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Research Article
 

Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh



Kala Chand Debnath, Md. Sahab Uddin, Srijan Goswami, Oscar Herrera-Calderon, Md. Tanvir Kabir, Md. Fakhrul Hasan, Kamrun Nahar Lucky, Sayema Khanum and Mohamed M. Abdel-Daim
 
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ABSTRACT

Background and Objective: Worldwide cancer is an important public health problem. Tobacco smoking, betel quid chewing and alcohol consumption are closely linked with the oral cavity cancer. Therefore, the aim of this study was to explore the status of smoking, chewing and alcohol consumption habits of patients with oral cavity cancer in Dhaka, Bangladesh. Materials and Methods: A cross sectional study was conducted among usual oral cancer patients, who attended at the outdoor of the City Dental College and Hospital during the period of January, 2015-February, 2017. Data on socio-demography, risk habit profiles, site of cancer and number of ulcer patients were recorded by previously designed questionnaire. Data entered in the data collection form were entered into the Microsoft Excel. The results obtained were expressed as Mean±SD. Results: A total of 200 oral cancer patients were selected for study and highest percentage 24.5% of the patients were in the age group of 60 years and above. It was found that highest percentage, 68.5% of the patients had habit of chewing betel leaf and 60.5% patients had habit of smoking. The most preferred mode of smoking was bidi (52.07%) followed by cigarette (44.63%) and very few were habituated with hookah (1.65%). For 38.3% patients single ulcer was detected in the palate and upper jaw and 52.9% patients had multiple ulcers in the tongue. Single ulcer was found to be high among 69.4% patients having habit of chewing betel leaf and highest multiple ulcers, 47.1% were reported for patients taking gul inside mouth. Conclusion: Tobacco smoking and chewing betel quid are strong risk factors in the development of oral cancer. Furthermore, age, gender, education and occupation influence the development of oral cancer.

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Kala Chand Debnath, Md. Sahab Uddin, Srijan Goswami, Oscar Herrera-Calderon, Md. Tanvir Kabir, Md. Fakhrul Hasan, Kamrun Nahar Lucky, Sayema Khanum and Mohamed M. Abdel-Daim, 2017. Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh. Journal of Medical Sciences, 17: 46-52.

DOI: 10.3923/jms.2017.46.52

URL: https://scialert.net/abstract/?doi=jms.2017.46.52
 
Received: June 08, 2017; Accepted: July 18, 2017; Published: July 26, 2017


Copyright: © 2017. This is an open access article distributed under the terms of the creative commons attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

INTRODUCTION

Oral cavity cancer is currently a major global health issue1. It is a very disastrous disease that affects many people each year all over the world and it is the 11th most dominant cancer in the world according to the World Health Organization2. In developing countries, oral cancer is estimated to be the 3rd most common malignancy after cancer of the cervix and stomach3. Among these modern epidemics, cancer is the 2nd commonest cause of mortality in developed countries. In developing countries, cancer is the 10th most common cause of mortality4. Oral cancer represents approximately 13% of all cancers, thereby translating into 30,000 new cases every year4.

Epidemiological studies have shown that incidence of oral cancer varies significantly in different continents. The highest incidence rates were reported in Asia region (i.e. India, Sri Lanka, Pakistan, Bangladesh and Taiwan) and parts of Europe (i.e. France, Hungary, Slovakia and Slovenia)5. In addition, for parts of Latin America, the Caribbean (i.e. Brazil, Uruguay and Puerto Rico) and the Pacific region (i.e. Melanesia and Papua New Guinea) largely attributed to exposure to specific risk factors for oral cancer5. In Bangladesh more than 7000 people are newly diagnosed each year and among them 6.6% people are died due to their lifestyle and other factors5,6. Oral cancer mostly affects in the area of the lips, tongue, mouth, salivary glands and oropharynx7,8.

Smoking is one of the most important risk factors for developing oral cancers9,10. Other risk factors have been reported to be closely associated with oral cancers, including betel quid chewing, alcohol consumption11, poor oral health12 and human papilloma virus infection13. The most widespread form of tobacco is chewing of betel quid with tobacco and this has been demonstrated as a major risk factor for oral cavity cancer14,15. In addition, betel quid with or without tobacco is one of the independent major risk factors for oral cancer16,17. In countries where such habits were prevalent and had cultural importance in traditional and religious ceremonies, oral cancer was one of the most common cancers18,19. Apart from tobacco use ill-fitting dentures, syphilis, inadequate diet, malnutrition and chronic irritation from rough or broken teeth were reported more frequently in oral cancer patients20.

