Epidemiology of Oral

Cancer in Pakistan
BY: DR. ANOSHA RIAZ
Introduction:
 Globally, oral cancer is included in top ten most malignant issues.
 Oral carcinoma is one of the most frequently reported form of cancer in
Pakistan.
 In time oncogenic prognosis facilities are still available in various regions
countrywide. Provincial comparison indicates that more than 67% cases of
oral squamous cancer are reported from Punjab whereas ratio in KPK is
also higher than Sindh and Baluchistan. 
 What is CANCER?

“Cancer is an abnormal growth of cells, which has ability to

involve adjacent tissues and even distant organs and eventual
death of the affected patient if the tumor has progressed to stage
where it cannot be treated.”
 ORAL CANCER
 Oral cancer refers to cancers which arises
in the oral cavity including lips, tongue,
mouth and oropharynx as well as ill-
defined sites.
 Almost 90% are squamous cell carcinoma,
which is a malignant neoplasm that arises
from oral epithelium
 Types of Cancer
Carcinomas Sarcomas Lymphomas Leukemias
Carcinoma A type of cancer Lymphomas refers • Leukemia is a
is cancer that that begins in to types of cancer broad term for
forms in epithelial bone or in the soft that begin in the cancers of the
tissue. Epithelial tissues of the lymphatic system blood cells. The
tissue lines most body, including (the various lymph type of leukemia
of your organs, cartilage, fat, glands around the depends on the
the internal muscle, blood body) when type of blood cell
passageways in vessels, fibrous abnormal white that becomes
your body (like tissue, or other blood cells grow. cancer and
your esophagus), connective or whether it grows
and your skin. supportive tissue. quickly or slowly.
Squamous Cell Carcinoma:
 Squamous cell carcinomas are the most common among the oral
malignancies.
 Squamous cell carcinoma is type of oral cancer, which initiates from the oral
epithelial mucosa and results in long term malignant oral ulcers which
gradually become visible.
 Its major risk factors are tobacco, betel nut chewing and alcohol
consumption.
 Sites of Oral Cancer:

Lips Tongue Gum Inner Cheek

Floor of the Hard Palate

mouth
Epidemiological Triad of
Oral Cancer
 Host Factors
Age, Race and Sex
Older age shows increase incidence of oral cancer. Whites develop lip melanoma more frequently than
blacks. Cancer of lip is more common in women than in men.

Genetic Factors (oncogenes)

Occupation
Textile workers, Leather workers show increase in oral cancer.
Immunity
Kaposi sarcoma is more common in AIDS

Social Class
Low income groups show increase in cancer of oral cavity
Customs and Habits
 Agent Factors
Biological
(viruses HIV or HSV, Fungus Candida)

Chemical
(Arsenic, dyes, nickel, aromatic, amines, chromium)

Mechanical
(Sharp tooth, any other source of chronic irritation like ill fitting dentures, chronic sores from jagged teeth,
etc)

Nutritional Agents
Pre-carcinogens in food (saccharin, aflatoxin), increased consumption of fat, deficiency of folic acid, protein
deficiency, increased consumption of red chilly powder, decrease in copper, zinc, vegetables, vitamins E and
C
 Environmental Factors
Water Contaminants
It includes some organic pollutants like chloroform

Air Pollution

Geographic Variations

Solar Heat
Prolonged exposure to sunlight causes melanoma

Industrialization
Release of various toxins by the industries contaminate water and air, which may lead
to cancer
 Causes of Oral Cancer
Cigar
Marijuana
Cigarette Smoking
Shisha or Hookah or water pipe
Naswar (unsmoked tobacco)
Betel quid
Alcohol
Incidence and Prevalence of Oral
Cancer in Pakistan
Incidence of oral cancer:
 Review of published epidemiological data indicates that oral cancer more
frequently occurs in women and youngsters but specifically in Asian
countries, males are predominant sufferers of this type of cancer than
females
 But in Southeast Asia, it is considered among the most common types of
cancers because huge percentage of people are habitual for betel quid
chewing, smoking, and alcohol consumption
 Pakistan is at the second highest ASIR (Adaptive
statistical iterative reconstruction) of lip and oral cancer
and is mostly reported among males.
Survival and Mortality:
 Estimation of WHO indicates that 10.3 million persons die due to cancer
currently. In past 5 years survival rate of oral cancer patients is around
50% and so far, no improvement has been noticed in this ratio.
 When we consider Asian countries, among them, South Central Asia has
reported yet, the highest age standardized mortality rate of 3.0. Because
the diagnosis of oral cancer becomes difficult as the disease advances.
Moreover, data related to women show comparatively higher survival
rates than men, in cancer of tongue and oral cavity.
 Provincial Frequency
of Oral Cancer
In Pakistan
80%

70%

60%

50%

40%

30%

20%

10%

0%
Punjab KPK Sindh Baluchistan
Prevention and Control of
Oral Cancer
Control and preventive measures:
 To reduce the prevalence of oral carcinomas, the consumption of processed
meats, cakes, desserts, butter, eggs, soups, red meat, salted meat, cheese,
pulses, polenta, pasta, rice, millet, and corn bread should be avoided.
 Moreover reported data highlights that macronutrients (proteins,
carbohydrates, fat, and cholesterol) and micronutrients (vitamins like
vitamin A (retinol), C (AA), and E; carotenoids (β‑carotene); potassium; and
selenium and their analogs which are frequently found in common dietary
items play anticarcinogenic role.
 Important antioxidants e.g., β‑carotene, retinol, retinoids, vitamin C
(AA), and vitamin E(α‑tocopherol) are essential in reducing free radical
reactions that may ultimately result in DNA mutations, enzymatic
activity changes, and lipid peroxidation of plasma membranes.
 Similarly, in various experimental trails vitamin E has been found as
anti-tumor in nature, especially to control oral carcinogenesis.
Levels of Primary Prevention
Prevention
Preventive Health promotion Specific protection
Services
Services Periodic visits to dental office, Avoidance of known irritants
provided by demand for preventive services
individual

Services Dental health education

provided by the programs, promotion of research
community and lobby efforts.

Services Patient Education Removal of known irritants in

provided by oral cavity
Dental
Professional
Levels of Secondary Prevention Tertiary Prevention
Prevention
Preventive Early diagnosis and prompt Disability Rehabilitation
Services treatment limitation
Services provided Self examination and referral, use Use of dental Use of dental
by individual of dental services. services services

Services provided Periodic screening and referral, Provision of Provision of dental

by the community provision of dental services dental services services

Services provided Complete Examination, Biopsy, Chemotherapy, Maxillofacial and

by Dental Oral cytology, complete excision Radiation removable
Professional therapy, Surgery prosthodontics,
plastic surgery,
speech therapy,
counselling
Conclusion:
 It can be concluded that general awareness regarding oral
cancer is still much less, significantly in rural areas of third
world countries like Pakistan and there is a need to device
general awareness based public health program along with
active screening for risk estimation in rural and remote areas’
population. Because oral cancer is becoming a leading and
current public health problem in underdeveloped countries
Thank You!
Any Questions