Epidemiology of Oral Cancer in Pakistan

  • Anam Javed Assistant Professor of Zoology, School of Zoology, Minhaj University, Lahore, Pakistan.
  • Gull e Zahra BS researchers, Department of Zoology, University of Sargodha, RCS Campus, Circular Road, Narowal, Pakistan.
  • Asif Mahmood Qureshi Professor of Zoology, School of Zoology, Minhaj University, Lahore, Pakistan.
Keywords: Oral carcinoma, oncogenic prognosis, oral squamous cancer, oral hygiene, esophageal carcinogenesis


Oral carcinoma is one of the most frequently reported form of cancer in Pakistan. In time oncogenic prognosis facilities are still available in various regions countrywide. Provincial comparison indicates that more than 67% cases of oral squamous cancer are reported from Punjab whereas ratio in KPK is also high than Sindh and Baluchistan. The prevalence of this growing ailment can be minimized only by collaborative efforts of both government and general public regarding awareness of oral hygiene, causes of oral and esophageal carcinogenesis, early symptoms of this disease and its management.   


. M. Kumar, R. Nanavati, T. G. Modi and C. Dobariya (2016). “Oral cancer: etiology and risk factors: a review”. J Can Res Ther. 12, p. 458-463.

. N. Gupta, R. Gupta, A. K. Acharya, B. Patthi, V. Goud, S. Reddy, A. Garg and A. Singla (2016). “Changing trends in oral cancer - a global scenario”. Nepal J Epidemiol. 6(4), p. 613-619.

. S. Warnakulasuriya (2009). “Global epidemiology of oral and oropharyngeal cancer”. Oral Oncol. 45(4-5), p. 309-316.

. P. K. Petersen (2003). “Continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Program”. The World Oral Health Report 2003. p. 45

. S. R. Moore, N. W. Johnson, A. M. Pierce and D. F. Wilson (2000). “The epidemiology of mouth cancer: a review of global incidence”. Oral Dis. 6(2), p. 65-74.

. GLOBOCAN: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. International Agency for Research on Cancer [online] 2012 [cited 2016 July 16]. Source: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx

. N. W. Johnson and H. K. Amarasinghe (2011). “Epidemiology and etiology of Head and Neck Cancers”. In: Benier J ed. Head and Neck Cancer: Multimodality management. London: Springer. p. 01-40.

. S. K. Zhang, R. Zheng, Q. Chen, S. Zhan, X. Sun and M Chen (2015). “Oral cancer incidence and mortality in China, 2011”. Chin J Cancer Res. 27(1), p. 44-51.

. World Health Organization (2005). Global Action Against Cancer. World Health Organization and International Union Against Cancer, Geneva.

. R. T. Greenlee, M. B. Hill-Harmon, T. Murray and M. Thun (2001).“Cancer statistics, 2001”. CA Cancer J Clin. 51(1), p. 15-36.

. B. W. Neville and T. A. Day (2002). “Oral cancer and precancerous lesions”. CA Cancer J Clin. 52(4), p. 195- 215.

. S. Carnelio and G. Rodrigues. Oral cancer at a glance [online] 2003 [cited on 2016 July 16]. Source: http://ispub.com/IJDS/1/2/5720

. E. C. Halperin, D. E. Wazer, C. A. Perez and L. W. Brady (2013). Perez and Brady's Principles and practice of Radiation Oncology. 6th edition. Philadelphia: Lippincott Williams and Wilkins Publishers. p. 30-41

. R. Levine and C. Stillman-Lowe (2018). “Oral Cancers”. In: The Scientific Basis of Oral Health Education. p. 57-62.

. A. I. Irimie, C. Ciocan, D. Gulei, N. Mehterov, A. G. Atanasov, D. Dudea and I. Berindan-Neagoe (2018). “Current Insights into Oral Cancer Epigenetics”. Int. J. Mol. Sci. 19(670), p. 1-17.

