• Users Online: 600
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 61-70

Oral cancer awareness and attitude toward its screening: A study among people with different occupations


1 Department of Dentistry, N. R. S. Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Physiology, University of Calcutta, Kolkata, West Bengal, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Tathagata Bhattacharjee
Kamalpur, Chakdaha, Nadia - 741 222, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_19_18

Rights and Permissions
  Abstract 


Background: The number of oral cancer cases is increasing in India. The prevalence of this disease is increasing in various occupational groups.
Aims: This study aimed to assess the awareness of oral cancer and attitude toward screening and the prevalence of related habits and habit-related oral lesions among people with different occupations.
Settings and Design: Sixteen closed-ended questions were used to assess the awareness of oral cancer. Responses were scored in accordance with the defined rules. Patients' attitude toward oral cancer screening was also assessed using ten additional questions under four headings. Information regarding the oral habits was recorded using the WHO steps questionnaire.
Materials and Methods: Distribution of occupation in the study population was categorized as per the International Standard Classification of Occupations-08 structure and all the study samples ware clinically examined to diagnose any habit-related oral changes.
Statistical Analysis Used: Student's independent sample's t-test was applied to compare normally distributed numerical variables between groups; unpaired proportions were compared by Chi-square test or Fisher's exact test. One-way analysis of variance was used to compare the means of three or more samples for numerical data.
Results and Conclusion: A statistically significant difference (P = 0.0001) in general awareness of oral cancer was seen among various occupational groups. The attitude toward oral cancer screening was assessed and found no statistically significant results, which signifies that significant motivation for oral cancer screening is required in different occupational workplaces.

Keywords: Attitude; awareness; occupation; oral cancer; oral cancer screening


How to cite this article:
Bhattacharjee T, Gangopadhyay S. Oral cancer awareness and attitude toward its screening: A study among people with different occupations. Indian J Multidiscip Dent 2018;8:61-70

How to cite this URL:
Bhattacharjee T, Gangopadhyay S. Oral cancer awareness and attitude toward its screening: A study among people with different occupations. Indian J Multidiscip Dent [serial online] 2018 [cited 2019 Jul 21];8:61-70. Available from: http://www.ijmdent.com/text.asp?2018/8/2/61/249114




  Introduction Top


The estimated cancer prevalence in India is of around 2.5 million, with moreover 8 lakhs new cases and 5.5 lakhs deaths occurring each year. A large group of malignant neoplasms comes under oral cancer, of which squamous cell carcinoma comprises 95%.[1] The oral cancer is the 11th most common cancer around the globe.[2] It is more common in the developing countries than in developed countries.[3] As per oral cancer foundation, in India, the disease affects 130,000 people annually, of which 70% of patients present in the advance stages.

The most common habits related to oral cancer in India are use of tobacco smoking and tobacco chewing.[4] Use of alcohol can be considered as an additive factor. As per the report obtained from the Global Adult Tobacco Survey, from Indian states and union territories conducted during 2009–2010, approximately 274.9 million people use tobacco in India. As per data, more than one-third (35%) of adult use tobacco in some form or the other(Smoked or smokeless), 163.7 million are users of only smokeless tobacco, 68.9 million are only smokers, and 42.3 million are users of both smoking and smokeless tobacco.[2],[3]

Various studies have shown that both tobacco smoking and oral cancer vary by occupation. Tendency of smoking is more in people with agriculture and laborer as their occupation.[2] Mortality rates of oral cancer depend on stage of cancer. Early diagnosis increases the probability of cure, and as always prevention is better than cure.

In the high incidence areas, majority of oral cancers arise from long-standing premalignant lesions.[4] Early detection comprises increased awareness about early signs, symptoms, and risk factors of oral cancer and screening of common people for oral cancer. Early diagnosis could be aided by mandatory screening for signs and symptoms of oral cancer among workers with different occupations in their workplaces. There is no literature which described about the awareness of oral cancer and attitude toward oral cancer screening among people with different occupations. Hence, the study was conducted.

The objective of the present study was to determine and compare the oral cancer awareness and attitude toward oral cancer screening among people with different occupations and to determine the prevalence of various habits related to it and associated oral lesions. This study is the first of its kind in literature as per our knowledge. The results obtained from the study will assist to implement an effective health education program for people with different occupations in workplaces, which will help reduce incidence rates of oral cancer as well as its mortality rate.


  Materials and Methods Top


The questionnaire and the study procedures were approved by the Institutional Human Ethics Committee, Department of Physiology, University of Calcutta.

