Campbell BR, et al. - A total of 395 diagnosed and/or treated oral tongue squamous cell carcinoma (OTC) cases identified at the Vanderbilt University Medical Center from 2000 to 2017 and logistic regression was used to identify factors related to early onset of OTC. Cox proportional hazards models assessed survival and recurrence. Compared to typical onset patients, early onset OTC patients were more likely to receive multimodality treatment and report a history of snuff use; they were less likely to report a history of cigarette use. Patients with early onset had better overall survival. This is the largest study to assess factors related with early onset of OTC and the first to report a link to snuff.