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ORIGINAL RESEARCH Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 316-319
Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study


Department of Oral Pathology & Microbiology, Subharti Dental College, Meerut (UP), India

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Date of Submission06-Jun-2009
Date of Decision01-Oct-2009
Date of Acceptance25-Feb-2010
Date of Web Publication29-Sep-2010
 

   Abstract 

Objective: The purpose of the study was to identify trends in incidence rates of oral squamous cell carcinoma (OSCC) at specific anatomic sites or within specific age or sex groups in the Western Uttar Pradesh population.
Materials and Methods: The study covers the period from January 2004 through April 2009. OSCC cases were retrospectively analysed for site, age, gender and habits and the findings were formulated to chart the trends in Western U.P.
Results: The study revealed a male to female ratio of 2.2:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. Overall, the most common site was the buccal mucosa (63.75%), followed by retromolar area (15%), floor of the mouth (11.25%), lateral border of the tongue (3.75%), labial mucosa (3.75%), and palate (2.5%). Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. Karl - Pearson's correlation coefficient was calculated to find the degree of association between the two variables i.e. between gender to buccal mucosa and gender to smokeless and smoking tobacco habits, which were found to be positively correlated with respect to the age.
Conclusion: Oral cancer is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographic location, the incidence varies among groups categorized by age, sex, site or habit.

Keywords: Epidemiology, oral squamous cell carcinoma, trends

How to cite this article:
Sharma P, Saxena S, Aggarwal P. Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study. Indian J Dent Res 2010;21:316-9

How to cite this URL:
Sharma P, Saxena S, Aggarwal P. Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study. Indian J Dent Res [serial online] 2010 [cited 2014 Aug 23];21:316-9. Available from: http://www.ijdr.in/text.asp?2010/21/3/316/70782
Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity and represents about 90% of all oral malignancies. [1] Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. [2] In India, oral cancer represents a major health problem constituting up to 40% of all cancers and is the most prevalent cancer in males and the third most prevalent in females. Even within one geographic location, the incidence varies among groups categorized by age, sex or race. [1],[2] Recent publications have highlighted variations in oral cancer trends by geographical location, anatomic site, race, age and sex. [2],[3] Thus, descriptive oral cancer data for each specific geographic area are important for many reasons, including understanding the extent of the problem, determining which groups within the population are at highest and lowest risk, and relating the burden of oral cancer to that of other cancers to evaluate the allocation of resources for research, prevention, treatment and support services. [3],[4] Despite several diagnostic and therapeutic advances, the overall incidence and mortality associated with OSCC are rising, with current estimates of age-standardized incidence and mortality being 6.6/100,000 and 3.1/100,000 in men and 2.9/100,000 and 1.4/100,000 in women, respectively. [5]

There have been studies reported on the incidence and pattern of OSCCs from various parts of the world. [4],[5],[6],[7] However, very few studies have been reported on the incidence and trends of OSCC in the Western U.P population. The purpose of this retrospective study was to identify any trends in the number of cases or incidence rates at specific anatomic sites or within specific age or sex groups in the Western U.P. population and also to compare their trends with reports from other studies in which figures were made specifically on OSCC.


   Materials and Methods Top


Histologically verified cases of OSCCs diagnosed in the period from January 2004 to April 2009 were extracted from the archives of Subharti Dental College, Meerut. The anatomic sites included in the study were - tongue, floor of the mouth, hard palate, buccal mucosa, labial mucosa and retromolar area. As the pathophysiologic and epidemiologic behaviour of lip cancer is believed to be substantially different from the oral cavity sites, cancers originating in the lip were not included in this study. Charts were made listing the age, sex, site and habits of eighty OSCC patients. A comprehensive analysis was done on the data collected and the results were formulated.


   Results Top


Of the 80 OSCC patients, men represented a higher proportion (68.7%) of OSCCs than women (31.2%). Large number of cases were seen to develop in the fourth and fifth decades of life. Overall, buccal mucosa was the most common site involved (63.75%) while the palate showed the least incidence in this belt of U.P. (2.5%). The study also revealed that larger number of patients had the smokeless tobacco habit (60%) than the bidi or cigarette smoking habit (36.25 %) [Table 1], [Figure 1],[Figure 2],[Figure 3].
Table 1 :Oral squamous cell carcinoma trends in western U.P population according to age, sex, site, habit


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Figure 1 :OSCC in 80 patients (gender with respect to age)

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Figure 2 :OSCC in 80 patients (site with respect to age)

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Figure 3 :OSCC in 80 patients (habits with respect to age)

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Statistically, Karl - Pearson's correlation coefficient was calculated to find the degree of association between the two variables i.e. gender to buccal mucosa and gender to smokeless and smoking tobacco habits, which were found to be positively correlated with respect to the age. All of the above said correlations were found to be significant at 5% and 1% level of significance respectively; i.e. P<0.05 and P<0.01.


   Discussion Top


The incidence of OSCC seems to be increasing and is a global health problem with increasing incidence and mortality rates; around 300,000 patients are annually estimated to have oral cancer worldwide. [4],[7],[8] OSCC is known to show geographical variation with respect to the age, site, sex and habits of the population. [1],[2],[4],[8],[9] The present study revealed a male to female ratio of 2.2:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. This is consistent with an earlier report by Mehrotra and coworkers [8] confirming that oral cancer in Northern India was a disease of the middle aged men. An epidemiologic study on palatal changes in reverse smokers conducted in Andhra Pradesh (Southern India) by Mehta FS et al[10] showed a predominance of females in the middle age group (35-54 years).

