About Oral Cancer Foundation
About OCF
Oral Cancer Foundation (OCF) is a professionally- led “call to action” programme to eradicate oral cancer, strive for a ‘cancer free-India’ and thus improve the oral health of Indian by 2020. The detrimental effects of smoking and consumption of smokeless or chewing tobacco as carcinogenic agents are recognised world over. It affects the lives of billions of persons, posing an enormous public health challenge in its complexity, scale and impact, both at an individual and nation-wide level.

The OCF aims to establish a broad alliance of key influencers and policy makers from research, education, clinical practice, public health, government and industry, partnering in a common goal to effect fundamental change in health systems and individual behaviour to achieve the 2020 goal of optimal oral health for all.

India has one of the highest incidences of oral cancer in the world, as 4 in 10 in all cancer are oral cancers. The high incidence of oral cancer and oral pre-cancerous lesions in India has long been linked with the habit of betel quid chewing incorporating tobacco. Statistics show that annually 130,000 people succumb to oral cancer, which translates into approximately 14 deaths per hour.

After analyzing the gravity of the issue of oral cancer IDA initiated the Spot Prevent Oral-cancer Trauma (SPOT) Centres, a network of connected clinics under OCF banner, vital pipelines that carry out OCF’s mission of screening for early cancer detection. These clinics are run by dental professionals who are certified as OCF specialists, trained to screen and manage precancerous lesions to prevent oral cancer. Counselling for simple lifestyle changes and regular screening can bring down mortality of individuals.

Vision
Our vision - a nation free from Oral "Cancer"
Mission
The mission is to improve public health and well-being by periodic screening of the oral cavity.
We aim to accomplish our mission by:
We aim to accomplish our mission by:
  • Building a network of S.P.O.T. centres with oral cancer specialists for early detection.
  • We ensure that high-quality oral cancer care is accessible to all patients as specialized training is given to dentists in the latest oral cancer detection techniques.
  • Development and support to multidisciplinary approach in scientific and research related activities in the field of Oral Cancer detection and prevention.
  • Conduct oral cancer research for timely transfer of the research outcomes for practical application.
Prevention is the only cure for Oral Cancer therefore Counselling patient about risks. It is well known that oral cancer is strongly associated with tobacco and alcohol consumption.
Setting up dental clinics as specialized clinics for oral cancer detection brings up-to-the-minute information into patients’ homes, dental clinics and other clinical settings through easily accessible publications and online resources.
All this will need a coordinated effort from various health agencies and related.
Core Values
Core values—fundamental, enduring, deeply held beliefs, anchor our decisions to create a world free from cancer. This constitutes the moral foundation to establish a chain of S.P.O.T. centres and facilitate oral cancer prevention and early detection, accessible to all the citizens of India.
Scientific Approach
  • Our programmes and activities to support oral cancer training for the dental professionals and information dissemination will be carried out on scientific basis.
Trust
  • Our resources and programmes will be managed, conducted and evaluated in a manner that upholds the trust placed in us by the people.
Society
  • Our programmes and actions will aim to improve health, especially oral health, of all people through a service that provides both prevention and treatment of Oral Cancer.
Strategic Plan
The Oral Cancer Foundation’s Strategic Plan is to make India cancer free through early detection and prevention.

Prevention of oral cancer can be accomplished by (i) understanding cause-and-effect and modifying associated risks; (ii) recognizing and controlling pre-cancerous lesions; (iii) establishing the earliest possible diagnosis and administering timely and appropriate therapy; and (iv) effectively managing the complications of treatment.

