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Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
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Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India

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Cancer, being one of the most common causes of death after …

Cancer, being one of the most common causes of death after
coronary heart diseases, causes nearly 7 million deaths each
year worldwide and according to WHO, presently, almost 25
million people are suffering from cancer, and by 2020 it is
projected that there may be 16 million new cancer cases and
ten million cancer deaths reported every year.1 In most
countries, one to ten cases per 1,00,000 people are diagnosed
with oral cancer every year. Though, it accounts for only two
percent of all cancers reported worldwide, it is the second
most common cancer in males and the fourth most common
cancer in females in South-Central Asia, accounting for seven
percent of the total cancers diagnosed in this region, ranking
among the three most common types of cancers reported in
the region.2 With 75,000e80,000 new cases of oral cancers
being reported every year, India has the highest prevalence of
oral cancer in the world. According GLOBOCON 2012 report,
oral cancer is a third most frequent cancer after breast and
cervix with an estimated 5-year prevalence rate of 6.6%.3 In
India, Northeast India including Assam accounts for more
than 40% of these cases.4 Oral cancer has a higher cure rate
when detected early and treated accordingly, but unfortu-
nately most oral cancers are diagnosed in advanced stages,
requiring aggressive treatment and associated morbidity,
resulting in higher mortality rates.

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  • 1. Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India
  • 2. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme Original Article Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India Abhinay Yamsani a, Krishna Shastrula Prashanth b, Eshvendar Reddy Kasala c,*, Rubi Kataki d, Babul Kumar Bezbaruah a,b,c,e a Department of Pharmacy Practice, NIPER-Guwahati, Assam, India Department of Biotechnology, NIPER-Guwahati, Assam, India c Department of Pharmacology and Toxicology, NIPER-Guwahati, Assam, India d Department of Conservative Dentistry and Endodontics, Regional Dental College, Assam, India e Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India b article info abstract Article history: Objective: To evaluate the awareness of oral cancer when compared to other cancers in Received 13 December 2013 adults attending Regional Dental College, Guwahati, Assam and determine their knowledge Accepted 27 January 2014 regarding risk factors, signs, symptoms and causes of oral cancer. Available online xxx Method: A cross-sectional survey involving 824 adults was conducted using a questionnaire which covered 21 questions including topics like socio-demographic aspects, oral cancer Keywords: awareness, knowledge about risk factors associated with oral cavity and early signs of oral Awareness cancer, lifestyle habits like smoking, alcohol consumption and dentist visits. Knowledge Results: Nearly seventy percent (580 out of 824) of subjects participating in the study were Oral cancer aware of the term ‘oral cancer’. 74.27% and 63.59% subjects identified tobacco and smoking Questionnaire respectively as important risk factors, but failed to consider alcohol consumption as major Risk factors and survey contributing factor. 66.5% individuals considered “difficulty in swallowing” as a symptom of oral cancer though 62.1% individuals were unable to identify “persistent white or red spot” as a symptom of oral cancer. Only 11.16% individuals had undergone screening for oral cancer during their lifetime. Conclusion: The lack of basic awareness about the risk factors, causes, signs and symptoms of oral cancer in this cross-sectional population of Northeast India is clearly evident in our study. Since, Northeast India accounts for more than 40% of these cases, interactive cancer awareness programs should be taken up by research organizations and government to educate people and make them better understand the serious implications of oral cancer. Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved. * Corresponding author. Tel.: þ91 9700820750. E-mail address: ishreddy4@gmail.com (E.R. Kasala). 0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apme.2014.01.004 Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