The validity and reliability of the questionnaire were pretested. Result of mean knowledge scores (16 questions) and attitudinal variables (10 questions) on test–retest with a student sample were analyzed by kappa and gamma value. The mean kappa value was 0.017 ± 0.018 (mean ± standard error) and the mean gamma value was 0.047 ± 0.066 (mean ± standard error).

The study was conducted in different private dental clinics and oral health screening camp around West Bengal. A total of 150 willing healthy participants aged above 18 years were included in the study.

Information on the demographic characteristics, occupations, risk habits for cancer, knowledge about oral cancer, and attitude toward oral cancer screening was collected using a closed-ended questionnaire formatted both in English and in a vernacular language – Bengali.

Distribution of occupation in the study population was categorized as per the International Standard Classification of Occupations (ISCO)-08 structure. The ISCO-08 divides jobs into ten major groups: (1) managers, (2) professionals, (3) technicians and associate professionals, (4) clerical support workers, (5) service and sales workers, (6) skilled agricultural, forestry, and fishery workers, (7) craft and related trade workers, (8) plant and machine operators and assemblers, (9) elementary occupations, and (10) armed forces occupations. Each major group is further organized into submajor, minor, and unit groups.[5]

Measuring tool

Sixteen closed-ended questions were used to assess the awareness of oral cancer and knowledge of signs/symptoms and risk factors for oral cancer. The response categories for each of the questions were “no,” “don't know,” and “yes,” and the respondents were instructed to mark the most appropriate answer only. These were coded as 1, 2, and 3, respectively (except for the question asking if oral cancer is contagious where the scores were 3, 2, and 1, respectively). Responses were scored in accordance with the defined rules.

Patients' attitude toward oral cancer screening was also assessed using ten additional questions under four headings. Along with these, detailed information regarding the type of habit, duration, frequency, site of placement, and period of contact with the mucosa and history of discontinuation of habit were recorded using the standardized interviewer-based questionnaire (WHO steps questionnaire).[6] All the patients were then clinically examined using a mouth mirror and explorer under daylight, and whenever necessary, an additional artificial illumination was used. All the lesions were clinically diagnosed in accordance with the WHO criteria and color  Atlas More Details of oral pathology.

The questionnaire collected information regarding the person's place of residence, the number of individuals in the family, and total monthly income of the family from all sources which was used for determining the socioeconomic status (SES) of the individual using B. G. Prasad's SES scale.[7],[8]

Statistical methods

For statistical analysis, data were entered into a Microsoft Excel spreadsheet and then were analyzed by SPSS 24.0 (IBM corporation, New York City, New York, USA). Data had been summarized as mean and standard deviation (SD) for numerical variables and count and percentages for categorical variables. Student's independent sample's t-test was applied to compare normally distributed numerical variables between groups; unpaired proportions were compared by Chi-square test or Fisher's exact test, as appropriate. One-way analysis of variance was a technique used to compare the means of three or more samples for numerical data. P ≤0.05 was considered statistically significant.


  Results Top


A total of 150 participants participated in this study. Of which, as per occupational categories, Group I (managers) was 0.7%, Group II (professionals) was 22.0%, Group III (technicians and associate professionals) was 12.0%, Group IV (clerical support workers) was 10.7%, Group V (service and sale workers) was 3.3%, Group VI (skilled agricultural, forestry, and fishery workers) was 8.0%, Group VII (craft and related trade workers) was 35.3%, Group VIII (plant and machine operators and assemblers) was 0.7%, and Group IX (elementary occupations) was 7.3%. Among them, 87 (58.0%) were male and 63 (42.0%) were female. The highest number of male participants is from Group II (professionals) (26.4%) and lowest number of male participants is from Group I (managers) (1.1%) and Group VIII (plant and machine operators and assemblers) (1.1%). The highest number of female participants is from Group VII (craft and related trade workers) (73.0%) and lowest number of female participants is from Group V (service and sale workers) (3.2%). No participation of female was from Groups I, III, IV, VI, and VIII. The place of residence of people with different occupations is almost equal; 54% from rural area and 46% from urban area. Education-wise and SES-wise distribution of population with different occupations is described in [Table 1] and [Table 2]. The association of both is statistically significant.
Table 1: Distribution of the study population in different occupational categories based on socioeconomic status

Click here to view
Table 2: Association between occupation versus education

Click here to view


A statistically significant difference (P = 0.0001) in general awareness of oral cancer was also seen among various occupational groups. Group I (managers) showed the highest mean value (mean value = 15.0000) whereas Group VII (craft and related trade workers) had the least score (mean value = 10.6604).

The knowledge of signs and symptoms among different occupational groups was also not statistically significant. Group I (managers) showed the highest mean value (mean value = 16.0000) whereas Group VI (skilled agricultural, forestry, and fishery workers) (mean value = 11.2500) and Group VII (craft and related trade workers) (mean value = 11.5283) had the least score.

