Authors’ reply to Rajalakshmi and Iyer

We thank Rajalakshmi and Iyer[1] for their keen interest and valuable remarks on our article published in the last issue of Cancer Research, Statistics and Treatment.[2] Our article focused on the demographic and epidemiological profiles of patients with head-and-neck cancer (HNC) in Bihar, where it is the second most common cancer and is becoming more prevalent day by day.[2] Bihar also has a high prevalence of tobacco use, particularly chewing tobacco, which is a major factor contributing to the growing burden of HNC cases. Although our study was a single-institutional study, it was conducted at the Mahavir Cancer Sansthan and Research Center, Patna, the oldest and most dedicated cancer hospital in Bihar, which serves more than half of all cancer cases diagnosed in the state. It caters to patients not only from Bihar but also from neighboring states. Our study revealed that the oral cavity was the most prevalent HNC site, observed in 68.3% (n = 2205) of 3230 patients, with an increased incidence rate as compared to a previous study (58.4%, 292 among 500 patients).[3] Among oral cavity subsites, the buccal mucosa and tongue were most commonly affected due to the chewing habit. In the studied area, people often keep khaini and gutka below the base of the tongue for extended periods. The prolonged contact of these substances with the tongue and mucosal regions exposes them to harmful chemicals, leading to cellular damage and mutations that can lead to cancer over time.[4] This study revealed that 91.8% (n = 2499/2723) of male patients and 36.3% (n = 184/507) of female patients used tobacco and alcohol, which is higher than the national average.[5] However, 63.7% (n = 323/507) of female patients diagnosed with HNC had no history of tobacco or alcohol use. This finding underscores the need to explore other etiological factors for HNC beyond tobacco and alcohol in future studies. One notable feature of this study is its exploration of the geographical distribution of HNC in Bihar. This is significant because the state’s geographical divisions encompass variations in social customs, culture, food habits, and tobacco addiction. The results showed that HNC cases were more prevalent in the northern region of the state, where tobacco products like khaini and betel quid are widely grown and commonly used. In these areas, it is customary to chew these products directly with limestone or consume them indirectly through bidi and cigarette smoking. Due to limited healthcare infrastructure, many patients cannot access timely medical care. Consequently, more than 50% of patients are diagnosed with cancer at an advanced stage, resulting in lower survival rates.[6] We are thankful to Rajalakshmi and Iyer[1] for highlighting strategies for screening, early detection, healthcare delivery, and prevention of HNC, which could have a remarkable impact on reducing the burden of this disease. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.