Welcome to the second part of this enlightening conversation with Dr. Apoorva Gupta, who shares valuable insights on how to prevent oral cancer.

Dr. Apoorva Gupta: Which is the youngest patient that you have encountered in your career so far as an oral cancer screening consultant?

Dr. Anjali Singh: If we are talking about full-fledged cancerous conditions, then it has been in middle-aged patients that have been 35 years and older, but if we take into consideration premalignant conditions and potentially malignant disorders like leukoplakia or oral submucous fibrosis [OSMF], which includes group C and group D cases, then it has been reported in youngsters too who were around 14-15 years of age. The youngest patient that I have encountered in my career as a dental health professional was 12 years old, and he was diagnosed with Leukoplakia which is a premalignant condition. The child had somehow developed the habit of chewing tobacco at such an early age, which resulted in the development of premalignant lesions in his mouth.

Dr. Anjali Singh: Yes, because maybe someone in their family has the habit of chewing tobacco; they find it lying around at home and start chewing unknowingly, which later turns into a habit.

Dr. Apoorva Gupta: And sometimes it's the peer pressure or the friends encouraging them to try it once that gets them into these habits so young. And these kids were on the verge of developing cancer, but they were diagnosed and treated at the right time, or else the results could have been fatal.

Dr. Anjali Singh: As you said, you have encountered full-fledged oral cancer cases in middle-aged people only, and if we go by the incidence rates of oral cancer is called an older generation's or older man's disease, so what, according to you is the probable reason for that?

Dr. Apoorva Gupta: That's because cells take a particular time to change themselves; they have a particular rate of mitosis and miosis, which is why it is called an older age group's disease.

Dr. Anjali Singh: So it basically depends on the cell turnover rate and the time it takes for a cell to turn cancerous.

Dr. Apoorva Gupta: Also, the body and immunity of different people are designed differently, so how they react to different diseases also differs. Oftentimes, the patient complains and compares. Let's take for instance, an example that is very common: a patient complaining that he has only been chewing tobacco for five years and has developed oral cancer, while his friend, who has been chewing tobacco for several years now is hail and healthy. That is because different bodies have different immunities, and people need to understand that.

Dr. Anjali Singh: Exactly, this is something that is heard very commonly amongst patients and different bodies have different reaction mechanisms with several factors playing a role in this, like genetic makeup and other biological factors.

Dr. Apoorva Gupta: Yes, there are a lot of factors into play like environmental factors, lifestyle, food habits, upbringing, everything factors in.

Dr. Anjali Singh: Nowadays, electronic cigarettes, also known as vapes, have been garnering a lot of popularity amongst young adults these days with the belief that they're less harmful than smoking. What's your take on that? Is it actually true, or is it a myth?

Dr. Apoorva Gupta: E-cigarettes contain less harmful chemicals and toxins as compared to conventional cigarettes, but the claim that it doesn't contain any harmful toxins or it is risk-free is a myth. It has certain toxins and chemicals which affect your body slowly but steadily, maybe not at the rate a conventional cigarette might it but it definitely has harmful effects on body. Even E-cigarettes contain nicotine, and nicotine is a substance that releases dopamine in the body, which gives a feeling of rush and thrill same to what a cigarette makes you feel. Nicotine affects cellular growth, and leads to the abnormality in the cells. So we can say the harmful effects are comparatively less, but there are certainly side effects and harmful effects caused by E-cigarettes.

Dr. Anjali Singh: So we can say it is a myth because it may take time, but it will definitely show its harmful and toxic effects on the body.

