Risk Assessment of Smokeless Tobacco among Oral Precancer and Cancer Patients in Eastern Developmental Region of Nepal

Abstract

Background: Oral potentially malignant disorders (OPMDs) and oral cancer (OC) are preventable oral mucosal<br />diseases prevalent in Asian region. This epidemiological study aims to identify oral potentially malignant disorders<br />(OPMDs) and oral cancer (OC), confirm histopathologically, and treat or refer these cases among the population of<br />Eastern Development Region (EDR) of Nepal. It also attempts to assess the risk factors associated in order to compare<br />dose–response measurements of oral habits in these patients. Methods: Cross-sectional epidemiological study was<br />conducted over a period of 2 years in 16 districts of EDR. A total of 3,200 people were screened. A brief history was<br />taken and visual screening examination was conducted in two phases as described by British Columbia Oral Cancer<br />Prevention Program. Suspicious oral lesions were biopsied either by punch or scalpel after toluidine blue staining.<br />Tissue specimen was transported to the institutional lab for histopathological processing. The reports were sent to the<br />patients through the local leaders or organizations. Results: More than 40% of the study population either chewed<br />areca nut and/or tobacco. Eighteen percent were smokers. OPMDs were prevalent among 468 study population with<br />male-female ratio of 3:1. Tobacco pouch keratosis (50.4%) was the most prevalent OPMD, followed by OSF (29.1%).<br />Fifty-two had squamous cell carcinoma and 8 had verrucous carcinoma. Conclusion: Chewing areca nut, tobacco,<br />commercial areca nut/tobacco preparation and smoking being the major risk factors, there is high prevalence of oral<br />cancer and OPMDs in the EDR of Nepal.