Oral cancer: Clinicopathological features and associated risk factors in a high risk population presenting to a major tertiary care center in Pakistan

Abstract

Oral squamous cell carcinoma (OSCC) has the highest prevalence in head and neck cancers and is the first and second most common cancer in males and females of Pakistan respectively. Major risk factors include peculiar chewing habits like areca nut, betel quid, and tobacco. The majority of OSCC presents at an advanced stage with poor prognosis. On the face of such a high burden of this preventable cancer, there is a relative lack of recent robust data and its association with known risk factors from Pakistan. The aim of this study was to identify the socioeconomic factors and clinicopathological features that may contribute to the development of OSCC. A total of 186 patients diagnosed and treated at a tertiary care hospital, Karachi Pakistan were recruited. Clinicopathological and socioeconomic information was obtained on a structured questionnaire. Descriptive analysis was done for demographics and socioeconomic status (SES) while regression analysis was performed to evaluate the association between SES and chewing habits, tumor site, and tumor stage. The majority of patients were males and the mean age of OSCC patients was 47.62±12.18 years. Most of the patients belonged to low SES (68.3%) and 77.4% were habitual of chewing. Gender (male) and SES were significantly associated with chewing habits (p<0.05). Odds of developing buccal mucosa tumors in chewers (of any type of substance) and gutka users were 2 and 4 times higher than non-chewers respectively. Middle age, chewing habits, and occupation were significantly associated with late stage presentation of OSCC (p<0.05). In conclusion, male patients belonging to low SES in their forties who had chewing habits for years constituted the bulk of OSCC. Buccal mucosa was the most common site in chewers and the majority presented with late stage tumors.

Lip and oral cavity cancers (C00-C06) from a mega city of Pakistan: Ten-year data from the Dow Cancer Registry

“…For example, it has been observed that males, particularly those with a lower socioeconomic status, consume more tobacco products compared to females. 10 The various forms of tobacco used in Karachi include (i) smoking, such as cigarettes, bidi (dried and rolled tobacco leaves), shisha (tobacco with fragrant liquid) and, (ii) chewing smokeless tobacco including paan (betel-quids), beetle-nuts, naswar (powdered moist tobacco which is kept in the base of oral cavity or alongside teeth between the cheek and mandible for a long time), and gutka (a mixture of paraffin wax, areca nuts, lime, catechu, and tobacco). In Karachi, the use of smokeless tobacco ( naswar and gutka ) is particularly high compared to other parts of the country.…”

Study of Epidemiology and Human Papilloma Virus Prevalence in Oral Cavity Cancers

“…This could be explained by earlier exposure to common risk factors such as tobacco use [7] as is the case in India or Pakistan. In these regions, the average age of patients is between 41 and 50 years and one-third of the population aged 15 years uses tobacco in any form [22]. However, the consumption of these substances (tobacco and alcohol) is not common among patients with OCC in Senegal [10,11].…”

“…The tongue is one of the most common sites in OCCs with 40% of cases [8] especially in Western countries due to excessive smoking and alcohol consumption [22]. In 2005, according to Touré et al [10], the mandible (24.8%), tongue (21.9%) and maxilla (15.2%) represented the majority sites.…”

Histopathological Image Analysis for Oral Squamous Cell Carcinoma classification using concatenated deep learning models

“…The South Asian countries were observed to have significantly higher incidence rates of OSCC. Among them, India has the largest number of cases globally (one-third), while in Pakistan, it is the first and second most prevalent cancer in males and females, respectively [4]. The risk factors include use of alcohol and tobacco, poor oral hygiene, exposure to human papillomavirus (HPV), genetic background, lifestyle, ethnicity, and geographical location.…”