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EPIDEMIOLOGY
OF
ORAL CANCER
Presented by-Dr.Payal Dash
Dept Of Public Health Dentistry
CONTENTS
• Terminologies
• Background
• Introduction
• Global Scenario of Oral Cancer
• Oral Cancer in India
• Cancer Registry in India
• Epidemiological Triad
• Classification Of Oral Cancer
• Staging of Oral Cancer
• Prevention of Oral Cancer
• Summary
• Conclusion
• References
2
TERMINOLOGIES
EPIDEMIOLOGY
EPI = AMONG DEMOS = PEOPLE LOGOS = STUDY
DEFINITION OF EPIDEMIOLOGY
"Epidemiology is the study of the distribution and determinants of
health-related states or events in specified populations and the
application of this study to the control of health problems."
(Last, 1988)
-WORLD HEALTH ORGANIZATION
3
• Neoplasm- A “neoplasm” is defined as an abnormal mass of tissue, the growth of which
exceeds and is uncoordinated with the normal tissues and persists in the same excessive
manner even after cessation of the stimuli which evoked the change
• Clonality-Cancer originates from genetic changes in a single cell,which proliferates to
form a clone of malignant cells.
• Autonomy-Growth is not properly regulated by normal biochemical and physical
influences in the environment.
• Anaplasia-Lack of normal,coordinated cell differentiation
• Metastasis-Cancer cells develop the cappacity for discontinuous growth and
disseminaation to other parts of the body.
4
BACKGROUND
• Cancer - leading cause of death worldwide, - 10 million deaths in 2020
• Most common cancers are breast, lung, colon and rectum and prostate cancers.
• Around one-third of deaths from cancer are due to tobacco use, high body mass index,
alcohol consumption, low fruit and vegetable intake, and lack of physical activity.
• Cancer-causing infections, such as human papillomavirus (HPV) and hepatitis, are
responsible for approximately 30% of cancer cases in low- and lower-middle-income
countries.
https://www.who.int/news-room/fact-sheets/detail/cancer 5
Most common in 2020 (in terms of new
cases of cancer) were:
breast (2.26 million cases);
lung (2.21 million cases);
colon and rectum (1.93 million cases);
prostate (1.41 million cases);
skin (non-melanoma) (1.20 million cases);
and
stomach (1.09 million cases).
Most common causes of cancer death
in 2020 were:
lung (1.80 million deaths);
colon and rectum (916 000 deaths);
liver (830 000 deaths);
stomach (769 000 deaths); and
breast (685 000 deaths).
Each year, approximately
400 000 children develop
cancer.
Cervical cancer is the
most common in 23 https://www.who.int/news-room/fact-sheets/detail/cancer 6
INTRODUCTION
• WHO defines cancer as the uncontrolled growth and spread of cells.
• Growths often invade surrounding tissue and can metastasize to distant sites.
• Can be prevented by avoiding exposure to common risk factors, such as
tobacco smoke.
• Significant proportion of cancers can be cured, by surgery, radiotherapy or
chemotherapy.
7
• The term oral cancer is used to describe any
malignancy that arises from oral tissues.
• One of the most common sites of oral
cancer is on lateral aspect of the tongue.
• In the International Classification Of
Diseases, oral cancer is classified under the
rubrics 140 (lip), 141 (tongue), 143
(gingiva), 144 (floor of the mouth) and 145
(other parts of the mouth). Oral Cancer
Foundation 2016
8
Global Scenario of Oral Cancer
• World Health Report 2004 describes cancer as accounting for 7.1 million deaths
in 2003, and it was estimated that the overall number of new cases will rise by
50% in the next 20 years.
• Oral Cancer is the 8th most common cancer worldwide, the prevalence of which
is particularly high among men.
• In South-central Asia – Oral Cancer ranks the 3rd most common type of cancer.
9
• Europe and European Union
• In 2012, in Europe 73,860 and 25,770 of new cases of oral and pharyngeal cancers
among males and females reported
• total of 99,630 new cases.
• European Union (EU) 53,370 and 19,650 among males and females respectively
• A high incidence of oral and pharyngeal cancer among males were reported in
Russian Federation and Germany whereas countries like Cyprus and Iceland have
reported low incidences.
Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J
Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 10
• North America
• In United States of America (USA), cancers of the oral cavity and oropharynx constitutes 3% of all
the malignancies in men and 2% in women .
• The estimated number of new cases in US, 2013 was 41,380 for oral cavity and pharynx cancer,
13,590 for tongue cancer and 11,400 for mouth cancer .
• In 2012, an estimated 26,064 (1.6%) new cases were diagnosed of lip and oral cavity cancer.
• An estimated 4,620 deaths have occurred in 2012 due to cancer of lip and oral cavity,
• 11th most common cancer in USA among males while in Canada and Mexico it is the 12th and
13th most common cancer respectively.
Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J
Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 11
• South America
• cancer of the lip and oral cavity, 15,868 (2.0%) cases estimated to be diagnosed in
2012.
• The age-standardised incidence rate - 3.8 per 100,000 population.
• Death- 6,046 deaths have occurred in 2012 in South America due to lip and oral
cavity cancer
• In Brazil, lip and oral cavity cancer is the 7th most common cancer, with an
estimated 6,930 new cases diagnosed in the year 2012.
Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J
Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 12
• Africa
• According to GLOBOCAN 2012, lip and oral cavity cancer is the 15th most
common cancer in Africa and 7th most common cancer in Middle Africa.
• In 2012, an estimated 17,276 new cases of lip and oral cavity cancer were
diagnosed.
• incidence rate - 2.6 per 100,000 population, ranging from 1.5 in Western Africa to
4.0 in Southern Africa.
• A total of 10,341 deaths have occurred in Africa due to lip and oral cavity cancer
and the age-standardised mortality rate is 1.6, with highest mortality rate being
reported in Eastern Africa (2.2%) and Middle Africa (2.3%)
Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J
Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 13
• Asia
• According to GLOBOCAN 2012, lip and oral cavity cancer is the 12th most common cancer
in Asia and ranks 8th among all the cancers in men,
• with an estimated 16,88,50 new cases of lip and oral cavity cancer diagnosed in the year
2012. The standard incidence rate in Asia is 3.8.
• An estimated 97,408 deaths have occurred in Asia due to lip and oral cavity cancer and the
age-standardised mortality rate is 2.2.
• It is the second most common cancer among men in South-Central Asia, with an age-
standardised incidence of 9.9 and a 5-year prevalence of 129,057 (12.1%).
• The Eastern and Western parts of Asia have low incidence rate of cancer of lip and oral
cavity with a standard incidence rate of 1.8 and 2.1 respectively
Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J
Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 14
• Oral cancer is highly prevalent in South Asian countries like Bangladesh, India,
Pakistan and Sri Lanka, where one-third of all the cancers reported are oral cancer.
• Majority (90%) of the cases reported of oral cancer is attributed to tobacco
consumption in various forms in these regions .
• Sri Lanka (10.3) has the highest incidence in South Asia and the cancer of the
lip and oral cavity is the most common cancer among men in Srilanka .
• Pakistan has the second highest incidence rate of lip and oral cavity cancer (9.3)
and is the most common cancer among men in Pakistan
Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J
Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 15
16
State-wise Cancer Prevalence among women
(per 100,000 women), NFHS 4 (2015–16). 17
18
19
20
K V Deepa, Jubina Balan
Venghateri, Monty Khajanchi,
Anita Gadgil, Nobhojit Roy,
Cancer epidemiology
literature from India: Does it
reflect the reality?, Journal of
Public Health, Volume 42,
Issue 4, December 2020,
Pages e421–e427
21
22
Introduction
History
Population based Cancer
Registry
Hospital Based Cancer
Registry
6.CANCER REGISTRY IN
INDIA
CANCER REGISTRATION IN INDIA
• Cancer registration in India was initiated in 1964 and expanded since 1982,
through initiation of the National Cancer Registry Program (NCRP) by the Indian
Council of Medical Research.
• NCRP currently has twenty-six population based registries and seven hospital
based registries.
Chatterjee S, Chattopadhyay A, Senapati SN, Samanta DR, Elliott L, Loomis D, Mery L, Panigrahi P. Cancer Registration in
India - Current Scenario and Future Perspectives. Asian Pac J Cancer Prev. 2016;17(8):3687-96. PMID: 27644602. 23
• Until 1964, information on cancer cases in India was available only from adhoc surveys
(Yeole, 2015).
• Continuous systematic collection of data, their analysis and publication by registries is
important for evaluating disease trends over time and generating hypotheses about
disease etiologies (Jensen, 1991).
• The first cancer registry in India was established in June 1963 in Mumbai as a Unit of
the Indian Cancer Society with an aim to obtain reliable incidence and mortality data on
cancer from a precisely defined urban population (Yeole, 2015).
• However, the main thrust for cancer registration in India began in 1982, through
initiation of the NCRP by ICMR.
Chatterjee S, Chattopadhyay A, Senapati SN, Samanta DR, Elliott L, Loomis D, Mery L, Panigrahi P. Cancer Registration in
India - Current Scenario and Future Perspectives. Asian Pac J Cancer Prev. 2016;17(8):3687-96. PMID: 27644602. 24
• The NCRP began with three PBCRs (pre-existing Mumbai registry and new
registries at Bangalore and Chennai), and three hospitalbased registries (HBCRs)
(Chandigarh, Dibrugarh and Trivandrum).
• Further expansion of the NCRP occurred with the initiation of urban PBCRs at
Bhopal and Delhi in 1987; rural PBCRs at Barshi (Maharashtra) in 1987, and
HBCRs at the main hospital of PBCRs in Bangalore, Mumbai and Chennai in
1986. there are twentysix PBCRs and seven HBCRs under the NCRP network
(NCRP, 2015)
Chatterjee S, Chattopadhyay A, Senapati SN, Samanta DR, Elliott L, Loomis D, Mery L, Panigrahi P. Cancer
Registration in India - Current Scenario and Future Perspectives. Asian Pac J Cancer Prev. 2016;17(8):3687-
96. PMID: 27644602. 25
Population Based Cancer
Registries
“gold standard
criteria - a minimum period of one year
before the time of cancer diagnosis.
a small proportion of the population is covered
Accurate
Hospital Based Cancer
Registries
magnitude of cancer and patterns of patient care in
a given hospital
most HBCRs are located in regional
cancer centers
a rich source of material
for conducting etiological research
26
27
• Currently 269 HBCR centres registered under the NCRP, 96 HBCRs were selected
which had completed data transmission and quality checks for one or more years
during the period 2012-2019 for inclusion in the report.
• The 96 HBCRs’ were distributed according to their location according to six
regions of the country- North, South, East, West, Central and North East.
28
29
https://ncdirindia.org/All_Reports/HBCR_2021/resources/HBCR_2021.pdf
30
https://ncdirindia.org/All_Reports/HBCR_2021/resources/HBCR_2021.pdf
31
https://ncdirindia.org/All_Reports/HBCR_2021/resources/HBCR_2021.pdf
https://ncdirindia.org/All_Reports/HBCR_2021/resources/HBCR_2021.pdf 32
7.EPIDEMIOLOGICAL TRIAD
• Host
• Agent
• Environment
33
HOST FACTORS
• Demographic characteristics-
• Gender :
• Oral cancer and oropharyngeal cancer are twice as common in men as in women. This difference may be
related to the use of alcohol and tobacco, a major oral cancer risk factor that is seen more commonly in men
than women.
• Age:
• Most of the cases of OC occur between 50 and 70 years of age, it still could occur in children as early as 10
years of age in the absence of any known risk factors.
• Mean age of occurrence of cancer in different parts of oral cavity is usually between 51-55 years in most of
the countries but higher around 64 years.
34
• About 22.30% of the total female population consumed tobacco, mainly in the
smokeless forms, with only 0.50% of the tobacco users using smoked tobacco
(Mishra et al ,2020)
• 22% of men and 26% of women were using smokeless tobacco. While 46% of
men were smoking bidi, only 4% of women reported smoking bidi. Overall, men
are more likely to use tobacco. (Barik et al,2016)
• 64% of the women surveyed used only one type of SLT; of these, 30% used
mishri, 32% used pan with tobacco and the rest used chewed tobacco (11%), gul
(17%) or gutkha (10%). (Nair et al ,2015)
35
• Declining Trends of Smokeless Tobacco among Indian Women
• The fourth round of NFHS survey (2015–2016) estimated the prevalence of tobacco use
amongst adult women (n = 699,686 in 601,509 households) to be 6.8% (4.4% in urban
and 8.1% in rural)
36
Ghosal, S., Sinha, A., Kanungo, S. et al. Declining trends in smokeless tobacco use among Indian women:
findings from global adult tobacco survey I and II. BMC Public Health 21, 2047 (2021).