  • 3. 2 1. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 Introduction Cancer, being one of the most common causes of death after coronary heart diseases, causes nearly 7 million deaths each year worldwide and according to WHO, presently, almost 25 million people are suffering from cancer, and by 2020 it is projected that there may be 16 million new cancer cases and ten million cancer deaths reported every year.1 In most countries, one to ten cases per 1,00,000 people are diagnosed with oral cancer every year. Though, it accounts for only two percent of all cancers reported worldwide, it is the second most common cancer in males and the fourth most common cancer in females in South-Central Asia, accounting for seven percent of the total cancers diagnosed in this region, ranking among the three most common types of cancers reported in the region.2 With 75,000e80,000 new cases of oral cancers being reported every year, India has the highest prevalence of oral cancer in the world. According GLOBOCON 2012 report, oral cancer is a third most frequent cancer after breast and cervix with an estimated 5-year prevalence rate of 6.6%.3 In India, Northeast India including Assam accounts for more than 40% of these cases.4 Oral cancer has a higher cure rate when detected early and treated accordingly, but unfortunately most oral cancers are diagnosed in advanced stages, requiring aggressive treatment and associated morbidity, resulting in higher mortality rates.5 The most important etiological factors leading to oral cancer are tobacco and betel nut chewing, excess consumption of alcohol, improper diet and nutrition, human papilloma virus and immune-suppression.6 These are avoidable risk factors that can be effectively combated using primary preventive strategies. Health promotion is one of the most important components of primary prevention, which comprises health education, influencing knowledge and behaviors at all levels of social organization.7 The early detection of oral cancer is hindered by lack of public awareness of the early signs and symptoms associated with oral cancer.8,9 Knowledge regarding the risk factors of oral cancer like tobacco and alcohol consumption is limited in Indian high-risk population.10 Till date, a study on the extent of awareness and knowledge on oral cancer has not been performed in adults attending a dental hospital in Northeast India. The present study was aimed to examine the extent of awareness and knowledge of oral cancer in adults attending outpatient unit of Regional Dental College (RDC), Guwahati, India. Specific objectives of the study include: a) To assess the knowledge of oral cancer compared to other cancers, about its risk factors and early signs and symptoms. b) To correlate these knowledge levels according to age, gender and education levels. awareness of oral cancer as compared to other cancers, including degree of knowledge about oral cancer, its risk factors, signs, symptoms and popular beliefs. The study was approved by Institutional Ethical Committee, Regional Dental College (Regd. No-RDC-29/2011/2440). Following their consent to the study, attendees of age 18 or above to Regional Dental College were face to face interviewed consecutively in the order of their arrival to the hospital by a trained researcher accompanied by a duty doctor. A total of 866 subjects were invited to participate in the study, of which 42 adults were uninterested to participate. The time period of study was 1 month (1st February 2013e1st March 2013). The questionnaire (available on request from the corresponding author) was prepared based on similar previous studies,9,11 though few questions were adapted to better suit the local population. A pilot study of 40 subjects prior to the actual study was conducted to validate the questionnaire and modifications were made accordingly. The interview started with a formal introduction of the interviewer as a graduate student at National Institute of Pharmaceutical Education and Research, Guwahati undertaking a study on cancer information. The questionnaire was divided into four sections and constituted of 21 questions which were designed to obtain information