oral cancer awareness and knowledge in adults attending a dental hospital in northeast india

Oral cancer awareness and knowledge in adults attending a dental hospital in Northeast India

Original Article

Oral cancer awareness and knowledge in adultsattending a dental hospital in Northeast India

Abhinay Yamsani a, Krishna Shastrula Prashanth b,Eshvendar Reddy Kasala c,*, Rubi Kataki d, Babul Kumar Bezbaruah a,b,c,e

aDepartment of Pharmacy Practice, NIPER-Guwahati, Assam, IndiabDepartment of Biotechnology, NIPER-Guwahati, Assam, IndiacDepartment of Pharmacology and Toxicology, NIPER-Guwahati, Assam, IndiadDepartment of Conservative Dentistry and Endodontics, Regional Dental College, Assam, IndiaeDepartment of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India

a r t i c l e i n f o

Article history:

Received 13 December 2013

Accepted 27 January 2014

Available online xxx

Keywords:

Awareness

Knowledge

Oral cancer

Questionnaire

Risk factors and survey

a b s t r a c t

Objective: To evaluate the awareness of oral cancer when compared to other cancers in

adults attending Regional Dental College, Guwahati, Assam and determine their knowledge

regarding risk factors, signs, symptoms and causes of oral cancer.

Method: A cross-sectional survey involving 824 adults was conducted using a questionnaire

which covered 21 questions including topics like socio-demographic aspects, oral cancer

awareness, knowledge about risk factors associated with oral cavity and early signs of oral

cancer, lifestyle habits like smoking, alcohol consumption and dentist visits.

Results: Nearly seventy percent (580 out of 824) of subjects participating in the study were

aware of the term ‘oral cancer’. 74.27% and 63.59% subjects identified tobacco and smoking

respectively as important risk factors, but failed to consider alcohol consumption as major

contributing factor. 66.5% individuals considered “difficulty in swallowing” as a symptom

of oral cancer though 62.1% individuals were unable to identify “persistent white or red

spot” as a symptom of oral cancer. Only 11.16% individuals had undergone screening for

oral cancer during their lifetime.

Conclusion: The lack of basic awareness about the risk factors, causes, signs and symptoms

of oral cancer in this cross-sectional population of Northeast India is clearly evident in our

study. Since, Northeast India accounts for more than 40% of these cases, interactive cancer

awareness programs should be taken up by research organizations and government to

educate people and make them better understand the serious implications of oral cancer.

Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

* Corresponding author. Tel.: þ91 9700820750.E-mail address: [email protected] (E.R. Kasala).

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier .com/locate/apme

a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1e7

Please cite this article in press as: Yamsani A, et al., Oral cancer awareness and knowledge in adults attending a dental hospitalin Northeast India, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.01.004

0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.http://dx.doi.org/10.1016/j.apme.2014.01.004

1. Introduction

Cancer, being one of the most common causes of death after

coronary heart diseases, causes nearly 7 million deaths each

year worldwide and according to WHO, presently, almost 25

million people are suffering from cancer, and by 2020 it is

projected that there may be 16 million new cancer cases and

ten million cancer deaths reported every year.1 In most

countries, one to ten cases per 1,00,000 people are diagnosed

with oral cancer every year. Though, it accounts for only two

percent of all cancers reported worldwide, it is the second

most common cancer in males and the fourth most common

cancer in females in South-Central Asia, accounting for seven

percent of the total cancers diagnosed in this region, ranking

among the three most common types of cancers reported in

the region.2 With 75,000e80,000 new cases of oral cancers

being reported every year, India has the highest prevalence of

oral cancer in the world. According GLOBOCON 2012 report,

oral cancer is a third most frequent cancer after breast and

cervix with an estimated 5-year prevalence rate of 6.6%.3 In

India, Northeast India including Assam accounts for more

than 40% of these cases.4 Oral cancer has a higher cure rate

when detected early and treated accordingly, but unfortu-

nately most oral cancers are diagnosed in advanced stages,

requiring aggressive treatment and associated morbidity,

resulting in higher mortality rates.5

The most important etiological factors leading to oral

cancer are tobacco and betel nut chewing, excess consump-

tion of alcohol, improper diet and nutrition, human papilloma

virus and immune-suppression.6 These are avoidable risk

factors that can be effectively combated using primary pre-

ventive strategies. Health promotion is one of the most

important components of primary prevention, which com-

prises health education, influencing knowledge and behaviors

at all levels of social organization.7 The early detection of oral

cancer is hindered by lack of public awareness of the early

signs and symptoms associated with oral cancer.8,9 Knowl-

edge regarding the risk factors of oral cancer like tobacco and

alcohol consumption is limited in Indian high-risk popula-

tion.10 Till date, a study on the extent of awareness and

knowledge on oral cancer has not been performed in adults

attending a dental hospital in Northeast India.