37
• Race:
• An elevated incidence of cancers of the nasopharynx has been reported in persons of
Chinese ancestry in the United States and elsewhere; decreased incidence of oral cancers
has been observed in American Native populations compared with American whites.
• Biological characteristics
• Genetic: Increased risk of oral cancer associated with exposure to genetic mutagens in
tobacco, alcohol and betel quid.
• Gene mutations- 3p, 4q, 6p, 8p, 9p, 11q, 13q (retinoblastoma [Rb] tumor suppressor
gene), 14q, 17p (p53 tumor suppressor gene), 18q (deleted in colon cancer [DCC] tumor
suppressor gene) and 21q.
38
39
40
American Indians/Alaska Natives (Non-
Hispanic)
• higher prevalence of current smoking than most
other racial/ethnic groups in the United States.
• Factors that may affect smoking prevalence
include sacred tobacco’s ceremonial,
• religious, and
• medicinal roles in Native culture,
In 2019, 20.9% of AI/AN adults in the United
States smoked cigarettes, compared with 14.0%
of U.S. adults overall.
https://www.cdc.gov/tobacco/campaign/tips/res
ources/data/cigarette-smoking-in-united-
states.html
• Asians (Non-Hispanic)
• lowest current cigarette smoking prevalence
• significant differences in smoking prevalence among subgroups in this population.
• Many Asian Americans emigrate from countries where smoking prevalence is high and
smoking among men is the social norm.
• In 2019, 7.2% of non-Hispanic Asian adults in the United States smoked cigarettes,
compared with 14.0% of U.S. adults overall.
• Among women, smoking prevalence is highest - Koreans and lowest - Chinese.
• Among men, smoking prevalence is highest - Vietnamese and lowest - Asian Indians.
41
https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-
states.html
• Blacks (Non-Hispanic)
• Although prevalence of cigarette smoking is lower among non-Hispanic Black
high school students than among U.S. high school students overall (3.2%
compared with 8.1% in 20186, respectively), smoking prevalence among non-
Hispanic Black adults is similar to the overall adult population.3,6
• In 2019, 14.9% of non-Hispanic Black adults in the United States smoked
cigarettes, compared with 14.0% of U.S. adults overall.
• Smoking prevalence declined from 21.5% in 2005 to 14.9% in 2019
42
https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-
states.html
• Hispanics
• The prevalence of cigarette smoking among Hispanics is generally lower
than the prevalence among other racial/ethnic groups in the United States,
• Smoking prevalence among Hispanic men is significantly higher than
among Hispanic women
• In 2019, 8.8% of Hispanic adults in the United States smoked cigarettes,
compared with 14.0% among U.S. adults overall.3
• Current smoking prevalence among Hispanics declined from 16.2% in
2005 to 8.8% in 2019.
43
https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-
states.html
44
45
Honorato, J.; Rebelo, M.S.; Dias, F.L.; Camisasca, D.R.; Faria, P.A.; Azevedo e Silva, G.; Lourenço, S.Q.C. (2015). Gender differences in prognostic
factors for oral cancer. International Journal of Oral and Maxillofacial Surgery, (), S0901502715001757–.
• Social and economic characteristics
• Socio economic status: oral cancer affects those from the lower socioeconomic
groups of society due to a higher exposure to risk factors such as the use of
tobacco. Ken Russell Coelho (2020)
• Education: Illiterates those who never attended school and with low educational
attainment have greater risk. In the Indian population OR for OC related to
education is greater for illiterates (6.4) compared to low education level (5.3).
Krishna Rao et al (2019)
46
• In Australia smoking behaviour is inversely related to socio-economic
status, with disadvantaged groups in the population being more likely
to take up and continue smoking.
47
Greenhalgh, EM, Bayly, M, & Scollo, M. 1.7 Trends in the prevalence of smoking by socio-economic status. In
Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues .
Melbourne: Cancer Council Victoria; 2021.
48
Cai, L., Wang, XM., Fan, LM. et al. Socioeconomic disparities in prevalence and behaviors of smoking
in rural Southwest China. BMC Public Health 19, 1117 (2019).
49
Sreeramareddy CT, Acharya K. Trends in
Prevalence of Tobacco Use by Sex and
Socioeconomic Status in 22 Sub-Saharan
African Countries, 2003-2019. JAMA
Netw Open. 2021;4(12):e2137820.
• In India, tobacco consumption is more prevalent among the
disadvantaged group and they face higher exposure of tobacco harms.
• people who were wealthier, more educated, and having a decent job
were more prone to cigarette smoking, and on the other side, people
who are less educated with poor socioeconomic status had a habit of
bidi smoking. (Corsi and Subramanian in 2014)
50
Shah S, Dave B, Shah R, Mehta TR, Dave R. Socioeconomic and cultural impact of tobacco in
India. J Family Med Prim Care. 2018;7(6):1173-1176. doi:10.4103/jfmpc.jfmpc_36_18
• Occupation:
• Certain occupations where exposure to carcinogens is common like tar
manufacturing.
• Certain oils, textile industries etc – are susceptible to cancer.
• Leather workers are shown to have a higher rate of cancer of buccal cavity.
• Other workers at increased risk for cancer: Coal mine and tar workers, Oil factory
workers, Uranium miners and X-ray technicians
• BLOOD GROUPS:
• Association of blood groups with oral cancer has also been observed.
• It has been reported that Group O showed the least susceptibility, Group B and
AB showed doubtful susceptibility and Blood Group A showed higher
susceptibility.
51
52
Islam, M.S., Saif-Ur-Rahman, K.M., Bulbul, M.M.I. et al. Prevalence and factors associated with tobacco use
among men in India: findings from a nationally representative data. Environ Health Prev Med 25, 62 (2020).
• Lifestyle factors
• Living habits and Nutrition: It has been observed that vitamin deficiencies (A, C,
E)- contribute to high prevalence of oral cancers in India.
• In rural India- oral pre-cancerous lesions associated with low plasma levels of
vitamin E and beta-carotene.
53
Verma A, Vincent-Chong VK, DeJong H, Hershberger PA, Seshadri M. Impact of dietary vitamin D on initiation and
progression of oral cancer. J Steroid Biochem Mol Biol. 2020;199:105603.
• Body mass index (BMI) has been inversely associated with oral
cancer, and paan chewers with low BMI has a very high risk of oral
cancer.
• Low BMI may be a risk factor of moderate to severe oral
mucositis.(Saito et al,2018)
• Obesity may contribute to a higher recurrence rate and a worse
prognosis in oral squamous cell carcinoma patients.(Wang et al,2019)
54
Saito N, Imai Y, Muto T, Sairenchi T. Low body mass index as a risk factor of moderate to severe oral
mucositis in oral cancer patients with radiotherapy. Support Care Cancer. 2012 Dec;20(12):3373-7.
Wang C, Pan Y, Xu Q, Li B, Kim K, Mao M, Li J, Qin L, Li H, Han Z, Feng Z. Relationship between body mass
index and outcomes for patients with oral squamous cell carcinoma. Oral Dis. 2019 Jan;25(1):87-96.
• Site distribution
• Lip cancer is most common in fair skinned races, particularly in rural areas and in
men who work out doors.
• Intra oral cancer in western countries most commonly affects the lateral borders of
the tongue.
• Buccal mucosa (65%), lower alveolus (30%) and retromolar trigone (5%) : these
constitute more than 60% of all cancers.
55
• Genetic syndromes
• People with syndromes caused by inherited defects (mutations) in certain genes
have a very high risk of mouth and middle throat cancer.
• Fanconi anemia: People with this syndrome often have blood problems at an
early age, which may lead to leukemia or myelodysplastic syndrome. They also
have a very high risk of cancers of the mouth and throat.
• Dyskeratosis congenita: This is a genetic syndrome that can cause aplastic
anemia, skin rashes, and abnormal fingernails and toenails. People with this
syndrome also have a very high risk of developing head and neck cancers,
especially of the mouth and throat, at a young age.
56
AGENT FACTORS
• The disease "agent" is defined as a substance living or non- living, or a
force, tangible or intangible, the excessive presence or relative lack of
which may initiate or perpetuate a disease process.
57
CHEMICAL FACTORS
-Smoking,Alcohol
BIOLOGICAL FACTORS
-HPV
• Biological factors: Human papilloma viruses,HIV,Syphillis
• HPV has been identified in approximately 23.5% of OC cases .
• The most commonly detected HPV in head and neck squamous cell carcinoma
(HNSCC) is HPV-16, which has been demonstrated in 90–95% of all HPV positive
HNSCC cases, followed by HPV-18, HPV-31, and HPV-33.
• The prognostic significance of HPV in pre-cancerous oral lesion is not clear. However,
few studies have found improved disease-specific survival and better prognosis for HPV
positive OC.
58
Ram H, Sarkar J, Kumar H, Konwar R, Bhatt ML, Mohammad S. Oral cancer: risk factors and
molecular pathogenesis. J Maxillofac Oral Surg. 2011;10(2):132-137.
• Approximately 20% of oral cancers were thought to be attributable to HPV
infection.
• In 2012, the International Agency of Research of Cancer (IARC) declared that
there was sufficient evidence to associate a subtype of HPV 16 with oral cancers.
• Additionally, these HPV-related oral cancers differ from HPV-negative tumors or
cancers in their clinical response and overall survival rates.
• In the oral cavity, 24 types of HPV, 1, 2, 3, 4, 6, 7, 10, 11, 13, 16, 18, 30, 31, 32,
33, 35, 45, 52, 55, 57, 59, 69, 72, and 73, have been associated with benign
lesions, and 12 types, 2, 3, 6, 11, 13, 16, 18, 31, 33, 35, 52, and 57, with malignant
lesions.
59
Kim SM. Human papilloma virus in oral cancer. J Korean Assoc Oral Maxillofac Surg.
2016;42(6):327-336.
• HSV-1 or "oral herpes" is commonly associated with sores around the mouth and
lip and has been suggested to be a causative agent of OC .
• Epidemiological studies showed higher level of IgG and IgM antibodies to OC
patients compared to control subjects .
• Kassim et al also reported oncogenic relationship between HSV-1 and oral
squamous cell carcinoma (OSCC).
• A population based study showed HSV-1 to enhance development of OSCC in
HPV infected patients and individuals with history of cigarette smoking .
60
Ram H, Sarkar J, Kumar H, Konwar R, Bhatt ML, Mohammad S. Oral cancer: risk factors and
molecular pathogenesis. J Maxillofac Oral Surg. 2011;10(2):132-137.
• Risk of oral cavity and pharyngeal cancer is two-fold higher among human
immunodeficiency virus (HIV) patients indicating a link between HIV and OSCC .
• Epstein Barr Virus (EBV), human herpesvirus-8 (HHV-8) and cytomegalovirus have also
been reported as risk factors of OSCC in different studies
• Syphilis-The data on causal association between syphilis and OC is weak. There are
reports of 19 and 6% serological positivity for syphilis among tongue cancer patients.
• Candida-Candida has been suggested to play a role in initiation of OC. Clinical studies
have reported that nodular leukoplakia infected with Candida has a tendency for higher
rate of dysplasia and malignant transformation.
61
Ram H, Sarkar J, Kumar H, Konwar R, Bhatt ML, Mohammad S. Oral cancer: risk factors and
molecular pathogenesis. J Maxillofac Oral Surg. 2011;10(2):132-137.
• Mechanical- An association between oral carcinoma and chronic irritation of the
mucosa by the dentures. Case reports have detailed the development of oral
carcinomas in patients who wear ill fitting dentures. Shafers (2012)
• Ultraviolet (UV) radiation, and in particular solar radiation, is carcinogenic to
humans, causing all major types of skin cancer, such as basal cell carcinoma
(BCC), squamous cell carcinoma (SCC) and melanoma. • The lower lip receives
considerable sunlight exposure than upper lip that is comparatively shaded
accounting for a higher occurrence than later.
62
63
• genus Nicotiana
• family Solanaceae
TOBACC
O
64
Food And Agriculture Organization Of The United Nations. Retrieved November 3, 2019.
BIDI
• Most common
• 0.2-0.3 gm of sundried
tobacco flakes handrolled in
tendu
• 60mm/80mm
• Nicotine-1.7-3mg
• Tar--45-50mg
CHILLUM
• Conical clay pipe
• 10-14cm
CHUTTA
• Cigar/cheroor
• Cigars-air cured,fermented
tobacco
• Cylindrical coarsely prepared
cheroot. Cured tobacco is
wrapped in a dried tobacco
leaf.
