Oral Screening for Pre-cancerous Lesions Among Areca-nut Chewing Population from Rural India

Purpose: To detect early oral premalignant lesions (OPLs) in a rural population chewing tobacco-free areca nut preparations, determine their awareness level of oral cancer and educate them about maintaining good oral health. Materials and Methods: A total of 2175 18- to 65-year-old areca nut chewers (male:female ratio 2.5:1), without a history of consuming tobacco in any form, from the villages of two districts of the West Bengal state of India were screened clinically through oral examination for suspected OPLs. A pre-designed questionnaire was employed to record demographic data, information on tobacco-free areca-nut chewing habit and knowledge about oral diseases. Education on oral health was provided through distribution of printed leaflets, display of banner/posters and a public-announcement system. Results: Chewing areca nut in the form of betel quid was more popular (90.7%) than chewing areca nut alone (9%) or tobacco-free packaged areca nut preparation sold as 'pan masala' (0.3%). OPLs were detected in 7.3% of the subjects, more among the males. An increasing incidence of OPLs could be observed with an increase in age as well as with duration and frequency of areca-nut chewing, while decreasing incidence was observed with an increase in educational level. Oral submucous fibrosis showed the highest prevalence (2.7%) among the various OPLs detected. Conclusions: Tobacco-free areca-nut chewing is an independent risk factor for the development of OPL and a large rural population still practices such high risk behaviour. In rural areas with limited health care resources, screening by visual oral examination involving minimum cost may prove useful to reduce oral cancer mortality. Keywords: areca-nut chewing, oral cancer screening, oral submucous fibrosis