  • Understanding causative factors is a necessity as prevention strategies are developed. Aging is a risk factor without a solution, but effective control of two other risk factors, tobacco and alcohol consumption is attainable.
  • Recognising and controlling pre-cancerous lesions needs review of histology. This reveals that majority of oral malignancies are squamous cell carcinomas; they arise from the mucosa of the oral cavity and are epithelial in origin. Since these are surface tumours, the location enhances early detection. However, by the time many oral cancers are diagnosed, they are already in advanced stages.
  • Train dentist to recognise pre-cancerous oral lesions, primarily leukoplakias and erythroplakias Dentists need to be trained for both screening and prevention as this increases the accuracy of diagnosis, discovery of more biologic markers and improves their management. Next Counselling by dentist for simple lifestyle changes regarding health can work wonders in the occurrence of oral cancer.
OCF’s Forte
Dental specialization: Oral cancer remains a highly lethal and disfiguring disease. Therefore, a systematic oral mucosal examination, by visual means and digital palpation, should be part of every dental examination procedure and every dentist must be aware of the most rapid and adequate referral pathway for the effective management of these lesions. In this context dental professionals play an important role in its prevention and early detection.

As a dentist if you are not playing an active role in screening then you are missing out on the opportunity to perform a clinical service that is “in the public interest, in the highest of dental standards, and has the best potential for the growth of your dental practice,” It is therefore that Oral Cancer Foundation has taken to strengthen the stand of the Tobacco Intervention Initiative by bridging the gaps between various professionals and their organizations which is vital for establishing active communication with them and using various media.

Benefit to practice: Counselling by the dentist is important. Verbal information and advice is convenient to give but it often fails because messages are not understood or are forgotten. Therefore it is written information can then be a very useful supplement. Presentation of written information needs to be careful however and the language must be clear. Practice information leaflets and newsletters can raise the profile of oral cancer screening, with reminders about unhealthy lifestyles. Official smoking cessation literature could be made available in practice waiting rooms for patients to take home with them.

Sustain the Uniqueness: Uniqueness can be sustained by diverse investments and balanced coordination with various disciplines. As dentist we can explore patients' lifestyle choices that cause oral cancer, such as drinking, smoking and chewing tobacco and offers advice on how to overcome them. Although we seek to undertake multidisciplinary action through a multidisciplinary task force, the vision and strategies, adopted and executed through the diverse professional groups, with the dental profession assuming the central role, is what makes our efforts unique. It is through this uniqueness that we aim to assume leadership cooperation and coordination with all professional organizations.

Bridge Research and Practical Efforts: Despite the fact that Oral Cancer and its consequences can be totally prevented, treated and controlled, there exists a significant gap in the public’s knowledge, attitudes and behaviors. Our forte is in introducing various preventive measures that can significantly reduce the Oral Cancer burden, bridge the gap between research & development and public awareness. This implies knowledge dissemination to help people adopt behaviour patterns, which will improve their health and decisions making process. We stress on an enhanced system of communication for timely knowledge and information sharing. We not only equip the professionals with knowledge and skill but also connect the population in an effective manner.

Address Disparities: Oral Cancer is now a greater threat because people from the lower socio-economic strata are now being affected. This segment of the population is more vulnerable to oral cancer because of higher exposure to the risk factor—tobacco—which complicates the situation further. They have very limited access to education, prevention and treatment. In order to bridge these disparities, OCF direct its action towards provision of easy and accessible, detection and treatment services. Awareness and education programmes. Prevention through action against risk factors, especially tobacco. Provision of educational resources to both the professionals and public.

Infrastructure Needs for OCF
Professional Workforce: Adequately trained researchers, educators and practitioners having broad mix of skills are the foundation of OCF. Data show that under represented minority dentists play a large role in increasing access to under-served and minority populations. They can influence other health professionals to be more culturally sensitive, and serve as powerful role models to other minorities and to would- be educators or researchers. Sustained efforts, new partnerships, and innovative and flexible programmes are needed to ensure a competent, diverse and robust research workforce.

Strengthen the research: Strong research-oriented academic environments are needed to develop the intellectual talent for research and to enable existing investigators to acquire and expand their skills in new areas of science. Oral health research can be carried out in dental schools, different components of academic health centres, hospitals and independent research institutions. The dental schools are training grounds for future researchers.There exists shortage of faculty, lack of integration between the basic and clinical sciences in pre-doctoral programmes, incorporation of research into the dental curriculum and financial shortfalls. Efforts to bolster the research infrastructure to ensure a workforce that is adequate both in numbers and ability, is needed to meet the demands of the changing oral health needs of the community.

