Oral cancer is a major health issue in Sri Lanka, with alarming statistics revealing that approximately three individuals lose their lives every day due to this deadly disease. Dr. Anand Rathnayake, an esteemed oral and maxillofacial surgeon, recently shared this troubling information during a media briefing held by the Health Promotion Bureau in Colombo to commemorate World Oral Health Day. As the prevalence of oral cancer continues to rise, it has become imperative to understand the risk factors, the impact of lifestyle choices, and the critical need for early detection to lessen the burden of the disease. Dr. Anand Rathnayake’s statement serves as a stark reminder of the urgent need for comprehensive public health campaigns to address the growing threat of oral cancer in Sri Lanka.
Understanding oral cancer: Causes and risk factors
Oral cancer, often referred to as oropharyngeal cancer, encompasses malignant tumors that arise in the mouth, tongue, lips, cheeks, gums, and the back of the throat. Similar to many other cancer types, oral cancer is frequently associated with various lifestyle choices and environmental influences. Dr. Anand Rathnayake emphasised the significant role that tobacco products and betel leaf chewing play in the onset of oral cancer. (Pande et al., 2001)Research has established that these factors are carcinogenic, meaning they can lead to mutations in oral cavity cells, ultimately resulting in cancer.
Tobacco use, including cigarette and cigar smoking, ranks among the top causes of oral cancer globally.(Pathak & Verma, 2023)The harmful substances found in tobacco smoke, like nicotine, tar, and various carcinogens, penetrate the tissues in the mouth and throat, raising the likelihood of cancerous growth. In Sri Lanka, smoking has gained popularity among both men and women, despite persistent public health efforts aimed at curbing tobacco use. The connection between tobacco and oral cancer is significant; (Johnson, 2001)research consistently indicates that smokers face a greater risk of developing this lethal illness.
A late diagnosis greatly diminishes the chances for effective treatment and raises the risk of fatality. In Sri Lanka, many people lack access to regular dental check-ups or screenings, which leads to a higher rate of late-stage diagnoses. Additionally, the social stigma associated with cancer may cause some patients to hesitate in seeking assistance, worsening the situation. Dr. Anand Rathnayake highlights the importance of early detection, as early-stage oral cancer is more treatable and presents patients with a significantly improved prognosis.
In addition to these lifestyle factors, other elements may increase the risk of developing oral cancer. These include a history of oral infections, particularly human papillomavirus (HPV) infections, poor oral hygiene, excessive alcohol consumption, and prolonged exposure to ultraviolet radiation from the sun.(Lanka Lilani Ekanayake Peradeniya & Lanka, 2008) While these factors also contribute to the disease’s development, tobacco and betel-related habits remain the primary risk factors in Sri Lanka, and they are largely preventable.
The alarming statistics: Impact of oral cancer in Sri Lanka
Dr. Anand Rathnayake states that three people die from oral cancer every day in Sri Lanka paints a grim picture of the disease’s impact on the nation. This means that over 1,000 people die annually from oral cancer, a figure that could be substantially reduced with improved public health initiatives. Furthermore, the reported 3,000 new cases of oral cancer annually reflect an alarming trend that continues to rise, indicating that the burden of the disease is not only significant but growing.
Reference: Review of Oral Cancer Disease among the Poor: A Sri Lankan Context. Kalpani Senevirathna, Yovanthi Anurangi Jayasinghe, Shalindu Malshan Jayawickrama, Hemantha Amarasinghe and Ruwan Duminda Jayasinghe.
Oral cancer’s high mortality rate is partly attributed to late-stage diagnosis.(Basnayake & Perera, 2021). Unlike some cancers, oral cancer can often be difficult to detect in its early stage, as the symptoms are frequently overlooked or attributed to less serious conditions. Common signs of oral cancer include persistent mouth ulcers, difficulty swallowing, pain in the mouth or throat, and unexplained weight loss. However, these symptoms may not be immediately recognised as indicative of cancer, leading many individuals to delay seeking medical attention until the disease has progressed to an advanced stage.
The late diagnosis significantly reduces the chances of successful treatment and increases the likelihood of death. In Sri Lanka, many individuals do not have access to regular oral health check-ups or screenings, which contributes to the high incidence of late-stage diagnosis. Moreover, due to the social stigma surrounding cancer, some patients may delay seeking help, further exacerbating the problem. Dr. Anand Rathnayake, emphasises that early detection is a crucial point, as oral cancer, when detected early, can be treated more effectively, offering patients a much better prognosis. (Brocklehurst et al., 2013)
The role of public health campaigns and awareness
The importance of public health awareness in combating oral cancer cannot be overstated. Dr. Anand Rathnayake’s comments highlight the urgent need for increased awareness about the risks associated with tobacco use and betel leaf chewing. Public health campaigns that educate the population about the dangers of these habits and promote healthier alternatives are critical in reducing the incidence of oral cancer.