The present study was aimed to examine the extent of

awarenessandknowledgeoforal cancer inadults attendingout-

patient unit of Regional Dental College (RDC), Guwahati, India.

Specific objectives of the study include:

a) To assess the knowledge of oral cancer compared to other

cancers, about its risk factors and early signs and

symptoms.

b) To correlate these knowledge levels according to age,

gender and education levels.

2. Method

A cross-sectional study was carried out in the out-patient unit

of Regional Dental College, Guwahati, Assam to evaluate the

awareness of oral cancer as compared to other cancers,

including degree of knowledge about oral cancer, its risk fac-

tors, signs, symptoms and popular beliefs. The study was

approved by Institutional Ethical Committee, Regional Dental

College (Regd. No-RDC-29/2011/2440). Following their consent

to the study, attendees of age 18 or above to Regional Dental

College were face to face interviewed consecutively in the

order of their arrival to the hospital by a trained researcher

accompanied by a duty doctor. A total of 866 subjects were

invited to participate in the study, of which 42 adults were

uninterested to participate. The time period of study was 1

month (1st February 2013e1st March 2013).

The questionnaire (available on request from the corre-

sponding author) was prepared based on similar previous

studies,9,11 though few questions were adapted to better suit

the local population. A pilot study of 40 subjects prior to the

actual study was conducted to validate the questionnaire and

modifications were made accordingly.

The interview started with a formal introduction of the

interviewer as a graduate student at National Institute of

Pharmaceutical Education and Research, Guwahati under-

taking a study on cancer information. The questionnaire was

divided into four sections and constituted of 21 questions

which were designed to obtain information on: (1) socio-

demographic aspects; (2) oral cancer awareness and knowl-

edge; (3) knowledge about risk factors associated with oral

cavity and early signs of oral cancer; (4) lifestyle habits like

smoking, chewing of betel nut, alcohol consumption, dietary

intake, dentist visits, and oral hygiene habits. Participants

were first questioned whether they were aware of oral cancer

and the various other cancers. They were then asked ques-

tions regarding “mouth (oral cavity) examination as a part of

oral cancer detection during their life time”. Questions

regarding “oral cancer’s frequency based on age groups

(Children, young adults to 25 years, adults up to 45 years,

adults from 45 years, do not know), location in mouth most

frequently affected due to oral cancer (gum, tongue, cheek,

floor of the mouth, palate), gender (male or female), where

does mouth cancer rank amongst the ten most common

cancers in the world and what are the main risk factors, signs

and symptoms, and causes of oral cancer” were also asked.

Set of options was given in the questionnaire for these queries

and subjects were asked to select one from those options.

Then questions on “contribution of luck factor, chances of

successful treatment on early discovery and effect of lifestyle

changes to reduce the risk of oral cancer” were asked to

evaluate the oral cancer beliefs. Responses to these questions

were “agree”, “disagree”, or “do not know”. Questions based

on “tobacco chewing, alcohol consumption, smoking habits,

oral hygiene habits like brushing, fruit and vegetable intake

and dentist visits” were also posed to acquire the knowledge

of effect of oral hygiene and their role in oral cancer incidence

amongst attendees.

2.1. Statistical analysis

All the questions and responses were entered into a Microsoft

Excel database. The results were evaluated using SPSS version

16 software. Chi-square test was used to analyze the rela-

tionship between demographics and personal habits versus



Table 1 e Socio-demographic characteristics and their relations with some awareness and knowledge variables.

