Burden of Oral Precancer and Cancer among an Indigenous Tribal Population of South India – An Evaluative Study

Context: Oral cancer is of major concern in the Indian subcontinent and is found to be high among low socioeconomic groups. One such high?risk group is considered to be the tribal people, who are economically and socially marginalised. Aims: The aim of the present study is to assess the prevalence of oral cancer and precancer lesions among the Narikurava population in Puducherry state, India. Methods and Material: A total of 329 Narikurava tribal people were included in this study. Data was collected by clinical examination of the oral cavity by door?to?door screening. The oral cavity was examined for white/red lesions, ulcerative changes, leathery changes and tissue growths. Statistical Analysis Used: Prevalence was calculated in terms of percentages. Descriptive statistics included the calculation of percentages, mean, and standard deviation. Results: The prevalence of precancer in the population is 48.3%. The majority of the lesions were observed in the buccal mucosa: 41.6% had white lesions, 9.1% had red lesions, 0.3% had ulcerations or growth, and 28.3% had leathery changes followed by the labial mucosa: 0.6% had white lesions, 0.6% had red lesions, 0.3% had ulcerations or growth and 16.4% had leathery changes. Conclusions: The present study observed a high prevalence of precancerous lesions among the Narikurava tribe. The main reason for the high prevalence is attributed to tobacco and tobacco?related habits. Hence, cancer control activities should be prioritised. Designing a model to detect precancer and cancer early and to constantly monitor the detected cases in such populations is of utmost importance

Health-Related Quality of Life among Patients with Oral Potentially Malignant Disorder and Oral Cancer in Malaysia

ABSTRACT@#Presently there is a lack of health-related quality of life (HRQOL) measure and its corresponding utility values for oral cancer and oral potentially malignant disorders (OPMD). This limits patient-centered outcomes for cost-effectiveness evaluations. The study aimed to determine post-treatment HRQOL of patients and ascertained differences between OPMD, early and late-stage oral cancer. A cross-sectional survey was conducted among patients in oral maxillofacial specialist clinics in two public tertiary hospitals. Consented participants were required to complete the EQ-5D-5L questionnaire with the EQ Visual Analogue System (VAS). Kruskal-Wallis test was used to explore differences in values between stages. Multiple linear regression was used to explore factors that influenced the HRQOL. A total of 50 OPMD and 52 oral cancer patients were surveyed. The mean EQ-5D-5L health utility values was 0.842 (n = 50, SD = 0.139), 0.822 (n = 10, SD = 0.150) and 0.626 (n = 42, SD = 0.310) for OPMD, early- and late-stage cancer, respectively. The mean values of the EQ-5D-5L index and EQ-VAS scale showed significant differences between groups and between early- and late-stage cancer with good discriminative properties. Results of the multiple linear regression indicated that ethnicity, income, residency, diagnosis, and treatment modality were able to significantly account for 25% of EQ-5D-5L utility values, F(10,91) = 3.83, p < 0.001, R2 = 0.360. Indian ethnicity, rural location, income less than RM4,360, late-stage cancer, and multi-modal therapies were all predictors of poorer HRQOL. This study evidenced disease severity and treatment modality to greatly impact the HRQOL of patients, in addition to socio-demographic factors such as ethnicity and income.

Análisis de los Resultados nacionales obtenidos por grupos estatales de investigación del el cáncer ruso. Programa de Cribado de Enfermedades de la Mucosa Oral y Borde Bermellón / Analysis of The Results Obtained by National Research Groups with The Russian State Cancer Program for The Screening of Diseases of The Oral Mucosa and The Vermillion Border

This article analyzes the results obtained by national research groups in the implementation of the Russian State Cancer Program. From 2015 to the first half of 2019, specialists studied the epidemiology and structure of oncological and precancerous diseases of the oral mucosa and the vermillion border in 486,059 persons aged 18-92 years living in Tula, the Tula region, Moscow and Noyabrsk as a result of screening and medical aid appealability. In this period, the productivity of the research group from Tula grew by the factor of 18.92. The results of the research confirm low cancer alertness of practicing dentists. An individual patient registration card has been developed to systematize data and create a diagnostic register for the screening of cancer and precancerous diseases of the oral mucosa and the vermillion border.

