Byline: Nikhiya. Shamsher, Chaithanya. Prabhu
Introduction: Smoking, the leading cause of oral cancer in India, kills over 5 people every hour. As high mortality is due to late diagnosis, early detection is vital. Free radical-induced lipid peroxidation (LP) is known to promote multistep oral carcinogenesis. Free radicals generated by smoking damage polyunsaturated fatty acids releasing end product malondialdehyde (MDA). A simple, home-based test was devised to determine salivary MDA to assess early risk of oral precancer and cancer. It was hypothesized that heavier smokers would exhibit greater degree of salivary LP. Materials and Methods: A highly sensitive QuitPuff reagent was formulated which when heated with saliva, produces a color change, directly proportional to the amount of MDA. The MDA level was measured by matching the color change with a colorimetric LP index (LPI) chart. QuitPuff was tested on 500 subjects, validated using the gold standard, ultraviolet (UV) spectroscopy. Results: The mean LPI was consistently and significantly elevated (P < 0.001) in smokers with oral precancer and cancer (4.34) and smokers who smoked more than 20 (4.12), between 10 and 20 (3.43), and <10 cigarettes per day (2.43) as compared to nonsmokers (0.26). The mean LPIs of the test and validation methods correlated. Spearman's correlation indicated significant positive association between color changes and UV spectroscopy readings (r = 0.93). QuitPuff detected salivary MDA levels with 96% accuracy. Conclusion: Smokers exhibited greater degree of salivary LP as compared to nonsmokers; the heavier the smoker, greater was the degree of LP. QuitPuff has great potential as a point-of-care test for oral precancer and cancer.
High mortality in oral cancer attributed mainly to late diagnosis
Oral cancer also known as mouth cancer is any cancerous tissue growth located in the oral cavity. It most commonly involves the tongue, floor of the mouth, cheek lining, gums, lips, or roof of the mouth. More than 90% of all oral cancers are squamous cell carcinoma.
By country, the incidence of oral cancer is the highest in India, which accounts for almost one-third of cases found in the world. Over five people in India die every hour because of oral cancer. Public health centers and private hospitals have recognized oral cancer as a grave problem and efforts toward early detection and prevention can help reduce this burden.
The high prevalence of oral cancer in India is mainly due to the influence of tobacco and betel quid chewing. Greater than 90% of patients with oral cancer report using tobacco products. The incidence of oral cancer in patients who smoke and chew tobacco is 8.4 times greater than that of patients who do not.
Globally, the 5-year mortality rate of oral cancer is approximately 50% and has not improved despite advances in diagnostic techniques and improvements in treatment modalities. The high mortality rate in oral cancer is attributed to late diagnosis, which is either due to lack of knowledge or access to medical care.,, Most patients seek help only in later stages when symptoms such as pain, ulceration, or...