International Journal of Preventive and Clinical Dental Research

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 6  |  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

Correspondence Address:
Dr. Sweta Shah
Gujarat University, Ahmedabad, Gujarat
India

Abstract

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.



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;6:42-45


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 Sep 20 ];6:42-45
Available from: http://www.ijpcdr.org/text.asp?2019/6/2/42/267799


Full Text



 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.[1] Oral cancer is the most fatal health problem faced by humankind, and >90% of all oral cancers are squamous cell carcinomas.[2] 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.[3] According to the Indian Council of Medical Research, >300 billion rupees is washed off each year to battle the burden of tobacco consumption.[4] The International Agency for Research on Cancer has classified betel quid with and without tobacco as a human carcinogen.[5] 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).[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] 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.

Inclusion criteria

Those who were willing to participate.

Exclusion criteria

Those who were not willing to participateThose 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}{Table 2}

 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%).[11] Mehrotra et al. confirmed that OSCC in North India is a disease of middle-aged men,[15] which may be due to changing social habits in high socioeconomic groups or cultural habits of some rural areas of India.[16],[17],[18],[19],[20] 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.[21] On the whole, risk for daily smokers is three times that of nonsmokers.[16],[17],[18],[19],[20] 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.[18] 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.[21],[22],[23],[24],[25] 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.[16]

 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

Nil.

Conflicts of interest

There are no conflicts of interest.

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