Cancer, being one of the most common causes of death after coronary heart diseases, causes nearly 7 million deaths each year worldwide and according to WHO, presently, almost 25 million people are suffering from cancer, and by 2020 it is projected that there may be 16 million new cancer cases and ten million cancer deaths reported every year.1 In most countries, one to ten cases per 1,00,000 people are diagnosed with oral cancer every year. Though, it accounts for only two percent of all cancers reported worldwide, it is the second most common cancer in males and the fourth most common cancer in females in South-Central Asia, accounting for seven percent of the total cancers diagnosed in this region, ranking among the three most common types of cancers reported in the region.2 With 75,000e80,000 new cases of oral cancers being reported every year, India has the highest prevalence of oral cancer in the world. According GLOBOCON 2012 report, oral cancer is a third most frequent cancer after breast and cervix with an estimated 5-year prevalence rate of 6.6%.3 In India, Northeast India including Assam accounts for more than 40% of these cases.4 Oral cancer has a higher cure rate when detected early and treated accordingly, but unfortu- nately most oral cancers are diagnosed in advanced stages, requiring aggressive treatment and associated morbidity, resulting in higher mortality rates.

1. Oral cancer awareness and knowledge in adults
attending a dental hospital in Northeast India

2. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
Original Article
Oral cancer awareness and knowledge in adults
attending a dental hospital in Northeast India
Abhinay Yamsani a, Krishna Shastrula Prashanth b,
Eshvendar Reddy Kasala c,*, Rubi Kataki d, Babul Kumar Bezbaruah a,b,c,e
a
Department of Pharmacy Practice, NIPER-Guwahati, Assam, India
Department of Biotechnology, NIPER-Guwahati, Assam, India
c
Department of Pharmacology and Toxicology, NIPER-Guwahati, Assam, India
d
Department of Conservative Dentistry and Endodontics, Regional Dental College, Assam, India
e
Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India
b
article info
abstract
Article history:
Objective: To evaluate the awareness of oral cancer when compared to other cancers in
Received 13 December 2013
adults attending Regional Dental College, Guwahati, Assam and determine their knowledge
Accepted 27 January 2014
regarding risk factors, signs, symptoms and causes of oral cancer.
Available online xxx
Method: A cross-sectional survey involving 824 adults was conducted using a questionnaire
which covered 21 questions including topics like socio-demographic aspects, oral cancer
Keywords:
awareness, knowledge about risk factors associated with oral cavity and early signs of oral
Awareness
cancer, lifestyle habits like smoking, alcohol consumption and dentist visits.
Knowledge
Results: Nearly seventy percent (580 out of 824) of subjects participating in the study were
Oral cancer
aware of the term ‘oral cancer’. 74.27% and 63.59% subjects identified tobacco and smoking
Questionnaire
respectively as important risk factors, but failed to consider alcohol consumption as major
Risk factors and survey
contributing factor. 66.5% individuals considered “difficulty in swallowing” as a symptom
of oral cancer though 62.1% individuals were unable to identify “persistent white or red
spot” as a symptom of oral cancer. Only 11.16% individuals had undergone screening for
oral cancer during their lifetime.
Conclusion: The lack of basic awareness about the risk factors, causes, signs and symptoms
of oral cancer in this cross-sectional population of Northeast India is clearly evident in our
study. Since, Northeast India accounts for more than 40% of these cases, interactive cancer
awareness programs should be taken up by research organizations and government to
educate people and make them better understand the serious implications of oral cancer.
Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
* Corresponding author. Tel.: þ91 9700820750.
E-mail address: ishreddy4@gmail.com (E.R. Kasala).