Dr. Apoorva Gupta: Yes, it will definitely show the complications in the body and it has been seen that people these days have been shifting towards E-cigarettes to quit the habit of smoking cigarettes as they consider it to be a healthier option but it is not the case and it doesn't work like that. A person won't be able to quit like this because I have seen my patients that they shift to E-cigarettes but the withdrawal symptoms are still there in the body which makes them go back to smoking cigarettes again. And in cases like these, the side effect is doubled because there's inhalation through cigarettes as well as E-cigarettes. There is a psychology that is quite prevalent these days amongst people that now since we don't smoke cigarettes but we smoke E-cigarettes, there won't be any complications or side effects to it. But what needs to be understood is that E-cigarettes are not a substitute for smoking cigarettes because they still have harmful effects within their own accord. But instead what is acceptable in people who are trying to quit is moving from cigarettes to E-cigarettes and then quitting cigarettes altogether because one can't go from smoking cigarettes the entire day to quitting it altogether and it is not clinically advised also. So E-cigarettes can be used as a mediator to quitting cigarettes since they have low concentrations of chemicals and nicotine. But E-cigarettes can't be used as a substitute for cigarettes.

Dr. Anjali Singh: You explained it in such simple terms and so well. Ma'am, is oral cancer curable?

Dr. Apoorva Gupta: In certain stages, oral cancer is curable. If it is benign and hasn't metastasized to different parts of the body, then it is curable. There are treatment options available like invasive surgery, radiotherapy, and chemotherapy. It brings lifestyle changes, but yeah, it is definitely curable.

Dr. Anjali Singh: So it basically depends on how early it is diagnosed.

Dr. Apoorva Gupta: Exactly. The earlier it is diagnosed, the better the chances of survival. There's a report that also stated that early detection has led to an 83% improvement in survival rates, which is a huge number. So definitely, it is curable, but only to a certain extent. In cases where the cancer has already metastasized to the neck and throat, it becomes a little difficult to manage it. Generally, it is reported that the survival rate is 5 years in treating oral cancer cases.

Dr. Anjali Singh: Basically, we can say that early detection and early prevention is the key to bringing down the number of deaths caused by oral cancer.

Dr. Apoorva Gupta: Exactly. Early detection is the key to early prevention.

Dr. Anjali Singh: Ma'am, since awareness is the key, what do you think could be done to increase awareness, which may lead to early detection and prevention of oral cancer?

Dr. Apoorva Gupta: We can put posters in the clinics, and run videos that impart knowledge about how even the smallest of unhealed red or white patch or an ulcer in the mouth could turn into a premalignant lesion and eventually into a cancerous lesion. Different campaigns and camps could be arranged to impart knowledge and increase awareness about the benefits of early detection. The government has already running several initiative programs like the National Tobacco Control Program [NTCP], which has established health and wellness centres, so government is already doing its part. We need to keep in mind that government has its own limitations and that's where the private sector needs to provide a helping hand. As dental health practitioners it's our duty to spread awareness amongst the people.

Dr. Anjali Singh: So we need to get through to the people that any abnormality detected in the mouth needs to get consulted by the doctor. Because one of the major reasons for delay is neglect, especially in a country like India.

Dr. Apoorva Gupta: Yes, exactly. Neglect and presumptions are one of the major reasons for the late detection of oral cancer. In most cases, people presume it to be an aphthous ulcer and that it would get treated by the application of lignocaine gel.

Dr. Anjali Singh: People need to be made aware that if the ulcer or a patch in the mouth goes unhealed for more than a span of 14 days, they need to get it diagnosed. because there's a chance it could be a premalignant lesion.

Dr. Apoorva Gupta: Oral cancer has a very negative psychology attached to it because no one would want to entertain the possibility that their loved ones, friends, or they themselves could have cancer, but people need to be made aware that oral cancer is preventable if detected early. Because even when it comes to dental caries, we make people understand that if they notice a discoloration in their teeth, they need to visit the dentist. So similar is the case when it comes to oral cancer, they need to visit the dentist in the case of an unhealed ulcer or a patch, and it would get curbed in the nascent stage itself but could have devastating effects if left undiagnosed and untreated.

Dr. Anjali Singh: We need to reinforce and replace the negative psychology attached to cancer with positive psychology. Cancer is generally equated to deadly and fatal in the minds of people, so we need to understand that it could turn deadly and fatal if necessary action isn't taken at the right time.

(HN)