Oral cancer epidemic in the making
April 07, 2007 Saturday Rabi-ul-Awwal 18, 1428
KARACHI: Oral cancer epidemic in the making
By Faiza Ilyas
KARACHI, April 6: Karachi has the highest incidence of oral cancer in the world. With the increasing number of oral cancer cases, the city may witness an epidemic in the coming years. The government immediately needs to check the widespread use of betel leaf (paan), betel nut (chalia), tobacco and their various concoctions such as gutka and manpuri, as the disease now affects the younger population.
These facts came to light in discussions with different doctors. They included the Head of Karachi Cancer Registry and Aga Khan University Pathology-based Cancer Registry, Dr Yasmin Bhurgri; Head of ENT Department, Jinnah Postgraduate Medical Centre, Professor Dr Tariq Rafi; Head of ENT Department, Civil Hospital Karachi, Dr Javed Alam; Head of Pathology Department Sindh Medical College Dr Serajuddaula Syed and General Secretary Pakistan Medical Association Dr Qaiser Sajjad.
Cancer of oral cavity, according to Dr Bhurgri, ranks sixth in the world in both sexes. It is the third most common cancer in men in developing countries. However in Karachi, the malignancy ranks second in both genders. The incidence, she claimed, is the highest in the world.
Dr Bhurgri proved this in her research paper, Cancer of the Oral Cavity -- Trends in Karachi South (1995-2002), which was published in Asian Pacific Journal of Cancer Prevention in 2005. A total of 2,253 oral cancer cases were registered in Karachi South for the 8-year study period, accounting for 8.8 per cent of all cancer cases. The study was divided into two parts; from 1995 to 1997 and 1998 to 2002.
According to the study, the Age Standardised Rates (ASIRs) per 100,000, from January 1 1998 to December 31, 2002 in Karachi South were 21.3 in males and 19.3 in females, whereas the ASIRs per 100,000 from January 1, 1995 to December 31, 1997 were 14.2 and 14.6 in males and females, respectively.
The second part of the study is under publication, which further confirms that Karachi has the highest incidence of oral cancer in the world. The city also has a high rate of cancer in the pharynx. Besides, a large number of head and neck cancers can also be attributed to paan, chalia, tobacco and gutka, she said.
The study showed oral cancer was found to be equally common in men and women; the most common site was the mucosa cheek (55.9pc), tongue (28.4pc), palate (6.8pc), gum (4.4pc) and floor of the mouth (1.4pc). About 30pc of cases occurred in patients 40 years and younger and 23pc in patients 65 years and older. A strong socio-economic factor, with a poorer, low-literacy profile, was found to be associated with oral cancer in the entire study period.
The increasing number of oral cancer cases in the city was confirmed by Professor Dr Tariq Rafi of JPMC and Dr Javed Alam of CHK. At JPMC five to six cases of oral cancer are reported every day, while CHK has eight to 10 cases of oral cancer every day, with the same number of patients with pre-malignant conditions.
People often seek medical help very late, making treatment more costly and complicated. This increases the chances of recurrence while minimising years of survival. According to Dr Qaiser Sajjad, teenagers, especially girls, are now becoming victims of oral sub-mucous fibrosis, a pre-malignant condition.
The severity of the situation can be gauged from a study conducted last year by students of Department of Social Work, University of Karachi (KU). It says 93per cent children of 50 government and private schools in Saddar Town spent their pocket money on buying chalia or supari and 7 per cent on paan and gutka.
Though chalia does induce a mild sense of excitement, several brands of chalia and saunf supari were found to be laced with narcotics, according to a KU research study. Dr Serajuddaula Syed points out most of the chalia being sold in the market is of very cheap quality and has fungus, making it harmful for human consumption. The colours added to the compound have also proved to be harmful.
However, it doesnt mean chalia or paan without tobacco is safe. In many studies paan chewing and chalia have proved to have sufficient evidence of carcinogenicity and are independent risk factors for the disease.
While the burden of oral cancer is increasing on public sector hospitals, which have limited resources, no preventive measures are being taken to check the widespread use of chalia, manpuri and gutka, especially among school-children. This is a grave situation. If preventive measures are not taken, oral cancer may take the form of an epidemic in coming years, says Dr Tariq Rafi.
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