Rising oral cancer burden in T.N. highlights urgent need for awareness, early detection

Tamil Nadu reported around 8,000 new oral cancer cases in 2025. While the incidence rates are considerably higher in men - 11.6 per 1,00,000 compared to 5.4 per 1,00,000 in women, as per data from the Tamil Nadu Cancer Registry Programme, doctors remain concerned about the persistent trend of late presentation, and highlight the urgent need for stronger early detection and awareness efforts.

Placing this in a broader national and global context, Arvind Krishnamurthy, head of surgical oncology, Cancer Institute, WIA, said, “India bears a disproportionate burden of oral cavity cancer, accounting for nearly one-third of global cases. This epidemic displays distinct epidemiological, etiological, and clinical features compared to Western patterns.”

Unlike high-income countries, where Human Papillomavirus (HPV) and heavy alcohol consumption predominate, India’s oral cancer surge is primarily driven by widespread use of smokeless tobacco products (gutka, khaini, zarda), betel quid/areca nut chewing (with or without tobacco), and beedi smoking, he said, adding: “These deeply entrenched cultural habits promote field cancerisation, leading to multifocal lesions and aggressive involvement of the buccal mucosa and tongue - subsites that dominate the Indian disease profile.”

Demographic and socioeconomic factors further compound the issue. “The disease disproportionately affects lower socioeconomic groups, rural populations, and increasingly younger adults due to early initiation of tobacco habits,” Dr. Krishnamurthy said. “Late presentation remains a major barrier: low awareness, illiteracy, social stigma, and inadequate screening result in 70–80% of cases being diagnosed at advanced stages (III–IV), contributing to a five-year survival rate of approximately 50% - substantially lower than in developed nations,” he added.

Scale of the issue

Further emphasising the scale of the issue nationwide, Naveen Hedne, senior consultant, head and neck surgical oncology, Apollo Proton Cancer Centre, Taramani, pointed out that the incidence and prevalence of oral cancers in India is very high. “The incidence is about 15 to 20 cases per lakh population. About 80,000 to one lakh new cases are diagnosed every year. The average age of oral cancer presentation compared to any other country in the world is lesser in India; the patients are younger compared to the Western population. Most of the oral cancers are related to tobacco use, mostly different types of tobacco. Oral cancer is the number one cancer in men, and number three in women in India,” he explained.

Importantly, he also underlined the stage at which patients seek care. “In contrast to other countries, persons with oral cancer present in advanced stages in India. About 80% of oral cancers in India present in stage four due to ignorance and accessibility to proper healthcare and early diagnosis,” he added.

Elaborating on the tobacco link, he said, “Oral cancer incidence is increasing because of consumption of smokeless tobacco in various forms. There is a lack of awareness that chewing tobacco can cause cancer. There is a lot of misbelief that only smoking can cause cancer. But the cause association between the initiation of habit and development of cancer is much shorter in smokeless or chewing tobacco. For example, for a smoker to develop oral cancer, it may take 10 to 15 years, whereas for those who chew tobacco it can happen in as short as six months to one year or two years. People who use smokeless tobacco keep it in their mouth almost continuously, resulting in constant irritation and early development of these cancers,” Dr. Hedne said.

Advances in treatment

While prevention remains critical, advances in treatment are also reshaping outcomes. M. A. Raja, director and senior consultant, medical oncology, MGM Cancer Institute, said significant advances have been made in cancer treatment, particularly in the area of precision medicine. “Robotic surgery is being performed for head and neck cancers, while radiation therapy has become more targeted, minimising damage to surrounding healthy tissues. Targeted therapy and immunotherapy considerably improve outcomes,” he said.

He emphasised that greater focus is needed on ensuring accessibility and affordability of treatment. “Prevention remains the most effective strategy,” Dr. Raja said, stressing that annual oral screening should become a routine habit and a key priority.

Treatment of oral cancer is being standardised, Dr. Hedne noted. Elaborating on it, he said: “The mainstay of oral cancer treatment is surgery which involves removal of the cancer with at least half a cm of normal tissue all around, and also removing lymph nodes from the neck. In early days, the treatment used to be radical - it used to remove a lot of tissues and bones. But over a period of time, with better understanding of the cancer, we have moved on to lesser radical surgeries, with minimally invasive surgery, resulting in better functional outcome. With advancements in plastic surgery and reconstruction, we are able to have better functional and cosmetic outcomes to bring the patient back to near normal or almost normal.” There are improvements in different radiation techniques such as Intensity Modulated Radiation Therapy, Image-Guided Radiation Therapy and proton therapy. There is a lot of emphasis on precision medicine resulting in targeted treatment, immunotherapy and better chemotherapy agents that have led to lesser toxicity and better outcomes, he pointed out.

Dr. Arvind Krishnamurthy added that management of advanced oral cancers is highly resource-intensive, requiring multimodal therapy (extensive surgery with complex reconstruction, adjuvant chemoradiotherapy). “While global trends in 2026 increasingly favour personalised approaches - including neoadjuvant immunotherapy showing promising pathological responses and potential for de-escalation in locally advanced resectable oral cancers - access to these expensive agents remains severely limited in India due to cost, availability, and infrastructure constraints,” he stated.

Prevention of oral cancers

Dr. Krishnamurthy noted that oral cavity cancer is largely preventable. “Visual inspection-based opportunistic screening and tobacco cessation programmes have proven effective for early detection, yet implementation faces persistent challenges: weak enforcement of gutka bans, cultural acceptance of chewing, and under-utilisation of screening in primary care. Strengthened public health policies, community-based awareness campaigns, and equitable access to early intervention offer the best path to reversing this preventable epidemic,” he said.

Dr. Hedne felt that there is definitely a trend in early detection with more people being aware of the ill effects of tobacco and the need for early detection, screening and diagnosis that will improve prognosis and outcomes both oncologically, functionally and cosmetically. He highlighted the need to educate people that smokeless tobacco is as harmful as smoking to reduce the burden of oral cancer in India. “Next is creating awareness about screening in high risk individuals. Screening of targeted people who are high risk individuals, especially tobacco users, will result in identifying these cancers early leading to better outcomes,” he added.