internal
Medicine
0891-6640/03/1704-0012/$3.00/0
found in smokeless tobacco.13,14 Additional studies in hu-
mans have suggested that oral SCC might be associated
with aspects of diet,15–18 oral hygiene,16,19–21 and occupa-
tional exposure to pesticides.22,23
In sharing their living environment with humans, pet cats
are exposed to many of the same environmental contami-
nants as their owners.24 For example, cats living with smok-
ers might be exposed to substantial concentrations of en-
vironmental tobacco smoke (ETS), both through inhalation
and oral ingestion during grooming of particulate matter
deposited on the fur. Like humans, cats exposed to house-
hold ETS metabolize nicotine into cotinine and demonstrate
urinary cotinine concentrations that increase with exposure
dose (Bertone, unpublished data). Similarly, grooming be-
havior can expose a cat’s oral cavity to high concentrations
of other chemicals, such as those contained in flea control
products.
To assess whether exposure to ETS and other factors can
increase the risk of oral SCC in domestic cats, we con-
ducted a hospital-based case-control study of this exposure
in cats presented to the Tufts University School of Veteri-
nary Medicine (TUSVM).
Materials and Methods
The Foster Small Animal Hospital at TUSVM is a large veterinary
teaching hospital in central Massachusetts and serves as the referral
hospital for the region. The Animal Care and Use Committee at
TUSVM reviewed and approved the protocol used in the study.
Case Definition
Eligible cats for this study included all cats receiving biopsy-con-
firmed diagnoses of oral squamous cell carcinoma (SCC) made by
board-certified pathologists at the Harrington Oncology Clinic of the
Foster Small Animal Hospital at TUSVM between January 1994 and
June 2000 (n 5 61). In June 2000, letters were then sent to owners
of all eligible cats at their last known address acknowledging a pre-
vious diagnosis of oral SCC in their pet and explaining the general
purpose of the study, but not the study objectives. Owners were asked
to complete a short questionnaire inquiring about general character-
istics of their pet’s care and home environment and to return the ques-
tionnaire to TUSVM in the enclosed, postage-paid envelope. Owners

