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ePaper created 2014-09-11, 14:51:02 | version 1.30.01
Science & Practice Thursday, 11 September 2014 O ral cancer is the most rapidly- growing dental condition worldwide. On the Indian sub- continent, it is now one of the most common types of cancers, causing 48,000peopletodiefromthedisease per year. Worldental Daily spoke with congress presenter Dr Pankaj Chaturvedi, a head and neck cancer surgeon from the Tata Memorial Hos- pital in Mumbai, about awareness among the Indian population, risk factorsandwhatisbeingdonetofight the epidemic. I Worldental Daily: Oral cancer cases are growing worldwide in double digit rates. How prevalent is the disease in theIndianpopulationandwhatdemo- graphicsaremostlyaffected? Dr Pankaj Chaturvedi: Oral cancer currentlyranksamongstthethreemost common cancers in India and accounts for almost 40 per cent of total cancer deathsinsomeareas.Inmostregionsof thecountry,theconditionisthesecond most common malignancy diagnosed amongmen,accountingforupto20per cent of cancers, and is the fourth most commonamongwomen. To make things worse, approxi- mately 70,000 new cases are added to the already high number of oral cancer patients each year. Prevalence is high- est in rural areas and vulnerable popu- lations, such as among people with a lowsocio-economicstatus. I The most common etiological agents for oral cancer have been identified to be tobacco, alcohol, and increasingly thehumanpapillomavirus(HPV).Does thispatternalsoapplytoyourcountry? The real concern in India is tobacco as it is one of the leading causes of premature death and disability. Its use here is rather complex because it is consumed in a variety of ways, such as being smoked, chewed, and snuffed orally. Patterns of consumption also differ significantly throughout the whole country. Manufacturers of to- bacco and its related products have successfully developed and imple- mented new marketing tactics to lure in younger demographics and make them use their products. Therefore, we are facing a major health crisis as tobacco consumption is continuously increasingamongstyouth. In addition to to- bacco, established risk factorsfororalcancerare the heavy consumption of alcohol, as well as the presence of an oral premalignant disease. Other contributory or predisposing factors include dietary defi- ciencies, particularly of vitamins A, C and E and iron, as well as viral infections, particularly inducedbyHPVwhichis known to be of high oncogenic potential. I According to figures of the World Lung Founda- tion, the direct medical costsoftreatingtobacco- related diseases includ- ing oral cancer in India amounted to more than US$1 billion in 2010/11. Do patients have general accesstotreatment? Astheavailabletreatmentcentres are mainly located in the cities and have very few resources, patients usually have limited access to treatment. Unfavourable socio- economic determinants like low lit- eracy and low per capita income also hinder effective disease management. I Since the aetiology of oral cancer in India is predominantly tobacco- related, should prevention strategies primarily focus on people overcoming traditionalhabits?Howrealisticisthat scenarioinyouropinion? In the last decade, huge resources havebeenputintopreventionaswellas the control of tobacco and its related diseases. In the current scenario, pre- vention will hold the key for changing the age old customs and traditions into morehealthyhabits.Thisrequiresinter- vention at individual, community and national levels. Right now, there are a number of initiatives provided by the government in terms of policy making and implementation. Non-governmen- tal organisations have also started to reach out to communities to raise awareness and refer people for early screenings. There are lot of challenges though,thatwehavetodealwith. IWhatstrategiesdoyourecommend? Tobacco control needs ongoing commitment from all parts of society. While as an individual you have the choice to use or not to use it, society has to advocate generally for a more healthy way of life. The government’s role in this is to firmly check the production, distribution and sale of tobacco. Strict enforcement and vigilance are required to effectively implement tobacco control laws. I India's health ministry and doctors have recently asked the Ministry of Financetoraisetaxesforconsumption of cigarettes and tobacco products. In your mind, could this lead to less consumption? Raisingtaxesontobaccoproductsis certainly one of the evidence-based strategies to reduce consumption of tobacco. Promising results have been achieved in states which have already seenanincreaseintaxation. I Prevention first starts with aware- ness. Is the medical and dental pro- fession in your country sufficiently aware of the issues related to oral cancer? Health care professionals are the major contributors in addressing the problemtothegeneralpublic.Lobbying forevidence-basedpolicymakingtothe implementationandcontinuationofto- baccocessationservicesarejustfewof theinitiativesthatshouldbesupported by them. The real challenge however is todevelopamoresustainablemodelfor remote and rural areas, where poverty and illiteracy are high and an adequate preventive health infrastructure is lacking. I How effective can oral cancer aware- nesscampaignsbethere? Studies have demonstrated that mostIndians,particularlyinruralareas, are not even aware of the benefits of basic oral health measures like tooth brushing. Owing to its diversity, traditional practices in India significantly differ. Of course,oralhygienepracticesstillhave tobeconsideredprimitiveinmostparts of India but this depends largely on education and financial resources. Most people are definitely aware of the benefitsofgoodoralhealthbutthelack of supportive environments makes themvulnerable,sotheyresorttomore primitivehabits. Theneedistorenormalisethehabit, advocate for effective public health campaigns and focus on the ability to self-examine the oral cavity for early signs and symptoms of oral cancer. Community participation and involving youth to bring in change can be an effectivestrategy. I Thank you very much for the inter- view. “A very large burden for the country” AninterviewwithFDIAWDC2014presenterDrPankajChaturvedi,Mumbai,aboutoralcancerinIndia 6 www.fdiworldental.org Annual World Dental Congress 22 - 25 September 2015 - Bangkok Thailand FDI 2015BANGKOK www.fdi2015bangkok.org www.fdiworldental.org AD Workersenjoyingacigarette.TheconsumptionoftobaccoinIndiaisonanall-timehigh. “...wearefacingamajorhealthcrisis...”