Epidemiology of Oral Lichen Planus in a Cohort of South Indian Population: A Retrospective Study

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated potentially malignant disorder of the oral cavity. Dysplastic OLP has an altered cytogenic profile and can progress into oral squamous cell carcinoma. The epidemiology of OLP is well-described in several relatively large series from various geographic locations, whereas such series from southern India is rare. The aim of the present study was to determine the epidemiology of OLP in a cohort of South Indian population. METHODS: All the case data records of 29,606 patients who visited Mar Baselios Dental College and Hospital, Kerala, India from 2014 to 2015 were retrospectively reviewed. For data review, 122 patients of OLP were selected Estimated were type, number, and location of lesions, clinical manifestation, age of the patient, gender, onset and duration of lesion, stressful life style, habits, skin involvement and associated systemic illness, and presence/absence of dysplasia. RESULTS: When the distribution of OLP among the gender was considered, we found more prevalence in females than males. Fifty-seven percent of patients were associated with stressful lifestyle. Reticular lichen planus was the most common clinical subtype found. Bilateral buccal mucosal was the common site, when the distribution of sites of OLP were compared (P < 0.05). Hypersensitivity reaction was frequently associated with systemic illness with OLP (P < 0.05). Anaplasia was found among 5% of lichen planus lesions. CONCLUSIONS: OLP patients had high incidence of hypersensitivity reactions and 5% of OLP lesions showed anaplasia. Long term follow-up is necessary to monitor the recurrence, prognosis, and malignant transformation of OLP.

Autofluorescence and Diagnostic Accuracy of Lesions of Oral Mucosa: A Pilot Study

The purpose of this study was to determine the accuracy of autofluorescence techniques for diagnosing oral mucosa lesions, using as reference pattern for comparison the visual diagnosis made by a clinical specialist. A pilot study was conducted with 60 patients divided in a control group without mucosal pathology and a study group with known clinical history for mucosal pathology. Both groups were examined by an oral medicine specialist and by a general dentist who used VELscope(r) system, which applies tissue fluorescence visualization to identify oral mucosal abnormalities. Using the VELscope(r) system, the general dentist made overdiagnosis in two cases and underdiagnosis in one case. The sensitivity and specificity for the oral medicine specialist were 1 (95% CI: 0.884 to 1). For the general dentist, the sensitivity did not improve significantly with the use of VELscope(r) system [0.53 (95% CI: 0.343 to 0.717) versus 0.49 (95% CI: 0.406 to 0.773)] and the specificity was 0.80 (95% CI: 0.614 to 0.923). A limitation of the study is the small sample size, which does not fully represent a population and extrapolation of the data should be done carefully. Based on the obtained results, no clinical benefits were obtained using this VELscope(r) system.

Resumo O objetivo deste estudo foi determinar a precisão das técnicas de autofluorescência para o diagnóstico de lesões da mucosa oral, utilizando como padrão de referência para comparação o diagnóstico visual feito por um especialista clínico. Um estudo piloto foi realizado com 60 pacientes, divididos em um grupo controle sem patologia da mucosa oral e um grupo de estudo com história clínica conhecida de patologia da mucosa oral. Ambos os grupos foram examinados por um especialista em medicina oral e por um dentista clínico geral que usou o sistema VELscope(r), que aplica a visualização por fluorescência para identificar anormalidades do tecido da mucosa oral. Usando o sistema VELscope(r), o dentista geral realizou sobrediagnóstico em dois casos e subdiagnóstico em um caso. A sensibilidade e especificidade para o especialista em medicina oral foi 1 (IC 95%: 0,884 a 1). Para o dentista geral, a sensibilidade não melhorou significativamente com o uso do sistema de VELscope(r) [0,53 (95% CI: 0,343 to 0,717) versus 0,49 (95% CI: 0,406 to 0,773)], e a especificidade foi de 0,80 (IC de 95% : 0,614-0,923). Uma limitação do estudo é o pequeno tamanho da amostra, que não representa totalmente a população e a extrapolação dos dados deve ser feita com cuidado. Com base nos resultados obtidos, não houve benefícios clínicos com o uso do sistema VELscope(r).

