| Abstract|| |
Context: Oral cancer incidences are increasing in young generation for the past few decades. Gutkha chewing and cigarettes smoking being responsible for oral cancer, increase in consumption of these products among younger generation have significant impact on incidence of oral cancer. Those who are having nonmedical background may have less exposure to the information of oral cancer. This study was aimed to find out the information of nonmedical stream students perception about oral cancer. Materials and Methods: Nonmedical stream students between ages 19 and 25 years were evaluated for their insight about oral cancer using self-administered questionnaire. Questionnaire has included the questions about general knowledge about oral cancer, causative factors, signs and treatment of oral cancer. Students habits in relation to tobacco-related products were also evaluated. Results: Majority of the students has heard about oral cancer, but hardly have picture about causative factors and their clinical signs. Gutkha and cigarette smoking are still the major forms of tobacco product consumption among nonmedical stream students. Oncologist is the preferred choice for consultation of oral cancer treatment, though nearly half of the participants do not know about the treatment and how to seek it. Conclusion: The nonmedical stream students have less awareness about oral cancer. There is a great need for increase in oral cancer awareness programs as well as may be educational syllabus can have dedicated portion for such a preventable disease such as oral cancer.
Keywords: Awareness, Gutkha, nonmedical stream, oral cancer, tobacco use
|How to cite this article:|
Rathore A, Tijare M, Yuwanati M, Kallianpur S. Nonmedical stream students' insight into oral cancer: A school-based study. Ann Trop Med Public Health 2017;10:1511-7
|How to cite this URL:|
Rathore A, Tijare M, Yuwanati M, Kallianpur S. Nonmedical stream students' insight into oral cancer: A school-based study. Ann Trop Med Public Health [serial online] 2017 [cited 2018 Aug 15];10:1511-7. Available from: http://www.atmph.org/text.asp?2017/10/6/1511/222659
| Introduction|| |
Oral cancer (ICD 141, 143-146), still one of the most common cancer in Asia and South Asia, is responsible for many deaths across India and the World. It was previously considered to be disease of older age but becoming relatively common in young age. This has increased focus of government and nongovernment organization toward increasing the awareness of oral cancer and its causative factors among general population. Tobacco and areca nut consumption is prevalent in many developing countries, especially India, which has a major contributing role in the occurrence of oral cancer. There is no reduction in consumption of tobacco and areca nut products, causing rise in new cases of oral cancer. The World health Organization (WHO) has declared the tobacco and areca nut as carcinogen in their recent monogram. Long-term use of areca nut can develop addiction in person. There are numerous factors influencing the tobacco and areca nut products consumption habit such as stress, peer pressure, and social/culture rituals., There are many articles; newspaper columns and digital media activities on adverse effect of tobacco and areca nut products consumption., Despite the fact, various surveys reported rise in tobacco and areca nut products consumption among the youths and adults., The younger generation is getting more susceptible to these habits than anticipated. About 36.5% and 14.5% persons 15-year or older and 13–15 years young's are tobacco user.,, It is difficult to assess whether it is because of their lack of knowledge/awareness. Beside tobacco and related products, environmental factors such as infection, alcohol, diet, physical activity, and adiposity are credited to cancer development., Oral cancer prevention is one of effective way of dropping cancer incidence. Identification of sign/symptoms and early diagnosis of oral cancer can greatly reduce mortality and morbidity in cancer patients. People consider oral cancer as noncurable disease and have fear among them due to general misconception. Some of them aware about treatment but do not know where to treat it. The present survey was conducted among the nonmedical stream students in city. It was focused on enquiries about general awareness about cancer with special emphasis on oral cancer, personal hygiene, and prevention aspect. It may help in identifying the overall perception of cancer in college students and to develop effective educational strategy against cancer incidence among students.
| Materials and Methods|| |
Study design and population
The present prospective study was conducted in five nonmedical colleges in Bhopal city. The participants were randomly selected from each class. Total 100 participants were included in the study between 19 and 25 years age group. The participants were explained the about the objective of the study. The institutional ethics committee and college permission was obtained in the beginning of the study.
Instruments and data collection
Data were collected using a self-administered questionnaire [Table 1]. The questionnaire includes questions to assess awareness, knowledge, causes, attitude toward oral cancer and its risk factors. The purpose of the study was explained to respondents, confidentiality, and their right to withdraw was assured. In addition to oral briefing and description, each respondent received a written description of the purpose and aims of the study along with the study questionnaires. The completed questionnaire was collected along with inform consent.
