Awareness Regarding Oral Cancer among Teenagers and Young Adults (between 15 To 25 Years of Age) Patients: A Descriptive Cross-Sectional Study

Dr. Satish Verma¹, Dr. Ravinder Prakash², Dr. Neeta Sharma³ and Dr. Manish Sahore⁴

¹Senior Lecturer, Department of Oral Medicine and Radiology, Government Dental College, Shimla, India

²Medical Officer, Government Dental College, Shimla, India

³Professor & Head, Department of Oral Medicine and Radiology, Government Dental College, Shimla, India

⁴Assistant Professor, Department of Oral and Maxillofacial Surgery, Government Dental College, Shimla, India

Abstract: Background: Oral cancer is considered a public health problem worldwide. Dental colleges may play an important role in educating patients about oral cancer. This study was done to evaluate the knowledge regarding Oral Cancer among teenagers & young adult patients attending Dental Clinic. Methods: A descriptive cross sectional survey was conducted between 15th Aug 2019 to September 15th 2019 in the Department of Oral Medicine and Radiology, Government dental college, Shimla amongst the teenagers & young adult patients using self designed, close ended 20 questionnaires. Results: Out of total 318 patients in age group of 15-25 years present to the OPD, 250 people agreed to participate in the study.Among these, 226 (90.40%) had heard about oral Cancer and their major 158(63.20%) source of information was Mass Media. 175(70%) patients thought that oral cancer is preventable, 188(75.20%) thought that it is curable and 66(26.405) thought that it is contagious. Among the total, 119( 47.6%) had knowledge that Tobacco smoking was the risk factor for oral cancer ,215(86%) told Tobacoo chewing, 214(85.7%) told Heavy alcohol drinking,161(64.4%) told Sun radiation, 132(52.8%) told Non consumption of fruits & vegetables and 172(68.8%) told that Advancing age was the risk factor for oral cancer. Among the total , 198(79.2%) participants told that oral cancer was present as Non healing ulcer, 142(56.8%) told that it present as red patch, 145(58%) told that it present as white patch, 174(69.6%) told that it present as Lump in mouth/neck while 179(71.6%) told that it present as Growth of abnormal tissue. Among the total, 218(87.2%) told that oral cancer can recurrence was possible after cancer treatment, 211(84.4%) had Knowledge about post cancer treatment survival. 155(62%) told that oral cancer can be treated with surgery, 169(67.6%) told that it can be treated with medications, 131(52.4%) told that it can be treated with Chemotherapy and 95(38%) told that it can be treated with Radiotherapy. Conclusion: These findings emphasize the importance of IEC (Information, education & Communication) programs in dental colleges as well providing integrated services for patients seeking care at dental colleges, including population’s awareness on oral cancer.

Keywords: Awareness, Oral Cancer, teenagers and young adults Patients, OPD, Dental College, Shimla.

INTRODUCTION

Oral Cancer is a major public health problem, which is responsible for the high morbidity and mortality rates worldwide. Globally, it is estimated that 354,864 new cases of oral cancer occurred in 2018. There is an increasing trend for oral cancer to affect young men and women. Among the malignancies that affect the oral cavity, squamous cell carcinoma (SCC) is the most prevalent, accounting for 90–95% of the cases (do Prado, N. S. et al., 2020; & Warnakulasuriya, S., & Kerr, A. R. 2021).

Two-thirds of the global incidence of oral cancer occurs in low- and middle-income countries (LMICs); half of those cases are in South Asia. India alone accounts for one-fifth of all oral cancer cases and one-fourth of all oral cancer deaths (JS, B. F. R. et al., 2013).

Oral cancer is often preceded by a clinical premalignant phase accessible to visual inspection, and thus there are opportunities for earlier detection and to reduce morbidity and mortality. But public awareness regarding Oral Cancer is poor, and many patients present with late-stage disease, contributing to high mortality (Warnakulasuriya, S., & Kerr, A. R. 2021 & JS, B. F. R. et al., 2013).

Early diagnosis of oral cancer includes the patient’s perception of the disease and the professional diagnosis and contributes to a significant improvement in the treatment of the disease and maintaining the patient’s quality of life. Therefore, patients must be aware about oral cancer, its signs and symptoms, and unhealthy lifestyle habits that may contribute to the development of the disease (Scott, S. et al., 2008).

Dental colleges have a formative function and play a fundamental role in educating patients about oral cancer. Thus, this study was done to evaluate the knowledge regarding Oral Cancer among teenagers & young adult patients attended Dental OPD of Department of Oral Medicine and Radiology, Government dental college, Shimla.

