Cultural Practices and Oral Cancer Risk in South America: An Evidence- and Experience-Based Position Paper.

BACKGROUND: Oral cavity squamous cell carcinoma (OSCC) remains a major public health challenge worldwide. In South America, its epidemiology is influenced by culturally embedded practices that remain underrepresented in the international literature. AIMS: To critically examine region-specific exposures that may contribute to oral carcinogenesis and to identify major knowledge gaps relevant to OSCC prevention and early detection in South America. MATERIALS AND METHODS: This evidence-informed position paper was developed through consensus among specialists from South American referral centers and a structured appraisal of the available literature, focusing on chimó use, coca leaf chewing, reverse smoking, hot mate consumption, and charcoal-grilled meat intake. RESULTS: Current evidence suggests that these practices involve biologically plausible mechanisms, including thermal injury, chronic mechanical irritation, exposure to potentially carcinogenic chemical compounds, and persistent mucosal inflammation, that may promote carcinogenesis. DISCUSSION: The strength of the available evidence varies considerably across exposures, and several associations remain hypothesis-generating and require further epidemiological, mechanistic, and molecular validation. CONCLUSION: This position paper identifies major knowledge gaps and proposes a regional research agenda aimed at improving risk assessment, prevention strategies, and the early detection of OSCC in South America.