How many of us have seen that ghastly image of a mouth on a cigarette pack and still gone on to light a smoke?

Despite efforts to raise awareness about the ills of head and mouth cancer, its instances are on the rise in the country and stand way above the global averages.

According to a recent report Globocan by the World Health Organization (WHO), about one-third of all cancers in India are of the head and mouth, while globally, these cancers account for just 3 per cent of malignancies. The main cause of this kind of cancer, clinically called oropharyngeal squamous cell carcinoma (OPSCC), is consumption of tobacco and alcohol.

The combined consumption of both reportedly increases the risk by 15 times. Doctors feel this is because alcohol acts as a solvent and enhances the penetration of carcinogens into the target tissues. Acetaldehyde, found in alcohol, has been recently found to increase the risk of tumors. Consumption of paan and gutka, even that which does not contain tobacco, is also a risk factor and has been seen to cause cancers of the oral cavity.

India has one of the highest rates of oral cancer in the world, and this is partly attributed to widespread chewing of tobacco in central, eastern, western (except Goa) and north-eastern states (except Meghalaya). Chewing of tobacco is more of a social norm, with normally starts early on. In north India, tobacco chewing is less common, but smoking is high in most states, except Punjab.

One of the main reasons for low rates of treatment and high mortality is late diagnosis. In a study of head and neck cancer by Dr. B Borooah Cancer Institute in Guwahati, Assam, about 84 per cent of cases were diagnosed only in Stage 4 of the cancer, whereas early diagnosis (in Stage 1) was seen in just 1.5 per cent of cases. The average age of diagnosis was 56 years.

Studies have demarcated a link between literacy levels and this kind of cancer. And, it is this lack of awareness which leads to late diagnosis. About 56.1 per cent of the women diagnosed with head and mouth cancer in India were illiterate, while for men, the figure was nearly 30 per cent.

Further, males were almost four times more affected by the disease than females, as they were found to be consuming both chewable tobacco and smoking it, a trend which was rare for women. Almost 85 per cent of women tobacco users were just chewing it.

Research has indicated a direct correlation between education and instances of head and mouth cancer. With increasing levels of education, the proportion of cancer cases showed a downward trend. The study also showed that in females, 62.1 per cent of the women who consumed tobacco in any form were illiterate, while barely 0.5 per cent of women who had completed a high degree of qualification consumed tobacco. The study also revealed that those with low levels of education were at the highest risk for cancers related to smoking.

There is, therefore, a need to spread awareness about the ills of head and mouth cancers and its direct correlation with consumption of tobacco and alcohol.