Article Information

Dr. Masroor Rahman^1*_, Dr. Mohammad Anwar Hossain¹_, Dr. Tawfiqur Rahman¹_, Dr. Arif Mahmud Jewel¹

¹Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

*Corresponding author: Dr. Masroor Rahman, Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Received: 20 August 2024; Accepted: 23 August 2024; Published: 28 August 2024

Citation: Masroor Rahman, Mohammad Anwar Hossain, Tawfiqur Rahman, Arif Mahmud Jewel. The Role of Tobacco as A Risk Factor in Head and Neck Cancers: A Comparative Study. Fortune Journal of Health Sciences. 7 (2024): 509-513

Abstract

Keywords

Head and neck cancer, Buccal mucosa carcinoma, orally advanced stage, Gingiva-buccal sulcus, Tobacco chewing, Smoking

Article Details

Introduction

Several recent studies have suggested a connection between periodontitis and the risk of various types of cancer. A systematic review and meta-analysis of individuals in the United States found that non-smokers and those with periodontal disease have a higher risk of developing hematopoietic and lymphatic cancer [1]. In a case-control study, results indicated that dental caries were associated with the risk of gastric adenocarcinoma [2], while a prospective cohort investigation of postmenopausal women revealed an increased risk of breast cancer associated with periodontal disease [3]. Additionally, a systematic review and meta-analysis detailed a significant relationship between periodontitis and the incidence of lung cancer [4]. Head and neck cancer (HNC) is the seventh most common cancer worldwide, and its cases are increasing in aging populations [5, 6]. HNC encompasses malignancies of the upper aerodigestive tract, including those originating from the paranasal sinuses, nasal cavity, oral cavity, and pharynx, and may be influenced by oral inflammatory disease [7, 8]. Therefore, periodontitis may be associated with a greater risk for HNC compared to other types of cancer. Studies and analyses have shown a connection between periodontitis and head and neck cancer (HNC) [9–12]. These studies looked at various factors such as number of lost teeth, periodontal pocket depth, tooth mobility, oral hygiene, dentist visits, daily tooth brushing, and evidence of alveolar bone loss on X-rays to assess periodontitis. However, these factors mainly represent past and current periodontal inflammation and are used to predict the outlook for individual teeth, rather than to assess current inflammatory activity in periodontal tissues. The Periodontal Inflamed Surface Area (PISA) is a new index developed by Nesse et al. It is used to quantify the inflammatory burden caused by periodontal disease by measuring the sum of probing pocket depth in bleeding on probing (BOP)-positive sites across all teeth [13]. Recent reports have shown that PISA values in patients with ankylosing spondylitis are positively correlated with periodontal indexes such as BOP, severity of periodontitis, frequency of Porphyromonas gingival is detection, and presence of that bacterium in the serum. Additionally, PISA has been associated with serum C-reactive protein (CRP) levels, indicating systemic inflammation in septuagenarian patients. Therefore, PISA is considered to be capable of indicating present inflammatory activity in periodontal tissues [14-16]. The current study’s objective is to study the population based on their gender-wise demographic and histopathological data to compare the role of tobacco consumption in the development of head and neck cancer compared to previous studies. Ethical clearance was ensured before the study.

Objectives

1. General objective: The present study aims to draw attention to the reasons behind head and neck cancer, specifically tobacco.
2. Specific objective: The target of this study is to compare the effects of tobacco consumption gender-wise in terms of head and neck cancer.

Methodology

This retrospective comparative study was conducted at the Department of Otolaryngology-Head & Neck Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh involving 110 patients, aged from 18 to 70 years, reported with head and neck cancer. The study was carried out for 12 months, from June 2023 to May 2024. In all the age groups, there was a significant male preponderance.

1. Inclusion criteria: All histologically verified cases of adult patients of head and neck from the single one were included.
2. Exclusion Criteria: Recurrent cases of head and neck cancer within the specified timeframe were excluded from the statistical analysis. Additionally, all instances of metastatic disease in the head and neck region were also excluded from the statistical analysis.

In this study, the demographic profile, sites affected, histopathological patterns, and stage of presentation of head and neck carcinoma were observed. Additionally, the study will examine any changes in the risk factor profile and gender-based prevalence. Data regarding the demographic profile and clinical information were collected from hospital and clinical records. Staging was determined using the American Joint Committee on Cancer criteria, which includes primary tumour size (T), regional neck status (N), and group stage. The site of cancer was categorized using the International Classification of Diseases for Oncology (ICD-O-2). Ethical clearance was taken from the hospital authority. Well-informed written consent was ensured before the study.

