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Oral Cancer Awareness among Patients Attending University Dental Clinic in Kuantan, Pahang
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ScienceDirect Materials Today: Proceedings 16 (2019) 2253–2261
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Bio-CAM 2017
Oral Cancer Awareness among Patients Attending University Dental Clinic in Kuantan, Pahang Zurainie Abllaha*, Sofiah Juharib , Nasuha Ahmad Pauzib , Tin Myo Hanc , Haszelini Hassand, Ghasak Ghazi Faizale a
Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, IIUM Kuantan, 25200, Kuantan, Pahang, Malaysia. b
Klinik Pergigian Kg Pandan, Jalan Kampung Pandan,Kementerian Kesihatan Malaysia, 55100 Kuala Lumpur,Malaysia. b
Klinik Pergigian Luyang, Kementerian Kesihatan Malaysia, Off Jalan Lintas, 88300 Kota Kinabalu, Sabah,Malaysia. c
d e
Secretary of International Relations, Myanmar General Practitioners’ Society, PO 11221 Yangon, Myanmar.
Department of Oral Maxillifacial Surgery and Diagnosis, Kulliyyah of Dentistry, IIUM Kuantan, 25200, Kuantan, Pahang, Malaysia.
Department of Fundamental Dental and Medical Sciences, Kulliyyah of Dentistry, IIUM Kuantan, 25200, Kuantan, Pahang, Malaysia.
Abstract
In Malaysia oral cancer is the 21st most common cancer in general population. It is 17th most common cancer in male and 16th most common cancer in female. The incidence of oral cancer is predominant among Indian ethnic group where mouth and tongue cancer were among most 10 most cancer for both male and female The study is to assess the awareness of dental patients on oral cancer and its relation to their socio-demographic background. Questionnaires were distributed to the 100 participants to assess their awareness on oral cancer in a university dental clinic in Kuantan, Pahang. Cross analysis, t-test and ANOVA tests were applied to infer the relationship between socio-demographic and awareness level of the respondents. There was a trend for young, good education and income with good awareness about oral cancer, but not significant associated with socio-demographic. The awareness levels of the participants are low and not significantly influenced by socio-demographic status. © 2019 Elsevier Ltd. All rights reserved. Selection and/or Peer-review under responsibility of Biomedical and Advanced Materials (Biocam 2017).
Keywords: Oral cancer awareness; Socio-demographic; Dental clinic
* Corresponding author. Tel.: +6-012-884-8211; fax: +6-09-570-5580. E-mail address: [email protected]
2214-7853 © 2019 Elsevier Ltd. All rights reserved. Selection and/or Peer-review under responsibility of Biomedical and Advanced Materials (Biocam 2017).
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1. Introduction Oral cancer is the 11th most common cancer in the world (Atessa et al., 2010)[1] and it has high incidence rate in developing countries (Peterson, 2003)[2]. In Malaysia oral cancer is the 21st most common cancer in general population. It is 17th most common cancer in male and 16th most common cancer in female. The incidence of oral cancer is predominant among Indian ethnic group where mouth and tongue cancer were among most 10 most cancer for both male and female (MNCR, 2007)[3]. In both developed and developing countries the incidence and prevalence are rapidly increasing and Malaysia is no exception (F Kazmi et al., 2011)[4]. The predisposing factors for oral cancer are; heavy use of tobacco and excess alcohol consumption (X Castellsague et al., 2004) [5], betel nut chewing and poor oral hygiene (P Balaram et al., 2004)[6], old age, obesity and ill-fitting denture (Sami Abdo R et al., 2012)[7]. Individuals with HIV/AIDS or people who have undergone organ transplants have increased risk of oral cancer (F Kazmi et al., 2011)[4]. Premalignant lesions include leukoplakia, erythroplakia or a painless non healing ulcer may be the first sign of oral cancer, localized pain may occur later (L S Monteiro et al., 2012)[8]. It has been reported that lack of awareness among the public about oral cancer and the risk factors is the primary reason for delayed presentation of oral cancer (JK Elango J et al., 2009)[9]. Hence, it causes significant factor in delaying diagnosis and treatment of oral cancer (Warnakulasuriya et al., 1999)[10]. A study in Malaysia showed significant increase in the number of patients who had heard of oral cancer knowledge after receiving information by using media mass approach, however, their ability to recognize the signs and symptoms remain unchanged (DM Parkin et al., 2002)[12]. Head and neck cancer describes a range of tumours that arise in the head and neck region, which includes the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid and salivary glands. The worldwide incidence of head and neck cancer exceeds half a million cases annually, ranking it as the 5thmost common cancer worldwide (DM Parkin et al., 2002)[12]. Approximately 90% of oral cancers are squamous cell carcinoma (SCC), which is particularly common in the developing world, mostly in older males. Based on Malaysia National Cancer Statistics (MNCR, 2007)[3] the most frequent cancer in all residence in Malaysia is breast cancer where it has 18.1 percentages among other types of cancers. Colorectal, trachea-bronchus-lung, nasopharynx, cervix uteri, lymphoma, leukaemia, ovary, stomach and liver are the other most common types of oral cancer in Malaysia. Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths) in 2008 (WHO, 2008). The main types of cancer are; lung with 1.37 million death, stomach with 736 000 death, liver with 695 000 deaths, colorectal with 608 000 deaths, breast with 458 000 deaths and cervical cancer with 275 000 deaths (IARC, 2010). Awareness is the knowledge or perception of a situation or fact as in noun, and, has a synonym of concern about and well-informed interest in a particular situation or development. The overall awareness among respondent about oral cancer and risk factor can be assessed by their responses of sign and symptoms and predisposing factor of oral cancer (JK Elango J et al., 2009)[9]. There is no significant difference in gender in the knowledge of oral cancer where the greatest awareness are among the age group of 35 - 67 years and the subjects who owns alcohol and smoking habits have tendency towards increased awareness of the disease among smokers and those who drank alcohol daily (Warnakulasuriya et al., 1999)[10]. Mass media played significant role as source of information about oral cancer as compared to newspaper and family member of dental surgeon. There is low information regarding oral cancer knowledge and it seems necessary to increase the level of awareness with the use of various educational programs in order to reduce morbidity and mortality (P Atessa et al. 2010)[1]. Socioeconomic is defined as any ‘to or concerned with the interaction of social and economic factors’ while defining demographic as any ‘relating to the structure of populations. There is significant relationship between socio-demographic backgrounds a group and their socioeconomic background. It is recorded that when comparing education level and awareness, the highest numbers of individuals who had heard of oral cancer were amongst the university graduates (A. Salleh et al., 2013). It was observed that the knowledge scores across most dimensions among the various education groups was significantly more for those respondents whose education level was high school or more and lower among respondents who were illiterate or had only primary education (M Agrawal et al., 2012). In study showed that the respondents are aware of oral cancer had higher knowledge and they agreed that the following are risk factors for oral cancer; smoking, poor oral hygiene, family history, alcohol and poor fitting denture where these values decrease respectively with smoking being the highest (Sami Abdo R Al Dubai et al., 2012)[7]. There was also relationship between oral cancer and smoking among 89.5% subjects but less of the association with alcohol misuse (63.3%) (L S Monteiro et al., 2012)[8]. Study in London showed that 94% of the people were aware of the relation between