558 Bertone, Snyder, and Moore
who had not responded by mail within 2 months were sent a 2nd copy
of the introduction letter and questionnaire. Nonrespondents to the 2nd
mailing were telephoned by study staff and asked to complete the
questionnaire over the phone. Complete questionnaire information was
obtained from 36 (59%) owners of study cats. Of the nonrespondents,
4 (7%) refused to participate, 7 (11%) could not be reached by tele-
phone, and 14 (23%) were no longer living at their last known address
and could not be located.
Control Definition
Eligible control animals were 168 cats diagnosed with renal failure
at TUSVM between January 1994 and June 2000. The control group
also was used for a concurrent study of risk factors for feline malignant
lymphoma.25 These cats were selected as controls because renal dis-
ease is a nonmalignant, serious condition but is not known to be eti-
ologically associated with passive smoking in either cats or humans.
In addition, cats with renal disease diagnosed at TUSVM were be-
lieved to be more representative of the population that gave rise to
oral SCC than healthy controls would be because cat owners who
bring their pets to a large teaching hospital for clinical evaluation and
laboratory testing are likely to differ substantially from the general
population of cat owners. The diagnosis of renal failure in all potential
controls was based on low urine specific gravity (,1.018) and pres-
ence of concurrent azotemia (abnormally high serum creatinine con-
centration). Mailing procedures were identical to those used in the
study group. Completed responses were obtained ultimately from 112
(67%) owners of control animals, whereas 14 (13%) refused partici-
pation, 13 (12%) could not be reached by telephone, and 28 (25%)
were no longer living at their last known address and could not be
located.
Exposure and Covariate Assessment
The owners of eligible cats and controls were sent a 2-page ques-
tionnaire inquiring about the characteristics, care, and home environ-
ment of their pet in a specific year, corresponding to 2 years before
the diagnosis of oral SCC or renal disease; we specifically asked about
the period 2 years before diagnosis in order to capture exposure levels
at a time that would be etiologically relevant to the development of
incident disease.4,26 Questions on characteristics of the subject included
age, birth year, sex, breed, hair length, reproductive status (ie, neutered
or spayed versus reproductively intact), and general medical history.
Other questions inquired about aspects of the cat’s care and home
living environment, such as number of years owned, frequency of
grooming, bathing, and teeth brushing (never, 1–2 times ever, once a
year, twice a year, once every 2–3 months, once a month or more),
amount of time the cat spent outside during the day and at night, house
size, home location, and home heating sources. Questions pertaining
to exposure to ETS queried whether the cat had ever lived in the same
household as a smoker, the types of tobacco products used (cigarettes,
cigars, pipes), the number of years the cat had lived with a smoker,
total number of smokers in the household, and the average number of
cigarettes smoked per day by all household members combined. To
measure use of flea control products, owners were asked whether they
had ever used flea control products on their cat and what type of
products were used (eg, collars, shampoos, sprays, powders, pills,
drops). The usual diet of subjects was measured by asking owners
what proportion of their pet’s total diet consisted of dry food, moist
canned food, table scraps, canned tuna fish, and liver (none, less than
half, more than half, all).
Statistical Analysis
Division of cats into categories was based on level of exposure in
the 2 years before diagnosis to various potential risk factors for oral
SCC, as reported by their owners via questionnaire. Several aspects
of ETS exposure were evaluated, including ‘‘ever’’ versus ‘‘never ex-
File # 02em
posed,’’ duration of exposure (none, ,5 years, $5 years), number of
household smokers (0, 1, 2, or more), and average total number of
cigarettes smoked per day by all household members (0, 1–19, $20).
Flea control product use was categorized in several ways. Cats 1st
were divided into categories on the basis of the use of any flea control
product (any versus none). We then classified animals as users or non-
users of specific types of products, including collars, shampoos,
sprays, powders, and medication. Cats were divided into groups on
the basis of make-up of their usual diet (mostly dry food, equal
amounts of dry and canned cat food, mostly canned cat food). Cate-
gorization of animals also was based on their usual intake of tuna fish,
table scraps, and liver. We classified intake of these foods as ‘‘any’’
versus ‘‘none,’’ because no owner reported a high intake of either of
these foods. Other factors including frequency of bathing, grooming
and teeth brushing were categorized as ‘‘any’’ versus ‘‘none’’ because
few owners reported these practices more than once per year.
Odds ratios were used to estimate the relative risk (RR) for the
association between all risk factors and oral SCC, with RR 5 1.0
indicating no association between the exposure and disease. Ninety-
five percent confidence intervals (CIs) were calculated to evaluate the
role of chance; intervals that excluded the null value of 1.0 were con-
sidered to be statistically significant. P-values for all associations were
calculated by the Wald test, with P , .05 considered to be statistically
significant. Multivariate logistic regression modeling (SPSS system)a
was used to adjust all risk estimates for confounding factors.27 A co-
variate was considered to be a confounder and included in the multi-
variate regression model if its inclusion altered the RR for the exposure
of interest and oral SCC by 10% or more.
Results
Age-adjusted RR for the association between oral SCC
and selected characteristics are presented in Table 1. Study
cats were significantly older than controls and were slightly
more likely than controls to live in the suburbs. Study cats
were slightly less likely than controls to be bathed and or
to have their teeth brushed, but results were not significant.
After adjustment for other factors in multivariate analyses,
none of these factors were significantly associated with risk
of oral SCC. Home heating source, in addition to other
factors including sex, breed, hair length, declawing, repro-
ductive status, indoor or outdoor status, and drinking water
source, did not differ between study cats and controls.
Multivariate relative risks for oral SCC associated with
household exposure to passive smoking are presented in
Table 2. Cats that had ever lived in a household with a
smoker had a 2-fold increase in risk of oral SCC, with
results of marginal statistical significance (RR 5 2.3; 95%
CI, 0.8–6.5; P 5 .11). Risk also was high in animals that
had lived with a smoker for 5 or more years and in those
that lived with 2 or more smokers compared to those in
nonsmoking households. However, risk was not linearly as-
sociated with the total daily number of cigarettes smoked
by all household members. Whereas cats whose owners re-
ported smoking 1–19 cigarettes per day had a significant 4-
fold increase in risk of oral SCC compared to cats in non-
smoking households (RR 5 4.0; 95% CI, 1.1–14.8; P 5
.037), cats living in homes where $20 cigarettes were
smoked each day were not at increased risk (RR 5 1.3;
95% CI, 0.3–5.5; P 5 .77).
We then assessed the relationship between use of flea
control products and oral SCC (Table 3). Use of any flea
control product was associated with a nonsignificant 60%
increase in risk of oral cancer, compared to nonuse (RR 5
 File # 02em

