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EPIDEMIOLOGY OF ORAL CANCER

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Etiology and epidemiology of oral cancer.

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EPIDEMIOLOGY OF ORAL CANCER

  1. 1. EPIDEMIOLOGY OF ORAL CANCER
  2. 2. INTRODUCTION Major threat to public health in developing and developed sector. Cancer is the second most common cause of death.
  3. 3. 4 characteristic features: Clonality Autonomy Anaplasia Metastasis
  4. 4. EPIDEMIOLOGY OF ORAL CANCER Oral Cancer is one of the ten leading cancer in the world. In India it is a common cancer & is an important public health problem (third commonest cancer). Tongue is the most common site ( lateral borders). 90-95% of oral cancer are of the squamous cell ca type.
  5. 5. ICDS CLASSIFICATION In the ICDS (WHO – 9th version) classification oral cancer is under 140-145. Includes- Squamous cell Carcinoma of lip(ICD140) Tongue (ICD 141) Gum (ICD143) Floor of mouth (ICD144) ICD refers to the WHO international classification of diseases
  6. 6. About 2.5 lakh new cases occur every year in India, Pakistan, Bangladesh etc. Study done in Mumbai, Pune, Chennai and Bangalore: Higher in males except in Bangalore. Indian Oral Cancer – Buccal mucosa(65%), lower alveolus(30%) and retro molar trigone(5%) : as these constitute more than 60% of all cancers. WHAT DOES THE NUMBERS SAY??
  7. 7. Age, gender and site distribution Predominant in older age group. 5th & 6th decade of life. In developing countries as compared to industrialized countries it is 2.5 times more in males & 4 times in females . Cancer Registries in India Hospital based registry. Population based- definite population. Special purpose registry for epidemiological study in a radiation exposed area.
  8. 8. Etiology of Oral Cancer  Tobacco  Alcohol  Exposure to sun  Diet and Nutrition  Fungal infections  Viral infections  Trauma and dental irritation  Genetic factors
  9. 9. TOBACCO It is estimated that 47 % of Indians aged 15 years or more use tobacco in one form or other. High incidence rates in India is associated with addition of betel quid chewing where addition of tobacco to quid is a critical factor.
  10. 10. RECIPE FOR DISASTER Tobacco leaves curing (fire curing, sun curing) for partial drying further drying fermentation/sweetening for months upto 2 years. During this time moisture loss reduces weight of tobacco
  11. 11. TOBACCO Derived from Nicotiana tabacum and Nicotiana rusticum. CONSTITUENTS: Nicotine Tar Carbon monoxide Nitrogen oxide Hydrogen cyanide and other ciliatoxics Metals Radioactive compounds
  12. 12. Constituents of Tobacco CONSTITUENTS ADVERSE EFFECTS Polycyclic aromatic hydrocarbon Carcinogenesis Nicotine Carcinogenic Phenol Ganglionic stimulation and depression & tumour promotion Benzopyrene Tumour promotion & irritation CO Impaired O2 transport Formaldehyde and oxides of N2 Toxicity to cilia and irritation Nitrosamine Carcinogenic
  13. 13. TOBACCO PREPARATIONS SMOKED TOBACCO Bidi Chillum Chutta Cigarettes Dhumti Hookah Hookli SMOKELESS TOBACCO Khaini Mainpuri tobacco Mawa Mishri Paan Snuff Zarda Gutka Gudaku
  14. 14. BIDI 0.2 to 0.3 gms of sun dried tobacco flakes are hand rolled. Nicotine 1.7 to 3.0 mgs Tar 45to50mgs CHILLUM A 14 cms straight conical clay pipe Coarsely cut tobacco pieces and a glowing charcoal is kept on top. It is held vertically and to prevent tobacco from entering mouth a pebble stone is introduced
  15. 15. CHUTTA Cured tobacco is wrapped in a dried tobacco leaf. It is also called as cigar CIGARETTES 1 gm of tobacco cured in the sun or artificial heat is covered with a paper Nicotine 1-1.4mg Tar 19-27mg
