On World Head and Neck Cancer Day today, July 27, experts emphasise upon the need for prevention and early screening to reduce the disease burden and not allow it to spiral, which it would looking at its rate of growth.Statistics in head and neck cancer burden in IndiaHead and Neck cancers are a leading contributor to the Indian health care burden with a staggering incidence of 149,782 patients in 2012, which, experts say, is expected to rise by 23.76% within the next two years alone.A large majority comprises the oral cavity (ASR (age-standardised rate) of 7.2 per 100,00) followed by pharynx (3.1 per 100,00). Bhopal has the world’s highest ASR in males for both tongue (10.9 per 100,00) and mouth cancers (9.6 per 100,00), while Trivandrum has the highest in oropharynx.A “belt of thyroid cancer” has been recognised in the Western costal districts of Goa, Karnataka and Kerala.“The estimated prevalence of these cancers is a conservative estimate, as the real incidence is expected to be at least 1.5 to 2 times higher due to the low coverage of cancer registries,” says Dr Pankaj Chaturvedi, senior cancer surgeon (head and neck), Tata Memorial Hospital, Mumbai.Over the past 30 years, a steady ascending trend in prevalence has been observed for these cancers, especially the mouth. Typically, they present in elderly males, but recent data suggests a shift towards younger age groups, probably due to the rising numbers of population with early age of initiation of habits.Outcomes of head and neck cancer in IndiaThe mortality of these cancers has been reported to be quite high in our demographic, as most of the affected present at an advanced stage, making them quite expensive for an emerging economy like India.If diagnosed early, the survival has been shown to be quite good for early stage head and neck cancers.The 5-year relative overall survival of cancers of the oral cavity is 45.1%, oropharynx is 29.7%, hypopharynx is 29.1% and larynx is 41.2%; all of which are much less compared to the Western literature.Also read: How Arjun Rampal’s mother fought cancer and wonCauses of head and neck cancer in IndiaMost of the head and neck cancers are due to a combination of individual predilection and exposure to various carcinogens caused by lifestyles activities. Tobacco use, enjoying widespread social acceptance in the Indian community, has shown a decrease in the past few years from 28.6% to 34.6%, with Khaini and Beedi being the most popular forms used. About double the adult population use smokeless compared to smoked tobacco. Additionally, the average rural Indian consumes almost twice the quantity of alcohol than the global average individual consumption per year (11.4 versus 6.2 liters). Others include areca nut, poor oral hygiene, chronic dental trauma and the HPV virus.“Sharp tooth is one of main reasons for developing sores that over a period of time can lead to serious conditions, even mouth cancer. We have an ulcer clinic running in our hospital and those who notice mouth ulcer that’s not healing, should get screened,” says Dr OP Kharbanda, head, dental institute, All India Institute of Medical Sciences, Delhi. Signs and symptoms of head and neck cancer in IndiaThe symptoms depend on the area of cancer growth. For oral cavity, an obvious growth or non-healing ulcer, especially at the site of tobacco use, are the most common indicators given by the patient. Oropharyngeal cancers often present with large neck swellings along with a mild to moderate change in voice due to the obstruction at the tonsil or tongue base. For the larynx, change in voice and/or dysphagia (difficulty in swallowing), along with different grades of difficulty in breathing, are common symptoms. Presentation with radiating pain, quick progression, numbness, bleeding and regional nodal swelling, all suggest progression of disease. Preventive strategies for head and neck cancer in IndiaThe overall cost of cancer related productivity lost in developing countries is $46.3 billion, while the highest due to lip and oral cavity was in India, at an astounding total of $0.74 billion ($30,563 loss per death). Prevention and early detection is the most effective way to reduce disease burden in India.