on: (1) sociodemographic aspects; (2) oral cancer awareness and knowledge; (3) knowledge about risk factors associated with oral cavity and early signs of oral cancer; (4) lifestyle habits like smoking, chewing of betel nut, alcohol consumption, dietary intake, dentist visits, and oral hygiene habits. Participants were first questioned whether they were aware of oral cancer and the various other cancers. They were then asked questions regarding “mouth (oral cavity) examination as a part of oral cancer detection during their life time”. Questions regarding “oral cancer’s frequency based on age groups (Children, young adults to 25 years, adults up to 45 years, adults from 45 years, do not know), location in mouth most frequently affected due to oral cancer (gum, tongue, cheek, floor of the mouth, palate), gender (male or female), where does mouth cancer rank amongst the ten most common cancers in the world and what are the main risk factors, signs and symptoms, and causes of oral cancer” were also asked. Set of options was given in the questionnaire for these queries and subjects were asked to select one from those options. Then questions on “contribution of luck factor, chances of successful treatment on early discovery and effect of lifestyle changes to reduce the risk of oral cancer” were asked to evaluate the oral cancer beliefs. Responses to these questions were “agree”, “disagree”, or “do not know”. Questions based on “tobacco chewing, alcohol consumption, smoking habits, oral hygiene habits like brushing, fruit and vegetable intake and dentist visits” were also posed to acquire the knowledge of effect of oral hygiene and their role in oral cancer incidence amongst attendees. 2.1. 2. Method A cross-sectional study was carried out in the out-patient unit of Regional Dental College, Guwahati, Assam to evaluate the Statistical analysis All the questions and responses were entered into a Microsoft Excel database. The results were evaluated using SPSS version 16 software. Chi-square test was used to analyze the relationship between demographics and personal habits versus Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
  • 4. S. no 1 2 3 4 5 6 7 Variables Gender Male Female P Age <49 >49 P Marital status Married Unmarried P Education Un educated School High school Graduate Post graduate P Smoking Smokers Non smokers Ex-smokers P Alcohol Consumers Non consumers Ex-consumers P Dental visits <1 year 1 per year P n Oral cancer awareness (n ¼ 580; 70.3%) Oral cancer screening (n ¼ 92; 11.16%) Tobacco as risk factor (n ¼ 612; 74.2%) Alcohol as risk factor (n ¼ 280; 33.9%) Ulcer as sign (n ¼ 369; 44.78%) Red/white patch as sign (n ¼ 327; 52.8%) 496 328 344 (69.3) 236 (71.9) 0.424 36 (7.2) 56 (17.0) 0.888 364 (73.3) 248 (75.6) 0.475 164 (33.0) 116 (35.3) 0.495 242 (48.7) 127 (38.7) 0.004 229 (46.1) 98 (29.8) 0.001 652 172 448 (68.7) 132 (76.7) 0.04 60 (9.2) 32 (18.6) 0.001 472 (72.3) 140 (81.4) 0.016 224 (34.3) 56 (32.5) 0.658 281 (43.1) 88 (51.1) 0.058 243 (37.2) 84 (48.8) 0.006 600 224 380 (63.3) 192 (85.7) 0.001 64 (10.6) 28 (12.5) 0.457 436 (72.6) 176 (78.5) 0.085 188 (31.3) 92 (41.1) 0.009 246 (41) 123 (54.9) 0.001 225 (36.6) 102 (45.5) 0.036 112 292 176 196 48 36 (32.1) 200 (68.5) 124 (70.4) 176 (89.8) 44 (91.6) 0.001 12 (10.7) 28 (9.6) 8 (4.5) 20 (10.2) 24 (50) 0.001 32 (28.5) 224 (76.7) 156 (88.6) 156 (79.6) 44 (91.6) 0.001 20 (17.8) 88 (30.1) 56 (31.8) 100 (51) 16 (33.3) 0.001 28 (25) 120 (41.1) 88 (50) 100 (51) 33 (68.7) 0.001 24 (21.4) 124 (42.4) 68 (38.6) 72 (36.7) 39 (81.2) 0.001 252 492 80 132 (52.3) 388 (78.8) 60 (75) 0.001 48 (19) 32 (6.5) 12 (15) 0.001 156 (61.9) 396 (80.5) 60 (75) 0.001 60 (23.8) 192 (39) 28 (35) 0.001 106 (42) 219 (44.5) 44 (55) 0.126 130 (51.6) 157 (31.9) 40 (50) 0.001 248 512 64 124 (50) 416 (81.2) 40 (62.5) 0.001 44 (17.7) 36 (7) 12 (18.7) 0.001 160 (64.5) 400 (78.1) 52 (81.2) 0.001 60 (24.2) 204 (39.8) 16 (25) 0.001 85 (34.7) 248 (48.4) 36 (56.2) 0.001 121 (48.8) 174 (34) 32 (50) 0.001 698 126 489 (70) 91 (72.2) 0.624 80 (11.4) 12 (9.5) 0.525 513 (73.4) 99 (78.5) 0.23 242 (34.6) 38 (30.1) 0.325 313 (44.8) 56 (44.4) 0.934 270 (38.6) 57 (45.2) 0.166 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 3 Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004 Table 1 e Socio-demographic characteristics and their relations with some awareness and knowledge variables.
