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Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 66-69

Retrospective study on risk habits among buccal mucosa carcinoma patients in regional cancer Center, Tamil Nadu

Department of Medical Research, SRM Medical College Hospital and Research Centre, SRM University, Kancheepuram, Tamil Nadu, India

Date of Web Publication25-Jan-2018

Correspondence Address:
Ms. Ramasamy Padma
Department of Medical Research, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Kancheepuram - 603 203, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijohr.ijohr_30_17

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Background: Oral squamous cell carcinoma occurrence had geographical variations. In South India, the high incidence of buccal mucosa carcinoma occurs due to widespread use to tobacco chewing. There have been no studies reported on buccal mucosa carcinoma in Tamil Nadu. Objective: The aim of this was to analyze risk habits profile of buccal mucosa carcinoma patients. Materials and Methods: A cross-sectional, retrospective study of buccal cancer patients who reported during 2013–2015 in regional cancer center, Kanchipuram, Tamil Nadu. Data on demographic, socioeconomic, and risk habit profiles of the patients were recorded in a questionnaire. Results: A total of 198 buccal mucosa carcinoma patients included in the study. The buccal mucosa carcinoma was highly prevalent; 195 (98.5%) were reported with risk habits either with tobacco (smoking and smokeless), nontobacco (betel nut, pan masala, and alcohol), and multihabits. Further, an alarming identification that three (1.5%) were not have any habits of tobacco and nontobacco habits. The present study included 125 (63.1%) males and 73 (36.9%) females. The mean age of the patients was 55 years with high frequency of ≥40 years old (range: 12–88 years). Of 198 patients, 124 (62.2%) were reported from lower socioeconomic status who were likely to chew tobacco, smoke bidi, and drink alcohol. The study revealed highly significant relation of risk habits with gender, age, and socioeconomic status by Chi-square analysis at P < 0.001. Conclusions: The prevalence of buccal mucosa carcinoma was higher in the elderly male population with multihabitual. Thus, the study showed etiologic clues for prevention of buccal mucosa carcinoma in Tamil Nadu.

Keywords: Alcohol, areca nut, betel quid, oral cancer, smokeless tobacco, smoking

How to cite this article:
Padma R, Sathish P, Sundaresan S. Retrospective study on risk habits among buccal mucosa carcinoma patients in regional cancer Center, Tamil Nadu. Indian J Oral Health Res 2017;3:66-9

How to cite this URL:
Padma R, Sathish P, Sundaresan S. Retrospective study on risk habits among buccal mucosa carcinoma patients in regional cancer Center, Tamil Nadu. Indian J Oral Health Res [serial online] 2017 [cited 2023 Jan 31];3:66-9. Available from: https://www.ijohr.org/text.asp?2017/3/2/66/223927

  Introduction Top

Oral squamous cell carcinoma shows geographical variation with respect to the age, sex, site, and habits of the population.[1] In South East Asia, the high incidence was due to risk habits of smoking, betel quid, and tobacco chewing habits. The mixed habits act as synergistic effect, with higher risk than independent risk habits.[2] India had highest incident rate of oral cancer; it was aptly labeled oral cancer capital of the world with an estimated 1% of the population having oral premalignant lesions.[3]

Socioeconomic status was one of the most important variables affecting health-related quality of life and an important predictor of disease mortality and morbidity.[4],[5] Low socioeconomic condition related to poor hygiene, poor diet, or infections of viral origin had been demonstrated as a risk factor for cancer of oral cavity.[6]

In India, oral cancer was one of the most common cancers highly prevalent due to betel quid, tobacco, and pan masala chewing habits. These habits had cultural importance in traditional and religious ceremonies.[7],[8] The descriptive data for each specific geographic area were important for understanding the extent of the problem, determining which groups within the population were at highest and lowest risk, and relating the burden of disease to that of other diseases to evaluate the allocation of resources for research, prevention, treatment, and support services.[9] Therefore, this descriptive study was conducted to evaluate risk habits among buccal mucosa carcinoma patients reported between 2013 and 2015 in regional cancer center, Kanchipuram, Tamil Nadu.

  Materials and Methods Top

With approval of Institutional Ethical clearance, the present retrospective study was conducted in Oral Oncology Department, Arignar Anna Memorial Cancer Hospital and Regional Centre, Kanchipuram, between 2013 and 2015 (Ref No. 24984/2013).

To confirm the diagnosis, inclusion and exclusion criteria were implemented through physical and histopathological examination and classified by the standard International Classification of Disease 10 criterion. A total of 198 buccal mucosa carcinoma patients were included and demographic, socioeconomic, and risk habits details were collected using questionnaire.

