Oral cancer is currently the eleventh most common cancer on a global scale, with an estimated 300,000 cases being reported each year. In most countries oral cancer makes up around three to 10 percent of overall cancer cases — but it's fast becoming more prevalent. In India, oral cancer is already the most commonly diagnosed cancer, accounting for as many as four in 10 cancer cases. Why is India being held in the grip of oral cancer? And equally importantly, what can we do about that?
Why Is Oral Cancer So Common In India?
Oral cancer is, in fact, a group of cancers, each with a different set of predisposing characters, rate of progression, appearance and treatment. Ninety percent of all oral cancer cases can be attributed to the effects of tobacco and alcohol consumption, with smoking posing a particular risk. Huge numbers of Indians smoke: close to 57 percent people between the ages of 15 and 49 reported some amount of tobacco use in a recent survey.
Also extremely common across the country is the use of smokeless tobacco. A "betel quid", or a "pan", as it is known in the local language, consists of areca nut, tobacco, slaked lime and some other condiments wrapped in a leaf. Consuming tobacco this way has a high level of social acceptability and is almost a post-meal ritual in large parts of the country.
Other locally-available mixtures of areca nut and tobacco called gutkha, zarda, mawa and khainni are sold at almost every nook and corner.
In fact, family members introduce the habit of chewing tobacco or eating pan to youngsters in a large percentage of cases. The reason for this is ignorance about the possible adverse effects of these habits and the "everyone is doing it so it must be right" principle.
Certain parts of India, like rural parts of Andhra Pradesh, practice a habit called reverse smoking in which people actually inhale while keeping the lit end of the cigarette inside the mouth. This is much more harmful to the oral tissues and expectedly results in a very high incidence of oral cancer.
A recent trend has also seen the rise of oral cancer in young adults even though they not have any of the risk factors present among them.
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According to WHO estimates, 130,000 people die due to oral cancer every year in India, which is approximately 14 deaths every hour. In a country with widespread poverty and lack of education, this puts a huge toll on the already stretched healthcare resources of the country.
Reducing Oral Cancer Rates In India And Elsewhere: The Way Forward
Screening
Oral cancer is the only kind of cancer that gives a visual clue before it actually begins to develop. Also, with the oral cavity being easily accessible, the need for spreading awareness about self-examination and at local healthcare centers is extremely pressing.
Pre-malignant lesions such as leukplakia, erythroplakia and oral sub mucous fibrosis can be seen in people who are extremely heavy users of tobacco. Patients develop white, reddish or mixed patches in their oral cavity. The most common place where these patches develop is the buccal vestibule where people pack the tobacco and leave it for prolonged periods of time.
Other symptoms, such as a burning sensation while eating, the inability to bear any sort of spices whatsoever and in the case of oral sub mucus fibrosis, an inability to open the mouth. All of these symptoms are quite easily identifiable and can help forewarn people against an impending danger.
Affordable Treatment
India as a country is still riddled with extreme poverty and the large majority of its population cannot afford quality health care. In such a situation, the government needs to set up more schemes like those run by Dr Devi Shetty, who provides access to health care to entire families for as little as $3 per year. This is made possible by grants and donations from the private sector, as well as aid from the government institutions.
Taxing Tobacco
One of the more obvious things to do seems to be to tax cigarettes and other tobacco products at a much higher rate, thereby making them expensive. The money received from this taxation should be used to help provide funding to ailing healthcare facilities. Unfortunately, this does not seem likely in the near future.
Promises made are often rolled back seemingly at the behest of a strong tobacco lobby. A favorite argument that is used is that tobacco farmers will go out of business if tobacco products are taxed excessively. Experiments all over the world have shown that farmers are happy to be compensated and settled into newer industries, thereby ensuring that no one is left behind.
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Conclusion
There are many problems and social habits that are endemic to the Indian subcontinent. This is the region that is responsible for over a billion people all over the world. Measures must be taken, keeping short-term and long-term goals in mind so that oral cancer can be effectively fought against.
Sources & Links
- Photo courtesy of Artist in doing nothing. via Flickr: www.flickr.com/photos/miran/6636568853
- Photo courtesy of Artist in doing nothing. via Flickr: www.flickr.com/photos/miran/6636568853
- Photo courtesy of mckaysavage via Flickr: www.flickr.com/photos/mckaysavage/3059483658
- 1. http://ocf.org.in/professional/IncidenceAndPrevalence.aspx
- 2. http://www.deccanherald.com/content/309608/86-per-cent-global-oral.html
- 3. J Community Health. 2012 Apr
- 37(2):316-9. doi: 10.1007/s10900-011-9447-6. Oral cancer in India: an epidemiologic and clinical review.