Killers – Areca nut and smokeless tobacco
SRI LANKA – The chewing of smokeless tobacco and areca nut allied products such as babul and betel has proved to be the main cumulative factor for oral cancer, it has been found, and therefore he called for a concerted public campaign to discourage these habits.
“There are around 14,000 patients affected with oral cancer in Sri Lanka; while 1,800 new cases are reported annually, nearly 1,000 people die every year,” Prof Tilakaratne said.
“If detected early, oral cancer could be cured. It is imperative that counter campaigns against smoking are launched, especially to discourage youth in particular from chewing betel with areca nut, tobacco and chunam.”
Prof Tilakaratne acknowledged that it was difficult to convince people about the harm since it was an old custom among millions of Sri Lankans and observed that social and public organizations, media and medical professionals have a role to play in educating the people.
Raising awareness, it was opined, would lay the foundation for new legislations necessary to reverse this trend. Similar initiatives have already shown good results in the Indian state of Maharashtra where oral cancer was reported to be a significant health and socio-economic burden. Secondly it was hoped that updated information of clinicians who treat oral cancer, on the various aspects of the disease from diagnosis to treatment could be compiled.
The conference also offered an in-depth program on precursor lesions, as the majority of oral cancers arise in the background of oral pre-cancer (oral potentially malignant disorders). Experts in the field of oral cancer from countries such as UK, USA, Australia, India and Korea also spoke on different aspects to update Sri Lankan clinicians.
This important initiative to deal with these habits and the treatment of oral cancer was coupled with a declaration on restricting smokeless tobacco and areca nut use in Sri Lanka with the aim of reducing the oral cancer burden in the country.
The betel chewing habit in Sri Lanka dates back to 340 B.C and introduction of tobacco to the betel quid might have happened much later during the colonial period by the Portuguese. Until recently it was the common belief that the main etiological factor for oral cancer is the tobacco in the betel quid.
However, in some countries such as Taiwan, although the use of tobacco with chewing is not practiced, oral cancer incidence was not significantly less, indicating the existence of another carcinogen in the betel quid. There is ample research to show that some ingredients present in areca nut, especially arecoline are definite carcinogens after metabolic activation. This has led to the labeling of areca nut as a carcinogen by the International Agency for Research on Cancer and World Health Organization.
The majority of oral cancers in Sri Lanka are preceded by some kind of a pre-cancer which is now defined as an oral potentially malignant disorder. The population prevalence of oral pre-cancer in Sri Lanka, based on one large epidemiological survey, was estimated at 4.2 percent. Recent studies conducted using similar clinical criteria for detecting prevalence of oral pre-cancer showed a figure of 6.7 percent. Although there is a long list comprised of oral sub mucous fibrosis,
leukoplakia, oral lichen planus, erythroplakia, chronic hyperplastic candidiasis, sideropenic dysphagia, tertiary syphilis and actinic keratosis, the first two entities are the most important, as a significant number oral cancers arise from those in Sri Lankan patients. Oral sub mucous fibrosis which is a chronic progressive disorder and its clinical presentation depends on the stage of the disease at detection.
The majority of patients show intolerance to spicy food, rigidity of lips, tongue and palate leading to varying degrees of limitation with respect to opening the mouth and tongue movement. The disease is predominantly seen in India, Bangladesh, Sri Lanka, Pakistan, Taiwan, Southern China, Polynesia and Micronesia. Of these, 7-13 percent may develop oral cancer, it is estimated. Up to 25-30 percent of oral cancer patients have evidence of oral sub mucous fibrosis. The other important oral pre-cancer in Sri Lanka is leukoplakia which manifests as a white patch. The malignant transformation rate varies, depending on the clinical type of leukoplakia. However, the overall malignant transformation rate appears to be 5-7 percent.
Since most of these cancers arise in the background of pre-cancers, prevention if not early detection should not be a difficulty. Unfortunately this aspect is not adequately addressed.
Islandwide health awareness programs enhancing self-identification of lesions and more importantly educating the public on health hazards of tobacco and areca nut should be carried out systematically. It must be remembered that most victims are from low socio-economic backgrounds.
Despite the fact that oral cancer is preventable with habit intervention, prevalence data does not seem to show a downward trend over many decades. About 70 percent of our oral cancer patients present to clinicians at a very late stage which leads to poor prognosis irrespective of the treatment.
The Centre for Research in Oral Cancer at the Faculty of Dental Sciences, University of Peradeniya was established to facilitate this process. The Centre works very closely with the National Cancer Control Program of Sri Lanka.
Source: The Nation
Published: 07 Sep 2014
Category: Features, Health alert
