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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1406-1409  

Analysis of risk factors associated with squamous cell carcinoma in the Indian population


1 Reader, Department Of Oral Pathology And Microbiology, Sarjug Dental College And Hospital, Darbhanga Bihar, India
2 Assistant Professor, Department Of Public Social Medicine, Great Eastern Medical School, Ragolu, Sriakulum, Andhra Pradesh, India
3 Assistant Professor, Department of Oral Medicine and Radiology, Nalanda Medical College And Hospital, Patna, Bihar, India
4 Assistant Professor, Department Of Oral Pathology And Microbiology, Dr. Ziauddin Ahmad Dental College and Hospital, Aligarh Muslim University, Uttar Pradesh, India
5 Senior Resident, Department of Oral Medicine and Radiology, All India Institute of Medical Sciences, Patna, Bihar, India
6 Oral And Maxillofacial Surgery, Consultant, The Dental Office, Harlur, Banglore, Karnataka, India
7 Associate professor, Department of Dentistry, Sri Shankaracharya Medical College, Bhilai, Durg Chhattisgarh, India

Date of Submission23-Mar-2021
Date of Decision20-Apr-2021
Date of Acceptance06-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Wagisha Barbi
Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_228_21

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   Abstract 


Background: Squamous cell carcinoma (SCC) describes the carcinomatous growth in the oral cavity. Recently, various authors have described increased SCC incidence in the young population. The distribution of SCC shows varied geographic spread, with the highest distribution in Asian countries. Aims: The present trial was carried out to assess the associated factors that could lead to increased risk of developing oral cancer. Materials and Methods: Oral examination was carried out for 21 participants by a dentist and any significant oral lesion or deleterious habit if present, was recorded. The data collected were analyzed. Results: Areca nut was chewed by 47.61% participants (n = 10), smoking tobacco by 76.19% (n = 16), chewing tobacco by 38.09% (n = 8), and consuming alcohol in 9 participants (42.85%). No significant difference was seen concerning age for any factor except alcohol which showed higher intake in the older group where six participants depicted alcohol intake as compared to three participants in the younger group. In participants who chewed areca nuts, 6 participants also smoked tobacco and 1 consumed alcohol. For tobacco chewing, 5 consumed alcohol and 6 also took tobacco as smoke. Conclusion: The present study showed that areca nut and tobacco chewing along with alcohol consumption and tobacco smoking increase the risk of developing SCC in the Indian population.

Keywords: Risk factors, smoking, squamous cell carcinoma, tobacco chewing


How to cite this article:
Dhumale AJ, Mohite S, Rela R, khan S, Barbi W, Irfan K A, Rangari P. Analysis of risk factors associated with squamous cell carcinoma in the Indian population. J Pharm Bioall Sci 2021;13, Suppl S2:1406-9

How to cite this URL:
Dhumale AJ, Mohite S, Rela R, khan S, Barbi W, Irfan K A, Rangari P. Analysis of risk factors associated with squamous cell carcinoma in the Indian population. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 11];13, Suppl S2:1406-9. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1406/330022




   Introduction Top


The carcinomas affecting the head-and-neck region are found in both genders and are the third most common malignancy encountered in the human species. Squamous cell carcinoma (SCC) among all head-and-neck carcinomas is the most common type found in India. SCC describes the carcinomatous growth in the oral cavity.[1] Recently, various authors have described increased SCC incidence in the young population. The distribution of SCC shows varied geographic spread, with the highest distribution in Asian countries.[2]

Oral cancers comprise a huge variety of cancers most common being SCC. Oral cancers also include nasopharyngeal carcinomas, basal cell carcinomas, ameloblastomas, and various others affecting the tongue, lip, and buccal mucosa, lip, and/or mouth linings.[3] In India, approximately 48 thousand people die of oral cancer. However, the actual data are higher than the reported, especially in places with limited access to the health-care sector. SCC in India is the fourth most common cancer in females and the second most common in males.[4]

Tobacco in chewable form or smoking makes is the most common etiological and risk factor for SCC along with consumption of alcohol. In India, areca nut chewing is also a commonly encountered risk factor for SCC along with various viral infections caused by the human papillomavirus family.[5] Smokeless tobacco consumption in India also remains a major risk factor for oral cancer. Genetic predisposition and heredity also play a role in SCC pathogenesis via altering host immunity, impairing neoangiogenesis, and causing DNA damage.[6]

SCC in the majority of cases of India remains undetected until advanced, due to lack of proper screening tools and lack of public awareness. Varying clinical presentation with various signs and symptoms also makes the diagnosis difficult as it can present as an area of hyperpigmentation, depigmentation, skin lesion, the lump of oral cavity/neck, and/or mucosal changes.[7] Two precancerous lesions in the oral cavity including leukoplakia and erythroplakia are the definitive precursors of oral malignancies. They initially present as painless white or red areas of the oral cavity which proceeds to dysphagia and burning sensation as they advance. Owing to the varying presentation, lack of screening tools, and lack of public awareness toward SCC in India, identification of risk factors associated remains an important goal for timely diagnosis and treatment.[8] Hence, the present trial was carried out to identify various risk factors associated with an increase in the risk for developing oral cancer.


