|Year : 2019 | Volume
| Issue : 2 | Page : 42-45
Prevalence of oral squamous cell carcinoma in South Gujarat population
Sweta Shah1, Neelampari Parikh2, Deepali Ayre3, Hemali Patel4, Rakesh Sutariya4, Pandya Sajankumar Rakesh5
1 PhD Student, Department of Pathology, Bharat Cancer Hospital and Research Centre, Gujarat University, Ahmedabad, Gujarat, India
2 Professor and Head, Department of Oral and Maxillofacial Pathology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
3 Chief Pathologist, Bharat Cancer Hospital and Research Centre, Surat, Gujarat, India
4 Reader, Department of Oral and Maxillofacial Pathology, Vaidik Dental College and Research Centre, Daman, Daman and Diu, India
5 Senior Lecturer, Department of Public Health Dentistry, Vaidik Dental College and Research Centre, Daman, Daman and Diu, India
|Date of Web Publication||25-Sep-2019|
Dr. Sweta Shah
Gujarat University, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
Background: The purpose of the study was to determine the prevalence of oral squamous cell carcinoma (OSCC) at specific anatomic sites or within specific age or gender groups and the correlation between various forms of tobacco usage in South Gujarat population.
Methodology: The study covers the period from January 2016 to January 2018. OSCC cases who reported to the Bharat Cancer Hospital and Research Centre, Saroli, Surat, Gujarat, were analyzed for age, sex, site, and habits. The findings were formulated to chart the prevalence in South Gujarat population.
Results: The study revealed that males represented a higher proportion than females, i.e., 79% of males and 21% of females, with the highest incidence of OSCC developing in the fourth and fifth decades of life, whereas recently a shift was also observed in terms of age group as 23 patients were falling into younger age group (20–30 years), which is an alarming factor. Overall, the most common site was buccal mucosa followed by tongue and lower alveolus. Smokeless tobacco habit was more prevalent than smoking tobacco habit.
Conclusion: Close follow-up and education about the harmful and carcinogenic effects of tobacco and alcohol should be provided on a larger scale and broader population.
Keywords: Oral cancer, oral squamous cell carcinoma, smokeless tobacco, smoking, tobacco
|How to cite this article:|
Shah S, Parikh N, Ayre D, Patel H, Sutariya R, Rakesh PS. Prevalence of oral squamous cell carcinoma in South Gujarat population. Int J Prev Clin Dent Res 2019;6:42-5
|How to cite this URL:|
Shah S, Parikh N, Ayre D, Patel H, Sutariya R, Rakesh PS. Prevalence of oral squamous cell carcinoma in South Gujarat population. Int J Prev Clin Dent Res [serial online] 2019 [cited 2020 Jan 21];6:42-5. Available from: http://www.ijpcdr.org/text.asp?2019/6/2/42/267799
| Introduction|| |
in developing countries, cancer is among the ten most common causes of mortality, out of which oral cancer is the sixth most common cancer worldwide. Oral cancer is the most fatal health problem faced by humankind, and >90% of all oral cancers are squamous cell carcinomas. In India, because of cultural, ethnic, and geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. It has been reported that rapid urbanization leading to unhealthy lifestyle such as increased access to and the utilization of tobacco in its various forms as well as abuse of alcohol both alone and in combination leads to an increased incidence of precancerous and cancerous lesions. According to the World Health Organization, cancer has been growing at a rate of 11% annually in India due to widespread tobacco consumption. According to the Indian Council of Medical Research, >300 billion rupees is washed off each year to battle the burden of tobacco consumption. The International Agency for Research on Cancer has classified betel quid with and without tobacco as a human carcinogen. The South-East Asian traditional cultural habit of betel nut chewing is now a worldwide phenomenon that is increasing at an alarming rate with a known risk factor of oral leukoplakia, oral submucous fibrosis, and oral squamous cell carcinoma (OSCC).,,,,,,,,, A matter of concern to be emphasized is that oral cancer is often not being detected until people experience debilitating circumstances to the normal oral function. Hence, the purpose of this study was to determine the prevalence of OSCC and to assess the correlation between various forms of tobacco usage, specific age and sex groups, and anatomic sites to develop OSCC in South Gujarat population.
| Methodology|| |
Clinically diagnosed and histopathologically confirmed cases of OSCC in South Gujarat population between the years 2016 and 2018 were extracted from the archives of Bharat Cancer Hospital and Research Centre, Surat, Gujarat. Ethical clearance was obtained from the ethical committee of Bharat Cancer Hospital and Research Center. Patient consent was taken for the use of patient data. Further, various modes of tobacco- and alcohol-consuming habits were assessed among different age groups and sex of patients along with the site of occurrence.
