| Abstrakt: |
BACKGROUND: Oral cancer is a frequent encounter in Pakistan. Its rising incidence particularly in women has been largely attributed to the increasing trend of smokeless tobacco use. Despite government ban, it is sold in different combinations namely Ghukta (areca nut, tobacco, catechu, slaked lime, flavourings), Mawa (areca nut, processed tobacco, slaked lime), Naswaar (Powdered tobacco) and Paan(Betel leaf, areca nut, tobacco). Oral malignancy is usually preceded by a pre-malignant lesion such as leukoplakia, erythroplakia, oral melanosis and submucous fibrosis. Increased incidence of such lesion in women would indicate a further rise in oral malignancy in future. OBJECTIVES: To determine the incidence and independent predictors of oral lesions in women with habitual use of smoke-less tobacco associated with patterns of use. METHODS: A cross-sectional survey was done in two squatter settlements in suburbs of Karachi namely Dhabeji and Abdullah Goth (combined approximate population 10,000) on women aged 15-75 years. 102 women who used smokeless tobacco and consented to participate were recruited. A questionnaire was filled inquiring the forms of smokeless tobacco used, the starting age, the frequency of use in 24 hours, the duration of contact with oral mucosa with each use in hours and total duration of use in years. The oral cavities of each subject were examined after rinsing the mouth with water and pre-malignant lesions, if any were noted. RESULTS: Of the 385 women who were approached, 277 (72%) admitted to have been using smokeless tobacco however only 102 consented to take part in the study. The average age was 36.6±12.4 years and 88(73.3%) were married. 19.6%(n=20) were working as housemaids. The average starting age was 20.5±10.9. About 47%(n=48) were found to have oral lesions, the most common being oral ulcers 41%(n=42), leukoplakia 21%(n=22), melanotic macules 18%(n=19), clinically evident submucous fibrosis 4%(n=5) with inability to completely open the mouth and erythroplakia was observed in 2%(n=3). Two patients were found to have large irregular oral lesions suspicious of malignancy and were advised further workup. 8 had 3 lesions,22 had 2 lesions and 48 had atleast 1. 42% (n=43) women had gingivitis and loosening of teeth. The highest frequency of oral lesions were found in ghutka users 57.4% (n=27/47), followed by Naswaar 53.3%(n=8/15), Paan25.9% (7/27) and Mawa25%(3/12). 97% (n=98) reported atleast one of the family members using some forms of tobacco. 43 women reported atleast 1 child below 10 using smokeless tobacco. 82 women reported withdrawl symptoms, most frequent being headache(n=62), followed by 'low' mood(n=32), vertigo(n=22), bodyaches(n=22) and decreased apetite(n=4). The frequency of use greater than 3times /day (OR 2.62, 95% CI(1.17-5.86), the age of initiation below 20(OR 4.173, 95%CI(1.74-10.01) and duration of use greater than 10 years(OR 4.917, 95%CI (2.07-11.67) were independent factors associated with increased incidence of oral lesions. CONCLUSION: A high incidence of oral lesions including the pre-malignant ones among women with habitual use of smokeless tobacco is a cause of concern as it is an indicator of increased morbidity and mortality in Pakistan in the future due to oral cancer. Appropriate measures are required to address this issue. [ABSTRACT FROM AUTHOR] |
