|Year : 2018 | Volume
| Issue : 1 | Page : 11-14
Oral cancer prevalence in Western population of Maharashtra, India, for a period of 5 years
Padhiar Rutvij Ajay1, SR Ashwinirani2, Ajay Nayak2, Girish Suragimath2, KA Kamala2, Abhijeet Sande2, Radhika Santosh Naik1
1 Department of Oral Medicine and Radiology, School of Dental Sciences, Karad, Maharashtra, India
2 Department of Periodontology, School of Dental Sciences, Karad, Maharashtra, India
|Date of Web Publication||2-Feb-2018|
S R Ashwinirani
Department of Oral Medicine and Radiology, School of Dental Sciences, Karad, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to report the prevalence of oral cancer and its association with habits, age, gender, and site in Western population of Maharashtra.
Materials and Methods: Data were collected from the previous records of patients from June 2011 to June 2016 for 5 years. A total of 81,325 patients' data were obtained. Details regarding patient's habits, age, gender, and site with OC were recorded. The data recorded were tabulated in the MS Excel and subjected to statistical analysis using SPSS software 16. Data were analyzed using Student's t-test and Chi-square test.
Results: The prevalence of OC was 0.1%. The majority of patients were tobacco chewers (41.5%), followed by the group of those who were smokers, tobacco chewers, and alcoholic (28.1%). Majority of patients were in the age group of 60 years and above, followed by 40–59 with a male predominance, and buccal mucosa was the most common site followed by alveolus. Smokeless tobacco consumed in India is one of the most common forms of tobacco, leading to cause OC.
Conclusion: There is need to spread awareness about this tobacco-related cancer and immediate consultation on suspicion of cancer. There should be regular oral checkup for male and female patients above 40 years for the early detection of cancer and its prevention.
Keywords: Alveolus, buccal mucosa, cancer, India, tobacco
|How to cite this article:|
Ajay PR, Ashwinirani S R, Nayak A, Suragimath G, Kamala K A, Sande A, Naik RS. Oral cancer prevalence in Western population of Maharashtra, India, for a period of 5 years. J Oral Res Rev 2018;10:11-4
|How to cite this URL:|
Ajay PR, Ashwinirani S R, Nayak A, Suragimath G, Kamala K A, Sande A, Naik RS. Oral cancer prevalence in Western population of Maharashtra, India, for a period of 5 years. J Oral Res Rev [serial online] 2018 [cited 2018 Jun 17];10:11-4. Available from: http://www.jorr.org/text.asp?2018/10/1/11/224537
| Introduction|| |
Cancers are the most common cause of death in adults. Oral cancer (OC) is a broad term that includes various malignant diseases that are present in oral tissues, which are found on the lip, floor of the mouth, buccal mucosa, gingiva, palate, or in the tongue. The majority (84%–97%) of OCs are squamous cell carcinoma (SCC) which arise from preexisting “potentially malignant” lesions or more often from normal appearing epithelium.,, The term “oral potentially malignant disorders” is recommended by the WHO in 2005. It includes both oral premalignant lesions and conditions. There are number of potentially malignant disorders which constitute a detectable preclinical phase of OC. The most important ones are oral submucous fibrosis, leukoplakia, erythroplakia, candidal leukoplakia, lichen planus, dyskeratosis congenita. Around 300,000 patients are annually estimated to have OC worldwide. India has world's highest number (nearly 20%) of OCs with an estimated 1% of the population having oral premalignant lesions. Approximately 95% of OC occurs in people older than 40 years, with an average age at diagnosis of approximately 60 years.
