Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India


CONTEXT: Oral cancer is preceded by visible changes in the oral mucosa. These lesions can be
detected by oral self‑examination, but awareness about oral cancer is still low in developing countries.
AIM: To evaluate the effect of health education on awareness about oral cancer and oral
SETTINGS AND DESIGN: Quasi‑experimental trial was conducted in an urban resettlement colony
of Chandigarh, India.
MATERIALS AND METHODS: A brochure having information and pictorials on oral lesions was
used for conducting health education sessions on a one‑to‑one basis in the household setting
among 85 males in age group 15–59 years during 2013, and each participant was encouraged
to perform an oral self‑examination. Study participants were interviewed about their awareness
on oral cancer and oral self‑examination before‑ and after‑health education using a pretested
interview schedule.
STATISTICAL ANALYSIS: Awareness items were scored, and mean change in awareness score
was computed. Paired t‑test was used for testing statistical significance.
RESULTS: Thirty‑three percent of the study participants were current smokers, 25% consumed
alcohol, and 9.4% chewed tobacco. The awareness scores after health education increased
significantly from 5.3 to 6.7 (P < 0.05), and 34% of the tobacco or alcohol users expressed their
intention to quit these habits, and two persons actually quit tobacco chewing. Out of the 77 study
participants who performed oral self‑examination, nine were able to detect lesions, and one was
found to have submucous fibrosis.
CONCLUSIONS: Health education intervention was able to initiate a favorable behavior change in
the community. Hence, oral self‑examination programs should be promoted.


1. International Agency for Cancer Research. GLOBOCAN
2012: Estimated Cancer Incidence, Mortality and Prevalence
World‑wide in 2012. Available from: http://www.globocan.iarc.
fr/Default.aspx. [Last accessed on 2015 Sep 26].
2. Prasad LK. Burden of oral cancer: An Indian scenario. J Orofac
Sci 2014;6:77. Available from:
asp?2014/6/2/77/143043. [Last accessed on 2015 Oct 11].
3. Sankaranarayanan R, Masuyer E, Swaminathan R, Ferlay J,
Whelan S. Head and neck cancer: A global perspective on
epidemiology and prognosis. Anticancer Res 1998;18:4779‑86.
4. Sankaranarayanan R. Oral cancer in India: An epidemiologic
and clinical review. Oral Surg Oral Med Oral Pathol
5. Boyle P, Macfarlane GJ, Scully C. Oral cancer: Necessity for
prevention strategies. Lancet 1993;342:1129.
6. Why Screening Works. Available from: http://www.
php. [Last accessed on 2015 Jun 11].
7. McLeod NM, Saeed NR, Ali EA. Oral cancer: Delays in referral
and diagnosis persist. Br Dent J 2005;198:681‑4.
8. Jullien JA, Zakrzewska JM, Downer MC, Speight PM. Attendance
and compliance at an oral cancer screening programme in a
general medical practice. Eur J Cancer B Oral Oncol 1995;31B:
9. Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R,
Thara S, Mathew B, et al. Effect of screening on oral cancer
mortality in Kerala, India: A cluster‑randomised controlled trial.
Lancet 2005;365:1927‑33.
10. Barbadoro P, Lucrezi D, Prospero E, Annino I. Improvement
of knowledge, attitude, and behavior about oral health in a population of alcohol addicted persons. Alcohol Alcohol
11. Humphris GM, Field EA. An oral cancer information leaflet for
smokers in primary care: Results from two randomised controlled
trials. Community Dent Oral Epidemiol 2004;32:143‑9.
12. Etter JF, Laszlo E. Evaluation of a poster campaign against
passive smoking for World No‑Tobacco Day. Patient Educ Couns
13. Srikanth Reddy B, Doshi D, Padma Reddy M, Kulkarni S,
Gaffar A, Ram Reddy V. Oral cancer awareness and knowledge
among dental patients in South India. J Craniomaxillofac Surg
14. Kish Summary of Eight Table. Available from: http://www.
doc. [Last accessed on 2013 Dec 26].
15. Elango KJ, Anandkrishnan N, Suresh A, Iyer SK, Ramaiyer SK,
Kuriakose MA. Mouth self‑examination to improve oral cancer
awareness and early detection in a high‑risk population. Oral
Oncol 2011;47:620‑4.
16. The Importance of Oral Self‑examination. Available from: http://‑content/uploads/Self‑Exam.
pdf. [Last accessed on 2013 Dec 26].
17. General Techniques of Oral Self Examination. Available from:
and view=article & id=79 & Itemid=34. [Last accesed on
2013 Dec 26].
18. Ariyawardana A, Vithanaarachchi N. Awareness of oral cancer
and precancer among patients attending a hospital in Sri Lanka.
Asian Pac J Cancer Prev 2005;6:58‑61.
19. Warnakulasuriya KA, Harris CK, Scarrott DM, Watt R, Gelbier S,
Peters TJ, et al. An alarming lack of public awareness towards oral
cancer. Br Dent J 1999;187:319‑22.
20. Cruz GD, Le Geros RZ, Ostroff JS, Hay JL, Kenigsberg H,
Franklin DM. Oral cancer knowledge, risk factors and
characteristics of subjects in a large oral cancer screening program.
J Am Dent Assoc 2002;133:1064‑71.
21. Ariyawardana A, Sitheeque MA, Ranasinghe AW, Perera I,
Tilakaratne WM, Amaratunga EA, et al. Prevalence of oral
cancer and pre‑cancer and associated risk factors among tea
estate workers in the central Sri Lanka. J Oral Pathol Med
22. Ford PJ, Farah CS. Early detection and diagnosis of oral cancer:
Strategies for improvement. J Cancer Policy 2013;1:e2‑7.
23. Petti S, Scully C. Oral cancer knowledge and awareness: Primary
and secondary effects of an information leaflet. Oral Oncol
24. Global Adult Tobacco Survey‑ India Survey. Avaliable
l892s/1455618937GATS%20India.pdf. [Last accessed on
2015 May 27].