65
66
d) Cigarettes : About 1gram of tobacco cured in
the sun or artificial heat is covered with paper
Tobacco smoke consists of more than 4000
chemical compounds and approximately 60
known carcinogens.
Hydrogen cyanide
Formaldehyde
Lead
Arsenic
Ammonia
Radioactive elements, such as polonium-210
(see below)
Benzene
Carbon monoxide
Tobacco-specific nitrosamines (TSNAs)
Polycyclic aromatic hydrocarbons (PAHs)
The temperature at
the burning end of
a cigarette is about
900C during puffs,
and about 400C
between puffs.
67
e) Dhumti :
• Rolled leaf tobacco is used inside a leaf of fruit tree.
• Sometimes dried leaf of the banana plant is used.
• Used among women
f) Hookli :
Clay pipe- short stem varying from about 7 to 10 cms with a
mouth piece and a bowl.
Commonly used in Bhavnagar district of Gujarat.
• Hookah/water pipe/hubble-bubble
• Moghul Cultural influence
• Indian Origin
• Tobacco smoke drawn through water in the base of hookah which
cools and filters the smoke
68
Paan : Most common habit of smokeless tobacco
usage in India. Paan refers betel leaf (from piper
betel wine) itself and often to the quid. 69
• Khaini : Powdered sun-dried tobacco, slaked lime (calcium
hydroxide)-paste mixture occasionally used with arecanut.
• Widespread in use in Maharastra
• Premolar of mandibular groove
• Mainpuri Tobacco
• Tobacco,Slaked lime,arecanut,camphor,cloves
• 7% Uttarpradesh
• Mawa
• Arecanut,Tobacco,Slaked lime
• Wrapped in cellophane paper,Tied in shape of small ball
70
• Gudakhu : Paste of powdered tobacco, molasses (brown sugar)
and other ingredients primarily used to clean tooth. Used- women
in Bihar.
Snuff : Finely powdered air-cured and fire-
cured tobacco leaves. It may be dry or moist,
used plain or with other ingredients. Used orally
or nasally.
Zarda : Tobacco leaf is boiled in water along with lime and
spices until evaporation. The residual tobacco is then dried and
coloured with dyes. It is chewed.
71
72
73
• CONSTITUENTS IN TOBACCO
• NNN(N-Nitrosonornicotine)-1st
organic carcinogen
• 1.NICOTINE
• Lethal dose- 30-60 mg
• Releases dopamine
• Physiological effects-increased heart
rate,blood pressure,muscular
hormonal metabolic effects
74
• Reverse smoking :
• The habit of tobacco smoking
with the lighted end inside the
mouth (reverse smoking) is
found in people of the lower
socio-economic states in
Colombia, Panama.
• India- females of
Vishakhapatnam,Srikakulam
• Adda poga
• Temperature-Palatal mucosa 58
degree C
75
76
77
78
Secondhand smoke is the
combination of smoke from the
burning end of a cigarette and the
smoke breathed out by smokers.
79
Classification of lesions in the oral cavity
Benign tumours of epithelial origin
Premalignant lesions of epithelial origin
Malignant tumours of epithelial tissue origin
Benign tumours of connective tissue origin
Malignant tumours of connective tissue origin
80
ORAL POTENTIALLY MALIGNANT DISORDERS
• PRECANCEROUS LESION
• It is defined as a
morphologicaaly altered tissue
in which cancer is more likely to
develop than in its apparently
normal counterpart.
• Ex-
Leukoplakia,Erythroplakia,Smoke
rs Palate
• PRECANCEROUS CONDITION
• It is generalised state associated
with significantly increased risk
of cancer.
• Ex-OSMF,Lichen Planus
81
LEUKOPLAKIA
82
• a prevalence of 2.6% and a
malignancy conversion rate ranging
from 0.1% to 17.5%
• India, in particular, concluded the
prevalence of leukoplakia ranging
from 0.2% to 5.2% and the malignant
transformation of 0.13% to 10%.
• incidence rate of leukoplakia arrays
between 6.2 and 29.1 cases per
100,000 people
STUDIES PREVALENCE
Martorell-
Calatayud et al.
0.4% to 0.7%
Feller et al. 0.5% to 3.46%
Brouns et al. 2%
Mohammed F, Fairozekhan AT. Oral Leukoplakia. [Updated 2021 Jul 27]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
83
ERYTHROPLAKIA
0.02% and
0.83%
84
SQUAMOUS CELL CARCINOMA
85
86
Rao, N.R., Villa, A., More, C.B. et al. Oral submucous fibrosis: a contemporary narrative review with a
proposed inter-professional approach for an early diagnosis and clinical management. J of Otolaryngol -
Head & Neck Surg 49, 3 (2020).
87
Rao, N.R., Villa, A., More, C.B. et al. Oral submucous fibrosis: a contemporary narrative review with
a proposed inter-professional approach for an early diagnosis and clinical management. J of
Otolaryngol - Head & Neck Surg 49, 3 (2020).
88
Rao, N.R., Villa, A., More, C.B. et al.
Oral submucous fibrosis: a
contemporary narrative review with
a proposed inter-professional
approach for an early diagnosis and
clinical management. J of
Otolaryngol - Head & Neck Surg 49,
3 (2020).
• Oral SCC more frequently affects men
than women (M:F = 1.5:1) most
probably because more men than
women indulge in high-risk habits.
• In the USA the median age of
diagnosis of oral SCC is 62 years.
However, the incidence of oral SCC in
persons under the age of 45 is
increasing
• In Western countries oral SCC
affects the tongue in 20% - 40% of
cases and the floor of the mouth in
15% - 20%
• The mean 5-year survival rate of
persons with oral SCC is about
50% with no gender difference; but
black persons have a lower five year
survival rate than persons of other
race
(5) (PDF) Oral Squamous Cell Carcinoma: Epidemiology, Clinical Presentation and Treatment. 89
90
91
92
• PREVENTION OF ORAL CANCER
• Mainly focuses on modifying habits associated with the use
of tobacco.
• 3 well-known approaches:
• 1. Regulatory Approach
• 2. Service Approach
• 3. Educational Approach
93
• REGULATORY OR LEGAL
APPROACH
• As early as 1590, The Government in
Japan, edict against tobacco use, where
users were penalized by having their
property confiscated or were jailed.
• Similar edicts have been reported in
Turkey, Russia and China. Religious
groups have also banned the use of
tobacco.
94
• In India, Cigarette Act 1975 has made it necessary to print warning on
cigarette packets.
• In some countries like Italy, Norway, Portugal Singapore and
Thailand there has been a ban on advertising tobacco products.
• The cigarette packs are now required to carry graphical health
warnings.
• After years of wrangling, graphic health warnings (GHW) are now
mandatory on tobacco products sold in India.
• The Cigarette and Other Tobacco Products (Packaging and Labelling)
Rules 2009 requiring GHW came into force on 31 May.
95
• Cigarettes And Other Tobacco
Products (prohibition Of
Advertisement And Regulation Of
Trade And Commerce, production,
Supply Distribution)Act (COTPA),
in 2003:
• The Indian Parliament passed the bill
in April 2003. This bill became an act
on 18 May 2003.
96
• The key provisions of COTPA-
2003 are as follows:
• Prohibition Of Smoking In
Public Places Implemented From
2nd October 2008.
• Prohibition Of Advertisement-
direct Or Indirect And Promotion
Of Tobacco Products.
97
• Prohibition of sales to
minors(tobacco products cannot
be sold to children less than
18yrs of age and cannot be sold
within a radius of 100 yards of
any educational institutions.
98
• Regulation of health warning in tobacco products pack .
• Law pertaining to pictorial health warnings on tobacco product packages:
Implemented with effect from 31st May 2009.
99
100
• Out of 307 schools observed, on
average 85% of the schools violated
Section 4 – no signage displaying ‘No
Smoking Area – Smoking here is An
Offence’, and on average 69% violated
Section 6b – shops selling tobacco
products within a radius of 100 yards
of schools
101
Pradhan A, Oswal K, Padhan A, et al. Cigarettes
and Other Tobacco Products Act (COTPA)
implementation in education institutions in
India: A crosssectional study. Tob Prev Cessat.
2020;6:51. Published 2020 Sep 10.
• In Anantapur and Chittoor districts of Andhra
Pradesh, an average of 80%, in Prayagraj
district of Uttar Pradesh an average of 96%, in
Khordha, Cuttack and Puri districts of Odisha
an average of 90%, in Gumla, Khunti,
Lohardaga and Ranchi districts of Jharkhand
an average of 74% and in Dakshina Kanada
and Udupi districts of Karnataka an average of
4% educational institutions violated Section
6b
102
Pradhan A, Oswal K, Padhan A, et al. Cigarettes
and Other Tobacco Products Act (COTPA)
implementation in education institutions in
India: A crosssectional study. Tob Prev Cessat.
2020;6:51. Published 2020 Sep 10.
• SERVICE APPROACH
• Primary goal is a fundamental of prevention. This can be achieved through
screening and early detection.
• It also provides an opportunity to identify and council the patients about habits
that increase the risk of cancer. Other than professional, primary health care
workers can also be used for screening.
• Diagnostic methods such as Biopsy Technique, Exfoliative Cytology, Toluidine
Blue Vital Staining can be used under this approach.
103
• EDUCATIONAL APPROACH
• The process of becoming a smoker, for example, essentially involves
four stages :
• Awareness
• Initiation / Experimentation
• Habituation
• Maintenance / Dependence
• So education has an important part to play in discouraging people
from starting its use and from helping people to stop the habit.
104
• Guide to Counseling for tobacco
cessation (5A’s):
• Ask –use of tobacco
• Advise –non users to never use
andusers toquit
• Assess- the patient readiness
toquit
• Assist-with quitting
• Arrange-for follow ups
105
106
107
108
• 1.Relevance to quitting
• Ask the patient why quitting is
relevant
• 2.Risks
• Acute Risks
• Long term risks
• Environmental Risks
• 3.Rewards of quitting
• Improved oral health
• Feel better
• Increased energy levels
• money is saved
• longer healthier life
• 4.Roadblocks to qutting
• Fear of withdrawal symptoms
• fear of failure
• lack of support
• fear of weight gain
• depression
109
• USE OF PHARMACOTHERAPY
• There are 2 main types of pharmacotherapy for tobacco use cessation:
• Nicotine Replacement therapies (NRT): These lessen the cravings and other
withdrawal symptoms and the individual learns to stop the behaviours connected
with tobacco use. Eventually, patients need to give up using nicotine replacement.
• Antidepressants: They also serve as anticraving medications and can be used
with NRTs.
110
• Use of Pharmacotherapy
• 1.Nicotine Replacement Therapies-
• Nicotine gum
• Nicotine patch
• Nicotine inhaler
• nicotine nasal spray
• nicotine lozenges
111
• The first NRT - transmucosally delivered
nicotine polacrilex (nicotine gum).
• intermittently chewed and held in the mouth over
about 30 minutes
• available in both 2 mg and 4 mg dosage forms.
• Acidic beverages have been shown to interfere
with buccal absorption of nicotine; therefore,
patients should avoid acidic beverages (eg, soda,
coffee, beer) for 15 minutes before and during
chewing gum.
112
• Nicotine Lozenge
• 2mg and 4mg formulations.
• lozenge is not chewed
• it dissolves in the mouth over
approximately 30 minutes with some
variation across individuals.
• nicotine from the lozenge is absorbed
slowly through the buccal mucosa and
delivered into systemic circulation.
113
• Nicotine Sublingual tablet
• Placed under the tongue where the
nicotine in the tablet is absorbed
sublingually.
• It is recommended that smokers use
the product for at least 12 weeks.
• After 12 weeks, the number of tablets
used should be gradually tapered.
114
• Nicotine Oral inhaler
• consists of a mouthpiece and a plastic cartridge containing nicotine.
• The vapour inhaler was designed to satisfy behavioral aspects of smoking, namely,
the hand-to-mouth ritual, while delivering nicotine to reduce physiological
withdrawal symptoms produced by tobacco withdrawal.
• Majority of nicotine is delivered into the oral cavity (36%) and in the oesophagus
and stomach (36%).
• Each inhaler cartridge contains 10mg nicotine, of which up to 4 mg can be delivered
and 2 mg can be absorbed following frequent “puffing”.