Epidemiology of Feline Oral Squamous Cell Carcinoma 559

Table 1. Age-adjusted relative risks for selected charac- 1.6; 95% CI, 0.8–3.1; P 5 .19). However, use of specific
teristics of feline oral squamous cell carcinoma (SCC) cases types of flea control products was significantly associated
and renal disease controls. with risk. After adjusting for the effects of other factors,
cats that wore a flea collar had a significant 5-fold increase
Age-
in risk of oral SCC compared to nonusers (RR 5 5.3; 95%
No. of No. of Adjusted
Cases Controls RRa P-Valueb CI, 1.8–15.7; P 5 .002). In contrast, use of flea shampoo
was associated with a significant 90% reduction in risk of
Age at diagnosis oral SCC (RR 5 0.1; 95% CI, 0.04–0.6; P 5 .011). Use
,9 4 41 0.3 .065
of flea powders and sprays was not associated with risk of
10–14 21 46 1.0 .93
oral cancer.
$15 11 25 1.0 —
Sex Multivariate results concerning the relationship between
Male 16 58 1.0 — dietary factors and oral SCC are presented in Table 4. Cats
Female 20 54 1.3 .50 that ate mostly canned cat food had 3.6 times the risk of
Reproductive status oral SCC compared to those that ate mostly dry food (RR
Intact 1 7 1.0 — 5 3.6; 95% CI, 1.3–9.9; P 5 .014). Risk of oral SCC also
Spayed/neutered 35 105 1.6 .68 was significantly associated with intake of canned tuna fish;
Purebred cats whose usual diet consisted of any canned tuna fish had
No 34 101 1.0 — nearly 5 times the risk of oral SCC as those whose diet did
Yes 2 11 0.7 .71
not contain canned tuna (RR 5 4.7; 95% CI, 1.6–13.7; P
Long-haired
5 .004). Risk of oral cancer was not significantly related
No 27 75 1.0 —
Yes 9 37 0.7 .33 to intake of liver and table scraps.
Declawed
No 30 81 1.0 — Discussion
Yes 6 31 0.5 .23
Bathing Results from this case-control study suggest that several
None 34 98 1.0 — factors might be associated with the development of oral
Any 2 14 0.5 .16 SCC in domestic cats. Use of flea collars and dietary intake
Grooming of canned cat food and tuna fish were each associated with
None 29 75 1.0 —
a significant increase in risk of oral SCC. Cats exposed to
Any 7 37 1.3 .58
household environmental tobacco smoke also appeared to
Teeth brushed
None 7 29 1.0 — be at increased risk, but results were of marginal statistical
Any 29 83 0.4 .23 significance. In contrast, use of flea shampoo was associ-
History of dental problems ated with a substantial reduction in oral SCC risk. This
No 24 88 1.0 — study is the 1st to examine the association between risk
Yes 12 24 1.8 .18 factors such as passive smoking, flea control products, and
Cat allowed outdoors diet and risk of oral SCC in cats or other domestic animal
No 13 47 1.0 — species.
Yes 23 65 1.2 .59 Few epidemiologic studies of risk factors for disease in
Location of residence
cats have been conducted, but a recent study observed an
City 5 33 0.4 .067
increase in risk of malignant lymphoma in cats exposed to
Small town/suburb 20 47 1.0 —
Rural 10 31 0.7 .52 household ETS, with evidence of a strong dose-response
Drinking water source relationship.25 Several other studies have considered the re-
City water 12 26 1.0 — lationship between exposure to passive smoking and cancer
Other 23 86 0.6 .23 in pet dogs, which have been proposed as appropriate sen-
Heating sourcec tinels for environmental health hazards in humans.24,28 In 2
Oil 7 19 0.8 .61 case-control studies based in a Colorado veterinary teaching
Wood 11 53 0.8 .65 hospital,29,30 Reif and colleagues evaluated the associations
Coal 22 60 0.9 .90 between household exposure to ETS and risk of lung, nasal,
Gas 1 3 0.4 .12
and sinus cancers in pet dogs. Dogs exposed to ETS dem-
a
Relative risks (except for age) adjusted for age (continuous). onstrated a nonsignificant 60% increase in risk of lung can-
b
Wald test from age-adjusted logistic regression modeling compar- cer.29 Risk of nasal cancer was significantly higher in long-
ing the risk of oral SCC for subjects in each level of the factor to that nosed dogs exposed to household ETS than in unexposed
of subjects in the reference level. animals, but there was no evidence of an increase in risk
c
Numbers do not sum to total numbers of study plus control cats in short-nosed breeds.30 Although the findings do not sug-
because respondents could report more than one heating source; heat- gest a clear dose-response relationship between exposure to
ing sources adjusted for each other, and all compared to electric heat
household ETS and risk of oral SCC in cats, the observed
only.
increases in risk in cats with any household exposure and
in those with the longest duration of exposure suggest that
further evaluation of this relationship in larger studies might
be warranted.
Few studies have evaluated the relationship between fac-
 File # 02em