S. no Variables n Oral cancerawareness

(n ¼ 580; 70.3%)

Oral cancerscreening

(n ¼ 92; 11.16%)

Tobacco asrisk factor

(n ¼ 612; 74.2%)

Alcohol asrisk factor

(n ¼ 280; 33.9%)

Ulcer as sign(n ¼ 369; 44.78%)

Red/whitepatch as sign

(n ¼ 327; 52.8%)

1 Gender

Male 496 344 (69.3) 36 (7.2) 364 (73.3) 164 (33.0) 242 (48.7) 229 (46.1)

Female 328 236 (71.9) 56 (17.0) 248 (75.6) 116 (35.3) 127 (38.7) 98 (29.8)

P 0.424 0.888 0.475 0.495 0.004 <0.001

2 Age

<49 652 448 (68.7) 60 (9.2) 472 (72.3) 224 (34.3) 281 (43.1) 243 (37.2)

>49 172 132 (76.7) 32 (18.6) 140 (81.4) 56 (32.5) 88 (51.1) 84 (48.8)

P 0.04 <0.001 0.016 0.658 0.058 0.006

3 Marital status

Married 600 380 (63.3) 64 (10.6) 436 (72.6) 188 (31.3) 246 (41) 225 (36.6)

Unmarried 224 192 (85.7) 28 (12.5) 176 (78.5) 92 (41.1) 123 (54.9) 102 (45.5)

P <0.001 0.457 0.085 0.009 <0.001 0.036

4 Education

Un educated 112 36 (32.1) 12 (10.7) 32 (28.5) 20 (17.8) 28 (25) 24 (21.4)

School 292 200 (68.5) 28 (9.6) 224 (76.7) 88 (30.1) 120 (41.1) 124 (42.4)

High school 176 124 (70.4) 8 (4.5) 156 (88.6) 56 (31.8) 88 (50) 68 (38.6)

Graduate 196 176 (89.8) 20 (10.2) 156 (79.6) 100 (51) 100 (51) 72 (36.7)

Post graduate 48 44 (91.6) 24 (50) 44 (91.6) 16 (33.3) 33 (68.7) 39 (81.2)

P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

5 Smoking

Smokers 252 132 (52.3) 48 (19) 156 (61.9) 60 (23.8) 106 (42) 130 (51.6)

Non smokers 492 388 (78.8) 32 (6.5) 396 (80.5) 192 (39) 219 (44.5) 157 (31.9)

Ex-smokers 80 60 (75) 12 (15) 60 (75) 28 (35) 44 (55) 40 (50)

P <0.001 <0.001 <0.001 <0.001 0.126 <0.001

6 Alcohol

Consumers 248 124 (50) 44 (17.7) 160 (64.5) 60 (24.2) 85 (34.7) 121 (48.8)

Non consumers 512 416 (81.2) 36 (7) 400 (78.1) 204 (39.8) 248 (48.4) 174 (34)

Ex-consumers 64 40 (62.5) 12 (18.7) 52 (81.2) 16 (25) 36 (56.2) 32 (50)

P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

7 Dental visits

<1 year 698 489 (70) 80 (11.4) 513 (73.4) 242 (34.6) 313 (44.8) 270 (38.6)

�1 per year 126 91 (72.2) 12 (9.5) 99 (78.5) 38 (30.1) 56 (44.4) 57 (45.2)

P 0.624 0.525 0.23 0.325 0.934 0.166

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cancer awareness, knowledge, and popular cancer beliefs. At

P < 0.05, the differences were considered statistically

significant.

3. Results

3.1. Demographic characteristics

Of the 824 individuals participating in the study 496 (60.194%)

were males and 328 (39.86%) were females. The average age

was 38.45 years, in the age range of 18 and 75 years. The de-

mographic characteristics of subjects are further illustrated in

Table 1.

3.2. Cancer awareness

Most subjects were aware of lung cancer (88.35%) followed by

breast cancer (82.04%) and thyroid cancer (79.12%) (Table 2).

The term ‘Oral cancer’ was relatively well known, with 70.4%

of total subjects having heard of it though they significantly

lacked knowledge about the risk factors, signs and symptoms

of oral cancer as emphasized further. The most mentioned

cancers in the study were illustrated in Table 2.

3.3. Oral cancer awareness in adults visiting dentists

Ninety one (72.2%) individuals who visited the dentist more

than once a year were more aware of oral cancer when

compared to less frequent visitors (n ¼ 489; 98.2%). Only 12

(9.5%) out of total 126 subjects who have visited the dentist

more than once a year had their mouth screened for oral

cancer (Table 1).

3.4. Oral cancer examination

Only 92 (11.16%) individuals of total subjects have had a

mouth examination as part of oral cancer screening during

their lifetime and only 24 (2.9%) of them had their mouth ex-

amination done in the last one year. This shows the signifi-

cant lack of interest among subjects to undergo oral cancer

screening (Table 1).

