Oral Cancer—Curse, Cure and Challenge

Oral cancer is mostly a man-made disease associated with tobacco since centuries. In early part of the seventeenth century, few original documents do suggest large tumour masses in the oral cavity following tobacco ingestion, initially used to be taken as medicine for some oral ailments. Among the epidemiological factor causing oral cancer, tobacco is the most important culprit along with alcohol. Both together are responsible for 40 % of cancer and 60 % of cancer-related death all over the world. Oral cancer is the 8th most common cancer in USA, 13th in UK and 1st or 2nd in most of South and South East Asia. It forms 2 % of all cancer in Western countries but accounts for 30–40 % in Indian and neighbouring countries. China consumes 39 % of tobacco followed by 5 to 8 % in the USA and 3 % in India in various forms. In China and in the West, smoking and alcohol are the important causes of oral cancer, but in South Asia, it is oral tobacco [1, 2]. Male and female ratio is 1.7 to 1.0 in most of the countries. The mean age is 45 years in the West with peak at 60–69 years [2]. In India, the mean age is 36 years and peak at 55–60 years. It is a disaster to learn that 10 to 20 % of high school students in USA do take tobacco orally in various forms occasionally or regularly and get oral cancer in 4 % of this population. This is true for most of the Western countries. In South Asia, the figure is still high, 30–40 % in 15 to 30 years age group, with 40–50 % developing oral cancer and 42 % of all deaths due to tobacco-related diseases. In USA, 6.5–8 per 100,000, France 8–9 per 100,000 and India 20 per 100,000 get oral cancer. In China, 1.2 million deaths were due to tobacco-related disorder including oral cancer annually [3, 4]. Few important statistics are eye opener. The tobacco industry profit is $35 billion at the cost of six million deaths. In India, tobacco-related products industry for oral consumption is more than Rs. 1,000 crore with profit of 50 % at the cost of 1.6 lacs to 2 lacs reported deaths, while those unreported are much more. In USA, cigarettes are sold worth $71 billion/year and responsible for an estimated $193 billion in its health-related expenditure. One cane of Marlboro cigarette ($12/20 sticks) can purchase 29 cans of rice to feed eight people, and part of its sale can save millions of life from hunger deaths. If proper steps are not taken, there will be 300,000 cases/year in the USA by 2020, and 15 million new cases every year in the world, of which two out of three in developing countries with poor survival. The risk factor is 0.86 % in man/women born today in their life time [4]. In USA, 80 % of oral cancers are diagnosed in early stage but 5 years survival is 60 %, while in Indian and South East Asia countries, late diagnosis (III and IV stages) is more than 70 %, with 5 years survival of 35 %, in Arab countries 5 years survival is 32 %. Overall survival in young age group of patients is still low. Low socioeconomic group patients form a large percentage of the group and found to be of genetic P53 dissociation and still poor survival. The last three decades has seen improved management and total care system all over the world but total survival rate is not much improved.