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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 327-329

The fight against tobacco and oral cancer: Jharkhand scenario

1 Department of Oral Medicine and Radiology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
2 Department of Public Health Dentistry and Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

Date of Submission27-Jul-2021
Date of Decision13-Aug-2021
Date of Acceptance02-Sep-2021
Date of Web Publication20-Dec-2021

Correspondence Address:
Amit Vasant Mahuli
Department of Public Health Dentistry and Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_130_21

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The article highlights the current scenario on the fight against tobacco and oral cancer in the state of Jharkhand. The Khaini and bidi are the most used tobacco products in the state. India is among the top three countries on the charts in both tobacco production and tobacco consumption globally. The state of Jharkhand has shown higher use of tobacco than the national average, with approximately 38.9% of the adults aged 15 or above using tobacco. The regulatory mechanism in place to control the use of tobacco and thus prevent oral cancer is discussed. The article focuses on the prevention of oral cancer in the early stage for better prognosis and preventing mortality.

Keywords: Jharkhand state, oral cancer, tobacco cessation

How to cite this article:
Rai A, Mahuli AV. The fight against tobacco and oral cancer: Jharkhand scenario. J Dent Res Rev 2021;8:327-9

How to cite this URL:
Rai A, Mahuli AV. The fight against tobacco and oral cancer: Jharkhand scenario. J Dent Res Rev [serial online] 2021 [cited 2023 Jan 30];8:327-9. Available from: https://www.jdrr.org/text.asp?2021/8/4/327/332918

  Introduction Top

Tobacco is the common risk factor for most noncommunicable diseases, and tobacco use prevention can reduce mortality. The global burden of tobacco is rapidly shifting to the developing world. According to the Global Adult Tobacco Survey (2016–2017), 28.6% of adults in India use tobacco. Khaini and bidi are the most used tobacco products.[1] India stands second in consumption of tobacco and related products globally, and it is the third largest producer of tobacco and tobacco products globally.[2] According to the estimate, tobacco use results in more than 1 million deaths in India.[3] On average, tobacco users lose 10 years of life.[4] It was earlier predicted that tobacco use could approximate 13% of all mortality in India in 2020.[5] The state of Jharkhand has shown higher use of tobacco than the national average, with approximately 38.9% of the adult population who are 15 years or above using tobacco in any form. Of these, 59.7% are males, 17% are females, while smokeless tobacco use is 27.7%, smoking 3.5%, and dual-use 7.7%. It was also noted that 56% of the adult population in the state had shown exposure to secondhand smoke, which is higher than the national average (52%).[1]

A recent study reported that 83% of tobacco users were interested in quitting tobacco, of whom 51% were unsuccessful.[6] The GATS 2 study indicates that about 55% of smokers and 50% of smokeless tobacco users in India plan to quit tobacco use. In Jharkhand, the quit attempts are lower than the national average, i.e. 18.4% of smokers and 18.7% of smokeless tobacco users have attempted.[1] There are many barriers to not quitting the habit, like less awareness about the ill effects of tobacco, cultural barriers, and lack of support for subjects willing to quit tobacco.

The tobacco-related mortality in India is mainly because of the high incidence of oral cancer and lung cancer. Two-thirds of the global cancer cases are from developing countries, totaling 267,000 new cases and 128,000 deaths.[7] In India, oral cancer accounts for one-third of cancer cases with increased mortality rates, much higher than any developed country. Other than higher tobacco usage, the main reason is lack of access to the health-care facility and delayed diagnosis of cancer.[8],[9] The contributing risk factors are avoidable, such as tobacco, alcohol, and accessibility to health-care services to prevent and treat oral cancer. Unlike embarrassing procedures for examining breast cancer and cervix cancer, oral cancer screening for malignancies in the mouth is acceptable. Despite this, Indian males reported the highest oral cancer and cancer-related death.[10] This is mainly due to the high tobacco consumption rate, poor screening service at the grassroots level, and lack of awareness to seek timely services at the early stages of oral cancer. When detected later, oral cancer results in poor prognosis and expensive treatment, which cannot be affordable for the low-income group.[11] Second, accessibility to trained health-care professionals competent to diagnose oral cancer from rural and remote places can delay early diagnosis and treatment, resulting in advanced stages of oral cancer.[11] On the other hand, early detection of oral cancer can facilitate a good prognosis and affordable treatment modalities,[12] and thus, indicating the importance of the primary and secondary prevention of oral cancer in the country and state of Jharkhand.