. P. C. Gupta, P. R. Murti, R. B. Bhonsle, F. S. Mehta and J. J. Pindborg (1995). “Effects of cessation of tobacco use on the incident of oral mucosal lesions in a 10-yr follow-up study of 12,212 users”. Oral Dis. 1, p. 54-58.

. K. A. Warnakulasuriya, N. W. Johnson, K. M. Linklater and J. Bell (1999). “Cancer of mouth, pharynx and nasopharynx in Asian and Chinese immigrants' resident in Thames regions”. Oral Oncol. 35, p. 471-475.

. C. Scully, J. K. Field and H. Tanzawa (2000). “Genetic aberrations in oral or head and neck squamous cell carcinoma (SCCHN): Carcinogen metabolism, DNA repair and cell cycle control”. Oral Oncol. 36, p. 256-263.

. K. A. Warnakulasuriya and R. Ralhan. “Clinical, pathological, cellular and molecular lesions caused by oral smokeless tobacco--a review”. J Oral Pathol Med. 36, p. 63-77, 2007.

. IARC Global cancer rates could increase by 50% to 15 million by 2020. IARC Press; 2003. Release No. 145.

. F. S. Mehta, P. C. Gupta, D. K. Daftary, J. J. Pindborg and S. K. Choksi (1972). “An epidemiologic study of oral cancer and precancerous conditions among 101,761 villagers in Maharashtra, India”. Int J Cancer. 10, p. 134-141.

. T. Axell (1987). “Occurrence of leukoplakia and some other oral white lesions among 20,333 adult Swedish people”. Community Dent Oral Epidemiol. 15, p. 46-51.

. S. S. Hecht (2003). “Tobacco carcinogens, their biomarkers and tobacco-induced cancer”. Nat Rev Cancer. 3, p. 733-744.

. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans (1985). Tobacco habits other than smoking; betel- quid and areca-nut chewing; and some areca-nut-derived nitrosamines. 37, p. 188.

. N. A. Jafarey, Z. Mahmood and S. H. Zaidi (1977). “Habits and dietary pattern of cases of carcinoma of the oral cavity and oropharynx”. J Pak Med Assoc. 27, p. 340-343.

. IARC monographs program declares second‑hand smoke carcinogenic to humans, (2002). IARC Press Release No. 141.

. A. Z. Keller (1969). “Residence, age, race and related factors in the survival and associations with salivary tumors”. Am J Epidemiol. 90, p. 269-277.

. T. V. Evstifeeva and D. G. Zaridze (1992). “Nass use, cigarette smoking, alcohol consumption and risk of oral and esophageal precancer”. Eur J Cancer B Oncol. 28B, p. 29-35.

. P. R. Murti, R. B. Bhonsle, J. J. Pindborg, D. K. Daftary, P. C. Gupta and F. S. Mehta (1985). “Malignant transformation rate in oral submucous fibrosis over a 17-year period”. Community Dent Oral Epidemiol. 13, p. 340-341.

. M. Hashibe, B. Mathew, B. Karuvilla, G. Thomas, R. Sankaranarayanan, D. M. Parkin and Z. F. Zhang (2000). “Chewing tobacco, alcohol, and the risk of erythroplakia.” Cancer Epidemiol Biomarkers Prey. 9, p. 639-645, .

. J. H. Jeng, M. C. Chang and L. J. Hahn (2001). “Role of areca nut in betel quid-associated chemical carcinogenesis: Current awareness and future perspectives”. Oral Oncol. 37, p. 477-492.

. E. Bernzweig, J. B. Payne, R. A. Reinhardt, J. K. Dyer and K. D. Patil (1998). “Nicotine and smokeless tobacco effects on gingival and peripheral blood mononuclear cells”. J Clin Periodontol. 25, p. 246-252.

. M. A. Jaber, S. R. Porter, M. S. Gilthorpe, R. Bedi and C. Scully (1999). “Risk factors for oral epithelial dysplasia-the role of smoking and alcohol”. Oral Oncol. 35, p. 151-156.

