Association of smokeless tobacco with oral cancer - evidence from the South Asian studies: a systematic review

Smokeless tobacco [SLT] is associated with many health hazards including oral cancer. Its use is more common in South Asian countries. The current paper aims to systematically review the South Asian studies to assess the association of SLT and oral cancer. Detailed automated literature searches of PubMed, Medline, EMBASE and ISI Web of Science from January 1980 to July 2015 were conducted using the key words "oral cancer", "oral precancer", "oral premalignant lesions", "oral squamous cell carcinoma", "smokeless tobacco", "betel quid", "areca nut", "Gutkha" in various combinations. Letters to the editor, review articles, and case-reports were excluded. A total of 21 studies were included. Three studies were of cohort design while the remaining were of case-control design. Nine studies reported betel quid as a risk factor for oral cancer, while fifteen studies reported data on other types of chewing tobacco. The odds ratio [OR] for betel quid and risk of oral cancer varied from 3.1 to 15.7 [11.0-22.1]; and for chewable tobacco and risk of oral cancer varied from 1.2 [1.0-1.4] to 12.9 [7.5-22.3]. A strong association between different types of SLT and oral cancer was observed. Well-structured programmes should be employed in South Asian region, both in terms of educating the general public about the health hazards of SLT as well as providing cessation assistance

Are dental access centers, the potential locations for primary prevention of oral cancer

The objectives of the study was to determine the proportion of patients attending dental access centers that are at risk of developing oral cancer because of lifestyle habits. Data were collected prospectively about the smoking and smokeless tobacco habits of patients attending a dental access centre at Karachi Medical and Dental College and Abbasi Shaheed Hospital in Karachi. It was a cross-sectional questionnaire survey. Results showed that more than 50% of patients attending the dental access centre were smokers, with almost 30% of the patients in high or very high tobacco use groups. The majority of attendees were under 45 years of age. It was concluded that significant numbers of patients attending the dental access centre have lifestyle habits that make them vulnerable to oral cancer. Dental access centres could usefully provide opportunistic health messages to patients about risk factors in the development of oral cancer and could create smoking cessation programmes