A revisit at 16 years for individuals from peri-urban New Delhi for tobacco use and associated oral lesions

Abstract

Introduction: Oral cancer and tobacco consumption (the primary risk factor for oral cancer), are major global health issues. India has a high incidence of this cancer type due to multifarious tobacco use, in both its smoked and smokeless forms, the latter being more prevalent. Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs), which may be diagnosed effectively through the conventional oral visual examination (OVE). However, so far, minimal attempts have been made on this front through cohort studies. Aim: To assess the status of tobacco-related oral lesions over 16 years, in a screen-detected population. Methods: This cross-sectional study involved home visits of 2000 Delhi (India) residents, previously screened for OPMDs/oral cancer and counselled for tobacco cessation. Their basic demographics and tobacco/alcohol history were noted followed by oral visual examination (OVE) for any related mucosal abnormalities. The data thus obtained were statistically analysed. Results: Two hundred and sixty-five individuals (13.2%) could be traced after 16 years. The status of oral lesions varied across the participants, mainly in terms of their location, type, number, and/or presence/absence; no oral malignancies were noted. Most individuals had either a decreased use (34%, p < 0.001) or had quit tobacco (25.7%, p < 0.001); 8.3% individuals from the former and 5.7% from the latter group showed complete lesion(s) regression. The overall change in the tobacco use and oral lesions showed a highly significant positive association (p < 0.05). Conclusion: A direct relationship exists between tobacco use and oral mucosal lesions. Therefore, tobacco cessation/reduction can prevent the progression/development of OPMDs, including their malignant transformation, as deciphered by the absence of malignancies among our participants, even after a long period of 16 years. Globally, preventive health programs, and effective policy measures, towards tobacco cessation and oral cancer screening among high-risk individuals, are essential to reduce the overall oral cancer relatedmortality and morbidity. All these measures are especially required in the high-tobacco burden countries globally.