The data collected and tabulated in Microsoft Excel sheet and were analyzed using statistical analysis software.
| Results|| |
A total of 100 participants response were analyzed. Fifty-one males and 49 females were took part in the questionnaire study to obtain the current status of awareness of oral cancer.
Participants were asked, basic informational question, about cancer based on a common understanding that there is less knowledge in population, especially nonmedical personnel. Participants were well aware of cancer, but most of them were afraid of it [Figure 1]. 49.5% of the participants were aware of the signs and symptoms for the identification of oral cancer [Figure 2], which was mostly, obtained through family, relatives/social communication. There was no consensus among them when asked about the most commonly heard type of cancer [Figure 3]. According to participants, the rate of occurrence is range from 12% to 19%.
To gauze knowledge about oral cancer, which is prevalent in India due to the common use of tobacco/areca nut products, they were asked about possible risk factors for the development of oral cancer. Surprisingly, 36.4% of participants have no idea what causes oral cancer. Nearly 29.3%, 19.2%, and 15.2% of participants attributed it to tobacco, environmental factors and genetic factors, respectively [Figure 4]. Participants were lacking about signs of oral cancer with 42.4% saying, that they have no idea about it. About 28.3% considered ulcer as sign for identification [Figure 2]. Participants have better knowledge about dangerous effects of oral cancer on affected person, however, could not acknowledge the correlation of positive family in oral cancer diagnosis and its significance. Majority participant prefers to go to an oncologist (40.4%) and a dental surgeon (33.3%) rather than going to a general physician (12.1%) 14.1% were not sure to whom they should approach [Figure 5]. Response to the importance of oral hygiene was mixed, though about 50% of participants had dental clinic visits commonly [Figure 6]. A toothache was the most common reason for visit other then ulceration and esthetics being least of it [Figure 7]. About 72.8% of participants were not involved in any kind of tobacco-related products habits [Figure 8]. Consumption of smokeless tobacco (18.32%) and smoking (7.1%) or both (0.78%) was present in those involved [Figure 9]. Chewing gutka was the most common form of smokeless tobacco in participants followed by zarda, pan masala, and khaini. A daily average of smokeless tobacco product was 1–5 mg among the users. Average time duration use of per smokeless/smoking per day was 10–20 min with 10–20 min average interval. About 43% said that they know how to prevent oral cancer, such as stopping or avoiding consumption of tobacco and related products [Figure 10]. Importance of early identification was evident among participants (32%), which can help in reducing the mortality and morbidity. About three-fourth of participants have never attended any oral cancer awareness/educational program. Nearly 48% said they educate peoples around them about the ill effects of tobacco and encourage them to quit. Participants (37%) have no knowledge about oral cancer treatment [Figure 11].
| Discussion|| |
Oral cancer is worldwide known as dangerous disease with established causative factors. Knowledge about oral cancer can help in reducing its burden among the population. International and national agencies are actively engaged in reducing the incidence of oral cancer. Hands-on information are considered as best mean of achieving the goals. It is important to find out the outcome of these steps, especially among the young generation. Nonmedical college students when evaluated for general information about cancer/oral cancer, it was observed that about 49% are well informed about cancer. Sathyanarayanan et al. found only 8% of students have heard about oral cancer. Mehboob et al. and Warnakulasuriya et al. study group  found 3% and 59% awareness level, respectively. The variation awareness level could be difficult to ascertain since population studied may have different level of exposer to oral cancer information. The participants family background as well as surrounding campus may have impact on knowledge about oral cancer. The students having oral cancer affected person in family/relative or close friend can influence information though students belonging to nonmedicine field. College campus having the nearby medical college or oral cancer center can contribute to its awareness since medical college and hospital organize cancer awareness programs. Lung cancer and breast cacner are most common cancer in India. Participants had difficult time to tell commonly heard type cancer. Warnakulasuriya et al. found 97% and 86% of participant had heard about lung cancer and cervical cancer, respectively.
