9TH ASPP Presentation OF DR.TATHAGATA BHATTACHARJEE.pptx

ORAL CANCER AND PREVENTION

1. Title - Cancer causing habits and related oral lesions: A study among people with different occupations of West Bengal,India Name of Presenter- Tathagata Bhattacharjee Research Laboratory- Occupational Ergonomics Laboratory Department of Physiology University College of science and technology University of Calcutta 92,APC Road,Calcutta 700009,India Name of Superviser - Prof. Dr.Somnath Gangopadhyay Ph.D , FABMS Professor Department of Physiology University of Calcutta

2. Introduction Oral Cancer - eleventh most common cancer around the globe. India-14 deaths per hour. Increased mortality rate is due to delayed presentation. ‘Potentially malignant disorder’ Habits related to oral cancer – Global Adult Tobacco Survey -2 report (2016-2017)- 266.8 million people uses tobacco in India. Tobacco use as well as oral cancer both varies by occupation &Socioeconomic status. Tobacco quit rate did not increased due to poor follow up of tobacco users for counselling. The best community based tobacco cessation facility will be occupation based or workplace based tobacco cessation centre; where follow up of past tobacco users, spreading awareness among them and periodic check up for tobacco related health issues will be easy.

3. Aim- Assess the prevalence of different habits and habit-related different oral lesions among people with different occupations. Objectives- Determine and compare * Different habit products * Pattern of use of different habit products * Risk factors for different oral lesions among people with different Occupations

4. Subject recruitment & Data Collection Different free dental health and oral cancer screening camp - around different districts of West Bengal.

5. Written Informed consent sample of information sheet and informed consent form in English and Bengali were prepared. After giving Information sheet; Written informed consent was taken from people, prior to conducting the study.

6. Inclusion and exclusion criteria: Inclusion -People, without any known systemic diseases; those who gave consent for the study; irrespective of their age, sex, occupation, income etc. Exclusion -Pregnant woman as well as pre diagnosed oral cancer patients.

7. Questionnaire Questionnaire was divided in 2 sections Demographic details Habit details After Subjects selection- A pre-tested Questionnaire was given

8. Demographic details Demographic characteristics EDUCATION AGE GENDER NO OF FAMILY MEMBERS OCCUPATION INCOME PLACE OF RESIDENCE

9. Habit details- WHO Questionnaire WHO steps questionnaire

10. In this structure - Each major group is further organized into sub-major, minor and unit groups Occupation – The ISCO-08 structure DIVISION OF STUDY POPULATION

11. Clinical Part-Diagnosis Oral cavity examination was done in the daylight using mouth mirror and explorer and whenever necessary an additional light was used. WHO criteria and colour atlas of oral pathology was used for diagnosis of oral mucosal lesions. Whenever necessary patients were sent for biopsy and follow-up of the patients were done for proper diagnosis.

12. Statistical methods Data were entered into a Microsoft Excel spreadsheet. Based on data, groups were formed. Analyzed by SPSS 24.0 (IBM corporation, New York City, New York, USA).

13. Results Total 841 people participated in this study. 467 were from North Bengal and 374 were from South Bengal. 446 were male and 395 were female. 49.20% from rural area & 50.80% from urban area. Mean age of our study population was 40.21

14. Cancer Causing habits 49% People had Cancer Causing Habits in Our Study Population.

15. Cancer Causing habits in different Occupation Group-0 occupation/ People in armed forces had cancer causing habits most and People with Group-1 Occupation /managers had Cancer causing habits least.

16. Smoking and occupation Housewives and people with Group-1 occupation/ Managers did not smoke . In North Bengal, smoking was most common among people with Group-9 occupation/Elementary occupations, followed by students. In south Bengal, smoking was most prevalent among Group-6 occupation/ Skilled agricultural, forestry, and fishery workers.

17. Distribution of smoking product Group-9 Occupation (28.7%) 55-64 age group. North Bengal (51.7%). Group-9 Occupation (19.4%). 25-34 age group less among females than Bidi and other products South Bengal (58.3%). Combined Bidi and Cigarette use was more common in South Bengal (70.6%) BIDI CIGARETTE

18. Group-6 occupation = Skilled agricultural, forestry, and fishery workers

19. Group-3 occupation - Technicians and associate professionals Group-6 occupation – Skilled agricultural, forestry, and fishery workers

20. Chewing habits AMONG OCCUPATIONAL GROUPS = C hewing habit was most common among housewives and people with group-9 occupation/ Elementary occupations.(Both Part of West Bengal ) 30.20% IN WHOLE POPULATION

21. Chewing habits Highest number of Chewers - Age group 35-44 Females - Pan with arecanut . Males - Pan with arecanut > Khaini >Packet arecanut .

22. Increased Duration of Chewing Males> Females. North Bengal Rural area. Housewives

23. 1.Managers 2 Professionals 3.Technicians and associate professionals 4. clerical support workers 5. service and sales workers 6. Skilled agricultural,foresty , and fishery workers 7. craft and related trade workers. 8. Plant and machine operators and assemblers 9. Elementary occupations 0. Armed forces occupations

24. Distribution of Chewing products in different occupation

25. Drinking habit

26. DURATION OF DRINKING HABIT

27. Cigarette (51%) Bidi (50.9%) Khaini (35.8%) Pan with areca nut (36.9%) Khaini (29.4%) Packet areca nut Bidi /Cigarette/Both Bidi (48.1%) DISTRIBUTION OF HABIT PRODUCTS AMONG USERS

28. Tobacco product and Oral lesions ORAL LEUKOPLAKIA & SMOKERS MELANOSIS BIDI ORAL SUBMUCOUS FIBROSIS GUTKHA, PAN WITH BETELNUT , PACKET ARECANUT

29. Oral Submucous fibrosis was most Common among housewives. Oral Squamous cell Carcinoma and Oral Erythroplakia was more common in people with group-6 Occupation(skilled agricultural,forestry and fishery workers).

30. risk factor associated with Oral lesions of housewives

31. Discussion Occupation related oral mucosal changes is well established.(Workplace exposure to different work related chemicals and dusts). Few study describes workplace exposure to environmental tobacco smoke. Kaori Fujishiro et al in 2012 showed that, male blue-collar and sales/office workers had higher odds of having consumed >20 pack-years of cigarettes than managers/professionals.  Prabhakar B et al in 2012 showed that, odd ratio for tobacco use was highest among unemployed but able to work people and least among students. Present Study- Smoking- Highest among Group-9 occupation(38.6%) Chewing- Highest among Housewives (28.4%) Drinking- Highest among Group-3 occupation(16.3%)

32. Oral Lesions

33. Present Study Soft tissue lesion-12.2% Leukoplakia-2% OSMF-2.6% Lichen Planus-1.8% Habit related oral changes Highest- Housewives (30.2%) Benign lesions- Group-9 occupation Premalignant lesions-Housewives Malignant lesions- Group-6 occupation

34. Unique finding of the study Predominant f actor associated with Oral Lesions of housewives Predominant factor associated with Chewing habit of housewives

35. conclusion West Bengal can be divided based on geographical variations, cultural variations, climate variations and other associated variables. Hence, pattern of tobacco consumption as well as need of tobacco cessation, counselling methods will be different from each other. At present there is urgent need of selection of target population as well as proper counselling procedure in West Bengal to prevent oral cancer. These findings could help clinicians, researchers, and policy makers for campaigning and policy making against oral Cancer .

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