Various factors such as tobacco (smoking and smokeless form), alcohol, human papillomavirus (HPV) 16 and 18, dietary factors, and genetic factors are considered as etiological factors for OC. Clinically, OC appears as red or white lesion, proliferative, infiltrative, or ulcerative growth. The most common sites involved are buccal mucosa, alveolus, lip, palate depending on the form of tobacco usage. Various studies have been conducted across the world to study the prevalence and factors affecting OC., In developing countries like India, the usage of tobacco is more because it is easily available. With this background, the present study was designed to study the prevalence of OC and its association with habits, age, gender, and site in the Western population of Maharashtra.
| Materials and Methods|| |
A retrospective study was carried out from the records of the period of June 2011–June 2016 in the Department of Oral Medicine and Radiology, School of Dental Sciences, Karad, Maharashtra, India. Ethical clearance was obtained from Krishna Institute of Medical Sciences, Deemed university before commencing the study. Pervious patient's records were retrieved from outpatient registers and special case registers, which included all oral potentially malignant disorders. Habit history of patients including all forms of tobacco chewing, smoking, and alcohol along with quantity and duration was recorded in clinical pro forma. Details of patient's age, gender, and site of OC were recorded. The data recorded were entered in MS Excel sheet and subjected to statistical analysis.
The continuous data were summarized as mean and standard deviation while discrete (categorical) in numbers (n) and percentage (%). The data were analyzed by independent Student's t-test and Chi-square (χ2) test. A two-tailed (a = 2) P < 0.05 was considered statistically significant. Statistical analysis was performed using SPSS software (Windows version 16.0 IBM, Chicago).
| Results|| |
Out of 81,325 patients, 142 were diagnosed with OC with a prevalence rate of 0.1% records analysed. The frequency of OC according to tobacco habits is summarized below. The majority of patients were tobacco chewers (41.5%), followed by tobacco chewers, alcoholic, and smoking (28.1%), only smokers (14.7%), and only alcoholic (10.5%). The least common group affected in our study was patients with no habits (4.9%) [Table 1].
Association of gender and age with oral cancer
Majority of patients were in the age group of 60 years and above (n = 74 [52.1%]), followed by age group of 40–59 (n = 58 [40.8%]). Out of 142 patients, 96 were males (67.6%) and 46 were females (32.3%), with a male to female ratio of 2:1. There was no statistically significant difference between 40–59 age group and 60 years and above age groups [Table 2].
Sitewise distribution of oral cancer
Buccal mucosa was the most common site (36.6%) for OC in both males and females constituting 38.5% and 32.6%, respectively. The second most common site was alveolus, followed by the tongue (31.6% and 21.1%, respectively). The least affected site was palate and oropharynx (0.7%). The prevalence of OC did not differ between different sites between the gender in our patients (χ2 = 6.39, P = 0.381), i.e., found to be statistically same [Table 3].
| Discussion|| |
In Asia, OC ranks as the sixth most frequent malignancy. Developing nations situated in South-Central and Southeast regions such as India, Pakistan, Bangladesh, Taiwan, and Sri Lanka report high incidence rates. In developing countries, OC is the third most common type of cancer after cervix and stomach.
OC has a multifactorial etiology, which includes chronic use of smoking and smokeless form of tobacco, alcohol, and viruses. In India and Southeast Asia, chronic use of betel quid (pan) and tobacco has been strongly associated with an increased risk for OC along with alcohol, HPV 16 and HPV 18, dietary deficiency, and poor oral hygiene.,,,,
Different forms of tobacco are smokeless tobacco, pan (pieces of areca nut), processed or unprocessed tobacco, aqueous calcium hydroxide (slaked lime), and some pieces of areca nut wrapped in the leaf of piper betel vine leaf. Risk of OC increases with quantity, frequency, and duration of usage of tobacco and alcohol. Smokeless tobacco and tobacco smoke contain multiple carcinogens, and increased exposure enhances the risk for the development of oral potentially malignant disorders., The buccal mucosa, gingiva and buccal sulcus are more commonly affected due to placement of tobacco quids such as khaini, gutkha, and betel quid in the oral cavity. Previous studies have shown that the micronuclei cells were found to be significantly higher in smokeless tobacco users than in smokers. Previous morphometric studies conducted as a diagnostic tool for potentially malignant lesions showed significantly increased nuclear diameter, nuclear area, cell area, nuclear-cytoplasmic ratio in oral leukoplakia, oral verrucous carcinoma, SCC patients than normal oral mucosa, which was statistically significant.
The prevalence of OC in the present study was 0.17%, whereas higher prevalence was seen in previous study. Epidemiological studies have shown regional differences in different states of India, with Kerala reporting a lowest incidence  and West Bengal reporting a highest  incidence of OC.
