RESUMEN
The head and neck squamous cell carcinoma (HNSCC) accounts for about 30-40% of all cancer types in India and the subcontinent in general. HNSCCs are primarily not hereditary, but rather a disease of older and middle aged adults. Many etiological factors like tobacco, alcohol and HPV infection are known to play important roles. Eastern India, particularly Kolkata, has a population heavily exposed to various types of smoked and smokeless tobacco, with only limited exposure to alcoholic beverages. Since there have been no previous epidemiological studies on tobacco as the main risk factor for head and neck carcinogenesis in Kolkata, we here carried out a hospital based case control study in the city and its adjoin regions. Data from 110 patients diagnosed with HNSCC and a similar number of matched control samples were analyzed using the chi-square test. Survival status of the patients was also analyzed using the Kaplan-Meier method. A tobacco habit was significantly correlated with the incidence of HNSCC and persons with current addiction had a 2.17 fold increased risk of cancer development. Dose-response relationships were seen for the frequency (p=0.01) and duration (p=0.02) of tobacco exposure with the risk. No significant difference in impact was found with smoked as opposed to smokeless tobacco in the development of the disease. Among HNSCC patients, significant poor survival in cases with tobacco habit than in those with no addiction and in cases with >10 years of addiction than in those with 10 years of addiction. Our data suggest that tobacco in both smoked and smokeless forms is the most important risk factor for both development and prognosis of HNSCCs and may be a major source of field cancerization on the head and neck epithelium in the eastern Indian population.
RESUMEN
A pilot survey was conducted based on 900 respondents of the population of West Bengal to assess their level of awareness regarding cancer with the aim of estimating associations between response variables (knowledge about cancer) and predictor variables (age, sex, level of education). The data of the pilot survey revealed that 98% of the respondents had heard of the disease 'Cancer'. Unfortunately only 35% of the respondents were aware of the 7-danger signals (i.e. the primary symptoms of cancer) as defined by the World Health Organisation (WHO). None of the respondents knew all 7-primary symptoms of cancer and the majority (about 88%) knew only one or two (mainly tumour lumps and ulcers). Only 44.67% were aware of the major risk factors (like smoking and tobacco chewing). The percentage of the respondents believing that most cancers are curable in early stages was 58%. Some of the respondents (21%) expressed the vague idea that cancer is a infectious disease which is creating a problem of isolation from the family/society with some unfortunate cancer patients. Over 11% of the respondents suggested that a cancer diagnosis should be kept secret from neighbours due to some social stigma like problems with daughters' marriage. Only 8% had experienced any cancer awareness programme conducted by any organisation, only 37% had listened to any cancer awareness programme conducted by the All India Radio, only 36% had seen any cancer awareness programme conducted by Doordarsan/ private Television channels, only 34% had read cancer awareness articles in the newspapers/magazines and only 13% had seen posters/hoardings regarding cancer awareness. The results thus revealed a huge lack regarding cancer awareness in the region. Most of the respondents (68%) expressed a wish for starting cancer awareness programmes. From the Pilot Survey it has been found that the average Knowledge Index of the respondents is 58+ 1.7 irrespective of the socio-economic and personal status. On testing of associations, there was no statistically significant association of the Knowledge Index with the domicile status (rural or urban), sex, occupation and religion of the respondents. However, statistically significant links were evident with the level of education (p=0.00001), social participation (p=0.00004) and income (p=0.00013) of the respondents.