. P. E. Tolbert, C. M. Shy and J. W. Allen, (1991). “Micronuclei and other nuclear anomalies in buccal smears: A field test in snuff users”. Am J Epidemiol. 134, p. 840-850.

. M. Soler, C. Bosetti, S. Franceschi, E. Negri, P. Zambon, R. Talamini, E. Conti and C. L. Vecchia (2001). “Fiber intake and the risk of oral, pharyngeal and esophageal cancer”. Int J Cancer. 91, p. 283-287.

. K. A. Warnakulasuriya (2012). “Smoking and chewing habits in Sri Lanka. Implications for oral cancer and precancer”. In: Gupta PC, Hamner JE, Murti PR, editors. Control of tobacco‑ related cancers and other diseases, vol. 24. International symposium. Bombay: Oxford University Press. p. 113‑8.

. E. De Stefani, A. Ronco, M. Mendilaharsu and H. Deneo-Pellegrini (1999). “Diet and risk of cancer of the upper aerodigestive tract- II nutrients”. Oral Oncol. 35, p. 22-26.

. R. P. Dikshit and S. Kanhere (2000). “Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer: A population‑based case‑control study in Bhopal, India”. Int J Epidemiol. 29, p. 609-614.

. E. Negri, S. Franceschi, C. Bosetti, F. Levi, E. Conti, M. Parpinel and C. La Vecchia (2000). “Selected micronutrients and oral and pharyngeal cancer”. Int J Cancer. 86, p. 122-127.

. P. D. James and I. O. Ellis (1986). “Malignant epithelial tumors associated with autoimmune sialadenitis”. J Clin Pathol. 39, p. 497-502 .

. I. Karia, S. Syrjanen, T. Usenious, M. Vornanen and Y. Collan (2008). “Oral cancer in children under 15 years of age: A Clinicopathologic and Virological study”. Acta Otolaryngol Suppl. 449, p. 145 -149.

. R. Sankaranarayanan, B. Mathew, C. Varghese, P. R. Sudhakaram, V. Menon, A. Javadeep, M. K. Nair, C. Mathews, T. R. Mahalingam, P. Balaram and P. P. Nair (1997). “Chemoprevention of oral leukoplakia with vitamin A and beta carotene: An assessment”. Oral Oncol. 33, p. 231-236.

. S. E. Benner, R. J. Winn, S. M. Lippman, J. Poland, K. S. Hansen, M. A. Luna and W. K. Hong (1993). “Regression of oral leukoplakia with alpha-tocopherol: A community clinical oncology program chemoprevention study”. J Natl Cancer Inst. 85, p. 44-47.

. W. S. Stryker, L. A. Stein, M. J. Stampfer, A. Sober and W. C. Willett (1988). “The relation of diet, cigarette smoking, and alcohol consumption to plasma beta-carotene and alpha-tocopherol levels”. Am J Epidemiol. 127, p. 283-296.

. R. B. Zain, F. Fukano, I. A. Razak, P. Shanmuhasuntharam, N. Ikeda and Z. A. Rahman (1999). “Risk factors for oral leukoplakia: A comparison of two ethnic groups in Malaysia. India: Macmillan”. Oral Oncol. 37, p. 207-210.

. [46]. I. Cruz, A. J. Van Den Brule, A. A. Brink, P. J. Snijders, J. M. Walboomers, I. Van Der Waal and C. J. Meijer (2000). “No direct role for Epstein-Barr virus in oral carcinogenesis: A study at the DNA; RNA and protein levels”. Int J Cancer. 86, p. 356-361.

. G. M. Swanson and S. H. Belle (1982). “Cancer morbidity among woodworkers in the U.S. automotive industry”. J Occup Med. 24, p. 315-319.

. L. D. Ke, K. Adler-Storthz, M. F. Mitchell, G. L. Clayman and Z. Chen (1999). “Expression of human papillomavirus E7 mRNA in human oral and cervical neoplasia and cell lines”. Oral Oncol. 35, p. 415-420.

