Tobacco-Driven Oral Cancer in India: Clinicopathological Correlates and Prevention Priorities

Oral cavity cancer (OCC) is a significant public health concern in India, where tobacco use contributes to aggressive disease patterns, mainly smokeless tobacco. This study evaluated the clinicopathological profile of OCC patients, focusing on the influence of gutka, bidi, and cigarette use, as well as age distribution and TNM staging.

A retrospective observational study was conducted on 200 biopsy-confirmed OCC patients at a tertiary care centre. Data included demographics, tobacco habits (gutka, bidi, cigarettes), and tumor staging (TNM classification). Statistical analyses were performed using SPSS software, version 29 (IBM Corp., Armonk, NY), with significance set at p < 0.05.

The mean age of patients was 47.1 years (SD = 12.0), with 78.3% (n = 65) being male. Gutka use was the most prevalent (54.2%, n = 45), followed by bidi (25.3%, n = 21) and cigarette smoking (16.9%, n = 14). Stage IV disease was observed in 60.2% (n = 50) of patients. T4 tumors were present in 43.4% (n = 36), and N2 nodal involvement in 31.3% (n = 26). Gutka use was associated with advanced T4 tumors (adjusted OR = 2.8; 95% CI: 1.6-4.9; p = 0.002), while bidi smoking predicted nodal metastasis (N2 stage: OR = 1.9; 95% CI: 1.1-3.4; p = 0.03).

OCC in India predominantly affects middle-aged males with a history of gutka or bidi use. Our findings mandate screening for 'gutka', a smokeless tobacco preparation, and 'bidi' (local cigarette) users, and strict enforcement of tobacco bans to curb advanced-stage diseases, especially focusing on regions prone to tobacco exposure in different forms, especially smokeless tobacco called 'gutka', widely used in Kanpur, India.