Oral cancer is attribute to the tobacco product and consumption. Over million peoples die because of tobacco-related habits or use. About 34.6% of adult population are tobacco user in any form. Nearly 9.6% are minors (age 15–19) who consume tobacco in any form. It important to that younger ration should be aware of the hazardous effect of tobacco and related products. There is still less knowledge among nonmedicine students about the causative factor for oral cancer which was found in the present study (36.4%) and Shah and Praveen (14.57%) in rural population. Ahire and Palekar found it nonsatisfactory when compared among studied population  Information about tobacco use causing oral cancer needed to be given at college and school level. Devadiga and Prasad found 69.8% medicine students can accurately tell that tobacco use can predispose person to oral cancer. A large number of oral cancer patients report in late or advanced stage of cancer, by the time cancer involve other body areas causing local and distance metastasis. Metastasis increases the morbidity and mortality in oral cancer patients. Initial signs of oral and precancer usually started as ulcer, growth/lump in the oral cavity are difficult to be identified by common population. Nonmedical students having less information about signs of oral cancer was found in other studies. Ahire and Palekar reported 81% among the nonmedical students. Although person is aware of having ulcer or lump, they may not think of it as suspicious of cancer. Their understandings of these signs can come from the information from family friends and mass media. Steps taken by nongovernment organization and government has improved the understanding among the general population about oral cancer in recent years. Oral cancer incidence in the family can help in increase dangerous effects of oral cancer in the affected person and predisposition of other family member to oral cancer.
Oncologist (40.4%) or dentist (30.3%) was preferred choice for participants in case of having suspicion of oral cancer. Seeking the help of oncologist rather than dentist may due to perception of participant about oral cancer that it requires surgery for cure. Hence, they think to approach to oncologist which generally a medical specialist in cancer treatment but not the oral surgeon.
About half percentage of participant have routine dental clinic visit for toothache. Toothache was being most common reason has also been reported in the previous published studies., Since toothache is painful condition, participant seeks urgent help to treat it. However, ulcer or esthetics were of last on their priority. General population usually see dentist as only in context of toothache and tooth-related disease. Surprisingly, little <3/4th of participants do not have any tobacco (smoke ad smokeless)-related habits. Chkhaidze I et al. and Chatterjee et al. found 48%, 61.2% participants having tobacco habits, respectively, which was in contrast to the present study. Cigarette smoking is still common prevalent habit in the world; however, gutkha by followed zarda, pan masala, and khaini becoming more popular recently. Elfassy et al. found 400% increase in smokeless tobacco among youth. This shift in habit is result of increase promotion by tobacco industries as safe alternative to cigarettes and due to increase taxes on cigarettes in India and world.
Prevention of tobacco use, especially among the young population hold the key to most effective way to stop oral cancer. Areca nut is another factor which presents in gutkha and pan masala responsible for oral cancer on long-term use. However, over half percentage of participants were not aware of how to prevent disease. This indicates potential for preventive and education promotion young population. It is in concurrence with Merchant et al. and De Silva well-differentiated angiosarcoma studies. It becomes more important considering the fact that about 40% of participants does not know about treatment modalities and how to seek this treatment. The current approach for oral cancer treatment increase the survival of cancer patient person thought not totally cure it except in very initial stages and that too with certain degree of morbidity.
This study result was derived from the sample pooled from city college; it should be expanded to get large randomized controlled sample. Although the sample size was small, it helped to increase our clarity on oral cancer problem in young generation. Finally, there is a great need for increase oral cancer awareness programs targeting young generation at the early school level.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Joshi P, Dutta S, Chaturvedi P, Nair S. Head and neck cancers in developing countries. Rambam Maimonides Med J 2014;5:e0009.
Oliver RJ, Dearing J, Hindle I. Oral cancer in young adults: Report of three cases and review of the literature. Br Dent J 2000;188:362-5.
Gupta B, Ariyawardana A, Johnson NW. Oral cancer in India continues in epidemic proportions: Evidence base and policy initiatives. Int Dent J 2013;63:12-25.
Kumar S, Debnath N, Ismail MB.”Prevalence and risk factors for oral potentially malignant disorders in Indian population.” Adv Prev Med 2015;2015:7.
Hashibe M, Jacob BJ, Thomas G, Ramadas K, Mathew B, Sankaranarayanan R, et al.
Socioeconomic status, lifestyle factors and oral premalignant lesions. Oral Oncol 2003;39:664-71.
Herzog TA, Murphy KL, Little MA, Suguitan GS, Pokhrel P, Kawamoto CT, et al.
The betel quid dependence scale: Replication and extension in a Guamanian sample. Drug Alcohol Depend 2014;138:154-60.
Ghani WM, Razak IA, Yang YH, Talib NA, Ikeda N, Axell T, et al.
Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults. BMC Public Health 2011;11:82.
Hedman L, Bjerg A, Perzanowski M, Sundberg S, Rönmark E. Factors related to tobacco use among teenagers. Respir Med 2007;101:496-502.
National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. NIH Pub. No. 07-624. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2008.
Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: An integrative review. Tob Control 2012;21:127-38.
Chadda R, Sengupta S. Tobacco use by Indian adolescents. Tob Induc Dis 2003;1:8.
WHO Global Report on Trends in Prevalence of Tobacco Smoking; 2015.
International Institute for Population Sciences, Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey India (GATS India); 2009-10. New Delhi: Ministry of Health and Family Welfare; Mumbai: International Institute for Population Sciences; 2010.
Mishra GA, Pimple SA, Shastri SS. An overview of the tobacco problem in India. Indian J Med Paediatr Oncol 2012;33:139-45.
] [Full text]
Mathur MR, Singh A, Dhillon PK, Dey S, Sullivan R, Jain KK, et al
. Strategies for cancer prevention in India - Catching the 'low hanging fruits'. J Cancer Policy 2014;2:105-6.
Murthy NS, Mathew A. Cancer epidemiology, prevention and control. Curr Sci 2004;86:518-24.
Mangalath U, Aslam SA, Abdul Khadar AH, Francis PG, Mikacha MS, Kalathingal JH, et al.
Recent trends in prevention of oral cancer. J Int Soc Prev Community Dent 2014;4:S131-8.
Ford LG, Minasian LM, McCaskill-Stevens W, Pisano ED, Sullivan D, Smith RA, et al.
Prevention and early detection clinical trials: Opportunities for primary care providers and their patients. CA Cancer J Clin 2003;53:82-101.
Sathyanarayanan R, Karthigeyan R, Dinesh DS. Awareness about oral cancer among non medical university students of Puducherry. JIDENT 2012;1:1-5.
Mehboob B, Khan E, Khan M. Awareness about oral cancer among non medical university students of Peshawar. Pak Oral Dent J 2011;1:31.
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.
Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, et al.
Recommendations for screening and early detection of common cancers in India. Lancet Oncol 2015;16:e352-61.
Shah SP, Praveen BN. Awareness of oral cancer in rural Bangalore population: A questionnaire based study. Int J Sci Study 2014;1:14-6.
Ahire S, Palekar K. Awareness of oral cancer related habits among college going youngsters in Nasik City, Maharashtra – A cross sectional survey. J Adv Med Dent Sci Res 2015;3:S53-7.
Devadiga A, Prasad KV. Knowledge about oral cancer in adults attending a dental hospital in India. Asian Pac J Cancer Prev 2010;11:1609-13.
Noguti J, De Moura CF, De Jesus GP, Da Silva VH, Hossaka TA, Oshima CT, et al.
Metastasis from oral cancer: An overview. Cancer Genomics Proteomics 2012;9:329-35.
Karageorgos I, Mizzi C, Giannopoulou E, Pavlidis C, Peters BA, Zagoriti Z, et al.
Identification of cancer predisposition variants in apparently healthy individuals using a next-generation sequencing-based family genomics approach. Hum Genomics 2015;9:12.
Bastos JL, Nomura LH, Peres MA. Dental pain, socioeconomic status, and dental caries in young male adults from Southern Brazil. Cad Saude Publica 2005;21:1416-23.
Lacerda JT, Simionato EM, Peres KG, Peres MA, Traebert J, Marcenes W, et al.
Dental pain as the reason for visiting a dentist in a Brazilian adult population. Rev Saude Publica 2004;38:453-8.
Chatterjee T, Haldar D, Mallik S, Sarkar GN, Das S, Lahiri SK, et al.
study on habits of tobacco use among medical and non-medical students of Kolkata. Lung India 2011;28:5-10.
] [Full text]
Elfassy T, Yi SS, Kansagra SM. Trends in cigarette, cigar, and smokeless tobacco use among New York City public high school youth smokers, 2001-2013. Prev Med Rep 2015;2:488-91.
De Silva WD. Effectiveness of tobacco control measures in reducing tobacco use among adolescents and young adults in Anuradhapura, Sri Lanka. Asia Pac J Med Toxicol 2012;1:22-6.
Department of Oral Pathology, People's College of Dental Sciences and Research Centre, Peoples Campus, Bhanpur, Bhopal - 462 037, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]