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Year : 2012  |  Volume : 49  |  Issue : 2  |  Page : 215--219

Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India

L Addala1, C Kalyana Pentapati1, PK Reddy Thavanati2, V Anjaneyulu3, MD Sadhnani4,  
1 Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
2 Profesor y Investigador, Instituto de Genética Humana, Departamento de Biología Molecular y Genomica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México, USA
3 Department of Pathology, MNJ Cancer Hospital, Andhra Pradesh, India
4 Institute of Genetics, Osmania University, Hyderabad, Andhra Pradesh, India

Correspondence Address:
L Addala
Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka


Objective: To define the demographic risk profile and stage at diagnosis among the head and neck cancer (HNC) patients reported in two hospital-based cancer registries in Andhra Pradesh. Materials and Methods: A cross-sectional study was conducted in patients with histologically confirmed diagnosis of squamous cell carcinoma of the head and neck during 2002-2006. Data on the demographic profile and clinical information were obtained from hospital and clinical records. Staging was based on the American Joint Committee on Cancer and included primary tumor size (T), regional neck status (N), and group stage. The site of cancer was classified based on the International Classification of Disease for oncology (ICD-02). Results: A total of 5458 cases of HNC were included in this study. Majority of the subjects were in the age range of 40-69 years with a significant male preponderance in all the age groups (P<0.001). The most common habit was the combination of smoking, alcohol, and chewing in both males and females (20.1 and 35.1%, respectively) (P<0.001). Tongue and buccal mucosa were the most common sites of cancer in both males (26.8 and 12.8%, respectively) and females (22.9 and 19.8%, respectively) (P<0.001). Tongue was the commonest site of cancer occurrence with respect to all the habits (both singly and in combination) except for chewing tobacco where buccal mucosa was the most common site. Males were more likely to be diagnosed in stage 3 (37.6%) and 4 (20.6%), while females were diagnosed in stage 1 (36.3%) and 2 (32.7%) (P<0.001). Conclusion: A male preponderance of cancer occurrence and combination of all the three habits (smoking, alcohol, and chewing) were found to be the significant risk factors. Males were more likely to be diagnosed later than females.

How to cite this article:
Addala L, Pentapati C K, Reddy Thavanati P K, Anjaneyulu V, Sadhnani M D. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India.Indian J Cancer 2012;49:215-219

How to cite this URL:
Addala L, Pentapati C K, Reddy Thavanati P K, Anjaneyulu V, Sadhnani M D. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. Indian J Cancer [serial online] 2012 [cited 2019 Jun 17 ];49:215-219
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Head and neck cancers (HNCs) are the sixth most common malignancy and are a major cause of cancer morbidity and mortality worldwide. In India and South East Asia, oral cancer incidence accounts for up to 40% of all the malignancies. [1] The overall survival percentage has not changed in recent years in spite of extensive research on the biological and molecular aspects of cancer. [2]

The most common risk factors associated with HNC are tobacco and alcohol use with significant interaction observed between the two. [3] Other reported risk factors in the existing literature are poor oral hygiene [4] and the human papillomavirus (HPV) 16 for tongue, tonsil, and oropharyngeal HNC and in non-smoking cases of HNC. [5] In South Asian countries, the risk of HNC is further aggravated by smoking of bidis, [6] reverse smoking, and chewing tobacco, betel quid, and areca nut. [7]

The prevalence of cancer is often strikingly dissimilar in different groups of population, varies greatly from one community to another, and differs in different communities in the same geographic location, depending on the practices and lifestyles of the people in that location. Moreover, differences have been observed in the etiological, clinicopathological, and molecular pathological profile in the tobacco smoking, chewing, and alcohol associated oral cancers, particularly in the Indian subcontinent.

To identify and quantify the etiological profile that might be implicated in a selected population, it is essential to determine the behavioral patterns, habits, customs, and environmental background of the group under study. It is necessary to identify the differences, if any, in the sites, patterns, and incidence rates of the disease amongst various communities living in geographic areas having varying patterns of climate and physical environments by identifying dietary habits, social customs, and such other factors. Many independent researchers [8],[9],[10],[11],[12] had reported the wide ranged prevalence of oral cancer and its risk factors in various parts of the country, but there is a scant literature concerning the risk factor profile of oral cancer patients in Andhra Pradesh. Since considerable differences exist in the consumption of tobacco, alcohol, diet, literacy, social status, and availability of the services in the state of Andhra Pradesh compared to the other states, we attempt to define the demographic, risk profile, and stage at diagnosis among the group of HNC patients reported in two hospital-based cancer registries in Andhra Pradesh during the period of 2002-2006.

 Materials and Methods

Patients' selection, data collection, and variables

The study population consisted of 5621subjects (males: 3742 and females: 1879) out of which 5458 (males: 3653 and females: 1805) were new patients with a histologically confirmed diagnosis of squamous cell carcinoma of the head and neck, who reported during the period from 2002 through 2006 in two hospital-based cancer registries of Mehdi Nawaj Jung (MNJ) Institute of Oncology and Regional Cancer Center, Hyderabad, and Indo American Cancer Institute and Research Hospital, Hyderabad, Andhra Pradesh, India. The demographic profile and clinical information obtained includes the information on age, gender, site of origin, risk factor, and stage at presentation. However, subjects without the risk factor information were excluded (n = 163; males = 89 and females = 74). Staging was based on the American Joint Committee on Cancer and included primary tumor size (T), regional neck status (N), and group stage. [13] The site of cancer was classified (C32.0-32.9) based on the second edition of the International Classification of Disease for oncology [14] (ICD-02), depending on the 11 presentation sites of HNC: base of tongue (BOT), tongue, buccal mucosa, palate, floor of mouth (FOM), lip, gingiva, oral cavity, oropharynx, nasopharynx, and hypopharynx. This study was approved by the MNJ cancer hospital Ethical Committee.