OBJECTIVES OF THE STUDY

To evaluate the knowledge regarding Oral Cancer among teenagers & young adult patients came to the OPD of Department of Oral Medicine and Radiology, Government Dental College, Shimla.

RESEARCH METHODOLOGY

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: OPD of Department of Oral Medicine and Radiology, Government dental college, Shimla.

• Study duration- 15^th August 2019 to September 15^th 2019

• Study population- Teenagers & Young adults

• Sample size- 250 samples and age group were 15-25 years.

• Study tool: A self designed, close ended questionnaires consisting of 20 questions regarding socio-demography and risk factors, signs & symptoms, perception, treatment, prognosis of oral cancer etc. was created.

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. Responses were then recorded in a Google Excel spreadsheet, the information from which was used to generate graphical display.

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc..

• Ethical Considerations- Participants confidentiality and anonymity was maintained.

RESULTS

Present study is a hospital based cross sectional questionnaire based study being conducted between 15 th Aug. 2019 to September 15^th 2019 in Department of Oral Medicine and Radiology to evaluate the knowledge regarding Oral Cancer among teenagers & young adult patients came to the OPD of Department of Oral Medicine and Radiology, Government dental college, Shimla.

Out of total 318 patients in age group of 15-25 years present to the OPD, 250 people agreed to participate in the study. The study sample included 250 samples (130 male and 120 female) and age group was 15-25 years.

Among these 250 patients, maximum 131(52.4%) in the age group of 21-15 years, 130(52%) were males, 154(61.6%) were educated up to secondary level and 169(67.6%) were students. (Table-1)

Table-1: Socio-Demographic Pattern of Study Participants

Among the total 250 participants, 226 (90.40%) had heard about oral Cancer and their major 158(63.20%) source of information was Mass Media. 175(70%)patients thought that oral cancer is preventable, 188(75.20%) thought that it is curable and 66(26.405) thought that it is contagious. (Table-2)

Table-2: Awareness & Perception about Oral Cancer

Among the total 250 participants, 119(47.6%) had knowledge that tobacco smoking was the risk factor for oral cancer, 215(86%) told Tobacoo chewing, 214(85.7%) told Heavy alcohol drinking, 161(64.4%) told Sun radiation, 132(52.8%) told Non consumption of fruits & vegetables and 172(68.8%) told that Advancing age was the risk factor for oral cancer. (Figure-1)

Figure Image is available in PDF File

Figure-1: Knowledge about Risk Factors for Oral Cancer

Among the total 250 participants, 198(79.2%) participants told that oral cancer was present as Non healing ulcer, 142(56.8%) told that it present as red patch, 145(58%) told that it present as white patch, 174(69.6%) told that it present as Lump in mouth/neck while 179(71.6%) told that it present as Growth of abnormal tissue.(Figure-2)

Figure Image is available in PDF File

Figure-2: Knowledge about Oral Cancer Presentation

Among the total 250 participants, 218(87.2%) told that oral cancer can recurrence was possible after cancer treatment, 211(84.4%) had Knowledge about post cancer treatment survival. 155(62%) told that oral cancer can be treated with surgery, 169(67.6%) told that it can be treated with medications, 131(52.4%) told that it can be treated with Chemotherapy and 95(38%) told that it can be treated with Radiotherapy. 233(93.2%) told that delay in Treatment effects the Outcome of Disease.(Table-3)

Table-3: Knowledge about Oral Cancer Treatment and Prognosis

DISCUSSION

Low public awareness of oral cancer and delays in symptomatic patients presenting to health services have been identified as contributing factors to poor survival rates (Macpherson, L. M. D. 2018). Knowledge of the signs and symptoms of oral cancer may well aid in early diagnosis and treatment. A gap in patient knowledge and health literacy surrounding Oral cancer, specifically related to risk factors and symptomology, is posited to be among the key modifiable factors contributing to high morbidity and mortality. This is bound to result in increasing survival rates, as well as reducing the oral cancer burden on the society (Babiker, T. M. et al., 2017; & Shimpi, N. et al., 2018).

In the present study, Out of total 318 patients in age group of 15-25 years present to the OPD, 250 people agreed to participate in the study. The study sample included 250 samples (130 male and 120 female) and age group was 15-25 years.Among these 250 patients, maximum 131(52.4%) in the age group of 21-15 years, 130(52%) were males, 154(61.6%) were educated up to secondary level and 169(67.6%) were students. Among the total 250 participants, 226 (90.40%) had heard about oral Cancer and their major 158(63.20%) source of information was Mass Media. 175(70%)patients thought that oral cancer is preventable, 188(75.20%) thought that it is curable and 66(26.405) thought that it is contagious. In the study done by (Laakshmi, G. M. 2016), 58%patients marked oral cancer as curable disease. In the another study by (Babiker, T. M. et al., 2017), majority of the individuals 66.1% (290), the most common source of information about oral cancer was from the media, while 33.9% individuals (149), obtained knowledge from direct contact of health workers.

