| Abstract|| |
Background: Cancer is a menace to public health and is the most common cause of morbidity and mortality. The incidence of oral cancer among men in Pondicherry is found to be one of the highest rates of cancer in the world. The present survey was conducted to assess the relationship between sociodemographic factors and oral cancer awareness level.
Materials and Methods: A questionnaire-based survey was conducted among the patients who reported to the dental college and hospital in Pondicherry for routine dental examination. The questionnaire comprised of 19 questions that assessed the participant's awareness regarding oral cancer, signs and symptoms, and the risk factors. Sociodemographic information was also recorded. Data collected were analyzed using Statistical Package for the Social Sciences version 20.
Results: A total of 503 participants participated in the study comprising 61.6% males and 38.4% females. A significant difference was noted in awareness level and knowledge with respect to gender, place of residence, and marital status (P < 0.001). Males had higher mean scores when compared to females and urban population was more knowledgeable compared to rural group. Post hoc analysis showed that the awareness was least among the older age group (>50 years) with a significant statistical difference (P < 0.001). Comparison between different education groups revealed a higher awareness level among the graduate group, and working group was more knowledgeable in all three domains.
Conclusion: Sociodemographic factors were found to be significantly associated with oral cancer awareness, knowledge of early symptoms, and risk factors.
Keywords: Knowledge, oral cancer awareness, risk factors, socio demography
|How to cite this article:|
Pancharethinam D, Daniel MJ, Subbiah S, Srinivasan SV, Jimsha VK. Relationship between sociodemographic factors and oral cancer awareness and knowledge: A hospital-based study. J Educ Ethics Dent 2016;6:56-60
|How to cite this URL:|
Pancharethinam D, Daniel MJ, Subbiah S, Srinivasan SV, Jimsha VK. Relationship between sociodemographic factors and oral cancer awareness and knowledge: A hospital-based study. J Educ Ethics Dent [serial online] 2016 [cited 2018 Apr 22];6:56-60. Available from: http://www.jeed.in/text.asp?2016/6/2/56/223005
| Introduction|| |
Cancer is a menace to public health and is the most common cause of morbidity and mortality in the developed and the developing countries. According to GLOBOCAN 2012, an estimated 14.1 million new cancer cases and 8.2 million cancer-related deaths occurred in 2012, compared with 12.7 million and 7.6 million, respectively, in 2008. Estimates predict a substantive increase to 19.3 million new cancer cases per year by 2025, due to growth and aging of the global population.
Oral cancer is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries. In India, because of cultural, ethnic, and geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. It ranks number one in terms of incidence among men and third among women.
The Atlas More Details of Cancer in India (2005) reveals that the average annual age-adjusted incidence rates for microscopically diagnosed cases of oral cancer (microscopic age-adjusted incidence rates) were highest among females in Kolar district (10.7/100, 000), followed by Bengaluru rural in Karnataka, Kollam district in Kerala, Villupuram district in Tamil Nadu, and Pondicherry district in the Union Territory of Puducherry. The highest incidence among males is reported from Wardha in Maharashtra (14/100, 000) followed by Kanyakumari (Tamil Nadu), Kollam (Kerala), Thiruvananthapuram (Kerala), and Pondicherry as per Atlas of Cancer in India (2005). Five districts (Wardha, Kanyakumari, Pondicherry, Thiruvananthapuram, and Kollam) in India have recorded a much higher mouth cancer incidence ranging from 9.1 to 14.1 as compared to the global scenario.
Tobacco use accounts for 3 million deaths each year worldwide, and nearly a third of these deaths occur in India alone. One of the major risk factors associated with the high prevalence of head and neck cancer and oral potentially malignant diseases in Southeast Asia is smokeless tobacco.
Despite the oral cavity being a very accessible site for clinical or even self-examination, patients with oral cancer report to the health professionals at advanced stages mainly due to the poor public awareness of the signs and symptoms of oral malignant and premalignant lesions. The objective of the present study was to assess the awareness and knowledge of oral cancer, knowledge of risk factors, signs and symptoms of oral cancer and to associate the sociodemographic factors with the awareness level in the high-risk population of Pondicherry.
| Materials and Methods|| |
The survey was conducted between February and March 2015 among a random sample of 503 patients who reported to the dental college and hospital in Pondicherry for routine dental examination and treatment. The study population included individuals from in and around Pondicherry who visited the institute. Participants of 18 years of age and above were included in the study and individuals who were diagnosed with oral cancer at any point of their lifetime were excluded from the study. An interviewer-administered questionnaire was provided to the participants. The survey was conducted by one researcher in the clinics of Department of Oral medicine and Radiology.
