Cancer is a malignant neoplastic disease where unlimited and uncoordinated growth of a group of cells occurs within a tissue and invades the surrounding tissues causing destruction and has the potential to spread to other parts of the body. Malignant neoplasms of the oral cavity or oropharynx predominately begin from epithelial tissue, despite the fact that mesenchymal neoplasms can occur from bone, fibrous tissue and endothelial cells. Epithelial-derived neoplasms are classified as carcinomas and can emerge from the epithelium of the oral cavity, oropharynx and salivary glands, as well as or less commonly residual odontogenic epithelium within the jaw.15 Among them, squamous cell carcinoma (SCC) is the most common type. Oral malignant growth is a quiet ailment in the underlying stages, when the side effects are either absent or very vague and exceptionally insignificant clinical findings are evident from physical examination. Oral disease may sometimes develop subsequent to other conditions in the mouth, referred to as oral potentially malignant disorders (OPMD). In most cases, the oral malignant growth lesion would be in advanced stages at the time of examinition to health care professionals. The signs and side effects include a quickly developing tumor mass with or without ulceration, a chronic non- healing ulcer, trouble in talking, trismus, dysphagia, terrible breath and mobile teeth. There might be pain when the injury is contaminated or when there is auxiliary inclusion of nerves, and occasionally spontaneous bleeding.16
SOCIOECONOMIC INEQUALITIES IN ORAL CANCER
A social gradient exists for health. Social imbalances in different wellbeing results have been seen in both developed and developing countries. There are contrasts in the frequency; mortality and survival explicit to oral disease.17 Individuals of low SEC have higher mortality and lower five-year survival post-treatment than their counterparts. This difference could be related to a delay in examination of a person’s characteristics for example, nutrition, diet, awareness about the diseaseas well as the uptake of screening programs that have a socioeconomic component.18 Oral malignant growth is more frequently seen among those from the low financial status and those living in deprived areas.19.20 Low pay, low dimensions of training and occupation are connected to oral malignancy in developing and developed countries.21-24 It is trusted that the social imbalance in oral disease might be clarified by the risk factors.21,23 All things were considered, but still there is some degree of risk among individuals of low SEC that isn’t clarified.9
Some studies have been done to understand the relationship between SEC and oral cancer which is reviewed and found that unskilled workers had higher chance for developing oral cancer 25, low education was associated with oral cancer when adjusted with age 26, there was no relation between income and oral cancer 27 and those who worked in vehicle maintenance shops had higher chance for oral/oropharyngeal cancer than other occupational groups after adjusting for age, alcohol and smoking.28
In India, 20 per 100000 populations are affected by oral cancer which accounts for about 30% of all types of cancer. According to statistics in 2012, 53842 in males and 23161 in females were reported with oral cancer but in 2018 1,19,992 cases were registered in India both in males and females. Oral malignancy will remain a noteworthy medical issue and the occurrence will increment by 2020 and 2030 in both genders, anyway early discovery and counteractive action will diminish this trouble.29,30 The prevalence is high in South Asian countries such as India, Bangladesh, Sri Lanka, and Pakistan and in some countries of West Asia (Yemen) and Melanesia (PNG) among them the prevalence in India is North: Delhi, Patiala, South: Bangalore, Chennai, Kollam, Thiruvananthapuram Central: Bhopal, East: Kolkata, Northeast: Cachar district, Kamrup urban, Manipur, Mizoram, Nagaland, Meghalaya, Sikkim and Tripura, West: Mumbai, Nagpur, Pune, Ahemedabad and Barshi extended Rural west: Barshi (rural) and Ahemedabad (rural).31 When compared to men, females are more prone to oral cancer.
Oral malignancy is a preventable disease, where smoking and alcohol is considered as major risk factors which are present in 90% of cases, having them both a synergic effect.
