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Year : 2020  |  Volume : 31  |  Issue : 4  |  Page : 625-628
Knowledge and awareness of oral cancer patients regarding its etiology, prevention, and treatment

1 Department of Oral Pathology and Microbiology, PDMDCRI, Bahadurgarh, Haryana, India
2 Department of Public Health Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
3 Department of Radiation Oncology, Regional Cancer Center, PGIMS, Rohtak, Haryana, India

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Date of Submission12-Nov-2018
Date of Acceptance31-Oct-2019
Date of Web Publication16-Oct-2020


Introduction: Assumption on part of healthcare workers that individuals suffering from oral cancer are usually aware of the reasons why they got the disease can lead to creation of a knowledge deficit group and may increase chances of relapse and complications in future. Methodology: An interview-based questionnaire study was conducted on 218 patients with oral cancer admitted for treatment at a Regional Cancer Centre (RCC) in north India. Questions were designed to assess their knowledge and awareness regarding etiology, treatment, and prevention of oral cancer. Results: The majority of the study participants were from lower and lower middle socioeconomic class. Most of them were not aware about early signs of oral cancer. Some of them were still continuing with the habit of tobacco consumption. Conclusion: There is an urgent need to improve the knowledge level of oral cancer patients for its primary and secondary prevention.

Keywords: Awareness, knowledge, oral cancer, questionnaire

How to cite this article:
Lakra S, Kaur G, Mehta A, Kaushal V, Atri R, Sunder. Knowledge and awareness of oral cancer patients regarding its etiology, prevention, and treatment. Indian J Dent Res 2020;31:625-8

How to cite this URL:
Lakra S, Kaur G, Mehta A, Kaushal V, Atri R, Sunder. Knowledge and awareness of oral cancer patients regarding its etiology, prevention, and treatment. Indian J Dent Res [serial online] 2020 [cited 2022 Jun 26];31:625-8. Available from:

   Introduction Top

Together with oropharyngeal region, the cancer of oral cavity is ranked the sixth most common cancer in the world.[1] In the Indian subcontinent, these cancers rank the third most common in order of hierarchy.[2] Oral cancer has a dismal survival rate of 50% when compared with other cancers in the body possibly due to lack of awareness among common man regarding its early sign and symptoms.[3],[4] Early diagnosis of oral precancerous and cancerous lesions at their incipient and localized stages can reduce mortality and morbidity. Although studies had been conducted in the past to assess knowledge and awareness of individuals regarding various aspects of oral cancer, they are mostly restricted to general population[4],[5] or on patients reporting to dental hospital for other problems.[6] It is usually assumed that the patients suffering from oral cancer are well aware of its etiology and consequences, hence we found few studies conducted for this population on literature search.[7],[8] Most of these studies were conducted on a small sample of patients and none in a Regional Cancer Centre (RCC) which usually gets patients from a larger geographical area and different cultural and social background. It is difficult to design effective preventive strategies unless we provide an accurate picture regarding the level of awareness of these patients to the concerned authorities.

This cross-sectional questionnaire survey was conducted in a RCC to collect information on knowledge and awareness of oral cancer patients regarding various aspect of its etiology, clinical presentation, and factors causing delay in diagnosis of oral cancer.

   Methodology Top

The study participants were patients who were diagnosed with oral cancer and were admitted for treatment at a RCC located in Rohtak city of Haryana state in India. A total of 218 patients were interviewed in a period of 3 months (September–December 2017). Patients who did not wish to participate in the study or not in position to communicate were excluded. Informed consent was obtained from each participant prior to his or her participation in the study. The study protocol was approved by the Institutional Ethical Committee (letter no. PDM/IEC/15/2017 Dated - 03-11-2017).

Data were collected by a single investigator (LS) in the form of an interview using a structured questionnaire. To establish the content and consensual validity, the draft of the questionnaire was sent independently to two experts who are working with patients with oral cancer. Based on experts' feedback, changes were done to the questionnaire. A Hindi version of the questionnaire was also prepared by a linguistic translator for ease of understanding by the participants. The questionnaire was divided into subsections to record the following information:

  • General information of the study population, that is, age, sex, socioeconomic status (SES) (using revised Kuppuswamy scale)[9]
  • Current, past, and family history of tobacco and alcohol consumption
  • Knowledge regarding clinical features, etiology, and prevention of oral cancer
  • Initial symptom, time lapsed, and staging at the time of diagnosis
  • Perception regarding oral cancer treatment.

Statistical Package for Social Sciences (SPSS) version 21 was used to calculate frequencies, mean, and percentages of the studied parameters.

   Results Top

Of the 218 participants in this study, 192 were males and the rest were females. More than 80% of them were from lower middle and lower SES category. Due to this skewed distribution, we did not perform gender- and SES-wise comparison for dependent variables. All the subjects were above 50 years of age with females having higher mean age than males [Table 1].
Table 1: Baseline characteristics of the study population

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Knowledge regarding initial sign/symptom of oral cancer was poor among the study participants as 84.4% (n = 184) were unaware of any one of those listed by the investigator [Pie Chart 1]. History of tobacco consumption was positive in 202 (92.6%) participants and 23 were still continuing with this habit. Family history for oral cancer was present in 34 patients. The most common initial sign/symptom recalled by patients was pain followed by a combination of any two signs mentioned to them as listed in the questionnaire. More than half of them said that they reported to RCC within 6 months after appearance of the first symptom and only six patients told they stopped treatment in between. Patients with Stages 3 and 4 cancer were most prevalent in our study population [Table 2].

