Oral Cancer Foundation (OCF) is a professionally- led “call to action” initiative for a ‘cancer free- India’. Oral Cancer is the number 1 killer cancer in India. But the incidence of oral cancer is rising at an alarming speed due to consumption of masala / Gutka and other tobacco products.
Oral cancers account for 40% of the cancer in men and include cancers of
We observed there was high incidence, late detection, lack of access to quality affordable care and hence high mortality. Oral cancer was not being detected early in India due to lack of access, affordability and awareness.
After analyzing the gravity of oral cancer, IDA initiated the Spot Prevent Oral-cancer Trauma (SPOT) Centres, a network of connected dental 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 pre-cancerous lesions to prevent oral cancer. Counseling for simple lifestyle changes and regular screening can bring down mortality of individuals.
Prevalence of cancer in India is estimated to be 3.9 million people with reported incidence of 1.1 million in 2015. This is however a conservative estimate, as the real incidence of cancer is expected to be at least 1.5 to 2 times higher at 1.6-2.2 million, as suggested by data from large screening studies and low coverage of Indian cancer registries.
From the recent report by the National Institute of Health and Family Welfare (NIHFW), it is clear that India accounts for the 86% of the total oral cancer figure across the globe. 90% of oral cancer is caused by chewing tobacco and eating gutka. Each year, there are 1.5 lakh of cancer cases because of tobacco use. Cancer of oral cavity can be detected at a very early stage by efficient screening.
One in three inhabitants of the state of Madhya Pradesh aged 15 and older—or some 15m people—use the stuff, a preparation of crushed betel nut, tobacco and an acacia extract called catechu, according to 2010 a survey by the National Cancer Registry Programme (NCRP). Even more worryingly, a report in 2008 estimated that 5m Indian children were addicted. It is not uncommon for children as young as eight to be users. Gutka is also popular among women, in part because smoking among the fairer sex remains frowned upon in much of India. Add cheapness—1 rupee, or 2 cents, buys a sachet, whereas a cigarette costs at least twice as much—and it is little wonder that two-thirds of Indian tobacco users get their fix in chewable form. As a result, however, India has one of the highest rates of oral cancer in the world.
Factors that have been associated with increased risk of cancer including tobacco use, rising alcohol consumption, increasing use of processed food and meat, reduced fiber content in the diet, rising incidence of obesity and environmental factors are anticipated to contribute to the rising cancer incidence in India.
India is witnessing a gradual rise in key risk factors, as evidenced below:
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.
The mission is to improve public health and well-being by periodic screening of the oral cavity.
We aim to accomplish our mission by:
All this will need a coordinated effort from various health agencies.
Core values—fundamental, enduring, deeply held beliefs, anchor our decisions to create a nation 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 by inculcating the following.
Scientific Approach
We conduct 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.
Prevent occurrence of oral cancer which increasing incidences indicate is today the number one killer in the country. Our goal is to curb the disease. No doubt, this is an ambitious goal for Oral Cancer Foundation (OCF), which can be achieved through early detection and prevention.
Here, we 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 SPOT Centres.
The dental professional will have a key role in early detection of suspicious lesions plus to 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 conduct routine dental examination..
The Oral Cancer Foundation plans 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.
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 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.
Strengthen research
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.
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 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 needed 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.
Counseling 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 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.
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.
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 patient 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.