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early diagnosis and treatment to oral cancer prognosis by (Warnakulasuriya et al., 1999)[10]. Hence, the study is conducted in IIUM polyclinic to assess the awareness of dental patient on oral cancer and its relation to their sociodemographic background. 2. Materials &Methods A cross-sectional clinic based survey was carried out among outpatients attending IIUM Polyclinic. Subject (n=100) had been chosen conveniently and a self-administered questionnaire was given to them to be filled in while they were waiting for their treatment after getting their consent to participate in the study. Respondents who already been diagnose with oral cancer, young respondents less than 20 years old and mentally disable respondents were excluded in this study. The questionnaires consisted of relevant questions to ascertain socio-demographic and education information, awareness of Oral Cancer, its signs and symptoms and the risk factors. Socio-demographic information was collected includes age, gender, race, nationality, marital status, educational level and individual’s monthly income. The second part of the questionnaires asked whether the respondents have heard of oral cancer. Then, if they answered yes, respondents will be asked where they heard about the oral cancer (internet, television, newspaper, friends, family, dentist or doctor, exhibition). The question regarding whether oral cancer can be cured and can be transmitted also been asked to the respondents. Third part of the questionnaires, respondents was answering regarding early sign and symptoms of oral cancer (white patches, red patches, ulcer, swelling, oral bleeding). Fourth part of the questionnaires recorded whether respondents know the risk factors of oral cancer with followed by list of risk factors (smoking, positive family history of oral cancer, elder people more than 60 years old, alcohol, betel quid, sunlight exposure). The fifth and final part of the questionnaires recorded that whether respondents were aware that oral cancer can cause death if left untreated; if early detection of oral cancer can give better prognosis; if early treatment provide better chance to cure; if reducing smoking and tobacco consumption can reduce the chance of getting oral cancer. A total of 105 questionnaires were sent out and 100 were returned. 5 questionnaires were rejected due to incomplete data and respondents are in excluded criteria. 3. Results 3.1 Socio-demographic background of the participants A total of 100 questionnaires were analysed. There were 52 respondents are female and 48 respondents are male. The majority of the respondents (49%) were from 20-30 year old age group followed by 20% from 51-60 year old age group, 19% from 31-40 year old, and 12% from 41-50 year old age group. 51 out of 100 respondents (51%) are possessed university education followed with 29% from secondary school level, 11% from collage, 7% from primary school and only 2% without any formal education. Only 47 respondents provided income information; among them, 53% were in RM500-2000 per month group, 33% in RM2001-5000 group, 8% in less than RM500 group and only 5.3% in more than RM5000 group. Single, married and divorced were 49%, 49% and 2% respectively 3.2 Awareness of respondents on Oral cancer As Table 1, female answered yes by 90.4% as compared to male 81.2%. When analysed with according to age group, most of respondents aged 31-40 years old (94.7%) were aware of oral cancer followed by 20-30 year old age group (89.8). However, age group of 51-60 and age group 41-50 share same percentage of 75%. 92.7% of university graduates, 90.9% of collage leavers, 75.9% secondary school leavers and 85.7% of primary school leaver have heard of oral cancer.1 out of 2 respondents with no formal education show lowest percentage (50%). Based on our data, majority of our respondents (45%) have heard about oral cancer from more than one sources. 25% solely heard from mass media (television, internet and newspaper), 8% from professional (dentist, doctors and oral education) and 6% heard about oral cancer from peers (friends and family). Among 100 respondents, 62% agree that oral cancer is not a curable disease. Majority of the female (65.4%) agree that oral cancer is not a curable disease while male by 58.3%. 91 out of 100 respondents agree that oral cancer is not contagious. 9 respondents who did agree that oral cancer are contagious disease, 1 respondent (14.3%) are from primary school leavers, 6 respondents (20.7%) were secondary school leavers and 2 respondents (3.9%) were university graduates.
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3.3 Knowledge on sign and symptoms of oral cancer Regarding early sign and symptoms of oral cancer, more than half of the respondents believe that white patches (65.0%), red patches (67.0%), swelling (51.0%), and oral bleeding (52.0%) are not the sign and symptoms of oral cancer. However, 55% agree that ulcer is the sign and symptoms of oral cancer. Table1: Association between Socio-demographic background and respondent’s knowledge on Oral cancer Variable
P2.1 Have u heard of oral
P2.3 is oral cancer is curable
P2.4 Is oral cancer a contagious
cancer?
disease?
disease?
Y
%
N %
Total
Y
%
N
%
Total
Y
%
N
%
Male
39
81.2
9
Female
47
90.4
5
18.8
48
20
41.7
28
9.6
52
18
34.6
34
20-30 years
44
89.8
5
10.2
49
14
28.6
31-40 years
18
94.7
41-50 years
9
75.0
1
5.3
19
8
3
25.0
12
4
51-60 years
15
75.0
5
25.0
20
1
50.0
1
50.0
2
Primary
6
85.7
1
14.3
Secondary
22
75.9
7
24.1
College
10
90.9
1
9.1
University
47
92.2
4
< RM 500
3
60.0
501-2000
24
80.0
2001-5000
17
>RM5000
3
Total
58.3
48
2
4.2
46
95.8
65.4
52
7
13.5
45
86.5
52
35
71.4
49
3
6.1
46
93.9
49
42.1
11
57.9
19
0
0
19
100
19
33.3
8
66.7
12
2
16.7
10
83.3
12
12
60.0
8
40.0
20
4
20.0
16
80.0
20
1
50.0
1
50.0
2
0
0
2
7
5
71.4
2
28.6
7
1
14.3
6
85.7
7
29
12
41.4
17
58.6
29
6
20.7
23
79.3
29
11
3
27.3
8
72.7
11
0
0
11
100
11
7.8
51
17
33.3
34
66.7
51
2
3.9
49
96.1
51
2
40.0
5
3
60.0
2
40.0
5
1
20.0
4
80.0
5
6
10.0
30
16
53.3
14
46.7
30
4
13.3
26
86.7
30
89.5
2
10.5
19
4
21.1
15
78.9
19
0
0
19
100
19
100
0
0
3
2
66.7
1
33.3
3
0
0
3
100
3
48
No formal education
100
2
3.4 Knowledge of the respondents on risk factors of oral cancer Based on Table 2, a majority of female (76.9%) however male, only (60.4%) respondents answered yes for risk factors questionnaire. When analysed according to age group, most of those aging 20-30 years old (75.5%) knew of oral cancer risk factors. 100% (2 out of 2) of Indian respondents answered yes for this questionnaire though, the majority race is Malay with 69.7% (62 out of 89) respondents who answered positive for oral cancer risk factors. 76.5% (39 out of 51) respondents of university attendee/graduates, 72.7% (8 out of 11) respondents of college attendee/graduates and 62.1% (18 out of 29) respondents of secondary school leavers knew of oral cancer risk factors. However only 50% (1 out of 2) respondents with no formal education and 42.9% (3 out of 7) respondents of primary school leaver knew of oral cancer risk factors. The table shows that 66.7% (20 out of 30) of respondents who answered positive for oral cancer risk factors came from those with income group RM501-2000 which ties with those respondents with income group more than RM5000 (2 out of 3), 63.2% (12 out of 19) from income group RM2001-5000 and 40.0% (2 out of 5) came from income group less than RM 500. From Table 3, most of the
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respondents can only answer smoking as one of the risk factors of oral cancer correctly with 67.0%. The respondents cannot identify the other oral cancer risks factors correctly. 44% of the respondents identified alcohol as risk factor of oral cancer, followed by 38% for betel quid, 31% for positive family history, 20% for elderly more than 60 years old and only 9% identifies sunlight exposure as oral cancer risk factors.
