Oral Cancer is associated with high burden of risk with human life. As we can see Cancer is one of the most common cause of morbidity and mortality today. Cancer is one of the most common causes of morbidity and mortality today. Approximately more than 10 million new cases and more than 6 million cases deaths due to Cancer each year worldwide (Patterson, 2008). More than 20 million people around the world live with diagnosis of Oral Cancer, and more than half of cancer cases occur in developing countries .Cancer is responsible for approximately 20% of deaths due to disease in high income countries and 10% in low income countries. It means it is projected that by 2020 will be every year 15 million new Cancer cases and 10 million Cancer deaths (Patterson, 2008).
Path way of this kind of growth derive from ageing of population at worldwide. It is also estimated that around 43% of Cancer deaths due to use of tobacco, unhealthy diets, excessive alcohol consumption, inactive lifestyle and various kinds of infections. The cancer epidemic says that in high income countries and increasingly middle income countries increasing level of prevalence of Cancer risk factors. Of these the world's most avoidable cause of cancer is quit the tobacco use. Chewing tobacco consumption is most responsible cause of oral cavity but it also affects pharynx, oesophagus, stomach, pancreas, liver, bladder, uterine cervix and bone marrow (Shafer). Exposure of environmental tobacco like passive smoking increases risk of lung cancer. The habit of use of alcohol and chewing tobacco act synergistically for cause of Cancer of Oral Cavity (Shafer).
Socio-economic factors are clearly linked to Cancer incidence and survival rates. India is low income country so generally more exposed to avoidable risk factors of Cancer such as environmental caseinogens and infectious agents and other diverge groups like alcohol and tobacco use. It's also considerable some population groups have less access to health services and health education those factors would empower to make decision to protect and provide their own health . Changing life style reduces the exposure of Cancer but it is possible in only developed countries. Specific prevalence from biological factors and prospective measures to avoid or control carcinogens will reduce significantly incidence of cancer.
Epidemiology and Prevalence of Oral Cancer in India:
Cancer is one kind of group of diseases with similar characteristics. Cancers can be occur in kinds of living cells in the body and different cancers have altered natural history. Magnitude of the problem based Cancer registries within the National Cancer Registry Programme and outside the network estimated about 800,000 new cancer cases in India every year. Cancer sites associated with tobacco from 35 to 50% of Oral Cancers in men and 17% Cancers in women (Cancer pevention and control). Oral Cancers can be controlled by primary prevention to a large extent.http://ars.els-cdn.com/content/image/1-s2.0-S0264410X0800577X-gr1.jpg
(http://www.indg.in/india/sitemap-1/health/national_health_programmes/Cancer%20Prevention%20and%20Control%20in%20India.pdf#page=1&zoom=121,93,138)
Epidemiological study says that 70 to 90% Oral cancers are due to consumption of chewing tobacco and alcoholism but 50% are either due to smoking tobacco in whole country. Dietary, reproductive and sexual practices report for 20 to 30% of Cancers. Chewing tobacco is a huge burden in India for Oral Cancer and Oral precancerous conditions. There are other various forms of tobacco use in various parts of India also needs attention for prevention. Dietary factors have some relationship with Oral Cancer because they cause certain kind of chronic ulcers in mouth, tongue and oesophagus, so diet takes importance in country like India which fast moves towers industrialization and western diet.