Socioeconomic status scoring scale

Kuppuswamy's modified scale was used to evaluate socioeconomic status of study patients. Socioeconomic scale scoring was on the basis of three variables such as education, occupation, and income of total family. The total three weightages were assigned to each according to the seven-point predefined scale which was graded to indicate five socioeconomic classes such as upper class, upper middle, lower middle, lower upper, and lower class.[10]

Statistical analysis

The statistical analysis software IBM SPSS for windows, Version 16.0 (Chicago, IL, USA) was used to measure the mean and standard deviation of the quantitative variables and the absolute and relative frequencies of the qualitative variables. Chi-square/Fisher's exact test was used to test the association within variables. The results were considered significant at P < 0.001.

  Results Top

[Table 1] summarizes the basic characteristics of buccal mucosa carcinoma patients. The study included 198 Buccal mucosa carcinoma (BMC) patients between 2013 and 2015. There were more males 125 (63.1%) than females 73 (36.9%) in the study population. Of 198 patients, 71 (35.9%) of the study participants were in the young age group (<40 years) and remaining 127 (64.1%) were in the old age group of ≥ 40 years.
Table 1: Baseline characteristics of buccal mucosa carcinoma patients

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In the study, one-third of the study participants 164 (83%) had only school education or were illiterates and the remaining 33 (17%) of the participants were either degree or diploma holders. Occupation constitutes 79 (39.9%) participants were unemployed, 46 (23.2%) were unskilled, followed by 12 (6.06%) were semi-skilled workers, 18 (9.1%) were skilled worker, 11 (5.55%) were clark/shopkeeper/farmers, 16 (8.1%) were semi-professional, and 10 (5.05%) were professional. More than 157 (79.3%) of the study patients come from families with monthly income < Rs. 5000 per month, whereas others 41 (19.7%) belonged to families with income ≥ Rs. 5000/month.

The overall prevalence of drinking alcoholic beverages, areca nut chewing, pan without tobacco chewing, tobacco in smoking and smokeless, alcohol and pan, pan with tobacco, multihabitual, and nonhabits were 2 (1%), 7 (3.5%), 5 (2.5%), 36 (18.2%), 16 (8.1%), 51 (25.8%), 78 (39.4%), and 3 (1.5%), respectively.

[Table 2] summarizes the prevalence of habits by gender and age. Of 198 patients, the highest patients 78 (39.4%) had multirisk habits; the prevalence of multihabits was higher among men 63 (50.4%) when compared to women 15 (20.5%). Furthermore, the prevalence of multihabits was higher among ≥40 years of age groups, i.e., 66 (52%). In this population, the second most prevalence was tobacco consumption, tobacco consumption in the form of smoking and smokeless tobacco was more common among men 30 (24%) when compared to women 6 (8.2%), with the high prevalence 28 (39.4%) in the young adults, who were in the age group of ≥40 years. Pan chewing without tobacco and habits of alcohol beverages consumption were highly prevalent in old age groups and male participants 10 (7.9%) and 12 (9.6%), respectively. In women, the pan chewing habit was more prevalent when compared to the other habits, might be due to cultural habits 4 (5.5%) as compared to male 1 (0.8%), with the highest 4 (3.1%) being in the ≥40 years of age groups. In the study participants, more males 6 (4.8%) were likely to chew pan masala (commercially available processed areca nut product without tobacco) or gutkha (commercially available processed areca nut product without tobacco) than female 3 (4.2%) participants and also highest being in the ≥40 years of age. In men, the prevalence of alcohol beverages was 2 (1.6%) in both age groups whereas female did not have habits of alcohol consumption. However, an alarming identification of this study is that two (2.7%) females and one (0.8%) male, who were in older did not have any risk habits exposure. Thus, the present study revealed significant difference of risk habits in gender and age groups of participants by Chi-square analysis at P < 0.001.
Table 2: Association of risk habits according to gender and age groups of participants

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[Table 3] summarizes the prevalence of habits by socioeconomic status. In the present study, high prevalence of multirisk habits was from lower socioeconomic group, i.e., 64 (51.6%). In lower upper group, the highest participant was likely to chew pan with tobacco 17 (53.1%) than other groups. The prevalence of tobacco consumption in smoking and smokeless chewing was highest in lower middle 11 (52.4%), upper 2 (40%), and also upper middle 5 (31.2%) groups of participants. The fact that 3 (2.4%) participants were identified without any risk habits from lower socioeconomic group was disappointing. However, the risk habits had highly significant relation with socioeconomic status of participants at P < 0.001.
Table 3: Association of risk habits according to socioeconomic status of participants

