Prevalence of Oral Carcinoma among Younger Individuals-A Cross Sectional Study

Aim: To study the prevalence of oral cancer among younger individuals in India. Introduction: It helps us to study the prevalence, management, causative agents, signs and symptoms of oral cancer. Oral cancer is defined as an uncontrolled growth of tumour cells in the oral cavity. Cancer can occur in the tongue, lips, hard palate, and soft palate, floor of mouth, cheeks and mucosal layer. There is a wide range of variations in prevalence of oral cancer in different regions from minorities or sub-population. Materials and Methods: The survey was carried out with Google forms and recorded 104 responses for 10 self prepared questionnaires. Responses collected were analyzed using SPSS software. The analysis shows that there was a significant awareness of oral cancer. Results: There was a significant level of awareness of oral cancer among younger individuals. The present observation shows statistically significant (0.032) between gender and awareness of prevalence by screening oral mucosa, by using Pearson Chi Square test with confidence level 95% with the value of 0.05. Conclusion: The important message is that early detection of asymptomatic early stages of cancer translates in general terms to satisfactory clinical outcome and cures in most cases.


INTRODUCTION
Cancers are the most common cause of death in adults and are seen all ages. Oral cancer is one of the three most prevalent cancers in India. Causes of oral carcinoma can be alcoholism, tobacco chewing, betelnut chewing, smokeless tobacco, etc,. Oral cancer may also occur due to poor oral hygiene and poor diet. About 55-60% of oral cancer that occurs in India is squamous cell carcinoma [1,2]. Previous studies have come up with a prediction that cancer may increase from 1 million to 1.7 million by the year 2035. And it also gives a proposal that cancer case prevalence is interrelated with the low income of the population.
Since a low income population is affected by factors like proper nutrition, healthcare, living surroundings and risk behaviors which contribute to the development of oral cancer. In recent years there has been no development in discovery of treatment of cancer strains [3]. According to another study men are twice as likely to get oral cancer compared to women because of their risk behaviors. Basically oral cancer is divided into four stages. Treatment for oral cancer depends upon type, stage, and location of the tumor. It can be treated by surgery, radiotherapy, chemotherapy, targeted therapy, oral hygiene and nutrition [4][5][6].
Apart from tobacco use and alcohol abuse, human papillomavirus has recently received special attention. HPV-16, a particular type of virus, has been indicated as an etiological agent for development of a subset of squamous cell carcinoma [7,8]. There is a wide range of variations in prevalence of oral cancer in different regions from minorities or sub populations [9]. The aim of the study is to create awareness on oral carcinoma and to study its prevalence in younger individuals in India [10].
The WHO (World Health Organisation) has conducted a GLOBAL ORAL HEALTH PROGRAMME which established a global surveillance system of oral cavity carcinoma in order to assess risk factors and to help the planning of effective national intervention programmes [11,12].

MATERIALS AND METHODS
A descriptive cross sectional study was done to analyses knowledge, attitude, among younger individuals. Approval was obtained from the institutional board to conduct an online survey. The survey was carried among 104 younger individuals. The responses were collected, tabulated in the excel sheet and analyzed. Data was then entered into SPSS software version 23 and the results were obtained in bar graphs and pie charts. Chi square test was used to analyses and compare the educational level of students and their knowledge and awareness on oral cancers. The study was approved by Institutional Review Board, Saveetha Dental College and Hospitals, Saveetha Institute of Technical and Medical Sciences.
The following study was done using a survey containing the following self prepared questionnaire-

RESULTS
The results for each questionnaire are discussed below according to the responses obtained from the online survey.

DISCUSSION
About half of all tumors in the head and neck arise in the oral cavity, accounting for 5% of all tumors. Oral cancer is the world's sixth most common cancer. In 2012, 300,000 people were diagnosed with oral cavity and lip cancer, accounting for 2.1 percent of all cancer cases. One hundred and forty-five thousand people died from cancers of the mouth and lips [13].
Tobacco use, including smokeless tobacco, and heavy alcohol intake have long been recognized as the primary etiologic factors in the development of oral cancer. A number of suspected risk factors, including chronic discomfort, poor oral hygiene, viral infection, occupational exposure, malnutrition, including low fruit and vegetable diets, and genetic factors, have also been identified [14]. Tobacco use and alcohol consumption are the two most significant risk factors for squamous cell carcinoma, and they have a synergistic impact [15,16]. According to the International Agency for Research on Cancer, cigarette smoke contains more than 60 carcinogens [17,18]. The most popular etiological agents are alcohol and tobacco use. In Southeast Asia, chewing tobacco and betel quid are the most popular etiologic agents. Human Papillomavirus infection has become a prominent associated factor in non-smoking and nondrinking young people of both sexes in the last decade [19,20]. Oral cancer prevalence has risen in women over the last few decades. Oral cancer treatment targets are clear: eliminate the cancer, maintain or restore shape and function, avoid or reduce treatment side effects, and prevent secondary tumours [21,22]. Surgery, radiotherapy, and chemotherapy, either individually or in combination, are the medical options available to achieve these objectives [23].
According to the tabulated results obtained through SPSS software it is clear that there is a significant level of awareness of oral cancers among younger individuals [24,25] (Figs. 1-6). Chemotherapy of this disease remains a mainstay of treatment. It is important to understand the risks of secondary cancers that develop from primary cancers within the upper aero digestive tract as a result of cancerization [26,27]. The most important feature is that early detection of the asymptotic early stage of cancers gives satisfactory outcomes for treatment and cures in most patients [28,29].

CONCLUSION
The present study thus concludes that, although the prevalence of oral cancer is not high compared to other entities, oral cancer poses significant mortality and morbidity in patients, especially when diagnosed at later stages of tumors. The study highlights some anatomical locations where oral cancers are frequently encountered. As a result, clinicians must not only pay attention to the teeth but also to the oral mucosal layers and other entities where lesions are often seen. Early detection of precancerous lesions or cancers increases the chance of patients being cured and greatly reduces mortality and morbidity.

LIMITATIONS
The survey was conducted only with a sample size of 104 people. This cannot be considered as the whole population representation and the result may change statistically. Perfect results can be obtained only with an even larger population.

FUTURE SCOPE
In future, this study should be done on a large scale population for better results. As oral carcinoma is prevalent among all the age groups, the data obtained in the study must be again investigated in future.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It is not applicable.