  • 5. 4 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 Table 2 e Most mentioned cancers in the study. S. no 1 2 3 4 5 6 7 8 9 10 11 Cancer type n Percentage (%) Lung Breast Thyroid Blood Stomach Mouth Skin Colon Cervix Pancreas Prostate 728 676 652 620 608 580 432 340 320 304 276 88 82 79 75 74 70 52 41 39 37 33 cancer awareness, knowledge, and popular cancer beliefs. At P 0.05, the differences were considered statistically significant. 3. Results 3.1. Demographic characteristics Of the 824 individuals participating in the study 496 (60.194%) were males and 328 (39.86%) were females. The average age was 38.45 years, in the age range of 18 and 75 years. The demographic characteristics of subjects are further illustrated in Table 1. 3.2. Table 3 e Mostly mentioned sites of mouth associated with oral cancer. S. no 1 2 3 4 5 6 Percentage (%) 404 152 116 100 44 8 49 18.4 14.1 12.1 5.3 1 3.5. Awareness about age-related, gender-related and location of the mouth most likely to develop oral cancer When asked about the frequency of incidence of oral cancer with relation to age group, 24 (2.9%) subjects responded 0e18 years, 104 (12.6%) responded 18e25 years, 136 (16.5%) responded 25e45 years, and 136 (16.5%) said that it was more frequent in people above 45 years. 424 (51.45%) individuals reported they do not know the correct answer. 308 (37.4%) individuals mentioned that oral cancer affected more males than females, 88 (10.8%) individuals answered that it affected more females, 228 (27.66%) individuals answered that it affects both sexes equally, and 200 (24.27%) individuals could not frame any answer. The location of the mouth most referred to as likely to develop oral cancer was the gum (n ¼ 152; 18.45%), followed by cheek mucosa (n ¼ 116; 14.1%), floor of the mouth (n ¼ 100; 12.1%), tongue (n ¼ 44; 5.3%), and palate (n ¼ 8; 0.9%). Majority of individuals (n ¼ 404; 49.03%) reported they do not know the correct answer (Table 3). 3.6. Oral cancer awareness in adults visiting dentists Ninety one (72.2%) individuals who visited the dentist more than once a year were more aware of oral cancer when compared to less frequent visitors (n ¼ 489; 98.2%). Only 12 (9.5%) out of total 126 subjects who have visited the dentist more than once a year had their mouth screened for oral cancer (Table 1). 3.4. n Do not know Gum Cheek mucosa Floor of mouth Tongue Palate Cancer awareness Most subjects were aware of lung cancer (88.35%) followed by breast cancer (82.04%) and thyroid cancer (79.12%) (Table 2). The term ‘Oral cancer’ was relatively well known, with 70.4% of total subjects having heard of it though they significantly lacked knowledge about the risk factors, signs and symptoms of oral cancer as emphasized further. The most mentioned cancers in the study were illustrated in Table 2. 3.3. Location of mouth Oral cancer examination Only 92 (11.16%) individuals of total subjects have had a mouth examination as part of oral cancer screening during their lifetime and only 24 (2.9%) of them had their mouth examination done in the last one year. This shows the significant lack of interest among subjects to undergo oral cancer screening (Table 1). Knowledge about risk factors of oral cancer To the question regarding factors which can cause or increase the risk of mouth cancer, 612 (74.27%) individuals considered tobacco as risk factor followed by cigarette smoking (n ¼ 524; 63.59%), reduced oral hygiene (n ¼ 512; 62.14%), slaked lime consumption with pan leaves (n ¼ 460; 55.8%), betel nut consumption (n ¼ 444: 53.88%), infections in teeth (n ¼ 296; 35.9%), Table 4 e Most risk factors or causes mentioned for oral cancer. S. No 1 2 3 4 5 6 7 8 9 10 11 12 Risk factors n Percentage (%) Tobacco Smoking Reduced oral hygiene Slaked lime consumption with pan leaves Betel nut consumption Coffee consumption Infections in the teeth Alcohol Close contact with other cancer patient Sun exposure Low consumption of vegetables fruits Treatments at the dentist 612 524 512 460 74.2 63.5 62.1 55.8 444 316 296 280 228 53.8 38.3 35.9 33.9 27.6 124 88 15.1 10.6 60 7.28 Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