560 Bertone, Snyder, and Moore

Table 2. Multivariate relative risks for the relationship between exposure to household environmental tobacco smoke and
risk of feline oral squamous cell carcinoma.
No. of No. of
Cases Controls MV RRa 95% CI P-Valueb
Any household environmental tobacco smoke (ETS)
No 22 81 1.0
Yes 13 31 2.3 0.8–6.5 .11
Years of ETS exposure
0 22 81 1.0
.0–4 2 16 0.9 0.2–4.8 .86
$5 9 16 2.7 0.8–9.0 .12
Number of household smokers
0 22 81 1.0
1 7 24 2.0 0.6–7.1 .26
2 5 7 2.8 0.6–12.6 .20
Number of cigarettes smoked per day in household
0 22 81 1.0
1–19 8 17 4.0 1.1–14.8 .037
$20 4 10 1.3 0.3–5.5 .77
a
Multivariate relative risks (MV RR) adjusted for age, intake of canned cat food, intake of tuna fish, use of flea collars, and use of flea shampoo.
b
Wald test from multivariate logistic regression modeling.

tors such as diet and flea control product use and risk of
oral SCC in cats or other domestic animal species. How-
ever, studies of similar exposures in humans have suggested
that a variety of factors in addition to use of tobacco prod-
ucts might be etiologically associated with risk of oral
SCC.6 Dietary intake of fruits and vegetables has been as-
sociated with significant reductions in risk of oral SCC in
several studies,16–18 attributed largely to the high content of
antioxidants such as beta-carotene and vitamin C in these
foods.31,32 In contrast, high intake of saturated fats17,18 and
meat products16,18 has been positively associated with oral
cancer. We observed a significant increase in risk in cats
that frequently ate canned cat food compared to those eat-
ing dry food, which potentially could be related to differ-
ences in the nutrient content of these foods. The findings
suggest that further research into the effects of the specific
nutrients of dry and canned foods might be warranted. An
alternative explanation of the difference in risk among food
types might be that cats eating dry food could have less
tartar buildup and consequently better oral hygiene than
those that eat canned food.33 Poor oral hygiene, including
infrequent teeth brushing and a high number of lost teeth,
has been associated with a 2-fold increase in risk in several
studies of humans.16,19,21 We observed a modest, but non-
significant reduction in oral SCC risk in cats that had their
teeth brushed, but no significant increase in risk in cats with
a history of dental problems.
We observed a significant 5-fold increase in oral cancer
risk in cats that wore flea collars, perhaps because of the
proximity of collars, which contain substantial concentra-
tions of pesticide chemicals, to the oral cavity. To our
knowledge, few studies in humans or other species have
specifically evaluated the relationship between exposure to
pesticides and risk of oral SCC. However, several studies
in humans have observed increases in risk of brain cancer
in children observed pre- or postnatally to household use

Table 3. Multivariate relative risks for the relationship between flea control products and risk of feline oral squamous
cell carcinoma.
No. of No. of
Cases Controls MV RRa 95% CI P-Valueb
Use of flea control products
No 14 59 1.0
Yes 22 52 1.6 0.8–3.1 .19
Flea control product typec
None 14 59 1.0
Collar 13 12 5.3 1.8–15.7 .002
Shampoo 2 23 0.1 0.01–0.6 .011
Powder 5 12 1.7 0.5–6.2 .42
Spray 5 8 1.2 0.3–5.1 .81
a
Multivariate relative risks (MV RR) adjusted for age, intake of canned cat food, and intake of tuna fish. Flea control product types also
adjusted for each other.
b
Wald test.
c
Numbers for use of specific flea control products are larger than total number of study plus control cats because of use of multiple product
types on the same subject.

