Patterns of Tobacco Use and its Relation to Oral Precancers and Cancers among Individuals Visiting a Tertiary Hospital in South India
Aarish Khan, Ravikiran Ongole, Joanna Baptist, Natarajan Srikant, Fatema Lukmani
India, Oral cancer, Oral precancers, Prevalence, Tobacco
Citation Information :
Khan A, Ongole R, Baptist J, Srikant N, Lukmani F. Patterns of Tobacco Use and its Relation to Oral Precancers and Cancers among Individuals Visiting a Tertiary Hospital in South India. J Contemp Dent Pract 2020; 21 (3):304-309.
Aim: The aim of this study was to evaluate the use of tobacco and its association with oral precancers and cancers. Materials and methods: Medical records of 1,007 individuals were assessed for the patterns of tobacco abuse and the presence of tobacco-related oral mucosal alterations. Results: This study comprised 1,007 individuals (M:F: 95.4%:4.6%). In the cohort, 60.1% had smoking habit and 56.1% had smokeless habit. Of the bidi smokers, 18.2% developed carcinoma, 14.3% developed leukoplakia, which is statistically significant (p < 0.001). A logistic regression analysis of the development of oral submucous fibrosis (OSMF) shows that habit of smokeless forms of tobacco has an odds ratio (OR) of 18+ when compared with smoking. Combination of bidi and gutkha had 12.3 times higher risk of developing oral cancer and 4.4 times risk of developing leukoplakia. A total of 33.3% betel quid and gutkha chewers presented with tobacco pouch keratosis, which is statistically significant. Conclusion: Smoked and smokeless forms of tobacco were equally popular among the study population. The packeted form of smokeless tobacco (gutkha) was more prevalent. Oral submucous fibrosis was more common than leukoplakia, and oral cancer developed more frequently in elderly men smoking bidis. Clinical significance: This study throws light on the fact that the use of both smoke and smokeless forms of tobacco is still prevalent, and the use of gutkha was most prevalent. These findings will help tobacco cessation and counseling centers to focus their effort in motivating people to stop gutkha chewing habit. This also brings to the forefront the need to create better treatment strategies to manage OSMF.
Petti S. Lifestyle risk factors for oral cancer. Oral Oncol 2009;45(4): 340–350. DOI: 10.1016/j.oraloncology.2008.05.018.
International agency for research on cancer. tobacco smoke and involuntary smoking. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 83. Lyon: IARC; 2004.
Sankaranarayanan R, Ramadas K, Amarasinghe H, et al. Oral cancer: prevention, early detection, and treatment. Disease Control Priorities. 3rd ed., 2015.
Proia NK, Paszkiewicz GM, Nasca MA, et al. Smoking and smokeless tobacco-associated human buccal cell mutations and their association with oral cancer—a review. Cancer Epidemiol Prev Biomarkers 2006;15(6):1061–1077. DOI: 10.1158/1055-9965.EPI-05-0983.
Gupta B, Johnson NW. Oral cancer: Indian pandemic. Br Dent J 2017;222.7(7):497–497. DOI: 10.1038/sj.bdj.2017.293.
Kim SM. Human papilloma virus in oral cancer. J Korean Assoc Oral Maxillofac Surg 2016;42(6):327–336. DOI: 10.5125/jkaoms.2016.42.6.327.
Herrero R, Castellsagué X, Pawlita M, et al. Human papillomavirus and oral cancer: the international agency for research on cancer multicenter study. J Natl Cancer Inst 2003;95(23):1772–1783. DOI: 10.1093/jnci/djg107.
Westra WH. The changing face of head and neck cancer in the 21st century: the impact of HPV on the epidemiology and pathology of oral cancer. Head Neck Pathol 2009;3(1):78. DOI: 10.1007/s12105-009-0100-y.
Yadav A, Kumar L, Misra N, et al. Estimation of serum zinc, copper, and iron in the patients of oral submucous fibrosis. Natl J Maxillofac Surg 2015;6(2):190–193. DOI: 10.4103/0975-5950.183851.
