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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 207-210

Awareness of patients about existing oral precancerous lesions/conditions in Nashik city of Maharashtra


Department of Oral Medicine and Radiology, MGV'S KBH Dental College and Hospital, Nashik, Maharashtra, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Ajay R Bhoosreddy
Ganesh Niwas, Near Public School, Vakhari Road, Gunjal Nagar, Deola, Nashik - 423 102, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.181897

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  Abstract 


Introduction: Many oral squamous cell carcinomas develop from premalignant lesions/conditions of oral cavity. Hence, the awareness of such lesions/conditions is important. Aim: To assess the awareness about existing oral precancerous lesions/conditions among patients arriving for dental treatment at a dental hospital, in Nashik city of Maharashtra. Materials and Methods: A questionnaire was used to collect information from 80 patients with existing oral precancerous lesions/conditions attending the dental hospital, in Nashik city of Maharashtra. The questionnaire included questions to ascertain information on sociodemographic parameters, awareness, and sources of information about of oral precancerous lesions/conditions, habit of tobacco, areca nut chewing, smoking, alcohol, and combined habits. Results: We found that 40% (n = 32) respondents knew about the existence of lesion in their mouth of which only 50% (out of 40%) had thought that it was precancerous lesion/condition. Among all subjects, only 47.5% (n = 38) were aware of oral precancerous lesions/conditions. Television was the major source of information about oral precancerous lesions/conditions almost all the subjects (97.5%) wanted more information about oral precancerous lesions/conditions but through television (42.5%) and lectures (27.5%). Conclusion: Awareness of patients (coming to hospital) about oral precancerous lesions/conditions was found to be low. The people must be made aware of symptoms, signs, and preventive strategies of oral precancerous lesions/conditions through their preferred media – television and lectures.

Keywords: Alcohol drinking, awareness, betel chewing, information media, oral precancerous lesions/conditions, tobacco


How to cite this article:
Ahire BS, Bhoosreddy AR, Bhoosreddy SA, Pandharbale AA, Kunte VR, Shinde MR. Awareness of patients about existing oral precancerous lesions/conditions in Nashik city of Maharashtra. J Indian Assoc Public Health Dent 2016;14:207-10

How to cite this URL:
Ahire BS, Bhoosreddy AR, Bhoosreddy SA, Pandharbale AA, Kunte VR, Shinde MR. Awareness of patients about existing oral precancerous lesions/conditions in Nashik city of Maharashtra. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 May 25];14:207-10. Available from: http://www.jiaphd.org/text.asp?2016/14/2/207/181897




  Introduction Top


Oral cancer is seriously growing health problem, and it is the sixth most common cancer in the world. In high-risk countries such as Sri Lanka, India, Pakistan, and Bangladesh, oral cancer is one of the most common cancers in men and may contribute up to 25% of all new cases.[1] The higher incidence of oral cancer and precancers has been associated with the habit of betel quid and tobacco chewing in India. Among the 400 million individuals aged 15 years and above, 47% use tobacco in one form or the other in our country.[2] Patient's delay has been cited as the main reason for late attendance. It seems probable that in both high risk and general population, neither the symptoms of oral cancer nor the main risk factors are well-understood.[3] Oral squamous cell carcinoma (SCC) develops from preexisting potentially malignant disorders including oral leukoplakia, erythroplakia, submucous fibrosis, and lichenoid dysplastic lesions or can arise de novo.[4]

Public awareness is very low with respect to the knowledge of risk factors and methods of early detection of oral cancer.[3] Although there are community oral cancer screening programs, chronic tobacco chewers and smokers, who are at a higher risk, do not take advantage of it. Hence, patients are frequently diagnosed with advanced stage of cancer with 5 years survival rates are around 50%.[5] The early detection of cancer is of critical importance because survival rates markedly improve when the oral lesion is identified at an early stage.

In Sri Lanka, 95% of the respondents were aware that cancer could occur in the mouth. However, only 44.9% knew of the existence of an entity called oral precancer.[6] However, the natural history of oral cancer and precancer provides some encouraging evidence that early detection and management of cancers can be possible. Hence, awareness of these precancerous lesions in the mouth is important.

This survey aims to get information about awareness of existing oral precancerous lesions/conditions in patients and awareness of these patients regarding the development of cancer in future.


  Materials and Methods Top


A questionnaire survey was carried out among outpatients attending the dental hospital in Nashik city of Maharashtra. All patients visiting the dental hospital between 3 months duration (March 2014 and May 2014) and who had clinically diagnosed oral precancerous lesions/conditions were included in this study. No sampling was used. Hence, a total number of patients included in this study were eighty. Patients with cancer or with red or white lesions which are not precancerous or without any oral lesion in the mouth were excluded from the study, and questionnaire was filled by asking questions to patients. The questionnaire consisted of relevant questions to ascertain sociodemographic information, awareness of precancer, source of information of precancer and tobacco/betel chewing, smoking, and alcohol habits. This was a close-ended questionnaire, constructed on the basis of previously conducted studies,[3],[6],[7],[8] and based on the understanding of the precancerous lesions and conditions.