. E. Shore-Freeman, C. Abrahams, W. Recant and A. B. Schneider (1983). “Neurilemmomas and salivary gland tumors of the head and neck following childhood irradiation”. Cancer. 51, p. 2159-2163.

. D. A. Hoffman, W. M. McConahey, J. F. Fraumeni Jr and L. T. Kurland (1982). “Cancer incident following treatment of hyperthyroidism”. Int J Epidemiol. 11, p. 218-224.

. M. P. Copper, A. Lovanovic, J. J Nauta, B. J. Braakhuis, N. de Vries, I. van der Waal and G. B. Snow (1995). “Role of genetic factors in the etiology of squamous cell carcinoma of the head and neck”. Arch Otolaryngol Head Neck Surg. 121, p. 157-160.

. G. Hernandez, L. Arriba, C. Jimenez, J. V. Bagan, B. Rivera, M. Lucas and E. Moreno (2003). “Rapid progression from oral leukoplakia to carcinoma in an immunosuppressed liver transplant recipient”. Oral Oncol. 39, p. 87-90.

. B. L. Rostrona, C. G. Coreya and R. M. Gindib (2019). “Cigar smoking prevalence and morbidity among US adults, 2000–2015 Preventive Medicine Reports 14”.

. D. Chang, J. Lee and T. Lin, A new perspective on satellite communications via incompatible signal polarization features and wavefront multiplexing techniques, 2015. International Conference on Computing, Networking and Communications (ICNC), Garden Grove, CA, pp. 390-394, 2015.

. Centers for Disease Control and Prevention (2018). Centers for Disease Control and Prevention. Cigars Fact Sheet. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/ (2018) [Accessed 10th Sep 2018]

. R. Nagler, A. Weizman and A. Gavish (2019). Cigarette smoke, saliva, the translocator protein 18 k Da (TSPO), and oral cancer Oral Diseases. 25, p. 1843-1849.

. S. Patil, P. Ajagopalan, K. Patel, T. Subbannayya, N. Babu, S. V. Mohan, J. Advani, G. Sathe, S. Bhandi, H. S. Solanki, D. Sidransky, A. Chatterjee, H. Gowda and M. Ferrari (2019). Chronic shisha exposure alters phosphoproteome of oral keratinocytes. Journal of Cell Communication and Signaling.13, p. 281–289.

. N. A. Dar, G. A. Bhat, I. A Shah, B. Iqbal, M. A. Makhdoomi, I. Nisar, R. Rafiq, S. T. Iqbal, A. B. Bhat, S. Nabi, S. A. Shaz, R. Shafi, A. Masood, M. M. Lone, S. A. Zargar, M. S. Najar, F. Islami and P. Boffetta (2012). “Hookah smoking, Nass chewing, and esophageal squamous cell carcinoma in Kashmir, India. Br J Cancer. 107(9), p. 1618–1623.

. Waterpipe (shisha, hookah) smoking, oxidative stress and hidden disease potential. Mohammad Badran and Ismail Laher, Redox Biology, https://doi.org/10.1016/j.redox.2020.101455

. J. Ferlay, I. Soerjomataram, M. Ervik, R. Dikshit, S. Eser, C. Mathers, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. http://globocan.iarc.fr, accessed on 03/09/2016.

. M. de Camargo Cancela, D. L. B. de Souza and M. P. Curado (2012). “International incidence of oropharyngeal cancer: a population-based study”. Oral Oncol. 48, p. 484-490.

. S. Warnakulasuriya (2009). “Global epidemiology of oral and oropharyngeal cancer”. Oral Oncol. 45, p. 309-316.

. Z. Khan, R. A. Suliankatchi, T. L. Heise and S. Dreger (2019). “Naswar (smokeless tobacco) use and the risk of oral cancer in Pakistan: a systematic review with meta-analysis". Nicotine & Tobacco Research. 21, p. 32-40.

. M. Mushtaq (2018). “Smoking tobacco (naswar). A risk factor for oral cancer and its legislation in Pakistan”. KJMS. 11(3), p. 323-325.