  • 6. 5 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 Table 5 e Mostly mentioned early manifestations of oral cancer. S. No 1 2 3 4 5 6 7 8 Symptoms n Percentage (%) Difficulty swallowing Difficulty in open the mouth Bleeding from the mouth Lump or tissue growth Ulcer that does not heal Persistent white or red spot Abscess, boil or infection Gastric pain 548 520 384 372 360 312 268 192 67 63 47 45 44 38 33 23 alcohol consumption (n ¼ 280; 33.98%) and sun exposure (n ¼ 124; 15%). It was interesting to note that 300 (36.41%), 228 (27.7%), and 60 (7.28%) individuals considered coffee consumption close contact with other cancer patients, and treatment at the dentist respectively are risk factors of oral cancer (Table 4). Non-smokers identified tobacco as a cause of oral cancer (n ¼ 396; 80.5%) more frequently than the smokers (n ¼ 156; 61.9%) (P 0.001). The clinical relevance of certain findings in relation to other demographic factors and their knowledge on risk factors was found to be obscure (Table 1). 3.7. Knowledge about sign and symptoms of oral cancer Five hundred forty eight (66.5%) individuals considered “difficulty in swallowing” as a symptom of oral cancer followed by 520 (63.1%) as “difficulty in opening mouth”, 384 (46.6) as “bleeding from mouth”, 372 (45.1%) as “lump or tissue growth” and 360 (43.6%) individuals considered “ulcer that does not heal” as a symptom of oral cancer. However, only 312 (37.9%) individuals considered “persistent white or red spot” as a symptom of oral cancer. Alarmingly 192 (23.3%) individuals considered “gastric pain” as symptoms of oral cancer (Table 5). The reference that “an ulcer that does not heal” could be a sign of oral cancer was correlated with higher education (P 0.001). Whereas reference to “persistent white or red spot” could be a sign of oral cancer was correlated more by males than females (P 0.001) and by smokers than non-smokers (P 0.001) (Table 1). 3.8. Popular cancer beliefs To the query “having oral cancer is a question of luck and there is nothing we can do to avoid it”, 42.72% (n ¼ 352) of the subjects disagreed. However, 232 (28.15%) agreed with this Table 6 e Socio-demographic characteristics and their relations with popular cancer beliefs. S. no 1 2 3 4 5 6 7 Variables Gender Male Female P Age 49 49 P Marital status Married Unmarried P Education Uneducated School High school Graduate Post graduate P Smoking Smokers Non smokers Ex-smokers P Alcohol Consumers Non consumers Ex-consumers P Dental visits 1 year 1 per year P n Disagree with question of luck (n ¼ 360; 43.6%) Early detection can improve treatment (n ¼ 518; 62.86%) Lifestyle influence risk of oral cancer (n ¼ 508; 61.6%) 496 328 227 (45.7) 133 (10.06) 0.139 305 (62.3) 213 (64.9) 0.316 326 (65.7) 182 (55.5) 0.002 652 172 308 (47.2) 52 (30.2) 0.001 422 (64.7) 96 (55.8) 0.031 425 (65.2) 83 (48.2) 0.001 600 224 222 (37) 138 (61.6) 0.001 342 (57) 176 (78.5) 0.001 350 (58.3) 158 (70.5) 0.001 112 292 176 196 48 10 (8.9) 80 (27.4) 94 (53.4) 132 (67.3) 44 (91.6) 0.001 29 (25.9) 175 (59.9) 92 (52.2) 180 (91.8) 42 (87.5) 0.001 17 (15.1) 152 (52.0) 132 (75) 164 (83.6) 43 (89.5) 0.001 252 492 80 102 (40.4) 210 (42.7) 48 (60) 0.007 111 (44) 346 (70.3) 61 (76.2) 0.001 151 (59.9) 297 (60.3) 60 (75) 0.001 248 512 64 99 (39.9) 231 (45.1) 30 (46.8) 0.346 100 (40.3) 375 (73.2) 43 (67.1) 0.001 153 (61.6) 316 (61.7) 39 (60.9) 0.023 698 126 293 (41.9) 67 (53.1) 0.02 441 (63.1) 77 (661.1) 0.658 427 (61.1) 81 (64.2) 0.509 Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
  • 7. 6 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 affirmation and 240 (29.12%) could not form an opinion on this. Subjects with unmarried status (P 0.001), higher education level (P 0.001), younger age (P 0.001), non-smokers (P ¼ 0.007), frequent dentist visits (P ¼ 0.02) were in disagreement with the statement (Table 6). Only 492 subjects (59.7%) agreed that the detection of oral cancer in early stages could increase the success of the treatment. This was rejected by 40 subjects (4.85%), and 292 (35.4%) were unable to respond. Agreement was associated in attendees with younger age (P ¼ 0.031), unmarried status (P 0.001), higher education level (P 0.001), and alcohol nonconsumers (P 0.001) (Table 6). Finally, when we asked the subjects if they agree “whether change in lifestyle will reduce the risk of cancer of the mouth”, 496 (60.2%) said yes, 100 (12.1%) said no, and 228 (27.7%) said they do not know. Subjects with higher education level (P 0.001), younger age (P 0.001) and unmarried status (P 0.001) responded positively (Table 6). 