Validity of questionnaire was assessed by the medical professionals and some questionnaire papers used as a pilot study checked in by our study group and necessary corrections made. The questionnaire was prepared in English language. As examiner and patients were from the same regional area, there were no language problems.

After answering the questionnaire, each respondent was informed about the type of lesion in their oral cavity and was advised to quit oral abusive habits if any. Appropriate treatment was instituted wherever necessary. All the collected data were entered into Microsoft Excel. After sorting it out, a total number of responses were calculated. No statistical test was applied.


  Results Top


The study population comprised 64 males and 16 females with an average age of 32.3 years (range = 16–88 years). Maximum patients with precancerous lesions/conditions are 15–40 years of age. In terms of education, 87.5% had some level of formal education.

Only 40% of the subjects knew about a lesion/condition in their mouth. Average duration of lesion in the mouth is approximately 3.8 years. Of 40% positive responder subjects (n = 32), only 50% (16 subjects) felt it as precancerous lesion/condition (possibility of occurrence of cancer), and also out of 40% positive responder subjects, 87.5% knew about a lesion in their mouth by self-examination and 6.25% knew by family members and friends respectively, each. All the patients were asked about awareness of oral precancer; however, only 47.5% (n = 38) are aware of oral precancer [Table 1] and [Table 2].
Table 1: Percentage details about awareness of oral precancerous among patients

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Table 2: Awareness of lesion/condition in mouth among patient (n=32)

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In determining the source of information about oral precancer, it was found that television, radio, posters, and banners had played a significant role [Table 3].
Table 3: Details of sources of information about oral precancer (n=38)

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Maximum patients with oral precancer had tobacco chewing habit with mean duration of 12 years and mean frequency of 3–4 times/day, followed by combined habit with mean duration of 10 years and mean frequency of 4–5 times/day [Table 4].
Table 4: Habit of patients

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It was seen that prevalence of tobacco pouch keratosis (32.5%) and leukoplakia (32.5%) was maximum [Table 5]. We found that 75% subjects (out of 32 subjects, n = 24) thought of association between their habit and lesion [Table 6]. Only 12.5% subjects (out of 32 subjects, n = 4) consulted a doctor and were undergoing treatment, whereas the remaining 87.5% subjects though they knew about the existence of lesion in their mouth, neither consulted the doctor nor were taking any treatment [Table 7]. Overall (n = 80), almost all (97.5%) subjects wanted more information about oral precancer and maximum preferred to get information through television (42.5%) and lectures (27.5%) [Table 8] and [Table 9].
Table 5: Prevalence of lesions/conditions

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Table 6: Association of habit with lesion/condition (n=32)

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Table 7: Consultation and treatment (n=32)

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Table 8: Wanting more information about oral precancer

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Table 9: Preferred modality

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  Discussion Top


Oral cancer is one of the common cancers in India accounting for 50–70% of total cancer mortality.[9] High proportion of cases among males may be due to high prevalence of tobacco consumption habits.[9],[10],[11] Most of the subjects belonged to middle and lower socioeconomic scale.[12]

Indian subcontinent shows highest incidence and prevalence of oral SCC and the risk of developing it is mainly because of chewing tobacco, betel quid, and areca nut.[13] In this context, it is important to note that more than half (60%) of the respondents were not aware of the existence of precancer. This piece of information is an eye opener to the public health personnel of this country and points to the direct need for educational programs to enlighten the public about this dreadful disease.

Awareness of the causal relationship of tobacco in the betel quid and occurrence of cancer in the study population was high. This implies that in spite of being aware of tobacco as a causative factor for oral cancer, still there is a high tobacco consumption among the patients. Treatment of precancerous lesions and cancers is more effective if they are detected at early stages when they are small. In developing countries, more than 50% of oral cancers are detected only after they have become advanced. Cancers in the advanced stage are more painful, disfiguring, and the treatment necessary is radical and expensive with a low survival rate.[14] The present survey revealed that 50% subjects did not know that there is a possibility of occurrence of cancer in the lesion/condition and near about 52.5% were not aware of precancer. This may lead to a “loss of hope” type situation resulting in a delay in seeking treatment or the patient may not seek treatment at all.

Although manpower is a limiting factor, opportunistic screening could afford early detection leading to a greater survival and less radical treatment.[15] Dental professionals, especially those who serve at peripheral centers, have a vital role to play in this regard. Opportunistic screening, undertaken when patients attend a healthcare professional for some other purpose, may however be beneficial.[15],[16],[17] Especially, if high-risk groups can easily be identified and targeted for primary preventive advice and a mucosal examination.[17],[18]

Limitations

The limitation of this study is that it is carried out in a restricted geographical area. Sample size was small. Thus, the results of our study need to be confirmed by larger sample size and extended the geographical area.

