Early detection and tobacco cessation: The cornerstones of oral cancer prevention

We read with great interest the article by Sreeja et al. titled “Prevalence and risk factors of oral premalignant lesions through visual screening among security personnel working at a tertiary care hospital: A descriptive cross-sectional study,” which caught our attention.[1] Oral cancer has become a major health problem worldwide, especially in South Asia. In India, it accounts for 40% of all reported cancers, with a higher incidence in males.[2] It is a well-established fact that tobacco is one of the strongest risk factors for oral cancer and pre-cancerous conditions. According to the Global Adult Tobacco Survey 2016-17, nearly 267 million adults aged 15 and above in India (29% of the adult population) use tobacco. As a result, tobacco consumption remains the leading preventable risk factor for cancer.[3] The World Cancer Report states that the anticipated sharp rise in cancer cases in the coming years is primarily driven by current smoking trends and the increasing adoption of unhealthy lifestyles.[4] Identifying at-risk populations—those more likely to use tobacco frequently, either by choice or as a coping mechanism for lifestyle challenges-is an essential aspect of primary prevention. In this context, we appreciate that the authors included security personnel as a study group. Early detection of oral precancer is also a preventive measure. When detected in its early stages, oral cancer has a better prognosis, resulting in higher survival rates and an improved quality of life.[5] For many years, various oral screening methods have been used to detect oral cancer. The most widely used method is clinical examination, which involves visually inspecting the oral cavity and probing the tissues for abnormalities. This approach is cost-effective, practical, easy to learn, and simple to perform, even as a self-examination. Although several new technologies such as visual enhancement tools, liquid biopsy, and molecular diagnostic tests for detecting oral cancer have emerged, their practical application in community screening remains limited. Therefore, employing this straightforward method to detect any unusual changes in the oral cavity is highly commendable. We conducted a similar study funded by the Indian Council of Medical Research (ICMR), Government of India, focusing on long-distance heavy vehicle drivers as part of developing an oral cancer prevention model for this population.[6] Additionally, we took a step further by identifying actual lesions using toluidine blue staining and teaching participants how to perform self-examination of the oral cavity. A major challenge we encountered during the project was the difficulty of following up with participants, as this particular population was often traveling away from their home base due to the nature of their work. We would like to know if the authors had a systematic approach to follow-up with the cases that were identified and referred. Additionally, was any effort made to assess the acceptance of tobacco cessation counseling, and did the individuals actually quit the habit over time? Furthermore, we emphasize that studies like these are crucial for cancer prevention, as this issue must be addressed at multiple levels. Research should be conducted to determine the prevalence of harmful habits and to identify gaps in the knowledge and attitudes of the general population.[5] This will help establish the scale of the problem. The results of the study are concerning, particularly with the odds ratio of 25.9 for smokeless tobacco use. Health authorities must play a central role in developing policies to limit the use of these products. Healthcare professionals need to be proactive in counseling high-risk patients specifically, and the general public as well. Without such concerted efforts, the incidence of oral cancers will continue to rise.[7] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.