  16. 16. DHUMTI Rolled leaf tobacco is used inside a leaf of jack fruit tree HOOKAH Tobacco smoke is drawn through the water in the base of hookah which cools and filters the smoke It is also called water pipe or hobble- bubble
  17. 17. HOOKLI Clay pipe of 7 to 10 cms long with a mouth piece and a bowl KHAINI Powdered sundried tobacco, slaked lime-paste mixture occasionally with used with areca nut
  18. 18. MAINPURI TOBACCO Tobacco, slaked lime, finely cut areca nut, camphor, cloves MAWA Thin shavings of areca nut + tobacco + slaked lime are wrapped in cellophane paper and tied in a shape of a ball It should be vigorously mixed before consumption
  19. 19. MISHRI The roasted tobacco is powdered + catechu(a residual extract obtained by soaking the heartwood of acacia catechu PAAN Betel leaf+ areca nut+ tobacco +lime+ cinnamon or coconut or cloves or sugar are wrapped in betel leaf
  20. 20. SNUFF Finely powdered air cured and fire cured tobacco leaves+ areca nut + lime carried in a metal container It is locally called MUKKU PODUMU ZARDA Tobacco leaf is boiled in water along with lime and spices until evaporation. The residual tobacco is dried and coloured with dyes.
  21. 21. GUTKA Crushed betel nut, tobacco, sweet or savory flavorings GUDAKHU Paste of powdered tobacco, molasses, and other ingredients primarily used to clean the teeth.
  22. 22. ALCOHOL It is an independent risk factor. Synergistic effect of tobacco & alcohol . Accounts for 75% of all oral & pharyngeal cancer . Heavy drinkers who smoked over 20 cigarettes a day were observed to have 24 times more risk of oral cancer.
  23. 23. Exposure to Sun Effect of Solar Radiation – Sunlight- Chronic exposure to sunlight – cancer of the lip. Diet and Nutrition- Vitamin A, C, E & Antioxidant [β-carotene] , copper, zinc and manganese shows protective effect against cancer. Red chilli powder has emerged as a risk factor to cancer
  24. 24. Fungal Infections Dysplastic lesions [leukoplakia] with candidial infection have greater risk of malignancy. Viruses Human herpes virus1(HHV1),Herpes simplex virus1(HSV1),Human immunodeficiency virus have been associated with squamous cell carcinoma(SCC).
  25. 25. Trauma and dental irritation Continuous irritation from jagged teeth and dentures poor oral hygiene are risk factors for oral cancer . Genetic factors- Alterations in in many genes have been implicated in development and progression oral cancer. Eg:3p (FHIT), 9P (CDKN2A)
  26. 26. Definition…. Precancerous lesion- Is defined as morphologically altered tissue in which cancer is more likely to develop than its apparently normal counter part. Precancerous condition- Its is a generalized state associated with a significantly increased risk of cancer.
  27. 27. Precancerouslesions Precancerouscondition 1. Leukoplakia 2. Erythroplakia 3. Leukodema 4. Smokers palate 5. Palatal erythema 1. Oral Sub mucous Fibrosis 2. Lichen planus
  28. 28. Precancerous lesions Leukoplakia Erythroplakia leukedema Palatal erythema Smokers palate
  29. 29. Precancerous condition Oral submucous fibrosis Lichen planus
  30. 30. Squamouscell carcinoma (Epidermoid carcinoma) Most malignant neoplasm in the oral cavity Can occur as: • Carcinoma of lip • Carcinoma of tongue • Carcinoma of floor of mouth • Carcinoma of buccal mucosa • Carcinoma of gingiva • Carcinoma of palate • Carcinoma of maxillary sinus
  31. 31. GLOBAL INITIATIVES IN PREVENTION AND CONTROL OF ORAL CANCER THE CRETE DECLARATION ON ORAL CANCER PREVENTION 2005. WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL. BLOOMBERG INITIATIVE TO REDUCE TOBACCO CONTROL.