Table 2: Distribution of study participants according to information related to history, diagnosis, and treatment of oral cancer

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More than three-fourth of patients had seen picture/advertisement related to causes/consequences of oral cancer and 121 (55.5%) were aware of the fact that the habit of tobacco and alcohol increases the risk of oral cancer. Around 30% had awareness regarding tobacco de-addiction methods. Knowledge regarding precancerous oral lesions and conditions was poor as except for two patients others said they had never heard of them [Table 3]. More than 80% of participants agree that oral cancer is a life-threatening condition and regular follow-up is necessary even after full treatment. Almost half of them were aware of the fact that cancer can reoccur even after treatment. On the statement whether timely diagnosis of oral cancer can prevent complications, it was agreeable only with 136 (49.5%) participants [Table 4].
Table 3: Frequency distribution of respondents on questions related to awareness regarding various aspects of oral cancer

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Table 4: Distribution of study population according to awareness regarding oral cancer treatment

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   Discussion Top

The results from this study showed that a majority of study participants were males and above 50 years of age. This could be due to high prevalence of tobacco consumption habits among males in India. The proportion of people who were aware of ill effects of tobacco on the oral cavity was marginally higher than reported in other studies.[7],[8],[10] The possible reason could be increase in level of awareness of general public with time as most of the previous studies were conducted 15–20 years back. Most patients were unaware of the early signs and precancerous lesion or condition associated with oral or oropharyngeal cancer. This finding highlights the unawareness among patients undergoing treatment for oral cancer and has been reported by other studies.[7],[8]

Before discussing the implications and recommendations, we would like to discuss the limitations of this study. First, being a cross-sectional questionnaire survey, it has certain inherent biases due to study design such as memory/recall bias (because of the inability of participants to remember all the events happened in the past), interviewer bias (as examiner was aware of the disease status of the participants), and inability to establish the cause–effect relationship. In spite of these weaknesses, our study has certain positive aspects such as its sample size is larger when compared with previous studies and it is conducted in a RCC, thereby increasing the generalizability of study results.

Two-thirds of the study participants had seen the images and advertisements regarding the ill health effects of tobacco or its products. Health warning on cigarette or tobacco packs has been found to reduce the tobacco consumption rate in Indian population.[11] Despite access to healthcare services, most patients reported delay in starting treatment. SES could be a barrier to early diagnosis as 80% of patients were from lower strata of society. People from this group usually have comparatively less knowledge and awareness on health matters. Various other reasons were reported by patients for this delay such as they were “waiting” to see whether symptoms pass away without any intervention or at first they could not think of the seriousness of the symptoms like a simple ulcer or mild pain, or were taking symptomatic medicines from some local medical shop without the advice of health professional (self-medication).

Our study highlights that the main barrier to lack of knowledge in the study population was cognitive, as the awareness about the symptoms, signs, screening methods, and risk factors of oral cancer among the study population was low. Other barriers such as economic and social barrier such as insufficient fund for treatment and lack of family support can be probed further.

   Recommendations Top

It can be recommended from the results of our study that future public awareness programs should reflect more on communicating the initial signs and symptoms of oral/oropharyngeal cancer as the pictures/images or health education advertisements. We feel campaign similar to self-examination among women for breast cancer can be initiated for oral cavity in high-risk populations.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.  Back to cited text no. 1
Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.  Back to cited text no. 2
Rogers SN, Brown JS, Woolgar JA, Lowe D, Magennis P, Shaw RJ, et al. Survival following primary surgery for oral cancer. Oral Oncol 2009;45:201-11.  Back to cited text no. 3
Warnakulasuriya KA, Harris CK, Scarrott DM, Watt R, Gelbier S, Peters TJ, et al. An alarming lack of public awareness towards oral cancer. Br Dent J 1999;187:319-22.  Back to cited text no. 4
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.  Back to cited text no. 5
Srikanth Reddy B, Doshi D, Padma Reddy M, Kulkarni S, Gaffar A, Ram Reddy V. Oral cancer awareness and knowledge among dental patients in South India. J Cranio-Maxillofacial Surg 2012;40:521-4.  Back to cited text no. 6
Kerawala CJ. Oral cancer, smoking and alcohol: The patients' perspective. Br J Oral Maxillofac Surg 1999;37:374-6.  Back to cited text no. 7
Mehta A, Kaur G, Gupta S. Are patients treated for oral cancer aware of its risk factors and symptoms? A thought provoking study. Indian J Dent Sci 2013;5:13-6.  Back to cited text no. 8
Shaikh Z, Pathak R. Revised kuppuswamy and B G Prasad socio-economic scales for 2016. Int J Community Med Public Heal 2017;4:997.  Back to cited text no. 9
Roychowdhury S, Roychowdhury G, Sen U. Assessment of awareness level on tobacco and smoking habits as risk factors for cancer among lung and laryngeal cancer patients in Kolkata--A case control study. Asian Pac J Cancer Prev 6:332-6.  Back to cited text no. 10
GATS-2 Global Adult Tobacco Survey Fact Sheet India 2016-17. Available from: FactSheet.pdf. [Last accesed on 2018 Oct 15].  Back to cited text no. 11

Correspondence Address:
Dr. Gurkiran Kaur
Department of Oral Pathology and Microbiology, PDMDCRI, Bahadurgarh, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_838_18

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  [Table 1], [Table 2], [Table 3], [Table 4]


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