A structured questionnaire was prepared both in English and the vernacular language Tamil. The questionnaire consisted of 19 close-ended questions assessing the participant's general awareness about oral cancer, knowledge of its early signs and symptoms, and also the risk factors associated with oral cancer. It also included sociodemographic information such as age, sex, occupation, education level, marital status, and place of residence.
Questions and variables
First section of the questionnaire comprised of six questions and it assessed the general awareness of oral cancer. The second section consisted of eight questions assessing the participant's knowledge of signs and symptoms of oral cancer. The third section was to assess the knowledge of risk factors associated with oral cancer, and it consisted of five questions.
Response categories for each of the questions were yes, do not know, and no and were scored as 3, 2, and 1, respectively. The participants were instructed to give only the most appropriate answer. Apart from these 19 questions, participants were also asked about their habits such as smoking, alcohol consumption, betel quid, and use of smokeless tobacco and those information was also recorded.
Descriptive statistics of sociodemographic variables were reported as percentage. Statistical analysis was performed by means of IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp). Analysis was done in terms of mean, standard deviation (SD), and for comparison of means unpaired t-test and one-way ANOVA test was carried out. Post hoc Bonferroni analysis was done to compare mean between different groups.
The ethical clearance was obtained from the Ethical Committee meet conducted in the institution. The survey was explained to the patients and informed consent was obtained from those who agreed to participate in the survey.
| Results|| |
A total of 503 participants participated in the study comprising 61.6% males and 38.4% females. Majority of the participants were from the age group of 18–30 years (37.8%). Neatly 31% of the participants were graduates and illiterates accounting for 21.1%. With respect to the place of residence, 55.3% of them belonged to urban areas and 44.7% with rural background. Most of the participants were married (70%) and 54.5% of the participants were working [Table 1]. On assessing the general awareness, 85.48% of the participants were aware of oral cancer. Almost 52.4% of them replied that oral cancer is not a communicable disease and 17% of them believed that oral cancer is contagious.
The general awareness of oral cancer varied significantly among different age groups, with more awareness of the younger age group (18–30 years) with a mean score of 17.10 (SD: 1.42). Awareness was least among the participants who were above 50 years of age with a mean score of 15.44 (SD: 2.18). Similarly, on assessing the knowledge of signs and symptoms and risk factors, the younger age group of 18–30 years showed a highest mean score of 21.48 ± 2.51 for knowledge of signs and symptoms and 13.83 ± 1.37 for knowledge of risk factors, respectively. This difference in observation was found to be statistically significant in all the three domains (P < 0.001) [Table 2].
|Table 2: Mean±standard deviation scores for general awareness, knowledge of symptoms, and knowledge of risk factors for different age groups|
Click here to view
The awareness of oral cancer was directly proportional to the educational level which was highest among the graduates with a mean score of 17.28 ± 1.20 for general awareness, 21.81 ± 2.15 for knowledge of signs and symptoms, and 14.10 ± 1.26 for knowledge of risk factors followed by the participants who had their high school and primary school education and was lowest among the illiterates. This difference in observation was found to be statistically significant in all the three domains (P < 0.001) [Table 3].
|Table 3: Mean±standard deviation scores for general awareness, knowledge of symptoms, and knowledge of risk factors for different education groups|
Click here to view
A significant difference was noted on comparing the mean scores of general awareness (P = 0.002) and knowledge of risk factors (P = 0.018) between the gender indicating higher awareness among males whereas no significant difference was found between males and females with respect to knowledge of signs and symptoms [Table 4].
|Table 4: Mean±standard deviation scores for general awareness, knowledge of symptoms, and knowledge of risk factors across gender|
Click here to view
The mean scores for general awareness, knowledge of symptoms, and risk factors differed significantly across different occupation groups with P < 0.001 indicating that the nonworking group had a low awareness [Table 5]. A significant difference in the awareness and knowledge level was observed with respect to place of residence and marital status showing that the urban population and unmarried individuals being more knowledgeable [Table 6] and [Table 7].
|Table 5: Mean±standard deviation scores for general awareness, knowledge of symptoms, and knowledge of risk factors for occupation groups|
Click here to view
|Table 6: Mean±standard deviation scores for general awareness, knowledge of symptoms, and knowledge of risk factors for place of residence|
Click here to view
|Table 7: Mean±standard deviation scores for general awareness, knowledge of symptoms, and Knowledge of risk factors for marital status|
Click here to view
Post hoc Bonferroni analysis indicated that the mean scores for working group in all three domains were significantly different than nonworking group (P < 0.01). However, there is no significant difference between working and student group (P = 1). Comparison between different age groups showed that age group >50 years had least mean scores and significantly differed from all the other age groups pertaining to the general awareness and knowledge of symptoms and risk factors (P < 0.001), whereas there was only a mild deviation in the mean scores between other age groups. Comparing the different education groups revealed a significant difference between illiterates and other groups (P < 0.001). The awareness level of graduate group was signifi cantly higher compared with other three groups (P < 0.01); however, there was no signifi cant difference between high school group and individuals who had a primary education (P = 1).