One of the key challenges in Sri Lanka is the deep ingrained cultural acceptance of tobacco use and betel chewing.(Mahees et al., 2021) These practices are not only socially accepted but are often seen as an integral part of daily life. Changing such behaviour requires a concerted effort from the government, health authorities, and community organisations. Public health campaigns should focus on providing information about the link between tobacco and betel consumption and oral cancer, emphasising the importance of early detection and encouraging people to seek medical advice if they notice any concerning symptoms.
Additionally, schools, workplaces, and community centres can serve as important venues for spreading awareness about oral cancer. Programs that promote a healthy lifestyle, including smoking cessation and the reduction of betel leaf use, can help educate individuals about the risks and provide resources for quitting these habits. This type of education should be aimed not only at adults but also at young people to prevent the initiation of harmful behaviour from an early age.
Furthermore, it is essential that public health campaigns also focus on making healthcare services more accessible to all segments of the population. Regular oral health screenings should be integrated into primary healthcare settings, ensuring that individuals are regularly checked for signs of oral cancer. Establishing a robust screening system would increase the likelihood of early detection (Herdman & Lichtenfeld, 2004)and reduce the number of people who only seek medical care when the disease is in its advanced stages.
The importance of early detection and treatment
Dr. Anand Rathnayake’s emphasis on the fact that oral cancer can be easily managed and controlled if detected early cannot be stressed enough. Early-stage oral cancer has a much higher survival rate than cancers diagnosed at a later stage. (Herdman & Lichtenfeld, 2004) The prognosis for individuals with early-stage oral cancer is significantly better, with many patients experiencing full recovery after treatment, which may involve surgery, radiation therapy, and chemotherapy.
Early detection also means that treatment can be less invasive, reducing the overall impact on a person’s quality of life. (Dr. Janaki Vidanapathirana et al.., 2020)In contrast, late-stage oral cancer often requires more aggressive treatments, which can lead to significant physical and psychological consequences. Furthermore, the financial burden of treating advanced cancer is often much higher, both for the patient and the healthcare system. By investing in early detection and screening programmes, Sri Lanka can reduce the overall cost of treating oral cancer and improve the quality of life for patients.
Regular oral health checkups are essential in identifying potential signs of oral cancer before they develop into to more serious issue. Dental professionals play a critical role in the process, as they are often the first to identify early signs of oral cancer during routine checkups. Educating dentists about the importance of screening for oral cancer and providing them with the tools to detect abnormalities can help identify cancer at an early, more treatable stage.
Addressing the stigma: Overcoming cultural barriers
One of the most challenging aspects of addressing oral cancer in Sri Lanka is the cultural stigma surrounding the disease. Cancer, in general, often carries a social stigma, and this is particularly true for oral cancer. Many individuals who develop symptoms of oral cancer may feel embarrassed or ashamed, leading them to delay seeking medical attention. This is particularly concerning when considering the role of tobacco and betel leaf chewing, which are often linked to long-standing cultural practices and social gatherings.
Overcoming this stigma requires a concerted effort from public health authorities to normalise the conversation around oral cancer. This can be done by integrating cancer education into the national curriculum, promoting media campaigns that emphasise the importance of seeking help, and encouraging healthcare providers to create supportive environments where patients feel comfortable discussing their symptoms without fear of judgment.
Conclusion: A collective effort to combat oral cancer
Oral cancer remains a significant public health challenge in Sri Lanka, with the number of cases continuing to rise each year. Dr. Anand Rathnayake’s comments about the devastating impact of tobacco use, betel leaf chewing, and the urgent need for early detection highlight the critical areas of focus in tackling this disease. Through increased public health awareness, lifestyle changes, and better access to healthcare services, Sri Lanka can begin to reduce the burden of oral cancer on its population.
The fight against oral cancer requires a collective effort from government agencies, healthcare professionals, and the general public. By promoting healthy habits, increasing awareness about the risks of tobacco and betel consumption, and prioritising early detection. Sri Lanka can take significant steps toward reducing the prevalence of this deadly disease.
Additionally, it is essential for international collaborations and partnerships to play a role in addressing this issue. Sri Lanka can benefit from research, funding, and technological advancements from global health organisations that focus on cancer prevention, detection, and treatment. By embracing a multifaceted approach that includes education, healthcare reform, and public engagement, Sri Lanka can make meaningful strides in reducing the incidence of oral cancer and ultimately save countless lives. The time to act is now, and the entire nation must come together to combat preventable and deadly diseases.
Lieutenant Colonel Palitha Herath RSP psc M.CPS PgD CPS Dip in Law SLA is a Military Research Officer at the Institute of National Security Studies (INSS), the premier think tank on National Security established under the Ministry of Defence. The opinions expressed are his own and not necessarily reflective of the Institute or the Ministry of Defence.