Challenges of the Oral Cancer Burden in India

Oral cancer ranks in the top three of all cancers in India, which accounts for over thirty per cent of all cancers reported in the country and oral cancer control is quickly becoming a global health priority. This paper provides a synopsis of the incidence of oral cancer in India by focusing on its measurement in cancer registries across the country. Based on the International Classification of Disease case definition adopted by the World Health Organisation, and the International Agency for Research on Cancer, this review systematically examines primary and secondary data where the incidence or prevalence of oral cancer is known to be directly reported. Variability in age-adjusted incidence with crude incidence is projected to increase by 2030. Challenges focus on measurement of disease incidence and disease-specific risk behavior, predominantly, alcohol, and tobacco use. Future research should be aimed at improving quality of data for early detection and prevention of oral cancer. 1. High Burden of Oral Cancer in India Oral cancer is a major problem in the Indian subcontinent where it ranks among the top three types of cancer in the country [1]. Age-adjusted rates of oral cancer in India is high, that is, 20 per 100,000 population and accounts for over 30% of all cancers in the country [2]. The variation in incidence and pattern of the disease can be attributed to the combined effect of ageing of the population, as well as regional differences in the prevalence of disease-specific risk factors [3]. Oral cancer is of significant public health importance to India. Firstly, it is diagnosed at later stages which result in low treatment outcomes and considerable costs to the patients whom typically cannot afford this type of treatment [4]. Secondly, rural areas in middle- and low-income countries also have inadequate access to trained providers and limited health services. As a result, delay has also been largely associated with advanced stages of oral cancer [5]. Earlier detection of oral cancer offers the best chance for long term survival and has the potential to improve treatment outcomes and make healthcare affordable [6]. Thirdly, oral cancer affects those from the lower socioeconomic groups, that is, people from the lower socioeconomic strata of society due to a higher exposure to risk factors such as the use of tobacco [7]. Lastly, even though clinical diagnosis occurs via examination of the oral cavity and tongue which is accessible by current diagnostic tools, the majority of cases present to a healthcare facility at later stages of cancer