Oral Cancers

Oral cancers are considered a hallmark of Indian cancer amongst all HNSCC. There is little doubt that a significant majority are associated with overt tobacco use , there are a small group where there there is no known etiologic factors .

Hyponutrition has been attributed be an important contributory factor as has HPV in the recent past ( Kuriokose ). Being in an easily examinable location one would have expected this OSCC to be more amenable to careening and early detection . While the only landmark study by Shankarnarayan et al from Kerala attested to this possibility using trained health worker force and oral examination using torch ona house to house basis. They concluded “Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37 000 oral cancer deaths worldwide.”The impact of this publication ( 2005) has yet to lead to an attrition in OSCC incidence in the Indian subcontinent . Advanced stage OSCC stages 3&4 are still prevalent amongst most cancer registries across the country where only tertiary care can be offered at great cost, both actual and figurative with 5year disease control rates which are at best 40-50%!Complex reconstrutive surgery is required to make these post excision defects presentable and functional .

On the contrary early stage cancers are so “silent “ owing to their innocuous symptomology that they are often missed until they become advanced with metastatic regional nodes . Dental colleagues, stomatologists ,otolaryngologists and MBBS general practitioners need to be sensitized as part of their clinical education recognize these clinical entities such as non healing oral ulcers/sores , swellings in area of neck and face in a high risk population and see that they receive expert opinion at the earliest . These early lesions can be treated with minimal surgical interventions and be ‘cured’ if they can drop their tobacco habit . Fortunately almost all these early cancers are preceded by a host of conditions known as oral precancers , whcich have been shown by oral biologists to be a continuum which at molecular level are characterized by a multistep carcinogenetic processes that lead finally to invasive cancers . However if these lesions are picked up early then there is every possibility of reversing the process by wide excision and /or abstaining from the consumption of tobacco and alcohol . So adoption of a changed lifestyle can be totally curative .

What has been encouraging is the mass campaign in the media across the country attesting to the evils associated with tobacco use . Hopefully this should over next few decades translate into lesser incidence of this dreaded disease . What should be the next move by the health providers and the government ? Nothing short of banning the free availability of tobacco products across the length and breadth of this country may be the only answer. Other products under the guise of pan masala are equally carcinogenic and since the marketing and consumption of these “smokeless “ varieties cannot be contained by legislation these may prove to be more difficult to control in the long run .