Events & Issues
New Delhi, 14 September 2015
Rising Oral Cancer Menace
STRINGENT MEASURES NEEDED
By Oishee Mukherjee
Oral
hygiene has been steadily declining with the increase in the intake of tobacco
by people, including many youngsters over the years. The problem has got accentuated
world-wide and India
is no exception, specially in the Hindi speaking States. Statistics reveal that
oral cancer resulted in 135,000 deaths in 2013 up from 84,000 in 1990. However,
many believe the figure would go up by 20 per cent as many cases remain unreported.
Sadly,
there is little awareness of the consequences of the intake of raw or even
processed tobacco in the form of cigarettes and what its prolonged use could
have on human health.
Importantly,
oral cancer, a type of malignant growth of the oral cavity, is one of the most
common types of cancer. It is rated 3rd in India and 12th
globally. Experts believe that 75 per cent of oral cancers are linked to
modifiable behaviours such as tobacco use and excessive alcohol consumption.
Other factors include poor hygiene, irritation caused by ill-fitting dentures
and other rough surfaces on the teeth, poor nutrition and some chronic
infections caused by bacteria or viruses.
Chewing betel, paan and Arcea is known to be a strong risk factor for developing oral
cancer. And in our country this is the most common form of cancer, representing
40 per cent of all cancers compared to just 4 per cent in UK and other
western nations. Shockingly, 130,000 people succumb to oral cancer annually
though the actual figure is probably much higher as such diseases go unrecorded
in rural areas of the country.
Moreover,
oral cancer is particularly dangerous because in its early stages it might not
be noticed by the patient as it can fester without causing pain or symptoms doctors
might readily recognize. Worse, it has a high risk of producing second, primary
tumours. This means that patients who survive the first brush with the disease
have up to 20 times higher risk of developing a second occurrence.
According
to doctors, this heightened factor could last for 5-10 years after the first
occurrence. As is general agreed, there are several types of oral cancer but
around 90 per cent are squamous cell carcinomas. The occurrence of such cancers
is found normally in people over 40 years at the time of detection.
Further,
there are links to young men and women who use conventional ‘smokeless’ chewing
or spit tobacco. Promoted as a safer alternative to smoking, it has actually
not proven to be any safer for those who use them vis-à-vis oral cancers.
From a
gender perspective, in India
the ratio of occurrence of oral cancer works out to two-three men compared to
each woman. Undoubtedly, lifestyle factors still remain the biggest cause,
specially the rapid increase in the number of women smokers --- bidi for rural women and cigarettes for
their urban counterparts.
Delving
into the causative factors, it has been found that the age of diagnosed
patients might indicate a time component in the biochemical or biophysical
processes of ageing cells that allows malignant transformation. Surprisingly,
recent records show the fastest growing segment of the oral cancer population
is non-smokers under the age of 50.
Obviously,
an indication of a paradigm shift in the cause of the disease. According to a
recent Oral Cancer Foundation report on the anterior of the mouth, tobacco and
alcohol associated cancers have declined along with a corresponding decline in
smoking while posterior of oral cavity sites associated with HPV16 viral cause
are increasing.
It stands
to reason that strategies for enhancement of detection (and diagnostic
techniques of oral cancer) and approach for prevention need to be seriously
considered and implemented. Diagnosis is presently done by checking the patient
for traces of pre-malignant lesions like erythroplakia (red lesions) or
leukoplakia (white lesions).
Clearly,
without early diagnosis and proper medication these can prove to be life
threatening. In a survey of 35,122 people in Maharashtra’s
Sangli district symptoms of poor oral hygiene were noticed in most patients.
The main cause was identified as tobacco and alcohol consumption. Over 112 people
showed signs of oral cancer i.e. 1.12
per cent, an alarming rate considering the semi-urban nature of the area.
In fact,
there are a variety of screening devices that could assist dentists in
detecting oral cancer, including Velscope, Vizilite Plus and the identafi 3000.
But there is no evidence to show that routine use of these devices in general
can help dentists save lives. Yet, there are compelling reasons to be concerned
about the risk of harm this device might cause if routinely used in general
practice.
Such problems
include false positive, unnecessary surgical biopsies which put a financial
burden on the patient. Experts believe there are six common species of bacteria
found at significantly higher levels in the saliva of patients with oral
squamous cell carcinoma (ORCC) than in saliva of oral-free cancer patients.
Three of the six --- C. gingivalis, P.
melaninogenica and S. mitis --- can be used as a diagnostic
tool to predict more than 80 per cent of oral cancers.
Additionally,
surgical removal of the tumour is usually recommended if it is small enough and
if surgery is likely to result in a functionally satisfactory result. Radiation
therapy with or without chemotherapy is often used in conjunction with surgery.
But, survival rates for oral cancer depend on the precise site and the stage of
diagnosis. Survival rates for stage one cancers hover around 80 to 90 per cent
and hence early detection is necessary for survival of patients.
Furthermore,
after treatment, rehabilitation might be necessary to improve movement,
chewing, swallowing and speech. Speech and language pathologists could also be
involved at this stage.
Taking
cognizance, the Union Health Ministry has formulated the National Cancer
Control Programme envisaging control of tobacco consumption in all forms
through advertisements to raise general awareness amongst the masses. Intake of
fresh green vegetables has been highly recommended for prevention of oral
cancer.
Alas, in
spite of repeated campaigns the awareness level in the public, specially in the
rural areas about the gravity of the problem still remains grossly inadequate. According
to sociologists and dental hygienists, this is probably due to poor education
levels as also addiction. Thus, one can safely state the scenario in India is gloomy.
Scandalously, the 5-year survival rate in the country is
yet to improve, and it has been decades. Hence, an increased impetus is
required for awareness generation along with prevention and early detection,
thereby reducing morbidity and enhancement of survival rates amongst patients. ---- INFA
(Copyright,
India News and Feature Alliance)
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