Epidemiology of Feline Oral Squamous Cell Carcinoma
Table 4. Multivariate relative risks for the relationship between aspects of diet and risk of feline oral squamous cell
carcinoma.
No. of Cases No. of Controls
Main source of diet
Mostly dry food 10 59
Dry and canned cat foods 6 14
Mostly canned cat food 20 39
Canned tuna fish
None 21 89
Any 15 23
Table scraps
None 20 80
Any 16 31
Liver
None 35 107
Any 1 5
a
Multivariate relative risks (MV RR) for each food variable adjusted for all other foods, in addition to age, use of flea collars, and use of flea
shampoo.
b
Wald test.
of flea control products.34,35 Other studies have reported as-
sociations between oral SCC and occupational exposure to
other classes of chemicals.22,23 A prospective study of Ger-
man workers reported that the incidence of cancers of the
buccal cavity and pharynx in those occupationally exposed
to phenoxy herbicides and dioxins were twice as high as
rates in the general population.23 Similar results were ob-
served in a case-control study in Sweden, where occupa-
tional exposure to phenoxyacetic acid was associated with
a 70% increase in risk of oral cancer.22 In this study, we
also observed a significant reduction in risk associated with
the use of flea shampoo. Although this finding might be
inconsistent with a hypothesis relating pesticide exposure
to oral SCC, it is also possible that shampooing might re-
duce the buildup of chemical contaminants on the coat and
thus reduce the quantity of chemicals ingested orally. This
interpretation is supported to some extent by the similar
reduction in risk we observed in cats that were bathed by
their owners (Table 1).
Cats with renal failure were chosen as control subjects
because, to our knowledge, incident renal disease has not
been associated with exposure to tobacco smoke, flea con-
trol products, or diet in studies of cats or humans. In ad-
dition, cats diagnosed with renal failure at TUSVM are ap-
propriate controls because they are likely to be represen-
tative of the underlying study base that gave rise to oral
SCC. Pet owners that bring their cats to a large teaching
hospital for clinical examination and laboratory tests, as
were required for both oral SCC and renal failure diagno-
ses, are likely to be similar in terms of demographic char-
acteristics.
As with any case-control study, incomplete participation
by all eligible subjects can result in selection bias if partic-
ipation is influenced by both exposure and disease status.
Study participation was somewhat higher in controls than
in study cats, but did not vary by demographic factors such
as sex, reproductive status, and breed. Although cat owners
who smoke might be less likely to participate than those
who do not, participation is unlikely also to vary by disease
diagnosis. To date, few studies have evaluated lifestyle risk
File # 02em
561
MV RRa 95% CI P-Valueb
1.0
2.2 0.5–9.5 .27
3.6 1.3–9.9 .014
1.0
4.7 1.6–13.2 .004
1.0
1.2 0.5–2.6 .87
1.0
0.3 0.02–3.2 .30
factors for chronic disease in companion animals, so it is
unlikely that owner participation would be influenced by
previous knowledge of a relationship between factors such
as smoking, flea control product use, diet, and health in
pets. The lack of previous research in this area and the
selection of a control group with a serious illness should
also serve to limit recall bias in this study; it is unlikely
that owners of cats with oral SCC and renal failure would
misreport exposure history differently. Inaccurate recall of
lifestyle factors by the owners of both study cats and con-
trols could result in some exposure misclassification be-
cause many owners were required to recall an exposure that
occurred several years earlier. Research in humans suggests
that misclassification of smoking status tends to be low36
and that the effect of misclassification on risk estimates in
studies of ETS and cancer is small,37,38 so we do not expect
this factor to have a large effect on this study. Also, because
any misclassification of smoking status and other factors is
likely to be nondifferential with respect to study or control
status, we would expect it to lead to an underestimation of
results.
Epidemiologic studies of companion animals offer an ex-
cellent opportunity to evaluate the effects of specific envi-
ronmental exposures on the incidence of chronic disease.
In addition, because all subjects are free-living pets and
data are collected by observation and owner report, these
studies provide a humane, noninvasive method of studying
exposure-disease relationships. The information gathered
from these analyses is directly applicable to disease pre-
vention efforts and can greatly improve pets’ quality of life.
Results from this study suggest that flea control products,
diet, and perhaps environmental tobacco smoke might be
associated with risk of oral SCC and indicate that further
investigation into these relationships is warranted.
Footnote
a
SPSS software, version 10.0, SPSS Inc, Chicago, IL

562 Bertone, Snyder, and Moore
Acknowledgments
This research was conducted at Tufts University School
of Veterinary Medicine and supported by grants from the
Geraldine R. Dodge Foundation, the Cape Cod Cat Club,
the International Feline Foundation, and NIH training grant
T35 DK07635.
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