Oral cancer is on a dangerous upward curve in Sri Lanka, affecting youth in the prime of their lives, persons in middle and old age. The tragedy is unlike breast cancer this type of cancer is preventable as it is largely due to bad habits acquired from adolescence and continued into middle age and old age. These habits include smoking (cigarettes, beedi or cigar), drinking (arrack, kasippu, whisky) and betel chewing (with or without tobacco).
The last is one of the chief causes of oral cancer in Sri Lanka. It’s not just chewing betel leaves but betel quid chewing and arecanut consumption that often leads to oral cancer. The results are deadly as it affects the lips, oral cavity and pharynx resulting in patients being unable to open their mouths to speak or even eat. For forty percent of victims the chance of survival is five years and the remaining 60 percent will die within a much shorter time.
Due to ignorance of the grave implications of this disease and how it is caused the Health Ministry launched a social marketing campaign for prevention and early detection of oral cancer in Sri Lanka. The topic was also widely discussed by experts in the field at a seminar held at the Health Education Bureau.
Dental Services Deputy Director General Dr. J. Jayasundara Bandara said that the campaign was targeted at reducing cancer with especial emphasis on oral cancer. He said that the public could easily resolve the problem as oral cancer was preventable and mainly due to aforementioned bad habits. Pointing to the history of betel chewing in Sri Lanka linked with ancient cultural practices he emphasized that betel chewing still continued to be a major cause of oral cancer especially among women in the estate sector.
WHO Sri Lanka Country Representative Dr. F. R. Mehta observed that oral cancer was the most prevalent cancer among males while breast cancer was the most prevalent among women in South Asia. Worldwide seven in 100,000 people had oral cancer with a mortality rate of 400,000. In European countries the risk factors were mostly smoking, alcohol consumption and Human Papilon Virus (HPV) whereas in south Asian countries such as India and Sri Lanka the main cause was betel chewing.
National Cancer Institute Maharagama Consultant Onco-surgeon Dr. Indrani Amarasinghe listing the risk factors of oral cancer said they were betel chewing, smoking (including passive smoking), alcohol consumption and poor dietary habits that weakened resistance to the disease. She said even though the percentage of head and neck cancers had dropped from 40 percent in 2010 to 28 percent in 2012 oral cancer was still a problem with both men and women.
She said there were four stages of oral cancer, the last being the most severe. “Advanced cases are what we’re seeing mostly today. By the time they visit us their jaw bone (mandible) is completely gone. The procedure of its replacement is very complicated sometimes requiring surgeons to take a bone from the leg and attach it to the jaw,” explained Amarasinghe. “The procedure requires costly surgery which can extend up to eight hours. Besides, the procedure is very traumatic. Preventing oral cancer with early detection is thus the best solution,” she reiterated.
National Cancer Control Program Community Dentistry Consultant D. Hemantha Amarasinghe citing 2006 statistics said that the reported number of patients with oral cancer totaled 1817 with oral cancer being the most common among males. There was a marked difference in the ratio for the incidence of oral cancer (16 per 1000,000 in males and four per 100,000 in females). There was very little difference in the ratio for death rates (2: 3). He cited that it was discovered that oral cancer was particularly high in Kadugannawa area in 1984 where it was recorded 4.2 percent having Oral Potentially Malignant Disorders (OPMD). In 2007, in Sabaragamuwa Leukoplakia (white or grey whitish patch in the mouth leading to cancer if neglected) was present in 89 per 1,000 of the population. A National Oral health survey conducted in 2003 showed 7.6 percent of the population having OPMD. Over 82 percent of the rural and estate sector ran a risk of oral cancer with 82 percent being unaware of the danger of arecanut consumption.
Bus drivers and conductors also run high risks of oral cancer due to their lifestyles, as over 50 percent of them smoked daily, 31 percent consumed alcohol weekly or daily, 59.2 percent chewed betel occasionally and 22.3 percent daily. The highest risk group was over 30 years’ old and guilty of following these bad habits daily.
“Our biggest problem is to get them to give up these bad habits. Some think that because they have been treated for oral cancer once they are cured. But it can recur if they continue to smoke, drink and chew betel. The best way is for them to learn to recognize the symptoms themselves by looking inside their mouths in a mirror or visit their dentist regularly. If treated early they can be completely cured,” he stressed.