0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2014.01.004
Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

3. 2
1.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
Introduction
Cancer, being one of the most common causes of death after
coronary heart diseases, causes nearly 7 million deaths each
year worldwide and according to WHO, presently, almost 25
million people are suffering from cancer, and by 2020 it is
projected that there may be 16 million new cancer cases and
ten million cancer deaths reported every year.1 In most
countries, one to ten cases per 1,00,000 people are diagnosed
with oral cancer every year. Though, it accounts for only two
percent of all cancers reported worldwide, it is the second
most common cancer in males and the fourth most common
cancer in females in South-Central Asia, accounting for seven
percent of the total cancers diagnosed in this region, ranking
among the three most common types of cancers reported in
the region.2 With 75,000e80,000 new cases of oral cancers
being reported every year, India has the highest prevalence of
oral cancer in the world. According GLOBOCON 2012 report,
oral cancer is a third most frequent cancer after breast and
cervix with an estimated 5-year prevalence rate of 6.6%.3 In
India, Northeast India including Assam accounts for more
than 40% of these cases.4 Oral cancer has a higher cure rate
when detected early and treated accordingly, but unfortunately most oral cancers are diagnosed in advanced stages,
requiring aggressive treatment and associated morbidity,
resulting in higher mortality rates.5
The most important etiological factors leading to oral
cancer are tobacco and betel nut chewing, excess consumption of alcohol, improper diet and nutrition, human papilloma
virus and immune-suppression.6 These are avoidable risk
factors that can be effectively combated using primary preventive strategies. Health promotion is one of the most
important components of primary prevention, which comprises health education, influencing knowledge and behaviors
at all levels of social organization.7 The early detection of oral
cancer is hindered by lack of public awareness of the early
signs and symptoms associated with oral cancer.8,9 Knowledge regarding the risk factors of oral cancer like tobacco and
alcohol consumption is limited in Indian high-risk population.10 Till date, a study on the extent of awareness and
knowledge on oral cancer has not been performed in adults
attending a dental hospital in Northeast India.
The present study was aimed to examine the extent of
awareness and knowledge of oral cancer in adults attending outpatient unit of Regional Dental College (RDC), Guwahati, India.
Specific objectives of the study include:
a) To assess the knowledge of oral cancer compared to other
cancers, about its risk factors and early signs and
symptoms.
b) To correlate these knowledge levels according to age,
gender and education levels.
awareness of oral cancer as compared to other cancers,
including degree of knowledge about oral cancer, its risk factors, signs, symptoms and popular beliefs. The study was
approved by Institutional Ethical Committee, Regional Dental
College (Regd. No-RDC-29/2011/2440). Following their consent
to the study, attendees of age 18 or above to Regional Dental
College were face to face interviewed consecutively in the
order of their arrival to the hospital by a trained researcher
accompanied by a duty doctor. A total of 866 subjects were
invited to participate in the study, of which 42 adults were
uninterested to participate. The time period of study was 1
month (1st February 2013e1st March 2013).
The questionnaire (available on request from the corresponding author) was prepared based on similar previous
studies,9,11 though few questions were adapted to better suit
the local population. A pilot study of 40 subjects prior to the
actual study was conducted to validate the questionnaire and
modifications were made accordingly.
The interview started with a formal introduction of the
interviewer as a graduate student at National Institute of
Pharmaceutical Education and Research, Guwahati undertaking a study on cancer information. The questionnaire was
divided into four sections and constituted of 21 questions
which were designed to obtain information on: (1) sociodemographic aspects; (2) oral cancer awareness and knowledge; (3) knowledge about risk factors associated with oral
cavity and early signs of oral cancer; (4) lifestyle habits like
smoking, chewing of betel nut, alcohol consumption, dietary
intake, dentist visits, and oral hygiene habits. Participants
were first questioned whether they were aware of oral cancer
and the various other cancers. They were then asked questions regarding “mouth (oral cavity) examination as a part of
oral cancer detection during their life time”. Questions
regarding “oral cancer’s frequency based on age groups
(Children, young adults to 25 years, adults up to 45 years,
adults from 45 years, do not know), location in mouth most
frequently affected due to oral cancer (gum, tongue, cheek,
floor of the mouth, palate), gender (male or female), where
does mouth cancer rank amongst the ten most common
cancers in the world and what are the main risk factors, signs
and symptoms, and causes of oral cancer” were also asked.