The majority of patients were tobacco chewers (41.5%), followed by patients with multiple habits such as tobacco chewing, smoking, and alcoholic (28.1%). Previous studies have shown the association of tobacco with OC, which was in accordance with our study.
In our study, the highest incidence of OC was seen in the age group of 60 years and above, followed by 40–59 years, which was also in concurrence with the previous studies.,, Male to female ratio was 2:1 in this study, which was in accordance with various studies where high incidence was noted in males than females which may be due to easy access to tobacco products.,,, The gender-based preponderance of OC in India is also regional, tilting toward men in most parts of the country and toward women in South India owing to the prevailing practice of reverse smoking (chutta).
Buccal mucosa was the most common site (36.6%) in our study in both genders, followed by alveolus (31.6%) and tongue and the least common site was palate (0.7%). The results of our study were in accordance with other studies where they showed buccal mucosal as the most common site. Most of the patients in our study were using chewing form of tobacco which may be the reason for buccal mucosa as the common site.,,, Tongue and floor of the mouth carcinoma are more common in Western countries due to consumption of alcohol and smoking., The grade and metastatic status of OC at the time of detection are vital as it determines the treatment plan and the prognosis. Various treatments such as radiotherapy, chemotherapy, surgery, and brachytherapy are available depending on the stage and site of OC. Better treatment outcomes are shown if carcinoma is diagnosed in the early stage of development. In India, late diagnosis of carcinoma is one of the major factors, which worsens the disease prognosis.
| Conclusion|| |
Smokeless tobacco consumed in India is one of the most common forms of tobacco abuse leading to cancer and death. Depending on the form of tobacco usage, site of cancer in the oral cavity differs. There is need to spread awareness about this tobacco-related cancer and immediate consultation on suspicion of cancer. Early detection of OC always helps the patient treatment and survival rates. The government should make strict rules to ban tobacco all over the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ariyoshi Y, Shimahara M, Omura K, Yamamoto E, Mizuki H, Chiba H, et al.
Epidemiological study of malignant tumors in the oral and maxillofacial region: Survey of member institutions of the Japanese Society of Oral and Maxillofacial Surgeons, 2002. Int J Clin Oncol 2008;13:220-8.
Bhurgri Y, Bhurgri A, Hussainy AS, Usman A, Faridi N, Malik J, et al.
Cancer of the oral cavity and pharynx in Karachi – Identification of potential risk factors. Asian Pac J Cancer Prev 2003;4:125-30.
Kruaysawat W, Aekplakorn W, Chapman RS. Survival time and prognostic factors of oral cancer in Ubon Ratchathani Cancer Center. J Med Assoc Thai 2010;93:278-84.
Babshet M, Nandimath K, Pervatikar S, Naikmasur V. Efficacy of oral brush cytology in the evaluation of the oral premalignant and malignant lesions. J Cytol 2011;28:165-72.
] [Full text]
Chaturvedi P. Effective strategies for oral cancer control in India. J Cancer Res Ther 2012;8 Suppl 1:S55-6.
Mashberg A, Samit AM. Early detection, diagnosis, and management of oral and oropharyngeal cancer. CA Cancer J Clin 1989;39:67-88.
Singh MP, Misra S, Rathanaswamy SP, Gupta S, Tewari BN, Bhatt ML, et al.
Clinical profile and epidemiological factors of oral cancer patients from North India. Natl J Maxillofac Surg 2015;6:21-4.
] [Full text]
Fazeli Z, Pourhoseingholi MA, Pourhoseingholi A, Vahedi M, Zali MR. Mortality of oral cavity cancer in Iran. Asian Pac J Cancer Prev 2011;12:2763-6.
D'Souza G, Kreimer AR, Viscidi R, Pawlita M, Fakhry C, Koch WM, et al.
Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007;356:1944-56.
Furniss CS, McClean MD, Smith JF, Bryan J, Applebaum KM, Nelson HH, et al.
Human papillomavirus 6 seropositivity is associated with risk of head and neck squamous cell carcinoma, independent of tobacco and alcohol use. Ann Oncol 2009;20:534-41.
