To Evaluate the Level of Awareness of Patients About Existing Oral Precancerous Lesions: A Longitudinal Study

ABSTRACT

Background:

The prevalence of oral cancer and other oral premalignant diseases (OPMDs) is increasing. Particularly among lower socioeconomic countries, awareness with respect to oral cancer is quite poor. The aim of the current study is to evaluate the level of awareness of patients about existing oral precancerous lesions.

Materials and Methods:

Fifty people with existing oral precancerous lesions whose diagnosis was confirmed by a clinician’s examination were included in this research. Questions were asked of patients to fill out a questionnaire; those with cancer, non-precancerous red or white lesions, or no lesions in the mouth were not included. Questions on demographics, precancer knowledge, precancer information sources, and tobacco/betel chewing, smoking, and alcohol use were included in the survey. Informed by prior research and knowledge of precancerous lesions and circumstances, a closed-ended questionnaire was developed.

Results:

The study found that just 44 percent of participants were aware that they had oral lesions or diseases. Self-examination was the most common method (81.82%), followed by inquiring with friends and family (9.09%) and medical professionals (9%). Most patients (41.67 percent) learn about oral precancers via the media, followed by posters and banners (33.33%), friends and family (12.5%), other sources (8.33%), and physicians (4.17%). About half of the patients with oral precancers chewed tobacco for 11 years on average, doing so 4-5 times a day. Another 38% smoked and drank alcohol, also at 4-5 times a day. Oral lichen planus (16%), Oral Submucous fibrosis (12%), and Erythroplakia (12%) were shown to be the next most common oral lesions after tobacco pouch keratosis (30%) and leukoplakia (30%).

Conclusion:

Research indicates that few people are aware of the existence of oral precancerous lesions or diseases. Patients’ awareness of oral precancerous lesions/conditions was shown to be significantly influenced by media such as television, radio, posters, and banners.

INTRODUCTION

The rising number of new cancer cases each year has elevated cancer to the level of a major public health concern worldwide. Carcinoma, which derives its Latin name from the Greek word ‘Karkinos’ meaning curmudgeon or crab, spreads its venomous claws into neighboring tissues, like a crab. To maintain overall health, it’s very important to take care of the health of your oral cavity very well. Having good oral health and healthy teeth are just part of what it means to have excellent oral health. In India, people from all walks of life share a wide range of perspectives on what constitutes good health.

The epidemiological and demographic variables contribute to the increase in the prevalence of NCDs in India. The higher prevalence of oral cancer in this underserved group is mostly attributable to their low socioeconomic situation, low understanding of risk factors, low level of education, social behaviors, and distinctive cultural beliefs.[1]

Oral cancer is a severe health problem that affects people all over the globe.[2] As the second most frequent kind of cancer in India, oral cancer ranks sixth worldwide in frequency.[3] Oral cancer rates are rising rapidly in third-world nations.[3] It has been estimated that the chance of acquiring oral cancer is 10-20 times higher in tobacco users compared to nontobacco users and that this risk rises in tandem with the frequency and duration of tobacco use. People who use tobacco products have a greater chance of acquiring mouth cancer. On the other hand, mouth cancer may also be caused by things like smoking, drinking too much alcohol, not getting enough vitamins (especially vitamins C and A), and so on.[4] Given the high prevalence of tobacco use in our state and the knowledge that it is a modifiable risk factor, the potential for primary prevention is immense.

It is likely that neither the symptoms of oral cancer nor the key risk factors are well understood by either the high-risk or general population. Several precancerous conditions, such as oral leukoplakia, erythroplakia, submucous fibrosis, and lichenoid dysplastic lesions, might pave the way for the development of oral squamous cell carcinoma (SCC), while SCC can also form from scratch.[5]

There is a severe lack of public understanding about the causes and preventative measures that may be taken to prevent oral cancer.[6] People who are at a greater risk for oral cancer, such as those who regularly use tobacco products, are less likely to participate in community screening programs.[7] As a result, the majority of cancer diagnoses are made at an advanced stage, and the 5-year survival rate is often about 50%.[6-8] Survival chances significantly increase when an oral lesion is detected at an earlier stage, making early identification of cancer crucial. The purpose of this survey is to collect data on how well patients understand the risk of developing cancer from precancerous lesions or diseases in their mouths.