4. Discussion This study was conducted to assess the awareness level and knowledge about risk factors and early signs of oral cancer and to correlate the knowledge levels according to age, sex and education among Northeast Indian dental patients. Guwahati, a metropolitan, is the largest city of Northeast India, is often referred to as “Gateway of North Eastern Region of India,” since it is the most developed and major city of Eastern India. Regional Dental College, Guwahati, Assam is a premier institute of dental education in the North Eastern region of India and is in association with Gauhati Medical College Hospital (GMCH). Since 95.2% individuals attending out-patient department of Regional Dental College obliged to participate in the study, any bias in our findings with respect to others is limited. The oral cancer awareness and knowledge in the present population is poor. It is interesting to note that only 70% subjects mentioned about oral cancer and it was ranked sixth among all cancers mentioned. Our results are in line with the previous studies, where similar kind of awareness about oral cancer reported.12,13 Oral Cancer is a multifactorial disease where multiple factors like smoking, tobacco chewing and heavy alcohol consumption contribute individually and/or collectively for the development of cancer. As per the Global Adult Tobacco SurveyeIndia (GATS 2009e10), conducted by the Ministry of Health and Family Welfare, 44.1% people belonging to Northeast States of India above the age of 15 years are consuming tobacco in some form or other, when compared to the national average of 35%. Smokeless and other chewable tobacco products like gutkha and zarda are famous among 39.8% of adult males and 25.3% of females.4 Another study also reported high prevalence of tobacco use of among male (57.9%) and females (26.5%) school personnel in Northeast region of India.14 Though most of the subjects in our study identified tobacco products and smoking as important risk factors, they failed to consider alcohol consumption as major contributing factor. The lack of awareness about the impact of alcohol consumption on oral cancer is observed among most populations worldwide as reported by various researchers.9,11,12,15,16 Nonetheless, some retrospective studies recently have shown increase in knowledge about alcohol consumption as a major risk factor in oral cancer in other countries.17,18 Therefore, for strengthening people knowledge on their increased cancer risks by alcohol use should be included in future health promotion strategies. Less than fifty percent of adults participating in this study were unable to identify non-healing wound, lumps or tissue growths and persistent white or red spot as the early signs of oral cancer. This observation was in accordance with other reports which also reported lesser percentage of awareness.19,20 This can be problematic because on top of being an early sign of cancer they can correspond to potentially malignant disorders whose removal in time could help in reducing the risk of further developing oral cancer. This could be addressed by frequent dental visits. Disappointingly only 4.8% of the total individuals participating in this study have ever had their mouth tested for oral cancer. This is in line with other previous reports which illustrated fairly similar results.12,21 Although most of the subjects in the present study agreed that an early detection of oral cancer may increase the success of treatment, there is still a significant lack of interest among these individuals to frequently visit dentists and undergo preliminary cancer tests which is clearly evident in this study. It has already been suggested by researchers that a network of dentists and other healthcare professionals can significantly contribute efficient oral cancer detection, control and prevention. Thus, government and other healthcare institutes should actively take up campaigns of awareness and knowledge of oral cancer. Various studies have previously highlighted the fact that an increase in awareness could increase early presentation and therefore improved treatment outcomes.20,22 5. Limitation of our study The only limitation of our study was that it was limited to adults who were attending out-patient setting of RDC, Guwahati during the study period were considered. It may exclude the patients of in-patient setting of hospital and other dental clinics. As our study was cross-sectional we were able to represent the snapshot of awareness and knowledge about the oral cancer in the adults attending RDC. It would have been ideal to survey a random sample of the general population, but our resources were limited. Therefore caution should be taken before generalizing the findings of this study. 6. Conclusion The results of present study suggest that most of the individuals were never had their mouth tested for oral cancer detection and also lack the basic knowledge and awareness about the risk factors like tobacco and alcohol consumption on oral cancer. Therefore, our study concludes that the lack of basic awareness about the risk factors, causes, signs and symptoms of oral cancer in this cross-sectional population of Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