115
116
• Nicotine Patches
• Advantage- compliance is simple; the patient simply
places the patch on the body in the morning, rather
than actively using a product throughout the day.
• It delivers nicotine more slowly than acute NRT
formulations
• They are available in different doses, and deliver
between 5mg and 22mg of nicotine over a 24-hour
period
• The most frequently reported side effects are local
skin reactions.
• Nicotine Nasal spray
• The device available to consumers is a multi-dose
bottle with a pump mechanism fitted to a nozzle
that delivers 0.5 mg of nicotine per 50-uL squirt.
• Each dose consists of two squirts, one to each
nostril.
• Patients should be started with one or two doses per
hour, which may be increased up to the maximum
of 40 doses per day.
• One dose of nasal spray per hour (1mg nicotine) for
10 hours produces average plasma concentrations
of 8ng/ml.
117
• Nicotine preloading
• The use of nicotine replacement therapy before quitting smoking is called nicotine
preloading.
• This approach involves using NRT for a several weeks prior to quitting; it is also
known as precessation or pre-quitting NRT.
• The most plausible mechanisms include habituation with use of NRT in the lead-
up to quitting, attenuation of desire to smoke due to nicotine receptor saturation
and it reduces satisfaction from smoking by which it undermines the learned
association between smoking and reward.
118
Wadgave U, Nagesh L. Nicotine Replacement Therapy: An Overview.
Int J Health Sci (Qassim). 2016;10(3):425-435.
• True pulmonary inhaler
• delivery nicotine to the lung in a manner more comparable to cigarette smoking.
• reduce background cravings and withdrawal symptoms, and would allow for
rapid relief of acute cravings and morning craving.
• Nicotine Vaccines
• Nicotine vaccines represent a new approach to the treatment of nicotine
dependence and are currently under investigation.
• NicVAX developed by Nabi Biopharmaceuticals
119
Wadgave U, Nagesh L. Nicotine Replacement Therapy: An Overview.
Int J Health Sci (Qassim). 2016;10(3):425-435.
Wadgave U, Nagesh L. Nicotine Replacement Therapy: An Overview. Int J Health Sci
(Qassim). 2016;10(3):425-435.
120
The preliminary results of the trials showed
that the primary endpoint of 16 weeks
abstinence measured at 12 months was not
met; there was no statistically difference
between the NicVAXW and placebo group
Interim analysis showed that the primary
endpoint (continuous abstinence from
smoking from weeks 8–12 after start of
treatment) was not achieved, possibly
because NIC002 failed to induce sufficiently
high antibody titers.
Not
Declared
• 2.Antidepressants
• Firstly, nicotine withdrawal may produce depressive symptoms or precipitate a
major depressive episode and antidepressants may relieve these.
• Secondly, nicotine may have antidepressant effects that maintain smoking, and
antidepressants may substitute for this effect.
• Finally, some antidepressants may have a specific effect on neural pathways (e.g.
inhibiting monoamine oxidase) or receptors (e.g. blockade of nicotinic‐cholinergic
receptors) underlying nicotine addiction.
• First line therapies
• Buproprion SR,Selegeline
• Second line therapies
• Clonidine,Nortryptiline
121
Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane
Database Syst Rev. 2014;2014(1):CD000031. Published 2014 Jan 8. doi:10.1002/14651858.CD000031.pub4
• doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine;
S‐Adenosyl‐L‐Methionine (SAMe); sertraline; St. John's wort; tryptophan; venlafaxine; and
zimeledine.
• Bupropion.
• dopaminergic and adrenergic actions, and an antagonist at the nicotinic acetylcholinergic receptor
(Fryer 1999).
• It may work by blocking nicotine effects, relieving withdrawal (Cryan 2003; West 2008), or reducing
depressed mood (Lerman 2002).
• Licensed as a prescription aid to smoking cessation in many countries.
• The usual dose for smoking cessation is 150 mg once a day for three days increasing to 150 mg twice
a day continued for 7 to 12 weeks
122
• Tricyclic antidepressant nortriptyline.
• Its presumed mechanism of action is increased noradrenergic activity.
• It is sometimes prescribed when first‐line treatments have been unsuccessful
• licensed for smoking cessation in New Zealand.
• The recommended regimen is 10 to 28 days of titration before the quit attempt,
followed by a 12‐week dose of 75 to 100 mg daily (Cahill 2013).
123
Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane
Database Syst Rev. 2014;2014(1):CD000031. Published 2014 Jan 8. doi:10.1002/14651858.CD000031.pub4
Global
Intitiatives in
Prevention
Of Oral
Cancer
124
1. Crete Declaration on Oral Cancer
Prevention
2. National Tobacco Control
Programme
3. WHO Framework Conevention
on Tobacco Control
4. Bloomberg Initiative
5. Tobacco Cessation Centre
125
126
127
• National Tobacco Control Programme (NTCP)
• Government of India launched the National Tobacco Control Programme (NTCP)
in the year 2007-08 during the 11th Five-Year-Plan, with the aim to
• (i) create awareness about the harmful effects of tobacco consumption,
• (ii) reduce the production and supply of tobacco products,
• (iii) ensure effective implementation of the provisions under “The Cigarettes and
Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade
and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA)
• (iv) help the people quit tobacco use, and
• (v) facilitate implementation of strategies for prevention and control of tobacco
advocated by WHO Framework Convention of Tobacco Control .
• During the 11th Five Year Plan, NTCP was implemented in 21 states covering 42
districts.
• To carry forward the momentum generated by the NTCP during the 11th Five Year
Plan and baseline data generated through the Global Adult Tobacco Survey
(GATS) India 2009-2010, indicating high level of prevalence of tobacco use, it
was upscaled in the 12th Five Year Plan with a goal to reduce the prevalence of
tobacco use by 5% by the end of the 12th FYP.
• As per the second round of GATS, the number of tobacco users has reduced by
about 81 lakh (8.1 million).
128
• The main thrust areas for the NTCP are as under:
• Training of health and social workers, NGOs, school teachers, and
enforcement officers;
• Information, education, and communication (IEC) activities;
• School programmes;
• Monitoring of tobacco control laws;
• Coordination with Panchayati Raj Institutions for village level
activities;
• Setting-up and strengthening of cessation facilities including provision
of pharmacological treatment facilities at district level.
129
• NTCP is implemented through a
three-tier structure, i.e.
• (i) National Tobacco Control
Cell (NTCC) at Central level
• (ii) State Tobacco Control Cell
(STCC) at State level &
• (iii) District Tobacco Control
Cell (DTCC) at District level.
• There is also a provision of
setting up Tobacco Cessation
Services at District level.
130
• NTCP has resulted in provision of dedicated funds and manpower for
implementation of the Programme. State/District Tobacco Control components viz.
STCC and DTCC Plan have been subsumed in the Flexi-pool for Non-
Communicable Disease (NCDs) under National Health Mission (NHM) for
effective implementation since 12th Five Year Plan.
• Currently, the Programme is being implemented in all 36 States/Union Territories
covering around 612 districts across the country.
131
• National Tobacco Control Cell (NTCC)
• The National Tobacco Control Cell (NTCC) at the Ministry of Health and Family
Welfare (MoHFW) is responsible for overall policy formulation, planning,
implementation, monitoring and evaluation of the different activities
envisaged under the National Tobacco Control Programme (NTCP).
• The National Cell functions under the direct guidance and supervision of the
programme in-charge from Joint Secretary.
• The technical assistance is provided by the identified officers in the Directorate
General of Health Services.
132
• The programme broadly envisages;
• National level:
• Public awareness/mass media campaigns for awareness building and behavioural
change
• Establishment of tobacco product testing laboratories.National level:
• Mainstreaming research and training on alternative crops and livelihood with other
nodal Ministries.
• Monitoring and evaluation including surveillance
• Integrating NTCP as a part of health-care delivery mechanism under the National
Health Mission framework.
133
• State Level:
• Dedicated State Tobacco Control Cells for effective implementation and
monitoring of tobacco control initiatives.
• The key activities include;
• State Level Advocacy Workshop
• Training of Trainers Programme for staff appointed at DTCC under NTCP.
• Refresher training of the DTCC staff.
• Training on tobacco cessation for Health care providers.
• Law enforcers training / sensitization Programme
134
• District Level:
• The key activities include-
• Training of Key stakeholders: health and social workers, NGOs,
school teachers, enforcement officers etc.
• Information, Education and Communication (IEC) activities.
• School Programmes.
• Monitoring tobacco control laws.
• Setting-up and strengthening of cessation facilities including provision
of pharmacological treatment facilities at the district level.
• Co-ordination with Panchayati Raj Institutions for inculcating concept
of tobacco control at the grassroots.
135
• WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL (WHO
FCTC)
• First international treaty negotiated under the auspices of WHO.
• There are currently 181 Parties to the Convention.
• Adopted by the World Health Assembly on 21 May 2003 and entered into force on
27 February 2005.
• It aims to tackle some of the causes of that epidemic, including complex factors
with cross -border effects, such as trade liberalization and direct foreign
investment, tobacco advertising, promotion and sponsorship beyond national
borders, and illicit trade in tobacco products.
• Govt. of India ratified the WHO Framework Convention on Tobacco Control
(WHO FCTC) in 2004, the first ever international public health treaty focusing on
the global public health issue of tobacco control.
136
• The key demand reduction strategies are contained in Articles 6 to 14 which
includes;
• Article: 6 – Price and tax measures to reduce the demand for tobacco.
• Article: 7 – Non-price measures to reduce the demand for tobacco
• Article: 8 - Protection from exposure to second hand tobacco smoke.
• Article: 9 & 10 - Tobacco content and product regulation
• Article: 11 - Packaging and labeling of tobacco products.
• Article: 12 - Education, communication, training and public awareness.
• Article: 13 - Tobacco advertising, promotion and sponsorship
• Article: 14 – Demand reduction measures concerning tobacco dependence and
cessation
137
• The key supply reduction strategies are contained in Articles 15 to 17 which
includes;
• Article: 15 – Illicit trade in tobacco products.
• Article: 16 - Sales to and by minors;
• Article: 17 - Provision of support for economically viable alternative activities.
138
139
Michael Bloomeberg-US 125 million dollar
The Tobacco Control Grants Program is an important
component of the Bloomberg Initiative to Reduce
Tobacco Use.
China,Egypt,Polland,Russia,Thailand,Turkey,India,Ind
onesia,Bangladesh,Pakistan,Vietnam,Philippines,Braz
il,Ukraine,Mexico
BLOOMBERG INITIATIVE
140
• Definition
• Aims and Objectives
• Infrastructural Requirements
• Floor Plan
• Referrals
• Fagerstrorm Nicotine
Dependence Scale
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf 141
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
TOBACCO COUNSELLING CENTRE
142
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf 143
144
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
145
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf 146
147
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
148
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
149
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf 150
151
152
153
154
155
156
157
https://dciindia.gov.in/Rule_Regulation/FinaloperationalguidelinesTCCindentalcolleges.pdf
CONCLUSION
• India is a heterogeneous country, and solutions to the challenge of oral cancer
must be tailored. A comprehensive set of solutions must be deployed by
multiple stakeholders to put India on the path to further preventing and
controlling this disease.
• Affordable and accessible diagnostic, therapeutic and palliative care services
should be made available in India.
• Tobacco control has to be strengthened and the present status of women and
children as non-users of tobacco should be sustained at any cost.
158
159
REFERENCES
• K. Park. Park’s Textbook of Preventive and Social medicine. 23th ed. Jabalpur: M/s Banarsidas bhanot; 2015.
• MC Gupta and BK Mahajan. Textbook of Preventive and Social Medicine. 3rd Edition 2003. Jaypee Brothers Medical
Publishers Ltd, New Delhi.
• P. Soben. Essentials of preventive and social medicine. 5th ed. Arya publishing house, New Delhi; 2013.
• Hiremath SS. Textbook of Preventive and Community Dentistry. 3rd edition. Elsevier Publishers, New Delhi; 2016.
• CM Marya. A Textbook of Public Health Dentistry. 1st Edition 2011. Jaypee Brothers Medical Publishers, New Delhi.
• Byakodi R,Byakodi S,Hiremath S,Byakodi J,Adaki S,Mara.the K et al.Oral Cancer in India:An Epidemiological and
Clinical Review.J Community Health 2012;37:316-319.
• Centre for Disease Control.Improving Diagnoses of Oral Cancer. http://www.cdc.gov/ OralHealth/pdfs/ oral_cancer.pdf
• CoelhoKR. Challenges of the Oral Cancer Burden in India. Journal of Cancer Epidemiology: 2012, June :1-17. 87
160
• American joint committee on cancer 1997.