Set of options was given in the questionnaire for these queries
and subjects were asked to select one from those options.
Then questions on “contribution of luck factor, chances of
successful treatment on early discovery and effect of lifestyle
changes to reduce the risk of oral cancer” were asked to
evaluate the oral cancer beliefs. Responses to these questions
were “agree”, “disagree”, or “do not know”. Questions based
on “tobacco chewing, alcohol consumption, smoking habits,
oral hygiene habits like brushing, fruit and vegetable intake
and dentist visits” were also posed to acquire the knowledge
of effect of oral hygiene and their role in oral cancer incidence
amongst attendees.
2.1.
2.
Method
A cross-sectional study was carried out in the out-patient unit
of Regional Dental College, Guwahati, Assam to evaluate the
Statistical analysis
All the questions and responses were entered into a Microsoft
Excel database. The results were evaluated using SPSS version
16 software. Chi-square test was used to analyze the relationship between demographics and personal habits versus
Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

4. S. no
1
2
3
4
5
6
7
Variables
Gender
Male
Female
P
Age
<49
>49
P
Marital status
Married
Unmarried
P
Education
Un educated
School
High school
Graduate
Post graduate
P
Smoking
Smokers
Non smokers
Ex-smokers
P
Alcohol
Consumers
Non consumers
Ex-consumers
P
Dental visits
<1 year
1 per year
P
n
Oral cancer
awareness
(n ¼ 580; 70.3%)
Oral cancer
screening
(n ¼ 92; 11.16%)
Tobacco as
risk factor
(n ¼ 612; 74.2%)
Alcohol as
risk factor
(n ¼ 280; 33.9%)
Ulcer as sign
(n ¼ 369; 44.78%)
Red/white
patch as sign
(n ¼ 327; 52.8%)
496
328
344 (69.3)
236 (71.9)
0.424
36 (7.2)
56 (17.0)
0.888
364 (73.3)
248 (75.6)
0.475
164 (33.0)
116 (35.3)
0.495
242 (48.7)
127 (38.7)
0.004
229 (46.1)
98 (29.8)
0.001
652
172
448 (68.7)
132 (76.7)
0.04
60 (9.2)
32 (18.6)
0.001
472 (72.3)
140 (81.4)
0.016
224 (34.3)
56 (32.5)
0.658
281 (43.1)
88 (51.1)
0.058
243 (37.2)
84 (48.8)
0.006
600
224
380 (63.3)
192 (85.7)
0.001
64 (10.6)
28 (12.5)
0.457
436 (72.6)
176 (78.5)
0.085
188 (31.3)
92 (41.1)
0.009
246 (41)
123 (54.9)
0.001
225 (36.6)
102 (45.5)
0.036
112
292
176
196
48
36 (32.1)
200 (68.5)
124 (70.4)
176 (89.8)
44 (91.6)
0.001
12 (10.7)
28 (9.6)
8 (4.5)
20 (10.2)
24 (50)
0.001
32 (28.5)
224 (76.7)
156 (88.6)
156 (79.6)
44 (91.6)
0.001
20 (17.8)
88 (30.1)
56 (31.8)
100 (51)
16 (33.3)
0.001
28 (25)
120 (41.1)
88 (50)
100 (51)
33 (68.7)
0.001
24 (21.4)
124 (42.4)
68 (38.6)
72 (36.7)
39 (81.2)
0.001
252
492
80
132 (52.3)
388 (78.8)
60 (75)
0.001
48 (19)
32 (6.5)
12 (15)
0.001
156 (61.9)
396 (80.5)
60 (75)
0.001
60 (23.8)
192 (39)
28 (35)
0.001
106 (42)
219 (44.5)
44 (55)
0.126
130 (51.6)
157 (31.9)
40 (50)
0.001
248
512
64
124 (50)
416 (81.2)
40 (62.5)
0.001
44 (17.7)
36 (7)
12 (18.7)
0.001
160 (64.5)
400 (78.1)
52 (81.2)
0.001
60 (24.2)
204 (39.8)
16 (25)
0.001
85 (34.7)
248 (48.4)
36 (56.2)
0.001
121 (48.8)
174 (34)
32 (50)
0.001
698
126
489 (70)
91 (72.2)
0.624
80 (11.4)
12 (9.5)
0.525
513 (73.4)
99 (78.5)
0.23
242 (34.6)
38 (30.1)
0.325
313 (44.8)
56 (44.4)
0.934
270 (38.6)
57 (45.2)
0.166
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
3
Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004
Table 1 e Socio-demographic characteristics and their relations with some awareness and knowledge variables.