No significant advancement in the treatment of oral cancer has been found in recent years. Although better combinations of multidiscipline approach have improved the quality of life in oral cancer patients, the overall 5 year survival rate has not improved much over the past decades21. The primary prevention, such as cessation of tobacco smoking and alcohols drinking along with early detection is necessary control procedures to improve the prognosis of oral cancer22, 23.

Bangladesh is one of the under developing and over populated country in South Asia24. There are 13,00000 cancer patients in Bangladesh, with about 200,000 patients newly diagnosed with cancer each year2,25. Among these all cancer patients, 7120 were affected in lip, oral cavity and pharynx. Considering other Asian countries the number of patients was not higher26-28. Among the risk factors as stated earlier smoking, chewing and alcohol consumption are considered as the important risk factors for developing oral cancers10. The incidence of oral cancer among patients who had the habit of tobacco smoking was 8.4 fold higher than that among patients who did not11. Therefore, the objective of this study was to analyze the smoking, chewing and alcoholic consumption pattern of oral cancer patients attending City Dental College and Hospital, Dhaka, Bangladesh. This study will be effective to get the condition of the oral cancer patients with smoking, chewing and alcohol consumption habits in Bangladesh as well as to detect the most important causative factors.

MATERIALS AND METHODS

Study design and study site: A cross-sectional study was carried out to assess the prevalence and various risk factors among patients with oral cavity cancer attending in the City Dental College and Hospital of Dhaka City, Bangladesh.

Study population: A total of 200 patients suffering from oral cavity cancers were selected from the outpatient department of the City Dental College and Hospital during the period of January, 2015-February, 2017. All the selected patients were brought to the Department of Oral Pathology and Microbiology, examined and interviewed. A preformat questionnaire was used to record all the relevant information.

Data collection: The data were collected from the patients with clinically diagnosed and histopathologically confirmed oral cavity cancer. Necessary ethical approval was obtained from the respective authorities. Socio-demographic profile of the patients and study relevant information were collected in a preformed at questionnaire. The data collected in this study are presented in Table 1.

Ethical considerations: The study protocol was approved by the ethics committee of the City Dental College and Hospital, Dhaka, Bangladesh. The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Statistical analysis: The data entered in data collection from the Microsoft Excel 2010 (Roselle, IL, USA) and analyzed. Proportions and percentages were calculated. The results obtained were expressed as Mean±SD.

RESULTS

In Table 2, details of socio-demographic information of the patients for example sex, religion, occupation, marital status, education level and family income are presented.

Table 1:List of collected information
Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh

The distribution of the patients based on their ages is offered in Table 3 in which most of the patients were in the age group 60 years and above.

In Table 4, details of smoking, chewing and alcohol consumption habits of oral cancer patients are presented.

Out of 60.5% smoker patients, in Fig. 1 the pattern of smoking habit of the patients is mentioned.

The distribution of cancer by number of ulcers (i.e. single/multiple) and different anatomical sites of oral cavity (i.e. tongue, palate and upper jaw, buccal mucosa, pharynx, lip) among oral cancer patients are shown in Table 5.

Table 6, represents the distribution of the oral cancer patients by number of ulcers (i.e. single/multiple) and pattern of tobacco smoking, betel quid chewing and alcohol consumption habits.

DISCUSSION

Oral cancer remains one of the most life-threatening oral disease in the world. Globally oral cavity cancer is the most common cancer and is a major problem in regions where tobacco use is prevalent in the form of chewing and smoking as well as alcohol consumption7,29. Its distribution and occurrence varies by age, ethnic group, lifestyle and habits of individuals. It also varied from country to country29-31.

In this study among the male patients, highest percentage of oral cancer were reported in the age group 55-59 years, whereas among the female highest percentage were in the age group 50-54 years. Data also revealed that the oral cancer was lowest in the age group less than 45 years. The study suggested that the incidence of oral cancer increases with age, predominantly in people aged 50 years and above32.

Table 2:Socio-demographic characteristics of the patients (n = 200)
Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh
SSC: Secondary school certificate, HSC: Higher secondary certificate

Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh
Fig. 1:Percent distribution of patients by type of smoking (N = 121)

In line with the annual report by the Taiwan Cancer Registry System, the median age of diagnosis for oral cancer is 51 years33.

In the South Asian region over one third of tobacco consumed is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used34. More than 90% of oral cancer cases report using tobacco products in Asian countries35. It is used in smoking as well as smokeless forms. Betel quid chewing is the most common form of chewing in Bangladesh and also reported in Asia-Pacific regions24. Betel quid consists of areca nut, betel leaf, catechu, zarda and slaked lime36. About 10% of the world’s population chews betel quid regularly37.