Results

A total of 110 patients were selected for this study among which age group of 51 to 60 years people were found to be more affected. Most of the patients (72.73%) belong from urban areas [Table-1]. According to Table-2, most of the study patients had zero comorbidities, 21.81% were diagnosed with hypertension and 19.09% were suffering from both diabetes and hypertension. Buccal Mucosa Lesion was commonly found (60.91%) symptom. Neck swelling was the second most common syndrome [Table-3]. Table-4 shows Gingivobuccal Sulcus (46.36%) and CA Buccal Mucosa (25.45%) dominated the histopatholical reports of the patients. Study patients included in the research are mostly addicted to tobacco smoking (63.64%) and tobacco chewing (21.83%) [Table-5]. Histopathological subtype of squamous cell carcinoma was dominated by male patients [Figure-1]. Majority of the patients were diagnosed in locally advanced stage of cancer in which female patients were the majority [Figure-2].

Table-1: Demographic characteristics of patients (N=110)

Table-2: Comorbidities of the study patients (N=110)

Table 3: Symptoms and affected areas of the patients

Table 4: Various diagnosis among study patients

Table 5: Prevalence of tobacco consumption

Figure 1: Histopathological subtype of squamous cell carcinoma

Figure 2: Stage presentation of the patients

Discussion

The current research indicates that men are more likely than women to engage in behaviors that increase the risk of head and neck cancer. Previous studies conducted in similar geographical areas have also shown a male plurality of cancer cases. In a previous study, the combination of alcohol, tobacco, and smoking was the most prevalent behavior among both genders [13,14]. However, in this study, tobacco smoking was the most common addiction among females, while males indulged in both tobacco chewing and smoking. Additionally, a previous study also found that the combination of chewing and smoking along with alcohol drinking showed a very high relative risk [9].

A majority of the participants in the study have used tobacco, either by chewing or smoking, like previous studies in both South and North India. This highlights the importance of prevention through a shared risk factor approach. Tobacco use has been linked to various multi-system illnesses, making it imperative to implement proper preventive techniques through a common risk factor approach alongside a comprehensive educational campaign [13, 14]. In this study, the majority of the population presenting to the hospital belonged to urban locations, possibly due to the geographical location of the hospital and lack of awareness of disease presentation and severity in rural populations. The tongue was the second most prevalent location of malignancy after the buccal mucosa, which differs from a previous study where the tongue was the most common site of malignancy. However, an analysis based on published data from other cancer registries in 2023 indicates that the buccal mucosa is the most common site of cancer in both males and females [15]. Repeated contact with the quid during tobacco chewing could be a possible cause of the increased incidence of cancer in the tongue and buccal mucosa. Around 40% of cases were of cancer in the gingivo-buccal sulcus, possibly due to the habit of keeping tobacco there for a long time. Limited visibility and inaccessibility of the gingivo-buccal sulcus during regular oral hygiene maintenance may cause early cancerous changes like leuoplakia/erythroplakia to go unnoticed. In the northeastern states, the incidence of hypopharynx cancer was the highest for both males and females, possibly due to the high prevalence of smoking and smokeless forms of tobacco use in the region. The majority of the patients had histopathological type squamous cell carcinoma (WDSCC), which is the most common type in head and neck cancers. Most patients were diagnosed at a locally advanced stage, similar to a previous study, resulting in a higher need for composite resection and complex plastic surgery for reconstruction, leading to higher morbidity [7, 13, 15]. After undergoing treatment for head and neck cancer, it's crucial to consider physical therapy as an essential part of preventing complications and helping patients recover shoulder, neck, and facial function. Monitoring for early symptoms like leukoplakia, voice changes, and swelling is also important to ensure early intervention [5, 7].

Limitations

This single-centre study may not represent the overall scenario of the country.

Conclusion

According to the current study, the higher occurrence of carcinoma in males suggests that they are more likely to engage in behaviors that increase the risk of head and neck carcinoma. Buccal mucosa carcinoma, particularly at the gingivo-buccal sulcus, is noted to be the most common site, and is closely correlated with tobacco smoking and chewing habits. Keeping tobacco quid at the gingivo-buccal sulcus leads to prolonged exposure. Prevention and early diagnosis are the two main pillars that will determine the control of head and neck cancer.

Funding

Self-funded research

Conflicts of interest :

N/A

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