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  Discussion Top

In India, oral cancer is a major public health problem.[11] It is a multifactorial origin; age, gender, illiteracy or low education level, working in agriculture sector, low monthly household income, marital status, smoking, chewing tobacco, drinking, and dietary habits were considered as significant contributing factors modifying the multistage process of carcinogenesis.[12]

Many Indian studies showed that oral squamous cell carcinoma was highly prevalent because of chewing betel quid alone/with tobacco and smoking.[13],[14] Pratik and Desai showed that 1% of all the screened patients had habits of alcohol consumption, which is lowest when compared with other habits.[15] Subapriya et al. revealed in their study that combination of smoking, chewing, and alcohol had a 11.34-fold higher risk than independent risk of disease.[8] Similar to earlier reports, the present retrospective study showed a total of 98.5% prevalence of buccal mucosa carcinoma with regard to risk habits of tobacco smoking, chewing, pan/areca nut chewing, and alcoholism. However, 39.4% had multihabits, which proved to be aggressive than single habits. Further, compared with all habits, alcohol prevalence reported with lowest of 1% buccal mucosa carcinoma patients. This baseline characteristic on buccal cancer provides etiological clues for future hospital-/population-based epidemiological studies.

Although 90% of oral cancer occurs with cause of established risk factor such as tobacco, pan masala, areca nut, and alcohol, the rest of 10% might be risk of dietary factors, poor oral hygiene, poor dental status, denture irritation, genetic predisposition, oncogenic viruses, occupation, exposure to sunlight, hormones (estrogens), and sexual practices.[6],[16] A previous cohort study from Kerala reported the high incidence of buccal mucosa carcinoma among young adults without any risk habits. Another hospital-based ten-year retrospective study from Karnataka reported with 25% habit-free oral cancer patients.[9] Similarly, the present study also identified three (1.5%) habit-free buccal mucosa carcinoma patients between 2 years.

The previous study showed the increased incidence of oral cancer and male predominance in patients aged ≥50 years with multirisk habits of betel quid/tobacco chewing and smoking.[9] In contrary, another study from Rajasthan reported a high prevalence of male than female when compared to smoking and a high prevalence of female than male with smokeless tobacco chewing habits, i.e., 15. The present study also follows the previous reports, indicating a high prevalence of male patients aged ≥40 years with multihabits of tobacco consumption in smoking and chewing form.

In a meta-analysis study, 41 case–control studies across the globe had demonstrated that low socioeconomic condition includes people doing manual occupations such as agriculture, laboring, and working in industries. Illiterates those who never attended school and with low educational attainment reported as an independent risk factor for oral cancer development.[4],[5],[17],[18] In accordance with the previous reports, the present study revealed highly significant relation with socioeconomic status of patients. In the study, most of the patients from lower socioeconomic status who had habit of tobacco chewing might not know the nutritional value of diet.

  Conclusions Top

The present study concludes shed light on the preventive measures of buccal mucosa carcinoma on risk habits, particularly tobacco chewing/smoking, pan masala chewing, and alcoholism in this region. Further, the study suggested implementing risk of habits, early sign symptoms, self-examination instructions, and oral cancer screening programs might prevent the morbidity and mortality of buccal mucosa carcinoma in this region.


Our team would like to acknowledge and thank Arignar Anna Memorial Cancer Hospital and Research Centre, Kanchipuram, permitted to conduct the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ayesha Z, Nagi AH, Nadia N. A clinicopathological study of orofacial squamous cell carcinoma in local population. Biomedica 2013;29:147-50.  Back to cited text no. 1
Abdul HS, Taqi M, Ttazeen R. Evaluating the correlation between histopathological patterns of oral squamous cell carcinoma, age & site. Pak Oral Dent J 2015;35:30-2.  Back to cited text no. 2
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Conway DI, Brewster DH, McKinney PA, Stark J, McMahon AD, Macpherson LM. Widening socio-economic inequalities in oral cancer incidence in Scotland, 1976-2002. Br J Cancer 2007;96:818-20.  Back to cited text no. 4
Ganesh R, John J, Saravanan S. Socio demographic profile of oral cancer patients residing in Tamil Nadu - A hospital based study. Indian J Cancer 2013;50:9-13.  Back to cited text no. 5
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  [Table 1], [Table 2], [Table 3]


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