Among the participants, 22.4% had the habit of alcohol consumption, 8.34% were smokers (cigarettes and bidis), and 6.56% used smokeless tobacco. Nearly 4.17% were betel quid chewers, and this risk habit was more common among the elderly illiterate women. Almost 10.33% of the respondents were exposed to both smoking and alcohol consumption. About 51.8% of the respondents were exposed to one or more of the risk habits.
Nearly 95.4% of the respondents recognized smoking as a major contributing risk factor for oral cancer and 87.9% associated the use of smokeless tobacco with oral cancer. Almost 70.4% and 66% of the participants related to betel quid chewing and alcohol consumption with oral cancer, respectively. About 8.3% of the participants associated with genetic factors with oral cancer.
| Discussion|| |
In India, the incidence of oral cancer is about 3–7 times more common as compared to resource-rich countries. Oral cancer remains the most common cancer among the male population and is the third most common cancer among women after cervical and breast cancer in India. High incidence rates are seen among the subpopulations of women in Southern India because of tobacco chewing.
India is the second largest producer of tobacco, and most of the tobacco produced is consumed within the country, with approximately 274.9 million tobacco users according to data (Global Adult Tobacco Survey, 2010). It is quite understandable that knowledge of oral cancer in a given population is directly related to the prognosis of the cases identified. This is because the enhanced awareness on oral cancer in general and specifically in relation to its symptoms and risk factors can possibly lead to early clinical presentation. The lack of knowledge in identifying early signs of oral cancer may result in ignoring early precancerous lesions.
The present questionnaire-based survey was carried out among the high-risk population of Pondicherry which is identified as the place with a higher incidence of oral cancer among men worldwide (8.9/1,000,000). Sociodemographic factors were found to be significantly associated with oral cancer awareness in this study. The Directorate of Economics and Statistics (Government of Pondicherry) in 2011 census had documented a literacy rate of 91.23% for males and 79.86% for females in Pondicherry. Nearly 69.2% of the population belonged to urban areas and 30.8% to rural areas. The results indicated that the awareness of oral cancer, knowledge of symptoms, and the associated risk factors were proportional to the educational level of the participants. This may be attributed to the higher literacy rate among this study population which signifies the impact of education on health awareness. This finding is in accordance with other studies ,,, which have documented that awareness is proportional to the education level of the respondents. In this study, the working participants showed higher mean scores in all three domains which again indicate the significance of education on oral health and awareness. A difference was observed in the gender-wise knowledge pertaining to general awareness and risk factors which was statistically significant with males having a higher mean score than females owing to the higher male literacy rate in this population. This is in contrary to a study by Ghani et al. where women were found to be significantly more aware than men.
In a study by Misirlioglu et al., age was found to affect awareness, with older participants being more aware of the signs of oral cancer compared with younger participants. The present study showed that the knowledge level in all the three domains was highest with the respondents from younger age group (18–30 years) with most of them belonging to the student and graduate group. The awareness level in this younger population may be attributed to mass media exposure, health awareness programs, and antitobacco campaigns. The above-mentioned factors can also be related to the higher awareness among the urban population in our study.
Tomar and Logan  reported that 50% of study participants were aware that red and white lesions could be cancerous lesions and Ariyawardana and Vithanaarachchi  found that 44.9% were knowledgeable regarding precancerous lesions in the oral cavity. In this study, nearly one-quarter of the participants (23%) were aware of precancerous lesions. The health-care workers should extend their role in training the public to practice self-oral examination so that the patient delay in presenting to the health-care professional may be minimized.