Comparison between different occupational groups was done to assess the knowledge about risk factors for oral cancer. The result showed statistically significant result (P = 0.0004). Among different occupational groups, Group I (managers) showed highest mean value (mean value = 15.0000) and Group VII (craft and related trade workers) showed least mean value (mean value = 8.4151).

Analysis of individual questions regarding general awareness of oral cancer among different occupational groups showed statistically significant result except for the question “Is treatment of oral cancer possible?”

Group VII (craft and related trade workers) people believed the least that prevention of oral cancer is possible and Group I (managers) people having the misconception that oral cancer is contagious.

Analysis of individual questions regarding signs/symptoms related awareness of oral cancer among different occupation groups was done. None of them showed statistically significant result. Group I people (managers) showed increased mean value for all other signs/symptoms, except the sign “continuous pain in jaw.”

Group I (managers), Group V (service and sales workers), and Group VII (craft and related trade workers) showed highest mean value to identify smoking as the risk factor. Group I (managers) and Group VIII (plant and machine operators and assemblers) showed highest mean value to identify taking alcohol as the risk factor. Group I (managers) and Group VIII (plant and machine operators and assemblers) showed highest mean value to identify taking tobacco chewing as the risk factor. Group I (managers) only showed highest mean value to identify sedentary lifestyle and positive family history of oral cancer as a risk factor.

Mean and SD for individual questions for different occupational groups is described in [Table 3].
Table 3: Mean and standard deviation for individual questions for different occupational groups

Click here to view


Attitude toward oral cancer assessment

In assessment of patients' attitude toward oral cancer screening, statistically significant value was obtained for the questions (easy to ask for mouth cancer check and if I wanted to have [P < 0.0001]) and (able to decide to allow dentist to give mouth cancer check [P < 0.0001]) which was formatted to tap the sense of control that the patient may think he or she possesses in accepting the screen. Among questions to rule out distress associated with a screen, “anxiety toward mouth cancer screening” only showed statistically significant result (P = 0.0440).

The mean value and SD of different occupational groups regarding attitude toward mouth cancer checking is depicted in [Table 4].
Table 4: The mean value and standard deviation of different occupational groups regarding attitude towards mouth cancer checking

Click here to view


Prevalence of oral cancer-causing habits

Comparative data regarding various oral cancer-causing habits among different occupational groups showed that 21.1% of current smokers were from Group II (professionals) and Group IV (clerical support workers) and 18.4% current smokers were from Group VI (skilled agricultural, forestry, and fishery workers). Major population of current smokeless tobacco chewers (44.4%) were from Group VII (craft and related trade workers). Current drinkers were more or less equally from different occupational groups. Duration and frequency of smoking habits among different occupational groups are described in [Table 5] and [Table 6]. As well as, duration and frequency of chewing tobacco uptake are described in [Table 7] and [Table 8].
Table 5: Duration of smoking habits in different occupational groups

Click here to view
Table 6: Frequency of smoking habits in different occupational groups

Click here to view
Table 7: Duration of smoking habits in different occupational groups

Click here to view
Table 8: Frequency of chewing tobacco in different occupational groups

Click here to view


Prevalence of habit-related oral diseases

The prevalence of habit-related oral diseases among different occupational groups is described in [Table 9]. Statistically significant data were obtained only for tobacco stain (P = 0.0226) and oral submucous fibrosis (P < 0.0001).
Table 9: Frequency of habit related oral disease in different occupational groups

Click here to view



  Discussion Top


In this study, among different occupational groups, Group I (managers) showed the highest mean value (mean value = 15.0000) whereas Group VII (craft and related trade workers) had the least score (mean value = 10.6604) for general awareness regarding oral cancer.

During determination of knowledge regarding risk factor of oral cancer among occupational groups, the result showed statistically significant result (P = 0.0004). Among different occupational groups, Group I (managers) showed highest mean value (mean value = 15.0000) and Group VII (craft and related trade workers) showed least mean value (mean value = 8.4151).

On the other hand, though the knowledge of signs and symptoms among different occupational groups was not statistically significant, Group I (managers) showed the highest mean value (mean value = 16.0000) whereas Group VI (skilled agricultural, forestry, and fishery workers) (mean value = 11.2500) and Group VII (craft and related trade workers) (mean value = 11.5283) had the least score.

In our study, the majority of population from Group VI (skilled agricultural, forestry, and fishery workers) and Group VII (craft and related trade workers) are from secondary education level; whereas, Group I (managers) people are graduate. The education level for their occupational post could play a role regarding awareness of oral cancer in different aspect.

