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Oral Cancer in Semi urban and Rural India

by cancerhospital

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Oral cancer is one of the leading ten cancers in the world. It is the most common cancer which affects Indian men and third most common in Indian women. Statistically as per WHO reports, approximately 200,000 annual deaths globally are due to oral cancer and in India this number is at 46,000 annual deaths. Developing countries are more at risk as compared to developed nations with India being a forerunner in the highest risk category.

Oral cancer is caused by tobacco abuse, which is world – wide the single greatest cause of deaths which could be prevented.  Currently 9 million new cancer cases are detected each year and 7lakh of these are contributed by India. 33% of these 7 lakh cases are life style related like tobacco abuse.  Thus oral cancer amounts to the most fatal cancer affecting the humans. India like any other geographical entity has diverse urban, semi- urban and rural sections.  It has been seen that universal practice of chewing betel quid or paan in semi – urban and rural areas is the primary cause of a high incidence of oral cancer.

Statistics clearly show that more than 60% of affected population of oral cancer in India is residing in semi urban and rural areas. The observed variations in recorded incidence difference can be attributed to excessive exposure to tobacco use, dietary habits and infection proneness, health care access and cancer knowledge. In semi urban and rural areas due to historical pull of addictive habits oral cancer affects population in high frequency. Oral cancer has highest incidence in men and third highest in women. The higher incidence in rural areas in India is due to rampant use of tobacco and tobacco products combined with alcohol abuse. Genetic predisposition is prominent factor coupled with hormonal factors which play into high incidence rates in semi – urban India. This community is also not pre-disposed to cancer awareness, systematic evaluation, screening & close follow up. Also passive smoking is resulted in public gatherings, events and social gatherings adding to the disease burden. Unlike urban population who has got a healthy lifestyle and dietary habits this population is more at risk with the oral cancer. The rural population has low access to health education and the literacy rates are quite low. It has been statistically proven that awareness of risk factors is proportionate to literacy level and as this level is not very satisfactory in rural areas.

The primary hazard to causing oral cancer was tobacco abuse, weather consumed in the form of ghutka/paan or as bidi/cigarette smoking. But with studies later alcohol consumption also was counted as an independent risk factor. Both have adverse effect if consumed additively. Now diet and nutrition status also contribute to the aggressive run of the cancer. 

Poor public awareness is a direct indication of poor preventive compliance even for available health facilities in rural areas. The semi urban and rural population has no knowledge of oral malignant and premalignant lesions in the oral cavity. With no awareness, the prospects of detecting and noticing early and precancerous invasive lesions and sores are highly reduced. Thus affecting morbidity and eventually with late detection the mortality.

As is clear from the above paragraph the risk factors are quite apparent and clearly defined. Also because of a long natural history with the disease burden the population is aware of pre-cancer lesions in the oral cavity. All this makes this cancer potentially highly preventable. The only and necessary need of the hour is community education and awareness in these localities. This will increase screenings, promote early detection thus positively influencing preventive measures compliance.

As the affected age group is >30 and literacy levels are better in younger age groups <30, there is a need of cancer awareness propagation. The associated risks and the importance of systematic evaluation should be made known to the masses at a broader scale and may help in preventing the younger generation from picking up this deadly habit of tobacco abuse. Also systematic evaluation is wanted in this rural population. The awareness program initiated by health care delivery models involving evaluation, multi-modal medical attention is warranted to reduce the cancer burden.

We need to have objective based programs targeted at semi-urban and rural population to increase awareness about the risks and hazards of oral cancer and importantly its symptoms. As the cases are presented in late advanced stages and have poor outcome this education will help the masses in understanding associated risks. The masses have to understand the relative higher threat with population in combination of obesity, lifestyle and literacy negatives.


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