• Cancer: Current scenario, intervention strategies and projections for 2015 M. Krishnan Nair, Cherian Varghese, R.
Swaminathan NCMH Background Papers Burden of Disease in India, WHO India.
• Ken Russell Coelho, Review Article Challenges of the Oral Cancer Burden in India Journal of Cancer Epidemiology
Volume 2012, 17 pages
• Krishna Rao et.al Epidemiology of Oral Cancer in Asia in the Past Decade- An Update (2000-2012) Asian Pac J Cancer
Prev, 14 (10), 5567-5577
• • Shafer’s Textbook of Oral Pathology,2012 Seventh Edition
• NCRP ANNUAL REPORT of hospital based cancer registries 2007- 2011.
• Petti S Lifestyle risk factors for oral cancer,Oral Oncology. 2009 Apr-May;45(4-5):340-50. •
• WHO (ONLINE)http://www.who.int/cancer/prevention/en/ •
• WHO Report on the Global Tobacco Epidemic, 2015 http://www.icd10data.com/ICD10CM/Codes/C00-D49/C00- C14
161
162

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Epidemiology of oral cancer

  • 1. EPIDEMIOLOGY OF ORAL CANCER Presented by-Dr.Payal Dash Dept Of Public Health Dentistry
  • 2. CONTENTS • Terminologies • Background • Introduction • Global Scenario of Oral Cancer • Oral Cancer in India • Cancer Registry in India • Epidemiological Triad • Classification Of Oral Cancer • Staging of Oral Cancer • Prevention of Oral Cancer • Summary • Conclusion • References 2
  • 3. TERMINOLOGIES EPIDEMIOLOGY EPI = AMONG DEMOS = PEOPLE LOGOS = STUDY DEFINITION OF EPIDEMIOLOGY "Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems." (Last, 1988) -WORLD HEALTH ORGANIZATION 3
  • 4. • Neoplasm- A “neoplasm” is defined as an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with the normal tissues and persists in the same excessive manner even after cessation of the stimuli which evoked the change • Clonality-Cancer originates from genetic changes in a single cell,which proliferates to form a clone of malignant cells. • Autonomy-Growth is not properly regulated by normal biochemical and physical influences in the environment. • Anaplasia-Lack of normal,coordinated cell differentiation • Metastasis-Cancer cells develop the cappacity for discontinuous growth and disseminaation to other parts of the body. 4
  • 5. BACKGROUND • Cancer - leading cause of death worldwide, - 10 million deaths in 2020 • Most common cancers are breast, lung, colon and rectum and prostate cancers. • Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity. • Cancer-causing infections, such as human papillomavirus (HPV) and hepatitis, are responsible for approximately 30% of cancer cases in low- and lower-middle-income countries. https://www.who.int/news-room/fact-sheets/detail/cancer 5
  • 6. Most common in 2020 (in terms of new cases of cancer) were: breast (2.26 million cases); lung (2.21 million cases); colon and rectum (1.93 million cases); prostate (1.41 million cases); skin (non-melanoma) (1.20 million cases); and stomach (1.09 million cases). Most common causes of cancer death in 2020 were: lung (1.80 million deaths); colon and rectum (916 000 deaths); liver (830 000 deaths); stomach (769 000 deaths); and breast (685 000 deaths). Each year, approximately 400 000 children develop cancer. Cervical cancer is the most common in 23 https://www.who.int/news-room/fact-sheets/detail/cancer 6
  • 7. INTRODUCTION • WHO defines cancer as the uncontrolled growth and spread of cells. • Growths often invade surrounding tissue and can metastasize to distant sites. • Can be prevented by avoiding exposure to common risk factors, such as tobacco smoke. • Significant proportion of cancers can be cured, by surgery, radiotherapy or chemotherapy. 7
  • 8. • The term oral cancer is used to describe any malignancy that arises from oral tissues. • One of the most common sites of oral cancer is on lateral aspect of the tongue. • In the International Classification Of Diseases, oral cancer is classified under the rubrics 140 (lip), 141 (tongue), 143 (gingiva), 144 (floor of the mouth) and 145 (other parts of the mouth). Oral Cancer Foundation 2016 8
  • 9. Global Scenario of Oral Cancer • World Health Report 2004 describes cancer as accounting for 7.1 million deaths in 2003, and it was estimated that the overall number of new cases will rise by 50% in the next 20 years. • Oral Cancer is the 8th most common cancer worldwide, the prevalence of which is particularly high among men. • In South-central Asia – Oral Cancer ranks the 3rd most common type of cancer. 9
  • 10. • Europe and European Union • In 2012, in Europe 73,860 and 25,770 of new cases of oral and pharyngeal cancers among males and females reported • total of 99,630 new cases. • European Union (EU) 53,370 and 19,650 among males and females respectively • A high incidence of oral and pharyngeal cancer among males were reported in Russian Federation and Germany whereas countries like Cyprus and Iceland have reported low incidences. Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 10
  • 11. • North America • In United States of America (USA), cancers of the oral cavity and oropharynx constitutes 3% of all the malignancies in men and 2% in women . • The estimated number of new cases in US, 2013 was 41,380 for oral cavity and pharynx cancer, 13,590 for tongue cancer and 11,400 for mouth cancer . • In 2012, an estimated 26,064 (1.6%) new cases were diagnosed of lip and oral cavity cancer. • An estimated 4,620 deaths have occurred in 2012 due to cancer of lip and oral cavity, • 11th most common cancer in USA among males while in Canada and Mexico it is the 12th and 13th most common cancer respectively. Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 11
  • 12. • South America • cancer of the lip and oral cavity, 15,868 (2.0%) cases estimated to be diagnosed in 2012. • The age-standardised incidence rate - 3.8 per 100,000 population. • Death- 6,046 deaths have occurred in 2012 in South America due to lip and oral cavity cancer • In Brazil, lip and oral cavity cancer is the 7th most common cancer, with an estimated 6,930 new cases diagnosed in the year 2012. Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 12
  • 13. • Africa • According to GLOBOCAN 2012, lip and oral cavity cancer is the 15th most common cancer in Africa and 7th most common cancer in Middle Africa. • In 2012, an estimated 17,276 new cases of lip and oral cavity cancer were diagnosed. • incidence rate - 2.6 per 100,000 population, ranging from 1.5 in Western Africa to 4.0 in Southern Africa. • A total of 10,341 deaths have occurred in Africa due to lip and oral cavity cancer and the age-standardised mortality rate is 1.6, with highest mortality rate being reported in Eastern Africa (2.2%) and Middle Africa (2.3%) Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 13
  • 14. • Asia • According to GLOBOCAN 2012, lip and oral cavity cancer is the 12th most common cancer in Asia and ranks 8th among all the cancers in men, • with an estimated 16,88,50 new cases of lip and oral cavity cancer diagnosed in the year 2012. The standard incidence rate in Asia is 3.8. • An estimated 97,408 deaths have occurred in Asia due to lip and oral cavity cancer and the age-standardised mortality rate is 2.2. • It is the second most common cancer among men in South-Central Asia, with an age- standardised incidence of 9.9 and a 5-year prevalence of 129,057 (12.1%). • The Eastern and Western parts of Asia have low incidence rate of cancer of lip and oral cavity with a standard incidence rate of 1.8 and 2.1 respectively Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 14
  • 15. • Oral cancer is highly prevalent in South Asian countries like Bangladesh, India, Pakistan and Sri Lanka, where one-third of all the cancers reported are oral cancer. • Majority (90%) of the cases reported of oral cancer is attributed to tobacco consumption in various forms in these regions . • Sri Lanka (10.3) has the highest incidence in South Asia and the cancer of the lip and oral cavity is the most common cancer among men in Srilanka . • Pakistan has the second highest incidence rate of lip and oral cavity cancer (9.3) and is the most common cancer among men in Pakistan Gupta N, Gupta R, Acharya AK, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613-619. Published 2016 Dec 31. doi:10.3126/nje.v6i4.17255 15
  • 16. 16
  • 17. State-wise Cancer Prevalence among women (per 100,000 women), NFHS 4 (2015–16). 17
  • 18. 18
  • 19. 19
  • 20. 20
  • 21. K V Deepa, Jubina Balan Venghateri, Monty Khajanchi, Anita Gadgil, Nobhojit Roy, Cancer epidemiology literature from India: Does it reflect the reality?, Journal of Public Health, Volume 42, Issue 4, December 2020, Pages e421–e427 21
  • 22. 22 Introduction History Population based Cancer Registry Hospital Based Cancer Registry 6.CANCER REGISTRY IN INDIA
  • 23. CANCER REGISTRATION IN INDIA • Cancer registration in India was initiated in 1964 and expanded since 1982, through initiation of the National Cancer Registry Program (NCRP) by the Indian Council of Medical Research. • NCRP currently has twenty-six population based registries and seven hospital based registries. Chatterjee S, Chattopadhyay A, Senapati SN, Samanta DR, Elliott L, Loomis D, Mery L, Panigrahi P. Cancer Registration in India - Current Scenario and Future Perspectives. Asian Pac J Cancer Prev. 2016;17(8):3687-96. PMID: 27644602. 23
  • 24. • Until 1964, information on cancer cases in India was available only from adhoc surveys (Yeole, 2015). • Continuous systematic collection of data, their analysis and publication by registries is important for evaluating disease trends over time and generating hypotheses about disease etiologies (Jensen, 1991). • The first cancer registry in India was established in June 1963 in Mumbai as a Unit of the Indian Cancer Society with an aim to obtain reliable incidence and mortality data on cancer from a precisely defined urban population (Yeole, 2015). • However, the main thrust for cancer registration in India began in 1982, through initiation of the NCRP by ICMR. Chatterjee S, Chattopadhyay A, Senapati SN, Samanta DR, Elliott L, Loomis D, Mery L, Panigrahi P. Cancer Registration in India - Current Scenario and Future Perspectives. Asian Pac J Cancer Prev. 2016;17(8):3687-96. PMID: 27644602. 24
  • 25. • The NCRP began with three PBCRs (pre-existing Mumbai registry and new registries at Bangalore and Chennai), and three hospitalbased registries (HBCRs) (Chandigarh, Dibrugarh and Trivandrum). • Further expansion of the NCRP occurred with the initiation of urban PBCRs at Bhopal and Delhi in 1987; rural PBCRs at Barshi (Maharashtra) in 1987, and HBCRs at the main hospital of PBCRs in Bangalore, Mumbai and Chennai in 1986. there are twentysix PBCRs and seven HBCRs under the NCRP network (NCRP, 2015) Chatterjee S, Chattopadhyay A, Senapati SN, Samanta DR, Elliott L, Loomis D, Mery L, Panigrahi P. Cancer Registration in India - Current Scenario and Future Perspectives. Asian Pac J Cancer Prev. 2016;17(8):3687- 96. PMID: 27644602. 25
  • 26. Population Based Cancer Registries “gold standard criteria - a minimum period of one year before the time of cancer diagnosis. a small proportion of the population is covered Accurate Hospital Based Cancer Registries magnitude of cancer and patterns of patient care in a given hospital most HBCRs are located in regional cancer centers a rich source of material for conducting etiological research 26
  • 27. 27
  • 28. • Currently 269 HBCR centres registered under the NCRP, 96 HBCRs were selected which had completed data transmission and quality checks for one or more years during the period 2012-2019 for inclusion in the report. • The 96 HBCRs’ were distributed according to their location according to six regions of the country- North, South, East, West, Central and North East. 28
  • 33. 7.EPIDEMIOLOGICAL TRIAD • Host • Agent • Environment 33
  • 34. HOST FACTORS • Demographic characteristics- • Gender : • Oral cancer and oropharyngeal cancer are twice as common in men as in women. This difference may be related to the use of alcohol and tobacco, a major oral cancer risk factor that is seen more commonly in men than women. • Age: • Most of the cases of OC occur between 50 and 70 years of age, it still could occur in children as early as 10 years of age in the absence of any known risk factors. • Mean age of occurrence of cancer in different parts of oral cavity is usually between 51-55 years in most of the countries but higher around 64 years. 34
  • 35. • About 22.30% of the total female population consumed tobacco, mainly in the smokeless forms, with only 0.50% of the tobacco users using smoked tobacco (Mishra et al ,2020) • 22% of men and 26% of women were using smokeless tobacco. While 46% of men were smoking bidi, only 4% of women reported smoking bidi. Overall, men are more likely to use tobacco. (Barik et al,2016) • 64% of the women surveyed used only one type of SLT; of these, 30% used mishri, 32% used pan with tobacco and the rest used chewed tobacco (11%), gul (17%) or gutkha (10%). (Nair et al ,2015) 35
  • 36. • Declining Trends of Smokeless Tobacco among Indian Women • The fourth round of NFHS survey (2015–2016) estimated the prevalence of tobacco use amongst adult women (n = 699,686 in 601,509 households) to be 6.8% (4.4% in urban and 8.1% in rural) 36 Ghosal, S., Sinha, A., Kanungo, S. et al. Declining trends in smokeless tobacco use among Indian women: findings from global adult tobacco survey I and II. BMC Public Health 21, 2047 (2021).