In the current study, Among the total 250 participants,119( 47.6%) had knowledge that tobacco smoking was the risk factor for oral cancer ,215(86%) told Tobacoo chewing, 214(85.7%) told Heavy alcohol drinking,161(64.4%) told Sun radiation, 132(52.8%) told Non consumption of fruits & vegetables and 172(68.8%) told that Advancing age was the risk factor for oral cancer. In the study done by (Laakshmi, G. M. 2016), 32% of patients opted smoking and alcohol as major cause of oral cancer. In another study by (do Prado, N. S. et al., 2020), most participants were knowledgeable about oral cancer and identified tobacco use (48.6%), alcohol consumption (25.1%), and solar radiation (12%) as the primary risk factors for the disease. Similarly, in the study by (Shimpi, N. et al., 2018), Knowledge about tobacco and alcohol use and increased Oral cancer risk was reported by 94 and 40%, respectively.

In our study, Among the total 250 participants, 198(79.2%) participants told that oral cancer was present as Non healing ulcer, 142(56.8%) told that it present as red patch, 145(58%) told that it present as white patch, 174(69.6%) told that it present as Lump in mouth/neck while 179(71.6%) told that it present as Growth of abnormal tissue. In the study done by (Laakshmi, G. M. 2016), 63% of patient aware how oral cancer comes about.56% opted that they have abnormality in the oral cavity, in which 37% opted for ulcers in their mouth. In another study by (Shimpi, N. et al., 2018), about 50% reported knowledge ability regarding cancer-associated symptomology.

In the present study, Among the total 250 participants, 218(87.2%) told that oral cancer can recurrence was possible after cancer treatment, 211(84.4%) had Knowledge about post cancer treatment survival. 155(62%) told that oral cancer can be treated with surgery, 169(67.6%) told that it can be treated with medications, 131(52.4%) told that it can be treated with Chemotherapy and 95(38%) told that it can be treated with Radiotherapy. 233(93.2%) told that delay in Treatment effects the Outcome of Disease. In the study done by (Laakshmi, G. M. 2016), 66% patients aware of treatment options for oral cancer in which 27% patients opted for chemotherapy as treatment option for oral cancer.

CONCLUSION

This study has highlighted that the teenagers & younger patients still had a general lack of awareness regarding the risk factors, early signs and symptoms, treatment and prognosis. The study revealed several aspects of public uncertainty and ignorance with regard to oral cancer which need to be emphasized in future public education programmes, particularly using mass media. These findings emphasize the importance of IEC (Information, education & Communication) programs in dental colleges as well providing integrated services for patients seeking care at dental colleges, including population’s awareness on oral cancer.

REFERENCES

1. do Prado, N. S., Bonan, R. F., & da Silva Leonel, A. C. L. (2020). Awareness on oral cancer among patients attending dental school clinics in Brazil. Medicina oral, patologia oral y cirugia bucal, 25(1), e89-e95. 

2. Warnakulasuriya, S., & Kerr, A. R. (2021). Oral Cancer Screening: Past, Present, and Future. Journal of Dental Research, 100(12), 1313-1320.

3. JS, B. F. R., Masuyer, E., & Ferlay, J. (2013). Estimates of global cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer, 132(5), 1133-45.

4. Scott, S., McGurk, M., & Grunfeld, E. (2008). Patient delay for potentially malignant oral symptoms. European journal of oral sciences, 116(2), 141-147.

5. Macpherson, L. M. D. (2018). Raising awareness of oral cancer from a public and health professional perspective. British dental journal, 225(9), 809-814.

6. Babiker, T. M., Osman, K. A. A., Mohamed, S. A., Mohamed, M. A., & Almahdi, H. M. (2017). Oral Cancer Awareness among Dental Patients in Omdurman, Sudan: a cross-sectional Study. BMC Oral Health, 17(1), 69-73.

7. Shimpi, N., Jethwani, M., Bharatkumar, A., Chyou, P. H., Glurich, I., & Acharya, A. (2018). Patient awareness/knowledge Towards Oral Cancer: A Cross-Sectional Survey. BMC oral health, 18(1), 86-89.

8. Laakshmi, G. M. (2016). Awareness of oral cancer among a hospital based out-patient population-A questionnaire based study. Journal of Pharmaceutical Sciences and Research, 8(7), 687-691