As regards the site of preference for intra-oral SCC, our study showed some degree of variation from most of the studies conducted at Spain, Canada, Scandinavia and some parts of India. [11],[12],[13] A retrospective study conducted by S. Manuel and co-workers, [14] in 2003, at the Regional Cancer Centre (RCC), Thiruvananthapuram, Kerala analysed one of the largest series of young patients under the age of 45 years having SCC of the oral tongue.

In the present study, the buccal mucosa and retromolar pad were the most frequently involved sites (63.75 and 15% respectively), while the palate was the least commonly involved site (2.5%). These regional differences may be attributed to the exclusive use of chewing tobacco in the Indian subcontinent compared to smoking in the West. [12],[13],[14] SCC of buccal mucosa is one of the most common cancers along a geographical belt extending from Central to South East Asia because of the practice of chewing "pan", a combination of tobacco, nut and lime. [15] In contrast, the lateral tongue and floor of mouth are the more commonly involved sites in the West. [11],[12],[13] The anterior two-thirds of the tongue is commonly involved in India, while the posterior lateral border and ventral surfaces are frequently involved in the United States. [8]

In 1969, the results of the first epidemiologic survey of palatal changes in reverse smokers in the Srikakulam district of Andhra Pradesh in India were reported by Mehta FS et al, [10] who later emphasized that the palatal changes seen in reverse smokers exhibited greater clinical variations than the leukokeratosis nicotina palati known from the Western countries. Earlier, OSCC was thought to be a disease primarily of the elderly. [1],[2] Some recent studies conducted in United States, South East of England, Spain and Scandinavia have, however, shown that the incidences of oral cancer are increasingly being reported in the young (<40 years of age) also, particularly younger male patients. [13],[14],[16],[17] Our study, finds increasing number of OSCC cases being recorded in the fourth and fifth decades of life. This may be related to the habits like tobacco and alcohol.

Men represented a higher proportion of OSCCs than women simulating the trends in many recent publications. [3],[6],[11],[18] Some studies show the opposite trend with the increased incidence among women, which may be due to the changing social habits in high socioeconomic groups or cultural habits of some rural areas of India. [10],[16] Interestingly, 3.75% of the patients were not associated with any habits like tobacco smoking or chewing in our study which may be attributed to other etiological factors of OSCCs like certain viruses (such as human papilloma virus), low consumption of fruits and vegetables, genetic predisposition, etc. [16]

"Pan" chewing or Gutkha chewing were the most prevalent habits recorded in our study, the incidence being highest at mucosal sites with prolonged contact with carcinogens. There has been strong evidence that smokeless tobacco can cause oral cancer and precancerous oral lesions like leukoplakia. [8] Smokeless tobacco is thought to induce cancer in regions where it is held in direct contact, such as the cheek or gum. [8] The clinicopathologic profile of Indian oral cancers shows significant differences from oral cancer in several developed countries of world, including the USA, UK, France and Japan, where it is associated with tobacco smoking with or without alcohol consumption. [19]


   Conclusion Top


As useful clinical information on the trends of OSCCs among Western U.P. population is limited, this retrospective study was undertaken to present a comprehensive data on the trends of OSCC in Western U.P population. Different levels of tobacco and alcohol exposure, diet, socio economic circumstances, age, gender and sites are the causative factors in the differences seen in the incidence rates of OSCC in various populations globally. Because of the magnitude of the oral cancer problem and the trends reported, serious thought should be given to plans for prevention and early detection of premalignant and malignant oral diseases in Western U.P. Race, ethnicity and age cannot be altered; however, lifestyle behavior such as use of tobacco and alcohol are amenable to change and increased intake of fruits and vegetables must be addressed. The dental profession has a well-deserved reputation for preventing other oral diseases. Now is time to focus on the prevention and early detection of oral cancer.

 
   References Top

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3.Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg 2002;128:268-74.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Rautava J, Luukkaa M, Heikinheimo K, Alin J, Grenman R, Happonen RP. Squamous cell carcinomas arising from different types of oral epithelia differ in their tumor and patient characteristics and survival. Oral Oncol 2007;43:911-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
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6.Llewellyn CD, Linklater K, Bell J, Johnson NW, Warnakulasuriya KA. Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England form 1990 to 1997. Oral Oncol 2003;39:106-14.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
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8.Mehrotra R, Singh MK, Pandya S, Singh M. The use of an oral brush biopsy without computer - assisted anaylsis in the oral lesions: a study of 94 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:246-53.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
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10.Mehta FS, Jalnawalla PN, Daftary DK, Gupta PC, Pindborg JJ. Reverse smoking in Andhara Pradesh, India: Variability of clinical and histologic appearances of palate changes. Int J Oral Surg 1977;6:75-83.  Back to cited text no. 10  [PUBMED]    
11.Martin-Granizo R, Rodriguez-Campo F, Naval L, Diaz Gonzalez FJ. Squamous cell carcinoma of the oral cavity in patients younger than 40 years. Otolaryngol Head Neck Surg 1997;117:268-75.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
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Correspondence Address:
Preeti Sharma
Department of Oral Pathology & Microbiology, Subharti Dental College, Meerut (UP)
India
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DOI: 10.4103/0970-9290.70782

PMID: 20930335

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