  32. 32. CRETE DECLARATION  Provision of systemic epidemiological information on prevalence of oral cancer and cancer risk specially in developing countries. Promotion of research (biological, behavioral and psychosocial factors of oral cancer).  Integrating oral cancer information into national health surveillance system. Dissemination of information. Active involvement of oral health professionals.  Training of primary health care worker in screening. Access to health facilities and provision of system for early detection and intervention.
  33. 33. WHO Frameworkconvention on tobacco control WHO FCTC treaty opened – 16th to 22 June 2003. 168 signatories. Most widely embraced treaties in UN history. Member states – strive in good faith to ratify, accept or approve it and show political commitment not to undermine the objective set out in it. Into force – 27 Feb 2005
  34. 34. Spread.. Cross border effect, trade liberalization and direct foreign investment. Global marketing, promotion and sponsorship and international movement of contraband and counterfeit cigarettes. Assert importance of – Demand reduction strategies. Supply reduction provisions.
  35. 35. BLOOMBERG INTIATIVETO REDUCE TOBACCO USE This initiative funded by Bloomberg philanthropies, is 2 year contribution of US$125 million by Michael R Bloomberg for global tobacco control. In 15 developing countries (Bangladesh, Brazil, China, Egypt, India, Indonesia, Pakistan, Poland, Thailand). 5 key partner organizations- Campaign for tobacco free kids. Centre for disease control and prevention foundation. John Hopkins Bloomberg School of Public Health Education/training. WHO/TFI. World Lung Foundation.
  36. 36. Prevention and control of oral cancer Mainly focuses on modifying habits associated with the use of tobacco. India- 4th largest consumer and 3rd largest producer of tobacco. 3 well-known approaches: Educatio nal approac h Service approa ch Regulat ory or legal approac h
  37. 37. Regulatory approach In India, Cigarette act 1975 – print warnings on cigarette packets. National Cancer Control Programme, 1985 – health warning displays & banning of advertisements on tobacco products. In countries like Italy, Norway, Portugal etc – ban on advertising tobacco products. Regulatory/legistlative measures Ban tobacco and alcohol use. Ensure adequate legislation . Ensure warnings on products sold . Increase cost. Avoid glorification of products through advertisements.
  38. 38. SERVICE APPROACH Services provided by the professionals.- In order to be suitable for screening certain criteria have to be met Disease is serious yet treatable in early stages. Facilities for diagnosis and treatment exists.  Natural history of disease is known.  Screening tool is inexpensive and safe. For early detection –  Self examination Toludine Blue Vital Staining Other techniques used are – Biopsy Techniques. Exfoliative Cytology.
  39. 39. Educational approach Dentist See harmful effects Counsel child and youth patients Spend more time with patients Treat women of childbearing age Build patient’s interest in quitting Speak with authority in community
  40. 40. DANGER SIGNALS Any persistent scaly white patch Any lesion which increase in size Non healing ulcer Non healing extraction socket Facial asymmetry Oral numbness or pain during jaw movements.
  41. 41. Guide to Counseling for tobacco cessation (5A’s) Ask – use of tobacco Advise – non users to never use and users to quit Assess- the patient readiness to quit Assist- with quitting Arrange- for follow ups Use of Pharmacotherapy Nicotine replacement therapy Antidepressants (Selegeline, Clonidine)
  42. 42. Counseling those unwilling to quit (5R)
  43. 43. CONCLUSION No Tobacco Day” is being observed on the 31st May. The suffering, disfigurement and death due to oral cancer is easily avoidable since the factors associated with the disease have been identified.  Another important aspect is its easy accessibility for diagnosis. This feature along with the finding that oral cancer is generally preceded by precancerous lesions provide an excellent opportunity for early detection and control.
  44. 44. For further reading, Refer.. 1. Hiremath S. S. Textbook of Preventive and Community Dentistry. (2nd edition). New Delhi: Elsevier; 2011 2. Soben Peter. Essentials of Preventive and Community Dentistry. 4th ed.

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