Table 2: Association between Socio-demographic background and knowledge of the respondents on risk factors of oral cancer Variable
P4. Q1. Do you know risk factors of oral cancer? Yes
%
No
%
Total
%
20-30 years
37
75.5
12
24.5
49
100.0
31-40 years
14
73.7
5
26.3
19
100.0
41-50 years
7
58.3
5
41.7
12
100.0
51-60 years
11
55.0
9
45.0
20
100.0
Male
29
60.4
19
39.6
48
100.0
Female
40
76.9
12
23.1
52
100.0
Malay
62
69.7
27
30.3
89
100.0
Indian
2
100.0
0
0.0
2
100.0
Chinese
4
57.1
3
42.9
7
100.0
Others
1
50.0
1
50.0
2
100.0
1
50.0
1
50.0
2
100.0
Primary
3
42.9
4
57.1
7
100.0
Secondary
18
62.1
11
37.9
29
100.0
College
8
72.7
3
27.3
11
100.0
University
39
76.5
12
23.5
51
100.0
less than RM500
2
40.0
3
60.0
5
100.0
RM501-2000
20
66.7
10
33.3
30
100.0
RM2001-5000
12
63.2
7
36.8
19
100.0
more than RM5000
2
66.7
1
33.3
3
100.0
Age
Gender
Race
Education level No formal education
Income
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Z. Abllah et al. / Materials Today: Proceedings 16 (2019) 2253–2261 Table 3: Knowledge of the participants on risk factors of oral cancer
Variable
Yes
%
No
%
Total
%
Smoking
67
67.0
33
33.0
100
100.0
Positive family history
31
31.0
69
69.0
100
100.0
Elderly >60 years old
20
20.0
80
80.0
100
100.0
Alcohol
44
44.0
56
56.0
100
100.0
Betel quid
38
38.0
62
62.0
100
100.0
Sunlight exposure
9
9.0
91
91.0
100
100.0
3.5 Knowledge of respondents on outcome of oral cancer Based on our data on 78.9% (15 out of 19) respondents who are affirmative that oral cancer can cause death came from those in age group of 31-40 years and 71.4% (35 out of 49) came from age group of 20-30 years. 80.8% female respondents agreed while only 56.2% of male respondents agreed that oral cancer could cause death. Although 100% of Indian race agreed to this statement, it comes from 2 out of 2 respondents. However the largest number of race contributing to this answer came from Malay race with 69.7% from 62 out of 89 respondents. 100.0% (2 out of 2) of respondents with no formal education agreed to this statement but, 78.4% (40 out of 51) respondents from university background has contributes larger number. 100.0% (3 out of 3) respondents with income group more than RM5000 agreed that oral cancer can cause death, 73.7% (14 out of 19) respondents come from income group RM2001-5000 and followed by 66.7% (20 out of 30) respondents come from group income RM501-2000. 3.6 Early detection of oral cancer can give better prognosis of treatment. From the data, 91.8% respondents, which came from 20-30 years age group, agreed that early detection give better prognosis of oral cancer. Majority of both females (90.4%) and males (87.5%) respondents agreed to this statement. Almost all races admit to this statement with 100.0% comes from both Indian and Others respondents (2 out of 2), 89.9% (80 out of 89) Malay respondents, and 71.5% (5 out of 7) respondents from Chinese race. Respondents coming from different educational background also acknowledge that early detection helps with the prognosis with 100.0% (2 out of 2) comes from those with no formal education, 94.1% (48 out of 51) from those with university background, 86.2% (25 out of 29) from those of secondary school leavers, 81.8% (9 out of 11) from those with college background and 71.4% (5 out of 7) from those of primary school leavers. Those respondents with income group more than RM5000 100.0% (3 out of 3) agreed along with 89.5% (17 out of 19) from income group RM2001-5000, followed by 86.7% (26 out of 30) from income group RM501-2000 and 80.0% (4 out of 5) from income group less than RM500. 3.7 Early treatment of oral cancer provides high chance of cure. Majority of respondents acknowledge that early treatment of oral cancer provide high chance of cure, with highest percentage (91.7%) coming from respondents with 41-50 years age group, followed by 90.0% by 51-60 years, followed by 84.2% and 81.6% from 31-40 years and 20-30 years respectively. Both female (90.4%) and male (79.2%) respondents agreed that early treatment has better cured. Most races also agree on this statement with 100.0% agreement from both Indian (2 out of 2) and Others (2 out of 2) respondents, 86.5% (77 out of 89) from Malay respondents and 57.1% (4 out of 7) Chinese respondents. Regardless educational background, most of the respondents do agree on this as well, 100.0% (2 out of 2) respondents with no formal education, 86.3% (44 out of 51) respondents from university background, 86.2% (25 out of 29) respondents from secondary school leavers and 72.7% (8 out of 11) respondents from college background. It’s the same scenario found in respondents with different income group. Most of them acknowledge this statement with 90.0% coming from those with income group RM501-2000, followed by those income group RM2001-5000 with 84.2%, followed by 80.0% from those with income group less than RM500 and 66.7% from those with income group more than RM5000.
