“A STUDY TO ASSESS THE KNOWLEDGE REGARDING

RISK FACTORS RELATED TO OROPHARYNGEAL CANCER

AMONG STUDENTS OF SELECTED COLEGES AT
BANGALORE”

BRIEF RESUME ON INTENDEND WORK

INTRODUCTION

The oral cavity and pharynx combined is the sixth commonest site of cancer in
both sexes. In many countries the mortality rate is increasing among younger
men . A causal role in the etiology of mouth cancer has been established for
tobacco use, both smoking and chewing, separately and in conjunction with
betel quid chewing; with alcohol consumption and, less certainly, with other
factors such as poor oral hygiene, nutritional factors and certain occupational
exposures.

In Asian societies, a high attributable risk can be ascribed to

cigarette smoking and betel chewing. Oropharyngeal cancer is an important
form of cancer, and one for which practical prospects for prevention already
exist. Against this background of a continually increasing trend among younger
persons, it seems essential to engage upon programmes of prevention, including
increasing awareness for early detection, against Oropharyngeal cancer

At present, the
highest incidence rates of mouth cancer in men are to be found in Bas-Rhin,
France (13.5 per 100 000), Poona (8.4) and chennai (8.1) in India, Sao Paulo,
Brazil (8.0) and Doubs, France (8.0). [All rates shall be the directly-adjusted,
annual, age standardized rates per 100 000 person-years using the
World Standard Population (as described in ref 3) unless otherwise stated in the
text.] Rates are also high in Calvados, France (6.9) and Bombay, India (6.5).
The lowest incidence rates are reported from Northern European countries,
Eastern European countries and Japanese and Chinese population groups.
 Rates in women, overall, are generally lower than in men although the highest
female rate (Bangalore) was higher than the highest recorded male rate.
Interestingly, the five highest rates recorded in women are
from the five regions of India (Bangalore 15.7, chennai 10.0, Poona 6.3,
Bombay 5.0 and Nagpur 4.6). Rates of mouth cancer in Britain are generally
intermediate in each sex. Overall, the incidence in each sex is higher in
Scotland than England and Wales (men 2.0 and 1.2; women 0.8 and 0.5).
Around 1975, the incidence of mouth cancer in men appeared almost double in
'urban' as opposed to 'rural' areas of the same region (Table 2). This excess was
observed in 14 of 16 regions where the necessary
data were available. Using data from around 1980, the pattern was not so clear
although 6 out of 11 regions had higher rates in urban areas than in rural areas.
Of the seven regions with such data covering both time periods, the excess of
mouth cancer observed in urban areas of Miyagi, Japan and Doubs, France both
disappeared between these observation points.

Oral cancer is one

of the few forms of malignant disease which is increasing notably in many
countries of the developed and developing world. It is a disease which has
attracted relatively little attention from epidemiologists compared to many other
forms of cancer. Cigarette smoking and alcohol consumption
have clearly been identified as important etiological risk factors for mouth
cancer in the developed world. In the developing world, There is also evidence
that mouth cancer risk increases with the use of oral snuff and suggestions that
dietary factors may also be of importance in the etiology of this disease. At the
present time it does not appear that occupational factors are important causes of
mouth cancer and the role of mouthwash, dentition and other risk factors, such
as Candida albicans, herpes simplex or human papilloma virus infection, remain
unclear WT. There has recently been a number of important publications on the
epidemiology of oral cancer.
Prospects for the prevention of mouth cancer clearly do exist. Reduction of
tobacco smoking and alcohol consumption would bring about substantial
declines in the frequency of mouth cancer in developed countries.
Reductions in cigarette smoking and betel chewing would bring about similar
reductions in the Indian subcontinent. Another possible factor in reducing
mortality from mouth cancer would be an increased awareness of mouth cancer
among dentists, clinicians and the general public which could possibly lead to
earlier diagnosis.

Hence, the importance of structured teaching

programme among alcoholics and smokers is highly influential for the
prevention of this rrisk factors which may result in oral and pharyngeal cancer.

NEED FOR THE STUDY

Alcohol and tobacco, alone or in combination, are associated with an increased

risk of various cancers, including those of the upper aero-digestive tract and
liver. Both alcohol and tobacco use can increase the risk of cancer of the oral
cavity and throat (pharynx), and their combined use has a multiplicative effect
on risk. Moreover, those regions of the mouth and pharynx that are more
directly exposed to alcohol or tobacco are more likely to be affected by cancer
than other regions. A similar effect was found with respect to cancer of the
voice box (larynx). For squamous cell carcinoma of the esophagus, alcohol and
tobacco also appear to increase risk synergistically. With liver cancer, in
contrast, alcohol consumption and tobacco use appear to be independent risk
factors.
KEY WORDS: Alcohol and tobacco; alcohol consumption; ethanol; smoking;
tobacco use; multiple drug use; cancer; risk factors; relative risk; population-
attributable risk; oral cancer; pharyngeal cancer; laryngeal cancer; esophageal
cancer; liver cancer; hepatocellular carcinoma.