3.5. Awareness about age-related, gender-related andlocation of the mouth most likely to develop oral cancer

When asked about the frequency of incidence of oral cancer

with relation to age group, 24 (2.9%) subjects responded 0e18

years, 104 (12.6%) responded 18e25 years, 136 (16.5%)

responded 25e45 years, and 136 (16.5%) said that it was more

frequent in people above 45 years. 424 (51.45%) individuals

reported they do not know the correct answer. 308 (37.4%)

individuals mentioned that oral cancer affected more males

than females, 88 (10.8%) individuals answered that it affected

more females, 228 (27.66%) individuals answered that it af-

fects both sexes equally, and 200 (24.27%) individuals could

not frame any answer.

The location of the mouth most referred to as likely to

develop oral cancer was the gum (n¼ 152; 18.45%), followed by

cheek mucosa (n ¼ 116; 14.1%), floor of the mouth (n ¼ 100;

12.1%), tongue (n ¼ 44; 5.3%), and palate (n ¼ 8; 0.9%). Majority

of individuals (n ¼ 404; 49.03%) reported they do not know the

correct answer (Table 3).

3.6. Knowledge about risk factors of oral cancer

To the question regarding factors which can cause or increase

the risk of mouth cancer, 612 (74.27%) individuals considered

tobacco as risk factor followed by cigarette smoking (n ¼ 524;

63.59%), reduced oral hygiene (n ¼ 512; 62.14%), slaked lime

consumption with pan leaves (n ¼ 460; 55.8%), betel nut con-

sumption (n¼ 444: 53.88%), infections in teeth (n¼ 296; 35.9%),

Table 2 e Most mentioned cancers in the study.

S. no Cancer type n Percentage (%)

1 Lung 728 88

2 Breast 676 82

3 Thyroid 652 79

4 Blood 620 75

5 Stomach 608 74

6 Mouth 580 70

7 Skin 432 52

8 Colon 340 41

9 Cervix 320 39

10 Pancreas 304 37

11 Prostate 276 33

Table 3 e Mostly mentioned sites of mouth associatedwith oral cancer.

S. no Location of mouth n Percentage (%)

1 Do not know 404 49

2 Gum 152 18.4

3 Cheek mucosa 116 14.1

4 Floor of mouth 100 12.1

5 Tongue 44 5.3

6 Palate 8 1

Table 4 e Most risk factors or causes mentioned for oralcancer.

S.No

Risk factors n Percentage(%)

1 Tobacco 612 74.2

2 Smoking 524 63.5

3 Reduced oral hygiene 512 62.1

4 Slaked lime consumption

with pan leaves

460 55.8

5 Betel nut consumption 444 53.8

6 Coffee consumption 316 38.3

7 Infections in the teeth 296 35.9

8 Alcohol 280 33.9

9 Close contact with other

cancer patient

228 27.6

10 Sun exposure 124 15.1

11 Low consumption of

vegetables & fruits

88 10.6

12 Treatments at the dentist 60 7.28



alcohol consumption (n ¼ 280; 33.98%) and sun exposure

(n ¼ 124; 15%). It was interesting to note that 300 (36.41%), 228

(27.7%), and 60 (7.28%) individuals considered coffee con-

sumption close contact with other cancer patients, and

treatment at the dentist respectively are risk factors of oral

cancer (Table 4).

Non-smokers identified tobacco as a cause of oral cancer

(n ¼ 396; 80.5%) more frequently than the smokers (n ¼ 156;

61.9%) (P < 0.001). The clinical relevance of certain findings in

relation to other demographic factors and their knowledge on

risk factors was found to be obscure (Table 1).

3.7. Knowledge about sign and symptoms of oral cancer

Five hundred forty eight (66.5%) individuals considered “dif-

ficulty in swallowing” as a symptomof oral cancer followed by

520 (63.1%) as “difficulty in opening mouth”, 384 (46.6) as

“bleeding frommouth”, 372 (45.1%) as “lump or tissue growth”

and 360 (43.6%) individuals considered “ulcer that does not

heal” as a symptom of oral cancer. However, only 312 (37.9%)

individuals considered “persistent white or red spot” as a

symptom of oral cancer. Alarmingly 192 (23.3%) individuals

considered “gastric pain” as symptoms of oral cancer (Table 5).

The reference that “an ulcer that does not heal” could be a

sign of oral cancer was correlated with higher education

(P< 0.001).Whereas reference to “persistentwhite or red spot”

could be a sign of oral cancer was correlated more by males

than females (P < 0.001) and by smokers than non-smokers

(P < 0.001) (Table 1).