In our study, Group V (service and sale workers) and Group VII (craft and related trade workers) showed highest mean value to identify smoking as the risk factor along with Group I people (managers). Group VIII (plant and machine operators and assemblers) showed highest mean value to identify tobacco chewing as the risk factor along with people with Group I occupation (managers). This widespread awareness could be attributed to image of oral cancer on packets of smoked and chewable tobacco.

None of the occupational groups had clear-cut idea regarding treatment of oral cancer as well as sedentary lifestyle as a risk factor of oral cancer. Hence, it is very essential to improve their knowledge regarding oral cancer.

In this study, the attitude toward oral cancer screening was assessed and among questions to rule out distress associated with a screen, “anxiety toward mouth cancer screening” only showed statistically significant results (P = 0.0440). All other questions to rule out distress associated with a screen as well as questions to identify beliefs about having an oral cancer screen showed no statistically significant value, which signifies need of huge motivation for oral cancer screening for early diagnosis of oral cancer irrespective occupational categories.

We assessed prevalence of various deleterious personal habits and found that 21.1% of current smokers were from Group II (professionals) and Group IV (clerical support workers) and 18.4% current smokers were from Group VI (skilled agricultural, forestry, and fishery workers). Major population of current smokeless tobacco chewers (44.4%) were from Group VII (craft and related trade workers). Current drinkers were more or less equally from different occupational groups. These data were in contrast with various previous studies which had shown that manual laborers had the highest prevalence of tobacco use.[1],[9] It signifies that mental stress of work also plays an important role to develop deleterious habits.

In this study, habit-related oral lesion among people of different occupational categories was assessed but failed to get any significant result except oral sub mucous fibrosis (P < 0.0001) and tobacco stain (P = 0.0226).

Oral submucous fibrosis is common among Group VII (craft and related trade workers) and Group VIII (plant and machine operators and assemblers) occupational groups.


  Conclusions Top


A lack of awareness of oral cancer with regard to general knowledge, sign/symptoms, risk factors, prevention, treatment, and prognosis was evident among people with different occupations in this study, which necessitating initiating and implementing educational programs. Oral cancer screening camp could be mandatory in different workplaces targeting the particular high-risk occupation in each and every area by dentists. Use of posters detailing the disease, images of lesions of oral cancer and sufferers, and cartoons against oral habits in workplace would help reduce tobacco usage as well as disease burden.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Maweri SA, Tarakji B, Alsalhani AB, Al-Shamiri HM, Alaizari NA, Altamimi MA, et al. Oral cancer awareness of the general public in Saudi Arabia. Asian Pac J Cancer Prev 2015;16:3377-81.  Back to cited text no. 1
    
2.
Pawar HJ, Singh KK, Dhumale GB. Prevalence and assessment of various risk factors among oral cancer cases in a rural area of Maharashtra state, India – An epidemiological study. JKIMSU 2015;4:74-81.  Back to cited text no. 2
    
3.
Agrawal M, Pandey S, Jain S, Maitin S. Oral cancer awareness of the general public in Gorakhpur city, India. Asian Pac J Cancer Prev 2012;13:5195-9.  Back to cited text no. 3
    
4.
Sujatha D, Hebbar PB, Pai A. Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pac J Cancer Prev 2012;13:1633-7.  Back to cited text no. 4
    
5.
International Labour Office. International Standard Classification of Occupations, ISCO-08, Vol. 1. Geneva: International Labour Office; 2012.  Back to cited text no. 5
    
6.
WHO STEPS Instrument, (Core and Expanded), The WHO STEP wise Approach to non Communicable Disease Risk Factor Surveillance (STEPS). Geneva, Switzerland: World Health Organization. Available from: www.who.int/ncds/surveillance/steps/STEPS_Instrument_v2.1.pdf. [Last accessed on 2018 Aug 30].  Back to cited text no. 6
    
7.
Guru Raj MS, Shilpa S, Maheswaran R. Revised socio-economic status scale for urban and rural India – Revision for 2015, Socioeconomica. Sci J Theory Pract Socio Econ Dev 2015;4:167-74.  Back to cited text no. 7
    
8.
Dudala SR, Arlappa N. An updated Prasad's socio economic status classification for 2013. Int J Res Dev Health 2013;1:26-8.  Back to cited text no. 8
    
9.
Devi LJ, Pradip Kumar Singh W. Prevalence and pattern of tobacco use among adults in an urban community. IOSR J Hum Soc Sci 2015;20:38-41.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
References
Article Tables

 Article Access Statistics
    Viewed1119    
    Printed129    
    Emailed0    
    PDF Downloaded6    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]