MATERIALS AND METHODS

Patients receiving dental care as outpatients were the subjects of a questionnaire survey. The study was carried out at Bibi Amena Dental Hospital and Implant Centre, Barkas, Chandrayangutta, Hyderabad, Telangana for a period from June 2021 to February 2022. Fifty people with existing oral precancerous lesions whose diagnosis was confirmed by a clinician’s examination were included in this research. Questionnaires were provided to patients to be filled; those with cancer, non-precancerous red or white lesions, or no lesions in the mouth were not included. Questions related to demographics, knowledge of precancerous lesions, and ill effects of tobacco/betel chewing, smoking, and alcohol use were an important components of the survey. Informed by prior research and knowledge of precancerous lesions and circumstances, a closed-ended questionnaire was developed. The questionnaire’s validity was determined by medical experts, and our research team double-checked and revised a subset of questionnaires used in a pilot study. Each responder received feedback regarding the kind of lesion present in their mouth cavity and was encouraged to give up any oral abusive behaviors after completing the questionnaire. The right care was given to everyone who needed it.

RESULTS

There were 40 men and 10 females in the sample, with an average age of 33.69 years. Thirty- to forty-year-olds make up the bulk of individuals diagnosed with precancerous lesions and diseases [Table 1].

Table 1.

Gender and age distribution of the patients

Parameter	Number	Percentage
Gender
Male	40	80
Female	10	20
Age
Below 20	3	6
20-30	8	16
30-40	20	40
40-50	12	24
Above 50	7	14

The study found that just 44 percent of participants were aware that they had a mouth lesion or disease. The typical oral lesion lasts for around 4.1 years [Table 2][Figure 1].

Table 2.

Awareness of oral precancerous

Awareness of oral precancerous	Yes	No	Total number
Know about existence of lesion in mouth	22	28	50
Awareness about Precancer	24	26	50

Figure 1.

Awareness of oral precancerous

Self-examination was the most common method (81.82%), followed by inquiring with friends and family (9.09%) and medical professionals (9%) [Table 3] [Figure 2]. After polling all of their patients, doctors found that barely half of them knew what oral precancer was. Most patients (41.67 percent) learn about oral precancers via the media, followed by posters and banners (33.33%), friends and family (12.5%), other sources (8.33%), and physicians (4.17%) [Table 4] [Figure 3].

Table 3.

Examination of lesion in mouth

Examination
	Self	Family member or friends	Doctors
Number	18	2	2
Percentage	81.82	9.09	9.09

Figure 2.

Examination of lesion in mouth

Table 4.

Sources of information about oral precancer (n=24)

	Family member or friends	Doctors	Media	Posters and banners	Others
Number	3	1	10	8	2
Percentage	12.5	4.17	41.67	33.33	8.33

Figure 3.

Sources of information about oral precancer

About half of the patients with oral precancers chewed tobacco for 11 years on average, doing so 4-5 times a day. Another 38% smoked and drank alcohol, also at 4-5 times a day [Table 5] [Figure 4]. Oral lichen planus (16%), Oral Submucous fibrosis (12%), and Erythroplakia (12%) were shown to be the next most common oral lesions after tobacco pouch keratosis (30%) and leukoplakia (30%) [Table 6] [Figure 5].

Table 5.

Habits

	Smoking	Alcohol	Tobacco chewing	Areca nut	Combination
Number	1	1	25	4	19
Percentage	2	2	50	8	38

Figure 4.

Habits

Table 6.

Prevalence of lesions

Lesion	Leukoplakia	Erythroplakia	Tobacco pouch keratosis	Oral lichen planus	Oral submucous fibrosis
Number	15	6	15	8	6
Percentage	30	12	30	16	12

Figure 5.

Prevalence of lesions

The majority of individuals (81.82%) made the connection between their behavior and lesion. Only 13.64 percent of people sought medical attention for their oral lesions, while the remaining 86.36 percent, although aware of the condition, did not see a doctor or take any medication [Table 7].

Table 7.