5. 4
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
Table 2 e Most mentioned cancers in the study.
S. no
1
2
3
4
5
6
7
8
9
10
11
Cancer type
n
Percentage (%)
Lung
Breast
Thyroid
Blood
Stomach
Mouth
Skin
Colon
Cervix
Pancreas
Prostate
728
676
652
620
608
580
432
340
320
304
276
88
82
79
75
74
70
52
41
39
37
33
cancer awareness, knowledge, and popular cancer beliefs. At
P 0.05, the differences were considered statistically
significant.
3.
Results
3.1.
Demographic characteristics
Of the 824 individuals participating in the study 496 (60.194%)
were males and 328 (39.86%) were females. The average age
was 38.45 years, in the age range of 18 and 75 years. The demographic characteristics of subjects are further illustrated in
Table 1.
3.2.
Table 3 e Mostly mentioned sites of mouth associated
with oral cancer.
S. no
1
2
3
4
5
6
Percentage (%)
404
152
116
100
44
8
49
18.4
14.1
12.1
5.3
1
3.5.
Awareness about age-related, gender-related and
location of the mouth most likely to develop oral cancer
When asked about the frequency of incidence of oral cancer
with relation to age group, 24 (2.9%) subjects responded 0e18
years, 104 (12.6%) responded 18e25 years, 136 (16.5%)
responded 25e45 years, and 136 (16.5%) said that it was more
frequent in people above 45 years. 424 (51.45%) individuals
reported they do not know the correct answer. 308 (37.4%)
individuals mentioned that oral cancer affected more males
than females, 88 (10.8%) individuals answered that it affected
more females, 228 (27.66%) individuals answered that it affects both sexes equally, and 200 (24.27%) individuals could
not frame any answer.
The location of the mouth most referred to as likely to
develop oral cancer was the gum (n ¼ 152; 18.45%), followed by
cheek mucosa (n ¼ 116; 14.1%), floor of the mouth (n ¼ 100;
12.1%), tongue (n ¼ 44; 5.3%), and palate (n ¼ 8; 0.9%). Majority
of individuals (n ¼ 404; 49.03%) reported they do not know the
correct answer (Table 3).
3.6.
Oral cancer awareness in adults visiting dentists
Ninety one (72.2%) individuals who visited the dentist more
than once a year were more aware of oral cancer when
compared to less frequent visitors (n ¼ 489; 98.2%). Only 12
(9.5%) out of total 126 subjects who have visited the dentist
more than once a year had their mouth screened for oral
cancer (Table 1).
3.4.
n
Do not know
Gum
Cheek mucosa
Floor of mouth
Tongue
Palate
Cancer awareness
Most subjects were aware of lung cancer (88.35%) followed by
breast cancer (82.04%) and thyroid cancer (79.12%) (Table 2).
The term ‘Oral cancer’ was relatively well known, with 70.4%
of total subjects having heard of it though they significantly
lacked knowledge about the risk factors, signs and symptoms
of oral cancer as emphasized further. The most mentioned
cancers in the study were illustrated in Table 2.