. K. H. Awan, Q. A. Hussain, S. Patil and M. Maralingannavar (2016). “Assessing the risk of oral cancer associated with gutka and other smokeless tobacco products: a case-control study”. J Contemp Dent Pract. 17(9), p. 740-744, .

. A. Garg, P. Chaturvedi, A. Mishra and S. Datta (2015). “A review on harmful effects of pan masala”. Indian J Cancer. 52, p. 663-666.

. U. Nair, H. Bartsch and J. Nair (2004). “Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: A review of agents and causative mechanisms”. Mutagenesis. 19, p. 251-262.

. R. A. Bhisey, A. G. Ramchandani, A. V. D. Souza, A. M. Borges and P. N. Notani (1999). “Long-term carcinogenicity of pan masala in Swiss mice”. Int J Cancer. 83, p. 679-684.

. J. S. Yadav and P. Chadha (2002). “Genotoxic studies in pan masala chewers: A high cancer risk group”. Int J Hum Genet. 2, p. 107-112.

. A. G. Ramchandan, A. V. D Souza, A. M. Borges and R. A. Bhisey (1998). “Evaluation of carcinogenic/co-carcinogenic activity of a common chewing product, pan masala, in mouse skin, stomach and esophagus”. Int J Cancer. 75, p. 225-232.

. R. Konduru, A. Newtonraj, S. Arun, A. Velavan and Z. Singh (2016). “Oral cancer awareness of the general public in coastal village areas of Tamilnadu, India: a population based cross sectional study”. Int J Community Med Public Health. 3, p. 1932-1939.

. M. Kadammanavar, M. Angolkar, A. D. Hirachand, J.K. Sha and S. Karikati (2015). “Awareness about oral cancer and its risk factors among rural adult population of Belagavi city, India”. Int J Health Sci Res. 5(7), p. 295-300.

. A. L. Kruse, M. Bredell and K. W. Grätz (2011). “Oral cancer in men and women: are there differences?” Oral Maxillofac Surg. 15, p. 51–55.

. A. Javed and A. Kabeer (2018). “Enhancing waterborne diseases in Pakistan and their possible control”. American Scientific Research Journal for Engineering, Technology, and Sciences. 49 (1), p. 248-256.

. W. C. Lin, Y. P. Lin, Y. C. Wang, T. K. Chang and L. C. Chiang (2014). “Assessing and mapping spatial associations among oral cancer mortality rates, concentrations of heavy metals in soil, and land use types based on multiple scale data”. Int. J. Environ. Res. Public Health.11, p. 2148-2168.

. M. Perera, N. N. Al-hebshi, D. J. Speicher, I. Perera and N. W. Johnson (2016). “Emerging role of bacteria in oral carcinogenesis: a review with special reference to periopathogenic bacteria”. Journal of oral microbiology. 8(1), p. 32762.

. H. Zhao, M. Chu, Z. Huang, et al. (2017). “Variations in oral microbiota associated with oral cancer”. Sci Rep. 7, p. 11773.

. J.M. García-Martín, P. Varela-Centelles , M. González, J.M. Seoane-Romero, J. Seoane and M.J. García-Pola (2019). Epidemiology of Oral Cancer. In: Panta P. (eds) Oral Cancer Detection. Springer, Cham.

. P. Kamatchinathan, N. Kaja, V. Muthuraman, Y. Antharaju, M. Kumar and U. Varadharajan (2016). Psychological analysis of oral cancer patients during pre-operative period in South Indian population: A prospective, quantitative, multicenter study. J Clin Diagn Res. 10(10), p. ZC72–ZC74.

. S. Goswami and S. S. Gupta (2019). How patients of oral cancer cope up with impact of the disease? A qualitative study in Central India. Indian J Palliat Care. 25(1), p. 103–109.

. A. W. Anwer, M. Faisal, M. Taqi, A. A. Malik, A. Jamshed and R. Hussain (2017). Head and neck cancer in a developing country - a hospital-based retrospective study across 10 years from Pakistan. J Cancer Allied Spec. 3(4), p. 1-5.