Sánchez MJ, Martínez C, Nieto A, Castellsagué X, Quintana MJ, Bosch FX, et al.
Oral and oropharyngeal cancer in Spain: Influence of dietary patterns. Eur J Cancer Prev 2003;12:49-56.
Garrote LF, Herrero R, Reyes RM, Vaccarella S, Anta JL, Ferbeye L, et al.
Risk factors for cancer of the oral cavity and oro-pharynx in Cuba. Br J Cancer 2001;85:46-54.
Talamini R, Vaccarella S, Barbone F, Tavani A, La Vecchia C, Herrero R, et al.
Oral hygiene, dentition, sexual habits and risk of oral cancer. Br J Cancer 2000;83:1238-42.
Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst 1999;91:1194-210.
Dubal M, Nayak A, Suragimath A, Sande A, Kandagal S. Analysis of smoking habits in patients with varying grades of smoker's palate in South Western region of Maharashtra. J Oral Res Rev 2015;7:12-5. [Full text]
Misra S, Chaturvedi A, Misra NC. Management of gingivobuccal complex cancer. Ann R Coll Surg Engl 2008;90:546-53.
Sangle VA, Bijjaragi S, Shah N, Kangane S, Ghule HM, Rani SA. Comparative study of frequency of micronuclei in normal, potentially malignant diseases and oral squamous cell carcinoma. J Nat Sci Biol Med 2016;7:33-8.
Christopher V, Murthy S, Ashwinirani SR, Singh S, Athira CP, Shivaram SK, et al.
Morphometry as a diagnostic tool for potentially malignant lesions. J Clin Diagn Res 2015;9:ZC22-5.
Sawlani K, Kumari N, Mishra AK, Agrawal U. Oral cancer prevalence in a tertiary care hospital in India. J Fam Med Community Health 2014;1:1022.
Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in Urban and Rural India. Asian Pac J Cancer Prev 2006;7:108-12.
Karmakar R, Bandyopadhyay A, Barui G, Maiti PK, Bhattacharya A, Choudhuri MK. Pattern of cancer occurrence in Rural population of West Bengal – A hospital-based study. J Indian Med Assoc 2010;108:505-6, 508.
Sharma P, Saxena S, Aggarwal P. Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study. Indian J Dent Res 2010;21:316-9.
] [Full text]
Addala L, Pentapati CK, Reddy Thavanati PK, Anjaneyulu V, Sadhnani MD. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. Indian J Cancer 2012;49:215-9.
] [Full text]
Shenoi R, Devrukhkar V, Chaudhuri, Sharma BK, Sapre SB, Chikhale A. Demographic and clinical profile of oral squamous cell carcinoma patients: A retrospective study. Indian J Cancer 2012;49:21-6.
] [Full text]
Singh MP, Kumar V, Agarwal A, Kumar R, Bhatt ML, Misra S. Clinico-epidemiological study of oral squamous cell carcinoma: A tertiary care centre study in North India. J Oral Biol Craniofac Res 2016;6:31-4.
Pindborg JJ, Mehta FS, Gupta PC, Daftary DK, Smith CJ. Reverse smoking in Andhra Pradesh, India: A study of palatal lesions among 10,169 villagers. Br J Cancer 1971;25:10-20.
Majchrzak E, Szybiak B, Wegner A, Pienkowski P, Pazdrowski J, Luczewski L, et al.
Oral cavity and oropharyngeal squamous cell carcinoma in young adults: A review of the literature. Radiol Oncol 2014;48:1-10.
Müller S, Pan Y, Li R, Chi AC. Changing trends in oral squamous cell carcinoma with particular reference to young patients: 1971-2006. The Emory University experience. Head Neck Pathol 2008;2:60-6.
Jerjes W, Upile T, Petrie A, Riskalla A, Hamdoon Z, Vourvachis M, et al.
Clinicopathological parameters, recurrence, locoregional and distant metastasis in 115 T1-T2 oral squamous cell carcinoma patients. Head Neck Oncol 2010;2:9.
[Table 1], [Table 2], [Table 3]