  • 37. 37
  • 38. • Race: • An elevated incidence of cancers of the nasopharynx has been reported in persons of Chinese ancestry in the United States and elsewhere; decreased incidence of oral cancers has been observed in American Native populations compared with American whites. • Biological characteristics • Genetic: Increased risk of oral cancer associated with exposure to genetic mutagens in tobacco, alcohol and betel quid. • Gene mutations- 3p, 4q, 6p, 8p, 9p, 11q, 13q (retinoblastoma [Rb] tumor suppressor gene), 14q, 17p (p53 tumor suppressor gene), 18q (deleted in colon cancer [DCC] tumor suppressor gene) and 21q. 38
  • 39. 39
  • 40. 40 American Indians/Alaska Natives (Non- Hispanic) • higher prevalence of current smoking than most other racial/ethnic groups in the United States. • Factors that may affect smoking prevalence include sacred tobacco’s ceremonial, • religious, and • medicinal roles in Native culture, In 2019, 20.9% of AI/AN adults in the United States smoked cigarettes, compared with 14.0% of U.S. adults overall. https://www.cdc.gov/tobacco/campaign/tips/res ources/data/cigarette-smoking-in-united- states.html
  • 41. • Asians (Non-Hispanic) • lowest current cigarette smoking prevalence • significant differences in smoking prevalence among subgroups in this population. • Many Asian Americans emigrate from countries where smoking prevalence is high and smoking among men is the social norm. • In 2019, 7.2% of non-Hispanic Asian adults in the United States smoked cigarettes, compared with 14.0% of U.S. adults overall. • Among women, smoking prevalence is highest - Koreans and lowest - Chinese. • Among men, smoking prevalence is highest - Vietnamese and lowest - Asian Indians. 41 https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united- states.html
  • 42. • Blacks (Non-Hispanic) • Although prevalence of cigarette smoking is lower among non-Hispanic Black high school students than among U.S. high school students overall (3.2% compared with 8.1% in 20186, respectively), smoking prevalence among non- Hispanic Black adults is similar to the overall adult population.3,6 • In 2019, 14.9% of non-Hispanic Black adults in the United States smoked cigarettes, compared with 14.0% of U.S. adults overall. • Smoking prevalence declined from 21.5% in 2005 to 14.9% in 2019 42 https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united- states.html
  • 43. • Hispanics • The prevalence of cigarette smoking among Hispanics is generally lower than the prevalence among other racial/ethnic groups in the United States, • Smoking prevalence among Hispanic men is significantly higher than among Hispanic women • In 2019, 8.8% of Hispanic adults in the United States smoked cigarettes, compared with 14.0% among U.S. adults overall.3 • Current smoking prevalence among Hispanics declined from 16.2% in 2005 to 8.8% in 2019. 43 https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united- states.html
  • 44. 44
  • 45. 45 Honorato, J.; Rebelo, M.S.; Dias, F.L.; Camisasca, D.R.; Faria, P.A.; Azevedo e Silva, G.; Lourenço, S.Q.C. (2015). Gender differences in prognostic factors for oral cancer. International Journal of Oral and Maxillofacial Surgery, (), S0901502715001757–.
  • 46. • Social and economic characteristics • Socio economic status: oral cancer affects those from the lower socioeconomic groups of society due to a higher exposure to risk factors such as the use of tobacco. Ken Russell Coelho (2020) • Education: Illiterates those who never attended school and with low educational attainment have greater risk. In the Indian population OR for OC related to education is greater for illiterates (6.4) compared to low education level (5.3). Krishna Rao et al (2019) 46
  • 47. • In Australia smoking behaviour is inversely related to socio-economic status, with disadvantaged groups in the population being more likely to take up and continue smoking. 47 Greenhalgh, EM, Bayly, M, & Scollo, M. 1.7 Trends in the prevalence of smoking by socio-economic status. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues . Melbourne: Cancer Council Victoria; 2021.
  • 48. 48 Cai, L., Wang, XM., Fan, LM. et al. Socioeconomic disparities in prevalence and behaviors of smoking in rural Southwest China. BMC Public Health 19, 1117 (2019).
  • 49. 49 Sreeramareddy CT, Acharya K. Trends in Prevalence of Tobacco Use by Sex and Socioeconomic Status in 22 Sub-Saharan African Countries, 2003-2019. JAMA Netw Open. 2021;4(12):e2137820.
  • 50. • In India, tobacco consumption is more prevalent among the disadvantaged group and they face higher exposure of tobacco harms. • people who were wealthier, more educated, and having a decent job were more prone to cigarette smoking, and on the other side, people who are less educated with poor socioeconomic status had a habit of bidi smoking. (Corsi and Subramanian in 2014) 50 Shah S, Dave B, Shah R, Mehta TR, Dave R. Socioeconomic and cultural impact of tobacco in India. J Family Med Prim Care. 2018;7(6):1173-1176. doi:10.4103/jfmpc.jfmpc_36_18
  • 51. • Occupation: • Certain occupations where exposure to carcinogens is common like tar manufacturing. • Certain oils, textile industries etc – are susceptible to cancer. • Leather workers are shown to have a higher rate of cancer of buccal cavity. • Other workers at increased risk for cancer: Coal mine and tar workers, Oil factory workers, Uranium miners and X-ray technicians • BLOOD GROUPS: • Association of blood groups with oral cancer has also been observed. • It has been reported that Group O showed the least susceptibility, Group B and AB showed doubtful susceptibility and Blood Group A showed higher susceptibility. 51
  • 52. 52 Islam, M.S., Saif-Ur-Rahman, K.M., Bulbul, M.M.I. et al. Prevalence and factors associated with tobacco use among men in India: findings from a nationally representative data. Environ Health Prev Med 25, 62 (2020).
  • 53. • Lifestyle factors • Living habits and Nutrition: It has been observed that vitamin deficiencies (A, C, E)- contribute to high prevalence of oral cancers in India. • In rural India- oral pre-cancerous lesions associated with low plasma levels of vitamin E and beta-carotene. 53 Verma A, Vincent-Chong VK, DeJong H, Hershberger PA, Seshadri M. Impact of dietary vitamin D on initiation and progression of oral cancer. J Steroid Biochem Mol Biol. 2020;199:105603.
  • 54. • Body mass index (BMI) has been inversely associated with oral cancer, and paan chewers with low BMI has a very high risk of oral cancer. • Low BMI may be a risk factor of moderate to severe oral mucositis.(Saito et al,2018) • Obesity may contribute to a higher recurrence rate and a worse prognosis in oral squamous cell carcinoma patients.(Wang et al,2019) 54 Saito N, Imai Y, Muto T, Sairenchi T. Low body mass index as a risk factor of moderate to severe oral mucositis in oral cancer patients with radiotherapy. Support Care Cancer. 2012 Dec;20(12):3373-7. Wang C, Pan Y, Xu Q, Li B, Kim K, Mao M, Li J, Qin L, Li H, Han Z, Feng Z. Relationship between body mass index and outcomes for patients with oral squamous cell carcinoma. Oral Dis. 2019 Jan;25(1):87-96.
  • 55. • Site distribution • Lip cancer is most common in fair skinned races, particularly in rural areas and in men who work out doors. • Intra oral cancer in western countries most commonly affects the lateral borders of the tongue. • Buccal mucosa (65%), lower alveolus (30%) and retromolar trigone (5%) : these constitute more than 60% of all cancers. 55
  • 56. • Genetic syndromes • People with syndromes caused by inherited defects (mutations) in certain genes have a very high risk of mouth and middle throat cancer. • Fanconi anemia: People with this syndrome often have blood problems at an early age, which may lead to leukemia or myelodysplastic syndrome. They also have a very high risk of cancers of the mouth and throat. • Dyskeratosis congenita: This is a genetic syndrome that can cause aplastic anemia, skin rashes, and abnormal fingernails and toenails. People with this syndrome also have a very high risk of developing head and neck cancers, especially of the mouth and throat, at a young age. 56
  • 57. AGENT FACTORS • The disease "agent" is defined as a substance living or non- living, or a force, tangible or intangible, the excessive presence or relative lack of which may initiate or perpetuate a disease process. 57 CHEMICAL FACTORS -Smoking,Alcohol BIOLOGICAL FACTORS -HPV
  • 58. • Biological factors: Human papilloma viruses,HIV,Syphillis • HPV has been identified in approximately 23.5% of OC cases . • The most commonly detected HPV in head and neck squamous cell carcinoma (HNSCC) is HPV-16, which has been demonstrated in 90–95% of all HPV positive HNSCC cases, followed by HPV-18, HPV-31, and HPV-33. • The prognostic significance of HPV in pre-cancerous oral lesion is not clear. However, few studies have found improved disease-specific survival and better prognosis for HPV positive OC. 58 Ram H, Sarkar J, Kumar H, Konwar R, Bhatt ML, Mohammad S. Oral cancer: risk factors and molecular pathogenesis. J Maxillofac Oral Surg. 2011;10(2):132-137.
  • 59. • Approximately 20% of oral cancers were thought to be attributable to HPV infection. • In 2012, the International Agency of Research of Cancer (IARC) declared that there was sufficient evidence to associate a subtype of HPV 16 with oral cancers. • Additionally, these HPV-related oral cancers differ from HPV-negative tumors or cancers in their clinical response and overall survival rates. • In the oral cavity, 24 types of HPV, 1, 2, 3, 4, 6, 7, 10, 11, 13, 16, 18, 30, 31, 32, 33, 35, 45, 52, 55, 57, 59, 69, 72, and 73, have been associated with benign lesions, and 12 types, 2, 3, 6, 11, 13, 16, 18, 31, 33, 35, 52, and 57, with malignant lesions. 59 Kim SM. Human papilloma virus in oral cancer. J Korean Assoc Oral Maxillofac Surg. 2016;42(6):327-336.
  • 60. • HSV-1 or "oral herpes" is commonly associated with sores around the mouth and lip and has been suggested to be a causative agent of OC . • Epidemiological studies showed higher level of IgG and IgM antibodies to OC patients compared to control subjects . • Kassim et al also reported oncogenic relationship between HSV-1 and oral squamous cell carcinoma (OSCC). • A population based study showed HSV-1 to enhance development of OSCC in HPV infected patients and individuals with history of cigarette smoking . 60 Ram H, Sarkar J, Kumar H, Konwar R, Bhatt ML, Mohammad S. Oral cancer: risk factors and molecular pathogenesis. J Maxillofac Oral Surg. 2011;10(2):132-137.
  • 61. • Risk of oral cavity and pharyngeal cancer is two-fold higher among human immunodeficiency virus (HIV) patients indicating a link between HIV and OSCC . • Epstein Barr Virus (EBV), human herpesvirus-8 (HHV-8) and cytomegalovirus have also been reported as risk factors of OSCC in different studies • Syphilis-The data on causal association between syphilis and OC is weak. There are reports of 19 and 6% serological positivity for syphilis among tongue cancer patients. • Candida-Candida has been suggested to play a role in initiation of OC. Clinical studies have reported that nodular leukoplakia infected with Candida has a tendency for higher rate of dysplasia and malignant transformation. 61 Ram H, Sarkar J, Kumar H, Konwar R, Bhatt ML, Mohammad S. Oral cancer: risk factors and molecular pathogenesis. J Maxillofac Oral Surg. 2011;10(2):132-137.
  • 62. • Mechanical- An association between oral carcinoma and chronic irritation of the mucosa by the dentures. Case reports have detailed the development of oral carcinomas in patients who wear ill fitting dentures. Shafers (2012) • Ultraviolet (UV) radiation, and in particular solar radiation, is carcinogenic to humans, causing all major types of skin cancer, such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. • The lower lip receives considerable sunlight exposure than upper lip that is comparatively shaded accounting for a higher occurrence than later. 62
  • 63. 63 • genus Nicotiana • family Solanaceae TOBACC O
  • 64. 64 Food And Agriculture Organization Of The United Nations. Retrieved November 3, 2019.
