Leading mouth cancer expert Dr Vinod K Joshi is warning Asians, particularly women, about the dangers of chewing paan. Dr Joshi said, "Watch your mouth! Mouth cancers have a higher proportion of deaths per number of cases than breast cancer, cervical cancer or skin melanoma. In the UK, the mortality rate is just over 50% despite treatment. There are about 1700 deaths per year in the UK. This is because of late detection. In its very early stages, mouth cancers can be almost invisible making it easy to ignore, although if detected and treated early enough the survival rate can rise from 50% to nearer 90%."

The mouth cancer awareness week (9-15 November 2003) theme of 'Watch your Mouth' was devised to instruct the public to examine their mouths on a regular basis as at present there is no screening programme for the cancer. Mouth Cancers can occur in any part of the mouth, tongue, lips and throat. There has been a 23% increase in cases reported from 3500 (1995) to over 4300 (1999). The use of tobacco, in all forms, and to a lesser extent alcohol abuse are the major risk factors for the development of mouth cancer. Smoking and alcohol consumption together greatly increase the risk factors. The risk of mouth cancer is increased 6-28 times in current smokers and the effects of tobacco and alcohol account for 75% of mouth cancer.

However, 25% of mouth cancers are not associated with any known risk factors. It has now finally been recognized that mouth cancer can occur in either gender at any age. There is a growing concern at the increase among younger age groups. Public knowledge about mouth cancer is low, even more so in the socio-economic groups where the incidence is higher.

You can reduce your chances of getting mouth cancers by:

• Not smoking or chewing tobacco, gutkha/paan.
• Limiting alcohol consumption.
• Having a healthier "low meat, low fat" diet, rich in vegetables and fruit with servings of bread, cereals or beans everyday.

You can improve your chances of survival by detecting a mouth cancer early. Be self-aware of anything abnormal. Perform regular, self-examinations and beware of:

• A sore in the mouth that does not heal within three weeks
• A white or red patch on the gums, tongue, or lining of the mouth
• A lump or overgrowth of tissue anywhere in the mouth or neck
• A chronic sore throat or hoarse voice that does not heal
• A feeling that something is caught in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness of the tongue or other area of the mouth
• Swelling in the jaw that affects the fit or comfort of your denture

ABOUT PAAN

'Paan' is a thin slice of the areca nut and lime paste wrapped inside a betel leaf and has been chewed for centuries in India. Tobacco is often added. For many British South Asians its use is culturally bound. In parts of India and Asia where chewing tobacco or betel nut is very common, the incidence of oral cancer is 3 times higher. In several areas of India, oral cancer accounts for about 40% of all female cancer deaths.

The popularity of chewable tobacco ready-packaged in small sachets (gutkha), particularly among the young, is a growing concern for doctors in India. They are already reporting a rise in pre-cancerous lesions in the mouth. There is a co-relation between areca nut use and the development of mouth cancer (oral squamous cell carcinoma) and its precursors leukoplakia and submucous fibrosis. No statistics have yet been collected to quantify the risk to British South Asians.

ABOUT THE RESTORATIVE DENTISTRY ONCOLOGY CLINICS

The Restorative Dentistry Oncology Clinics (RDOC) held at St Luke's Hospital, Bradford and at Pinderfields Hospital, Wakefield, provide oral care and advice to patients before, during and after their cancer treatment. Dr Vinod K Joshi is the Consultant in Restorative Dentistry at RDOC.

Click here to visit the Mouth Cancer Awareness web site or call 0845-126 0479.

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