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3.8 Reducing smoking and tobacco usage reduce the chance of having oral cancer. Continuing the trend from previous questions, most respondents were generally an agreement. Only those from 31-40 years age group have lowest percentage (73.7%) from 14 out of 19 respondents. Both female (86.5%) and male (83.3%) respondents were also in agreement. Those with primary school leavers have lowest percentage (57.1%) from 4 out of 7 respondents, while others are all agreed in general. Respondents with income group less than RM500 shows the lowest percentage (60.0%) from 3 out of 5 respondents; however contrast from other income groups, which generally agree. 3.9 Total awareness score Each of correctly answered questions was given with 1 mark. From each part of the question, total score were counted. The maximum and minimum values for each total score were recorded. Overall, the maximum score a respondent would obtain if the entire question given answered correctly is 16, and the minimum score is 0. From this value, respondent’s score were total up into grand total for awareness and were ranked into Low, Fair and High. The number of respondents with Low score group for total grand awareness score has the highest value (47%) compared to those of Fair (37%) and High (16%) score group. Based on table 4, the highest percentage of low grand total awareness group in 20-30 years old age group. Whereas, the lowest percentage of the low grand total awareness group is among 31-40 years old. Based on fisher’s exact test, there is no association between age group and grand total awareness score. 54.2% of male and 40.4% of female have Low Grand Total Awareness score. In High Grand Total Awareness score, female shows higher percentage than male with 17.3% and 14.6% respectively. However, Chi-square test shows no association between gender and Grand Total Awareness score. Majority of the education have high percentage in Low Grand Total Awareness Group, except for University level that 47.1% scored in moderate group. Based on fisher’s exact test, the ‘p’ value between education level and Grand Total Awareness Group is not significant. There is random distribution of percentage in all income groups. Hence, the fisher’s exact test shows no association between income group and Grand Total Awareness Group. 4. Discussion Based on our findings from the questionnaire, there is no significant difference between the number of male and female respondents that participated and the majority age group that partook in this questionnaire comes from those of 20-30 years old and 51 out of 100 respondents participated have university background. Regarding Part2 question 1 (Have u heard of oral cancer?) there is general agreement among male (81.2%) and female (90.4%) respondents that they are apperceive of it. Those respondents coming from 31-40 age groups are the ones that have the highest number (94.7%) as regard to this question. Respondents with university background also show the highest percentage concerning this information, which implies that education plays important role in having an informed population. Therefore campaigns for increasing awareness should perhaps target this group of population. From the list of information sources provided, majority of the respondents (45%) received information from multiple resources mainly from mass media (TV, internet and newspaper) compared to professional individuals and peers. Surprisingly, even with said sources of information the respondents claimed they received, more than half of them (62%) agree on oral cancer is not a curable disease, and females are higher in numbers compared of those males respondents. However, they seem to know that oral cancer is non-contagious, and only a few of them (9 person) said otherwise. The respondents particularly agree on ulcer as the sign and symptoms of oral cancer, however, more than half of them could not recognize white and red patches, swelling and oral bleeding as oral cancer’s sign and symptoms. This might signify that the sources of information received by respondents may not be totally accurate and authentic. There is greater number of female respondents that claimed they knew the risk factors of oral cancer compared to male respondents
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Z. Abllah et al. / Materials Today: Proceedings 16 (2019) 2253–2261 Table 4: Association between respondent's socio-demographic background and Grand Total Awareness Group Grand Total Awareness Group
Age Group
20-30 years 31-40 years 41-50 years 51-60 years
Gender
male
female
Frequency
Total
Low
Fair
High
20
18
11
49
36.7% 9 47.4% 5 41.7% 5 25.0%
22.4% 2 10.5% 0 .0% 3 15.0%
100.0% 19 100.0% 12 100.0% 20 100.0%
Percentage 40.8% Frequency 8 Percentage 42.1% Frequency 7 Percentage 58.3% Frequency 12 Percentage 60.0% Fisher’s exact test = 6.13 “p”0.405 Frequency
26
15
7
48
Percentage
54.2%
31.2%
14.6%
100.0%
Frequency
21
22
9
52
Percentage
40.4%
42.3%
17.3%
100.0%
1 50.0% 2 28.6% 8 27.6% 2 18.2% 24 47.1%
0 .0% 0 .0% 4 13.8% 2 18.2% 10 19.6%
2 100.0% 7 100.0% 29 100.0% 11 100.0% 51 100.0%
2 40.0% 7 23.3% 9 47.4% 2 66.7%
1 20.0% 8 26.7% 1 5.3% 0 .0%
5 100.0% 30 100.0% 19 100.0% 3 100.0%
Pearson Chi-Square = 1.949a “p” 0.407 Educational level
no formal education primary secondary college university
Income Group
less than 500 RM 501-2000 RM 2001-5000RM more than 5000 RM
Frequency 1 Percentage 50.0% Frequency 5 Percentage 71.4% Frequency 17 Percentage 58.6% Frequency 7 Percentage 63.6% Frequency 17 Percentage 33.3% Fisher's Exact Test = 9.405”p”0.248 Frequency 2 Percentage 40.0% Frequency 15 Percentage 50.0% Frequency 9 Percentage 47.4% Frequency 1 Percentage 33.3% Fisher's Exact Test = 6.623”p”0.305
Respondents aging 20-30 years old are the majority group that give positive answer for this statement. This might suggest that female and those of younger age group have better grasp and knowledge on risk factors of oral cancer. There is general consensus that smoking is one of the risk factors of oral cancer. However, their awareness on alcohol, betel quid chewing, positive family history, elderly more than 60 years old, and sunlight exposure are very low. This could be due to greater awareness on the harm done by smoking not only in oral cancer, but both lung cancer and heart disease. Generally, the respondents agree on these statements; oral cancer can cause death if left untreated, early detection of oral cancer can give better treatment prognosis and early treatment of oral cancer provide high chance of cure. Continuing from previous trend, most respondents agree that reducing smoking and tobacco usage reduce the chance of having oral cancer. This is true irrespective of their gender, age, race, educational background and income of the respondents. However, the number of respondents represented in each variable group differs greatly. Hence the p values of these variables are of no significant. Looking at the Grand Total Score for awareness, there is higher number of respondents with Low sore group this study shows there is low awareness of oral cancer, sign and symptoms, its risk factors, complication and prevention. This finding similar to the study done by Melda et al, 2013[13] stated that low awareness among Turkish dental patients. Although efforts
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have been spent to spread awareness through both governmental and non-governmental avenues, continuous work should be carried out in order to create informative population regarding oral cancer wholly. As with all survey, this study was limited by the fact that it relied on self-reporting. There was also possible bias as the respondent have to be literate to read the survey through. The wording of questions and statements also contribute to another limiting factor. Different wordings with different response format will result in different answers. As respondents had to choose a response from a list and this would be expected to overestimate knowledge and awareness. Findings of this preliminary study highlighted that the community need more program to be aware about oral cancer. A further community-based study should be conducted with adequate sample size to explore influencing factors on oral cancer awareness. 5. Conclusion The awareness levels of the participant are low which was not significantly influenced by sociodemograhic status. Thus, the community needs more programs about oral cancer. A further community-based study should be conducted with adequate sample size to explore influencing factors on oral cancer awareness. Acknowledgement This study was supported by research grant (RIGS 16-137-0301) from International Islamic University Malaysia (IIUM). References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]
P Atessa, F Farnaz, OE Habib, et al (2010). Oral cancer knowledge among respondentss referred to Mashad Dental School, Iran. Arch Iranian Med, 13, 543-48. PE Peterson (2003). The World Oral Health Report: continuous improvement of oral health in the 21st century-the approach of the WHO Global Health Programme. Community Dent Oral Epidemiol, 31, 3-24. Malaysian National Cancer Registry (MNCR) (2007). Cancer statistic. Ministry of Health Malaysia. F Kazmi, M A Chaudhary, M Mumtaz, M Bhatti, N Khawaja (2011). Oral Cancer Knowledge and Awareness.Pakistan Oral & Dental Journal, 31, 64-67. X Castellsague, MJ Quintana, MC Martinez, et al (2004). The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis. Int J Cancer, 108, 741-49 P Balaram, H Sridhar, T Rajkumar, et al (2002). Oral cancer in Southern India: the influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer, 98, 440-45. Sami Abdo R Al Dubai, K Ganasegeran, A M Alabsi, M A Alshagga, R S Ali (2012). Awarenesss and Knowledge of Oral Cancer among Malaysia Students. Asian Pacific Journal of Cancer Prevention, 13, 165-168 L S Monteiro, F Salazar, J Pacheco,S Warnakulasuriya(2012). Oral Cancer Awareness and Knowledge in the City of Valongo, Portugal. International Journal of Dentistry, 2012, 1-8. J K Elango, K R Sundaram, P Gangadharan et al (2009) Factors Affecting Oral Cancer Awareness in a High-risk Population in India. Asian Pacific J Cancer Prev, 10, 627-630 KA Warnakulasuriya, CK Harris, DM Scarrott, et al (1999). An alarming lack of public awareness towards oral cancer. Br Dental J, 187, 319-22. NM McLeod, NR Saeed, EA Ali (2005). Oral cancer: delays in referral and diagnosis persist. Br Dent J, 198, 681-84 DM Parkin, F Bray, J Ferlay, P Pisani. Global cancer statistics, 2002. CA Cancer J Clin 2005, 55:74 M Melda, N Rana, YY Selmi, ZA Mehmet (2013). Oral cancer knowledge among Turkish dental patients. CCI Journal, Vol 2, 149-152
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Bio-CAM 2017
Oral Cancer Awareness among Patients Attending University Dental Clinic in Kuantan, Pahang Zurainie Abllaha*, Sofiah Juharib , Nasuha Ahmad Pauzib , Tin Myo Hanc , Haszelini Hassand, Ghasak Ghazi Faizale a
Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, IIUM Kuantan, 25200, Kuantan, Pahang, Malaysia. b
Klinik Pergigian Kg Pandan, Jalan Kampung Pandan,Kementerian Kesihatan Malaysia, 55100 Kuala Lumpur,Malaysia. b
Klinik Pergigian Luyang, Kementerian Kesihatan Malaysia, Off Jalan Lintas, 88300 Kota Kinabalu, Sabah,Malaysia. c
d e
Secretary of International Relations, Myanmar General Practitioners’ Society, PO 11221 Yangon, Myanmar.