1. Tobacco and alcohol
Tobacco and alcohol use are the most preventable reasons for oral disease. About 75% of oral malignancy can be assigned to tobacco in either smoking or smokeless structures. Smokeless tobacco (SLT) use is reported in both men and women in developed and developing countries.32,33 Besides this SLTs are utilized more commonly by children and youth.34,35 It is available as finely chopped tobacco leaves, powder and furthermore industrially stuffed enhanced tobacco in Southeast Asian nations but in developed countries like the United States of America, Sweden and the United Kingdom. SLT is accessible as dry and clammy snuff (dissolvable or insoluble). The health implications of SLT in the American and European population might be definitely broader than recently accepted.36-38 In many case, SLT has been set up as a cancer-causing agent. Additionally, the SLT in America and Europe might be not quite the same as that of Asian nations. Asians and a portion of the Asian migrants in America and Europe use SLT alongside areca nut, lime and betel leaves that are increasingly cancer-causing.39
Tobacco smoking is in various forms such as cigars, cigarettes, bidis and pipes which are prevalent across the world. There is extensive proof that smoking plays an aetiological role in oral malignancy. Smoking has an independent effect and it interacts with SLT and alcohol to exert a joint effect which increases the risk for oral cancer.40
Drinking liquor is a vital hazard factor for oral disease. Oral cancer risk is increased with number of beverages expanded in India. A study has found that liquor utilization increase the rate by 49% among current users and 90% in past drinkers.41 This could be due to residual effect of alcohol consumption or having quit the habit due to serious illness. Utilization of mixed drinks was related with increased risk for oral malignant growth in men yet it was not seen in women because very few women consumed alcohol.42 There is evidence that alcohol is associated with oral cancer contributing to 7-30% of the oral cancer. Alcohols independent effect is less but it has a synergistic effect on the carcinogenic potential of tobacco.43 In a recent study details regarding patient’s habits, age, gender, and site with OC were recorded in which majority of patients were tobacco chewers followed by alcoholic and smoking, only smokers and only alcoholic.44
Diet has been investigated for risk enhancement and risk reduction for oral cancer. Dietary intake of animal protein and fat is independently associated with oral malignant growth.45 Consumption of processed meat increases the risk of oral malignancy more than the intake of red/white meat. Processed meat is frequently contaminated with nitroso compounds, which are known cancer-causing agents. Conversely a standard utilization of fish and dairy items decreases the risk.46 The dietary utilization of legumes, vegetables and organic products is observed to be defensive against oral malignant growth.47 In Brazil, reduced intake of fruits and vegetables increased the risk for oral disease but rice and beans are prevention for oral malignant growth. In some study, the garlic and onion intake has been found to be protective agent against oral malignancy.48 Among the Southern European population, such ‘allium’ vegetables were related with lower risk. Curcumin, a chief polyphenol compound present in turmeric, has been proposed to be anti- carcinogenic, with support for the anti-cancer property of curcumin mostly from laboratory studies.49
3. Poor oral health/hygiene
Poor oral hygiene has been related with malignant growth, and expanded mortality from disease, because of oral contamination. Tooth loss and poor oral hygiene reflecting poor oral wellbeing have been analyzed for a relationship with oral disease.50 An Italian study demonstrated that oral hygiene and general oral condition were imperceptibly more regrettable among cases than controls found those individuals with missing teeth and those announcing not brushing their teeth higher chances for oral disease.51 The recommended pathways connecting poor oral wellbeing and oral disease are through human papillomavirus (HPV) contamination is promoted by the presence of inflammatory sites in the mouth. The association is more attached to the site in the oropharynx than the oral hole.52 Other than HPV disease; other guessed clarification could be that oral malignant growth conclusion is related with unpredictable dental visits, which is additionally connected with missing teeth. The genetic studies support an association among alcohol and poor oral cleanliness.53 Among those with moderate alcohol utilizing genotype (ADH1B), salivary ethanol fixation stays higher and for a more extended span which could be used by gigantic smaller scale life forms in those with poor oral cleanliness, in this way expanding the danger of oral malignant growth. Additional proof is required to comprehend the connection between poor oral wellbeing and oral disease.54
4. Body mass index
Body mass index has been connected to oral and pharyngeal malignancies. Lean body mass has been appeared to upgrade the smoking-and drinking-related chances proportion (OR) for oral/pharyngeal disease, however no association was seen with oral/pharyngeal malignant growth among never consumers and never smokers.55 On the other hand, overweight and weight was related with a lower risk for oral disease. The connection between weight and oral disease is additionally upheld by the information from a study demonstrating lower chance with an increase in weight between the age of 30 years and two years before the meeting.57 There could be a potential bias from residual confounding or reverse causation. However, the underlying mechanism is yet unclear.56