Early detection of oral cancer

Early signs and symptoms of oral cancer include the following signs, an ulcer that does not heal, a red or white patch in the mouth, a lump in the mouth or throat, pain-dental or oral region, loosening of teeth, burning sensation of the mouth, swelling of the neck, difficulty in swallowing, restriction in mouth opening or tongue movement, hoarse voice and bleeding from the mouth that does not stop after rinsing.[9],[10]

Regulatory approach

The Ministry of Health and Family Welfare has taken several initiatives to battle the menace of tobacco. The regulatory action toward tobacco control by the Government started with the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, 2003 (COTPA). India was one of the first nations to adopt the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004.[13]

  • The National Tobacco Control Program (NTPC) was launched in the year 2007–2008. Support the states to set up tobacco cessation centers (TCCs) under NTPC and establish TCCs in Dental Colleges as a joint initiative under NTPC, and National Oral Health Program has been initiated[14]
  • The Jharkhand state assembly has passed the COPTA Amendment Bill 2021, in which

  1. Ban on using tobacco in public places, punishable with 1000 INR fine
  2. Ban on sale of tobacco the persons below 21 years of age
  3. Ban sale of tobacco products within 100 m of educational institutions, hospitals, government offices, and court buildings
  4. Ban on hookah bars
  5. Ban sale of loose cigarettes
  6. Make offenses cognizable under the act.

The national cancer control program was started in 1975.[15] The national cancer registry program was started in 1982 by the Indian Council for Medical Research.[16] Under this initiative, a network of population and hospital-based cancer registries (PBCR, HBCR) that systematically collect data related to cancer incidence, mortality, and clinical aspects to estimate burden, trends, survival, and management have been established and managed by National Centre for Disease Informatics and Research (NCDIR). These results then facilitate efforts to strengthen cancer prevention and control throughout the country. At present, there are 28 population-based registries and 58 hospital-based cancer registries in different states and union territories. The hospital-based cancer registry has been initiated in Rajendra Institute of Medical Sciences, Ranchi. In 2010, an umbrella program for noncommunicable diseases – a national program for control of cancer, diabetes, cardiovascular diseases, and stroke (NPCDCS) – was started to address preventable common risk factors and screening for high burden cancers.[17]

Preventive strategies

[Table 1] The road ahead and strategies for prevention of oral cancer.[18],[19]
Table 1: Prevention of oral cancer

Click here to view

  Conclusion Top

Training the medical, dental, nursing, and paramedical staff at the grassroots level for early detection of oral cancer and potentially malignant disorders is vital. Self-examination of the oral cavity in the population exposed to risk factors is crucial. Tobacco is one of the greatest threats to the health and well-being of the people of Jharkhand. Combating this threat is a collaborative effort of different state government departments in coordination with the central Government. The efforts by NTCP, NCDIR, and NPCDCS would strengthen us in our war against cancer. The onus lies on us to join our hands and strive toward better and universal tobacco control and cancer care.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

GATS. Global Adult Tobacco Survey: Fact sheet, India 2016-17; 2017. Available from: http://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf. [Last accessed on 2021 Jun 15].  Back to cited text no. 1
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West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health 2017;32:1018-36.  Back to cited text no. 4
Shimkhada R, Peabody JW. Tobacco control in India. Bull World Health Organ 2003;81:48-52.  Back to cited text no. 5
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Jnaneswar A, Goutham BS, Pathi J, Jha K, Suresan V, Kumar G. A cross-sectional survey assessing knowledge, attitude, and practice regarding oral cancer among private medical and dental practitioners in Bhubaneswar city. Indian J Med Paediatr Oncol 2017;38:133-9.  Back to cited text no. 7
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Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.  Back to cited text no. 9
Uplap P, Mishra G, Majumdar P, Gupta S, Rane P, Sadalge P, et al. Oral cancer screening at workplace in india-one-year follow-up. Indian J Community Med 2011;36:133-8.  Back to cited text no. 10
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Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012;2012:701932.  Back to cited text no. 11
Mangalath U, Aslam SA, Abdul Khadar AH, Francis PG, Mikacha MS, Kalathingal JH. Recent trends in prevention of oral cancer. J Int Soc Prev Community Dent 2014;4:S131-8.  Back to cited text no. 12
Kaur J, Jain DC. Tobacco control policies in India: Implementation and challenges. Indian J Public Health 2011;55:220-7.  Back to cited text no. 13
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Ministry of Health and Family Welfare. Operational guidelines: national tobacco control programme. Available from: http://www.nhmmp.gov.in/WebContent/Tobako-29102015/Operation-Guideline.pdf. [Last accessed on 2021 Jun 15].  Back to cited text no. 14
Rath GK, Gandhi AK. National cancer control and registration program in India. Indian J Med Paediatr Oncol 2014;35:288-90.  Back to cited text no. 15
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