   Materials and Methods Top


The present trial was carried out to assess associated factors that could lead to increased risk of developing oral cancer. A total of 21 participants were included in the study who presented with one or more risk factors of oral cancer. The study included both males and females with the age group of 20 years to 78 years. The mean age of study participants is 48.76 years.

Recruited participants were then divided into two groups, Group I included subjects with minimum one of the defined premalignant and/or malignant lesions in the oral region and the other group with no suspicious lesion. The inclusion criteria were the presence of one or more risk factors for oral cancer. The exclusion criteria were noncompliance and non-willingness to be a part of the trial. Institutional Ethical committee provided the needed ethical clearance.

Before taking informed consent, the participants were clearly explained about the study design and any queries, if there were answered. Following the consent, the participants were made to fill a structured questionnaire about demographic characteristics and personal habits such as smoking, alcohol, and others. The consent and questionnaire were explained in Hindi by a witness. Following this, an oral examination was carried out for all the participants by a dentist expert in the field, and any significant finding, if present, was recorded. The data collected were analyzed statistically.


   Results Top


The present trial was carried out to identify various risk factors associated with an increase in the risk for developing oral cancer. Twenty-one participants with one or more risk factors for developing oral cancers were recruited and participated in the study. The study included both males and females with the age group of 20–78 years with a mean age of 48.76 years. Of the included 21 participants, 17 (80.95%) were males and 4 (19.04%) were females. Among 21 participants, 8 (38.09%) visited the dental department for chief complaints related to teeth and had no lesion in the oral cavity. Nonmalignant lesions on oral examination were seen in 4 (19.04%) participants, no lesion in the oral cavity was seen in 7 (33.3%) participants, 6 (28.57%) study participants had clear premalignant lesions, and appreciable carcinomas were seen in 4 (19.04%) participants. The male participants had nonmalignant lesions, premalignant lesions, and carcinomas in equal distribution, whereas the female population of the study had malignant or premalignant lesions. These characteristics are explained in [Table 1].
Table 1: Characteristics of the study participants

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The study assessed the various deleterious habits which can lead to increased risk for developing oral cancer. The causes listed by study participants were chewing of areca nuts in 47.61% of participants (n = 10), smoking tobacco in 76.19% (n = 16), chewing tobacco in 38.09% (n = 8), and consuming alcohol in 9 participants (42.85%) [Table 2]. On evaluating these habits based on the reference mean study age (48.76), the results showed no significant difference was seen concerning any factor except alcohol which showed higher intake in the older group where six participants depicted alcohol intake compared to three participants in the younger group. The combination of habits was seen in study participants commonly areca nut and tobacco chewing.
Table 2: Factors and habits increasing the risk for squamous cell carcinoma with age distribution

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On assessing the combination of habits as seen in individual participants, it was seen that all the participants that chewed tobacco also took area nut (n = 8) [Table 3]. In participants who chewed areca nuts, 6 participants also smoked tobacco, and 1 consumed alcohol. For tobacco chewing, 5 consumed alcohol, and 6 also took tobacco as smoke.
Table 3: Individual habits of the study subjects

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   Discussion Top


The present trial was carried out to identify various risk factors associated with an increase in the risk for developing SCC in India. The results of the present study are less reliable in establishing significance regarding risk factors for SCC owing to the smaller sample size. However, the findings of the present study were consistent with the findings of the various previous studies.

The present study showed that participants who take areca nuts and tobacco in chewable forms have an increased risk of developing SCC and pre-malignant lesions of the oral region. These findings were in agreement with the studies by Galbiatti et al.[9] in 2013 and Al-Swiahb et al.[10] in 2010 where authors have reported the association of areca nut and tobacco chewing with oral cancer.

In the present study, it was seen that all participants who chewed areca nut also take chewable tobacco. In participants who chewed areca nuts, 6 participants also smoked tobacco and 1 consumed alcohol. For tobacco chewing, 5 consumed alcohol, and 6 also took tobacco as smoke. These findings can be attributed to the fact that these two compounds are sold in combination and show synergistic effects. Similar results showing synergistic effects of areca nut and tobacco chewing were also reported by the study of Garg et al.[11] in 2015.

The factors identified in the present study were chewing of areca nuts in 47.61% of participants (n = 10), smoking tobacco in 76.19% (n = 16), chewing tobacco in 38.09% (n = 8), and consuming alcohol in 9 participants (42.85%). The results showed no significant difference concerning mean age for any factor except alcohol which showed higher intake in the older group where 6 participants depicted alcohol intake compared to 3 participants in the younger group. The combination of habits was seen in study participants commonly areca nut and tobacco chewing. Areca nut and tobacco showed even distribution, whereas alcohol consumption did not. These findings were in agreement with the studies of the Indian population conducted by Sinha et al.[12] in 2016 and WHO[13] in 2014 where the same findings were seen for alcohol, tobacco, and areca nuts.