Liquid-based cytology versus conventional cytology for evaluation of cervical Pap smears: Experience from the first 1000 split samples.

Context and Aim: Screening programs using conventional cytology conventional Pap smear (CPS) have successfully reduced cervical cancer, but newer tests like liquid-based cytology (LBC) and human papillomavirus testing might enhance screening. The main aim of the present study was to assess the diagnostic accuracy of LBC versus CPS using “split samples.” Materials and Methods: This was a prospective study comprising of 1000 consecutive cervical “split samples” over a period of 1 year. Split sample was obtained using cervex-brush. CPS was prepared from the brush and the brush head was suspended in the LBC vial and processed by SurePath™ LBC. Results: There were 4.3% unsatisfactory (U/S) cases in CPS and 1.7% in LBC; the main cause is insuffi cient cells, and excess of blood in CPS. About 25/100 (2.5%) split samples had epithelial abnormalities both in CPS and LBC (1.2%-atypical squamous cells of undetermined signifi cance; 0.4%-low grade squamous intraepithelial lesion; 0.2%-high grade squamous intraepithelial lesion; 0.5%-squamous cell carcinoma; 0.1%-atypical glandular cells favouring neoplasia; 0.2%-adenocarcinoma). Infl ammatory organisms were almost equally identifi ed in both techniques but were better seen in LBC samples. Conclusions: LBC technique leads to signifi cant reduction of U/S rate. LBC samples offered better clarity, uniform spread of smears, less time for screening and better handling of hemorrhagic and infl ammatory samples. LBC had equivalent sensitivity and specifi city to CPS.

ABO blood groups and oral premalignancies: A clinical study in selected Indian population.

Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P < 0.05) between control versus leukoplakia and OSMF. Interestingly, 24% gutka chewers who had higher number of grades of dysplasia were falling in "A" blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.

Early Diagnosis of Oral Cancer: A Review

Oral cancer (OC) is a global burden. India has become the epicentre of OC globally. As clinicians we are responsible for recognizing and detecting early or incipient changes of the oral mucosa, because, inspite of numerous advances in the treatment of OC, 5-year survival rate remains only 50%. This poor prognosis is due to several factors. However, single most effective route to improving the long-term outcome of OC is early diagnosis. Dentists must be keenly aware of oral mucosal alterations; any observed suspicious mucosal abnormality must be sampled using biopsy. A variety of commercial diagnostic aids and adjunctive techniques are available to potentially assist in the screening of healthy patients, for evidence of otherwise occult cancerous change or to assess the biologic potential of clinically abnormal mucosal lesions. This article is aimed at helping the clinicians, about the various aids or adjuncts that can be used in OC detection; a systematic review of the literature by way of descriptive design was used.

Genetic, Environmental and Clinical Factors Related to Treatment Failure of Cervical Precancerous Lesions in a Cohort of Brazilian Women.

