Tobacco and Oral Cancer

Misuse of tobacco can be done in many ways and especially in India, the habit of chewing tobacco is responsible for an epidemic of oral cancer, of a magnitude not seen anywhere else in the world.

Cancer of the oral cavity is one of the most common cancers in India. 9.5% of all cancers and one-third of all head and neck cancers arise in the oral cavity. About 56,000 new cases occur each year and at any given year more than 100,000 individuals are suffering from oral cancer. 7% of all cancer deaths in males and 4 % in females are due to this disease.

Oral cancer includes cancer of the lip, tongue, gum (gingivum), and floor of mouth, cheek, hard palate and the retromolar trigone. Of this, in the Indian population, majority is located in the area comprised of the cheek (Buccal Mucosa), Gingivum and the retromolar trigone together termed as the Gingivo-buccal complex. Cancers located in the G-B complex have been proved both epidemiologically and experimentally to be related to the habit of chewing tobacco in the form of betel quid or "Paan (a combination of betel leaf, lime, areca nut and tobacco) and are therefore aptly termed as "The Indian Oral Cancer". In the west, the tongue and floor of the mouth form the predominant oral cancer.

Ninety percent of oral cancers can be attributed to specific etiologic agents, the most important being the habit of chewing and smoking tobacco in various forms. The risk of oral cancer is increased 8 - fold in those who chew tobacco (in the form of paan zarda, etc.) as compared with non-chewers. The risk rises in those who chew more than 6 times per day and in those who retain the quid in the mouth overnight the risk is alarmingly high. Tobacco specific nitrosamines (TSN's) are found in high concentration in the juice produced by chewing tobacco and are carcinogenic. Experimentally, the betel quid has shown to produce tumors in the Hamster cheek pouch.


Although the tobacco in the betel quid is the agent mainly responsible for the development of cancers, the lime paste (calcium hydroxide) which is used along with it also contributes to stimulating carcinogenesis by its local irritant action. The areca nut when chewed releases alkaloids, which causes oral sub-mucosa fibrosis, a pre-cancerous condition. The betel leaf by itself does not contribute to carcinogenesis and in fact may reduce cancer risk in the quid by diluting the carcinogens released from the chewed tobacco. In-addition to the habit of chewing tobacco, other etiologic agents which play a role in the causation of oral cancers include tobacco smoking, alcohol and diet.


Reverse smoking which is practiced in parts of Andhra Pradesh, western Orissa and Goa causes cancer of the palate and posterior tongue. Smoking of marijuana has shown in some studies in the US to be responsible for causing oral cancers in the younger population.


Since 90 percent of oral cancers are caused by specific etiologic agents, they should be preventable.


Eliminating the use of tobacco in various forms (paan, zarda, paan masala) through control programs and public education can go a long way in reducing the incidence of oral cancer. The effectiveness of this approach has been demonstrated in the west where the incidence of lung cancer has come down drastically in the last decade with heightened public awareness about the effects of smoking. In India due to varied culture, habits and educational levels, an active anti-tobacco policy in addition may be the only way to ensure a no tobacco generation.


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Article source: goarticles.com