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Rising Oral Cancer Menace: STRINGENT MEASURES NEEDED, By Oishee Mukherjee, 14 Sept, 2015 Print E-mail

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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