Age adjusted incidence rates of all Cancers in India(Sources: Refs 7-9) (Aleyamma Mathew, volume 2012)
The figure considers demographic shift in India for age adjusted rates of Cancers in India owing towards urbanization, industrialization lifestyle modification changes, population growth and ageing for epidemiological evolution. The unconditional number of cases new number of cases of Oral Cancer increasing rapidly due to expansion of population, and growth of older population results life expectancy following control of communicable diseases and load of problems such as Cancer. Cancer incidence and mortality from the population-based registries in India covering 28â€"30 million population from different parts of the country, the age adjusted incidence rates vary from 44 to 122 per 100,000 population in males and 52 to 128 per 100,000 females , Cancer incidence was higher in females compared to males. The incidence in rural areas was quite low compared to urban counterparts (february 2004) ( General Article Current Science , VOL. 86, NO. 4, 25 FEBRUARY 2004 519)
Causes of Oral Cancer:
There is not only one specific factor which is responsible for Oral Cancer but there are so many contributory factors which are responsible for occurrence of Oral Cancer. In Indian people are more habitual for use of various kind of tobacco. Use of chewing or smokeless tobacco is the most responsible reason Oral Cancer. Betel nut chewing also plays major role in precancerous and Cancer conditions in oral tissues and mucus membrane in oral cavity. The figure below shows various kinds of tobacco use in India is responsible for most cases of Oral Cancer. Alcohol use predominantly beer and hard liquor are connected with increasing risk of Cancer. at floor of the mouth and tongue. People might be not aware of that use of both alcohol and tobacco together giver synergistic effect to Oral Cancer. Long term exposure to sun light may increase chances of lip cancer, lover lip (sailor's lip) may be on high risk for epidermis carcinoma. Some studies suggest that HPV (Human Papilloma virus) infection increases risk of Oral Cancer. Chronic traumatic exposure to particular region in oral cavity predispose chances of Oral Cancer.
http://www.ijph.in/articles/2012/56/1/images/IndianJPublicHealth_2012_56_1_57_96977_b1.jpg (Cancer pevention and control)
Chronic irritation in oral cavity plays contributory role for causes of Oral Cancer.
Due to un healthy dietary habits deficiency of vitamins also responsible for Oral Cancer, Oral Cancer risk is superior for people who has low intake of beta carotene, riboflavin, thiamine, folic acid, vitamin A, copper, magnesium, zinc. People who are using tobacco and have Oral Cancer may Often develop second cancers in areas nearby vocal cord, pharynx, throat , nose, oesophagus. Larger quantities of Ionizing radiation at therapeutic level may causes cancer in oral cavity. (Shafer).
Barriers in prevention of Oral Cancer:
Tobacco;
Tobacco is more addictive so for people in India eradication of habit is more challenging kind of prevention. India is third largest producer and consumer of tobacco worldwide. India has long history of tobacco usage in many range of ways of chewing and smoking products. The habit of chewing (15-70%) and smoking (23-77) vary significantly from area to area in country, smokeless tobacco consumers are at high risk of mortality. Tobacco related cancers in India by 2001 has been estimated to be nearly 0.33 million cases annually, these estimates are bases on occurrence of Oral Cancer and estimated overall increase by 220% of cancer deaths related to tobacco use by the year 2025. (Aleyamma Mathew, volume 2012)
Alcohol;
Epidemiological studies in India shows that increased alcohol consumption is casually associated with enlarged cancers at various sites at oral cavity, throat and other parts. Its common heavy alcohol drinkers are also frequently intense smokers. Medical study suggests that tobacco and alcohol together gives synergistic effect to Oral Cancer. Public awareness and obliteration such habits from population is also demanding thing for prevention factors.
Dietary and nutritional profile in India;
Poverty, malnutrition and lack of balanced diet are serious things in India because of population growth, lack of resources and education. The nutrition scenario indicates chronic energy and immunity deficiency from protection of Cancer and its prevention.
Infections;
Control of infections is also major challenge for prevention of Oral Cancer. majority of neoplasia is caused by Human Papilloma Virus(HPV) and sexually transmitted infections. HPV is considerable factor for Oral Cancer so its control is important.
Others and Important;
There are some important barriers for prevention of Oral Cancer as follows.
- Age adjusted rates for Oral Cancer is High in India , 30% of all cancers among population in country.
- The variation in occurrence and pattern of disease as well as regional differences in the prevalence of condition at specific risk factors.
- Oral cancer is of considerable public health magnitude to India. it can be diagnosed at later stages which result in low treatment outcomes and extensive costs to the patients whom typically cannot afford this type of treatment.