  • 65. BIDI • Most common • 0.2-0.3 gm of sundried tobacco flakes handrolled in tendu • 60mm/80mm • Nicotine-1.7-3mg • Tar--45-50mg CHILLUM • Conical clay pipe • 10-14cm CHUTTA • Cigar/cheroor • Cigars-air cured,fermented tobacco • Cylindrical coarsely prepared cheroot. Cured tobacco is wrapped in a dried tobacco leaf. 65
  • 66. 66
  • 67. d) Cigarettes : About 1gram of tobacco cured in the sun or artificial heat is covered with paper Tobacco smoke consists of more than 4000 chemical compounds and approximately 60 known carcinogens. Hydrogen cyanide Formaldehyde Lead Arsenic Ammonia Radioactive elements, such as polonium-210 (see below) Benzene Carbon monoxide Tobacco-specific nitrosamines (TSNAs) Polycyclic aromatic hydrocarbons (PAHs) The temperature at the burning end of a cigarette is about 900C during puffs, and about 400C between puffs. 67
  • 68. e) Dhumti : • Rolled leaf tobacco is used inside a leaf of fruit tree. • Sometimes dried leaf of the banana plant is used. • Used among women f) Hookli : Clay pipe- short stem varying from about 7 to 10 cms with a mouth piece and a bowl. Commonly used in Bhavnagar district of Gujarat. • Hookah/water pipe/hubble-bubble • Moghul Cultural influence • Indian Origin • Tobacco smoke drawn through water in the base of hookah which cools and filters the smoke 68
  • 69. Paan : Most common habit of smokeless tobacco usage in India. Paan refers betel leaf (from piper betel wine) itself and often to the quid. 69
  • 70. • Khaini : Powdered sun-dried tobacco, slaked lime (calcium hydroxide)-paste mixture occasionally used with arecanut. • Widespread in use in Maharastra • Premolar of mandibular groove • Mainpuri Tobacco • Tobacco,Slaked lime,arecanut,camphor,cloves • 7% Uttarpradesh • Mawa • Arecanut,Tobacco,Slaked lime • Wrapped in cellophane paper,Tied in shape of small ball 70
  • 71. • Gudakhu : Paste of powdered tobacco, molasses (brown sugar) and other ingredients primarily used to clean tooth. Used- women in Bihar. Snuff : Finely powdered air-cured and fire- cured tobacco leaves. It may be dry or moist, used plain or with other ingredients. Used orally or nasally. Zarda : Tobacco leaf is boiled in water along with lime and spices until evaporation. The residual tobacco is then dried and coloured with dyes. It is chewed. 71
  • 72. 72
  • 73. 73
  • 74. • CONSTITUENTS IN TOBACCO • NNN(N-Nitrosonornicotine)-1st organic carcinogen • 1.NICOTINE • Lethal dose- 30-60 mg • Releases dopamine • Physiological effects-increased heart rate,blood pressure,muscular hormonal metabolic effects 74
  • 75. • Reverse smoking : • The habit of tobacco smoking with the lighted end inside the mouth (reverse smoking) is found in people of the lower socio-economic states in Colombia, Panama. • India- females of Vishakhapatnam,Srikakulam • Adda poga • Temperature-Palatal mucosa 58 degree C 75
  • 76. 76
  • 77. 77
  • 78. 78 Secondhand smoke is the combination of smoke from the burning end of a cigarette and the smoke breathed out by smokers.
  • 79. 79
  • 80. Classification of lesions in the oral cavity Benign tumours of epithelial origin Premalignant lesions of epithelial origin Malignant tumours of epithelial tissue origin Benign tumours of connective tissue origin Malignant tumours of connective tissue origin 80
  • 81. ORAL POTENTIALLY MALIGNANT DISORDERS • PRECANCEROUS LESION • It is defined as a morphologicaaly altered tissue in which cancer is more likely to develop than in its apparently normal counterpart. • Ex- Leukoplakia,Erythroplakia,Smoke rs Palate • PRECANCEROUS CONDITION • It is generalised state associated with significantly increased risk of cancer. • Ex-OSMF,Lichen Planus 81
  • 83. • a prevalence of 2.6% and a malignancy conversion rate ranging from 0.1% to 17.5% • India, in particular, concluded the prevalence of leukoplakia ranging from 0.2% to 5.2% and the malignant transformation of 0.13% to 10%. • incidence rate of leukoplakia arrays between 6.2 and 29.1 cases per 100,000 people STUDIES PREVALENCE Martorell- Calatayud et al. 0.4% to 0.7% Feller et al. 0.5% to 3.46% Brouns et al. 2% Mohammed F, Fairozekhan AT. Oral Leukoplakia. [Updated 2021 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan- 83
  • 86. 86 Rao, N.R., Villa, A., More, C.B. et al. Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J of Otolaryngol - Head & Neck Surg 49, 3 (2020).
  • 87. 87 Rao, N.R., Villa, A., More, C.B. et al. Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J of Otolaryngol - Head & Neck Surg 49, 3 (2020).
  • 88. 88 Rao, N.R., Villa, A., More, C.B. et al. Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J of Otolaryngol - Head & Neck Surg 49, 3 (2020).
  • 89. • Oral SCC more frequently affects men than women (M:F = 1.5:1) most probably because more men than women indulge in high-risk habits. • In the USA the median age of diagnosis of oral SCC is 62 years. However, the incidence of oral SCC in persons under the age of 45 is increasing • In Western countries oral SCC affects the tongue in 20% - 40% of cases and the floor of the mouth in 15% - 20% • The mean 5-year survival rate of persons with oral SCC is about 50% with no gender difference; but black persons have a lower five year survival rate than persons of other race (5) (PDF) Oral Squamous Cell Carcinoma: Epidemiology, Clinical Presentation and Treatment. 89
  • 90. 90
  • 91. 91
  • 92. 92
  • 93. • PREVENTION OF ORAL CANCER • Mainly focuses on modifying habits associated with the use of tobacco. • 3 well-known approaches: • 1. Regulatory Approach • 2. Service Approach • 3. Educational Approach 93
  • 94. • REGULATORY OR LEGAL APPROACH • As early as 1590, The Government in Japan, edict against tobacco use, where users were penalized by having their property confiscated or were jailed. • Similar edicts have been reported in Turkey, Russia and China. Religious groups have also banned the use of tobacco. 94
  • 95. • In India, Cigarette Act 1975 has made it necessary to print warning on cigarette packets. • In some countries like Italy, Norway, Portugal Singapore and Thailand there has been a ban on advertising tobacco products. • The cigarette packs are now required to carry graphical health warnings. • After years of wrangling, graphic health warnings (GHW) are now mandatory on tobacco products sold in India. • The Cigarette and Other Tobacco Products (Packaging and Labelling) Rules 2009 requiring GHW came into force on 31 May. 95
  • 96. • Cigarettes And Other Tobacco Products (prohibition Of Advertisement And Regulation Of Trade And Commerce, production, Supply Distribution)Act (COTPA), in 2003: • The Indian Parliament passed the bill in April 2003. This bill became an act on 18 May 2003. 96
  • 97. • The key provisions of COTPA- 2003 are as follows: • Prohibition Of Smoking In Public Places Implemented From 2nd October 2008. • Prohibition Of Advertisement- direct Or Indirect And Promotion Of Tobacco Products. 97
  • 98. • Prohibition of sales to minors(tobacco products cannot be sold to children less than 18yrs of age and cannot be sold within a radius of 100 yards of any educational institutions. 98
  • 99. • Regulation of health warning in tobacco products pack . • Law pertaining to pictorial health warnings on tobacco product packages: Implemented with effect from 31st May 2009. 99
  • 100. 100
  • 101. • Out of 307 schools observed, on average 85% of the schools violated Section 4 – no signage displaying ‘No Smoking Area – Smoking here is An Offence’, and on average 69% violated Section 6b – shops selling tobacco products within a radius of 100 yards of schools 101 Pradhan A, Oswal K, Padhan A, et al. Cigarettes and Other Tobacco Products Act (COTPA) implementation in education institutions in India: A crosssectional study. Tob Prev Cessat. 2020;6:51. Published 2020 Sep 10.
  • 102. • In Anantapur and Chittoor districts of Andhra Pradesh, an average of 80%, in Prayagraj district of Uttar Pradesh an average of 96%, in Khordha, Cuttack and Puri districts of Odisha an average of 90%, in Gumla, Khunti, Lohardaga and Ranchi districts of Jharkhand an average of 74% and in Dakshina Kanada and Udupi districts of Karnataka an average of 4% educational institutions violated Section 6b 102 Pradhan A, Oswal K, Padhan A, et al. Cigarettes and Other Tobacco Products Act (COTPA) implementation in education institutions in India: A crosssectional study. Tob Prev Cessat. 2020;6:51. Published 2020 Sep 10.
  • 103. • SERVICE APPROACH • Primary goal is a fundamental of prevention. This can be achieved through screening and early detection. • It also provides an opportunity to identify and council the patients about habits that increase the risk of cancer. Other than professional, primary health care workers can also be used for screening. • Diagnostic methods such as Biopsy Technique, Exfoliative Cytology, Toluidine Blue Vital Staining can be used under this approach. 103
  • 104. • EDUCATIONAL APPROACH • The process of becoming a smoker, for example, essentially involves four stages : • Awareness • Initiation / Experimentation • Habituation • Maintenance / Dependence • So education has an important part to play in discouraging people from starting its use and from helping people to stop the habit. 104
  • 105. • Guide to Counseling for tobacco cessation (5A’s): • Ask –use of tobacco • Advise –non users to never use andusers toquit • Assess- the patient readiness toquit • Assist-with quitting • Arrange-for follow ups 105
  • 106. 106
  • 107. 107
  • 108. 108 • 1.Relevance to quitting • Ask the patient why quitting is relevant • 2.Risks • Acute Risks • Long term risks • Environmental Risks
  • 109. • 3.Rewards of quitting • Improved oral health • Feel better • Increased energy levels • money is saved • longer healthier life • 4.Roadblocks to qutting • Fear of withdrawal symptoms • fear of failure • lack of support • fear of weight gain • depression 109
  • 110. • USE OF PHARMACOTHERAPY • There are 2 main types of pharmacotherapy for tobacco use cessation: • Nicotine Replacement therapies (NRT): These lessen the cravings and other withdrawal symptoms and the individual learns to stop the behaviours connected with tobacco use. Eventually, patients need to give up using nicotine replacement. • Antidepressants: They also serve as anticraving medications and can be used with NRTs. 110
  • 111. • Use of Pharmacotherapy • 1.Nicotine Replacement Therapies- • Nicotine gum • Nicotine patch • Nicotine inhaler • nicotine nasal spray • nicotine lozenges 111
  • 112. • The first NRT - transmucosally delivered nicotine polacrilex (nicotine gum). • intermittently chewed and held in the mouth over about 30 minutes • available in both 2 mg and 4 mg dosage forms. • Acidic beverages have been shown to interfere with buccal absorption of nicotine; therefore, patients should avoid acidic beverages (eg, soda, coffee, beer) for 15 minutes before and during chewing gum. 112
  • 113. • Nicotine Lozenge • 2mg and 4mg formulations. • lozenge is not chewed • it dissolves in the mouth over approximately 30 minutes with some variation across individuals. • nicotine from the lozenge is absorbed slowly through the buccal mucosa and delivered into systemic circulation. 113
  • 114. • Nicotine Sublingual tablet • Placed under the tongue where the nicotine in the tablet is absorbed sublingually. • It is recommended that smokers use the product for at least 12 weeks. • After 12 weeks, the number of tablets used should be gradually tapered. 114
  • 115. • Nicotine Oral inhaler • consists of a mouthpiece and a plastic cartridge containing nicotine. • The vapour inhaler was designed to satisfy behavioral aspects of smoking, namely, the hand-to-mouth ritual, while delivering nicotine to reduce physiological withdrawal symptoms produced by tobacco withdrawal. • Majority of nicotine is delivered into the oral cavity (36%) and in the oesophagus and stomach (36%). • Each inhaler cartridge contains 10mg nicotine, of which up to 4 mg can be delivered and 2 mg can be absorbed following frequent “puffing”. 115
  • 116. 116 • Nicotine Patches • Advantage- compliance is simple; the patient simply places the patch on the body in the morning, rather than actively using a product throughout the day. • It delivers nicotine more slowly than acute NRT formulations • They are available in different doses, and deliver between 5mg and 22mg of nicotine over a 24-hour period • The most frequently reported side effects are local skin reactions.
