Oral cancer is a pervasive global health concern, demanding an in-depth investigation into its prevalence, awareness levels, and knowledge base across diverse populations. This research embarks on a comprehensive exploration within the enchanting landscapes of District Shimla in Himachal Pradesh, India. As the capital district of this culturally rich state, Shimla serves as a microcosm reflecting the broader challenges faced by diverse communities concerning oral health.[1,2]

The global surge in oral cancer incidence poses a substantial public health challenge [1,2]. Despite significant advancements in medical science, the efficacy of interventions crucially depends on community awareness [3]. Oral cancer often evades early detection due to a lack of awareness, leading to delayed diagnoses and poorer prognoses [4].

District Shimla, nestled in the Himalayas, is characterized by a unique socio-cultural fabric and diverse demography. This study aims to assess the levels of awareness and knowledge about oral cancer within this population, with a focus on implications for prevention, early detection, and overall oral health. Insights gained from this research can inform targeted interventions, tailored to address the specific needs of the community and foster a culture of oral health consciousness. [3, 4]

This research aligns with the growing body of literature emphasizing the importance of community-based approaches to address oral health disparities [5, 6]. It draws inspiration from Indian studies, such as the one-day national survey in Sri Lanka, which highlighted oral cancer awareness among oral health-care professionals [3]. Additionally, the World Oral Health Report 2003 by Petersen outlines a global framework for improving oral health, and the integration of the common risk factor approach into a social determinants framework is explored by [6].

To deepen the contextual understanding, we incorporate insights from Indian studies. A study by [7] examines oral cancer awareness in urban and rural populations in North India, shedding light on regional variations. [8] Explore risk factors for oral cancer in a case-control study in South India, contributing valuable insights into the local determinants. Furthermore, [9] investigate the role of oral health literacy in oral cancer awareness among the Indian population, providing nuanced perspectives.

This research aspires not only to contribute to the global academic discourse on oral cancer awareness but also to guide policymakers and public health practitioners in designing interventions tailored to the unique challenges faced by District Shimla. It holds the potential to serve as a model for similar regions grappling with oral health disparities.

OBJECTIVES OF THE STUDY:

The objective of this study is to gauge the levels of awareness and knowledge about Oral Cancer among the general population of District Shimla Himachal Pradesh

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area:  District Shimla, Himachal Pradesh

• Study duration- between August 2023 to November 2023

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla for a minimum of 12 months

• Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Oral Cancer , a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Oral Cancer was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Oral Cancer. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla, Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Ethical Considerations- Participants confidentiality and anonymity was maintained. 

Table [1] the primary objective of this study was to gauge the understanding of Oral Cancer among the general population of Shimla. A total of 400 participants took part in the study, with 155 (38.75%) residing in urban areas and 245 (61.25%) in rural areas.

Table-1: Knowledge regarding Oral Cancer among study participants

Table [2] In the present study 24.5% (98)  participants had very good knowledge (16-20 marks) towards Oral Cancer , 41% (164) had good knowledge (12-15 marks), 20.5% (82) had fair knowledge  (8-11 marks) and 14% (56) having poor knowledge  (<8 marks).

Table-2: Knowledge scores towardsOral Cancer among study participants

The findings of this study reveal a nuanced understanding of oral cancer awareness among the general population of District Shimla, Himachal Pradesh. The research aimed to assess the knowledge levels, preventive practices, and perceptions related to oral cancer in this unique socio-cultural setting, offering valuable insights for public health interventions.

The majority of participants demonstrated a commendable level of awareness regarding oral cancer, with 91.75% having heard about it before. This aligns with studies conducted in other parts of India, such as the research by [7] in North India, where a significant proportion of participants were aware of oral cancer. The ability of 69.5% to identify common risk factors is noteworthy, emphasizing the need for targeted awareness campaigns focusing on these factors [7].

While a substantial percentage (69.75%) reported awareness of preventive measures, it is crucial to bridge the gap between knowledge and practices. [8] Found in their South India study that risk factor awareness did not always translate into preventive actions. This suggests the importance of reinforcing the adoption of preventive practices through targeted health education programs.

The study identified a notable gap in the understanding of the frequency of oral cancer screenings, with only 25.5% providing accurate responses. This underscores the necessity for educational initiatives emphasizing the significance of regular screenings for early detection, as early identification is key for successful treatment outcomes [3].

A noteworthy finding is that only 22.25% of participants had participated in oral health awareness programs, suggesting the potential for enhanced community engagement. Efforts to educate the population must be intensified, especially considering that a quarter of the respondents felt that insufficient initiatives were being taken in their area to educate people about oral cancer.

The study identified a substantial awareness (59.25%) of how oral cancer can impact a person's daily life, indicating an acknowledgment of the holistic implications of the disease. Additionally, a commendable 72.25% demonstrated awareness of the potential long-term effects of oral cancer treatment. These findings resonate with the study by [9] on the role of oral health literacy in oral cancer awareness among the Indian population.

The categorization of knowledge scores revealed that a significant proportion of participants (65.5%) possessed good to very good knowledge about oral cancer. This is encouraging, indicating a baseline awareness that can be further built upon through targeted educational interventions.

Comparisons with studies conducted in various parts of India, such as those by [7-9], underscore the consistency in the need for increased awareness and preventive practices. The variations in knowledge levels across regions highlight the importance of tailoring interventions based on local determinants [9,10].

The study provides valuable insights into the levels of oral cancer awareness in District Shimla, Himachal Pradesh. While commendable baseline awareness exists, targeted interventions focusing on preventive practices, regular screenings, and community engagement are imperative to bridge existing gaps. This research contributes to the evolving discourse on oral cancer awareness in India and provides a foundation for designing context-specific public health initiatives.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Directorate Health Services, Shimla-HP, 171009, India.

1. Parkin, D. Max, et al. "Global cancer statistics, 2002." CA: a cancer journal for clinicians 55.2 (2005): 74-108.

2. Ferlay, Jacques, et al. "Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018." European journal of cancer 103 (2018): 356-387.

3. Johnson, N. W., Jayasekara, P., Amarasinghe, A. A., and Warnakulasuriya, S. "One-Day National Survey of Oral Cancer Awareness and Practices Among Oral Health-Care Professionals in Sri Lanka." Journal of Investigative and Clinical Dentistry, vol. 8, no. 3, 2017, p. e12209.

4. Warnakulasuriya, Saman. "Global epidemiology of oral and oropharyngeal cancer." Oral oncology 45.4-5 (2009): 309-316.

5. Petersen, Poul Erik. "The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme." Community Dentistry and oral epidemiology 31 (2003): 3-24.

6. Watt, Richard G., and Aubrey Sheiham. "Integrating the common risk factor approach into a social determinants framework." Community dentistry and oral epidemiology 40.4 (2012): 289-296.

7. Choudhary, K., Prabhakar, R., and Prabhat, M. "Assessment of Oral Cancer Awareness Among the General Rural and Urban Population of North India: A Cross-Sectional Study." Journal of Cancer Research and Therapeutics, vol. 11, no. 2, 2015, pp. 294-298.

8. Azhar, Natasha, et al. "Risk factors of Oral cancer-A hospital based case control study." Journal of clinical and experimental dentistry 10.4 (2018): e396.

9. Top of Form

10. Singh, S., Pal, B., Jindal, S., and Prabhakar, M. "Oral Health Literacy and Awareness Regarding Oral Cancer Among the General Population in India: A Cross-Sectional Study." Journal of Indian Association of Public Health Dentistry, vol. 19, no. 3, 2021, pp. 243-248.