Recommendations

As these lesions/conditions are commonly found in socially and economically deprived strata of population, so along with above modes, well organized and low-cost educational programs should be carried out. In these programs, awareness about risk factors, preventive strategies, symptoms, and signs of oral precancerous lesions/conditions should be done. Furthermore, some attractive and informative reading material such as leaflets and posters comprising clinical information about precancerous lesions/conditions should be provided.


  Conclusion Top


According to this survey, awareness of existing oral precancerous lesions/conditions was low among patients. It was found that television, radio, posters, and banners had played a significant role in patients who were aware of oral precancerous lesions/conditions. Almost all subjects wanted more information about oral precancerous lesions/conditions and maximum preferred to get information through television and lectures.

Acknowledgment

I would like to convey my sincere and earnest thankfulness to the Almighty God for blessing me with virtues like perseverance and strength to complete this dissertation successfully. Sincere thanks to Dr. Ramesh Ahire, Dr. Vidya Ahire, my family, teachers and friends for lending me moral support and being pillars of strength.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009;45:309-16.  Back to cited text no. 1
    
2.
Sankaranarayanan R. Oral cancer in India: An epidemiologic and clinical review. Oral Surg Oral Med Oral Pathol 1990;69:325-30.  Back to cited text no. 2
    
3.
Warnakulasuriya KA, Harris CK, Scarrott DM, Watt R, Gelbier S, Peters TJ, et al. An alarming lack of public awareness towards oral cancer. Br Dent J 1999;187:319-22.  Back to cited text no. 3
    
4.
van der Waal I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol 2009;45:317-23.  Back to cited text no. 4
    
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Rogers SN, Brown JS, Woolgar JA, Lowe D, Magennis P, Shaw RJ, et al. Survival following primary surgery for oral cancer. Oral Oncol 2009;45:201-11.  Back to cited text no. 5
    
6.
Ariyawardana A, Vithanaarachchi N. Awareness of oral cancer and precancer among patients attending a hospital in Sri Lanka. Asian Pac J Cancer Prev 2005;6:58-61.  Back to cited text no. 6
    
7.
Sankeshwari R, Ankola A, Hebbal M, Muttagi S, Rawal N. Awareness regarding oral cancer and oral precancerous lesions among rural population of Belgaum district, India. Glob Health Promot 2014;35:9-14.  Back to cited text no. 7
    
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Sitheeque M, Ahmad Z, Saini R. Awareness of oral cancer and precancer among final year medical and dental students of Universiti Sains Malaysia (USM), Malaysia. Arch Orofac Sci 2014;9:53-64.  Back to cited text no. 8
    
9.
Park K. Textbook of Preventive and Social Medicine. 21st ed. Jabalpur: Banarsidas Bhanot Publishers; 1994. p. 353-58.  Back to cited text no. 9
    
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Mathew Iype E, Pandey M, Mathew A, Thomas G, Sebastian P, Krishnan Nair M. Squamous cell carcinoma of the tongue among young Indian adults. Neoplasia 2001;3:273-7.  Back to cited text no. 10
    
11.
Mehta FS, Gupta MB, Pindborg JJ, Bhonsle RB, Jalnawalla PN, Sinor PN. An intervention study of oral cancer and precancer in rural Indian populations: A preliminary report. Bull World Health Organ 1982;60:441-6.  Back to cited text no. 11
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12.
Conway DI, Petticrew M, Marlborough H, Berthiller J, Hashibe M, Macpherson LM. Significant oral cancer risk associated with low socioeconomic status. Int J Cancer 2008;122:2811-19.  Back to cited text no. 12
    
13.
Feller L, Lemmer J. Oral squamous cell carcinoma: Epidemiology, clinical presentation and treatment. J Cancer Ther 2012;3:263-8.  Back to cited text no. 13
    
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Control of oral cancer in developing countries. A WHO meeting. Bull World Health Organ 1984;62:817-30.  Back to cited text no. 14
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15.
Warnakulasuriya KA, Johnson NW. Strengths and weaknesses of screening programmes for oral malignancies and potentially malignant lesions. Eur J Cancer Prev 1996;5:93-8.  Back to cited text no. 15
    
16.
British Dental Association. Opportunistic oral cancer screening. In: Occasional Paper. Vol. 6. 64 Wimpole Street, London: British Dental Association; 2000. p. 1-31.  Back to cited text no. 16
    
17.
Speight PM, Downer MC, Zakrzewska JM. Screening for oral cancer and precancer: Report of a UK working group. Community Dent Health 1993;10 Suppl 1:1-89.  Back to cited text no. 17
    
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Downer MC, Jullien JA, Speight PM. An interim determination of health gain from oral cancer and precancer screening: 3. Preselecting high risk individuals. Community Dent Health 1998;15:72-6.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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