3.3.
Location of mouth
Oral cancer examination
Only 92 (11.16%) individuals of total subjects have had a
mouth examination as part of oral cancer screening during
their lifetime and only 24 (2.9%) of them had their mouth examination done in the last one year. This shows the significant lack of interest among subjects to undergo oral cancer
screening (Table 1).
Knowledge about risk factors of oral cancer
To the question regarding factors which can cause or increase
the risk of mouth cancer, 612 (74.27%) individuals considered
tobacco as risk factor followed by cigarette smoking (n ¼ 524;
63.59%), reduced oral hygiene (n ¼ 512; 62.14%), slaked lime
consumption with pan leaves (n ¼ 460; 55.8%), betel nut consumption (n ¼ 444: 53.88%), infections in teeth (n ¼ 296; 35.9%),
Table 4 e Most risk factors or causes mentioned for oral
cancer.
S.
No
1
2
3
4
5
6
7
8
9
10
11
12
Risk factors
n
Percentage
(%)
Tobacco
Smoking
Reduced oral hygiene
Slaked lime consumption
with pan leaves
Betel nut consumption
Coffee consumption
Infections in the teeth
Alcohol
Close contact with other
cancer patient
Sun exposure
Low consumption of
vegetables fruits
Treatments at the dentist
612
524
512
460
74.2
63.5
62.1
55.8
444
316
296
280
228
53.8
38.3
35.9
33.9
27.6
124
88
15.1
10.6
60
7.28
Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

6. 5
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
Table 5 e Mostly mentioned early manifestations of oral
cancer.
S. No
1
2
3
4
5
6
7
8
Symptoms
n
Percentage (%)
Difficulty swallowing
Difficulty in open the mouth
Bleeding from the mouth
Lump or tissue growth
Ulcer that does not heal
Persistent white or red spot
Abscess, boil or infection
Gastric pain
548
520
384
372
360
312
268
192
67
63
47
45
44
38
33
23
alcohol consumption (n ¼ 280; 33.98%) and sun exposure
(n ¼ 124; 15%). It was interesting to note that 300 (36.41%), 228
(27.7%), and 60 (7.28%) individuals considered coffee consumption close contact with other cancer patients, and
treatment at the dentist respectively are risk factors of oral
cancer (Table 4).
Non-smokers identified tobacco as a cause of oral cancer
(n ¼ 396; 80.5%) more frequently than the smokers (n ¼ 156;
61.9%) (P 0.001). The clinical relevance of certain findings in
relation to other demographic factors and their knowledge on
risk factors was found to be obscure (Table 1).
3.7.
Knowledge about sign and symptoms of oral cancer
Five hundred forty eight (66.5%) individuals considered “difficulty in swallowing” as a symptom of oral cancer followed by
520 (63.1%) as “difficulty in opening mouth”, 384 (46.6) as
“bleeding from mouth”, 372 (45.1%) as “lump or tissue growth”
and 360 (43.6%) individuals considered “ulcer that does not
heal” as a symptom of oral cancer. However, only 312 (37.9%)
individuals considered “persistent white or red spot” as a
symptom of oral cancer. Alarmingly 192 (23.3%) individuals
considered “gastric pain” as symptoms of oral cancer (Table 5).
The reference that “an ulcer that does not heal” could be a
sign of oral cancer was correlated with higher education
(P 0.001). Whereas reference to “persistent white or red spot”
could be a sign of oral cancer was correlated more by males
than females (P 0.001) and by smokers than non-smokers
(P 0.001) (Table 1).
3.8.
Popular cancer beliefs
To the query “having oral cancer is a question of luck and
there is nothing we can do to avoid it”, 42.72% (n ¼ 352) of the
subjects disagreed. However, 232 (28.15%) agreed with this
Table 6 e Socio-demographic characteristics and their relations with popular cancer beliefs.
