The National Programme for Prevention and Control of NCDs (NP-NCD) 2023-2030 outlines a comprehensive framework for the prevention and control of Non-Communicable Diseases (NCDs) at the national and sub national levels. The guidelines focus on integrating interventions of five common NCDs including cancers into existing healthcare systems, primarily focusing on early detection, prevention, treatment, and management. It also emphasizes on strengthening public health infrastructure, integrating cancer screening services, and promoting awareness campaigns to reduce cancer risk factors like tobacco use, alcohol consumption, and unhealthy diets. The guidelines also encourage the implementation of community-based screening programs for common cancers, including cervical, breast, and oral cancers, along with the development of cancer registries to monitor incidence and outcomes.

Globally, the burden of Non-Communicable Diseases (NCDs) is very high with 41 million deaths annually. Cancers ranks second among NCDs with 9.3 million deaths annually. As per the WHO-NCD India profile -2018, NCDs account for 63% of overall deaths in the country of which 9% deaths are because of cancer. Lip and oral cavity cancers are the 16th most prevalent cancer worldwide, with 389,846 new cases, and the second most common cancer in India, with 143,759 cases. It ranks first among cancers affecting males. Tobacco use remains the most significant global public health challenge. National Family Health Survey phase-I was conducted in 2019-20. It reports tobacco use in all states of India. The prevalence of tobacco use is higher in rural area. The high incidence of oral cavity cancers usually in low socioeconomic settings is due to increased use of tobacco in this population and lack of awareness. The high incidence rates of oral cancers in India are attributed to various risk factors, predominantly tobacco use, which is a major contributor to the development of oral cancers. Most commonly used smokeless product in India are, khaini, gutkha, betel quid with tobacco and zarda etc. Smoking forms of tobacco used are bidi, cigarette and hookah. Maharashtra, West Bengal and Uttar Pradesh have highest number of tobacco users and together account for more than 1/3^rd (38%) of tobacco users in India. Maharashtra has 26.6% of tobacco users with 24.4% of adults using tobacco in smokeless forms. A 2004 International Agency for Research on Cancer (IARC) review committee based on epidemiologic and laboratory studies concluded that smokeless tobacco use is carcinogenic to humans and attributed to oral cancers and pancreatic cancers. Studies indicate that smokeless tobacco products are particularly prevalent in India, with extensive evidence linking them to oral cancer through the presence of carcinogenic nitrosamines. With this background and with our past experience of implementation of tobacco cessation programmes at work place and in community, we initiated a service programme for awareness and screening of oral cavity cancers among the low socioeconomic settings of Mumbai.

Details of Service Programme and its outcomes:

Department of Preventive Oncology, Tata Memorial Hospital (TMH) with funding support from Watumull Sanatorium Trust had initiated a service programme titled “Oral Cancer Screening Programme among High Risk Population Residing in Low Socio-Economic Settings in Mumbai, Maharashtra: An Organized Service Programme”. The implementation of this project was in coherence with the operational guidelines of National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) 2023-2030 programme. The project was initiated in August 2022 and was completed in duration of four years. It was implemented in slums of 25 BMC wards in Mumbai, involving a total of 25,000 beneficiaries, around 1000 from each Ward. This project aimed towards creating awareness about hazards of smoking as well as smokeless tobacco and alcohol use among participants and identifying risk factor exposure and screening participants using tobacco &/or alcohol for oral cavity pre-cancers and cancers and ultimately assisting them for diagnostic investigations and further management.

Retrospective analyses conducted in different regions of India have concluded that different harmful tobacco habits are correlated with prevalence of oral cavity cancer. The retrospective analysis shows that close to 30-40% Oral Squamous Cell Carcinoma cases are linked to tobacco use, indicating the need for early detection strategies, effective awareness and screening programmes to mitigate the disease impact.

The proposed project would be conducted as a retrospective audit of case records of the participants recruited and screened positive during implementation of the Oral Cancer Awareness and Screening Programme. All case records of screen positives registered in Preventive Oncology Screening Clinic will be identified and retrieved through the central Electronic Medical Record (EMR) system of the hospital. To protect the patients’ identity, Unique Identification Code will be generated for all case records to remove all patient identifiers. The de-identified records will then use to capture data as per the study objective on a standardized structured data format.