|Year : 2021 | Volume
| Issue : 1 | Page : 1-5
Epidemiological trends of oral squamous cell carcinoma – An institutional study
Cathy Babu1, Treville Pereira2, Subraj Shetty2, Gotmare Swati Shrikant1, AK Anjali1, Rutuja Gajanan Vidhale1
1 Department of Oral and Maxillofacial Pathology, D Y Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
2 Department of Oral and Maxillofacial Pathology and Microbiology, D Y Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
|Date of Submission||22-Feb-2021|
|Date of Acceptance||09-Mar-2021|
|Date of Web Publication||03-Sep-2021|
Dr. Treville Pereira
Department of Oral and Maxillofacial Pathology and Microbiology, D Y Patil University School of Dentistry, Sector 7, Nerul, Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographic location, the incidence varies among groups categorized by age, gender or race. Aims and Objectives: The purpose of this retrospective study was to identify the trends in the age, gender, habits, sites involved and the histopathological grading which are given to patients diagnosed with OSCC in D.Y. Patil University School of Dentistry, Navi MumbaI. Materials and Methods: The study covered a period from July 2003 to July 2019. OSCC cases were retrospectively analysed for age, gender, habit, site of the lesion and histopathological grading given to patients diagnosed with OSCC. Charts were made, analysis was done and the results were formulated. Correlation was also done comparing gender vs habit, gender vs site of the lesion and gender vs histopathological grading given to the OSCC cases to check for statistical significance. Results: The study revealed a male to female ratio of ~ 0.7 : 0.3 with the largest number of OSCCs developing in the fourth and sixth decades of life. Overall, Buccal Mucosa (40%) was the most common site involved while floor of the mouth (2.8%) showed the least incidence. Other sites involved were gingiva (34%), tongue (12%), palate (4%) and labial mucosa (3%) respectively. Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. We even observed that 58% of cases were diagnosed with Well differentiated squamous cell carcinoma (WDSCC), 39% with Moderately differentiated squamous cell carcinoma (MDSCC) and 2% with Poorly differentiated squamous cell carcinoma (PDSCC). Correlation between gender vs habit, gender vs site of the lesion and gender vs histopathological grading of OSCC was done using chi square test and all the three parameters turned out to be statistically significant. Conclusion: An alarming rise in the number of OSCC cases over the years was observed from this 15-year retrospective study. Measures must be taken to make people aware about the ill effects of tobacco and the prolonged usage & the availability of treatment options should be made known to the affected individuals. Race, ethnicity and age cannot be altered; however, lifestyle behaviour such as use of tobacco and alcohol are amenable to change.
Keywords: Analysis, oral squamous cell carcinoma, retrospective study
|How to cite this article:|
Babu C, Pereira T, Shetty S, Shrikant GS, Anjali A K, Vidhale RG. Epidemiological trends of oral squamous cell carcinoma – An institutional study. Muller J Med Sci Res 2021;12:1-5
|How to cite this URL:|
Babu C, Pereira T, Shetty S, Shrikant GS, Anjali A K, Vidhale RG. Epidemiological trends of oral squamous cell carcinoma – An institutional study. Muller J Med Sci Res [serial online] 2021 [cited 2022 Jan 26];12:1-5. Available from: https://www.mjmsr.net/text.asp?2021/12/1/1/325483
| Introduction|| |
Oral squamous cell carcinoma (OSCC) is a well-known and established cause of morbidity and mortality globally with the incidence varying from one location to another.,, Oral and oropharyngeal carcinomas are the 6th most common carcinomas in the world of which OSCC seems to be the most prevalent. Various studies conducted worldwide and within our nation indicate that the incidence of OSCC varies among different regions of the world which can be linked to diverse sociocultural characteristics, location associated risk factors, variation in data collection methods and the availability and access of health services to privileged and unprivileged groups of people.,,,,, Even within each location, the cases of OSCC seem to be categorized according to the age, gender, and ethnicity of the person., Hence, analyzing and studying such distribution helps to put together descriptive cancer data which gives an idea about the extent of the problem and to understand the high-risk and the low-risk population., It also helps in relating the freight of oral cancer to that of other cancers to evaluate the allocation of resources for research, prevention, treatment, and support services. Dentists play a vital role in the early detection of oral malignancies thereby increasing the survival rate of the patients. Delay in diagnosis can be attributed to patient's ignorance of symptoms and lack of concern or delay brought about by an inexperienced dentist. Various studies have been done at the institutional level in India to analyze the geographic distribution, most of which covered a small period. Collecting the OSCC data of patients over a long period can help in the observation of how the prevalence of oral cancer has spiked over the years and to see if there is a significant change in the data known. The aim of this retrospective study was to identify the trends in the age group, gender, the different sites affected in the oral cavity and the histopathological grading given to the patients diagnosed with OSCC in D. Y. Patil University School of Dentistry, Navi Mumbai, covering a period of about 15 years.