- Those who were willing to participate.
- Those who were not willing to participate
- Those who had systemic diseases.
| Results|| |
There were 221 cases of oral cancer during the 2 years of study; out of these, 175 were male and 46 were female. According to age, the highest incidence was in the age group of third to fifth decades of life. According to the prevalence of habit, the majority of patients who were having a habit of tobacco chewing were found to develop OSCC, and the most prevalent site of OSCC was buccal mucosa followed by tongue and lower alveolus. [Table 1] describes the distribution of OSCC site among the study population by age. It was observed that the most prevalent site of OSCC was buccal mucosa, which was highest in the age group of 41–50 years, and this relationship was found to be statistically significant (P ≤ 0.05). Similarly, on gender-wise comparison, 75 males exhibited buccal mucosa as the most common site of OSCC whereas upper lip as the least prevalent site, and this relationship was statistically significant (P ≤ 0.05). [Table 2] explains the relationship of adverse habits and gender. On comparison, it was observed that a statistically significant association was found between adverse habits and gender (P ≤ 0.05). Males had the highest prevalence of gutkha chewing, and similar finding was observed in females.
|Table 1: Distribution of oral squamous cell carcinoma site among the study population by age|
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|Table 2: Distribution of adverse habits among the study population by gender|
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| Discussion|| |
In the present study, out of 221 OSCC cases, 79% were males and 21% were females, with the largest number of OSCC developing in the fourth and fifth decades of life. This is in accordance to a study conducted by Sharma etal. in Uttar Pradesh, in which 68.7% of males had OSCC, which is less as compared to females (31.2%). Mehrotra et al. confirmed that OSCC in North India is a disease of middle-aged men, which may be due to changing social habits in high socioeconomic groups or cultural habits of some rural areas of India.,,,, Furthermore, in the present study, 12 patients belonged to the age group of 26–35 years, whereas in other studies, majority of cases were aged >50 years. Among the patients in the younger age group, 12 fell within the age group of 25–35 years. This shows the alarming factor regarding tobacco consumption and OSCC cases in relation to age, which is dropping at a significant rate as mentioned in the present study. Tobacco being an independent risk factor, the relative risk of tobacco occurrence of OSCC in tobacco users is 11 times that of people who had never used tobacco. Tobacco is used in smoking as well as more smokeless forms. Smoking bidi is an important risk factor for OSCC. Bidi smokers have 3.1 times increased risk for oral cancer compared to nonsmokers in Southeast Asia. On the whole, risk for daily smokers is three times that of nonsmokers.,,,, Contrary to this, in Karunagapally cohort (India), bidi smoking did not show any risk for oral cancer in tobacco chewers, but an elevated risk was observed with bidi smoking when the analysis was restricted to nontobacco-chewing smokers. OSCC is largely associated with gutkha followed by tobacco flakes, gutkha, and pan masala which are termed “polyingredient oral dip products” and are more carcinogenic because of other carcinogenic products present.,,,, This could be due to the fact that tobacco and other carcinogenic compounds are kept in contact with oral mucosa for a considerably longer time. In the present study, those who chewed tobacco were also found to smoke heavily, which further exaggerates the effect and the risk of developing oral cancer. Tobacco chewing is a stronger risk factor for oral cancer than smoking where chewing is a prevalent practice. Interestingly, in our study, 15% of patients were not associated with any habits such as tobacco chewing or smoking, which may be attributed to other etiological factors of OSCC such as certain viruses (such as human papillomavirus), low consumption of fruits and vegetables, and genetic predisposition. The clinicopathologic profile of Indian oral cancers shows significant differences from oral cancer in several developed countries of the world, including the USA, the UK, France, and Japan where it is associated with tobacco smoking with or without alcohol consumption.
| Conclusion|| |
The prevalence of OSCC has shown an alarming rise among the local younger population of South Gujarat; hence, it is important to undertake programs to prevent and control OSCC by screening for early diagnosis and enabling societies to support a tobacco-free environment. It is also very important to improve the living standards of people where access to health care is poor or limited. Race, ethnicity, and age cannot be altered; however, lifestyle behavior and habits such as tobacco usage, smoking, and alcohol are amenable to change, all of which could be initiated through health education.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mishra A, Ghom S, Khandelwal A, Kanungo M, Pradhan P, Gupta P. Prevalence of oral cancer in Chhattisgarh-an epidemiological study. Chhattisgarh J Health Sci 2013;;1:1-4.