Creation of a united platform: Creation of a platform that allows activities and inputs from professionals from diverse backgrounds is essential for compilation and maximization of efforts and outcomes. It is vital to set-up a dynamic platform and undertake multilateral and inclusive research for compiling a tangible evidence base, which can ultimately benefit the common man. We need to utilize the media and communication to translate research into practical benefit for activities as well as resultant benefits.

Building capacity: Next we need trained workforce for early detection at S.P.O.T. Centres which are certified clinics for early detection, prevention and cure. This will maintain the unique leadership role of the Oral Cancer Foundation (OCF) in oral cancer prevention and early detection. We need to provide the necessary training to strengthen professionals for an effective task force and it is equally essential to communicate this initiative to the people. This further strengthens the role of the dental professionals against cancer.

Strategic Initiatives Needed
Oral Cancer has wide spread effects. Strategic initiatives are needed to enable people lead a healthy life. These will enable educate people and make them aware of the pre-malignant and malignant conditions so that they approach health professionals at the apt time and can get the right treatment. Lack of awareness, misconceptions that culminate into late detection of the disease will be addressed through our well reached service and awareness programmes. We aim to build an infrastructure of SPOT Centre for a healthy nation.

Build Competencies: With significant research and advancement in Oral Cancer detection and treatment techniques, (special mention of brush biopsy techniques for detection) there is an increased responsibility to increase the reach to all the professionals and oral health professionals in specific. Improve the dental clinic and upgrade and skills of every dental professional need a variety of flexible and innovative training programmes for early detection and diagnosis of Oral Cancer so that a competent task force, for addressing this problem can be set-up. Carrying out research and development and getting it into the mainstream are challenges that need to be dealt with, so that research can be adapted to benefit the common people.

Train professionals: The strategic initiatives neded is to enhance training of professionals about the latest cancer detection techniques.Promote early detection to dental professional by integrating learning opportunities into existing educational programmes, conferences and webinars. Understanding disease processes, underlying causes as well as the concepts that determine population dynamics related with oral cancer. This is possible by dissemination of the advanced science for professional development. The dental community is the first line of defence in early detection of the disease.

Screening: Screening for oral cancer needs more than just understanding of the signs and symptoms of disease. A systematic oral mucosal examination, by visual means and digital palpation, should be part of every dental examination procedure and every dentist must be aware of the most rapid and adequate referral pathway for the effective management of these lesions. Understanding disease processes, underlying causes as well as the concepts that determine population dynamics related with oral cancer. The aim was to develop realistic advice for dentists in primary care who need best practice in soft tissue screening.

Counselling patients: Dentist can explore patients' lifestyle choices that can cause oral cancer, such as drinking, smoking and chewing tobacco and offers advice on how to overcome them. They can provide guidance by talking to patients after examinations and offers tips on medical history taking and record keeping. Innovation and development of excellent communication infrastructure that would enable us to propagate the message of prevention and early detection and simultaneously help dental professionals to get connected to the community directly and provide them education as well as service. Detecting oral cancer early saves lives. Prevention, screening and subsequent early treatment are the essentials in reducing the incidence of oral cancer.

Involve media: Promote early detection to the general public through community events and opportunities. Build and strengthen new and existing partnerships to integrate safety programmes into communities, including hospitals, childcare centres and recreation facilities.

OCF Goal--Preventing Occurrence of Oral Cancer
Increasing incidence of oral cancer indicates that it is the number one killer in the country has raised the need to curb the disease. High mortality, 5 year survival is less than 50 % for several sites. Here the dentists play a key role in early detection of suspicious lesions plus they can identify those patients with a risk factor for oral cancer. It is their professional and ethical duty to opportunistically screen all patients for oral cancer when they attend routine dental examination.