3.8. Popular cancer beliefs

To the query “having oral cancer is a question of luck and

there is nothing we can do to avoid it”, 42.72% (n ¼ 352) of the

subjects disagreed. However, 232 (28.15%) agreed with this

Table 5 e Mostly mentioned early manifestations of oralcancer.

S. No Symptoms n Percentage (%)

1 Difficulty swallowing 548 67

2 Difficulty in open the mouth 520 63

3 Bleeding from the mouth 384 47

4 Lump or tissue growth 372 45

5 Ulcer that does not heal 360 44

6 Persistent white or red spot 312 38

7 Abscess, boil or infection 268 33

8 Gastric pain 192 23

Table 6 e Socio-demographic characteristics and their relations with popular cancer beliefs.

S. no Variables n Disagree withquestion of luck(n ¼ 360; 43.6%)

Early detection canimprove treatment(n ¼ 518; 62.86%)

Lifestyle influence riskof oral cancer(n ¼ 508; 61.6%)

1 Gender

Male 496 227 (45.7) 305 (62.3) 326 (65.7)

Female 328 133 (10.06) 213 (64.9) 182 (55.5)

P 0.139 0.316 0.002

2 Age

<49 652 308 (47.2) 422 (64.7) 425 (65.2)

>49 172 52 (30.2) 96 (55.8) 83 (48.2)

P <0.001 0.031 <0.001

3 Marital status

Married 600 222 (37) 342 (57) 350 (58.3)

Unmarried 224 138 (61.6) 176 (78.5) 158 (70.5)

P <0.001 <0.001 <0.001

4 Education

Uneducated 112 10 (8.9) 29 (25.9) 17 (15.1)

School 292 80 (27.4) 175 (59.9) 152 (52.0)

High school 176 94 (53.4) 92 (52.2) 132 (75)

Graduate 196 132 (67.3) 180 (91.8) 164 (83.6)

Post graduate 48 44 (91.6) 42 (87.5) 43 (89.5)

P <0.001 <0.001 <0.001

5 Smoking

Smokers 252 102 (40.4) 111 (44) 151 (59.9)

Non smokers 492 210 (42.7) 346 (70.3) 297 (60.3)

Ex-smokers 80 48 (60) 61 (76.2) 60 (75)

P 0.007 <0.001 <0.001

6 Alcohol

Consumers 248 99 (39.9) 100 (40.3) 153 (61.6)

Non consumers 512 231 (45.1) 375 (73.2) 316 (61.7)

Ex-consumers 64 30 (46.8) 43 (67.1) 39 (60.9)

P 0.346 <0.001 0.023

7 Dental visits

<1 year 698 293 (41.9) 441 (63.1) 427 (61.1)

�1 per year 126 67 (53.1) 77 (661.1) 81 (64.2)

P 0.02 0.658 0.509

a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1e7 5


affirmation and 240 (29.12%) could not form an opinion on

this. Subjects with unmarried status (P < 0.001), higher edu-

cation level (P < 0.001), younger age (P < 0.001), non-smokers

(P ¼ 0.007), frequent dentist visits (P ¼ 0.02) were in disagree-

ment with the statement (Table 6).

Only 492 subjects (59.7%) agreed that the detection of oral

cancer in early stages could increase the success of the

treatment. This was rejected by 40 subjects (4.85%), and 292

(35.4%) were unable to respond. Agreement was associated in

attendees with younger age (P ¼ 0.031), unmarried status

(P< 0.001), higher education level (P< 0.001), and alcohol non-

consumers (P < 0.001) (Table 6).

Finally, when we asked the subjects if they agree “whether

change in lifestyle will reduce the risk of cancer of themouth”,

496 (60.2%) said yes, 100 (12.1%) said no, and 228 (27.7%) said

they do not know. Subjects with higher education level

(P < 0.001), younger age (P < 0.001) and unmarried status

(P < 0.001) responded positively (Table 6).

4. Discussion

This study was conducted to assess the awareness level and

knowledge about risk factors and early signs of oral cancer

and to correlate the knowledge levels according to age, sex

and education among Northeast Indian dental patients.

Guwahati, a metropolitan, is the largest city of Northeast

India, is often referred to as “Gateway of North Eastern Region

of India,” since it is the most developed and major city of

Eastern India. Regional Dental College, Guwahati, Assam is a

premier institute of dental education in the North Eastern

region of India and is in association with Gauhati Medical

College & Hospital (GMCH). Since 95.2% individuals attending

out-patient department of Regional Dental College obliged to

participate in the study, any bias in our findings with respect

to others is limited.

