Oral cancer is one of the most fatal health problems faced by the mankind today. It is considered the 6th leading cause of cancer worldwide. In India, because of cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. It ranks number one in terms of incidence among men and third among women.
Age-adjusted rates of oral cancer in India are high, i.e., 20 per 100,000 population and accounts for over 30% of all cancers in the country. The variation in incidence and pattern of the disease can be attributed to the combined effect of ageing of the population, as well as regional differences in the prevalence of disease-specific risk factors. Several factors like tobacco and tobacco related products, alcohol, genetic predisposition and hormonal factors are suspected as possible causative factors.
Despite the fact that oral cancer and consequences can be prevented, treated, and controlled, there exists a significant gap in the Indian public’s knowledge, attitude, and behavior. Efforts must be made to introduce a suite of preventive measures that has the potential to significantly reduce the burden and to help bridge the gap between research, development and public awareness. Knowledge dissemination to help people adopt behavior patterns to improve their health and decision-making process and to provide required public health education and training to promote lifestyle modifications are keys to confronting the challenges.
The greatest threat of the oral cancer burden exists among the lower socio-economic strata. This segment of the population is the most vulnerable because of higher exposure to the risk factor—tobacco—which complicates the situation further. They have the most limited access to education, prevention and treatment. These disparities should be addressed to push for provision of easy, accessible, detection, and treatment services.
Efforts to prevent and control cancer are hampered by the low-priority frequently given to the disease by governments and health ministries, excessive reliance and expenditure on treatment, and a considerable imbalance between resources allocated for basic cancer research and those devoted to its prevention and control. Oral Morphine is the mainstay of cancer pain management and this has to be made available at all centers. The medical doctors as well as the administrators have to be sensitized and educated about the use of Oral Morphine and the regulations have to be made simple so that this essential drug is made available to those in pain. For example, primary prevention, early detection and palliative care are often neglected in favor of treatment-oriented approaches, even in cases where these approaches are not cost-effective and cause unnecessary human suffering.
Another example is the failure to take into consideration the social inequalities related to cancer prevention and control. The overall goal of cancer prevention and control is to reduce the incidence and mortality of cancer and to improve the quality of life of cancer patients and their families. A well conceived national cancer control program is the most effective instrument to bridge the gap between knowledge and practice and achieve this goal. In 2007, the World Health Assembly (WHA) passed a resolution on Oral Health for the first time in 25 years, which also considers oral cancer prevention.
The resolution WHA60 A16 urges Member states to take steps to ensure that prevention of oral cancer is an integral part of National Cancer-Control Programs, and to involve Oral-Health professionals or primary health care personnel with relevant training in oral health in detection, early diagnosis and treatment. Strengthening the research base is also another way of helping in early detection and prevention of oral cancer.
There are multiple factors which are causing obstacles in the effective tobacco control policy implementation at both national and regional levels. At regional level, there is a lack of trust between the member states of South Asian region and their border disputes. At national levels, corruption in politics involving politicians accepting money as bribes from the tobacco companies so they are not sincere in tackling this problem in most of these countries. Another problem at the public level is lack of awareness and social support for those people who want to quit smoking but can’t do it due to lack of tobacco cessation clinics and other facilities.
Despite the fact that the oral cavity is accessible for visual examination and that oral cancer and premalignant lesions have well-defined clinical diagnostic features, oral cancers are typically detected in their advanced stages. In fact, in India, 60–80% of patients present with advanced disease as compared to 40% in developed countries. It is imperative that cost-effective oral cancer screening and awareness initiatives be introduced in high-risk populations such as those found in India.
Mouth self-examination could further reduce the cost of the screening and increase awareness in high-risk communities in India. Such a simple and cost-effective strategy has the potential to have a significant impact on the awareness of oral cancer in the broader community.
The effect of oral cancer treatment takes a heavy toll on the financial condition of the person. India has the maximum number of oral cancer sufferers and the resources to serve such a huge number remain limited. The most pragmatic answer to such a situation is PREVENTION.
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