Department of Oral Maxillifacial Surgery and Diagnosis, Kulliyyah of Dentistry, IIUM Kuantan, 25200, Kuantan, Pahang, Malaysia.
Department of Fundamental Dental and Medical Sciences, Kulliyyah of Dentistry, IIUM Kuantan, 25200, Kuantan, Pahang, Malaysia.
Abstract
In Malaysia oral cancer is the 21st most common cancer in general population. It is 17th most common cancer in male and 16th most common cancer in female. The incidence of oral cancer is predominant among Indian ethnic group where mouth and tongue cancer were among most 10 most cancer for both male and female The study is to assess the awareness of dental patients on oral cancer and its relation to their socio-demographic background. Questionnaires were distributed to the 100 participants to assess their awareness on oral cancer in a university dental clinic in Kuantan, Pahang. Cross analysis, t-test and ANOVA tests were applied to infer the relationship between socio-demographic and awareness level of the respondents. There was a trend for young, good education and income with good awareness about oral cancer, but not significant associated with socio-demographic. The awareness levels of the participants are low and not significantly influenced by socio-demographic status. © 2019 Elsevier Ltd. All rights reserved. Selection and/or Peer-review under responsibility of Biomedical and Advanced Materials (Biocam 2017).
Keywords: Oral cancer awareness; Socio-demographic; Dental clinic
* Corresponding author. Tel.: +6-012-884-8211; fax: +6-09-570-5580. E-mail address: [email protected]
2214-7853 © 2019 Elsevier Ltd. All rights reserved. Selection and/or Peer-review under responsibility of Biomedical and Advanced Materials (Biocam 2017).
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1. Introduction Oral cancer is the 11th most common cancer in the world (Atessa et al., 2010)[1] and it has high incidence rate in developing countries (Peterson, 2003)[2]. In Malaysia oral cancer is the 21st most common cancer in general population. It is 17th most common cancer in male and 16th most common cancer in female. The incidence of oral cancer is predominant among Indian ethnic group where mouth and tongue cancer were among most 10 most cancer for both male and female (MNCR, 2007)[3]. In both developed and developing countries the incidence and prevalence are rapidly increasing and Malaysia is no exception (F Kazmi et al., 2011)[4]. The predisposing factors for oral cancer are; heavy use of tobacco and excess alcohol consumption (X Castellsague et al., 2004) [5], betel nut chewing and poor oral hygiene (P Balaram et al., 2004)[6], old age, obesity and ill-fitting denture (Sami Abdo R et al., 2012)[7]. Individuals with HIV/AIDS or people who have undergone organ transplants have increased risk of oral cancer (F Kazmi et al., 2011)[4]. Premalignant lesions include leukoplakia, erythroplakia or a painless non healing ulcer may be the first sign of oral cancer, localized pain may occur later (L S Monteiro et al., 2012)[8]. It has been reported that lack of awareness among the public about oral cancer and the risk factors is the primary reason for delayed presentation of oral cancer (JK Elango J et al., 2009)[9]. Hence, it causes significant factor in delaying diagnosis and treatment of oral cancer (Warnakulasuriya et al., 1999)[10]. A study in Malaysia showed significant increase in the number of patients who had heard of oral cancer knowledge after receiving information by using media mass approach, however, their ability to recognize the signs and symptoms remain unchanged (DM Parkin et al., 2002)[12]. Head and neck cancer describes a range of tumours that arise in the head and neck region, which includes the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid and salivary glands. The worldwide incidence of head and neck cancer exceeds half a million cases annually, ranking it as the 5thmost common cancer worldwide (DM Parkin et al., 2002)[12]. Approximately 90% of oral cancers are squamous cell carcinoma (SCC), which is particularly common in the developing world, mostly in older males. Based on Malaysia National Cancer Statistics (MNCR, 2007)[3] the most frequent cancer in all residence in Malaysia is breast cancer where it has 18.1 percentages among other types of cancers. Colorectal, trachea-bronchus-lung, nasopharynx, cervix uteri, lymphoma, leukaemia, ovary, stomach and liver are the other most common types of oral cancer in Malaysia. Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths) in 2008 (WHO, 2008). The main types of cancer are; lung with 1.37 million death, stomach with 736 000 death, liver with 695 000 deaths, colorectal with 608 000 deaths, breast with 458 000 deaths and cervical cancer with 275 000 deaths (IARC, 2010). Awareness is the knowledge or perception of a situation or fact as in noun, and, has a synonym of concern about and well-informed interest in a particular situation or development. The overall awareness among respondent about oral cancer and risk factor can be assessed by their responses of sign and symptoms and predisposing factor of oral cancer (JK Elango J et al., 2009)[9]. There is no significant difference in gender in the knowledge of oral cancer where the greatest awareness are among the age group of 35 - 67 years and the subjects who owns alcohol and smoking habits have tendency towards increased awareness of the disease among smokers and those who drank alcohol daily (Warnakulasuriya et al., 1999)[10]. Mass media played significant role as source of information about oral cancer as compared to newspaper and family member of dental surgeon. There is low information regarding oral cancer knowledge and it seems necessary to increase the level of awareness with the use of various educational programs in order to reduce morbidity and mortality (P Atessa et al. 2010)[1]. Socioeconomic is defined as any ‘to or concerned with the interaction of social and economic factors’ while defining demographic as any ‘relating to the structure of populations. There is significant relationship between socio-demographic backgrounds a group and their socioeconomic background. It is recorded that when comparing education level and awareness, the highest numbers of individuals who had heard of oral cancer were amongst the university graduates (A. Salleh et al., 2013). It was observed that the knowledge scores across most dimensions among the various education groups was significantly more for those respondents whose education level was high school or more and lower among respondents who were illiterate or had only primary education (M Agrawal et al., 2012). In study showed that the respondents are aware of oral cancer had higher knowledge and they agreed that the following are risk factors for oral cancer; smoking, poor oral hygiene, family history, alcohol and poor fitting denture where these values decrease respectively with smoking being the highest (Sami Abdo R Al Dubai et al., 2012)[7]. There was also relationship between oral cancer and smoking among 89.5% subjects but less of the association with alcohol misuse (63.3%) (L S Monteiro et al., 2012)[8]. Study in London showed that 94% of the people were aware of the relation between
