Risk Assessment of Smokeless Tobacco among Oral Precancer and Cancer Patients in Eastern Developmental Region of Nepal

Background: Oral potentially malignant disorders (OPMDs) and oral cancer (OC) are preventable oral mucosaldiseases prevalent in Asian region. This epidemiological study aims to identify oral potentially malignant disorders(OPMDs) and oral cancer (OC), confirm histopathologically, and treat or refer these cases among the population ofEastern Development Region (EDR) of Nepal. It also attempts to assess the risk factors associated in order to comparedose–response measurements of oral habits in these patients. Methods: Cross-sectional epidemiological study wasconducted over a period of 2 years in 16 districts of EDR. A total of 3,200 people were screened. A brief history wastaken and visual screening examination was conducted in two phases as described by British Columbia Oral CancerPrevention Program. Suspicious oral lesions were biopsied either by punch or scalpel after toluidine blue staining.Tissue specimen was transported to the institutional lab for histopathological processing. The reports were sent to thepatients through the local leaders or organizations. Results: More than 40% of the study population either chewedareca nut and/or tobacco. Eighteen percent were smokers. OPMDs were prevalent among 468 study population withmale-female ratio of 3:1. Tobacco pouch keratosis (50.4%) was the most prevalent OPMD, followed by OSF (29.1%).Fifty-two had squamous cell carcinoma and 8 had verrucous carcinoma. Conclusion: Chewing areca nut, tobacco,commercial areca nut/tobacco preparation and smoking being the major risk factors, there is high prevalence of oralcancer and OPMDs in the EDR of Nepal.