Oral Cancer in India: The Burden and the Opportunity

India has the highest number of oral cancer cases in the world. What steps can we take to curb the tobacco menace?

(Cancer survivor and NCP chief, Sharad Pawar said he regretted consuming tobacco & supari and wished someone had warned him to get rid of the habit 40 years ago. He said he suffered tremendously because of the surgery, the removal of teeth and the resulting difficulty in opening his mouth wide, in swallowing food and talking.)

Gutkas, bidis and cigarettes, in India, tobacco is consumed in many forms. India ranks second only to China in the total number of tobacco users. Unfortunately, India also has the world’s highest incidences of oral cancer and contributes to a fourth of worldwide deaths from the disease.

While individuals of low socioeconomic status generally bear the brunt of the disease, new trends are emerging including increasing incidence rates among younger adults who have traditionally had very low rates of oral cancer.

Although overall tobacco use has declined in India, the prevalence remains high for bidis and smokeless tobacco such as gutka, which are more likely to cause oral cancers.

Steps to Curb Tobacco Use

1. Taxation: It is the most cost-effective approach for reducing tobacco use. The Indian government has increased the excise duty on several tobacco products but implementation still remains poor.
2. Increased Awareness: Education and behavioral change can reduce the use of tobacco as well.
3. Early Detection: Widespread screening mechanism will help in early diagnosis and better treatment. A large scale trial performed by RTI International on 200,000 people showed that there was a significant reduction in mortality among those receiving oral cancer screening vs those receiving only educational messages and usual care.
4. Health Insurance Coverage: Treatment cost can be a big issue even when insurance coverage is available. A recent study by RTI International found that in addition to the actual cost of treatment, more than half the patients with oral cancer cited transportation and cost of staying near the cancer centre as a major barrier for treatment completion.

Health insurance coverage can serve as an important motivator to change this behaviour. Current insurance schemes mostly provide reimbursement after hospitalisation from an acute disease. They don’t focus on preventive tests. If this changes, a lot of lives can be saved by early detection.

Days like World Oral Health Day and World No Tobacco Day bring us a 24-hour period of tobacco abstinence to pause and reflect on the positive changes we can all drive as individuals, community workers, health providers and policy makers.

(Sujha Subramanian, PhD, Cancer Economics and Policy Fellow and Senior Health Economist at RTI International, North Carolina, USA)

(This piece was originally published on 31 May, 2015 and is being re-published from FIT’s archives to mark World Oral Health Day on 20 March.)