  • 8. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7 Northeast Indian adults attending dental hospital. It was suggested to initiate intensive public awareness programs to educate people about recognition of early warning signs and risk factors to facilitate early detection of oral cancer by self examination of mouth. Conflicts of interest All authors have none to declare. Acknowledgments This research was supported by the National Institute of Pharmaceutical Education and Research, Guwahati, under the aegis of Department of Pharmaceuticals, Ministry of Chemicals Fertilizers, Government of India. references 1. World Health Organization (WHO). Global Status Report on NonCommunicable Diseases 2010. 2. Petersen PE. Oral cancer prevention and controlethe approach of the World Health Organization. Oral Oncol. 2009;45:454e460. 3. GLOBOCON. Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012; 2012. http://globocan.iarc.fr/. 4. World Health Organization. Global Adult Tobacco Survey (GATS) India Report 2009-2010. 5. Neville BW, Day TA. Oral cancer and precancerous lesions. Cancer J Clin. 2002;52(4):195e215. 6. Rodriguez T, Altieri A, Chatenoud L, et al. Risk factors for oral and pharyngeal cancer in young adults. Oral Oncol. 2004;40:207e213. 7. Green LW, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. New York: McGrawHill; 1991. 8. Horowitz AM, Nourjah PA. Factors associated with having oral cancer examinations among US adults 40 years of age or older. J Public Health Dent. 1996;56:331e335. 7 9. Warnakulasuriya KA, Harris CK, Scarrott DM, et al. An alarming lack of public awareness towards oral cancer. Br Dent J. 1999;187:319e322. 10. Elango JK, Sundaram KR, Gangadharan P, et al. Factors affecting oral cancer awareness in a high-risk population in India. Asian Pac J Cancer Prev. 2009;10:627e630. 11. Prayman E, Yang Y, Warnakulasuriya S. Oral cancer awareness of patients attending health centres in Trinidad. Int J Clin Dent. 2009;2:207e218. 12. Cruz GD, Le Geros RZ, Ostroff JS, Hay JL, Kenigsberg H, Franklin DM. Oral cancer knowledge, risk factors and characteristics of subjects in a large oral cancer screening program. J Am Dent Assoc. 2002;133:1064e1071. 13. Ariyawardana A, Vithanaarachchi N. Awareness of oral cancer and pre cancer among patients attending a hospital in Sri Lanka. Asian Pac J Cancer Prev. 2005;6(1):58e61. 14. Satyanarayana Asthana S, Sharma KC. Tobacco related cancer risk in north eastern region of India. Indian J Med Res. 2008;128:318e319. 15. Rogers SN, Hunter R, Lowe D. Awareness of oral cancer in the Mersey region. Br J Oral Maxillofac Surg. 2011;49:176e181. 16. Pakfetrat A, Falaki F, Esmaily HO, Shabestari S. Oral cancer knowledge among patients referred to Mashhad Dental School, Iran. Arch Iran Med. 2010;13:543e548. ´ 17. Rebollo Palencia MR, Berlanga Gonzalez MA, Casado Alonso Y, et al. Knowledge and attitudes related with cancer prevention in a population served at a health center. Aten Primaria. 1996;18:417e424. 18. Albuquerque RP, Lopez Lopez J, Jane-Salas E, Rosa-Santos J, Ibrahim C. A pioneering epidemiological study investigating the incidence of squamous cell carcinoma of tongue in a Portuguese population. Med Oral Patol Oral Cir Bucal. 2012;17:550e554. 19. West R, Alkhatib MN, McNeill A, Bedi R. Awareness of mouth cancer in Great Britain. Br Dent J. 2006;200:167e169. 20. Monteiro LS, Salazar F, Pacheco J, Warnakulasuriya S. Oral cancer awareness and knowledge in the city of valongo, Portugal. Int J Dent. 2012;2012:1e8. 21. Tomar SL, Logan HL. Florida adults’ oral cancer knowledge and examination experiences. J Public Health Dent. 2005;65:221e230. 22. Robb K, Stubbings S, Ramirez A, et al. Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer. 2009;101:18e23. Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
  • 9. A o oh s i l ht:w wa o o o p a . m/ p l o p a : t / w .p l h s i lc l ts p / l ts o T ie: t s / ie. m/o p a A o o wt rht :t t r o H s i l p l t p /w t c ts l Y uu e ht:w wy uu ec m/p l h s i ln i o tb : t / w . tb . a o o o p a i a p/ o o l ts d F c b o : t :w wfc b o . m/h A o o o p a a e o k ht / w . e o k o T e p l H s i l p/ a c l ts Si s ae ht:w wsd s aen t p l _ o p a l e h r: t / w .i h r.e/ o o H s i l d p/ le A l ts L k d : t :w wl k d . m/ mp n /p l -o p a i e i ht / w . e i c c a y o oh s i l n n p/ i n no o a l ts Bo : t :w wl s l e l . / l ht / w . t a h a hi g p/ e tk t n

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