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early diagnosis and treatment to oral cancer prognosis by (Warnakulasuriya et al., 1999)[10]. Hence, the study is conducted in IIUM polyclinic to assess the awareness of dental patient on oral cancer and its relation to their sociodemographic background. 2. Materials &Methods A cross-sectional clinic based survey was carried out among outpatients attending IIUM Polyclinic. Subject (n=100) had been chosen conveniently and a self-administered questionnaire was given to them to be filled in while they were waiting for their treatment after getting their consent to participate in the study. Respondents who already been diagnose with oral cancer, young respondents less than 20 years old and mentally disable respondents were excluded in this study. The questionnaires consisted of relevant questions to ascertain socio-demographic and education information, awareness of Oral Cancer, its signs and symptoms and the risk factors. Socio-demographic information was collected includes age, gender, race, nationality, marital status, educational level and individual’s monthly income. The second part of the questionnaires asked whether the respondents have heard of oral cancer. Then, if they answered yes, respondents will be asked where they heard about the oral cancer (internet, television, newspaper, friends, family, dentist or doctor, exhibition). The question regarding whether oral cancer can be cured and can be transmitted also been asked to the respondents. Third part of the questionnaires, respondents was answering regarding early sign and symptoms of oral cancer (white patches, red patches, ulcer, swelling, oral bleeding). Fourth part of the questionnaires recorded whether respondents know the risk factors of oral cancer with followed by list of risk factors (smoking, positive family history of oral cancer, elder people more than 60 years old, alcohol, betel quid, sunlight exposure). The fifth and final part of the questionnaires recorded that whether respondents were aware that oral cancer can cause death if left untreated; if early detection of oral cancer can give better prognosis; if early treatment provide better chance to cure; if reducing smoking and tobacco consumption can reduce the chance of getting oral cancer. A total of 105 questionnaires were sent out and 100 were returned. 5 questionnaires were rejected due to incomplete data and respondents are in excluded criteria. 3. Results 3.1 Socio-demographic background of the participants A total of 100 questionnaires were analysed. There were 52 respondents are female and 48 respondents are male. The majority of the respondents (49%) were from 20-30 year old age group followed by 20% from 51-60 year old age group, 19% from 31-40 year old, and 12% from 41-50 year old age group. 51 out of 100 respondents (51%) are possessed university education followed with 29% from secondary school level, 11% from collage, 7% from primary school and only 2% without any formal education. Only 47 respondents provided income information; among them, 53% were in RM500-2000 per month group, 33% in RM2001-5000 group, 8% in less than RM500 group and only 5.3% in more than RM5000 group. Single, married and divorced were 49%, 49% and 2% respectively 3.2 Awareness of respondents on Oral cancer As Table 1, female answered yes by 90.4% as compared to male 81.2%. When analysed with according to age group, most of respondents aged 31-40 years old (94.7%) were aware of oral cancer followed by 20-30 year old age group (89.8). However, age group of 51-60 and age group 41-50 share same percentage of 75%. 92.7% of university graduates, 90.9% of collage leavers, 75.9% secondary school leavers and 85.7% of primary school leaver have heard of oral cancer.1 out of 2 respondents with no formal education show lowest percentage (50%). Based on our data, majority of our respondents (45%) have heard about oral cancer from more than one sources. 25% solely heard from mass media (television, internet and newspaper), 8% from professional (dentist, doctors and oral education) and 6% heard about oral cancer from peers (friends and family). Among 100 respondents, 62% agree that oral cancer is not a curable disease. Majority of the female (65.4%) agree that oral cancer is not a curable disease while male by 58.3%. 91 out of 100 respondents agree that oral cancer is not contagious. 9 respondents who did agree that oral cancer are contagious disease, 1 respondent (14.3%) are from primary school leavers, 6 respondents (20.7%) were secondary school leavers and 2 respondents (3.9%) were university graduates.
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3.3 Knowledge on sign and symptoms of oral cancer Regarding early sign and symptoms of oral cancer, more than half of the respondents believe that white patches (65.0%), red patches (67.0%), swelling (51.0%), and oral bleeding (52.0%) are not the sign and symptoms of oral cancer. However, 55% agree that ulcer is the sign and symptoms of oral cancer. Table1: Association between Socio-demographic background and respondent’s knowledge on Oral cancer Variable
P2.1 Have u heard of oral
P2.3 is oral cancer is curable
P2.4 Is oral cancer a contagious
cancer?
disease?
disease?
Y
%
N %
Total
Y
%
N
%
Total
Y
%
N
%
Male
39
81.2
9
Female
47
90.4
5
18.8
48
20
41.7
28
9.6
52
18
34.6
34
20-30 years
44
89.8
5
10.2
49
14
28.6
31-40 years
18
94.7
41-50 years
9
75.0
1
5.3
19
8
3
25.0
12
4
51-60 years
15
75.0
5
25.0
20
1
50.0
1
50.0
2
Primary
6
85.7
1
14.3
Secondary
22
75.9
7
24.1
College
10
90.9
1
9.1
University
47
92.2
4
< RM 500
3
60.0
501-2000
24
80.0
2001-5000
17
>RM5000
3
Total
58.3
48
2
4.2
46
95.8
65.4
52
7
13.5
45
86.5
52
35
71.4
49
3
6.1
46
93.9
49
42.1
11
57.9
19
0
0
19
100
19
33.3
8
66.7
12
2
16.7
10
83.3
12
12
60.0
8
40.0
20
4
20.0
16
80.0
20
1
50.0
1
50.0
2
0
0
2
7
5
71.4
2
28.6
7
1
14.3
6
85.7
7
29
12
41.4
17
58.6
29
6
20.7
23
79.3
29
11
3
27.3
8
72.7
11
0
0
11
100
11
7.8
51
17
33.3
34
66.7
51
2
3.9
49
96.1
51
2
40.0
5
3
60.0
2
40.0
5
1
20.0
4
80.0
5
6
10.0
30
16
53.3
14
46.7
30
4
13.3
26
86.7
30
89.5
2
10.5
19
4
21.1
15
78.9
19
0
0
19
100
19
100
0
0
3
2
66.7
1
33.3
3
0
0
3
100
3
48
No formal education
100
2
3.4 Knowledge of the respondents on risk factors of oral cancer Based on Table 2, a majority of female (76.9%) however male, only (60.4%) respondents answered yes for risk factors questionnaire. When analysed according to age group, most of those aging 20-30 years old (75.5%) knew of oral cancer risk factors. 100% (2 out of 2) of Indian respondents answered yes for this questionnaire though, the majority race is Malay with 69.7% (62 out of 89) respondents who answered positive for oral cancer risk factors. 76.5% (39 out of 51) respondents of university attendee/graduates, 72.7% (8 out of 11) respondents of college attendee/graduates and 62.1% (18 out of 29) respondents of secondary school leavers knew of oral cancer risk factors. However only 50% (1 out of 2) respondents with no formal education and 42.9% (3 out of 7) respondents of primary school leaver knew of oral cancer risk factors. The table shows that 66.7% (20 out of 30) of respondents who answered positive for oral cancer risk factors came from those with income group RM501-2000 which ties with those respondents with income group more than RM5000 (2 out of 3), 63.2% (12 out of 19) from income group RM2001-5000 and 40.0% (2 out of 5) came from income group less than RM 500. From Table 3, most of the
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respondents can only answer smoking as one of the risk factors of oral cancer correctly with 67.0%. The respondents cannot identify the other oral cancer risks factors correctly. 44% of the respondents identified alcohol as risk factor of oral cancer, followed by 38% for betel quid, 31% for positive family history, 20% for elderly more than 60 years old and only 9% identifies sunlight exposure as oral cancer risk factors.