Oral Cancer is an ambitious goal of Oral Cancer Foundation (OCF) which can be achieved through early detection and prevention. We also recognize the importance of partnerships in mobilizing an integrated health promotion enterprise comprising health professionals, voluntary health organizations, industry and government. To counter oral cancer requires ability to learn and absorb new techniques and create a sound infrastructure through S.P.O.T. Centres.

Facing the Burden of the Disease: The oral cancer affects physical, social, psychological and economic well being. The numbers of people affected mostly belong to the weaker socio-economic sectione. An intensified approach for the prevention of risk factors and behaviour is the need of the day. The younger population especially needs to be protected.

Train Professionals: OCF needs to organize training infrastructure to provide efficient Oral Cancer advice and councelling. For this training kit needs to be given to the dental professionals and support staff while imparting expertise. Next streamlining and stratification of the training project should be undertaken. These programmes must be marketed to the Dental Professionals. The importance of the training programme along with the course content. Sensitization the dentists to the oral cancer issue and training should happen simultaneously. Next, it is must to collaborate with various disciplines for value addition to the training. Getting the experts from various fields and disciplines, for example psychologists and social workers, to share their expertise during the training sessions. In doing so, the training programmes will encompass a variety of cancer aspects and its intervention.

Create Media awareness: Communication effort must ensure that target audiences becomes informed, changes behaviour and makes decisions that will improve clinical care and health outcomes. Target audiences include health care providers, consumers, the research community and other groups such as educators, policymakers, industry and the media. One of the main goal is to find the most effective ways to communicate and disseminate health information, clinical information and research findings to target audiences. Find, utilize and enhance communication so as to make the SPOT Centre services available as well as well acceptable to people.

Establish and Develop Collaborations: OCF’s goal is to collaborate with technical expertise for developing the collaborations network for interacting with different related science streams. Establishing communications with key stake holders and informing them about our various initiatives and developments. Communication of this nature will not get OCF the recognition of being one among various professional bodies. The recognition and acknowledgement of our work is the key to the diversification of our vision and goal. OCF will do its level best to contribute to various disciplines through our knowledge base and built capacity. The association with the various professional and scientific bodies would be bilateral to attract interest and investments from these disciplines in OCF. Thereby awarding multi-lateral benefits.

Create and Upgrade Evidence Base: OCF website provides an excellent resource for creation of a tangible data base for an effective and practical data collection. The provisions available should be suitable for use even at the preliminary stage. To achieve this task, we will provide training to professionals for data collection. The modules must be made easy and self explanatory for people. Unless this is not done the utilization will be restricted to net savvy people in metros and large cities. Next futuristic and inclusive questionnaires and modules must be developed framed to record information about the patients; similarly, quality and accurate data must be maintained. Creation of a large evidence base needs a lot good deal of documentation. The process will not be complete, unless the data collected is sorted and analyzed. Efforts will be made to put the data in the correct pockets.

Reasons for Initiation of OCF
OCF was initiated because oral cancer is a highly lethal and disfiguring disease. Not just India, it is also the commonest cause of morbidity and mortality in the world. Six million people die due to cancer every year. It is estimated that by 2020 there will be 15 million new cases every year. Oral Cancer occurrence is particularly high in males.

Tobacco and alcohol are regarded as the major causes for oral cancer. The population-attributable risks of smoking and alcohol consumption have been estimated to 80% for males, 61% for females, and 74% overall. The evidence that smokeless tobacco causes oral cancer was confirmed recently by the International Agency for Research on Cancer. Tobacco use, including smokeless tobacco, and excessive alcohol intake estimated to account for about 90% of oral cancers.

Indian Scenario: India tops in the prevalence of oral cancer in the world; as 4 in 10 of all cancers are oral cancers. Annually 130,000 people succumb to oral cancer in India which translates into approximately 14 deaths per hour. In fact, in India, 60-80% of patients are present with advanced disease as compared to 40% in developed countries.Increasing prevalence of oral submucous fibrosis, especially in younger individuals, caused by gutka has been seen. In India, the age standardized incidence rate of oral cancer is reported at 12.6 per 100,000 people.