In a study by Pakfetrat et al., 15.9% of the participants expressed awareness that smoking is a risk factor and 6.6% identified alcohol as a risk factor for oral cancer. In our study, 95.4% of the respondents identified smoking as the major risk factor and the association of alcohol with oral cancer was identified by 66% of the participants. Despite the fact that participants had a good knowledge about the risk factors of oral cancer, 51.8% of the respondents had one or more of the risk habits. Most of the participants who consumed alcohol were unaware of the fact that alcohol consumption may lead to oral cancer. The respondents had a poor knowledge about the synergistic effect of alcohol and smoking on oral cancer which could be a reason for the increased incidence of oral cancer among this population. The effect of combined exposure to alcohol and tobacco on risk of oral and pharyngeal cancer appears to be multiplicative; the risk of combined exposure is the product of the increases in risk associated with exposure to either habit. Investigations have to be carried out to explore the reasons behind the practice of high-risk habits in this population in spite of good knowledge. The advantage of mass media together with oral health awareness programs, antitobacco campaigns, and habit cessation counseling can educate the public about oral cancer and its risk factors. The limitation of this study was that the population studied included patients attending an educational institution and so the results could not be generalized to the entire population of Pondicherry.
| Conclusion|| |
Results of the present survey indicate that the sociodemographic factors do play a pivotal role in oral cancer awareness and are significantly related to the awareness level and knowledge. Social awareness through intensive educational programs regarding the deleterious effects of tobacco and alcohol are highly recommended in this population.
India has the maximum number of oral cancer sufferers and the resources to serve such a huge number remain limited. It is high time to initiate effective screening programs and to create awareness among the public regarding the risk factors and symptoms of oral cancer, thereby bridging the gap between the research and development and awareness among the public.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al
. GLOBOCAN 2012 Ver. 1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globocan.iarc.fr
. [Last accessed on 2014 May 19].
Sankaranarayanan R, Masuyer E, Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: A global perspective on epidemiology and prognosis. Anticancer Res 1998;18:4779-86.
Gupta V, Kumar P, Yadav S, Khattar A, Tyagi S. Oral cancer as a leading annoyance of the South Asian territory: An epidemiologic and clinical review. Clin Cancer Invest J 2012;1:196-200.
Nandakumar A, Gupta PC, Gangadharan P, Visweswara RN, Parkin DM. Geographic pathology revisited: Development of an atlas of cancer in India. Int J Cancer 2005;116:740-54.
Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.
Scott S, McGurk M, Grunfeld E. Patient delay for potentially malignant oral symptoms. Eur J Oral Sci 2008;116:141-7.
Khan Z. An overview of oral cancer in Indian subcontinent and recommendations to decrease its incidence. WebmedCentral Cancer 2012;3:WMC003626.
Gupta B, Ariyawardana A, Johnson NW. Oral cancer in India continues in epidemic proportions: Evidence base and policy initiatives. Int Dent J 2013;63:12-25.
Global Adult Tobacco Survey (GATS). Ministry of Health and Family Welfare, Government of India. International Institute for Population Sciences (IIPS); 2009-2010.
Agrawal M, Pandey S, Jain S, Maitin S. Oral cancer awareness of the general public in Gorakhpur city, India. Asian Pac J Cancer Prev 2012;13:5195-9.
Mudur G. India has some of the highest cancer rates in the world. BMJ 2005;330:215.
Formosa J, Jenner R, Nguyen-Thi MD, Stephens C, Wilson C, Ariyawardana A, et al.
Awareness and knowledge of oral cancer and potentially malignant oral disorders among dental patients in far North Queensland, Australia. Asian Pac J Cancer Prev 2015;16:4429-34.
Ariyawardana A, Vithanaarachchi N. Awareness of oral cancer and precancer among patients attending a hospital in Sri Lanka. Asian Pac J Cancer Prev 2005;6:58-61.
Elango JK, Sundaram KR, Gangadharan P, Subhas P, Peter S, Pulayath C, et al.
Factors affecting oral cancer awareness in a high-risk population in India. Asian Pac J Cancer Prev 2009;10:627-30.
Ghani WM, Doss JG, Jamaluddin M, Kamaruzaman D, Zain RB. Oral cancer awareness and its determinants among a selected Malaysian population. Asian Pac J Cancer Prev 2013;14:1957-63.
Misirlioglu M, Nalcaci R, Yardimci SY, Adisen MZ. Oral cancer knowledge among Turkish dental patients. Clin Cancer Invest J 2013;2:149-52.
Tomar SL, Logan HL. Florida adults' oral cancer knowledge and examination experiences. J Public Health Dent 2005;65:221-30.
Pakfetrat A, Falaki F, Esmaily HO, Shabestari S. Oral cancer knowledge among patients referred to Mashhad dental school, Iran. Arch Iran Med 2010;13:543-8.
Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C. Cancer risk associated with alcohol and tobacco use: Focus on upper aero-digestive tract and liver. Alcohol Res Health 2006;29:193-8.
Dr. Durgadevi Pancharethinam
Department of Oral Medicine and Maxillofacial Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry - 605 006
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]