Aims: To ascertain the risk of pre-cancerous treatment failure considering selected genetic, environmental, and clinical characteristics among Brazilian women. Study Design: A prospective study developed in a cohort of women treated for Cervical Intraepithelial Neoplasia (CIN) lesion. Place and Duration of Study: Gynecology Oncology day clinic of Brazilian National Cancer Institute, between October 2004 and May 2006. Methodology: We included 285 women (age range 18-75 years) with CIN submitted to lesion excision. All patients were interviewed at admission to identify epidemiological and clinical characteristics, having blood samples collected, and a colposcopic examination performed. TP53 polymorphism was ascertained using PCR-RFLP. After treatment, the study population was followed up with Pap-tests during two years. Treatment failure was evaluated using histological confirmation of any altered tissue. Kaplan-Meyer curves and Cox Proportional Risk Model were used for data analysis. Results: Frequencies of TP53 polymorphisms were: Arg72Pro genotype(Arg/Pro)- 177(62.1%); Arg72 genotype(Arg/Arg)-55(19.3%); Pro genotype (Pro/Pro)-53(18.6%). Women with endocervical margins involvement showed an HR 7.01(1.73-28.44). Current smoking was statistically related to CIN treatment failure (HR:3.90,95%CI:1.28-11.91). Comparatively to Arg/Arg, the risks for treatment failure were: HR 1.51(95%CI:0.23-9.80) for Arg/Pro women; and HR:1.41 (95%CI:0.31-6.52) for Pro/Pro. Conclusion: Surgical margins involvement and current tobacco smoking presented independent risks for CIN treatment failure among the studied population. Pro/Pro genotype seems to be associated with CIN treatment failure.

Evaluation of the effect of newer antioxidant lycopene in the treatment of oral submucous fibrosis.

Background and Objective: Oral submucous fibrosis (OSMF) is a well-known premalignant condition encountered in Indian population. Although the disease is advancing rapidly, its reliable treatment modality for its various stages has not yet evolved. The aim of the present study is to compare the effect of newer antioxidant lycopene with a placebo in conjunction with the cessation of causative habit in the treatment of OSMF. Materials and Methods: The study group included 92 patients with OSMF. The OSMF diagnosis was established through a composite of accepted clinical and histopathological characteristics. Out of 92, 46 patients were given lycopene and remaining 46 were on placebo drug. Lycopene group patients received 8 mg Lycored TM per day in two divided doses of 4 mg each, while placebo group patients received placebo tablet twice a day. Patients were examined for changes in mouth opening and other clinical symptoms of OSMF during three months and were followed up for next two months. Results: Lycopene was found to be significantly efficacious in the amelioration of signs and symptoms of OSMF. It was effective in reducing the objective signs of OSMF as demonstrated by the improved maximal mouth opening, percentage of which was 69.56%(P<0.05). Interpretation and Conclusion: Reactive oxygen compounds or free radicals have been implicated as one of the major harmful factors for premalignant and malignant conditions. Present study concludes that lycopene, a newer antioxidant, appears to be a very promising drug in the management of OSMF.

Alcoholism - Hand In Hand With Premalignancy And Malignancy.

Oral health - The health standard of the oral and related tissues that enable an individual to eat, speak or socialize without active disease, discomfort or embarrassment and that contributes to general well-being. Incidence and mortality rates of cancer of oral cavity in particular are rising in most areas of the world. Oral health is affected by wrong social habits or regular drinking practice of alcohol, leading to precancer and cancer. The type, quantity of alcohol and alcohol with smoking habits seems to have different roles in influencing the oral mucosa in transforming it to precancerous lesions. The aim of this article is to bring to limelight the pathogenesis, associated factors and inhibiting factors for developing precancerous and cancer lesions.

Sociodemographic correlates of male chewable smokeless tobacco users in India: A preliminary report of analysis of national family health survey, 2005-2006.

Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Oral submucous fibrosis : current concepts in etiopathogenesis.

Oral submucous fibrosis (OSF) is now accepted globally as an Indian disease, having highest malignant potential than any other oral premalignant lesions. The understanding of the exact role of alkaloids and other etiological agents with respect to pathogenesis will help the management and minimize the blind clinical trials and treatment modalities. This article provides an overview of the etiopathogenesis with stress on the recent concepts related to this chronic “Indian Disease”.