S. no
1
2
3
4
5
6
7
Variables
Gender
Male
Female
P
Age
49
49
P
Marital status
Married
Unmarried
P
Education
Uneducated
School
High school
Graduate
Post graduate
P
Smoking
Smokers
Non smokers
Ex-smokers
P
Alcohol
Consumers
Non consumers
Ex-consumers
P
Dental visits
1 year
1 per year
P
n
Disagree with
question of luck
(n ¼ 360; 43.6%)
Early detection can
improve treatment
(n ¼ 518; 62.86%)
Lifestyle influence risk
of oral cancer
(n ¼ 508; 61.6%)
496
328
227 (45.7)
133 (10.06)
0.139
305 (62.3)
213 (64.9)
0.316
326 (65.7)
182 (55.5)
0.002
652
172
308 (47.2)
52 (30.2)
0.001
422 (64.7)
96 (55.8)
0.031
425 (65.2)
83 (48.2)
0.001
600
224
222 (37)
138 (61.6)
0.001
342 (57)
176 (78.5)
0.001
350 (58.3)
158 (70.5)
0.001
112
292
176
196
48
10 (8.9)
80 (27.4)
94 (53.4)
132 (67.3)
44 (91.6)
0.001
29 (25.9)
175 (59.9)
92 (52.2)
180 (91.8)
42 (87.5)
0.001
17 (15.1)
152 (52.0)
132 (75)
164 (83.6)
43 (89.5)
0.001
252
492
80
102 (40.4)
210 (42.7)
48 (60)
0.007
111 (44)
346 (70.3)
61 (76.2)
0.001
151 (59.9)
297 (60.3)
60 (75)
0.001
248
512
64
99 (39.9)
231 (45.1)
30 (46.8)
0.346
100 (40.3)
375 (73.2)
43 (67.1)
0.001
153 (61.6)
316 (61.7)
39 (60.9)
0.023
698
126
293 (41.9)
67 (53.1)
0.02
441 (63.1)
77 (661.1)
0.658
427 (61.1)
81 (64.2)
0.509
Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

7. 6
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
affirmation and 240 (29.12%) could not form an opinion on
this. Subjects with unmarried status (P 0.001), higher education level (P 0.001), younger age (P 0.001), non-smokers
(P ¼ 0.007), frequent dentist visits (P ¼ 0.02) were in disagreement with the statement (Table 6).
Only 492 subjects (59.7%) agreed that the detection of oral
cancer in early stages could increase the success of the
treatment. This was rejected by 40 subjects (4.85%), and 292
(35.4%) were unable to respond. Agreement was associated in
attendees with younger age (P ¼ 0.031), unmarried status
(P 0.001), higher education level (P 0.001), and alcohol nonconsumers (P 0.001) (Table 6).
Finally, when we asked the subjects if they agree “whether
change in lifestyle will reduce the risk of cancer of the mouth”,
496 (60.2%) said yes, 100 (12.1%) said no, and 228 (27.7%) said
they do not know. Subjects with higher education level
(P 0.001), younger age (P 0.001) and unmarried status
(P 0.001) responded positively (Table 6).
4.
Discussion
This study was conducted to assess the awareness level and
knowledge about risk factors and early signs of oral cancer
and to correlate the knowledge levels according to age, sex
and education among Northeast Indian dental patients.
Guwahati, a metropolitan, is the largest city of Northeast
India, is often referred to as “Gateway of North Eastern Region
of India,” since it is the most developed and major city of
Eastern India. Regional Dental College, Guwahati, Assam is a
premier institute of dental education in the North Eastern
region of India and is in association with Gauhati Medical
College Hospital (GMCH). Since 95.2% individuals attending
out-patient department of Regional Dental College obliged to
participate in the study, any bias in our findings with respect
to others is limited.