Table 2: Association between Socio-demographic background and knowledge of the respondents on risk factors of oral cancer Variable
P4. Q1. Do you know risk factors of oral cancer? Yes
%
No
%
Total
%
20-30 years
37
75.5
12
24.5
49
100.0
31-40 years
14
73.7
5
26.3
19
100.0
41-50 years
7
58.3
5
41.7
12
100.0
51-60 years
11
55.0
9
45.0
20
100.0
Male
29
60.4
19
39.6
48
100.0
Female
40
76.9
12
23.1
52
100.0
Malay
62
69.7
27
30.3
89
100.0
Indian
2
100.0
0
0.0
2
100.0
Chinese
4
57.1
3
42.9
7
100.0
Others
1
50.0
1
50.0
2
100.0
1
50.0
1
50.0
2
100.0
Primary
3
42.9
4
57.1
7
100.0
Secondary
18
62.1
11
37.9
29
100.0
College
8
72.7
3
27.3
11
100.0
University
39
76.5
12
23.5
51
100.0
less than RM500
2
40.0
3
60.0
5
100.0
RM501-2000
20
66.7
10
33.3
30
100.0
RM2001-5000
12
63.2
7
36.8
19
100.0
more than RM5000
2
66.7
1
33.3
3
100.0
Age
Gender
Race
Education level No formal education
Income
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Z. Abllah et al. / Materials Today: Proceedings 16 (2019) 2253–2261 Table 3: Knowledge of the participants on risk factors of oral cancer
Variable
Yes
%
No
%
Total
%
Smoking
67
67.0
33
33.0
100
100.0
Positive family history
31
31.0
69
69.0
100
100.0
Elderly >60 years old
20
20.0
80
80.0
100
100.0
Alcohol
44
44.0
56
56.0
100
100.0
Betel quid
38
38.0
62
62.0
100
100.0
Sunlight exposure
9
9.0
91
91.0
100
100.0
3.5 Knowledge of respondents on outcome of oral cancer Based on our data on 78.9% (15 out of 19) respondents who are affirmative that oral cancer can cause death came from those in age group of 31-40 years and 71.4% (35 out of 49) came from age group of 20-30 years. 80.8% female respondents agreed while only 56.2% of male respondents agreed that oral cancer could cause death. Although 100% of Indian race agreed to this statement, it comes from 2 out of 2 respondents. However the largest number of race contributing to this answer came from Malay race with 69.7% from 62 out of 89 respondents. 100.0% (2 out of 2) of respondents with no formal education agreed to this statement but, 78.4% (40 out of 51) respondents from university background has contributes larger number. 100.0% (3 out of 3) respondents with income group more than RM5000 agreed that oral cancer can cause death, 73.7% (14 out of 19) respondents come from income group RM2001-5000 and followed by 66.7% (20 out of 30) respondents come from group income RM501-2000. 3.6 Early detection of oral cancer can give better prognosis of treatment. From the data, 91.8% respondents, which came from 20-30 years age group, agreed that early detection give better prognosis of oral cancer. Majority of both females (90.4%) and males (87.5%) respondents agreed to this statement. Almost all races admit to this statement with 100.0% comes from both Indian and Others respondents (2 out of 2), 89.9% (80 out of 89) Malay respondents, and 71.5% (5 out of 7) respondents from Chinese race. Respondents coming from different educational background also acknowledge that early detection helps with the prognosis with 100.0% (2 out of 2) comes from those with no formal education, 94.1% (48 out of 51) from those with university background, 86.2% (25 out of 29) from those of secondary school leavers, 81.8% (9 out of 11) from those with college background and 71.4% (5 out of 7) from those of primary school leavers. Those respondents with income group more than RM5000 100.0% (3 out of 3) agreed along with 89.5% (17 out of 19) from income group RM2001-5000, followed by 86.7% (26 out of 30) from income group RM501-2000 and 80.0% (4 out of 5) from income group less than RM500. 3.7 Early treatment of oral cancer provides high chance of cure. Majority of respondents acknowledge that early treatment of oral cancer provide high chance of cure, with highest percentage (91.7%) coming from respondents with 41-50 years age group, followed by 90.0% by 51-60 years, followed by 84.2% and 81.6% from 31-40 years and 20-30 years respectively. Both female (90.4%) and male (79.2%) respondents agreed that early treatment has better cured. Most races also agree on this statement with 100.0% agreement from both Indian (2 out of 2) and Others (2 out of 2) respondents, 86.5% (77 out of 89) from Malay respondents and 57.1% (4 out of 7) Chinese respondents. Regardless educational background, most of the respondents do agree on this as well, 100.0% (2 out of 2) respondents with no formal education, 86.3% (44 out of 51) respondents from university background, 86.2% (25 out of 29) respondents from secondary school leavers and 72.7% (8 out of 11) respondents from college background. It’s the same scenario found in respondents with different income group. Most of them acknowledge this statement with 90.0% coming from those with income group RM501-2000, followed by those income group RM2001-5000 with 84.2%, followed by 80.0% from those with income group less than RM500 and 66.7% from those with income group more than RM5000.
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3.8 Reducing smoking and tobacco usage reduce the chance of having oral cancer. Continuing the trend from previous questions, most respondents were generally an agreement. Only those from 31-40 years age group have lowest percentage (73.7%) from 14 out of 19 respondents. Both female (86.5%) and male (83.3%) respondents were also in agreement. Those with primary school leavers have lowest percentage (57.1%) from 4 out of 7 respondents, while others are all agreed in general. Respondents with income group less than RM500 shows the lowest percentage (60.0%) from 3 out of 5 respondents; however contrast from other income groups, which generally agree. 3.9 Total awareness score Each of correctly answered questions was given with 1 mark. From each part of the question, total score were counted. The maximum and minimum values for each total score were recorded. Overall, the maximum score a respondent would obtain if the entire question given answered correctly is 16, and the minimum score is 0. From this value, respondent’s score were total up into grand total for awareness and were ranked into Low, Fair and High. The number of respondents with Low score group for total grand awareness score has the highest value (47%) compared to those of Fair (37%) and High (16%) score group. Based on table 4, the highest percentage of low grand total awareness group in 20-30 years old age group. Whereas, the lowest percentage of the low grand total awareness group is among 31-40 years old. Based on fisher’s exact test, there is no association between age group and grand total awareness score. 54.2% of male and 40.4% of female have Low Grand Total Awareness score. In High Grand Total Awareness score, female shows higher percentage than male with 17.3% and 14.6% respectively. However, Chi-square test shows no association between gender and Grand Total Awareness score. Majority of the education have high percentage in Low Grand Total Awareness Group, except for University level that 47.1% scored in moderate group. Based on fisher’s exact test, the ‘p’ value between education level and Grand Total Awareness Group is not significant. There is random distribution of percentage in all income groups. Hence, the fisher’s exact test shows no association between income group and Grand Total Awareness Group. 