Banerjee SC, Ostroff JS, Bari S, et al. Gutka and Tambaku paan use among South Asian immigrants: a focus group study. J Immigrant Minority Health 2014;16(3):531–539. DOI: 10.1007/s10903-013-9826-4.
Moles DR, Fedele S, Speight PM, et al. Oral and pharyngeal cancer in South Asians and non-South Asians in relation to socioeconomic deprivation in south east England. Br J Cancer 2008;98(3):633–635. DOI: 10.1038/sj.bjc.6604191.
Cullen JW, Blot W, Henningfield J, et al. Health consequences of using smokeless tobacco: summary of the advisory committee's report to the surgeon general. Public Health Rep 1986;101(4):355.
Mehrotra D, Kumar S, Mishra S, et al. Pan masala habits and risk of oral precancer: a cross-sectional survey in 0.45 million people of north india. J Oral Biol Craniofac Res 2017;7(1):13–18. DOI: 10.1016/j.jobcr.2016.12.003.
International Institute for Population Sciences, Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey India (GATS India), 2009-10 2010 New Delhi Ministry of Health and Family Welfare; Mumbai: International Institute for Population Sciences.
Chockalingam K, Vedhachalam C, Rangasamy S, et al. Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai City, India. PLoS ONE 2013;8(10):e76005. DOI: 10.1371/journal.pone.0076005.
Mutti S, Reid JL, Gupta PC, et al. Patterns of use and perceptions of harm of smokeless tobacco in Navi Mumbai, india and Dhaka, Bangladesh. Indian J Community Med 2016;41(4):280. DOI: 10.4103/0970-0218.193337.
Karthik R, Mohan N. Prevalence of oral mucosal lesions among dental patients with mixed habits in Salem district-a study. J Pharm Bioallied Sci 2017;9(Suppl 1):S55. DOI: 10.4103/jpbs.JPBS_86_17.
Naveen Kumar B, Tatapudi R, Sudhakara-Reddy R, et al. Various forms of tobacco usage and its associated oral mucosal lesions. J Clin Exp Dent 2016;8(2):e172. DOI: 10.4317/jced.52654.
Sugar L, Banoczy J. Follow-up studies in oral leukoplakia. Bull World Health Organ 1969;41(2):289.
Gupta PC. A study of dose-response relationship between tobacco habits and oral leukoplakia. Br J Cancer 1984;50(4):527–531. DOI: 10.1038/bjc.1984.210.
Mehta FS, Pindborg JJ, Bhonsle RB, et al. Incidence of oral leucoplakias among 20,358 Indian villagers in a 7-year period. Br J Cancer 1976;33(5):549–554. DOI: 10.1038/bjc.1976.87.
Daftary DK, Pitkar VK, Gupta PC, et al. A study of the natural history of oral preleukoplakia. Acta Odontol Scand 1978;36(5-6):327–331. DOI: 10.3109/00016357809029083.
Niaz K, Maqbool F, Khan F, et al. Smokeless tobacco (paan and Gutkha) consumption, prevalence, and contribution to oral cancer. Epidemiol Health 2017;39:e2017009. DOI: 10.4178/epih.e2017009.
Kallischnigg G, Weitkunat R, Lee PN. Systematic review of the relation between smokeless tobacco and non-neoplastic oral diseases in Europe and the United States. BMC Oral Health 2008;8(1):13. DOI: 10.1186/1472-6831-8-13.
Keluskar V, Kale A. An epidemiological study for evaluation of oral precancerous lesions, conditions and oral cancer among Belgaum population with tobacco habits. Biosci Biotech Res Comm 2010;3(1):50–54.
Madani AH, Dikshit M, Bhaduri D. Risk for oral cancer associated to smoking, smokeless and oral dip products. Indian J Public Health 2012;56(1):57. DOI: 10.4103/0019-557X.96977.
Malson JL, Sims K, Murty R, et al. Comparison of the nicotine content of tobacco used in bidis and conventional cigarettes. Tob Control 2001;10(2):181–183. DOI: 10.1136/tc.10.2.181.
Gupta J. Increased risk of oral cancer in bidi smokers: a pilot study. EJMPR 2016;3(12):298–300.