  • 117. • Nicotine Nasal spray • The device available to consumers is a multi-dose bottle with a pump mechanism fitted to a nozzle that delivers 0.5 mg of nicotine per 50-uL squirt. • Each dose consists of two squirts, one to each nostril. • Patients should be started with one or two doses per hour, which may be increased up to the maximum of 40 doses per day. • One dose of nasal spray per hour (1mg nicotine) for 10 hours produces average plasma concentrations of 8ng/ml. 117
  • 118. • Nicotine preloading • The use of nicotine replacement therapy before quitting smoking is called nicotine preloading. • This approach involves using NRT for a several weeks prior to quitting; it is also known as precessation or pre-quitting NRT. • The most plausible mechanisms include habituation with use of NRT in the lead- up to quitting, attenuation of desire to smoke due to nicotine receptor saturation and it reduces satisfaction from smoking by which it undermines the learned association between smoking and reward. 118 Wadgave U, Nagesh L. Nicotine Replacement Therapy: An Overview. Int J Health Sci (Qassim). 2016;10(3):425-435.
  • 119. • True pulmonary inhaler • delivery nicotine to the lung in a manner more comparable to cigarette smoking. • reduce background cravings and withdrawal symptoms, and would allow for rapid relief of acute cravings and morning craving. • Nicotine Vaccines • Nicotine vaccines represent a new approach to the treatment of nicotine dependence and are currently under investigation. • NicVAX developed by Nabi Biopharmaceuticals 119 Wadgave U, Nagesh L. Nicotine Replacement Therapy: An Overview. Int J Health Sci (Qassim). 2016;10(3):425-435.
  • 120. Wadgave U, Nagesh L. Nicotine Replacement Therapy: An Overview. Int J Health Sci (Qassim). 2016;10(3):425-435. 120 The preliminary results of the trials showed that the primary endpoint of 16 weeks abstinence measured at 12 months was not met; there was no statistically difference between the NicVAXW and placebo group Interim analysis showed that the primary endpoint (continuous abstinence from smoking from weeks 8–12 after start of treatment) was not achieved, possibly because NIC002 failed to induce sufficiently high antibody titers. Not Declared
  • 121. • 2.Antidepressants • Firstly, nicotine withdrawal may produce depressive symptoms or precipitate a major depressive episode and antidepressants may relieve these. • Secondly, nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect. • Finally, some antidepressants may have a specific effect on neural pathways (e.g. inhibiting monoamine oxidase) or receptors (e.g. blockade of nicotinic‐cholinergic receptors) underlying nicotine addiction. • First line therapies • Buproprion SR,Selegeline • Second line therapies • Clonidine,Nortryptiline 121
  • 122. Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2014;2014(1):CD000031. Published 2014 Jan 8. doi:10.1002/14651858.CD000031.pub4 • doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine; S‐Adenosyl‐L‐Methionine (SAMe); sertraline; St. John's wort; tryptophan; venlafaxine; and zimeledine. • Bupropion. • dopaminergic and adrenergic actions, and an antagonist at the nicotinic acetylcholinergic receptor (Fryer 1999). • It may work by blocking nicotine effects, relieving withdrawal (Cryan 2003; West 2008), or reducing depressed mood (Lerman 2002). • Licensed as a prescription aid to smoking cessation in many countries. • The usual dose for smoking cessation is 150 mg once a day for three days increasing to 150 mg twice a day continued for 7 to 12 weeks 122
  • 123. • Tricyclic antidepressant nortriptyline. • Its presumed mechanism of action is increased noradrenergic activity. • It is sometimes prescribed when first‐line treatments have been unsuccessful • licensed for smoking cessation in New Zealand. • The recommended regimen is 10 to 28 days of titration before the quit attempt, followed by a 12‐week dose of 75 to 100 mg daily (Cahill 2013). 123 Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2014;2014(1):CD000031. Published 2014 Jan 8. doi:10.1002/14651858.CD000031.pub4
  • 124. Global Intitiatives in Prevention Of Oral Cancer 124 1. Crete Declaration on Oral Cancer Prevention 2. National Tobacco Control Programme 3. WHO Framework Conevention on Tobacco Control 4. Bloomberg Initiative 5. Tobacco Cessation Centre
  • 125. 125
  • 126. 126
  • 127. 127 • National Tobacco Control Programme (NTCP) • Government of India launched the National Tobacco Control Programme (NTCP) in the year 2007-08 during the 11th Five-Year-Plan, with the aim to • (i) create awareness about the harmful effects of tobacco consumption, • (ii) reduce the production and supply of tobacco products, • (iii) ensure effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA) • (iv) help the people quit tobacco use, and • (v) facilitate implementation of strategies for prevention and control of tobacco advocated by WHO Framework Convention of Tobacco Control .
  • 128. • During the 11th Five Year Plan, NTCP was implemented in 21 states covering 42 districts. • To carry forward the momentum generated by the NTCP during the 11th Five Year Plan and baseline data generated through the Global Adult Tobacco Survey (GATS) India 2009-2010, indicating high level of prevalence of tobacco use, it was upscaled in the 12th Five Year Plan with a goal to reduce the prevalence of tobacco use by 5% by the end of the 12th FYP. • As per the second round of GATS, the number of tobacco users has reduced by about 81 lakh (8.1 million). 128
  • 129. • The main thrust areas for the NTCP are as under: • Training of health and social workers, NGOs, school teachers, and enforcement officers; • Information, education, and communication (IEC) activities; • School programmes; • Monitoring of tobacco control laws; • Coordination with Panchayati Raj Institutions for village level activities; • Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at district level. 129
  • 130. • NTCP is implemented through a three-tier structure, i.e. • (i) National Tobacco Control Cell (NTCC) at Central level • (ii) State Tobacco Control Cell (STCC) at State level & • (iii) District Tobacco Control Cell (DTCC) at District level. • There is also a provision of setting up Tobacco Cessation Services at District level. 130
  • 131. • NTCP has resulted in provision of dedicated funds and manpower for implementation of the Programme. State/District Tobacco Control components viz. STCC and DTCC Plan have been subsumed in the Flexi-pool for Non- Communicable Disease (NCDs) under National Health Mission (NHM) for effective implementation since 12th Five Year Plan. • Currently, the Programme is being implemented in all 36 States/Union Territories covering around 612 districts across the country. 131
  • 132. • National Tobacco Control Cell (NTCC) • The National Tobacco Control Cell (NTCC) at the Ministry of Health and Family Welfare (MoHFW) is responsible for overall policy formulation, planning, implementation, monitoring and evaluation of the different activities envisaged under the National Tobacco Control Programme (NTCP). • The National Cell functions under the direct guidance and supervision of the programme in-charge from Joint Secretary. • The technical assistance is provided by the identified officers in the Directorate General of Health Services. 132
  • 133. • The programme broadly envisages; • National level: • Public awareness/mass media campaigns for awareness building and behavioural change • Establishment of tobacco product testing laboratories.National level: • Mainstreaming research and training on alternative crops and livelihood with other nodal Ministries. • Monitoring and evaluation including surveillance • Integrating NTCP as a part of health-care delivery mechanism under the National Health Mission framework. 133
  • 134. • State Level: • Dedicated State Tobacco Control Cells for effective implementation and monitoring of tobacco control initiatives. • The key activities include; • State Level Advocacy Workshop • Training of Trainers Programme for staff appointed at DTCC under NTCP. • Refresher training of the DTCC staff. • Training on tobacco cessation for Health care providers. • Law enforcers training / sensitization Programme 134
  • 135. • District Level: • The key activities include- • Training of Key stakeholders: health and social workers, NGOs, school teachers, enforcement officers etc. • Information, Education and Communication (IEC) activities. • School Programmes. • Monitoring tobacco control laws. • Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at the district level. • Co-ordination with Panchayati Raj Institutions for inculcating concept of tobacco control at the grassroots. 135
  • 136. • WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL (WHO FCTC) • First international treaty negotiated under the auspices of WHO. • There are currently 181 Parties to the Convention. • Adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. • It aims to tackle some of the causes of that epidemic, including complex factors with cross -border effects, such as trade liberalization and direct foreign investment, tobacco advertising, promotion and sponsorship beyond national borders, and illicit trade in tobacco products. • Govt. of India ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2004, the first ever international public health treaty focusing on the global public health issue of tobacco control. 136
  • 137. • The key demand reduction strategies are contained in Articles 6 to 14 which includes; • Article: 6 – Price and tax measures to reduce the demand for tobacco. • Article: 7 – Non-price measures to reduce the demand for tobacco • Article: 8 - Protection from exposure to second hand tobacco smoke. • Article: 9 & 10 - Tobacco content and product regulation • Article: 11 - Packaging and labeling of tobacco products. • Article: 12 - Education, communication, training and public awareness. • Article: 13 - Tobacco advertising, promotion and sponsorship • Article: 14 – Demand reduction measures concerning tobacco dependence and cessation 137
  • 138. • The key supply reduction strategies are contained in Articles 15 to 17 which includes; • Article: 15 – Illicit trade in tobacco products. • Article: 16 - Sales to and by minors; • Article: 17 - Provision of support for economically viable alternative activities. 138
  • 139. 139 Michael Bloomeberg-US 125 million dollar The Tobacco Control Grants Program is an important component of the Bloomberg Initiative to Reduce Tobacco Use. China,Egypt,Polland,Russia,Thailand,Turkey,India,Ind onesia,Bangladesh,Pakistan,Vietnam,Philippines,Braz il,Ukraine,Mexico BLOOMBERG INITIATIVE
  • 140. 140 • Definition • Aims and Objectives • Infrastructural Requirements • Floor Plan • Referrals • Fagerstrorm Nicotine Dependence Scale
  • 151. 151
  • 152. 152
  • 153. 153
  • 154. 154
  • 155. 155
  • 156. 156
  • 158. CONCLUSION • India is a heterogeneous country, and solutions to the challenge of oral cancer must be tailored. A comprehensive set of solutions must be deployed by multiple stakeholders to put India on the path to further preventing and controlling this disease. • Affordable and accessible diagnostic, therapeutic and palliative care services should be made available in India. • Tobacco control has to be strengthened and the present status of women and children as non-users of tobacco should be sustained at any cost. 158
  • 159. 159
  • 160. REFERENCES • K. Park. Park’s Textbook of Preventive and Social medicine. 23th ed. Jabalpur: M/s Banarsidas bhanot; 2015. • MC Gupta and BK Mahajan. Textbook of Preventive and Social Medicine. 3rd Edition 2003. Jaypee Brothers Medical Publishers Ltd, New Delhi. • P. Soben. Essentials of preventive and social medicine. 5th ed. Arya publishing house, New Delhi; 2013. • Hiremath SS. Textbook of Preventive and Community Dentistry. 3rd edition. Elsevier Publishers, New Delhi; 2016. • CM Marya. A Textbook of Public Health Dentistry. 1st Edition 2011. Jaypee Brothers Medical Publishers, New Delhi. • Byakodi R,Byakodi S,Hiremath S,Byakodi J,Adaki S,Mara.the K et al.Oral Cancer in India:An Epidemiological and Clinical Review.J Community Health 2012;37:316-319. • Centre for Disease Control.Improving Diagnoses of Oral Cancer. http://www.cdc.gov/ OralHealth/pdfs/ oral_cancer.pdf • CoelhoKR. Challenges of the Oral Cancer Burden in India. Journal of Cancer Epidemiology: 2012, June :1-17. 87 160
  • 161. • American joint committee on cancer 1997. • Cancer: Current scenario, intervention strategies and projections for 2015 M. Krishnan Nair, Cherian Varghese, R. Swaminathan NCMH Background Papers Burden of Disease in India, WHO India. • Ken Russell Coelho, Review Article Challenges of the Oral Cancer Burden in India Journal of Cancer Epidemiology Volume 2012, 17 pages • Krishna Rao et.al Epidemiology of Oral Cancer in Asia in the Past Decade- An Update (2000-2012) Asian Pac J Cancer Prev, 14 (10), 5567-5577 • • Shafer’s Textbook of Oral Pathology,2012 Seventh Edition • NCRP ANNUAL REPORT of hospital based cancer registries 2007- 2011. • Petti S Lifestyle risk factors for oral cancer,Oral Oncology. 2009 Apr-May;45(4-5):340-50. • • WHO (ONLINE)http://www.who.int/cancer/prevention/en/ • • WHO Report on the Global Tobacco Epidemic, 2015 http://www.icd10data.com/ICD10CM/Codes/C00-D49/C00- C14 161
  • 162. 162