4. Discussion Based on our findings from the questionnaire, there is no significant difference between the number of male and female respondents that participated and the majority age group that partook in this questionnaire comes from those of 20-30 years old and 51 out of 100 respondents participated have university background. Regarding Part2 question 1 (Have u heard of oral cancer?) there is general agreement among male (81.2%) and female (90.4%) respondents that they are apperceive of it. Those respondents coming from 31-40 age groups are the ones that have the highest number (94.7%) as regard to this question. Respondents with university background also show the highest percentage concerning this information, which implies that education plays important role in having an informed population. Therefore campaigns for increasing awareness should perhaps target this group of population. From the list of information sources provided, majority of the respondents (45%) received information from multiple resources mainly from mass media (TV, internet and newspaper) compared to professional individuals and peers. Surprisingly, even with said sources of information the respondents claimed they received, more than half of them (62%) agree on oral cancer is not a curable disease, and females are higher in numbers compared of those males respondents. However, they seem to know that oral cancer is non-contagious, and only a few of them (9 person) said otherwise. The respondents particularly agree on ulcer as the sign and symptoms of oral cancer, however, more than half of them could not recognize white and red patches, swelling and oral bleeding as oral cancer’s sign and symptoms. This might signify that the sources of information received by respondents may not be totally accurate and authentic. There is greater number of female respondents that claimed they knew the risk factors of oral cancer compared to male respondents
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Z. Abllah et al. / Materials Today: Proceedings 16 (2019) 2253–2261 Table 4: Association between respondent's socio-demographic background and Grand Total Awareness Group Grand Total Awareness Group
Age Group
20-30 years 31-40 years 41-50 years 51-60 years
Gender
male
female
Frequency
Total
Low
Fair
High
20
18
11
49
36.7% 9 47.4% 5 41.7% 5 25.0%
22.4% 2 10.5% 0 .0% 3 15.0%
100.0% 19 100.0% 12 100.0% 20 100.0%
Percentage 40.8% Frequency 8 Percentage 42.1% Frequency 7 Percentage 58.3% Frequency 12 Percentage 60.0% Fisher’s exact test = 6.13 “p”0.405 Frequency
26
15
7
48
Percentage
54.2%
31.2%
14.6%
100.0%
Frequency
21
22
9
52
Percentage
40.4%
42.3%
17.3%
100.0%
1 50.0% 2 28.6% 8 27.6% 2 18.2% 24 47.1%
0 .0% 0 .0% 4 13.8% 2 18.2% 10 19.6%
2 100.0% 7 100.0% 29 100.0% 11 100.0% 51 100.0%
2 40.0% 7 23.3% 9 47.4% 2 66.7%
1 20.0% 8 26.7% 1 5.3% 0 .0%
5 100.0% 30 100.0% 19 100.0% 3 100.0%
Pearson Chi-Square = 1.949a “p” 0.407 Educational level
no formal education primary secondary college university
Income Group
less than 500 RM 501-2000 RM 2001-5000RM more than 5000 RM
Frequency 1 Percentage 50.0% Frequency 5 Percentage 71.4% Frequency 17 Percentage 58.6% Frequency 7 Percentage 63.6% Frequency 17 Percentage 33.3% Fisher's Exact Test = 9.405”p”0.248 Frequency 2 Percentage 40.0% Frequency 15 Percentage 50.0% Frequency 9 Percentage 47.4% Frequency 1 Percentage 33.3% Fisher's Exact Test = 6.623”p”0.305
Respondents aging 20-30 years old are the majority group that give positive answer for this statement. This might suggest that female and those of younger age group have better grasp and knowledge on risk factors of oral cancer. There is general consensus that smoking is one of the risk factors of oral cancer. However, their awareness on alcohol, betel quid chewing, positive family history, elderly more than 60 years old, and sunlight exposure are very low. This could be due to greater awareness on the harm done by smoking not only in oral cancer, but both lung cancer and heart disease. Generally, the respondents agree on these statements; oral cancer can cause death if left untreated, early detection of oral cancer can give better treatment prognosis and early treatment of oral cancer provide high chance of cure. Continuing from previous trend, most respondents agree that reducing smoking and tobacco usage reduce the chance of having oral cancer. This is true irrespective of their gender, age, race, educational background and income of the respondents. However, the number of respondents represented in each variable group differs greatly. Hence the p values of these variables are of no significant. Looking at the Grand Total Score for awareness, there is higher number of respondents with Low sore group this study shows there is low awareness of oral cancer, sign and symptoms, its risk factors, complication and prevention. This finding similar to the study done by Melda et al, 2013[13] stated that low awareness among Turkish dental patients. Although efforts
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have been spent to spread awareness through both governmental and non-governmental avenues, continuous work should be carried out in order to create informative population regarding oral cancer wholly. As with all survey, this study was limited by the fact that it relied on self-reporting. There was also possible bias as the respondent have to be literate to read the survey through. The wording of questions and statements also contribute to another limiting factor. Different wordings with different response format will result in different answers. As respondents had to choose a response from a list and this would be expected to overestimate knowledge and awareness. Findings of this preliminary study highlighted that the community need more program to be aware about oral cancer. A further community-based study should be conducted with adequate sample size to explore influencing factors on oral cancer awareness. 5. Conclusion The awareness levels of the participant are low which was not significantly influenced by sociodemograhic status. Thus, the community needs more programs about oral cancer. A further community-based study should be conducted with adequate sample size to explore influencing factors on oral cancer awareness. Acknowledgement This study was supported by research grant (RIGS 16-137-0301) from International Islamic University Malaysia (IIUM). References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]
P Atessa, F Farnaz, OE Habib, et al (2010). Oral cancer knowledge among respondentss referred to Mashad Dental School, Iran. Arch Iranian Med, 13, 543-48. PE Peterson (2003). The World Oral Health Report: continuous improvement of oral health in the 21st century-the approach of the WHO Global Health Programme. Community Dent Oral Epidemiol, 31, 3-24. Malaysian National Cancer Registry (MNCR) (2007). Cancer statistic. Ministry of Health Malaysia. F Kazmi, M A Chaudhary, M Mumtaz, M Bhatti, N Khawaja (2011). Oral Cancer Knowledge and Awareness.Pakistan Oral & Dental Journal, 31, 64-67. X Castellsague, MJ Quintana, MC Martinez, et al (2004). The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis. Int J Cancer, 108, 741-49 P Balaram, H Sridhar, T Rajkumar, et al (2002). Oral cancer in Southern India: the influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer, 98, 440-45. Sami Abdo R Al Dubai, K Ganasegeran, A M Alabsi, M A Alshagga, R S Ali (2012). Awarenesss and Knowledge of Oral Cancer among Malaysia Students. Asian Pacific Journal of Cancer Prevention, 13, 165-168 L S Monteiro, F Salazar, J Pacheco,S Warnakulasuriya(2012). Oral Cancer Awareness and Knowledge in the City of Valongo, Portugal. International Journal of Dentistry, 2012, 1-8. J K Elango, K R Sundaram, P Gangadharan et al (2009) Factors Affecting Oral Cancer Awareness in a High-risk Population in India. Asian Pacific J Cancer Prev, 10, 627-630 KA Warnakulasuriya, CK Harris, DM Scarrott, et al (1999). An alarming lack of public awareness towards oral cancer. Br Dental J, 187, 319-22. NM McLeod, NR Saeed, EA Ali (2005). Oral cancer: delays in referral and diagnosis persist. Br Dent J, 198, 681-84 DM Parkin, F Bray, J Ferlay, P Pisani. Global cancer statistics, 2002. CA Cancer J Clin 2005, 55:74 M Melda, N Rana, YY Selmi, ZA Mehmet (2013). Oral cancer knowledge among Turkish dental patients. CCI Journal, Vol 2, 149-152