- The rural areas in India also have inadequate access to qualified providers and narrow health services. As a outcome, delay has also been principally associated with advanced stages of oral cancer.
- People from the lower socioeconomic groups have higher use of tobacco , so they have more chances for exposure of Oral Cancer.
- Many people even though via examination diagnosed cancer of Oral Cavity , but for advanced diagnosis like pathological tests they delay healthcare facilities so having less chances for getting better treatment.
- Public health officials, private hospitals, and academic medical centres within India have documented oral cancer as a grave problem. Efforts to enhance on the knowledge of the disease aetiology and regional distribution of risk factors have begun getting hold of momentum. Oral cancer will remain a most important health problem and efforts towards early detection, and prevention will reduce this trouble. (Russel, volume 2012)
Prevention and Control of Oral Cancer:
Oral Cancer and its prevention is huge burden for developing country like India. All kind of support work should be carried out by national and international health authorities, research and medical institutions, nongovernmental and non-profit organizations, civil society for successful control of Oral Cancer.
First of all following principle factors should be resolute;
- stipulation of systematic epidemiological information on prevalence of Oral Cancer and cancer risk factors in developing country like India.
- encouragement of research information understanding biological, behavioral and psychological factors in Oral Cancer, emphasize the exhume relationship between oral health and general health.
- Integration of oral Cancer in sequence into national health observation systems which evidence chronic diseases and common risk factors.
- Broadcasting of information on Oral Cancer, prevention and be bothered through every possible means of communication.
- Active participation of Oral health professionals in Oral Cancer prevention from beginning to end be in command of of risk factors such as tobacco, alcohol and diet.
- Assistance of primary health workforce in screening and provision of initial level care in Oral Cancer.
- Amplify access to health facilities and condition of systems for early detection and intercession, Oral health care and health promotion for the enhancement of quality of people life for people exaggerated by Oral Cancer. (Patterson, world health organization, 2003)
Primay prevention of Oral Cancer;
The statistics from the National Cancer Registry Programme showed that one third of Oral Cancers occuring in India are interrelated to tobacco usage and as a consequence they are prevantable. The most important stratergy for control of tobacco connected cancers would be all the way through primary prevention programmes. Comprehensive persuative health education for drowbacks of Oral Cancer needs to quit tobacco habits. Teen aged population need to be targeted as the majority of them pick up and choose habits at this time. The school curiculla should be engage with messges for healthy life style and notify dangerous effects of tobacco and alcohol. Suitable legislative measures needs to be occupied for sale of all kind of tobacco to youngsters to help out in protection of non users of tobacco. In addition ban of chewing tobacco products and control programmes will supprt for prevention of Oral Cancer. Priority must be given to control of tobacco and smoking would be supreme impact on reducing Cancer incidence and Cancer mortality compared to other approach. Based on the recommendations for Indian circumstances, the strategies have been recommended are public education, tobacco control practice and advocacy for tobacco control. Tobacco control polices and heath education programme achieved by government including legistation and societal actions will help to community from Oral Cancer. (Aleyamma Mathew, volume 2012)
Heavy alcohol consumers should be adviced to quit or moderate their consumption , also involment of tobacco with alcihol to prevent themself from hazardious situation like Oral Cancer. Nutritional education is important for growing public awareness, promoting better health an control of Cancer. The recomonded diatery guidelines for Oral Cancer prevention are lowering dietary fat and capsicium, increase intake of fibre, plenty of fresh fruts and vegetables, use of turmeric and antioxidants. Other environmental preventing factors like awareness of avoiding more sunlight exposure and genotoxicants to reduce risk of lip and mouth Cancer. Life style modification, behavioural changes and sexual activity are also important measures for prevention of Cancer. Vaccination of Hepatitis B and interruption of exposure from Human Papilloma Virus may prove efficient option for prevention of Cancer.