Table 3:Distribution of the patients by age and sex (n = 200)
Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh

Table 4:Distribution of the patients by smoking, chewing and alcohol consumption habits (n = 200)
Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh
Values were expressed as Mean±SD

Table 5:Distribution of the patients by site of cancer and number of ulcers (n = 200)
Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh

From this study it was found that highest percentage of the respondents had habit of chewing betel leaf, followed by lime with betel leaf, followed by betel nut with betel leaf, followed by smoking, followed by betel nut, followed by sadapata with betel leaf, followed by zarda with betel leaf, then gul inside mouth and alcoholism. A previous case-control study presented that the incidence of oral cancer was 123-fold higher in those who smoked, drank alcohol and chewed betel quid than in avoiders11.

Drinking alcohol is an important risk factor for oral cancer. In China, India, Pakistan, Sri Lanka, Bangladesh, Nepal and Thailand spirits are consumed more commonly8.

Table 6:Distribution of the patients by number of ulcers and pattern of smoking, chewing and alcohol consumption habits (n = 200)
Image for - Impact of Tobacco Smoking, Betel Quid Chewing and Alcohol Consumption Habits in Patients with Oral Cavity Cancer in Bangladesh

This study reported lowed alcohol consumption habit of the patients. Another study proposed that the alcohol might enable the passage of carcinogens through cellular membranes38. Furthermore, alcoholic consumption, enhanced liver metabolizing function and might, therefore, activate carcinogenic substances. Furthermore, alcohol might alter intracellular metabolism of the epithelial cells at the target site38. Thus, the oral mucosa was more susceptible to carcinogens brought by smoking and betel quid chewing.

Smoking includes the use of cigarettes, bidi and hookah. Though cigarette smoking is seen in all Asian countries, bidi smoking is common in countries like Bangladesh, India, Pakistan and Sri Lanka8,39. Bidi is prepared by rolling dried tobacco flakes into a dried Temburni leaf and secured with thread40. Smoking bidi is an important risk factor contributing to a considerable number of oral cavity cancer cases in Bangladesh, Nepal, India, Pakistan and Sri Lanka41. Bidi smokers are 4 times at risk of developing oral cancer compared to non-smokers8,42. In this study among the smoker patients the most preferred mode of smoking was bidi and very few were habituated with hookah. A previous study found the at equal intake or duration levels, black-tobacco smoking was associated with a 2-4 fold increase in cancer risk compared to blond tobacco smoking43.

Data analysis of this study revealed that multiple ulcers were found to be high in tongue, pharynx and lip whereas single ulcer was found to be high in palate and upper jaw and buccal mucosa. The affected sites of oral cancer patients are lip, base of the tongue, lingual tonsil, gum, floor of the mouth, hard palate, soft palate, uvula, palate, buccal mucosa, vestibule of mouth, oral cavity parotid gland, submandibular gland, tonsil fossa, tonsil, vallecular, anterior surface of epiglottis, bronchial cleft, oropharynx, etc44,45. Among all sites, tongue, oral cavity and parotid gland are highest affected sites44,46. This study revealed highest percentage of chewing betel leaf among patients with single ulcer (i.e., palate and upper jaw) and multiple ulcers (i.e., tongue) in patients taking betel nut. Previous studies found evidence of the synergistic effects of smoking, drinking and betel quid chewing on the risk of developing oral cavity cancer8,43.

CONCLUSION AND FUTURE RECOMMENDATION

This study reported the habits of chewing betel leaf, tobacco smoking and taking betel nut with betel leaf amid patients with oral cavity cancer. Among smoker patient’s bidi was mostly used mode of smoking. For most of the patients with habit of chewing betel leaf had single ulcer and multiple ulcers were reported for patients with habit of taking gul inside mouth. Among the patients older age group were more prone to develop oral cancer. The lower social-economic condition of the people is the main challenge for the development of oral cancer in Bangladesh. Moreover, lack of infrastructure and health workers, lack of awareness and illiteracy etc. potentiate the condition. The placement of community hospital in rural area as well as awareness and knowledge can be increased among people in Bangladesh for the maintenance of good oral health.

SIGNIFICANCE STATEMENT

This study discovers the relationship of tobacco smoking, betel quid chewing, alcohol consumption and oral cavity cancer that can be beneficial for readers/researchers to get the role of the aforementioned factors in Bangladeshi patients. This study will help the researcher to uncover the critical areas of factors affecting oral cavity cancer that many researchers were not able to explore. Thus, this study will be created a linkage between oral cavity cancer and potential prognostic factor, for patients with oral cavity cancer.

ACKNOWLEDGMENTS

The authors wish to thank the City Dental College and Hospital, Dhaka, Bangladesh for providing permission to conduct this study.

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