| Materials and Methods|| |
Three hundred and seventeen histologically verified cases of OSCC were extracted from the archives of D. Y. Patil University School of Dentistry, Navi Mumbai covering a period from July 2003 to July 2019. The anatomic sites considered were the buccal mucosa, the floor of the mouth, gingiva, labial mucosa, palate, and tongue. Cancer originating from the lip was not considered in the study as the pathophysiologic behavior is significantly varied compared to other oral cancers. Comprehensive statistical analysis was performed, and charts were made listing out the age, gender, site of the lesion, habit pattern, and final diagnosis of 317 OSCC patients after which the results were formulated using SPSS 64-bit version.(SPSS Inc., Chicago, USA). Correlation using Chi-square test between 2 variables i.e. gender versu habit, gender versus site of the lesion and gender versus histopathological grading of OSCC was done.
| Results|| |
Of the 317 patients, men (69.8%) represented a higher proportion of OSCCs than females (30.2%). The large number of cases was seen to develop in the 4th to 6th decades of life [Figure 1]. The most common site involved was the buccal mucosa, followed by gingiva, tongue, palate, labial mucosa, floor of the mouth [Figure 2]. It was also noted that most of these patients had smokeless tobacco habit compared to the smoking tobacco habit or the mixed habit (smoking + smokeless) [Figure 3]. Fifty-eight percent of cases were histopathologically graded as well-differentiated squamous cell carcinoma (WDSCC), 39% of cases were moderately differentiated squamous cell carcinoma (MDSCC) and 2% cases were poorly differentiated squamous cell carcinoma (PDSCC) [Figure 4].
|Figure 4: Age distribution with respect to histopathological grading of oral squamous cell carcinoma|
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Correlation was done using Chi-square test. Correlation between gender versus habit, gender versus site of the lesion and gender versus histopathological grading of OSCC was done and all the three parameters turned out to be statistically significant [Figure 5], [Figure 6], [Figure 7] [Table 1], [Table 2], [Table 3].
|Figure 5: The bar graph represents association between habit and gender where X axis represents gender, and the Y axis represents number of participants. Chi square test was done giving P value = .000 (P < 0.05), hence statistically significant|
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|Figure 6: The bar graph represents association between site of the lesion and gender where X axis represents gender, and the Y axis represents number of participants. Chi square test was done giving P value = .000 (P < 0.05 ), hence statistically significant.|
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|Figure 7: The bar graph represents association between habit and histopathological grading given to the OSCC cases where X axis represents gender, and the Y axis represents number of participants. Chi square test was done giving P value = .000 (P < 0.05 ), hence statistically significant.|
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| Discussion|| |
According to the World Health Organization, there are an estimated 657,000 new cases of cancers of the oral cavity and pharynx each year, and more than 330,000 deaths. In countries such as Sri Lanka, India, Pakistan and Bangladesh, oral cancer is the most commonly seen cancer. More than 50% of all carcinomas in India is oral carcinoma with about 1% of the population expressing premalignant lesions and has been titled as the oral cancer capital of the world., Patients affected with oral cancer may remain socially and functionally crippled for the rest of their lives. OSCC has become a global health problem with increasing incidence and mortality rates with variation in incidence in each geographic location in relation to age, gender, and habits. Diagnosing oral cancer early can help in planning and instituting the treatment procedures which leads to a better prognosis whereas late diagnosis is directly proportional to poor prognosis. Many institution-based studies have been done to analyze the distribution of OSCC cases by comparing the age, gender, site of the lesion and histopathological grading of OSCC.
In the present study, the number of male OSCC patients were significantly more compared to females giving the ratio of 0.7:0.3 which was consistent with other studies.,,,,,, Most of the studies showed a male predominance which can be attributed to the socioeconomic norms favoring the easy availability of tobacco products to the male population along with the easy acceptance of habits by the same., On the other hand, a recent study done among patients treated in Davengere Dental College in Karnataka by Nayak et al. showed a slight female predilection (0.72:1) which was also noted in studies done in Thailand, Connecticut and Pakistan. This seems to be attributed not only to the easy availability and affordability of tobacco and associated products but also due to the liberalization and transformed thinking of the conservative female population over the last decade., Another study done by Smitha et al. to analyse the predilection of gender revealed that the female gender was significantly associated with carcinoma of buccal mucosa which was also consistent with the finding of Singh et al. who reported that smokeless form of tobacco was significantly associated in OSCC with women. Mehta et al. also observed a significant female predilection in a study done among the Srikakulam district of Andra Pradesh where reverse smoking habit was prevalent.
OSCC was seen between the age group of 4th to 6th decades of life with the mean age of 51 years. Twenty-nine percent cases were within the age group of 40–49, 26% within the age group of 50–59 years and 22% within the age group of 60–69 years. The youngest of all patients affected was below 20 years of age. There were more female patients affected among the age group of 80–89 compared to men.
Regarding the habit history, smokeless tobacco habit was seen to be more prevalent compared to smoking tobacco habit and the combined habit. Among the age group of 20–29, smokeless tobacco habit was the habit of choice rather than the smoking tobacco habit.