Risk Factors: The greatest risk factor for Oral Cancer is tobacco. It is important to mention here that tobacco is one of the largest causes of preventable deaths in the world. The relation of Oral Cancer with tobacco is well established and documented. The risk of developing oral cancer is high in case of chewable tobacco. Smoking may also lead to development of oral cancer; however the chances of laryngeal cancers are more in case of smoking rather than Oral Cancer. Paan with tobacco is said to be the most potent risk factor for the development of Oral Cancer. The combination of Areca nut, Lime and tobacco is the possible reason behind the increased risk.

A case control study conducted in India revealed that the chances of development of oral cancer amongst men who were tobacco chewers was 6 folds higher than non chewers. As far as the female population was concerned the risk was as high as 46 times more than the women who had never chewed tobacco.

Other risk factors such as alcohol use and radiations have also been associated with Oral Cancer. However, the association is not as strong as with Tobacco.
Since risk factor is so profound and well established, undoubtedly curbing the use of tobacco is one of the major steps to prevent Oral Cancer occurrence.
The increasing use of tobacco amongst the younger population and children, has largely contributed to the sharp increase in the occurrence of Oral Cancer.

Stage of pre-cancer: The precancerous lesions and conditions of Oral Cancer are a ray of hope in prevention.

The Precancerous lesions are:
  • Leukoplakia
  • Erythroplakia
  • Palatal changes amongst reverse smokers (Smoker’s Palate)

The Precancerous Conditions are:

  • Oral Submucous Fibrosis
  • Oral Lichen Planus

The above mentioned conditions and lesions provide an opportunity for early detection and thus help prevent the malignant changes that cause oral cancer.

Diagnosed in the early phase, stopping the tobacco habit can reverse the condition. Thus, if appropriate measures for early detection and good public education are carried out, nipping the problem in the bud would be possible.

Diagnosis and Prevention: Early Diagnosis and Prevention are two terms that go hand in hand. For cancer, prevention and cure are synonymous. The only cure for cancer is early detection and prevention. Hence, the need of early detection cannot be underestimated. Since the treatment of Oral Cancer in the form of surgery and radiation causes many harmful side effects, especially facial disfigurement and also because surgical treatments can have a long lasting impact on physical as well as mental health of the patient, the need is to:

  • Increase research in the areas for easy and reliable cancer detection and diagnostic methods.
  • Increase public awareness regarding the importance of early detection.
  • Train health professionals, especially dentists, for diagnosis and prevention of Oral Cancer.
  • Train professionals in health awareness creation, early detection and counselling methodology.

In the wake of increasing prevalence and occurrence of Oral Cancer as well as evidence supporting the effectiveness of prevention of risk factors, the step of early diagnosis and prevention is the most crucial.

The Psychosocial aspects: The word ‘Cancer’ is enough to despair even the strongest person. Right from the time a biopsy is demanded for the diagnosis till the reports arrive the personality of the person changes. Role of the doctors/dentists is very crucial once the patient is confirmed to have Oral Cancer or even for that matter pre-malignant lesion. The deleterious effect of Oral Cancer on the patient’s psychosocial well being is one of the challenges faced by doctors. Also, the fear of recurrence or relapse curtails the person’s happiness and confidence even post treatment of the patient. Cancer surgery leads to the disfigurement of face, changes the complete insignia of the person. Oral Cancer Foundation aims to address these problems by training dental professionals to deal with these aspects of cancer.

The Economic Aspect: The Oral Cancer treatment drains the affect pateint financially. The treatment is expensive, apart from its side effects. India has the maximum number of Oral Cancer sufferers and the resources to serve such a huge number remain limited. The most pragmatic answer to such a situation is PREVENTION. The Oral Cancer foundation aims at prevention and early detection. Before the disease reaches the state of higher morbidity and mortality, it has to be prevented or identified early and treated effectively. Prevention and early detection is Oral Cancer Foundation’s answer to the economic impact of the disease.

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