Both alcohol and tobacco use are associated with numerous adverse health
consequences, including an increased risk of certain types of cancer. For
example, epidemiological studies found that alcohol consumption can increase
the risk for cancers of the upper aero-digestive tract, stomach, large bowel (i.e.,
colon and rectum), liver, and breast, with higher levels of consumption leading
to greater increases in risk (Bagnardi et al. 2001). Similarly, tobacco use is
associated with an elevated risk of lung cancer, as well as of cancers of the
upper aero-digestive tract, bladder, kidney, pancreas, stomach, and cervix and a
certain type of leukemia (International Agency for Research on Cancer [IARC]
2004).

Many people use and abuse both alcohol and tobacco, and their combined
effects on cancer risk also have been widely investigated. This article
summarizes those findings, focusing on cancers at sites that are most directly
exposed during alcohol and tobacco consumption--that is, the upper aero-
digestive tract (i.e., the oral cavity, throat [pharynx], voice box [larynx], and
esophagus) and the liver.

ORAL AND PHARYNGEAL CANCER

In developed countries, oral and pharyngeal cancers rarely occur in people who
neither smoke nor drink alcohol. However, many epidemiological studies
conducted over the last three decades in the Americas, Europe, and Asia have
provided strong evidence of an association between alcohol and tobacco use
(both separately and in combination) and an increased risk of oral and
pharyngeal tumors (Blot et al. 1988; Franceschi et al. 1990; Zheng et al. 1990,
2004).
Risk Associated With Alcohol Consumption:

The risk of both oral and pharyngeal cancer rises steeply with the level of
alcohol consumption. An analysis that pooled data (i.e., a meta-analysis) from
26 studies of oral and pharyngeal cancers found that consumption of 25, 50, or
100 g pure alcohol/day (1) was associated with a pooled relative risk (RR) of
1.75, 2.85, and 6.01, respectively, of oral and pharyngeal cancer (see Table 1)
(Bagnardi et al. 2001). The RR indicates the strength of the relationship
between a variable (e.g., alcohol consumption) and a given disease or type of
cancer. People without the exposure (e.g., nondrinkers) are assigned a RR of
1.0. A RR greater than 1.0 indicates that the variable (e.g., drinking) increases
the risk for that disease; furthermore, the greater the RR, the greater the
association. Thus, the meta-analysis clearly demonstrated that the RR for oral or
pharyngeal cancer increased significantly with increasing amounts of alcohol
consumed. Similarly, another study conducted in Switzerland and Italy found
that nonsmokers who consumed five or more drinks per day had a five-fold
increased risk of these cancers compared with nondrinkers (Talamini et al.
1998).
The relationship between duration of alcohol consumption and risk of oral or
pharyngeal cancer is less consistent. Moreover, the effect of drinking cessation
on the RR for oral or pharyngeal cancer is unclear. Thus, it appears that the RR
for these types of cancer appreciably declines only after 15 to 20 years of
abstinence (Hayes et al. 1999).
Several studies also evaluated the effects of different types of alcoholic
beverages on cancer risk. These analyses found that cancer risk generally was
increased regardless of the type of beverage consumed. Moreover, the
magnitude of the association between different types of beverages and cancer
risk was inconsistent across studies and populations. In general, the beverage
most frequently consumed in a population was associated with the highest risk
of oral and pharyngeal cancer in that population (Boffetta and Hashibe 2006).
PROBLEM STATEMENT
“A STUDY TO ASSESS THE KNOWLEDGE REGARDING OROPHARYNGEAL
CANCER AND ITS ASSOCIATION WITH ALCOHOL CONSUMPTION AND
SMOKING AMONG INDUSTRIAL WORKERS AT SELECTED INDUSTRIES IN
BANGALORE WITH A VIEW TO DEVELOP A SIM”

OBJECTIVE
1.Assess the pretest knowledge of adult industrial workers regarding association
of oral and pharyngeal cancer with alcohol consumption and smoking.

2.Assess the post test knowledge of adult industrial workers regarding

association of oral and pharyngeal cancer with alcohol consumption and
smoking.

OPERATIONAL DEFINITION