Buccal mucosa was the most common site involved which was consistent with many other studies.,,,, This was followed by gingiva, tongue, palate, labial mucosa, and floor of the mouth. Tobacco chewing has become a highly indulgent addiction in our country and is available in the form of chutki, gutkha, khaini, betel quid (paan) and tobacco smoking can be seen in the form of bidi, hukka, cigarettes etc., Consumption of Tobacco orally leads to direct contact between the carcinogens and irritants with the oral mucosa thereby leading to the development of cancer at the site of contact, which in turn affects the oral hygiene status and overall health of the patient. Betel quid is known to be associated with the proliferation and differentiation of oral epithelial cells. The prolonged placement of the betel quid in the buccal pouch to obtain a maximum effect as the constituents of betel quid produce a sense of well-being and increased capacity to work by stimulation of parasympathetic nervous system. The rising discovery of ready to use tobacco products and the marketing tactics attracts not only youths but also children. Efforts taken by the Government of India for the stoppage of the use of tobacco products seems to be inadequate and of weak effort as the availability of these products have increased over the years due to many factors such as the interference of the tobacco industry, issues with tobacco taxation and the failure of government to rehabilitate people involved with cultivation, production and distribution of tobacco products.,,
About 58% of cases were diagnosed with WDSCC, followed by 39% cases of MDSCC and 3% of PDSCC. The incidence of WDSCC being more than MDSCC and PDSCC was also consistent with other studies.,, Other studies have revealed MDSCC to be more compared to the other two gradings., This may be probably reflecting the contribution of etiological factors such as betel-quid and/or tobacco chewing toward the development of well or moderately differentiated tumors.,
Correlation using Chi-square test between two variables, i.e., gender versus habit, gender versus site of the lesion and gender versus histopathological grading of OSCC was done, all three correlations turned out to be statistically significant.
| Conclusion|| |
An alarming rise in the number of OSCC cases over the years was observed from this 15-year retrospective study. Measures must be taken to make people aware about the ill effects of tobacco and the prolonged usage and the availability of treatment options should be made known to the affected individuals. Race, ethnicity, and age cannot be altered; however, lifestyle behavior such as the use of tobacco and alcohol are amenable to change.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma P, Saxena S, Aggarwal P. Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study. Indian J Dent Res 2010;21:316-9.
] [Full text]
Shenoi R, Devrukhkar V, Chaudhuri., Sharma BK, Sapre SB, Chikhale A. Demographic and clinical profile of oral squamous cell carcinoma patients: A retrospective study. Indian J Cancer 2012;49:21-6.
] [Full text]
Nayak VN, Donoghue M, Selvamani M. Oral squamous cell carcinoma: A 5 years institutional study. J Med Radiol Pathol Surg 2015;1:3-6.
Singh MP, Kumar V, Agarwal A, Kumar R, Bhatt ML, Misra S. Clinico-epidemiological study of oral squamous cell carcinoma: A tertiary care centre study in North India. J Oral Biol Craniofac Res 2016;6:31-4.
Kaur J, Jain DC. Tobacco control policies in India: Implementation and challenges. Indian J Public Health 2011;55:220-7.
] [Full text]
Mukherjee S, Mishra US. Government interventions on tobacco control in India: A critical review. Indian J Human Dev 2014;13:183-94.
Perez RS, Freitas SM, Dedivitis RA, Rapoport A, Denardin OV, Sobrinho JA, et al.
Epidemiologic study of squamous cell carcinoma of the mouth and oropharynx. Int Arch Otorhinolaryngol 2007;11:271-7.
Salian V, Dinakar C, Shetty P, Ajila V. Etiological trends in oral squamous cell carcinoma: A retrospective institutional study. Cancer Transl Med 2016;2:33-6. [Full text]
Smitha T, Mohan CV, Hemavathy S. Clinicopathological features of oral squamous cell carcinoma: A hospital-based retrospective study. J NTR Univ Health Sci 2017;6:29-34. [Full text]
Jyoti D, Arti, Jamwal P, Kotwal S, Dolma K. Clinical profile of the patients with oral squamous cell carcinoma: A tertiary institutional study. Int J Otorhinolaryngol Head Neck Surg 2020;6:628-32.
Tandon A, Bordoloi B, Jaiswal R, Srivastava A, Singh RB, Shafique U. Demographic and clinicopathological profile of oral squamous cell carcinoma patients of North India: A retrospective institutional study. SRM J Res Dent Sci 2018;9:114-8. [Full text]
Ghafari R, Jalayer Naderi N, Emami Razavi A. A retrospective institutional study of histopathologic pattern of oral squamous cell carcinoma (OSCC) in Tehran, Iran during 2006-2015. J Res Med Sci 2019;24:53.
] [Full text]
Pindborg JJ, Mehta FS, Gupta PC, Daftary DK, Smith CJ. Reverse smoking in Andhra Pradesh, India: A study of palatal lesions among 10,169 villagers. Br J Cancer 1971;25:10-20.
Ayaz B, Saleem K, Azim W, Shaikh A. A clinicopathological study of oral cancers. Biomedica 2011;27:29-32.
Udeabor SE, Rana M, Wegener G, Gellrich NC, Eckardt AM. Squamous cell carcinoma of the oral cavity and the oropharynx in patients less than 40 years of age: A 20-year analysis. Head Neck Oncol 2012;4:28.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3]