Fellar L, Lemmer J. Oral squamous cell carcinoma: Epidemiology, clinical presentation and treatment. Asian Pac J Cancer Prev 2013;3: 263-8.
Priebe SL, Aleksejūniene J, Zed C, Dharamsi S, Thinh DH, Hong NT. Oral squamous cell carcinoma and cultural oral risk habits in Vietnam. Int J Dent Hyg 2010;8:159-68.
J. Bagan, G. Sarrion and Y. Jimenez. Oral Cancer: Clinical Features. Oral Oncology 2010; 46(6):414-7.
C. Scully and J. Bagan. Oral Squamous Cell Carcinoma Overview. Oral Oncology 2009; 45(4):301- 8.
Viviano M, Addano A, Lorenzini G. Oral Cancer. Int J Clin Dent2009; 6(3):45-47.
Elwood JM, Pearson JC, Skippen DH, Jackson SM. Alcohol, smoking, social and occupational factors in the aetiology of cancer of the oral cavity, pharynx and larynx. Int J Cancer 1984;34:603-12.
Mashberg A, Garfinkel L, Harris S. Alcohol as a primary risk factor in oral squamous carcinoma. CA Cancer J Clin 1981;31:146-55.
International Agency for Research on Cancer. Tobacco Habits Other Than Smoking: Betel Quid and Areca Nut Chewing and Some Related Nitrosamines. IARC Monographs on the Evaluation of the Carcinogenic Risks to Humans. Lyon, France: International Agency for Research on Cancer; 1985.
World Health Organization. IARC Monographs Programme Finds Betel Quid and Areca Nut Chewing Carcinogenic to Humans. World Health Organization Media News Release. Lyon: World Health Organization; 2003.
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(3):316-9.
Nair U, Bartsch H, Nair J. Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: A review of agents and causative mechanisms. Mutagenesis 2004;19:251-62.
Khandekar SP, Bagdey PS, Tiwari RR. Oral cancer and some epidemiological factors: A hospital based study. Indian J Community Med 2006;31(3):157-9.
Gervásio OL, Dutra RA, Tartaglia SM, Vasconcellos WA, Barbosa AA, Aguiar MC. Oralsquamous cell carcinoma: A retrospective study of 740 cases in a Brazilian population. Braz Dent J 2001;12:57-61.
Mehrotra R, Singh MK, Pandya S, Singh M. The use of an oral brush biopsy without computer-assisted analysis in the evaluation of oral lesions: A study of 94 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:246-53.
Franceschi S, Bidoli E, Herrero R, Muñoz N. Comparison of cancers of the oral cavity and pharynx worldwide: Etiological clues. Oral Oncol 2000;36:106-15.
Madani AH, Dikshit M, Jahrumi AS. Risk assessment of tobacco types, oral cancer. Am J Pharmacol Toxicol 2010;5:9-13.
Jayalekshmi PA, Gangadharan P, Akiba S, Koriyama C, Nair RR. Oral cavity cancer risk in relation to tobacco chewing and bidi smoking among men in Karunagappally, Kerala, India: Karunagappally cohort study. Cancer Sci 2011;102:460-7.
Balaram P, Sridhar H, Rajkumar T, Vaccarella S, Herrero R, Nandakumar A. Oral cancer in Southern India: The influence of smoking, drinking, Paan-chewing and oral hygiene. Int J Cancer 2002;98:440-5.
Rahman M, Sakamoto J, Fukui T. Bidi smoking and oral cancer: A meta-analysis. Int J Cancer 2003;106:600-4.
Rahman M, Sakamoto J, Fukui T. Calculation of population attributable risk for bidi smoking and oral cancer in South Asia. Prev Med 2005;40:510-4.
Muwonge R, Ramadas K, Sankila R, Thara S, Thomas G, Vinoda J, et al.
Role of tobacco smoking, chewing and alcohol drinking in the risk of oral cancer in Trivandrum, India: A nested case-control design using incident cancer cases. Oral Oncol 2008;44:446-54.
Madani AH, Dikshit M, Bhaduri D. Risk for oral cancer associated to smoking, smokeless and oral dip products. Indian J Public Health 2012;56:57-60. [Full text]
Dikshit RP, Kanhere S. Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer: A population-based case-control study in Bhopal, India. Int J Epidemiol 2000;29:609-14.
Gangane N, Chawla S, Anshu, Gupta SS, Sharma SM. Reassessment of risk factors for oral cancer. Asian Pac J Cancer Prev 2007;8:243-8.
[Table 1], [Table 2]