Association of habit with lesion

	Associated	Not associated
Number	18	4
Percentage	81.82	18.18

DISCUSSION

Most cases of oral cancer are preventable, and mass public education and information may result in a reduction in the oral cancer burden on society. Oral cancer is sometimes preceded by clinically visible lesions that are initially noncancerous and are thus referred to as precancerous. Many of these oral mucosal lesions have the potential to develop into cancer.[9] In India, oral cancer is one of the most common cancers, accounting for 50-70% of total cancer mortality. The high proportion of cases among men may be due to the widespread use of tobacco. The majority of the participants were from the medium and lower socioeconomic classes.[10-12]

The Indian subcontinent has the highest incidence and prevalence of oral SCC, and the main risk factors are chewing tobacco, betel quid, and areca nut.[13] It is important to note in this context that more than half of the respondents were unaware of the existence of precancers. This information should serve as a wake-up call to the country’s public health personnel, highlighting the urgent need for educational programs to educate the public about this dreadful disease.

The study population was made up of 40 men and 10 women, with an average age of 33.69 years. According to Amarasinghe et al., the majority of patients with precancerous lesions/conditions are between the ages of 30 and 40.[14]

Only 44% of the participants were aware of a lesion or disease in their mouth. The average duration of a lesion in the mouth is 4.1 years. This conclusion is consistent with the findings of Rehman and Khan’s research.[15] 79% of participants in a research done by Sangeetha et al. were aware of mouth cancer.[16] Horowitz et al. and Pakfetrat et al. discovered that public awareness of oral cancer was low.[17,18]

In determining the source of information about oral precancers, it was discovered that 41.67% of patients get their information from the media, 33.33% from posters and banners, 12.5% from family members or friends, 8.33% from others, and 4.17% from doctors. While conducting this study, the investigator discovered that people were aware of the importance of mass media in educating the public about oral cancer. A serious problem that must be addressed immediately is a lack of appropriate health education material, such as leaflets and posters depicting clinical features of oral cancer and precancer.[18]

The study population was well aware of the link between tobacco in betel quid and the occurrence of cancer. This implies that, despite being aware of tobacco as a cause of oral cancer, patients continue to consume a large amount of tobacco. Treatment of precancerous lesions and cancers is more effective when they are discovered in their early stages when they are small. More than half of oral cancers in developing countries are discovered after they have spread. Advanced cancers are more painful and disfiguring, and the therapy required is drastic and costly, with a poor survival rate.[19]

Maximum patients (50%) with oral precancers had a Tobacco chewing habit with a mean duration of habit of 11 years and a mean frequency of 4-5 times/day, followed by combined habit (38%) with a mean duration of habit of 9 years and mean frequency of 4-5 times/day, whereas all participants (300) in a study conducted by Tejasvi et al. had used tobacco in either chewing, smoking, or both forms.[20]

Although manpower is a constraint, opportunistic screening might provide early discovery, resulting in higher survival and less invasive treatment.[21] Dental practitioners, particularly those working in outlying areas, play an important role in this respect. Opportunistic screening, which is performed while individuals see a healthcare practitioner for another reason, may be advantageous.[21-23] particularly if high-risk populations may be readily recognized and targeted for basic preventive care and a mucosal check.[22,23]

People were generally aware of oral cancer, however, there was a lack of comprehensive knowledge of precancerous lesions and diseases. Because their overall knowledge of oral cancer was high, a shift in emphasis is needed to establish extensive oral health education programs for the identification of risk practices, warning signs, precancerous lesions, and conditions, as well as early diagnosis of oral cancer by mouth self-examination. Such oral health education programs could be carried out as a whole population strategy utilizing mass media or as a well-targeted risk approach aimed at different target groups, specifically, school-going teenagers (as part of the ongoing school dental service), college students, and young working adults to raise their awareness about various signs of oral cancer.[21,24]

CONCLUSION

Research indicates that few people are aware of the existence of oral precancerous lesions or diseases. Patients’ awareness of oral precancerous lesions/conditions was shown to be significantly influenced by media such as television, radio, posters, and banners. Nearly all participants expressed a desire to learn more about oral precancerous lesions and diseases, with the majority indicating that they would most want to do so through television and lecture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.