Secondary Prevention of Oral Cancer:
Oral Cancer Screening;
Screenin, Oral visual inspection sutable tests and role of dentist are recomonded for secondary prevention. It is potential to train paramedical employees to perform the Oral Cancer screening tests as perfect as doctors. Organize some Cancer control programmes in district level for early detection of Cancer and provide health education.
Prevention Clinics;
Cancer in late stage prevention is the possibility reason for poor survival from Cancer in India, it is mostly due to lack of diagnistic facilities at peipheral level. Government and health organizations should increase prevention clinics and provide diagnostic services and minimal treatment of Oral Cancer. Increase the range of cytology services which will help for early diagnosis of Cancer. Generate government and public participation to establish sufficient income, staff and quality of services of regional Cancer Centers.
Treatment;
Generate more trained surgeons and oncologist for an appropriate treatment of Oral cancer at regional cancer centres. Increaase transpot facilities for patients to get essential radiotherapy centres which can reduce long waiting lists, large propotion of Cancer and proper curing of disease. Free medicines or samples for poor and unaffordable patients from governent, nonprofit organizations and community is also neccesory prevention. Chemotherapy services for all kind of common cancers should be available to all centres.
Palliative Care;
In India more than 75% of cancers present in advanced stages so palliative care and pain relief are necessary to provide quality of life. Oral Morphine is main support of Cancer pain management, so it should be available to all health care centres and admimistrators should be aware of use and regulations.
Cancer registry network;
Assessment of the programme has to be undertaken with dependable records on the incidence and mortality from Oral Cancer. Registries under Indian counsil of medical research , population based Cancer can be networked. (Cancer pevention and control)
Participation of International Agencies;
The World Health Organization has promoted National Cancer Control Programmes and India is one of the few countries that has actively taken up this enterprise. India need to find other International Agencies whose most important areas are Tobacco Control, Palliative Care. India should follow these programmes and demonstrate to the World that Cancer Control is feasible and become a model for Cancer Control Programmes in low resource settings. (Cancer pevention and control)
Future Outcome of Oral Cancer Prevention:
In spite of the overall drop in occurrence and mortality rates for oral cancer in the most recent century, put up the shutters at hand is no place for complacency more than ever as recent trends report some significant increases surrounded by young and middle-aged men. Studies have reported an shocking lack of awareness about oral cancer, its symptoms and causes and this requirements to be addressed by further public education, probably targeted at high risk groups.
Continued existence rates have risen considerably over the last twenty years but could be supplementary improved by earlier detection and more successful treatments. Advances in surgical techniques encompass helped to reduce defacement and functional impairment. Over the next few years as the new government service strategy come into practice, patients should improvement. A nationwide review is ongoing with the aim of improving the information for head and neck patients so that the collision of new services can be considered and areas of apprehension can be addressed.
The converse on screening is ongoing but improved still would be the primary prevention of at least three quarters of cases from beginning to end the elimination of tobacco consumption and the self-control of alcohol consumption.
Additional research is obligatory into the natural times gone by of the disease, predominantly which precancerous lesions will advancement over time and how the risk factors interaction in the development of premalignant conditions and their carcinogenic revolution. At the molecular level there is a need to develop tumour markers so that treatment can be custom-made to the individual patient. (Canht)
Conclusion:
Non-communicable diseases as well as cancer are up-and-coming as important public health exertion in India. The increasing attention rear after year for risk factors vary from tobacco, dietary habits, insufficient physical activity, alcohol consumption and infections owing to viruses. Primary prevention. is the major approach to reduce the risk incidence and prevalence of Oral Cancer. Expensive health education of people is required to reduce risk from causative agents for example tobacco chewing habit. Nutrition education, safe sexual practices, prophylactic vaccination against Cancer causing viruses like Hepatitis B and HPV will help more reduce to reduce Cancer incidents. Regular screening for Oral, breast and cervical cancer should be promoted among people. These simple means will lead to a healthy personal life and society.
(Aleyamma Mathew, volume 2012)
