Head and Neck Cancers: Common Indian Cancer
Department of Cancer Epidemiology and Biostatistics, Dr.B Borooah Cancer Institute, Guwahati
Received date: 22 Aug 2017; Accepted date: 12 Sep 2017; Published date:
19 Sep 2017.
*Corresponding author: Manigreeva Krishnatreya, Department of Cancer
Epidemiology and Biostatistics, Dr. Bhubaneswar Borooah Cancer Institute,
Guwahati, India; E-mail: email@example.com
Keywords: Head and neck cancer; Oral cancer; Causation; Human Papilloma Virus
Head and neck cancer is one of the leading causes of death and disability
in India. Head and neck cancer comprises of cancers of the lip, tongue,
oral cavity, and throat. Of all head and neck cancers, oral cancer is the
most common in the country and it is the primary cause of cancer related
deaths in Indian men. Every year, nearly 100,000 cases of mouth cancers
are diagnosed, out of which 50% die within 12 months of diagnosis.
Throat cancer (pharynx and larynx) is the next common head and neck
cancer in terms of prevalence. As per estimates from the National Cancer
Registry Programme under the Indian Council of Medical Research,
India is witnessing an increase in the incidence of head and neck cancers.
Indeed, they are among the top cancers affecting men and are the third
most common cancers affecting women. Since 9% of these tumors are
related to tobacco, alcohol and areca-nut usage, head and neck cancers are
considered as preventable cancers.
The actual burden of head and neck cancer in India is much greater
than reflected through the existing literature and hence can be regarded
as a ‘tip of iceberg’ situation . In India, the distribution of populationbased
cancer registries is grossly uneven with major parts of the country
being not represented and hence the current cancer burden is not fully
reflected by present population based cancer registry data. Head and neck
cancer in India has distinct demographic profile, risks factors, food habits,
family and personal history . At the population level, around 30 in
100,000 and 10 in 100,000 men and women, respectively will be afflicted
with head and neck cancer each year . In India, head and neck cancers
are a major problem constituting approximately 20-30% of all cancer
cases, which is in contrast to 4-5% in the developed world. However, the
irony is, the management of these cancers is mostly if not all is dictated
by treatment guidelines that has evolved from the developed countries.
Although very recently, researchers from India have published a practice
changing paper and challenged the existing dogma in the management of
oral cancers .
The major risk factor for the causation of head and neck cancers is
the use of tobacco in any form. It has been seen that decreasing use of
tobacco over the last few decades in the developed world has resulted in a
decline in the incidence of tobacco-related head and neck cancers in those
countries. But, in India due to rampant prevalence of tobacco use, the
incidences of head and neck cancers are rising each year. There have been
some attempts by the government to decrease the use of tobacco and as
per the latest Global Adult Tobacco Survey there has been a slight decline
in the tobacco consumption in the country as a whole . However, given
the magnitude of the problem there is much more that needs to be done
to significantly impact on reduction in the incidence of head and neck
cancers in the country. More recently, Human Papilloma Virus (HPV) has
been implicated in the causation of head and neck cancers. Here again the
vast majority of data is from the western countries. Parallel to this decrease
in the incidence of tobacco-related cancers in developed countries,
there has been an increase in human HPV related cancer. However, this
changing epidemiology is not seen in India, despite literature suggesting
that up to 40% coexisting prevalence of HPV is seen in head and neck
cancers from the country. Areca nut chewing is another risk factor for
head and neck cancers in India. Areca nut chewing is a customary habit
in many parts of the country and it is believed to be the leading cause of
oral cancers in women . The current focus of oral cancer prevention in
India is on avoidance of chewable tobacco like gutkha, zarda, khaini etc.
by mass media and other forms of awareness creation among the public.
However, areca nut consumption is not focused as one of the potentially
preventable risk factor for the causation of oral cancer especially among
women of the country.
In India, majority of cancers present at advanced stage disease. While
most of the current efforts focus on the treatment and outcomes following
treatment, the need for early detection simply cannot be overlooked. An
earlier study from India has demonstrated the proven benefit of populationbased
screening for oral cancers . Oral cancer and potentially malignant
lesions of the oral cavity can be easily diagnosed due to its anatomical
location. The benefit of oral cancer screening is reduction in the number
of deaths in high risk population and this can be done by simply training
health workers without the need of sophisticated equipments, or even
doctors. Although it will be very difficult to implement population-based
cancer screening of oral cavity at a national level with existing resources,
but it is worthwhile to carry out opportunistic screening among highrisk
individuals or mouth self-examination is an even more cost-effective
alternative. A pilot study has shown that majority of patients reported late
due to lack of awareness about the disease .
Head and neck cancer control will require pro-active response from the
policy makers, Non-Government Organizations, health care professions,
researchers, and from the industry. By the means of collective efforts,
the burden of head and neck cancer in our population can be reduced
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