Statistical analysis

The data were analyzed using SPSS version 14 (SPSS Inc., Chicago, IL, USA). Chi-square test was performed to assess the association of gender with age groups, habits, site, and stage of cancer. The risk factor associations were reviewed and compared with site and habits. P value of <0.05 was considered to be statistically significant.


A total of 5458 cases of oral cancer were reported during the study period. In all the age groups, there was a significant male preponderance (PP[15] The hospitals chosen were the nearest cancer referral centers in this particular region and the culturally accepted toddy drinking habit in females might be one of the risk factors for cancer occurrence. [16] Following the combined risk factors like smoking, chewing, and alcohol habits, chewing habit and smoking were the most common habits in females and males, respectively, because females in our society are not indulged in tobacco smoking but likely to inculcate chewing habits. Similarly, in the current study, buccal mucosa was the common site in females than in males probably due to the dominant chewing habit and the prolonged contact of the mucosa to the quid. [17]

Tongue and buccal mucosa were the most common sites of cancer among males and females. This was similar to the reports of Iype et al., [9] and Mehrotra et al., [10] and Kuriakose et al., [17] where it was also highlighted that in older patients, cancer of tongue was always associated with smoking, alcohol, or chewing. A constant contact with the quid while chewing can be one of the reasons for higher prevalence of cancer in buccal mucosa and tongue. A significant number of patients had reported that they had no habit history. Unfortunately, using registry data, we have inadequate information on other risk factors (HPV-related cases of HNC), which possibly could indicate the frequency of non-habit related cases of HNC.

Although the current study was a hospital-based one, it highlights the risk factor profile of cancer patients from state of Andhra Pradesh. The data reflect a specific patient population but not the community as whole. Though the results from the study cannot be extrapolated directly to the general population, the data help in understanding the possible risk factors and behavior patterns in HNC patients. Cultural differences in the use of tobacco and toddy drinking habits lead to a variation in the geographic and anatomic incidence of HNCs among these patients. More than half of the study population had indulged in smoking, highlighting the need for prevention through common risk factor approach. Tobacco with or without other risk factors has been shown to be related to many multi-system disorders. Hence, there is an urgent need for taking appropriate prevention strategies through common risk factor approach along with intense educational program to revert back the present scenario of such preventable diseases.

The lack of proper standardized recording format to quantify the risk factors was also one of the drawbacks of our study. Cancer registries should design and use standardized format for recording the habits like tobacco and alcohol, their duration, and frequency, along with other risk factors such as oral hygiene, nutrition, viral infections, educational and socioeconomic status. The use of established classification like that of ICD-10 for cancer coding allows comparison with the other populations. Hence, further studies using such standardized format for recording habits are needed to understand the geographic, anatomic, histological, and cultural variations in the prevalence of HNC among the populations.


1Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med 1993;328:184-94.
2Nagpal JK, Patnaik S, Das BR. Prevalence of high-risk human papilloma virus types and its association withp53 codon 72 polymorphism in tobacco addicted oral squamous cell carcinoma (OSCC) patients of eastern India. Int J Cancer2002;97:649-53.
3Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res1988;48:3282-7.
4Guha N, Boffetta P, Wünsch Filho V, Eluf Neto J, Shangina O, Zaridze D, et al. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: Results of two multicentric case-control studies. Am J Epidemiol 2007;166:1159-73.
5Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: A systematic review. Cancer Epidemiol Biomarkers Prev 2005;14:467-75.
6Sapkota A, Gajalakshmi V, Jetly DH, Roychowdhury S, Dikshit RP, Brennan P, et al. Smokeless tobacco and increased risk of hypopharyngeal and laryngeal cancers: A multicentric case-control study from India. Int J Cancer 2007;121:1793-8.
7IARC working group on the evaluation of carcinogenic risks to humans. Betel quid and areca-nut chewing and some areca-nut derived nitrosamines. IARC Monogr Eval Carcinog Risks Hum 2004;85:1-334.
8Dikshit RP, Kanhere S. Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer: A population-based case-control study in Bhopal, India. Int J Epidemiol 2000;29:609-14.
9Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK. Squamous cell carcinoma of the tongue among young Indian adults. Neoplasia 2001;3:273-7.
10Khandekar SP, Bagdey PS, Tiwari RR. Oral Cancer and Some Epidemiological Factors: A Hospital Based Study. Indian J Community Med 2006;31:157-9.
11Sherin N, Simi T, Shameena PM, Sudha S. Changing trends in oral cancer. Indian J Cancer2008;45:93-6.
12Beahrs O, Henson DE, Hutter RV, Kennedy BJ, editors. Manual for staging of cancer. 4 th edition (American Joint Committee on Cancer) Philadelphia: J.B. Lippincott Company; 1992.
13Percy C, Van Holten V, Muir C,editors. International classification of disease for oncology (ICD-O). 2 nd ed. Geneva: World Health Organization; 1990.
14Potukuchi PS, Rao PG. Problem alcohol drinking in rural women of Telangana region, Andhra Pradesh. Indian J Psychiatry 2010;52:339-43.
15Rao DN, Desai PB. Risk assessment of tobacco, alcohol and diet in cancers of base tongue and oral tongue-a case control study. Indian J Cancer 1998;35:65-72.
16Sankaranarayanan R, Duffy SW, Padmakumary G, Day NE, Nair MK. Risk factors for cancer of the buccal and labial mucosa in Kerala, southern India. J Epidemiol Community Health 1990;44:286-92.
17Kuriakose M, Sankaranarayanan R, Nair MK. Comparison of oral squamous cell carcinoma in younger and older patients in India. Eur J Cancer Oral Oncol 1992;28B:113-20.