In 21 participants, 8 (38.09%) visited the dental department for chief complaints related to teeth and had no lesion in the oral cavity. Nonmalignant lesions on oral examination were seen in 4 (19.04%) participants, no lesion in the oral cavity was seen in 7 (33.3%) participants, 6 (28.57%) study participants had clear premalignant lesions, and appreciable carcinomas were seen in 4 (19.04%) subjects. The male subjects had nonmalignant lesions, premalignant lesions, and carcinomas in equal distribution, whereas the female population of the study had malignant or premalignant lesions. This can be contributed to the chewing of areca nut and tobacco combination by Indian women which is the main causative factor for developing premalignant lesions such as leukoplakia and SCC which was also confirmed by the study of Kademani[14] in 2007.


   Conclusion Top


The present study showed that areca nut and tobacco chewing along with alcohol consumption and tobacco smoking increase the risk of developing SCC in the Indian population. Hence, reduction of using these products should be implemented with simultaneous employment opportunities to people working in sectors associated with their production. More social programs with influencing personalities need to be employed for motivating people to quit these deleterious habits.

The study had few limitations including the small sample size, geographical area bias, no monitoring of the premalignant lesions, and questionnaire form which was in the language which was not native to the place. Hence, studies with larger sample size and from different geographical areas are required to reach definitive conclusions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Inchingolo F, Santacroce L, Ballini A, Topi S, Dipalma G, Haxhirexha K, et al. Oral cancer: A historical review. Int J Environ Res Public Health 2020;17:3168.  Back to cited text no. 1
    
2.
Hung LC, Kung PT, Lung CH, Tsai MH, Liu SA, Chiu LT, et al. Assessment of the risk of squamous cell carcinoma incidence in a high-risk population and establishment of a predictive model for squamous cell carcinoma incidence using a population-based cohort in Taiwan. Int J Environ Res Public Health 2020;17:665.  Back to cited text no. 2
    
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Montero PH, Patel SG. Cancer of the oral cavity. Surg Oncol Clin N Am 2015;24:491-508.  Back to cited text no. 3
    
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Sharma S, Satyanarayana L, Asthana S, Shivalingesh K, Goutham BS, Ramachandra S. Squamous cell carcinoma statistics in India on the basis of the first report of 29 population-based cancer registries. J Oral Maxillofac Pathol 2018;22:18-26.  Back to cited text no. 4
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5.
Muthukrishnan A, Warnakulasuriya S. Oral health consequences of smokeless tobacco use. Indian J Med Res 2018;148:35-40.  Back to cited text no. 5
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6.
Jiang X, Wu J, Wang J, Huang R. Tobacco, and oral squamous cell carcinoma: A review of carcinogenic pathways. Tob Induc Dis 2019;17:29.  Back to cited text no. 6
    
7.
Borse V, Konwar AN, Buragohain P. Squamous cell carcinoma diagnosis and perspectives in India. Sensors Int 2020;1:10046:1-12.  Back to cited text no. 7
    
8.
Mortazavi H, Safi Y, Baharvand M, Jafari S, Anbari F, Rahmani S. Oral white lesions: An updated clinical diagnostic decision tree. Dent J (Basel) 2019;7:15.  Back to cited text no. 8
    
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Galbiatti AL, Padovani-Junior JA, Maníglia JV, Rodrigues CD, Pavarino ÉC, Goloni-Bertollo EM. Head and neck cancer: Causes, prevention and treatment. Braz J Otorhinolaryngol 2013;79:239-47.  Back to cited text no. 9
    
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Al-Swiahb JN, Chen CH, Chuang HC, Fang FM, Tasi HT, Chien CY. Clinical, pathological and molecular determinants in squamous cell carcinoma of the oral cavity. Future Oncol 2010;6:837-50.  Back to cited text no. 10
    
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Garg A, Chaturvedi P, Mishra A, Datta S. A review on harmful effects of pan masala. Indian J Cancer 2015;52:663-6.  Back to cited text no. 11
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Sinha DN, Abdulkader RS, Gupta PC. Smokeless tobacco-associated cancers: A systematic review and meta-analysis of Indian studies. Int J Cancer 2016;138:1368-79.  Back to cited text no. 12
    
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World Health Organization. Global Status Report on Noncommunicable Diseases 2014. Vol. 1. Geneva, Switzerland: World Health Organization; 2014.  Back to cited text no. 13
    
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Kademani D. Oral cancer. Mayo Clin Proc 2007;82:878-87.  Back to cited text no. 14
    



 
 
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