The oral cancer awareness and knowledge in the present

population is poor. It is interesting to note that only 70%

subjects mentioned about oral cancer and it was ranked sixth

among all cancers mentioned. Our results are in line with the

previous studies, where similar kind of awareness about oral

cancer reported.12,13

Oral Cancer is a multifactorial disease where multiple

factors like smoking, tobacco chewing and heavy alcohol

consumption contribute individually and/or collectively for

the development of cancer. As per the Global Adult Tobacco

SurveyeIndia (GATS 2009e10), conducted by the Ministry of

Health and Family Welfare, 44.1% people belonging to

Northeast States of India above the age of 15 years are

consuming tobacco in some form or other, when compared to

the national average of 35%. Smokeless and other chewable

tobacco products like gutkha and zarda are famous among

39.8% of adult males and 25.3% of females.4 Another study

also reported high prevalence of tobacco use of among male

(57.9%) and females (26.5%) school personnel in Northeast

region of India.14 Though most of the subjects in our study

identified tobacco products and smoking as important risk

factors, they failed to consider alcohol consumption as major

contributing factor. The lack of awareness about the impact of

alcohol consumption on oral cancer is observed among most

populations worldwide as reported by various re-

searchers.9,11,12,15,16 Nonetheless, some retrospective studies

recently have shown increase in knowledge about alcohol

consumption as a major risk factor in oral cancer in other

countries.17,18 Therefore, for strengthening people knowledge

on their increased cancer risks by alcohol use should be

included in future health promotion strategies.

Less than fifty percent of adults participating in this study

were unable to identify non-healing wound, lumps or tissue

growths and persistent white or red spot as the early signs of

oral cancer. This observation was in accordance with other

reports which also reported lesser percentage of aware-

ness.19,20 This can be problematic because on top of being an

early sign of cancer they can correspond to potentially ma-

lignant disorders whose removal in time could help in

reducing the risk of further developing oral cancer. This could

be addressed by frequent dental visits. Disappointingly only

4.8% of the total individuals participating in this study have

ever had theirmouth tested for oral cancer. This is in line with

other previous reports which illustrated fairly similar

results.12,21

Although most of the subjects in the present study agreed

that an early detection of oral cancermay increase the success

of treatment, there is still a significant lack of interest among

these individuals to frequently visit dentists and undergo

preliminary cancer tests which is clearly evident in this study.

It has already been suggested by researchers that a network of

dentists and other healthcare professionals can significantly

contribute efficient oral cancer detection, control and pre-

vention. Thus, government and other healthcare institutes

should actively take up campaigns of awareness and knowl-

edge of oral cancer. Various studies have previously high-

lighted the fact that an increase in awareness could increase

early presentation and therefore improved treatment

outcomes.20,22

5. Limitation of our study

The only limitation of our study was that it was limited to

adults who were attending out-patient setting of RDC,

Guwahati during the study period were considered. It may

exclude the patients of in-patient setting of hospital and other

dental clinics. As our study was cross-sectional we were able

to represent the snapshot of awareness and knowledge about

the oral cancer in the adults attending RDC. It would have

been ideal to survey a random sample of the general popula-

tion, but our resources were limited. Therefore caution should

be taken before generalizing the findings of this study.

6. Conclusion

The results of present study suggest that most of the in-

dividuals were never had their mouth tested for oral cancer

detection and also lack the basic knowledge and awareness

about the risk factors like tobacco and alcohol consumption

on oral cancer. Therefore, our study concludes that the lack of

basic awareness about the risk factors, causes, signs and

symptoms of oral cancer in this cross-sectional population of



Northeast Indian adults attending dental hospital. It was

suggested to initiate intensive public awareness programs to

educate people about recognition of early warning signs and

risk factors to facilitate early detection of oral cancer by self

examination of mouth.

Conflicts of interest

All authors have none to declare.

Acknowledgments

This research was supported by the National Institute of

Pharmaceutical Education and Research, Guwahati, under the

aegis of Department of Pharmaceuticals, Ministry of Chem-

icals & Fertilizers, Government of India.

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5. Neville BW, Day TA. Oral cancer and precancerous lesions.Cancer J Clin. 2002;52(4):195e215.

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oral cancer awareness and knowledge in adults attending a dental hospital in northeast india

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