The oral cancer awareness and knowledge in the present
population is poor. It is interesting to note that only 70%
subjects mentioned about oral cancer and it was ranked sixth
among all cancers mentioned. Our results are in line with the
previous studies, where similar kind of awareness about oral
cancer reported.12,13
Oral Cancer is a multifactorial disease where multiple
factors like smoking, tobacco chewing and heavy alcohol
consumption contribute individually and/or collectively for
the development of cancer. As per the Global Adult Tobacco
SurveyeIndia (GATS 2009e10), conducted by the Ministry of
Health and Family Welfare, 44.1% people belonging to
Northeast States of India above the age of 15 years are
consuming tobacco in some form or other, when compared to
the national average of 35%. Smokeless and other chewable
tobacco products like gutkha and zarda are famous among
39.8% of adult males and 25.3% of females.4 Another study
also reported high prevalence of tobacco use of among male
(57.9%) and females (26.5%) school personnel in Northeast
region of India.14 Though most of the subjects in our study
identified tobacco products and smoking as important risk
factors, they failed to consider alcohol consumption as major
contributing factor. The lack of awareness about the impact of
alcohol consumption on oral cancer is observed among most
populations worldwide as reported by various researchers.9,11,12,15,16 Nonetheless, some retrospective studies
recently have shown increase in knowledge about alcohol
consumption as a major risk factor in oral cancer in other
countries.17,18 Therefore, for strengthening people knowledge
on their increased cancer risks by alcohol use should be
included in future health promotion strategies.
Less than fifty percent of adults participating in this study
were unable to identify non-healing wound, lumps or tissue
growths and persistent white or red spot as the early signs of
oral cancer. This observation was in accordance with other
reports which also reported lesser percentage of awareness.19,20 This can be problematic because on top of being an
early sign of cancer they can correspond to potentially malignant disorders whose removal in time could help in
reducing the risk of further developing oral cancer. This could
be addressed by frequent dental visits. Disappointingly only
4.8% of the total individuals participating in this study have
ever had their mouth tested for oral cancer. This is in line with
other previous reports which illustrated fairly similar
results.12,21
Although most of the subjects in the present study agreed
that an early detection of oral cancer may increase the success
of treatment, there is still a significant lack of interest among
these individuals to frequently visit dentists and undergo
preliminary cancer tests which is clearly evident in this study.
It has already been suggested by researchers that a network of
dentists and other healthcare professionals can significantly
contribute efficient oral cancer detection, control and prevention. Thus, government and other healthcare institutes
should actively take up campaigns of awareness and knowledge of oral cancer. Various studies have previously highlighted the fact that an increase in awareness could increase
early presentation and therefore improved treatment
outcomes.20,22
5.
Limitation of our study
The only limitation of our study was that it was limited to
adults who were attending out-patient setting of RDC,
Guwahati during the study period were considered. It may
exclude the patients of in-patient setting of hospital and other
dental clinics. As our study was cross-sectional we were able
to represent the snapshot of awareness and knowledge about
the oral cancer in the adults attending RDC. It would have
been ideal to survey a random sample of the general population, but our resources were limited. Therefore caution should
be taken before generalizing the findings of this study.
6.
Conclusion
The results of present study suggest that most of the individuals were never had their mouth tested for oral cancer
detection and also lack the basic knowledge and awareness
about the risk factors like tobacco and alcohol consumption
on oral cancer. Therefore, our study concludes that the lack of
basic awareness about the risk factors, causes, signs and
symptoms of oral cancer in this cross-sectional population of
Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

8. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e7
Northeast Indian adults attending dental hospital. It was
suggested to initiate intensive public awareness programs to
educate people about recognition of early warning signs and
risk factors to facilitate early detection of oral cancer by self
examination of mouth.
Conflicts of interest
All authors have none to declare.
Acknowledgments
This research was supported by the National Institute of
Pharmaceutical Education and Research, Guwahati, under the
aegis of Department of Pharmaceuticals, Ministry of Chemicals Fertilizers, Government of India.
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Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospital
in Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

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